Maddy Chen

November
Period 1

Annotated Source List

American Academy of Pediatrics. N.d. Web. 8 Oct. 2016

The American Academy of Pediatrics website provides a general summary of the

whole website with sections for News among the AAP, articles published, and health
topics. The first page on this website shows Professional Resources including journals,
resources, and webinars. The second page on this website shows Professional Education
on how to maintaining certification and online courses. These resources help
pediatricians stay current in practice and in tools. The next page shows the Advocacy and
Policy of the AAP and how they advocate in the federal, state, and local governments.
The AAP supports the health for all children and strives to end any child safety issues.
The fourth page redirects to a shopAAP page where one can purchase magazines. The
last page is About the AAP with lists of their departments, committees, and places to
donate. There are departments for Education, Federal Affairs, Finance, and Research.
Physical, mental, and social health are all taken to account in the AAP.
I could use some of the resources and journals provided to add to my source list
and narrow my range of research. Knowing the basis of pediatrics gives me some
background of principles of this field of medicine. A video on the website features some
pediatricians explaining how they will vote during the presidential election with the well
being of children in mind.

Calcium Supplements May Not Be Good for Your Heart, Researchers Say. Hub, 3 Oct.
2016. Johns Hopkins University. 24 Oct. 2016.

For years, people have been taking calcium supplements to aid in preventing
osteoporosis or for overall bone health. Recently, 10 years of research has shown that
certain calcium supplements can lead to heart problems. Some people take too much
calcium than is need for their body type, leading to calcium buildup in their arteries and
accumulation of calcium in the soft tissue. This can lead to atherosclerosis and hard
calcium deposits in the body. People should consult their doctor to see how much calcium
they should take. In the research that was conducted, in the group that took calcium
supplements, 22 percent of the participants developed heart problems. The group that
naturally ingested calcium through eating foods, such as milk, kale, and sardines, did not
show any risks of heart disease.
This article shows how people can be misinformed about what supplements they
need to take and how much is needed for their body type. Possibly, the people that took
calcium supplements already ingested enough through their diets. I take calcium because
my pediatrician recommended me to. I do not usually drink milk or eat cheese, but I do
eat dark leafy greens. This information should be more advertised than it is now, so more
people can be aware of the harmful effects of too much calcium.
Carter, Daria. Supplements Can Carry Hidden Risks. Courier Journal, 20 Oct. 2016.
PubMed. 20 Oct. 2016.

Dietary supplements do not have to be tested in studies or premarket safety. Many

risks can come with taking over the counter supplements such as the supplement
interacting negatively with other medications, false advertising of ingredients, and
dangerous unknown causes of some ingredients. People should always consult with their
physicians to ensure safety when taking dietary supplements. Some weight-loss
supplements were recalled because they contained sibutramine and sildenafil. These
substances interact with other medications in life threatening ways and lower blood
pressure to dangerous levels. A lot of supplements also falsely advertise their intended
use. These types of supplements should be removed especially if they claim to get rid of
arthritis, fibromyalgia, or prevent gray hair. People forget that supplements should be
included in the list of medications they provide to doctors. This information could help
diagnose unusual actions such as fainting and irregular heart beat. Doctors also need this
information for pre-surgery consultations to make sure the supplement will not make the
patient bleed worse. Buying supplements off of the internet is the most dangerous way of
obtaining supplements.
To prevent fatal side effects from supplements, people should look for the U.S.
Pharmacopeial Conventions USP verified mark or products certified by NSF
International. I think that pharmacies should have signs for people to know what these
stamps look like, so people do not buy the dangerous supplements.

Dietary Supplements: Do They Help or Hurt? Harvard Womens Health Watch. Jan.
2013. 29 Oct. 2016.

Most Americans do not ingest the proper amount of vitamins necessary to be

healthy, so they turn to multi-vitamins. While some vitamins benefit overall health and
sometimes prevent cancer, overdosing or taking supplement versions of the vitamin may
not be effective. Overdosing on a supplement can cause increased risk of cancer or heart
problems. The article lists recommended daily levels of daily intake of well known
nutrients. A lot of research has been conducted to see if certain vitamins prevented cancer,
diabetes, depression, etc., but may tests did not use a placebo supplement making the data
unreliable. Many of the people taking supplements are relatively healthy people, so
testing for a correlation between certain diseases and supplement intake is hard to control.
People are eager to accept good news about supplements and forget to read about the
reliability of information. Not only is getting the right amount of vitamins important, but
also the source of these nutrients should be taken into consideration. The vitamins and
minerals found naturally in fish, meat, fruit, and vegetables work together with other
substances already found in the food. Supplement versions of these nutrients are usually
interfere with the natural absorption of vitamins and minerals, and cause dangerous side
effects. The article lists food where nutrients can be found. Also, the article discusses
research that has shown a correlation between multivitamins and cancer prevention.
When considering buying supplements, people should research to find out if the benefits
can outweigh the potential life threatening risks. Like always, people should ask their
doctor what supplements are necessary for their body type and lifestyle.
This article did a good job at showing how supplements are not always extremely
dangerous and can sometimes be useful. The tables provided a lot of useful information
that could potentially be used in my presentation, or a final product of a pamphlet. I could
put these charts in a small pamphlet that contains other information to consider when
purchasing a new supplement. Also, my family has a history of cancer, so I will ask my
physician if I should consider taking a multivitamin in order to prevent it.

Dietary Supplements: What You Need To Know. U.S. Food and Drug Administration.
24 Oct. 2016.

The organization of this article was useful for people that need to be educated on
supplements. The article defines what supplements are and how people should find a
balance between supplements and in the food they eat. The FDA is not allowed to review
supplements safety or effectiveness, so supplement manufacturers are supposed to notify
the FDA if they use new ingredients in the supplements. By notifying, the FDA is
allowed to review the new ingredient by safety, but not effectiveness. The manufacturers
should make sure that the products are safe to use before they start to sell them.
Obviously, this rule does not work well because of the outcomes of some people taking
the medication. However, the manufacturers are not the only ones to blame because the
FDA does not review the entire supplements ingredients. The article explains how people
can help get rid of dangerous supplements and how to be smart while purchasing
supplements.
This article was able to describe how the FDA is also to blame for dangerous
supplements on the market. The information about how to help get rid of dangerous
supplements can go in my research and I can definitely use the information to help people
become educated in how to correctly use supplements.

FDA Investigates Elevated Lead Levels Linked to Ton Shen Health/Life Rising Dietary
Supplements. U.S. Food and Drug Administration. 24 Oct. 2016. 25 Oct. 2016.

The FDA has to recall many supplements, and this article highlights how bad
some supplements can be. The Ton Shen Health/Life Rising brand of dietary supplements
were shown to have high levels of lead in them after people went to the hospital for
taking these supplements and two people died. Luckily, the FDA has the power to remove
dangerous dietary supplements that are proven to be fatal or harmful. All Ton Shen
Health/ Life Rising supplements were deemed as potentially dangerous. The article
defines that lead is a toxic substance and that only in large amounts can cause lead
poisoning. Sometimes children can show symptoms of lead poisoning by vomiting,
weakness, delirium, or comas. Most of the time lead poisoning may not be visually
present in children, but it can cause them to develop learning disabilities, lower IQ
scores, and slower development overall. The article also explains how consumers and
retailers should appropriately approach this situation.
 This article was about an extreme case where not having the FDA investigate all
ingredients before hand should have be necessary. If the FDA was allowed to test all
supplements for safety, then less children would have lead poisoning and less people
would have died from this dangerous supplement.

Foden-Vencil, Kristian. Emergency Room Use Stays High In Oregon Medicaid Study.
19 Oct. 2016. NPR. 19 Oct. 2016. 14 Oct. 2016.

Recently Medicaid has lowered the amount of people avoiding the emergency
room in Oregon. As people stop using emergency rooms for primary care, the country
could save the country money. In the beginning, Oregon did not have enough money to
cover every eligible resident. They made an experiment where a lottery was made and
gave out coverage to as many people as possible. The results to this experiment surprised
a lot of residence because of the ability to study the differences between people with
Medicaid insurance and people similar to them who didnt have Medicaid. This was the
first ever, and largest, randomized study of the impact of health insurance. Medicaid
showed positive results in financial security of the residents, more residents choosing to
go to the doctor instead of the emergency room when they are sick, and a drop rate in
depression. However, the rate of emergency room visits increased by 40 percent, which
puzzled a lot of people because visiting the ER is where care is the most expensive.
Maybe the people with new insurance did not have time to make relationships with a
primary care doctor, so after more time, the ER rates should decrease as the residents
begin to find primary care doctors. While, the ER did not decrease, more people were
using preventative methods to prevent illness, going to doctors appointments, and taking
their prescribed medication. This experiment ended after the Affordable Care Act.
This experiment was very unusual and interesting because it was the first of its
kind. Researchers would not be able to recreate this experiment because the control group
was not allowed to have the benefits of health care. This experiment gave government
workers and ER doctors new information on how Medicaid affects people. I thought the
information was interesting, but I probably will not use it in my presentation.

Gilbert, Scott. Penn State Hershey Dedicates New Pediatric Emergency Department.
Penn State News. 21 January 2016. 24 Oct. 2016.

The Penn State Hershey Medical Center opened its new Pediatric Emergency
Department on January 21, 2016. The people of south central Pennsylvania will be able
to bring their children to the appropriate care. Child friendly staff members, toys, games,
colorful rooms, child friendly meals, and family friendly spaces make the Pediatric
Emergency Department perfect for children.
This article was very short, but it was able to explain how useful a Pediatric ED
is. Parents in the south central Pennsylvania area do not have to leave the area in order to
get pediatric care. Howard County is lucky to have such a nice Pediatric ED.
Harris, Richard. Pediatricians Recommend Flu Vaccination, Just Not With The Spray.
NPR. 6 Sept. 2016. 8 Oct. 2016.

In previous years, children were able to opt out of receiving the flu vaccination.
After getting a flu shot, many people experience pain in their arm along with other
reactions. Instead of the vaccination, children were able to receive the FluMist. This
mode of immunization is much less painful compared to the shot; therefore, making it
very popular among children. However, the FluMist has not been performing as well as
expected in the past years. The Centers for Disease Control and Prevention (CDC)
reported that only 3 percent of the children (2-17 year olds) found the FluMist to be
effective, compared to 66.6% of children in the same age group that were protected by
the flu shot. The CDC also announced that 85 children died from the flu, but most of the
deceased were not vaccinated. Because the children who had the FluMist will be new to
the flu shot, they will have to be vaccinated twice. Of course, all people especially
pregnant women and health care providers should receive a flu vaccine.
This article is very relevant for the types of patients I will observe this year.
Maybe more children will catch the flu because they were procrastinating on getting their
flu shot. Also, this article is very recent making it reliable and relatable. Possible, the
children that received the FluMist sneezed right after making the immunization useless. I
personally do not enjoy receiving vaccinations and try to put off shots until the last
minute. The FluMist was my preferred mode of immunization if I was already scheduled
for a shot during a yearly doctor visit, so I empathize with these children that have no
option other than a shot.

Hobson, Katherine. Is a Placebo A Sham If You Know Its A Fake And It Still Works?
NPR. 27 Oct. 2016. 24 Oct. 2016.

Recently, studies have been conducted to see if placebos actually help people with
mild medical problems. Doctors are not going to lie to patients that they are giving them
a cure-all medicine, because that is unethical. Instead, doctors are deliberately telling
patients that the medicine is a placebo and has no active ingredients. Patients that have a
positive attitude to the medication usually see a decrease in pain and reduced difficulty in
performing daily tasks. Even though patients are being given placebos, they can feel a
positive difference and physicians can observe the great outcomes. In the future, placebos
can help improve the health of people with body pain, cancer, and asthma.
The article shows how patients are willing to try placebos in place of medication
and how easily people can be persuaded into changing their point of view. Maybe if more
patients demand the need for placebo medication, more research will be put into this new
line of research.

Howard County General Hospital. Johns Hopkins Medicine, n.d. Web. 28 Sept. 2016

The Howard County General Hospitals website opens with many areas to apply
for jobs through Johns Hopkins. Also, there is a list of awards that this hospital has
received such as the Clinical Excellence Award and the Get With the Guidelines-Stroke
Gold Plus Award. On the Why the Johns Hopkins Health System page explains how
Johns Hopkins prides itself for its diverse patients and employees, especially among the
veteran community. JH also expounds how they try to help Baltimore by providing jobs
and through many different associations and partnerships. The website has a page for a
healthy lifestyle from sleep to the heart to aging. Another page of the website has
information for patients who are looking for a doctor, who want to pay their bill, and a
list of diseases and conditions to refer to including dermatology and pediatrics. The next
page shows all research, completed and ongoing, such as nanoparticles and how obesity
can lead to heart failure. The final page is about education for students, a list of the
faculty, and a list of the academic departments of Johns Hopkins.
This website is beneficial for me because it provides a background of the hospital
I am interning at. I am able to understand Johns Hopkins Medicines mission statement
and how Johns Hopkins strives to help the community by providing jobs in Baltimore.
Also, I have access to the contact information of numerous doctors in various fields of
medicine. Johns Hopkins Synergy has many research resources that I could possibly use
for other sources.

Kumar, Adesh, et al. Vitamin Supplementation: Unmonitored Prescription Can Be

Dangerous. BMJ. PubMed. 22 Oct. 2016.

Vitamins are commonly believed that they are harmless, but most people are not
educated on how too much of a vitamin can lead to toxicity. A 75 year old lady was
taking vitamin sachets once a day, even though she was only supposed to take them once
a week. She was illiterate, so she did not know the instructions. This hyper intake of
vitamins lead her to have hypocalcaemia (too much calcium in the blood) and
hypokalaemia (potassium deficiency). The doctors were able to diagnose her conditions
by an electrocardiogram (ECG). The elder lady had toxic levels of Vitamin D in her body,
even after treatment. She was educated in danger signs of hypervitaminosis, toxic levels
of vitamins. Doctors continued to monitor her vitamin D levels.
This article used a lot of medical jargon, so I had to look up what a lot of the
terms meant. Elderly people should monitor their vitamin intake because it can lead to
toxicity. People need to be educated on the dangers of taking too much vitamins and the
danger signs and symptoms of toxic levels.

Kemp, Carla. AAP National Conference: ED Docs to Present Challenging Cases of

Children with Acute Pain. AAP News, 22 Oct. 2016. American Academy of
Pediatrics. 24 Oct.

Injuries in children can easily be overlooked because they usually play rough.
During the AAP National Conference, they AAP addressed how minor prolonged pain the
head can be serious. Sometimes, if left untreated the mild concussion can become worse.
The hard part is discerning the difference between a simple bruised head or a concussion.
Some invasive tests should be taken if the child has a concussion, not if they have a
mildly bruised head. These cases can be puzzling because doctors have to take enough
tests to rule out important diagnoses, without damaging the childs health with too many
tests.
 While shadowing Dr. Tsai, I have seen many children who hurt their head while
riding their bike, playing football, and running. The first thing Dr. Tsai rules out is
concussion, because this can effect the childs brain development. The test for concussion
are non-invasive because Dr. Tsai just uses his hands to make eye contact with the patient
and to find if any range of motion is impaired.

Kemp, Carla. AAP National Conference: Get the Scoop on How to Handle Oral Health
Issues. AAP News, 23 Oct. 2016. American Academy of Pediatrics. 25 Oct. 2016.

Sometimes emergencies happen when children fall and teeth fall out.
Unfortunately, most ED do not have dentists present. This can cause confusion when
parents have to decide between taking their injured child to the dentist or the emergency
room. Dr. Slayton gave a talk at the AAP National Conference about how Pediatric
Emergency doctors should deal with oral health issues. She recommends that
pediatricians should get to know the dentists in the area in order to make the transition
from the emergency room to the dentists office easier.
When Dr. Tsai sees a patient with a dental problem, he first asks who their dentist
is and how quickly they can see them. The ED at HCGH does not have a dentist present,
but the University of Maryland Emergency Department does.

Luthra, Shefalia. How Gaps in Mental Health Care Play Out in Emergency Rooms.
NPR. 17 Oct. 2016.

Undiagnosed depression can lead to teens showing up in the ER because of a

suicide attempt. 20 percent of children suffer from psychiatric illnesses, and there are not
enough child psychologists. Psychiatric patients usually stay longer than physical ailment
patients. These patients must stay in the chaotic uncomfortable environment of the ER
because there are not enough in patient facilities for them to go to. Also, surveys have
shown that psychiatric patients are more likely to be uninsured compared to patients
treated from physical conditions.
The American Academy of Child and Adolescent Psychiatry has around 8,300
specialists for the 15 million young patients. Obviously this field of study needs more
doctors in this field, so I am going to put this job on my list of possible occupations.

Macdermott, Nurse Caroline. Personal Interview. 24 Oct. 2016.

I frequently see Nurse Caroline Macdermott helping other nurses, working in ER,
and assisting the doctors. She went to the Community College of Baltimore County
where she learned how to be a nurse. At other local community colleges, she learned
more specific skills for being an ED nurse. She has worked at HCGH for 14 years.
Michaels, Andrew. Effort in Howard County toward Eliminating Stigma of Mental
Illness. Howard County Times, 20 Oct. 2016. 23 Oct. 2016.

Dr. Meenakshi Suman has seen Howard County grow toward educating the
county on mental illness. She explained how Howard County (HC) has better access to
resources than Baltimore Country does. More than 60 percent of children with mental
health issues receive inpatient treatment at Sheppard Pratt. Many people have stigmas
attaches to what they perceive a mentally ill person is like, so Dr. Harsh K. Trivedi hopes
to change peoples views through a mental health film festival. By providing the
community more exposure and information about mental health, this may spark
conversation. Parents of children that have mental illnesses have the misconception that
the problem can be fixed as quickly as a physical problem could be mended; however,
one prescription will not fix a mental illness. The road to recovery is long-term. Through
data in the Maryland Youth Risk Behavior survey, it was found that 19.2 percent of HC
middle school students feel sad and hopeless with 15.7 percent of them making plans to
attempt suicide. In high school students, almost 25 percent felt sad and hopeless with
13.5 percent of females and 9.4 percent of males considering suicide. Two schools,
Bollman Bridge Elementary and Patuxent Valley Middle are trying to change how mental
illnesses are approached at school. University of Maryland provided licensed professional
counselors that can be used onsite and through telemedicine sites. Also, Howard County
General Hospital is explaining that families should address mental health concerns during
yearly check ups and that pediatricians should use standardized surveys to figure out if
anything is wrong. Dr. Eric Crawford from HCGH says that mental health should be
taught in school. A high school student from Atholton explains how when people have
physical diseases such as cancer or diabetes, people step up to help them. Then if people
have mental illnesses such as depression or anxiety, people step back.
I agree with the high school students in this article that students are over tested
and are becoming data points to make schools look better. Students should be treated like
individuals rather than a test group. I do not know people who are struggling with mental
illnesses, and this may be because of the stigmas that people should keep quiet about their
problems. Schools should have mental health class just as we have regular health class. In
health class they only touch on the surface facts about depression and anxiety, when they
should help others feel comfortable with communicating their feelings.

Mohney, Gillian. Consumer Reports Highlights Dietary Supplement Dangers. ABC

News. 27 Jul. 2016. 24 Oct. 2016.

Supplements are not bound to the same regulations as pharmaceutical,

prescription drugs. People should always consult with a doctor before taking supplements
because the supplement could interact with their present medication, could have
dangerous side effects, and the ingredients do not have to be safe or effective. 23,000
people go to the emergency room each year after taking supplements. A list of 15
ingredients that consumers should stray away from because they can lead to heart and
liver damage was provided at the end of the article.
 This article restated main ideas that I have been researching about how
supplements are dangerous, but also included a new way that supplements are dangerous.
Because these supplements do not have to be monitored, the amount of ingredients in
each pill could be inconsistent, making it not effective.

Mulpeter, Kathleen. The Right Way to Take Melatonin Supplements, According to a

Sleep Doc. Fox News Health. 22 Oct. 2016. 26 Oct. 2016.

Kathleen Mulpeter was looking for a way to adjust better to different time zones,
so she tried melatonin gummies. After the trip she kept taking them and began to worry
that she might be addicted to them. Dr. Chris Winter told Mulpeter that it is not possible
to become addicted to melatonin because our bodies naturally produce it already. Instead,
people can become psychologically dependent on the idea of taking the supplement in
order to fall asleep. Taking melatonin supplements more that 4-5 days at a time can push
back the bodys circadian rhythm making it even harder to fall asleep. Melatonin is
produced when the pineal gland in the brain is alerted that the sun is setting. If people
keep the environment around them peaceful after dinner until bedtime, then they will find
it easier to fall asleep at night. Also, if people wake up during the night, they should not
turn to melatonin supplements to help them sleep the whole night. People should allow
their body to learn from being tired to try to sleep through the night.
I was able to learn how people can become physiologically dependent on
something in order to fall asleep, such as a baby needing its blanket. Also, the tips on how
to fall asleep faster are similar to what I already do. After dinner, I complete my easier
homework such as Chinese and math. Right before I go to sleep, I spend 10 minutes
reading a book. I can vouch for these steps for falling asleep faster because they have
worked for me.

Nutt, Amy Ellis. Psychiatric Patients Wait the Longest in Emergency Rooms, Survey
Shows. The Washington Post. 18 Oct. 2016. 19 Oct. 2016.

Emergency rooms are chaotic and noisy places, the opposite of the ideal
environment for a mentally ill person. However, people with mental illnesses that should
go to in-patient facilities are not able to because there are not enough in-patient facilities.
Instead, they are boarded in the emergency room where they increase mortality rates
for ER patients, higher costs for the hospitals, and higher stress for the medical
professionals. These patients stay in the ER and have to wait for an in-patient bed for, on
average, two days. Renee Hsia, director of health policy studies at the University of
California at San Francisco, quotes that ERs are the dumping grounds for these
patients.
Only 17 percent of ER physicians have a psychiatrist on call to respond to
psychiatric emergencies. I think that the ER should be required to have psychiatrists on
call to keep the ER patients safe and to keep the psychiatric patient comfortable. Also,
more in-patient facilities should be created because there is a high demand for them.
Psychiatric visits to the hospital have roes 55 percent from 2002-2011, and the number of
group homes and halfway houses continues to decrease.
Oaklander, Mandy. Why You Need to Stop Eating Egg Whites. Time. 25 Oct. 2016. 16
Oct. 2016.

Most people believe that eating the egg yolk is unhealthy because of its high
concentration of cholesterol, but they forget about the other parts of the egg yolk. The egg
yolk contains vitamin E, carotenoids, and other nutrients that can help in eye health.
Some may argue that other fruits and vegetables contain carotenoids, but carotenoids are
best absorbed by the body when eaten with fats. By eating eggs with the yolk and the
white provide a lot of protein and useful nutrients. More research has found that eating
foods that have high cholesterol concentration does not cause people to develop high
cholesterol. Actually, some good cholesterol can help lower heart disease.
I though this article was going to talk about how egg whites were bad for you, but
they only addressed how eating egg yolks along with the egg whites is good for you. I
know that egg whites are the perfect form of protein because they are fat free and contain
all of the amino acids. Now that I know that eating eggs with vegetables helps you absorb
more nutrients, I will try to add eggs to my salads.

OConnor, Anahad. Study Warns of Diet Supplement Dangers Kept Quiet by F.D.A.
The New York Times, 7 Apr. 2015. 24 Oct. 2016.

BMPEA has been found in more than 5 supplements on the market. BMPEA is a
amphetamine, a stimulant that can increase blood pressure and lead to heart attacks and
strokes. People have been having heart complications while taking this supplement, but
the FDA has not taken all of them off of the shelves. Some people believe that the FDA
has been corrupted by the influence of the Natural Products Association. In the past, the
Natural Products Association has lobbied against the Dietary Supplement Labeling Act.
This law would have made it mandatory for manufacturers to label the warning signs for
children and pregnant women. The FDAs supplement division is lead by many people
from this association and they may have their backgrounds to impact decision making.
While other countries have already taken all supplements proven to contain BMPEA off
of the shelves, the FDA has only begun to send out warning letters to manufacturers. The
FDA has claimed to have misplaced or never received these letters. Other doctors have
sent multiple letters of concern because their patients have had side effects to the
supplements that were not posted on the labels.
In this article I was able to learn that the manufacturers are not the only reason
that dangerous supplements are still on the market. The corruption of the FDA has also
lead to the slowing down of recalling supplements. Even if people file complaints about
the supplements, the FDA will take a long time to address the concerns. The longer the
FDA takes to recall the supplement, the more people are being affected by them. The
government should intervene and make sure that the FDA is not biased from the workers
from the Natural Products Association. Also, the leader of the FDAs supplement division
is Daniel Fabricant, sounds like fabricate as in to lie.
On Medication? These Supplements Can Be Dangerous. The Washington Post, 15 Apr.
2016. 24 Oct. 2016.

People should always check with pharmacists, or doctors, to make sure that the
present medications they are taking are not going to interfere with supplements. Only 28
percent of people that take supplements checked with their doctors for interactions with
their medications. Some ingredients such as St. Johns wort and ginko leaves can cause
tremors and increased bleeding.
This was the shortest article that I read, and it was a short summary of the
Consumer Reports article. I found the tip to ask a pharmacist in addition to a doctor
useful.

Peachman, Rachel Rabkin. Supplements- a Complete Guide to Safety. Consumer

Reports. Sept. 2016. 16 Oct. 2016.

The article begins with an alarming story where a baby died at 8 days old from a
contaminated probiotic supplement. Probiotics are given to NICU patients because they
are supposed to ward off deadly intestinal diseases, but this baby was killed because of
the probiotics. Supplements that seem harmless are sometimes not strictly quality
controlled, so contamination may occur. Many hospitals and doctors recommend certain
brands of dietary supplements because people can easily buy unreliable brands. This is
because supplements, seemingly nature and safer, are easier to purchase than
prescriptions. A lot of supplements claim to address health issues that are already have
few solutions such as quick weight loss. The Government Accountability Office reports
that thousands of people using supplements have reported having health issues as a result
of taking the supplement, and possibly more go unreported. The FDA does not treat
supplements the same way as drugs, so supplements do not have to be proven to be safe,
although many consumers believe differently. A list of 15 ingredients to avoid is provided
with symptoms of reactions. Many of the employees selling the supplements are not
educated on the dangers of the 15 ingredients. With 15,000 supplement manufacturers on
the market, the FDA per year inspects fewer than 400. The article also explains what
certain seals mean and if they are reliable or not. Also, when 4 out of 5 herbal
supplements do not contain what is listed on the ingredients, what can people trust to
take?
This article sparked many peoples view on supplements. I have read many other
articles that have included information or statistics from this article. More people need to
be aware of the dangers that can come with taking supplements and how to correctly
procure them. They need to know that just because a supplement says it is natural, it does
not mean it is safe. It is concerning that no special training, education, or equipment are
needed to produce supplements. The people at Consumers Report even made their own
weight loss supplement to show how easy it is to get one on the shelves of pharmacies.
The table with the types of seals found on supplements will be very useful in a possible
pamphlet for my project. I agree that Congress should step in a help regulate the
production of dietary supplements.
Rocha Melo, Manuel, et al. "Dedicated Pediatricians in Emergency Department: Shorter
Waiting Times and Lower Costs." PLOS One, 26 Aug. 2016. 30 Sept. 2016.

A study was conducted in Porto, Portugal to see if there was a correlation between
having pediatricians in the emergency room and having lower costs and waiting time.
Recently, pediatric emergency medicine has been growing in its reputation in several
countries including the United States, Canada, and most of Europe. This study is the first
of its kind, evaluating costs and benefits of dedicated pediatricians in the pediatric
emergency department (ED). Two hospitals were included in this study. Both has controls
set such as the steps taken when a patient arrives and not including costs other than the
ones influenced by medical staff management. After collecting data from medical records
of 56,298 patients, the most frequent age group that visited the pediatric ED was 1-5
years old. When more pediatricians are in the ED, less diagnostic tests are taken because
the doctors have more knowledge on the proper medication that should be prescribed.
They concluded that pediatricians in the pediatric ED is related to lowered waiting time
in the ED and lowered costs. Because this experiment is the first of its kind, there still
needs to be further studies on this topic to prove the conclusion.
Overall this lab report was a little confusing with the technical terminology used.
The only way this article would be useful is if I had to write a lab report. They were very
thorough with their descriptions and keeping the study controlled. Also, they explained
how each number was calculated and what they represented. However, their conclusions
seemed to come out of nowhere with not much proof to back up their claims.

Starr, Ranjani R. Too Little Too Late: Ineffective Regulation of Dietary Supplements in
the United States. American Journal of Public Health. Mar. 2015. Public Health
Ethics. 16 Oct. 2016.

Ranjani R. Starr repeats most of the common arguments that supplements are
dangerous, but he goes into more detail about Dietary Supplement Health and Education
Act. The DSHEA allows the Secretary of Health and Humans Services to immediately
ban substances that are hazards. cGMP guidelines require manufacturers to confirm the
absence of contaminants, but cGMP does not address underlying safety of the
supplement. Manufacturers can pick and choose certain statistics that they want the FDA
to see to ensure the success of their supplements. Only a small fraction, 6 brands, are
verified by the USP, US Pharmacopoeia. Also, the Center for Food Safety and Applied
Nutrition AE Reporting System (CAERS) allows people to voluntarily report dangerous
supplements. The Dietary Supplements and Nonprescription Drug Consumer Protection
Act gave consumers more rights to reporting these supplements. Although people have
the right to report these supplements, the Government Accountability Office did not see
equal reports for the CAERS as they did for reports from the American Association of
Poison Control Centers.
I was able to learn more about the legal side to how supplements are verified and
reported as dangerous. Many statistics were provided in this article, so I could use them
in my presentation. After more people know how to report dangerous supplements, the
supplement market may become safer for consumers.
Stein, Rob. Dietary Supplements Send Thousands To ERs Yearly. NPR. NPR,
14 Oct. 2015. 8 Oct. 2016.

The CDC states that one of the leading causes for people going to the emergency
room, after heart diseases, are ones caused by dietary supplements. 71.8% of ER visits
from 2004-2013 were related to dietary supplement use, specifically weight-loss and
energy-boosting supplements. Some patients who died on the way to the hospital may
have had problems associated with supplements, but those deaths are not recorded in the
study database. Little children can consume these supplements on accident, older people
can choke on these pills, and supplements can also lead to heart problems. Not only are
dietary supplements dangerous to people of all ages, and are not required to be FDA
approved. This means that they could put other active ingredients that they do not post on
the ingredients list, or products with similar names could contain different active
ingredients. Consumers are being deceived by these misleading companies. Studies are
being conducted to figure out which supplements are dangerous and recalling them;
however, the critics of this research believe that the study will only shows how safe
supplements are. Others think that more research should be done, so supplements can be
recalled by the FDA before they hit the shelves. Duff MacKay believes that this research
does not include the problems caused by homeopathic remedies. Also, he says to keep the
supplements away from children and in the future, new pills will prevent older people
from choking.
This article was very inspiring and will probably be my research topic. A lot of the
new research is being conducted, making it easier to research. I found this article very
interesting because many people use supplements and I was surprised that supplements
are a leading cause for people visiting the emergency room. I can also ask Dr. Tsai if
many of his patients are from this group. Already, a couple of the patients I observed
visited the emergency room because of accidentally consuming their parents medicine.
People should be aware of what they put into their bodies, and if the supplements that
they are taking contain the wrong active ingredients then they have the right to know.

Tsai, Dr. Jackson. Personal Interview. 24 Oct. 2016.

I am interning with Dr. Jackson Tsai at HCGH. He attended University of

Maryland Baltimore County for undergraduate school and continued his education at
University of Maryland Medical School. Dr. Tsai has been working at HCGH since 1998.

Tsong, Nicole. Supplements Can Help, but the Best Medicine is Always Exercise and a
Healthy Diet. The Seattle Times. 10 Oct. 2016. 26 Oct. 2016.

Nicole Tsong talked to Kelsy Klausmeyer about how to choose the right
supplements for losing weight. Although Klausmeyer is not a doctor, reasonably explains
how people should ideally buy supplements. To ensure safety, consumers should always
consult their doctor about every supplement, even common ones like fish oil. He says to
treat supplements as they would any medicine. Consumers should buy from companies
that quality controls every bottle that is produced, do not use with ingredients that inhibit
the bodys ability to absorb the supplement, and get independent third party research on
the safety and usefulness of the supplement. Klausmeyer understands that supplements
that meet these standards will be more expensive.
Kelsy Klausmeyers statement that people should treat supplements as they would
treat any other prescribed medication, because supplements are powerful and can easily
damage the body. His consideration of fillers being part of the ingredient list of
supplements was a new idea that I will make sure to read more about.

Vaughn, Ronald J. Quality Assurance Issues in the Use of Dietary Supplements, with
Special Reference to Protein Supplements. The Journal of Nutrition. PubMed. 24
Oct. 2016.

Many people believe that taking supplements provide more benefits from them
than actual food. On average people take 5 separate supplements per day. Not only it this
expensive, it poses some dangers because more variables are added to the persons health.
Athletes and military personnel frequently use protein supplements because they believe
they help with strength, but many of the supplements contain little to no active
ingredients. The quality of these supplements is not guaranteed because they do not have
to be regulated. The environments that these supplements are produced in do not have to
be clean or safe, again, because the production is nor regulated.
This article stresses the cost and benefit relationship between supplement
purchasing. People need to get rid of their assumption that all supplements are beneficial
and safe. I now understand that because there are so many supplements, that it is almost
impossible to come up with a testing program. Another problem with supplements is
unlabeled allergens. Also, some ingredients that are not listed could interfere with
religious beliefs such as traces of pig in a supplement that a Muslim tries to take, or
dietary concerns such as any meat in a vegan supplement.