“We live in extraordinary times…thanks to medical and scientific advances that even a generation ago would have sounded like science fiction…An American born today has a projected average lifespan 20 full years longer than one born in 1925.” [Time Magazine, February 12, 2015]
Back in 2016, a landmark article was published highlighting seven great achievements in pediatric research over the previous 40 years.1 Major pediatric scholars and scientists were polled to solicit their opinions, and a stellar group of pediatricians wrote the article. This article was so poignant for me because these discoveries, advances, and changes occurred during my medical career. I was able to witness the heartbreak of so many of these health issues and then to see the dramatic changes due to the dedicated work of so many people.
As I was preparing this blog post, the date of publication (2016) struck me as being oddly prescient. The article was published at a time just before a president was elected who used science for his personal gain (advanced COVID therapy) yet openly flouted the science that was evolving to fight the crippling pandemic of 2020-2022. He openly doubted the work of our esteemed scientists and encouraged members of his administration to broadcast such doubt. His less than full-throated endorsement of the plans that evolved corrupted any attempts to effectively fight the pandemic. He laid the groundwork for the skepticism that questioned the use and effectiveness of the COVID vaccine. Such skepticism is estimated to have caused at least 232,000 preventable deaths for a 15-month period for unvaccinated adults in 2021-2022.2
Now, 9 years later, we are seeing the infrastructure that led to the advances highlighted below being torn at the seams. One cannot tear at one thread on the fabric of pediatric care and research and expect the wonderful tapestry of pediatric care and research to effectively continue to achieve great things.
Let’s review the seven achievements below and look for parallels in 2025.
- Preventing disease with life-saving immunizations – to quote from the article, “one of the most significant advances in child health over the past century has been the use of immunization to prevent disease. Numerous vaccines have saved millions [italics mine] of lives.” Indeed, during my medical career, I have witnessed that. From signing death certificates in my early years of training (1976-1979) to teaching young doctors what a disease used to look like, I have seen the near eradication of many crippling and lethal diseases. COVID popped up and then scientific discoveries from the past and present were used to create an incredibly effective vaccine in record time. The success of vaccines has also been a world-wide effort with rotavirus (a diarrheal illness) vaccine saving millions of worldwide. BUT WAIT…our vaccine efforts outside the US are being pulled back, putting the world’s children at risk. The current measles outbreak in the US is not being treated appropriately. It should be shouted from the rooftops by our leaders that measles vaccination is the only way to prevent this potentially serious infection and the vaccine is proven safe. The advances gained from vaccine development and vaccine dissemination are under serious threat.
- Reducing sudden infant death with back to sleep – In 1993, close to 4,700 infants died in the US from sudden infant death or SIDS. Researchers found that sleeping in the prone position (on the belly) was associated with SIDS. When sleep position recommendations were changed, from the front to the back (supine), the US SIDS rate dropped 50%. Having infants sleep on their back dramatically decreased the risk of SIDS. Many families greeted this news with doubt, yet Back-to-Sleep (also called Safe-to-Sleep) campaigns continued to decrease the risk of SIDS. BUT WAIT…I suspect that data such as used to decrease the risk of SIDS will become less robust as the CDC and NIH researchers are let go by the government. A government less interested in its population data will be a government that does not serve its people well.
- Curing a common childhood cancer – Acute lymphoblastic leukemia (ALL) was uniformly fatal mid-20thcentury, but now has survival rates over 90%. Why? Because of dedicated clinicians, scientists, and researchers continually striving to understand and advance their care and knowledge. With the assistance of the families, they added therapies, they adjusted therapies, they monitored therapies and they altered course as needed. They never lost sight of the ultimate goal (cancer cure) but knew that individualized care was the standard. BUT WAIT…clinical and basic science research will wither in an environment that devalues it and tears at their roots – the NIH, the CDC, medical center universities and the people that do the work. One cannot showcase a child with cancer, as a success story, while subsequently curtailing the very science and research that helped him and that future children will need to also beat their cancer.
- Saving premature babies – the advances in the care of premature babies are truly remarkable. Babies that we could not save back in the days of my training are now surviving due in large part to the discovery of a chemical that tends to keep lung sacs open (surfactant) and its subsequent widespread use. Of course, numerous other advances, in technology and care, increased the likelihood of survival with decreasing risk of some developmental problems. BUT WAIT…the system that saw the incredible increased survival of premature babies cannot survive in a climate of medical and scientific distrust or cuts in research. The system has thrived because of continued clinical and research advances. And children of today are better because of those advances.
- Preventing human immunodeficiency virus transmission from mother to baby – the transmission of HIV from mothers to infants was quite high in the 1980s-1990s, as high as 15-30%. The discovery of anti-retroviral agents and their subsequent use in pregnant women decreased that risk to around 2%. That work was due in large part to the National Institute of Allergy and Infectious Disease (NIAID) under the direction of Dr. Fauci.3 BUT WAIT…the international relief program known as PEPFAR (President’s Emergency Plan for AIDS Relief, started by President George W. Bush) is now under attack and being discontinued in large part as USAID is being scaled back.4 PEPFAR is estimated to have saved 25 million lives over 20 years. Diseases (and viruses) know no geographic boundaries. What happens in the rest of the world affects us in the US. Denial of that fact is a serious blunder.
- Increasing life expectancy for children with chronic diseases – Research continues to enhance the quality of life for children with chronic disease as well as significantly increasing life expectancy. The Cheng et al. study gives two dramatic examples – cystic fibrosis and sickle cell disease. The interventions for both of these diseases used advances in multiple spheres, from genetic identification, to antibiotics, to targeted therapies, to gene therapies. All of these advances occurred because of medical care and research systems that value all of its various components. One cannot pick out just one part and ignore the rest. BUT WAIT…current efforts to focus on chronic disease would appear to be just what we want but an unwillingness to fully embrace all of science and the necessity of research that is sometimes perceived as less direct will impede advances for all diseases. For example, the gene research that identified the affected genes for cystic fibrosis and sickle cell disease most likely was the result of indirect efforts from related research. That’s the advantage of serendipity in science and a strong research environment that welcomes diverse viewpoints and discussion.
- Saving lives with car seats and seat belts – campaigns to encourage the use of car seats and seat belts have reduced pediatric fatalities due to motor vehicle injuries by 55-78% at the time of the publication in 2016. Infants now leave the hospital in approved car seats, and children continue in car seats or booster seats until it is safe to use seat belts. These measures have had dramatic effects in my lifetime, and I am so grateful. It reflects a concern in the well-being of children that is pervasive and nurturing. (Note my “car seat” in the picture below when I was one year of age – not very safe.) BUT WAIT…when folks distrust the decisions of public health officials trying to save lives, positive changes can quickly be reversed and not recovered any time soon. We must continue to fight for children.
Author at 1 year of age
So, I have presented seven great pediatric advances that were highlighted back in 2016. We can never rest on our laurels. We must continue to advance the causes of children’s health and well-being.
To demonstrate similar advances in 2056 (40 years from the 2016 publication), we have to respect a robust health care system, a robust medical research system, a robust scientific community, a robust public health system and a robust social structure that values all. I do not see that happening with the current administration and that worries me. It actually more than worries me. I fear for the future unless we reverse the trend of demeaning language, disrespect for others and reductions in funding and workforce that will only make us weaker, not stronger.
As the opening quote from Time Magazine notes, science fiction can become real when we promulgate medical and scientific advances. Retreats or regressions are not acceptable. We need to build on the seven advances above and proudly tout more in the future.
- Cheng TL, Monteiro N, DiMeglio LA et al. Seven great achievements in pediatric research in the past 40 y. Pediatric RESEARCH 2016;80(3):330-337.
- Jia KM, Hanage WP, Lipsitch M et al. Estimated preventable COVID-19-associated deaths due to non-vaccination in the United States. Eur J Epidemiol 2023 Nov:38(11):1125-1128.
- https://mychildrenschildren.com/dr-fauci-to-the-rescue/
- https://mychildrenschildren.com/voices-for-children/