Vol. 141 February 1, 2016 Newspaper Update from Z to A

February 1, 2016

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All I know is just what I read in the papers.
Will Rogers

You can never get all the facts from just one newspaper,
and unless you have all the facts, you cannot make proper
judgements about what is going on.
Harry S. Truman

I usually start thinking about what to write in my next blog a few days before the 1st and 15th of the month. This Tuesday, January 26 I picked up a newspaper and was immediately struck by the number of medically relevant articles (some of which contained “medical fun facts”, from front page headlines to blurbs in the business section. Here are some of them.

El Salvador Advises Women to Stop having Babies for 2 Years Because of the Zika Virus (front page)
Zika is a mosquito-borne virus that causes minor symptom in an adult but can cause severe microcephaly and even death in a fetus. First reported n Brazil, 5000 adult cases have been identified in El Salvador. The rate of infected fetuses is not known. Turns out that the above recommendation has not caused much of a stir in El Salvador. In comparison to other developing countries its birth rate is low. Salvadorian women list their reasons as:  1. fear of violence, 2. poor economics and widespread poverty, and 3. their acceptance of contraception (despite the church’s stand), and now 4. Zika virus. Some have gone so far as to deride the recommendation as a government conspiracy to reduce the birth rate in “this most densely populated country on the entire continent” (per their Health Minister). Zika has caused more of a stir here, and our CDC has advised pregnant U.S. citizens not to travel to Central and South America.

As someone who is not usually receptive to conspiracy theories, I myself feel a bit concerned about “just who” is controlling information. This story sort of “dribbled out” as a minor note only to explode rapidly on the front page with lots of “known facts.”

Grand Jury Indicts the Accusers of Planned Parenthood (lead story on front page)
The Texas grand jury convened to investigate the criminal activity of Planned Parenthood as alleged by the Center for Medical Progress has instead indicted the Center’s founder Mr.Daleiden and Ms. Merritt, makers of the “selling baby parts” videos. After two months of investigating the evidence the grand jury issued indictments for a federal offense (illegal changes made to fake California driver licenses) and a misdemeanor (offering $1600 per sample to Planned Parenthood for fetal tissue which is against existing law).

That this grand jury was impaneled by a Republic DA in a Republican state with a Republican governor made this unexpected result immediately newsworthy because of the rabid Republican-led Congressional attacks on Planned Parenthood. Planned Parenthood noted that this was the eleventh investigation of them that found no wrongdoing.

Gluten-Free Diet Did Not Benefit Competitive Athletes (first page of Well Section)
A two week double-blind study of 13 seriously training, competitive cyclists eating indistinguishable gluten-free and gluten-laced sports bars revealed no difference in general feeling, performance, or inflammatory markers related to sports bar type. The researcher remarked that, “Unless you are having gastrointestinal problems a gluten-free diet will probably provide no benefit… I hope that people learn to be more objective in terms of what they hear and read about gluten-free diets and nutrition in general.” (1)

EKG Screening For College Basketball Players? (Op Ed page)
When the chief medical officer of the NCAA recommended in March 2015 that all male college basketball players should get a electrocardiogram (EKG) because of the risk of sudden cardiac death, 100 college team physicians reacted very loudly. They strongly pointed out that the inaccuracy of EKG screening causes lots of expensive and unnecessary medical investigation of commonly occurring “false positive” results. Another problem is that rates of sudden death in these students has been calculated to be all the way as low as 1 in 50,000-100,00 to as high as 1 in 1,300 (higher than the risk of dying in an auto accident). The American Heart Association and the American College of Cardiology both oppose EKG screening of 460,000 U.S. college athletes. Some colleges do require it. The newspaper editor suggests “maybe just for high-risk basketball and soccer players”. “More data later” remains the medical mantra.

More Gun Violence,  (multiple pages, no surprise,)
       Dorchester, Boston: A 34 year old male was shot in the abdomen at 2:35 PM because he had taken another male’s parking spot. The shooter sped away in a black BMW.
         East Boston: At 2 PM on the inbound Blue Line of the MBTA a man getting off the train turned around and fired 5 shots at a man he had been arguing with. He hit the 29 year old target and a 43 year old man just standing on the platform.
        Windham, Maine: A 33 year old man arising from bed in his house in the early morning hours opened fire with a shotgun at a figure at the end of the stairs that he thought was an intruder. It was his wife who had gotten up earlier.
        , Mass: An intoxicated 60 year old man was arrested for firing a gun at a snowplow driver in Plymouth Saturday night.
…………(NY Times probably doesn’t even report such common happenings)

Autism Therapies to be Tested on Genetically Engineered Monkeys (bottom of page in Science section)
Mice are not useful research models for studying social cognition and interaction, so scientists in China have turned to genetically engineered monkeys to test drug therapies for autism . The monkeys born from eggs injected with the human MECP2 gene (associated with autism) showed more repetitive behavior, more stress responses, more defensive behavior, more grunting when people gazed at them, and less social interaction than other monkeys. The higher cost of developing such monkeys compared to mice, the difficulty of equating monkey behavior to human autistic behavior, and the fact that the implanted gene is found only in the monkey’s nerves and not throughout their brains means that this “break-through”  may not be all that helpful(2). Though it could be a good science fiction plot. Synopsis: “Lab break-in releases autistic monkeys. Presidential primary candidates attack (or defend) animal rights activists, but most push their campaign ad content up to a higher reading level.”   

References: (other than the January 26, 2016 NY Times and Boston Globe)
1. Medicine & Science in Sports & Exercise, Dec. 2015, Dana Lis
2. Nature, January 2016, Institute of Neuroscience, Chinese Academy of Science,Shanghai


Vol. 140 January 15, 2016 A Review of 2015 Hubslist Blogs

January 15, 2016

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Click on the date to see the full blog

 

January 1 – 5 out of 10 of my resolutions were “kept”. You guess which ones.

January 15 – 6 reasons why patients are non-compliant , excuse me, “non-adherent”- the new PC term, with their medications.

February 1 – incidence of sudden death while watching the Super Bowl (Patriot fans probably don’t have to worry about that THIS year.)

February 15 – some myths revealed about cholesterol in your diet, global warming, measles vaccination rates, herbal supplements, and Dr. Oz, vendor of snake oil(s).

March 1 – 8 new causes of death caused by cigarette smoking added to the previously identified 12; a total of 20.

April 1 – Athena Health purchases MySpace which raises more concerns about privacy of health care data (April Fools edition).

April 15 – what does a “board certified physician” mean, and what does it have to do with Presidential candidates (Rand Paul)?

May 1 – physicians’ prognoses are often too optimistic for the same reasons patients’ are.

May 15 – E-cigarettes open new avenues for adolescent use of marijuana and synthetic cannabinoids (“bath salts”).

June 1 – annual review of sunscreens and bug repellents plus less universities providing student access to tanning booths.

June 15 – new forensic techniques of identifying individuals by bacterial, viral, and DNA “fingerprints”.

July 1 – 6 positive access outcomes and 4 positive health care delivery outcomes of Obamacare at 5 years of age.

July 15 – dangers of synthetic cannabinoids (attn: Chandler Jones?) and the minimal (“pending”) review of sunscreens by FDA.

August 1 – two websites with the best “symptom diagnosis” track record for helpfulness, and the one that is the worst.

August 15 – [ family vacation in a lighthouse without electricity or running water]
DSC01581

September 1 – why new drugs cost so much, no “gay gene” identified yet, and the myths of low testosterone, chronic Lyme, and  8 glasses of water a day.

September 15 – The health benefits of our “microbiome” and the “microbiome” of the New York City subway.

October 1 – the misleading, untruthful attacks on Planned Parenthood.

October 15 – the scope and magnitude of adverse effects of dietary supplements.

November 1 – transgender, transsexual, transvestite, and hermaphrodite, oh my!

November 15 – toddlers shooting people and other “norms” of gun deaths – “By Degrees“.

December 1 – changing advice about what NOT to eat during the holidays.

December 15 – the benefits of research using fetal tissue, short history of political attacks on Planned Parenthood, and why if you are NOT fat and live a long life you should thank your parents.

HAPPY NEW YEAR


Vol. 139 January 1, 2016 HEROIN: Cape Cod, USA

January 1, 2016

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A HBO documentary shown on December 28, 2015

 As a pediatrician and a parent I found this moving documentary of eight white, middle class heroin addict kids from stable families on Cape Cod to be very disconcerting. It was brutally honest with several scenes of addicts preparing and injecting heroin. The repetitive, “almost-expected”, relapses after detox, and the seemingly casual acceptance of inevitable drug deaths of other addicts set a tone of hopelessness. The onset of addiction in half of these addicts followed standard treatment with opioids for post-accident or post-surgical pain. 30-day detox programs, despite their noble intent, were depicted as mostly fruitless in the long run, like spitting in the ocean. (None of the eight addicts appeared to be enrolled in a heroin-replacement program – Suboxone or methadone) The recognition by the addicts that their craving drove them into behavior they themselves detested confirmed that insight is not enough.

 One addict said that “one dose of heroin was all that was needed to get you addicted”, but NIH statistics suggest that 23% of first heroin users become addicts. Even so, those one-in-four odds are worse than the odds of Russian roulette with a six-shot revolver! One could consider appropriate opioid treatment for post-surgery pain as a “screening test” to find those one-in-four addicts!

For the past decade physicians have been told that the patient should direct pain control. “How bad is your pain on a scale of 1 to 10?” Hospitals and doctors were, and are still, graded on their ability to reduce patient-reported pain quickly. Many of us physicians remember the pain control conferences that basically told us “you are not giving enough”. Perhaps that mind set contributed to the current easy access to opioids.

The Massachusetts Medical Society just promulgated lengthy opioid therapy guidelines consisting of 11 statements for acute care and 16 statements for chronic treatment (over 60 days). The guidelines are sprinkled with words like “function and pain”, “quality of life”, “short-term trial”, “minimum dosage”, “partial-fill prescriptions”, “low-dose sequential prescription”, and “useful consultation with a specialist or a second opinion”. Treatment of cancer. hospice, palliative care, and hospital inpatients is exempt from the guidelines.

The simple patient pain scale of 1 to 10 has been trumped by 11-16 sentences. If you think that is an overstatement then consider these words in the new guidelines,  “The guidelines will provide valuable guidance to physicians [mostly primary care] in their practices and as evidence of best practices and to the Board [of Registration in Medicine] in its responses to patient complaints, accusations of substandard care, or accusation of inappropriate prescribing.” [emphasis added].

The multiple pathways to addiction, its frequent appearance in several members of a family, and on functional MRIs similar active areas of the brain common to all types of addicts suggest a genetic basis of addiction. If that is true, than the cure for heroin addiction in the long run will depend on identification of the responsible genes and the development of drugs that will block or modify those specific genes.

In the short run, maybe we can do more in the U.S. to reduce the harms of addiction; overdose deaths, infectious diseases, and criminal behavior. One mother in the parents’ group eloquently summed up the need to “destigmatize” heroin addiction. ( “No one sent me casseroles when my son died of an overdose.”) To “destigmatize” addiction we will need to “decriminalize” it and treat it as a medical condition. Other countries (Switzerland 1994, Portugal 2000, Vancouver B.C. 2003, Netherlands 2009, Germany 2009, and U.K. 2009) have done that with both “heroin-replacement” and “heroin-assisted” treatment programs. Those programs have resulted in a reduction of overdose deaths and AIDS/Hep C infections WITHOUT increasing drug use.

According to the Boston Globe the “supervised injection site” in Vancouver (called “Insite”) has been shown by 30 peer-reviewed studies to have “saved thousands of lives, saved millions of dollars in both health care and public safety costs, reduced transmission of AIDS and hepatitis C, and promoted entrance into treatment without increasing drug use or drug-related crime”. (1) The Cato Institute studied the results of the successful Portugal program in 2009 and confirmed the same positive results. Critics remarked that such a model would not work in the U.S. because of our size, heterogeneity, and politics.

Isn’t that a shame?

References:
1. Boston Globe, December 27, 2015, K5, “Massachusetts needs safe injection sites”


Vol.138 December 15, 2015 Who Buys Baby Parts?

December 15, 2015

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The Colorado gunman who shot and killed three people at a Planned Parenthood clinic in Colorado Springs is reported to have said “no more baby parts.”

 

The distorted flap about Planned Parenthood “selling baby parts” continues. On December 3 the Senate ( Republican-led) voted to strip Planned Parenthood (PP) of government funding. President Obama (a Democrat) will veto it if it reaches his desk. (I’m not suggesting that this is a political issue, of course) Planned Parenthood received $528 million from the U.S. government in 2014 to help support 700 clinics providing health services to mostly poor women. Why so much money? Basically because PP is providing subsidized women’s health services that in every other developed country except ours is provided by the government. The Congressional Budget Office estimates that if Congress were to succeed in blocking Medicaid patients from obtaining care at PP health centers 390,000 women would lose access to preventative health care in the first year alone. (1)

Who wants “baby parts”?

In 2014 NIH funded 164 research projects using fetal tissue with about 0.27% of its total grant money. (2) These projects were researching HIV/AIDS (39%) , eye development and disease (32%), Hepatitis C and other infections, (13%), diabetes (8%), and miscellaneous others including Alzeihmer’s and Parkinson’s. “Fetal tissue is a flexible, less-differentiated tissue … and it is a tool for research that can’t be replicated with adult tissue.” (3) It is different from stem cells, a medical tissue that came under attack back in W. Bush’s administration.

Use of fetal tissue has been legal since 1993 when Congress passed the NIH Revitalization Act which permits the tissue from any type of abortion to be used for fetal tissue research. The law requires complete and detailed informed consent from the woman to donate tissue from the abortion after she has made the decision to have an abortion. The law allows clinics to recover “reasonable payments” ($45-60 per specimen at PP) for providing the tissue to biological-research supply companies. The companies process the tissue and provide it to the researcher for about $800 per specimen. (I wonder if any Republicans have stock in some of those companies).

An estimated 5.8 Billion (yes, a “B”) people have received vaccines made with the two cell lines derived from fetal tissue. (Oh, NO, another red flag! “VACCINES”, “Guns”, “abortions” – all mentioned in the same blog! It’s almost enough to make you believe that there is a government conspiracy to enslave us all.)

“People are talking about fetal tissue, but really what the discussion is about is abortion.” (4) ( Duh!!)   3% of PP services are abortions, done in 1% of the clinics, and in just 2 states. (5) Planned Parenthood leaders have now instructed any PP clinic providing fetal tissue NOT to accept the measly 60 bucks.

Planned Parenthood has experienced 15 smear campaigns in 10 years according to its medical director (5). The current campaign has included:
1) six votes in Congress to restrict woman’s health care,
2) five Congressional committees currently investigating PP,
3) submission of 25,000 pages of documents by PP, and
4) 5 hours of testimony to one committee by its president.

Abortion politics appear to be as complex and almost as emotionally provocative as Presidential election politics, but the outcome of election politics will immediately affect only two women, not hundreds of thousands.

A HOLIDAY DIVIDEND:
Another learned cardiologist has reaffirmed the Hubslist axiom: “Just pick your parents right .” Dr. Lee Goldman, Dean of Columbia School of Medicine, explains that obesity is due to our genes in his new book, “Too Much of a Good Thing: How Four Key Survival Traits Are Now Killing Us.” He thinks that our overreaction to stress and our cravings for sweet, fatty, and salty foods all served us well in the cave man years when we had a life-span of 30 years, but that these “survivor genes” are now mismatched with our environment as we live into the 80’s. Of course, being a modern scientist he knows it is too late to “pick your parents”, so he is placing his hopes on future drug therapies that will turn off or block specific genes. Dr. Goldman says, “Gaining weight doesn’t mean that you are a terrible, non-virtuous person. This is the way you were built.” (6)

So, my holiday (includes New Year’s eve, of course) mantra for me and you is:
“Merry Christmas. Don’t beat yourself up. YOU are NOT in control.”

References:
1. CBO cost estimate on H.R. 3134, Defunding Planned Parenthood, September 16, 2015
2. Nature Magazine, Dec. 9, 2015, Meredith Wadman
3. Carrie Wolinetz, Associate Director for Science Policy, NIH
4. Shari Gelbar, MD. Weill-Cornell Medical College
5. Tearing Down the Fetal Tissue Smokescreen, NEJM, December 10, 2015, p.2376, Reagan McDonald-Mosley, M.D., M.P.H.
6. Boston Globe December 14, 2015 , B11


Vol. 137 December 1, 2015 Holiday Season Eating Advice

December 2, 2015

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“WHY LISTEN TO SO-CALLED HEALTH ‘EXPERTS’
WHEN THEY ARE ALWAYS CHANGING THEIR MINDS
ABOUT WHAT’S GOOD OR BAD TO EAT?”

With the passing of the Thanksgiving turkey we are officially in the “holiday season”. Weight gain during the 6 week holiday season represents 51% of our annual weight gain which is actually only about a pound or two on average. Much less than the average weight gain during a 7-day ship’s cruise of a pound a day. So, what foods should be avoided in the next 6 weeks?

JUNK FOOD?
Junk Food has been the traditional scapegoat for our increasing obesity. But, what is junk food? Decades ago I remember a very savvy pediatric endocrinologist, Dr. Gilbert Forbes, challenging a forum of physicians at a national pediatric meeting to define junk foods.
“Food high in sugar and carbohydrates”, was our immediate response.
“Like grandma’s apple pie?” was Dr. Forbes’ equally quick reply.
“Oh… high starch foods” was our second try.
“Like potatoes? How come all Germans aren’t fat?”
Our working definition after an hour or more of back and forth boiled down to “anything wrapped in cellophane or delivered by a vending machine.” Dr. Forbes’ point was that it is the total number of calories ingested and not any particular food that contributes to obesity.
Today that definition still holds true

In its inexorable march towards the truth medical science has just thrown a stone at the junk food glass house. A Cornell study (1) based on nearly 5,000 surveys done by the CDC in 2007-2008 surprisingly showed that for 95% of the people their BMI  (a measure of obesity) was NOT linked to soda, fast food, or even candy. The researchers expected to find that the more junk food people ate the more apt they were to be obese. Instead they found no correlation between eating junk food and a higher BMI; no link between junk food and obesity. The researchers concluded that it was our increased intake of grains and added fats that was driving up the number of calories consumed by the average American.  “Junk foods may not be the central difference between fat and thin. Limiting those foods is a part of a healthy diet, but it might not be the whole thing.” (2)

 SUGAR?
Sugar continues to get a bad rap, and we consume more and more sugar substitutes. But, as we say in medical science, “there ain’t no free lunch”. Studies showing that Canadian lab mice were more prone to develop bladder cancer if fed saccharine (Sweet and Low) certainly caused a bit of a flap until someone calculated the comparative human doses to be several shovelfuls a day. Sucralose (Splenda) is now under investigation because its effect on our gut bacteria may make us more prone to gain weight and develop diabetes. Like Fox radio news says, “We report, You decide.”

SALT?
Excess (added) salt does seem to correlate with higher blood pressure.  I don’t have the space here to summarize again the whiplash swings of research on salt and disease, but I can tell another story from the past that makes the point more succinctly.
A bunch of physicians (all male – I told you this was a story from the past) who were having lunch at the same table in a hospital cafeteria started remarking about the prodigious amount of salt a cardiologist was pouring on his food. As the discussion heated up, the cardiologist looked up from his plate and stopped it with a question, “How many of you have talked to your father in the past year.” Half of us raised our hands. “You guys can eat what you want. The others better watch their diets. You just have to pick your parents right.”

EGGS?
After decades of branding eggs as “bad” because of its cholesterol the federal government’s Dietary Guidelines Advisory Committee reported in 2015 that “eggs are OK.” A 1999 Harvard study showed that there was no correlation between an egg a day and the risk of heart disease in healthy people (3). 90% of our cholesterol is manufactured by our own liver as directed by our genes. Restricting our intake of certain fats can normally decrease our cholesterol level by about 10% at most.

WINE or BEER?
Previous studies have shown that wine drinkers seemed to experience less heart disease and certain cancers. Efforts to analyze why wine seemed so healthy resulted in tagging resveratrol, a chemical in grape skin, as the “active ingredient”. Dozens of nutritional supplements containing resveratrol ($12 – $25 for a month’s supply) immediately hit the market. Four Danish scientists thought that answer might be too simple and launched a study of what else those wine drinkers were buying at the food store. After examining 3.5 million store receipt transactions from 98 supermarkets they found that wine drinkers were more apt to buy olives, low-fat cheese, fruits and vegetables, low-fat meat, spices, and tea. Beer drinkers were more likely to buy chips, ketchup, margarine, sugar, ready-cooked meals, soft drinks, and, of course, beer. (4)

BOTTOM LINE for this holiday season?
“PICK YOUR PARENTS RIGHT, AND EAT AND DRINK IN MODERATION.”

References:
1. Boston Globe, B12, November 23, 2015, Megan Scudellari
2. David Just, Cornell University Professor of Applied Economics and Management
3. Boston Globe, March 15, 2015, Walter Willett, MD, Professor of Nutrition and Epidemiology, Harvard School of Public Health
4. The Dorito Effect: The Surprising New Truth About Food and Flavor, Mark Schatzker, May 2015 as reported in The Atlantic, June 2015


Vol. 136 November 15, 2015 “By Degrees”

November 15, 2015

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“If a frog is placed into a pot of boiling water it will immediately try to jump out; but if it’s placed into a pot of cool water that’s gradually heated until boiling, it will stay put and never try to jump out.” (1)

Fall is here in New England. There’s a snap in the air as we shuffle through the leaves waiting to be raked up. It is a most beautiful time of the year when many of our thoughts turn to hunting. A noble sport, a timeless match-up of human endurance, skill, and patience against the stealth and quickness of wild game. Of course, the human often has the advantage of a gun. Except for the occasional cow, horse, or large dog that gets mistaken for a deer there are few accidental hunting deaths. That is because hunters are familiar with their guns, know how to handle them, and respect them. Not so much for toddlers.

“Toddlers in America this year have been shooting people at the rate of once a week.” (2)

That’s only 52 a year. Not a really big number. But if you add on 2 parents, 2.18 siblings (on average), 4 grandparents, and maybe at least one lovely teen age baby sitter per toddler, you get up to over 500 devastated people per year. Now THAT number might be big enough to get our attention.

Last week’s Miami Herald reported that a 3 year old who was looking for an iPad in his father’s dresser drawer found a loaded Smith & Wesson pistol instead. The .40 caliber bullet struck him between the eyes. The father worked as a fitness attendant, not usually considered a high-risk or dangerous occupation, so presumably he had the gun for self-defense.

Statistics show that people who have guns in their homes for self defense (”home protection”) are actually shot more often than intruders are. For every gun used to wound or kill in self-defense, four are involved in accidental shootings. (3)

Self-reported use of guns for self defense are grossly exaggerated. On examination most “self defense” use is actually  “threatening or intimidation” use.

In one study over 1/3 of parents who reported that their son had not handled a household gun were contradicted by the child.

By a margin of more than 3 to 1, Americans would feel less safe, not safer, when others in their community acquire guns.

Nearly one-half of gun deaths in U.S. are suicides. Suicides are often impulsive acts, and once the trigger is pulled the act is over.

75% of the guns used in crime are handguns.

An American teenager is more apt to die from a gun shot wound than from all natural causes.

Enough statistics. We all know that the debate about “gun control” is not a rational one anyway.

How about a musical contribution instead of quoting more statistics?  In the tradition of Pete Seeger, a singer of many protest songs, including the still relevant  “The Banks are Made of Marble”, Mark Erelli  (4) has just released “By Degrees” . Screen Shot 2015-11-14 at 9.56.03 AM Click below to watch Mark Erelli’s quietly powerful music video about gun violence in America..

References:
1.Edward Scripture, The New Psychology (1897): “The original 1872 experiment was cited in: Sedgwick, “On the Variation of Reflex Excitability in the Frog induced by changes of Temperature,” Stud. Biol. Lab. Johns Hopkins University (1882): 385. “in one experiment the temperature was raised at a rate of 0.002 °C. per second, and the frog was found dead at the end of 2½ hours without having moved.” 2. Washington Post, Christopher Ingraham, Oct 14, 2015
3. Brady Center to Prevent Gun Violence
4. Full disclosure: Mark is my favorite son-in-law…OK, my only son-in-law.


Vol. 135 November 1, 2015 “He, She, or It?”

November 2, 2015

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People tend to confuse sexuality and identity, and often want to conflate these things, but being transgender has nothing to do with sexuality.

— Norman Spack, Director Emeritus and Founder of the GeMS Program, Boston Children’s Hospital

Last week one of our five-man book-and-lunch club started our monthly gathering with, “Before we start can you tell me if an infant with unclear genitalia is called transgender?” It quickly became clear during the ensuing conversation that most of us not only knew someone with gender identity issues, but also that we (all over 60 y.o) had blurry, often overlapping, and quite different understandings of gender definitions and terms.  I suspected that we might not be the only ones confused, and thought that researching a blog on the subject might be clarifying for me and others.

What’s the difference between“transsexual”  and “transgender”?
“Transsexual” was coined by a German surgeon in the 1930’s for people (usually males) who wished to have sexual reassignment surgery (SRS) and change from male to female (M2F, MTF). “Transgender” was coined in the 1960’s, was much more about who the person thought they should be rather than about sexual orientation, and was not usually associated with the desire for SRS. In 1979 Christine Jorgensen rejected “transsexual” and insisted on “transgender” (even though he/she underwent SRS). Transgender seems to be the most PC term today, and transsexual, still implying an interest in SRS, is considered to be a subset of transgender. There is a World Professional Association for Transgender Health  as well as a blue/pink/white striped Transgender Pride flag that “will always be correct, no matter which way you fly it.”Screen Shot 2015-11-01 at 5.17.07 PM

A over-simplified, and not always correct, way to remember the differences is:
“Transsexual usually implies sexual orientation, ‘who you go to bed WITH’.
Transgender usually implies gender orientation, “who you go to bed AS?’ ” (1)

An excellent illustration of the complex interplay of these two terms is the Amazon Prime video “Transparent” for which Jeff Tambour won a 2015 Emmy for Lead Actor (a term, by the way, that is now often used for both male and female). In the series of 12 episodes we met several transgender characters, some of whom appeared to have had SRS and hormone therapy and some who have not.

What’s the difference between cross-dressers, drag queens, and transvestites?
Transvestites  are people who like to dress and act like those of the opposite sex. In the 1970‘s “cross dressers” was coined by such people who disliked the implications of fetishism or homosexuality in being called “transvestite”. Cross dressers can be private and have any kind of sexual orientation (J. Edgar Hoover?). Drag queens are theatrical cross dressers who are mostly male homosexuals with great pride in their flamboyant entertainment value.

Is a hermaphrodite the same as an infant with ambiguous genitalia?
Rarely an infant may be born with genitalia that appears to be neither clearly male or female (now called “intersex”). It is important for physicians and family to quickly forge ahead in checking chromosomes, internal anatomy, external physical appearance, parental wishes, and other factors to decide quickly which sex the child shall be raised as. Surgically, it is much easier to create a functional female than a male, but many factors are involved. Even rarer is the hermaphrodite who is born with both male and female genitalia. Unlike lesser species, these human hermaphrodites can not self-impregnate, but can apparently have a future career in adult porn.

In recent years our recognition of and services for gender identity confusion in children has increased. In 2007 Boston Childrens Hospital started a Disorders of Sexual Development and Gender Management Service (GeMS). Since then that multi-disciplinary team of 12 professionals have evaluated and treated over 160 pre-pubertal teen agers for gender identity confusion; 75% of whom lived within 150 miles of Boston. (1)  GeMS considers gender identity confusion as potentially life-threatening because of the higher than expected suicide rate among those adolescents not treated. Evaluations are initiated in “gender non-conforming” children  as soon as 10 or 11 years of age. Puberty is delayed by hormonal therapy, and later the child’s gender appearance can be changed to match the child’s mental gender identity through hormones and surgery.

Even a cursory review of these terms, what they used to mean and what they mean today, suggests many PC/sensitivity potholes dotting the road of their practical use. One Boston suburb middle school teacher started the first day of school this fall with a request to her class to indicate “by which pronoun each wished to be called”.  In addition to the grammatically traditional gender neutral terms like “it”, “one”, and “they”, invented gender neutral pronouns exist and include “zhe” and “zher” and “zhem”. (2000). The medical term “gender identity disorder”, disliked by many because it implies a disease condition, is being replaced with “gender dysphoria”.

References: 1. Norman Spack, MD TED talk


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