Health for life

Parents know its important for children to eat a wide variety of fruits and vegetables, low-fat dairy products, and whole grains. But its less clear whether spending the extra money on organic foods will bring a significant benefit to their childrens health.

To offer guidance to parents – and the pediatricians caring for their childrens health – the American Academy of Pediatrics (AAP) has conducted an extensive analysis of scientific evidence surrounding organic produce, dairy products and meat. The conclusion is mixed: While organic foods have the same vitamins, minerals, antioxidants, proteins, lipids and other nutrients as conventional foods, they also have lower pesticide levels, which may be significant for children. Organically raised animals are also less likely to be contaminated with drug-resistant bacteria because organic farming rules prohibit the non-therapeutic use of antibiotics.

However, in the long term, there is currently no direct evidence that consuming an organic diet leads to improved health or lower risk of disease. No large studies in humans have been performed that specifically address this issue.

"Whats most important is that children eat a healthy diet rich in fruits, vegetables, whole grains, and low-fat or fat-free dairy products, whether those are conventional or organic foods. This type of diet has proven health benefits," said Janet Silverstein, MD, FAAP, a member of the AAP Committee on Nutrition and one of the lead authors of the report. "Many families have a limited food budget, and we do not want families to choose to consume smaller amounts of more expensive organic foods and thus reduce their overall intake of healthy foods like produce."

The AAP report, "Organic Foods: Health and Environmental Advantages and Disadvantages," will be released at a news conference at 1 p.m. CT Monday, Oct. 22 at the AAP National Conference & Exhibition in New Orleans. It will be published in the November 2012 issue of Pediatrics (published online Oct. 22). The report outlines the research that has been conducted on organic foods, including convincing evidence of lower exposure to pesticides and less contamination of livestock with drug-resistant bacteria.

"At this point, we simply do not have the scientific evidence to know whether the difference in pesticide levels will impact a persons health over a lifetime, though we do know that children – especially young children whose brains are developing – are uniquely vulnerable to chemical exposures," said Joel Forman, MD, FAAP, a member of the AAP Council on Environmental Health and one of the lead authors of the AAP clinical report.

If cost is a factor, families can be selective in choosing organic foods, Dr. Forman said. Some conventionally grown fruits and vegetables tend to have lower pesticide residues. The AAP cites organic shoppers guides like those provided by Consumer Reports and the Environmental Working Group as erences for consumers. The AAP found no individual health benefit from purchasing organic milk, but emphasizes that all milk should be pasteurized to reduce the risk of bacterial infections. Raw milk increases the risk of serious infection with bacteria including Salmonella, E. coli, Listeria, Campylobacter and Brucella.

Purchasing meat from organic farms that do not use antibiotics for nontherapeutic uses has the potential to reduce antibiotic resistance in bacteria that infect people. The AAP calls for large, well-designed, prospective cohort studies that directly measure environmental exposures such as estrogen at low levels to understand the impact of hormonal exposure of children through milk and meat.

The AAP report also notes that the motivation to choose organic produce, meat and dairy products may be reasonably based on larger environmental issues, as well as human health impacts like pollution and global climate change.

"Pediatricians want families to have the information they need to make wise food choices," said Dr. Forman. "We hope that additional research will improve our understanding of these issues, including large studies that measure environmental exposures and neurodevelopment."

Most persons with insurance that includes a pharmacy benefit are probably very familiar with co-pays.  Those out-of-pocket expenses not only reduce the insurers costs, but are a powerful tool that can incentivize the choice of a months supply of an otherwise equivalent generic (for $5) versus an expensive brand medicine (for $30).

But suppose the brand drug manufacturer fights back with a $30 coupon?

Thats the topic of this JAMA paper by David Grande. While the coupons could be prohibited as "kickbacks," can be suddenly stopped and are often given on-line in exchange for otherwise private patient information, the main argument against them is that they substantially increase insurer costs.  As a result, Dr. Grande recommends that physicians resist the allure of giving their patients any coupons and that pharmaceutical companies find other ways to reduce patients out of pocket costs.

The DMCB has another idea that is going unmentioned by JAMA.  Why not suggest that insurers compete should against the manufacturers coupons with their own coupons?  Competition may eat into the insurers bottom lines but the patients will win.

Patient interests: Thats the point, right?