ACE Study inspires pediatrician to change her practice
- on April 7, 2011
"Can a stressful childhood make you a sick adult?" In this fascinating article in the March 21 issue of The New Yorker, author Paul Tough addresses that question as he looks at how Dr. Nadine Burke, a pediatrician who founded the Bayview Child Health Center in San Francisco's Bayview-Hunters Point neighborhood "faced a crisis of confidence" in how she was treating her patients.
Tough starts out by telling the story of Monisha Sullivan, who's lived a lifetime of stress in her short 16 years in Bayview-Hunters Point, San Francisco's poorest neighborhood. Her parents were addicted to drugs. Shortly after her birth, her mother abandoned her in the hospital. She lived with her father until she was 10, when she and her brother were put in a foster care home, the first of 10 she's lived in. When she came to the clinic, she had asthma, scabies, strep throat and a weight problem. And she has a baby daughter.
Sullivan encountered Nadine Burke at a moment when Burke was just beginning to think deeply about the physical effects of anxiety. She was immersing herself in the rapidly evolving sciences of stress physiology and neuroendocrinology. What if Sullivan’s anxiety wasn’t merely an emotional side effect of her difficult life but the central issue affecting her health? According to research that Burke had been reading, the traumatic events that Sullivan experienced in childhood had likely caused significant and long-lasting chemical changes in both her brain and her body, and these changes could well be making her sick, and also increasing her chances of serious medical problems in adulthood. And Sullivan’s case wasn’t unusual. Two years after Sullivan’s first visit, Burke has transformed her practice. She believes that regarding childhood trauma as a medical issue helps her treat more effectively the symptoms of patients like Sullivan.
Burke has found that 67 percent of her patients have an ACE score of one or more, and 12 percent have a score of 4 or more, which the CDC's ACE Study found would greatly increase the risk of adult onset of chronic disease. The ACE Study itself, which focused on 17,000 middle- and upper middle-class, mostly white, employed San Diegans with good health coverage, found similar results: almost two-thirds reported at least one ACE, and 12.5 percent reported an ACE score of 4 or more.
To find out how Burke has changed her practice, you'll have to read the entire article. For that, you have to subscribe to the digital or print edition of The New Yorker. I'll lend my copy out for anyone who wants to stop by the News Center and pick it up (on Friday, April 8, or after).