Joshua Sharfstein

Joshua Sharfstein is health commissioner of Baltimore City, Maryland.

Recent Articles

Unhealthy Partnership

F ourteen years old and sullen, he came to the hospital on a Sunday afternoon for evaluation of long-standing abdominal pain. As a first-year pediatric intern, I thought of incredible diagnoses: An intermittent twisting of the bowel? A rare parasite? When the preliminary tests came back negative, I told my patient the good news. He just cried, looked away, and held his stomach. The next morning, a senior pediatrician remarked that abdominal pain is often the only obvious manifestation of depression in children. Returning to the patient's room, I elicited a story of loneliness, anger at his siblings, and unwillingness to confide in his parents. Then I drew in a slow breath and ventured that some people do not find life to be worth living. Doctor, he replied, at night I stand in the kitchen with a knife to my neck and pray for the courage to kill myself. The next couple of hours passed quickly. I consulted with the primary care pediatrician and explained the situation to my patient's...

Kids First?

W ith clinical trials now underway, it is natural to expect that a safe and effective vaccine against HIV will soon spell the end of AIDS in this country. But consider a more likely scenario: Immediately after the Food and Drug Administration licenses the vaccine, the Centers for Disease Control and Prevention (CDC) recommend the immunization of all high-risk gay men, prostitutes, and intravenous drug users. Congress and state legislatures, however, do not rush to approve the funds needed to reach these groups. Years pass, and HIV infection rates barely budge. Stymied, the CDC teams with the American Academy of Pediatrics to endorse vaccinating all newborn babies against HIV, which should eventually protect the entire population. This strategy Congress funds. But when scattered reports of possible vaccine complications mount, suburbanites start asking why their children are being vaccinated against a disease they're unlikely to contract. Politicians launch investigations. Some parents...