Target Health Inc. on YouTube


Last week, Dr. Mitchel, President of Target Health was asked to be a keynote speaker at a breakfast at NY Medical College, which included a ribbon cutting ceremony for a new incubator. The slide presentation was titled “Working With FDA – How Creative  One Can  Be When Working with the FDA to Optimize the Drug and Device Development Process.“ The presentation addressed the innovative processes going on at FDA and how FDA, in part, is ahead of the industry in suggesting alternative approaches on how to get products to the market sooner. The presentation is also available on YouTube and the slides are on our website.



Laurence Gottlieb (Pres. & CEO HVEDC), Jules Mitchel (Target Health); Robert W. Amler, MD (VP & Dean) NY Medical College)


ON TARGET is the newsletter of Target Health Inc., a NYC-based, full-service, contract research organization (eCRO), providing strategic planning, regulatory affairs, clinical research, data management, biostatistics, medical writing and software services to the pharmaceutical and device industries, including the paperless clinical trial.


For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target HealthWebsite.


Joyce Hays, Founder and Editor in Chief of On Target

Jules Mitchel, Editor



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Size Matters: Baby’s Size at Birth May Predict Risk for Disease Later in Life


A new research report published in the November 2014 issue of The FASEB Journal suggests that being overweight might be better in the long term than being 1) ___. Before you reach for that box of Twinkies, however, it’s important to note that this discovery only applies to the weight of newborn babies in relation to risk of future disease. “These findings support the hypothesis that common long-term variation in the activity of genes established in the womb may underpin links between size at birth and risk for adult 2) ___,“ said Claire R. Quilter, Ph.D., study author from the Mammalian Molecular Genetics Group, Department of Pathology at the University of Cambridge in the United Kingdom. “If confirmed these could be important markers of optimal fetal growth and may be the first step along a path to very early disease prevention in the womb.“ Quilter and colleagues set out to determine whether or not there was any truth to the prevailing hypothesis that conditions in the womb that lead to a high birth weight or low birth weight could affect expression of genes in the baby, which in turn, leads to effects that persist into 3) ___ life. To do this, they looked at DNA derived from the cord blood of newborn babies from mothers with raised glucose levels during late pregnancy and in those babies born following relatively slow growth in the womb that later caught up after birth. These DNA methylation patterns (chemical modifications of DNA) are known to affect changes in 4) ___ activity. Results showed differences in these methylation changes which were specific to boys and girls and to each of the two groups. However, changes were also identified that were common to both groups of babies. Similar overlapping signals were seen in two other groups of babies studied.


“In the age of epigenetics, prenatal care is moving beyond infant survival and into optimizing the health of the baby for his or her entire life,“ said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. “Understanding the epigenetic factors that play a role in a baby’s birthweight will eventually help doctors give the best care and advice to their pregnant patients.“ Experts at the American Academy of Pediatrics (AAP) say parents should ask their child’s health care provider to keep tabs on children’s weight from birth on up. But they shouldn’t obsess about the weight of a child younger than 2 years. Members of the AAP Nutrition Committee say there are no data to support the belief that children in this age group who are overweight are more prone to be 5) ___ later.


Source: Federation of American Societies for Experimental Biology.

Journal Reference: C. R. Quilter, W. N. Cooper, K. M. Cliffe, B. M. Skinner, P. M. Prentice, L. Nelson, J. Bauer, K. K. Ong, M. Constancia, W. L. Lowe, N. A. Affara, D. B. Dunger. Impact on offspring methylation patterns of maternal gestational diabetes mellitus and intrauterine growth restraint suggest common genes and pathways linked to subsequent type 2 diabetes riskThe FASEB Journal, 2014; DOI: 10.1096/fj.14-255240


Over 60? Drink Up as Alcohol Use is Associated with Better Memory


“Once, during Prohibition, I was forced to live for days on nothing but food and water. (W.C. Fields)


“Candy is dandy but liquor is quicker.“ (Ogden Nash, Reflection on Ice-Breaking)


Researchers from the University of Texas Medical Branch at Galveston, University of Kentucky, and University of Maryland found that for people 60 and older who do not have dementia, light 6) ___ consumption during late life is associated with higher episodic memory — the ability to recall memories of events. Moderate alcohol consumption was also linked with a larger volume in the hippocampus, a brain region critical for episodic 7) ___. The relationship between light alcohol consumption and episodic memory goes away if hippocampal volume is factored in, providing new evidence that hippocampal functioning is the critical factor in these improvements. These findings were detailed in the October 2014, American Journal of Alzheimer’s Disease and Other Dementias.


The study used data from more than 660 patients in the Framingham Heart Study Offspring Cohort. These patients completed surveys on their alcohol consumption and demographics, a battery of neuropsychological assessments, the presence or absence of the genetic Alzheimer’s disease risk factor APOE e4 and MRIs of their brains. The researchers found that light and moderate alcohol consumption in older people is associated with higher episodic memory and is linked with larger hippocampal 8) ___ volume. Amount of alcohol consumption had no impact on executive function or overall mental ability. Findings from animal studies also suggest that moderate alcohol consumption may contribute to preserved hippocampal volume by promoting generation of new nerve 9) ___ in the hippocampus. In addition, exposing the brain to moderate amounts of alcohol may increase the release of brain chemicals involved with cognitive, or information processing, functions. “There were no significant differences in cognitive functioning and regional brain volumes during late life according to reported midlife alcohol consumption status,“ said lead author Brian Downer, UTMB Sealy Center on Aging postdoctoral fellow. “This may be due to the fact that adults who are able to continue consuming alcohol into old 10) ___ are healthier, and therefore have higher cognition and larger regional brain volumes, than people who had to decrease their alcohol consumption due to unfavorable health outcomes.“


Although the potential benefits of light to moderate alcohol consumption to cognitive learning and memory later in life have been consistently reported, extended periods of abusing alcohol, often defined as having five or more alcoholic beverages during a single drinking occasion is known to be harmful to the brain.


“My grandmother is over eighty and still doesn’t need glasses. Drinks right out of the bottle.“ (Henny Youngman)

Source: University of Texas Medical Branch at Galveston.


Journal Reference: B. Downer, Y. Jiang, F. Zanjani, D. Fardo. Effects of Alcohol Consumption on Cognition and Regional Brain Volumes Among Older AdultsAmerican Journal of Alzheimer’s Disease and Other Dementias, 2014; DOI:10.1177/1533317514549411


ANSWERS: 1) underweight; 2) disease; 3) adult; 4) gene; 5) heavy; 6) alcohol; 7) memory; 8) brain; 9) cells; 10) age


Benjamin M. Spock MD, World’s Best Known Pediatrician


Benjamin M. Spock MD (1903-1998)




Benjamin McLane Spock (May 2, 1903 – March 15, 1998) was an American pediatrician whose book Baby and Child Care, published in 1946, is one of the best-sellers of all time. Throughout its first 52 years, Baby and Child Care was the second-best-selling book, next to the Bible. Its message to mothers is that “you know more than you think you do.“ Spock was the first pediatrician to study psychoanalysis to try to understand children’s needs and family dynamics. His ideas about childcare influenced several generations of parents to be more flexible and affectionate with their children, and to treat them as individuals. In addition to his pediatric work, Spock was an activist in the New Left and anti Vietnam War movements during the 1960s and early 1970s. At the time his books were criticized by Vietnam War supporters for allegedly propagating permissiveness and an expectation of instant gratifications that led young people to join these movements, a charge Spock denied. Spock also won an Olympic gold medal in rowing in 1924 while attending Yale University. Spock had a 35-ft sailboat named Carapace, on which he lived in Tortola, British Virgin Islands. At age 84, Spock came in third out of a field of eight, rowing his dinghy across the Sir Frances Drake Channel between Tortola and Norman Island, a distance of four miles. It took him 2.5 hours. He credited his strength and good health to his life style and his love for life. Spock had a second sailboat named Turtle, which he lived aboard and sailed in Maine in the summers. They lived only on boats, with no house, for most of 20 years. At the very end of Spock’s life, he was advised to come ashore by his physician, Steve Pauker, of New England Medical Center, Boston.



Dr. Spock with granddaughter Susannah in 1968 (Wikimedia Commons / Library of Congress)


Dr. Benjamin Spock has been at the forefront of child care since he first made a splash more than 60 years ago. His advice has been religiously followed by some, dismissed as kooky by others; controversy has swirled around his ideas for decades. But despite the controversy, today new parents still follow his advice. They just might not realize they do. When Dr. Spock’s book Baby and Child Care was published in 1946, its simple core message was revolutionary: “Don’t be afraid to trust your own common sense.“ Between that and his insistence that parents should show love and affection to their children rather than constant strict discipline, Dr. Spock challenged the conventional wisdom of early 20th-century childrearing like no one else. A spokesperson for Pocket Books, Spock’s main publisher, said that over 50 million copies have been sold around the world, and translated into 42 languages.


Today, the basic tenets of Dr. Spock’s child care philosophy might seem obvious to most parents. Hug your child. Tell her/him they’re special and loved and unique. Feed her/him when hungry. Discipline with words, not corporal punishment. But in 1946, this was new. Parents had long been encouraged not to shower their children with affection as this would make them weak and unprepared for the world. Feeding and naps were to be done on a strict schedule, regardless of the baby’s immediate needs. And a child who just got a mild spanking for an offense got off easy – physical punishment was the norm. Spock changed all that with his encouragement for parents to follow their instincts, be attentive to the baby’s needs, and be generous with affection.




Dr. Spock visits Karen Anderson, mother of quintuplets with their sibling, in October 1974. (AP Photo)


What caused the greatest controversy for Dr. Spock, was his advice on treating children with love and affection that made a generation of conservative parents question what he taught. “The hand that rocks the cradle rules the world“ is a familiar and powerful adage. After all, perhaps no person exerts more power on a young person’s life than his or her mother. Yet in postwar Western society, no person has had more influence on mothers than Benjamin McLane Spock. Generations of children around the world have been reared on Spock’s fatherly advice, dispensed in a simple, straightforward and reassuring style. Indeed, Spock’s book became the modern bible of baby care, and he himself enjoyed near universal acclaim as America’s favorite doctor.


Benjamin McLane Spock was born May 2, 1903 to a prosperous family, in New Haven. He was the eldest of the six children — four girls and two boys — of Benjamin Ives Spock, a Yale graduate and railroad lawyer who was conservative in his politics, and Mildred Louise Stoughton Spock. The Spocks were descended from early Dutch settlers in the Hudson Valley; the family name was originally Spaak. After graduating from Phillips Academy in Andover, Mass., Dr. Spock entered Yale College, where he majored in English, minored in history and, as he recalled years later, “gravitated toward medical school without any real decision.“


Six feet 4 inches tall and broad-shouldered, he was, literally and figuratively, a big man on campus, a member of the Yale crew that won in the Paris Olympics in 1924. “I had an awfully good time at college,“ he recalled years later. He also worked summers in a home for crippled children. “I guess that’s why I became a baby doctor, thinking of those kids,“ he said later. “My doctoring was always vaguely humanitarian.“ After earning a Yale College B.A. in 1925, he studied at the Yale Medical School from 1925 to 1927, and then transferred to Columbia University’s College of Physicians and Surgeons and earned his M.D. in 1929, after being at the head of his class at the end of the last two years. He interned at Presbyterian Hospital in New York and was a resident in pediatrics at the New York Nursery and Child’s Hospital. “Sometime during the pediatric residency years (1931-1932)“ Dr. Spock wrote years later, “I conceived the idea that someone going into pediatrics should have psychological training.“ And so he also spent 10 months as a resident in psychiatry at New York Hospital, and he went on to part-time training at the New York Psychoanalytic Institute from 1933 to 1938. Spock’s experience with children made him realize that half the questions parents asked related to psychological issues. He became convinced that pediatricians should have training in psychology, and that Sigmund Freud’s insights provided a better framework within which to encourage child development than the harsh, rigid and moralistic approach of his own parents.


In 1933 he opened his pediatric practice and after a couple of lean years it began to flourish. His success was partly the result of his charm, warmth and vitality. “All the young mothers had a great crush on him,“ a former patient said years later. “He was a gay and charming man.“ Another reason he did well was that, as the product of a large and happy family, he took great pleasure in being with his little patients. He once said, “One of my faults as a pediatrician has always been that I whoop it up too much with children.“ His success was also the result in part of his concern for the feelings of his patients and their parents. He wore ordinary business suits, rather than white doctor’s coats, to make his visitors feel more relaxed. Describing Dr. Spock’s child-side manner, another writer on child care, Dr. Milton Levine, recalled later, “I used to hear parents and even doctors talk about him as ?the man with the gentle face and eyes.’ “ In addition to his private practice, Dr. Spock served, early in his career, as an instructor in pediatrics at Cornell Medical College, an assistant attending pediatrician at New York Hospital and a consultant to the New York City Health Department. He also was the part-time school doctor at the Brearley School on East 83d Street, a private school for girls from kindergarten through the 12th grade. At the school, Lynn Z. Bloom wrote in her 1972 book, “Dr. Spock: Biography of a Conservative Radical“: “He realized that the perceptive teachers could see each child in the context of the whole class and so understand her in a way the pediatrician never could. The perspective he gained at Brearley was to be drawn upon at length in his later writings for parents.“


In 1943, ten years after the birth of his first son, Michael, Dr. Spock began three years of writing “The Common Sense Book of Baby and Child Care.“ He spent countless evenings dictating it to his wife, the former Jane Davenport Cheney, who typed it up as he went along and assisted in many other ways. Dictating the book helped to give it the conversational tone that was one of its great attractions. By 1937 Spock became a board-certified pediatrician and was increasingly captivated with the goal of changing America’s child-rearing practices. By the early ?40s he was ready to commit his ideas to a book that would emphasize positive, commonsense, practical advice. It would embody the most up-to-date answers to all the problems that mothers might encounter during their children’s development from infancy through puberty. It would seek to correct the deficiencies of the overly strict parenting of the past, as revealed through psychoanalysis. He hoped it would revolutionize the way children were raised. Dr. Spock joined the Navy in 1944 and kept on writing in his spare time while working as a psychiatrist in military hospitals in New York and California. He left the Navy, with the rank of lieutenant commander, in 1946. Spock took enormous pains with the book and even worked on its original index during a slow troop-train journey from New York to California. To make things as convenient as possible for readers, he made sure the index included such common-sensical entries as “Bedtime — keeping it happy.“ When the book appeared in 1946, Spock’s positive, can-do, deliberately non-authoritative tone took America’s mothers by storm. Spock insisted mothers could trust their own judgment. He succeeded in establishing a more sympathetic, child-centered approach, and in the process he became a national phenomenon. In a 1972 interview, Dr. Spock said he had undertaken the book “as a departure from conventional wisdom.“ “It wasn’t radical, though it struck out in new directions,“ he said. Taking a longer look backward, in the 1992 interview, Spock ascribed much of his professional success to his own psychoanalytic training in the 1930’s. In that period, he said, it was highly unusual for an American pediatrician to have that kind of training. “For the first 10 years I was in practice, before I wrote the book,“ he said, “I was trying desperately to reconcile Freudian concepts with what mothers told me about their babies.“ In the book, Dr. Spock wrote that it was unnecessary for a mother to stick to a rigid feeding schedule for her baby and that it hurt a mother emotionally to have to wait for a fixed feeding time while her baby wailed. But he also stipulated: “This is not an argument against reasonable regularity. I do not think it is harmful for a baby or a mother to work toward a schedule. The mother has to run the rest of her household and when the baby is ready to fit in, it will help everybody.“


On the question of how to cope with crying, Dr. Spock took a balanced view: “I don’t think it’s good to let a baby cry miserably for long periods if there’s a way to comfort him, not because it will do him any physical harm but because of what it might do to his and his mother’s spirits. “The child, he wrote, “needs to feel that his mother and father, however agreeable, still have their own rights, know how to be firm, won’t let him be unreasonable or rude.“ And he added, “The spoiled child is not a happy creature even in his own home.“


From Book’s Success, A Frightened Author

In retrospect, it seemed almost inevitable that the book would become an enormous success, appearing as it did when the post-World War II baby boom was under way, and the winds of change were stirring in the baby and child care field. Even Dr. Spock’s flinty Yankee mother is said to have observed, after reading the book, “Why Benny, it’s really quite sensible.“ But Spock said in the 1992 interview that he was frightened when 750,000 copies were sold in its first year. “I was scared that the book would be misunderstood,“ he said, “that somebody, thinking she was following my advice, would do something that would make a child worse, or even kill a child.“ In its first six years the book sold more than four million copies, and the languages it was eventually translated into included Urdu, Thai and Tamil. Duell, Sloan & Pearce published the original hard-cover edition. Pocket Books, which had persuaded Dr. Spock to write the book, brought it out in paperback with the title, “The Pocket Book of Baby and Child Care,“ which later became simply “Baby and Child Care“ and then “Dr. Spock’s Baby and Child Care.“ That is the title of the hard-cover and paperback versions of the current, sixth edition, which came out in 1992. Dr. Spock’s earnings from the book were widely thought to have made him a millionaire but in the early 1990’s, they were about $150,000 a year. As time passed, Spock watched for new developments and insights that might require him to revise parts of his book. He recalled years later that when he returned briefly to his private pediatric practice in New York after the war, “I began to see examples of a going-to-bed sleep problem in infants that I had never seen before: a baby would object to being put to bed in the evening, and his mother would keep picking him up. “If she was a type who could be progressively intimidated, her baby could turn into a tyrant in six months. He could not only learn to stay awake until 10 or 11 o’clock at night but demand that his exhausted mother carry him around in her arms.“ Dr. Spock took that problem into account in 1954, when he began to prepare revisions. As he put it later, “I wrote that more mothers got into difficulty from being afraid to give firm leadership than from being too rigid. And I put more emphasis on the rights of parents, on the need for firm parental leadership, and on my conviction that firmness makes for not only better-behaved children but for happier ones.“


Changing of Guard in Child Authorities

After giving up his New York practice in 1947, Dr. Spock was affiliated with the Mayo Clinic in Rochester, Minn., and went on to serve as professor of child development at the University of Pittsburgh from 1951 to 1955 and at Case Western Reserve University in Cleveland from 1955 to 1967, when he retired from teaching. Over the next years, he kept active “writing articles and books, keeping up with correspondence, going out on frequent speaking tours,“ he wrote in a 1989 volume of memoirs, “Spock on Spock.“ He continued to make changes in his baby and child care book, and the fourth edition in 1976 was revised largely, as he said in a preface, “to eliminate the gender biases of the sort that help to create and perpetuate discrimination against girls and women.“ One change was to refer to the baby and child as “she“ as well as “he.“ Another was in descriptions of the parents’ roles. “I always assumed that the parent taking the greater share of young children (and of the home) would be the mother, whether or not she wanted an outside career,“ he said in the preface. “Yet it’s this almost universal assumption that leads to women feeling a much greater compulsion than men to sacrifice a part of their careers in order that the children will be well cared for,“ he went on. “Now I recognize that the father’s responsibility is as great as the mother’s.“


Spock began a nationwide TV show in 1955 and went on to write a monthly magazine column. In the early ?60s, as he approached the age of 60, Dr. Spock became an antiwar activist and opponent of the draft, nuclear armaments and the United States’ involvement in Vietnam. He was a co-chairman of the National Committee for a Sane Nuclear Policy, known as SANE, from 1962 to 1967. He became increasingly active in antiwar demonstrations, lending high-profile support to draft dodgers and various anti-establishment causes associated with the youth of that decade. Spock consistently urged greater political action by parents to force governments to adopt policies that, he believed, would better care for people’s needs.


Vice President Spiro T. Agnew, the tart-tongued political combatant who fired up the American electorate but then, in 1973, had to resign as Richard M. Nixon’s Vice President in the face of a kickback scandal, blamed the Dr. Spock for what Mr. Agnew called the “undue permissiveness abroad in the land.“ What irony, that Agnew, accusing Spock of permissiveness, had to bargain as Vice President with prosecutors to avoid prison and finally pleaded no contest to tax evasion charges in a lucrative statehouse ward-heeling scheme that dated from his public service in Maryland politics but continued to reap payoffs even during his days as Vice President.


Spock, promoting peace not war, was arrested at various protest demonstrations. In 1968 a Boston court convicted him of conspiring to counsel evasion of the draft. He was sentenced to two years in prison and fined $5,000, but the conviction was reversed in 1969 by the United States Court of Appeals for the First Circuit on the ground of insufficient evidence. In 1972 Dr. Spock was the Presidential candidate of the People’s Party, a coalition of progressive organizations. His platform called for free medical care, the legalization of abortion and marijuana, a guaranteed minimum income for families and the immediate withdrawal of all American troops from foreign countries. In 1976 he was the party’s candidate for Vice President, and in the late 1970’s he was also prominent in anti-nuclear demonstrations. By the time he turned 80, in 1985, he had been arrested a dozen times for civil disobedience, but he did not stop. In 1987, he and others were arrested and charged with trespassing after demonstrating at Cape Canaveral Air Force Station against the test launching of a Trident 2 missile.


The Rev. Dr. Norman Vincent Peale, the author of “The Power of Positive Thinking“ and a critic of Dr. Spock, saw it differently. He said the doctor had gone “out in the streets with these babies raised according to his books, demonstrating with them for things they claim we should not deny them.“

Dr. Peale said the doctor’s views amounted to: “Feed ?em whenever they want, never let them cry, satisfy their every desire.“ Dr. Spock said that Dr. Peale, Mr. Agnew and other critics had distorted what he had written. “I didn’t want to encourage permissiveness, but rather to relax rigidity,“ he once observed. “Every once in a while, somebody would say to me, ?There’s a perfectly horrible child down the block whose mother tells everybody that he’s being brought up entirely by your book.’ But my own children were raised strictly, to be polite and considerate. I guess people read into the book what they wanted to.“ On another occasion, striking a different note, he said: “Maybe my book helped a generation not to be intimidated by adulthood. When I was young, I was always made to assume that I was wrong. Now young people think they might be right and stand up to authority.“ Spock developed considerable visibility in politics; in 1972 he actually ran for U.S. president as a third-party candidate. But his political activism won him numerous detractors, who succeeded in branding him “the father of permissiveness.“ And indeed, his child-centered approach was often misapplied or taken to extremes. In response to accusations that he taught a laissez-faire approach to child rearing, he stressed in later editions that children need standards, and that parents, too, have a right to respect. He called for parents to express their love for their children while providing “clear, firm discipline,“ not instead of providing it. He suspected that he was being criticized for his liberal politics more than his childrearing philosophy.


Dr. Spock bounced back somewhat in the decades that followed the Vietnam war, although his advice continued to generate controversy. Spock had already broken with authority in his child-rearing handbook, which he saw as giving “practical application“ to the ideas propounded by two early 20th-century sages, Sigmund Freud and John Dewey, the American philosopher and educator. “John Dewey and Freud said that kids don’t have to be disciplined into adulthood but can direct themselves toward adulthood by following their own will,“ he observed in 1972. And so in the opening chapter of the book, first published in hardcover in 1946 with the title “The Common Sense Book of Baby and Child Care,“ Dr. Spock counseled his readers not to “take too seriously all that the neighbors say.“ “Don’t be afraid to trust your own common sense,“ he wrote. “What good mothers and fathers instinctively feel like doing for their babies is usually best.“ Such relaxed advice, given in the easy, practical, reassuring way that he had with parents, was light-years from the stern dictums of earlier standard works, like the 1928 book “Psychological Care of Infant and Child“ by Dr. John B. Watson. “Never, never kiss your child,“ Dr. Watson commanded. “Never hold it in your lap. Never rock its carriage.“


Dr. T. Berry Brazelton of the Harvard Medical School, noted pediatrician-author, once said of Dr. Spock: “Before he came along, advice to parents was very didactic. He opened the whole area of empowered parenting. He gave parents choices and encouraged them to think things out for themselves.“ Altogether, Benjamin Spock was the author or a co-author of 13 books. He was also a prolific author of magazine columns for more than 30 years. He wrote columns about raising children for Redbook and Ladies Home Journal and, more recently, for Parenting magazine.




89 year old, Dr. Spock holds 3-month-old Ryan Michl at a Boston baby fair April 30, 1993. The birthday cake was presented to Dr. Spock to celebrate his 90th birthday, two days later. (AP Photo / Elise Amendola)


By early 1990, when Dr. Spock was 86, the 71-year-old Dr. T. Berry Brazelton, another psychoanalytically oriented pediatrician, who tirelessly addressed parents’ groups, had become the country’s most visible contemporary authority on raising babies and young children. And Dr. Penelope Leach, a British psychologist-author, had also joined the top echelon of experts to whom new parents were turning for advice. But Dr. Spock remained one of the most widely read authorities on child-rearing. In an interview in 1994, soon after Dr. Spock’s 91st birthday, he attributed his good health and longevity to his life style, which still included rowing. In those days he began each day with an hour’s meditation, 30 minutes of yoga, a shiatsu massage, a hot sesame oil massage and a macrobiotic breakfast of brown rice, miso soup and vegetables. Nonetheless, he said at the time, “It surprised me very much to find I got to be 91.“ In 1994, Spock and his wife lived on a budget of roughly $100,000 a year, but their savings had been depleted by 24-hour nursing and by other kinds of care for the doctor, who came down with pneumonia six times the previous year and had been in declining health. Spock’s family was divided over whether the he should enter a nursing home, which would cost less. His home care in January, 1998 cost over $16,000 — which was largely not covered by Medicare and private insurance. In the end, the president of Pocket Books, his publisher, helped pay his medical bills and Spock remained at home. Toward the end of his life, Pocket Books published another edition of Spock’s great book, because he constantly sought to keep his material updated to be in line with the changing times – one of the reasons for his book’s enduring success.


Dr. Spock’s books continue to influence generations of parents – and the childcare experts of today and tomorrow. And even if a new parent in 2014 doesn’t read his Baby and Child Care, it’s likely that they’re still influenced by his advice. Any parents who hug and kiss their children, showing their love and encouraging their children to express their individuality, have Dr. Spock to thank. The life of Benjamin Spock is an amazing, dynamic and colorful story of success. It includes the story of how Freud’s humanistic philosophies were successfully introduced into the mainstream of American family life, by another wise physician. Spock lived to be 95 and toward the end he said, “Our greatest hope is to bring up children inspired by their opportunities for being helpful and loving.“


Spock died at his home in San Diego, CA on March 15, 1998. His ashes are buried in Rockport, Maine, formerly part ofCamden, Maine.


Editor’s note: I was one of those generations (later) of parents who knowing nothing, first hand, about child care, began reading the books of Dr. Spock, after becoming pregnant with my first child. When I gave birth I was anxious for a few hours. However, the second I began breast feeding, all fears disappeared and the words of Spock echoed forever, etched in my consciousness. Throughout the beginnings of my two children’s lives, Spock had passed on such a sense of confidence, that these early years of my children, were some of the best in my life. His books were, indeed, my Bibles. Such wisdom as Spock endowed is timeless. I recommend all of his books to all new parents. Spock is as relevant today as he has always been.


New Drug for Common Liver Disease Improves Liver Health


Nonalcoholic steatohepatitis (NASH) is a common, often “silent“ liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem. Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly. NASH affects 2-5% of Americans and an additional 10 to 20% have fat in their liver, but no inflammation or liver damage, a condition called “fatty liver.“ Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver. Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH. Diabetes and high blood cholesterol are also becoming more common among Americans.


According to an article published online in The Lancet (6 November 2004), an experimental drug aimed at treating a common liver disease showed promising results and potential problems in a multicenter clinical trial funded by the National Institutes of Health. The Farnesoid X Receptor Ligand Obeticholic Acid in NASH Treatment Trial (FLINT) study found that compared with placebo, people with NASH who took obeticholic acid (OCA) had improved liver health, including decreased inflammation and fat in the liver and decreased body weight. OCA, however, was also associated with increases in itching and total cholesterol. FLINT enrolled 283 people at eight centers across the country. At the study’s start, participants were 18 and older and had been diagnosed with definite or borderline NASH. They were randomly assigned to one of two groups: one took 25 milligrams of OCA daily and one received a placebo that resembled the OCA pill. The study was double-blinded, so neither participants nor investigators knew which person was in which group.


Trial investigators intended for the groups to receive the drug or placebo for 72 weeks, with an additional 24 weeks of follow-up off treatment. However, planned interim analysis for safety and efficacy showed that OCA had significant beneficial effects on NASH-related liver health. The analysis also found unanticipated increases in total cholesterol in the OCA group. They had increased LDL cholesterol (“bad“ cholesterol) and decreased HDL cholesterol (“good“ cholesterol) — notable because NASH patients are already at higher risk for cardiovascular diseases. As cholesterol treatment was not standardized as part of the study, further research is needed to fully understand the potential effect of OCA on cholesterol. Because of both factors, and with the concurrence of the Data Safety and Monitoring Board, NIDDK decided to stop treatment but continue the study, move all patients into the follow-up phase, and perform no additional liver biopsies – which carry their own risks. Adverse cholesterol increases were not sustained after stopping OCA.


According to the authors, while the causes of NASH are not fully understood, and causes and treatments may be different among patients, the FLINT trial represents an important advance in the search for treatments of NASH. The authors added that they need to study the changes in cholesterol levels more to know if the increases caused by OCA also increase the risk of hardening of the arteries. Since the study found that the improvement in liver enzymes with OCA were not sustained after treatment was stopped, it appears that treatment would need to be indefinite, much like the medications for diabetes and hypertension.


Intercept Pharmaceuticals, Inc. provided partial funding and supplies.


The Effects of a Telehealth Coping Skills Intervention on Outcomes in Chronic Obstructive Pulmonary Disease


Since chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality and reduced quality of life (QoL), novel interventions are needed to improve outcomes in patients. As a result, a study published in Psychosomatic Medicine (2014;76: 581-592), assessed the effects of a telephone-based coping skills intervention on psychological and somatic QoL and on the combined medical end point of COPD-related hospitalizations and all-cause mortality.


The investigation was a dual-site, randomized clinical trial with assessments at baseline and after 16 weeks of treatment. The study population comprised 326 outpatients with COPD aged 38 to 81 years, randomized to coping skills training (CST), including sessions promoting physical activity, relaxation, cognitive restructuring, communication skills, and problem solving, or to COPD education (COPD-ED). Patients completed a battery of QoL instruments, pulmonary function tests, and functional measures and were followed up for up to 4.4 years to assess medical outcomes. Results showed that the CST group exhibited greater improvements in psychological QoL compared with controls (p = .001), including less depression and anxiety, and better overall mental health, emotional role functioning, vitality, and social functioning. A significant baseline psychological QoL by treatment group interaction revealed that CST with lower QoL at baseline achieved even greater improvements in psychological QoL compared with COPD-ED. CST participants also exhibited greater improvements in somatic QoL (p = .042), including greater improvements in pulmonary QoL, less fatigue, and less shortness of breath and greater improvement in distance walked on the Six-Minute Walk test. However, there was no significant difference in risk of time to COPD-related hospitalization or all-cause mortality between CST (34 events) and COPD-ED (32 events; p = 0.430).


According to the authors, a telehealth CST intervention produced clinically meaningful improvements in QoL and functional capacity, but no overall improvement in risk of COPD-related hospitalization and all-cause mortality.


First Vaccine Approved to Prevent Serogroup B Meningococcal Disease


The FDA has approved Trumenba, the first vaccine licensed in the United States to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroup B in individuals 10 through 25 years of age.


Meningococcal disease is a life-threatening illness caused by bacteria that infect the bloodstream (sepsis) and the lining that surrounds the brain and spinal cord (meningitis). N. meningitidis is a leading cause of bacterial meningitis. The bacteria are transmitted from person to person through respiratory or throat secretions (e.g., by coughing, kissing, or sharing eating utensils). According to the Centers for Disease Control and Prevention, about 500 total cases of meningococcal disease were reported in the United States in 2012; of those cases, 160 were caused by serogroup B. Meningococcal disease can be treated with antibiotics to reduce the risk of death or serious long-term problems, but immediate medical attention is extremely important. Vaccination is the most effective way to prevent meningococcal disease. Until the current approval, meningococcal vaccines approved for use in the United States have only covered four of the five main serogroups of N. meningitidis bacteria that cause meningococcal disease: A, C, Y, and W.


Three randomized studies were conducted in the United States and Europe in approximately 2,800 adolescents. Among study participants who received three doses of Trumenba, after vaccination, 82% had antibodies in their blood that killed four different N. meningitidis serogroup B strains compared with less than 1% before vaccination. These four strains are representative of strains that cause serogroup B meningococcal disease in the United States. The safety of Trumenba was assessed in approximately 4,500 individuals who received the vaccine in studies conducted in the United States, Europe and Australia. The most commonly reported side effects by those who received Trumenba were pain and swelling at the injection site, headache, diarrhea, muscle pain, joint pain, fatigue and chills.


The FDA used the accelerated approval regulatory pathway to approve Trumenba. Accelerated approval allows the agency to approve products for serious or life-threatening diseases based on evidence of a product’s effectiveness that is reasonably likely to predict clinical benefit, reducing the time it takes for needed medical products to become available to the public. In the FDA’s evaluation for accelerated approval, evidence of effectiveness was demonstrated by the ability of Trumenba recipients’ antibodies to kill the four representative N. meningitidis serogroup B test strains. As part of the accelerated approval process, the manufacturer will conduct further studies to verify Trumenba’s effectiveness against additional strains of N. meningitidis serogroup B.


Trumenba was granted breakthrough therapy status, which is intended to expedite the development and review of medical products that address a serious or life-threatening condition. Working closely with the company, the FDA was able to evaluate Trumenba’s safety and effectiveness and approve it in well under six months, the usual timeframe for a priority review.


Trumenba is manufactured by Wyeth Pharmaceuticals Inc., a subsidiary of Pfizer Inc., Philadelphia, Pennsylvania.


Turkey Croquettes


Consider using this recipe for your left-over turkey after Thanksgiving   ©Joyce Hays, Target Health Inc.




3 Tablespoons butter

1/3 cup almond flour

1 cup chicken broth

3 cups finely minced cooked turkey

3 onions, finely chopped

3 cloves garlic, minced

1 teaspoon turmeric

1 teaspoon cumin

1/2 teaspoon cayenne

2 Tablespoons chopped fresh parsley, chives

2 Tablespoons fresh chives, (or scallions) chopped

1 fresh celery stalk, chopped well

1 fresh carrot, grated finely

1/2 teaspoon Salt (optional)

Pinch black pepper (or grind to your taste)

Almond flour for dredging

2 beaten eggs

1 1/2 cups Panko

Canola oil for frying




First, line up all the ingredients – ©Joyce Hays, Target Health Inc.




  1. Melt the butter in a small saucepan, stir in the flour, and cook gently over low heat 2 to 3 minutes, stirring frequently.


  1. Take pan off the heat, and pour in the chicken broth and whisk vigorously.


  1. Return the sauce to medium-low heat, bring to a simmer, stirring constantly to eliminate any lumps and cook gently, about 5 minutes. Stir in the turkey, onions, celery, grated carrot, garlic, turmeric, cayenne, herbs, one-half teaspoon salt (optional) and pinch black pepper (or to your taste), and let cool, then refrigerate for at least 1 hour.




After chilling, ready to cook – ©Joyce Hays, Target Health Inc.


  1. Shape the cold meat mixture into croquettes (roughly 3-inch circles flattened a bit at the ends); roll them first in flour, then in egg, and finally in breadcrumbs, making sure that they are coated all over. Chill at least 4 hours or overnight.



Cooked and ready to remove and drain – ©Joyce Hays, Target Health Inc.


  1. In a large, deep pot, or if you don’t have such a pot, use a frying pan and heat the canola oil until a thermometer inserted reads 360 degrees, or until a crumb of bread dropped in the oil sizzles immediately but doesn’t turn dark quickly. Now, place the croquettes, one or two at a time, into the hot oil. After about 2 minutes, when browned on the bottom, turn them and fry for 1 or 2 minutes more.


  1. Remove them with a slotted spoon and drain on paper towels. Keep warm in the oven until ready to serve, but they are best eaten right away.




Kitchen Quality Assurance – ©Joyce Hays, Target Health Inc.



You’ll never go wrong with Santa Margherita Pinot Grigio – ©Joyce Hays, Target Health Inc.


Trying to think ahead, to the day after Thanksgiving, when we all have left-over turkey. I came up with the turkey croquette recipe, which we loved experimenting with. This is such a yummy dish, you could serve it for lunch, dinner, brunch, snack. If you have any gravy left after T-day, pour it, hot, over the croquettes when you serve them, or just put it on the table so people can help themselves.


We started out with sliced cooked beets, goat cheese and white wine. Then the turkey croquettes, with apple sauce and risotto. These croquettes would also go well with saffron rice, or served over your favorite pasta. The chilled Santa Margherita Pinot Grigio was perfect with this meal.


We saw a highly stimulating, 2013 Pulitzer Prize winning, Broadway play “Disgraced“ by author, Ayad Akhtar in a sleek production, continuously engaging, vitally stimulating story about thorny questions of identity and religion in the contemporary world. In dialogue that bristles with wit and intelligence, Mr. Akhtar, a novelist and screenwriter, puts contemporary attitudes toward religion under a microscope, revealing how tenuous self-image can be for people born into one way of being who have embraced another. We highly recommend this play.  There is no doubt that we and the audience were so stimulated, that we talked about all the facets of this serious play and all the issues it raises.  We haven’t stopped talking about it.  This is a play that is definitely 21st Century.  GO !


From Our Table to Yours!


Bon Appetit!