Thursday, August 1, 2019

Letter to the Maryland Department of Health
Dated: July 19, 2019
Re: Failure to provide adequate state medical consultation

This letter was sent to the Maryland Department of Health (MDH) leadership and copied to Governor Hogan's staff on July 19. No response has been received regarding the Department's failure to provide reliable medical consultation in the State's development of health and safety best practices for the schools' digital devices, as required by law.

It now seems evident that the Joint Audit Committee should look into this matter, since the unanimous vote of the General Assembly to ensure classroom protections for students statewide has been inadequately addressed - in fact, it has largely been ignored - while the process itself was compromised by ed tech special interests whose influence cannot be overlooked.

Nothing prevents the Maryland Department of Health from updating and revising its direction to the Maryland State Department of Education. It's imperative that clear guidelines are presented to local school districts, or our children will continue to remain at risk from serious, known hazards.

July 19, 2019

Dear Mr. Ye,

The medical consultation from MDH required by HB1110/Ch244 should have served as evidenced-based guidance for local school district leadership, administrators, parents and students to mitigate the health risks posed by statewide demands for students to use hazardous school equipment.

Instead, MDH has partnered in the production of lukewarm suggestions that will likely put children at greater risk, since a false sense of 'protection' will result. Schools will be able to claim they are following your expert direction.

Students are required to put their own health at risk when they are required to use the schools' admittedly hazardous digital devices. Many will be put in serious peril because MDH, within the context of this law, didn't accurately or appropriately identify (or offer resources about) the serious health issues facing Maryland students. This lackluster approach adds to the false sense of protection - implying there are no real concerns.

Since the Maryland Health Department didn't mention it, it must not be that important, for instance, to properly evaluate students' health before requiring screen use. Pre-existing myopia, dry eye disease or other childhood health issues such as obesity, sleeplessness or scoliosis will only be exacerbated by unsafe practices in the use of digital devices at school every day and night. Medical experts know that any of these conditions could lead to crippling outcomes if not properly identified, treated and mitigated.

Yet, comprehensive evaluations of each child's health as it relates to the schools' screen use was simply ignored.

Pediatric optometrists and ophthalmologists who specialize in dry eye disease are now seeing permanently damaged corneas in ever younger patients, because the blink rate of device users is only 67% or less of what it normally should be.

And the myopia epidemic remains unbridled. It is a progressive eye condition that cannot be reversed. Severe myopia can lead to catastrophic eye conditions later in life: glaucoma, cataracts and detached retinas. Less recess and more device use is the one-two combination that is fueling this epidemic. Even the teachers' union is now recognizing the need for more outdoor play to mitigate myopia and obesity.

Why didn't MDH take these issues seriously, research this professionally, and advise school boards, administrators, teachers and parents appropriately?

Burgeoning research has been consistently shared on my website for years - it's time MDH became committed, and dig into its own resources to address this growing public health issue. Blue light hazards go far beyond melatonin suppression (see the University of Toledo work from last summer, and Review of Optometry's blue light research to better understand retinal cell death and the role of blue light as it relates to accommodation in refractive errors.)

And while the mention of blue light's relationship to sleep is important - it falls pathetically short.  Your department missed a key component: the schools send digital devices home at night for studying and homework. Where is the 'best practice' that would put an end to that? Online homework and studying are literally destroying the impossibly important health aspect of children's sleep, which of course, is directly related to obesity, anxiety and depression, with associated comorbidities: heart disease and diabetes.

Last June, I specifically noted the false underpinnings of the so-called "20-20-20 rule," warning against this type of bumper-sticker advice.  It has no scientific merit whatsoever, as revealed by Optometry Times. The 'rule' was originally posited within the context of ergonomics, not eye health.

I have shared this kind of research with the Maryland Department of Health for several years now. Even though your department was made well aware of the misleading nature of this 'rule,' you still released this graphic - making claims that lack any medical evidence.

Of course, any break is a good break. And of course, the encouragement of frequent blinking is imperative -- but at every turn, where the Department could have provided reliable research and reference, only AAP documentation is provided.

Please note; the American Academy of Pediatrics has yet to provide any research or documentation on the use of classroom devices, so even those references are not applicable within a school setting.


And your ergonomic image is simply wrong. By all accounts, including this one from "Let comfort be your guide" on HP's Safety and Comfort Guide, the top of the monitor should be just below eye level, and the elbow should form a right angle.

One glance at the suggestions you had in hand, and the research with which MDH has been presented for several years now, it's clear that this was an uncommitted exercise on the part of the state's medical experts who were supposed to care about protecting our kids, and who were required by law to provide medically-sound input.

That simply didn't happen.


Please consider updating, revising and supplementing the medical research that should be shared with school districts statewide. It can't be underscored enough: the use of this equipment poses serious health risks to Maryland children that will threaten their proper bone development, vision, eye health, weight, sleep and mental health for a lifetime.

Schools literally do not know what they're doing to the health of Maryland children. We were counting on you to fill them in, not whitewash this situation.

##

Cindy Eckard
@screensandkids

Tuesday, April 23, 2019

Maryland's Elusive Classroom Screen Safety
Ed tech group interferes - will Governor Hogan take action?

7/23/19 UPDATE: No action was taken to provide an interim report; MSDE failed to publish 'health and safety best practices' for the schools' digital devices by June 1, 2019, as mandated by law; and the documentation they have ultimately provided to local school districts is woefully inadequate. Here is just some of the documentation MSDE and MDH ignored.

Maryland passed the nation's first classroom screen safety law on April 24, 2018, with the support of the Maryland State Medical Association (MedChi), pediatric health specialists and mountains of medical evidence showing that digital devices pose serious health risks to growing children. The new law requires the state department of education to consult with the health department and develop health and safety best practices by June 1, 2019.

And while the Maryland General Assembly spoke with a single voice, unanimously approving HB1110/Ch244 "health and safety best practices for digital devices," the House Ways and Means Education Subcommittee, chaired by Delegate Eric Luedtke (D-Montgomery) had removed language from the original bill that would have required important stakeholder participation and an interim report, before voting it out of committee. In doing so, Delegate Luedtke's subcommittee enabled the state department of education to "implement" the law with no oversight or accountability.

Education Subcommittee Chair, Delegate Eric Luedtke, left
Where does screen safety in 
Maryland stand now?

Our children's classroom digital device protections remain in doubt a year after Governor Hogan signed the bill into law. The amended law only requires the Maryland State Department of Education (MSDE) to create something by June 1 - with no proof of merit whatsoever.

MSDE must present its suggestions for digital device health and safety practices to the school districts by July 1, 2019 - when stakeholders are at the beach, and little or no school communications take place.

And although the law does not require local districts to adopt the MSDE health and safety practices, most are "waiting to see" what MSDE does. Should the Department's efforts ultimately prove to be as hollow as they are right now, those empty promises are likely to be repeated statewide.

This means Maryland students could remain unprotected from the myriad health risks posed by the schools' digital devices - including myopia, dry eye disease, retinal damage, obesity, addiction, sleeplessness, and increasingly, mental illness - which are reaching epidemic proportions, according to children's health experts around the globe.

Ed Tech Influence Over Maryland's Screen Safety Law

After months of Public Information Act inquiries, it's become clear that MSDE has been working to minimize the impact of this critical law, undermining the intent of the General Assembly. Unlike other health threats to students, such as lead in the water or radon, this health threat is actually introduced by the schools themselves, so the situation is intolerable.

Documents reveal that powerful ed tech interests began micromanaging the new screen safety law's implementation soon after it was passed, with the complete cooperation of MSDE and full knowledge of the Maryland Board of Education.

The Consortium for School Networking (CoSN) recognized this law as the first of perhaps many threats to their empire - their membership boasts some of the biggest tech companies in the world, including Microsoft, HP and Amazon Web Services.

Records show that as early as June of last year, CoSN contacted MSDE and together, they began collaborating with the Maryland Department of Health (MDH) and Maryland Public Television (MPT).

The state's legal mandate to protect students is being ignored

It's clear that this powerful special interest group has had no trouble insinuating their ed tech messages into Maryland school policy, ensuring that daily digital device use in Maryland classrooms remains unchallenged - regardless of the law or the serious risks posed to children's health.

MSDE leaders who have consistently ignored medical concerns eagerly welcomed CoSN's participation and influence, and were pleased at the invitation to participate in the group's annual conference. PIA inquiries show that local school district IT directors across the state were also happy to cooperate with CoSN, many of whom are CoSN members themselves.

CoSN's executive director wrote to school IT directors across the state in October, assuring them that the special interest group had things well in hand when it came to Maryland's screen safety law, concluding: "Given that this is the first legislation passed of this sort, it is important to us that Maryland 'do it right.'"



The Maryland Department of Health (MDH) representative - who was supposed to ensure authentic medical oversight for our kids - likewise has cooperated and seemingly recanted earlier public warnings about digital device safety that have been publicized worldwide.

As noted above, Maryland Public Television (MPT) has also helped dilute the implementation of critical classroom safety measures.  A video that MPT has been contracted to produce for MSDE only mentions "healthy behaviors" in passing.

Indeed, the intended audience doesn't even include the students themselves, according to the MPT memorandum of understanding with MSDE, shown here:


Documents clearly reveal that state agencies and CoSN have been working together to protect the schools' digital curriculum - not our children's health. The group has widely distributed their manipulative messaging, encouraging the state to "shift the conversation" away from the serious health risks posed by the schools' digital devices.



Will Governor Hogan demand transparency and a public interim report?

Maryland elected officials voted unanimously in both the House of Delegates and the Senate to make sure our children have necessary protections from the schools' hazardous equipment. "Shifting the conversation," or watching a glossy video offers our children no protection whatsoever. MSDE's subversion of the law cannot continue unchecked.
 
This is a charade, about which Governor Hogan's administration has been consistently informed since September, as has Dr. Justin Hartings, president of the Maryland Board of Education. The 34 sponsors of the law have also recently been informed.

IT staff from MD attend CoSN's annual meeting in April 2019
Given the obvious interference by this special interest group, and the complicity of Maryland agencies and IT directors statewide, the Governor should take immediate action on behalf of Maryland students and voters.

An interim report for HB1110/Ch244 should be posted online for lawmakers, medical professionals and parents to review, to ensure that the law is upheld and our children get the authentic medical protections at school that they need and are legally owed.

Demanding adherence to the manufacturers' safety warnings - at minimum - would be a good first step, Governor Hogan. The schools have failed to share with teachers, parents or students even those basic warnings, which include "serious bodily harm" if the schools' devices are not used properly.

Let's hope it doesn't become necessary to ask the Joint Audit Committee to investigate this situation, to ensure that special interest groups and educational politics are not denying Maryland children their lawful right to a safe and healthy learning environment.


Cindy Eckard

@screensandkids
www.screensandkids.us

Saturday, March 9, 2019

A guide to classroom screen safety 
provided to the Maryland Department of Health, the Maryland State Department of Education, and the Maryland Board of Education, Fall, 2018

UPDATE: Ongoing updates to research about the negative health impacts of the schools' digital devices are shared on Twitter. You don't need a Twitter account to review the links and new data: www.Twitter.com/screensandkids.

The links contained herein are provided for quick access to some of the more definitive or recent scientific evidence, underscoring the need for the health and safety best practices that the Maryland General Assembly has required the Maryland State Department of Education, with consultation from the Maryland Department of Health, to develop. 

RISKS TO STUDENTS' EYE HEALTH AND VISION 

I. Myopia (refractive error; nearsightedness)
- epidemic, nationally and world-wide
- exacerbated by fixed, near work; doubled in the last 50 years in the U.S.
- lack of exposure to the sun and increased use of screens are considered pivotal factors
- genetic predisposition among Asian, African-American and Hispanic populations
- developmental predisposition among 11-15 year olds
- often undetected due to lack of proper eye exams
- blurs vision; interfering with academic, athletic abilities
- progressive; can lead to blinding conditions such as glaucoma, retinal detachment and cataracts

SUGGESTED MITIGATION:
- Increase recess and outdoor classes. Sunshine has proven to be a key factor in the mitigation of myopia. It stimulates dopamine in the brain, which helps to curb the elongation of the eye that is taking place when the child grows. That elongation helps to create the refractive error (myopia).
- Work toward increased eye exams - not just vision screening - for all students. The schools may be unwittingly exacerbating pre-existing conditions; students need comprehensive eye exams.
- Schedule consistent device use within grade levels to ensure routine breaks from screens every day. For instance, schedule device use for each class period during first 20 minutes of class, which would leave the remainder of each class screen-free. Consistent breaks should be guaranteed.
- Begin public health information campaign to alert families to risks at school and at home from excessive screen time; strongly encourage more breaks and more outdoor play.
- Develop classroom posters that remind teachers and students to take breaks; duplicate posters as flyers to be used at home.
- Develop classroom contracts similar to those needed for science class that outlines for the teacher, student and parent what the risks and mitigating practices are regarding the safe use of the school's digital devices (emulate the approach used for lab equipment). 
- Hazardous blue light is absorbed more by children because their lenses have yet to develop the protective pigmentation that provides adult eyes a bit of protection from retinal cell destruction caused by blue light, emitted by digital device screens.
- The light travels to the back of the eye - the macula - and the process permanently destroys the cells needed to see. This process has been recognized as part of aging. It has been called age-related macular degeneration or AMD. Today, signs of macular degeneration are being seen in much younger patients as a result of screen use.
- Blue light suppresses the production of melatonin, the hormone that regulates sleep. Sleeplessness is directly associated with anxiety, depression, poor academic performance, and obesity. Obesity is epidemic among children today and leads to heart disease, kidney disease and diabetes.  That's why the American Heart Association published a statement this summer calling for screen time limits for children.

SUGGESTED MITIGATION:
- Blue light filters should be installed on every school-issued digital device and made a basic requirement for all future RFPs.
- No homework should be assigned on devices. Schools cannot control the time which students use the schools' equipment, and therefore, could be contributing to the interruption of critically important healthy sleep patterns, since many students are doing homework late in the evening.
- To protect students from the serious risks posed by blue light exposure, the use of screens in the classroom should be limited to actual school work; "free play" or "quiet time" should not be spent using devices.

- Children (and adults) blink 67% less often when using digital devices, which has caused a significant rise in dry eye disease symptoms in younger patients. Severe dry eye can permanently damage the cornea.
- Dry eye disease and computer vision syndrome are closely related since the symptoms can overlap: red, scratchy eyes, blurred vision, headaches and tearing.
- The student's discomfort can interfere with academic performance since the child finds it difficult to concentrate. Moreover, if children are accustomed to experiencing this discomfort, many will find it "normal," and not report it to an adult.
- Sore necks, back pain and shoulder discomfort are also related to computer vision syndrome, as those muscles can also affect a student's vision. 
- Undetected, unreported chronic eye discomfort can be a sign of more serious conditions and permanently damage children's eyes and vision.

SUGGESTED MITIGATION:
- Adhere to manufacturers' safety guidelines for safe workstation settings to include monitor height, monitor angle, and proper settings for glare and contrast (and audio settings - which are often ignored, and necessary to protect students' hearing).
- Review classroom seating and overhead lighting to minimize glare and reflection from windows or other light sources.
- Ensure proper ergonomic posture among students; require proper posture to avoid muscular discomfort.
- Train teachers and school nurses to recognize the signs of discomfort when children are using devices, and develop policies to offer paper alternatives whenever possible.
- Teach children to recognize and report their own symptoms of dry eye or digital eye strain.
- Make these issues part of the overall public education component (classroom posters and letters to the home) for digital device screen safety.
- In all cases, encourage parents to provide a full eye exam for their children and establish a policy of uniform, scheduled breaks from the screens throughout each school day.

IV. ADDITIONAL CONSIDERATIONS
There are many additional health and safety concerns that must be addressed in the law's deliberations, chief among them:
- fundamental cultural biases within the school climate that encourage ever-increasing screen use
- little awareness of screen addiction; it is exacerbated by the constant demand that students use devices regardless of healthier alternatives that would serve the same purpose, and also made worse with the increase of educational "gamification"
- little understanding of the associations between screen use and mental health issues: anxiety and depression are sharply rising and suicides have tripled among teenage girls in recent years.

A clear understanding of the educational benefits and health risks posed by these devices must emerge so that they are used to their best advantage, without harming students in the process, visually, physically, or psychologically.

Cindy Eckard