Top Papers Of The Month

4 Top Papers You May Have Missed in February 2021

Scott T. Vergano, MD
Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA

Vergano ST. 4 top papers you may have missed in February 2021. Consultant360. Published online March 8, 2021.


With all of the breaking information related to the COVID-19 pandemic, it is easy to overlook the rest of the medical literature. To help fill the gap, here are several articles that I found important over the past month. Please feel free to share with your colleagues, discuss in your offices, and write to with your thoughts and opinions.

Baby Foods Are Tainted With Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury1

A congressional report1 disclosed internal documents obtained from multiple baby food manufacturers. The documents revealed tests that showed significantly elevated levels of arsenic, lead, cadmium, and mercury in commercial baby foods. The companies were aware of the results and continued to sell baby foods to consumers, despite knowledge of the long-term neurologic effects of these chemicals. Several other manufacturers of baby foods refused to comply with the congressional subcommittee’s request for records. Furthermore, the US Food and Drug Administration was aware of some of the issues and did not act to limit or restrict these foods, or to inform the public of the risks.1

The day the report was released, I started receiving calls from concerned parents. They were confused about potential exposures and unsure how to feed their infants safely. Fortunately, the American Academy of Pediatrics (AAP) released new guidance for parents and pediatricians the following week.2 Among the AAP recommendations are exclusive breastfeeding for about 6 months, offering a variety of complementary foods and alternating grains, avoiding fruit juice and certain fish known to be contaminated with methylmercury, and avoiding potential chemical exposures in the home. The AAP does not recommend testing children for exposure. They also offered resources, such as professional staff at their regional Pediatric Environmental Health Specialty Units (PEHSU), for pediatricians and parents to discuss issues of environmental contamination.2

I initially found it difficult to respond to parental concerns, given the extent of chemical exposure disclosed in the congressional report. The AAP guidance is helpful, although not fully satisfying. Further information contained in the Green Book3 and consultation with my local PEHSU have both been helpful for other environmental issues raised by parents in the past. What are your thoughts? How have you responded to parental questions?

Hospital-Physician Integration and Medicare's Site-Based Outpatient Payments4

In a study published in Health Services Research, the authors estimate the difference in payment from Medicare for services provided by hospital-affiliated physicians compared with nonaffiliated physicians. Due to extra payment for the facility component of reimbursement, hospital-affiliated physicians would have been paid an average of $114,000 more annually from Medicare than nonhospital-affiliated physicians for performing the same services. By specialty, the differences in reimbursement varied from $63,000 per physician per year for primary care physicians to $150,000 per physician per year for surgical subspecialists to $178,000 per physician per year for medical subspecialists.

As a former partner in a private pediatric practice now working for a hospital-affiliated practice, I can verify how significant the difference in reimbursement can be, even though pediatricians are not reimbursed through Medicare. Although the magnitude reported in this study seems high, my difference in salary has been significant since joining my current practice—more than might be expected just from the change in geographic location. In addition, the extra effort required to negotiate contracts with insurance companies was completely relieved once I became a part of a hospital-affiliated practice.

Do these data make you want to join with a hospital system? Is it reasonable that such great variations exist, and what can and should be done to correct the discrepancy?

Ethical Considerations on Pediatricians’ Use of Social Media5

Should you accept a friend request from a current patient, a former patient, or a patient's parent? Is it acceptable to search for information about a patient through social media or the internet? What should your practice's social media policy look like? The latest clinical report from the AAP answers these questions.

Universal​ Screening for Hepatitis C Virus6

New guidelines for hepatitis C virus screening call for routine screening in all pregnant women with each pregnancy and in all patients between the ages 18 and 79 years, except in areas where the documented prevalence of disease is less than 0.1%.


  1. Baby foods are tainted with dangerous levels of arsenic, lead, cadmium, and mercury. Subcommittee on Economic and Consumer Policy, Committee on Oversight and Reform, and US House of Representatives. Published February 4, 2021. Accessed March 5, 2021. 2021-02-04%20ECP%20Baby%20Food%20Staff%20Report%20(2).pdf
  2. Heavy metals in baby food. Updated February 10, 2021. Accessed March 4, 2021.
  3. Etzel RA, Balk SJ, eds. Pediatric Environmental Health. American Academy of Pediatrics; 2018.
  4. Post B, Norton EC, Hollenbeck B, Buchmueller T, Ryan AM. Hospital-physician integration and Medicare’s site-based outpatient payments. Health Serv Res. 2021;56(1):7-15.
  5. Macauley R, Elster N, Fanaroff JM; Committee on Bioethics, Committee on Medical Liability and Risk Management. Ethical considerations in pediatricians’ use of social media. Pediatrics. 2021;147(3):e2020049685.
  6. Testing recommendations for hepatitis C virus infection. Centers for Disease Control and Prevention. Reviewed July 29, 2020. Accessed March 5, 2021.