By Robin Urevich
California Health Report
Decades-old research links trauma and health, but doctors remain reluctant to probe
Childhood trauma isn’t just bad for the psyche; it’s debilitating for the body, and years later, can lead to adult illness.
Researchers who studied 17,000 patients at a Kaiser Permanente clinic in San Diego in the 1990s found that traumatized kids grew into adults who were not only more likely to smoke or drink or overeat, but also more likely to die young, suffer heart and lung problems, and develop cancer.
The more trauma children experienced, the sicker they tended to be in middle age.
What’s more, if the study participants, who were overwhelmingly white and college educated, are any indication, trauma affects a lot of Americans.
Dr. Vincent Felitti, who conducted the Adverse Childhood Experiences study along with a colleague at the Centers for Disease Control, said his findings have generated more than 70 journal articles and keen interest, but so far too little action, especially among his colleagues in medicine.
“It’s avoided like the plague,” Felitti said.
Felitti spoke recently in Los Angeles on a panel with talk show host Tavis Smiley and California State Senator Sandre Swanson. Gray haired and soft-spoken, Felitti is a physician who looks like he could play one on TV.
Felitti, who founded Kaiser Permanente’s Department of Preventive Medicine in San Diego, and ran its clinic said that patients there answered 17 survey questions about their childhoods, like “Did you often or very often feel that no one in your family loved you or thought you were important or special?” They were asked whether their parents divorced, if they’d witnessed domestic violence and if they’d been physically, sexually or emotionally abused.
Nearly two-thirds of the patients answered yes to at least one of the questions, and more than one in five had three or more yes answers.
Felitti and his colleagues would review the surveys with their patients and ask a simple question: How did that affect you later in life?
For years Felitti has spoken to groups of physicians to share his experience with his questionnaire as a diagnostic tool, but most are reluctant to use it.
“I will see one or two people leave with uncontrollable coughing fits. I’ve never seen that with another speaker. I think clearly ghosts are being awakened.”
Still, he said doctors have a lot to gain and nothing to fear. Diagnoses, he said are based more on medical history than lab tests and physical exams.
“It doesn’t open Pandora’s Box. Answers are to the point,” Felitti said. “People are willing to talk. It becomes an enormous relief to find people are interested and willing to listen.”
In fact, Felitti argued that the mere use of the questionnaire was therapeutic.
He said researchers found a 35 percent drop in doctor visits and an 11 percent decline in trips to the ER a year after a group of Kaiser patients had taken the ACES survey and discussed it with a physician.
The results suggested that using the questionnaire on a wide scale could save the massive HMO millions of dollars.
But Kaiser Senior Vice President Patti Harvey said in an email the health care giant had opted not to do so.
“Although much was learned from the earlier study, we do not consider making the questionnaire available to all members an appropriate tool for general screening,” Harvey wrote.
Harvey was unavailable for an interview to explain the organization’s thinking.
At the soon to be opened UC Riverside School of Medicine, Dr. Paul Lyons, a family physician and senior associate dean, said doctors may be uncomfortable with the survey, but not necessarily for the reasons Felitti expressed.
“The question is what do you do when you’ve found out the information…There is the weak link in the chain,” Lyons said.
“At least if I discover a patient has gonorrhea, I know what to do about it…If I look for child abuse, at least I have that phone number in my pocket…Physicians are very uncomfortable feeling at a loss. We are control-oriented individuals.”
In an interview, Felitti said he first got interested in studying trauma when he worked with obese patients who had come to him for help in losing weight.
His work suggested that learning why patients are sick or engage in risky behavior is key to curing them.
“I discovered that for many people, obesity is there for protective reasons,” he said.
One of his patients was raped at 23, and a year later gained 100 pounds.
“Overweight is overlooked and that’s the way I wanted to be,” Felitti said his patient told him.
A prison guard shed more than 100 pounds, but told Felitti he didn’t feel comfortable going to work without the extra weight.
Smokers use nicotine for similarly rational reasons, Felitti said. The same is true for drugs and alcohol. The reasons that trauma is linked to higher rates of cancer and other diseases are less clear but Felitti noted that research is emerging that links stress to immune system suppression.
Felitti no longer works full time at Kaiser. Instead he spends a lot of time on the road talking about the study. Nearly twenty years after its publication, its findings are gaining traction in scattered parts of the country like Spokane, Washington and Tarpon Springs, Florida and in fields like child development and education. They are catching on more slowly among physicians.
“The error we made was putting all of this in the medical literature. It certainly attracted interest and attention, but accomplished nothing,” Felitti said.
Now, so-called trauma informed approaches to parent education and school discipline are showing signs of success. A website called acestoohigh.com chronicles the latest efforts, including the creation of a deck of cards by a group in Walla Walla, Washington where players combat adverse childhood experiences with positive ones that build resilience.
Or, using the same approach that Felitti did when he asked how trauma had affected his patients, a school in the same city that has cut suspensions by 85 percent by taking kids who act out aside and asking why they were breaking school rules.
Now Felitti would like to get Hollywood involved with shows that weave supportive parenting into story lines. He said he’s struck chords of interest with industry types, although there is nothing in the works yet.
“The lessons would fly below the radar of resistance,” he said, and the message would be paid for by advertisers.