2008 Public Officials of the Year

Maverick Medic

Joshua Sharfstein

Health Commissioner, Baltimore, Maryland

Joshua Sharfstein asked for the truth about children's cold medicine.

When Joshua Sharfstein first heard about the opening for Baltimore health commissioner, he didn't think he would want, or get, the job.

It turns out that Sharfstein, a licensed pediatrician, was wrong on both counts. That's been good not only for Baltimore but also for kids and their parents everywhere. Because when Sharfstein began asking whether young children ought to be taking over-the-counter cough and cold medicine, it sparked a national discussion about whether such medicine might actually be harming kids.

The crusade blended both of Sharfstein's passions: one for public policy, the other for hands-on health care. Those twin interests began to merge when Sharfstein was in his early 20s, on a humanitarian mission. "I was in Central America working with Nicaraguan immigrants, going hut to hut and weighing kids," Sharfstein recalls. "On weekends, I'd buy the New York Times and read every word in every article." One article in particular never left his mind. It was about President George H.W. Bush's executive order prohibiting doctors in federally funded clinics from discussing abortion with patients. The American Medical Association, according to the Times, was furious about the gag order.

That story got Sharfstein thinking about politics and health care policy in Washington — and the AMA's tactics in particular. When he got back to the United States, he pored over AMA's campaign finance records. To Sharfstein's astonishment, he found that the AMA frequently supported political candidates who actually opposed the policies most doctors wanted. His subsequent analysis made the New England Journal of Medicine.

So it was no surprise that when Sharfstein took the Baltimore job, he would look for other areas where policy and practice didn't match up — and he found a huge one in pediatric practices around using cough and cold medicine. "This has been on my radar since medical school," says Sharfstein. "Because what we were taught in school and what pediatricians were practicing in the field was so different."

What he'd been taught in school — and what all the medical literature corroborated — was that there was no proven clinical benefit to giving kids six and younger cough and cold medicine. What's more, four childhood fatalities in Baltimore had been linked to cold medicine. Sharfstein recruited the best medical minds in pediatrics in the country to launch a fact- and research-based campaign questioning the safety and efficacy of kids taking cough and cold medicine. As a result, the cold-medicine industry voluntarily pulled off the shelves all medicine that was claimed to be safe for kids under two. And just this summer, the U.S. Food and Drug Administration announced that it would finally look into a new rule on over-the-counter cough and cold medicine for all kids.

— Jonathan Walters
Photo by Steve Barrett