Vol. 153 September 1, 2016 Is Nothing Sacred? No, Not in Medicine.

September 1, 2016

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It can be frustrating and unsettling when after years of telling us that something is good…or bad for you, doctors then tell us that the opposite is true! “Redefining the truth” is the essence of science, particularly the science of medicine. The medical mantra is: Keep studying, keep collecting data, keep analyzing, and if the “truth” changes, report it!
Here are some more revisions of the truth as examples.

Baby Dolls and Teen Pregnancies
Giving high school students a baby doll to take of care for several weeks is touted as a deterrent to teen-age pregnancies. The sophisticated doll is programmed to cry, make demands, go to sleep (or not), etc. just like a real baby. Students are instructed to care for it 24/7 as if it were a real baby. The expectation is that such a “reality-check” would make teen agers more aware of the burdens of caring for an infant and that would convince them to use effective birth control.

A recent report in the British Medical Journal documented that the average teen age pregnancy rate in those who cared for a doll stayed the same or even INCREASED in some schools. The article speculates that the positive, loving experience that some teens had and the extra attention they received while caring for the doll caused this. The company that makes the dolls quickly switched its marketing pitch from “reducing teen pregnancy” to “teaching quality infant care”.

Get the Lead Out”
The high level of lead in the water in Flint, Michigan in 2015 immediately raised an alarming concern about “poisoned children”.  A blood lead level of 5 micrograms per deciliter is considered “a threshold for official action as a “precautionary principle” according to public health experts.   5% of the kids in Flint had blood lead levels of 5-10 micrograms per deciliter.  The increase from 2.4% having a level over 5 in 2013 to 4.9% of kids tested in 2015 raised the public health alarm.

It is well known that the body can excrete lead. If the input of lead (ingested in food, water, or dirt or breathed in from car exhausts) exceeds the excretion rate and the blood lead level reaches 40-69 micrograms per deciliter then outpatient treatment is recommended, even though the person is asymptomatic. Blood levels above 70 can cause symptoms and are treated by hospitalization. None of the Flint children had lead levels over 40.

Lead performs no essential function in our bodies and chronically high levels can cause neurological damage, so it is incumbent of public health officials (and politicians) to prevent prolonged exposure, but these children have NOT been damaged. They will, I am sure, be monitored and studied for years to come to see if there is any subtle effect of these low lead levels. Because that’s what medical science does.

Lowering Blood Pressure in Intermediate-Risk Persons Without Heart Disease with Two Drugs Did Not Decrease the Rates of Major Cardio-vascular Events

NEJM 374:21 May 26, 2016,pg. 2009-2019

Lowering Cholesterol in Intermediate-Risk Persons Without Heart Disease and Normal Lipid Levels With One Drug Decreased the Risk of a Major Cardio-Vascular Event from 4.7% to 3.6% (a 25% reduction)

same NEJM issue pg. 2012-2031

Lowering Blood Pressure AND Cholesterol in the same study as above with Three Drugs Decreased the Risk of Some Major Cardio-vascular Events from 5.0% to 3.6% (a 30% reduction)

same NEJM issue pg. 2032-2043

Like Fox Radio, “We report the news. You decide.”

“Get the Fat Out…But Which Fat?”
The British Medical Journal published an article in April written by a team of scientists at NIH headed by Christopher Ramsden, called the “Indiana Jones of biology” because he specializes in excavating old studies, particularly those that go against our “mainstream government-sanctioned health advice”. He unearthed a 1968 five-year, tightly controlled study of over nine thousand participants randomly assigned to either a vegetable oil based diet or a standard animal fat diet.

The study documents that eating vegetable fats instead of animal fats did NOT, repeat did NOT, reduce the risk of heart disease or death. Substituting a vegetable oil diet ( about half of the saturated fat of the standard diet) did lower the average blood cholesterol by 14%, BUT the risk of death INcreased 22% for every 30 points the cholesterol fell! 

Dr. Robert Franz of the Mayo Clinic, the son of the organizer of the 1968 study, speculates that his father’s team was disappointed that they could find no benefit of the vegetable oil diet, and so didn’t publish it widely. An accompanying editorial in the BMJ concluded that “ the benefits of choosing polyunsaturated fat over saturated fat seem a little less certain than we thought.”

Again like Fox Radio:  “We report the news. You decide.”

“Worried About Peanut Allergy in Your Family?
Avoid Peanuts! No, NO, Eat Them as Early as You Can!”
The experts use to say “no solid foods to infants before age 4 to 6 months.”
Experts now say “do not delay solid foods beyond 4 to 6 months.”

In the past 10 years childhood peanut allergy has doubled from 1.4% to 3% (still small).
The experts use to say that “if you’re worried about peanut allergy in your child do not give peanut food until age 3 years”.
Experts now say “give the infant peanut food as early as 4 months of age.”

A 2015 study in the New England Journal of Medicine showed that consumption of peanut food at 4 months of age reduced the development of a peanut allergy (documented by skin-prick tests) by 70% – 86%!!

“We should no longer recommend avoidance of allergenic foods in infants.”

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Vol. 152 August 1, 2016 It’s Not the Screen Time, It’s the Content.

August 1, 2016

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“Playing rapid action video games benefits the mental skills of processing information, switching between tasks, and visualizing the rotation of an object.”
                 Scientific American, July 2016


What?!
“Shooting zombies and repelling aliens can lead to lasting improvement in some mental skills.” (1)

Bavelier while a graduate student in the 1990s developed a computerized psychological test of the ability to see an individual shape in a busy visual scene. He tested it first on himself, expected to get an “average score”,  and  got a perfect score. He next tested Green, his mentor who also unexpectedly got a perfect score. They figured something was wrong with the computer program, but they could not identify a bug. After a number of Green’s non-psychological buddies also scored perfect results they spent some time in looking for the reason. The only common denominator among the group was that each had spent more than 10 hours a week playing the video game Team Fortress Classic. That discovery launched them, and others, into 15 years of investigations into the cognitive effects of playing fast-paced “shooter” video games.

According to various studies video game playing can boost a variety of cognitive skills:

  • improve focus on visual details (like reading fine print in a contract or on a prescription bottle)
  • heighten awareness of visual contrast (help drive in a thick fog)
  • enhance mental rotation of objects (get that odd-shaped couch through the door)
  • improve audio and visual multitasking (read a menu while conversing with a dinner partner)
  • improve reaction time to unexpected events by 10%
  • increase the number of correct decisions made under pressure
  • improve specific attention in fast changing visual fields (better control of attention)

One study found that laparoscopic surgeons who were also game players could complete surgery faster with the same precision or quality as non-gamers . I remember many years ago learning that the Israeli Army realized that video game players made the best tank commanders.

Obsessive game playing (“binging”) is NOT needed to boost the brain, and the American Academy of Pediatrics has made recommendations for preventing excessive use of all media by children.   Short, daily intervals of play on fast-action games can reap cognitive benefits. Many so-called “brain games” marketed for improving cognitive skills do not live up to their claims. According to these researchers fast-action video games can because:
1. they are fun,
2. they have careful pacing and levels of play (reduces frustrations of early failures),
3.they require increasing attentional control as the game proceeds,
4. they consistently challenge the player,
5. they provide the successful gamer rewards on different time scales (promotes planning for short and long-term objectives).

The content of the game is very important. Violent, aggressive action games can adversely influence children’s attitudes and behavior. Games involving action sports, real-time strategy (like StarCraft), 3-D puzzles (like Portal 2),or “Prosocial” games that involve cooperation rather than competition are listed as examples of “brain-boosters” by these researchers.

They did not include their opinion of Minecraft , an open-ended, creative game that has captured the imagination of millions of children. This fast-paced, multi-level, 3-D building block game is too hard for this adult to understand or follow. One grandchild agrees and has started an instructional website “Minecraft4Momz” . Take a look on YouTube.

References:
1. The Brain-Boosting Power of Video Games, Sci Am; July 2016, D. Bavelier, Prof. of Psychology, University of Rochester and C.S. Green, Asst. Prof. of Psychology, University of Wisconsin


Vol. 149 June 1, 2016 Jargon Update, Placebo Prices May Count, and Visual Acuity in Kids and Baseball Players

June 1, 2016

Hub thumbnail 2015Jargon Update

Babylag” : the sleep deprivation symptoms experienced by 50% (gender not identified) of new parents; worse than jet lag because they can be cumulative.

“Brobats” : Robots, six times the size of human sperm cells, that move and turn by wriggling their tails; aka MagnetoSperm; may eventually be used to deliver drugs through the bloodstream.

Connectomics” : the study of “connectopathies” like Alzheimer’s, schizophrenia, depression, and autism spectrum disorders; spurred by the increasing use of functional MRIs (fMRI) as a non-invasive brain imaging.

Placebome” (pronounced Pla-SE-bom): the network of 10 genes that predisposes people to respond to a placebo; moving forward on personalized medicine is a long-standing goal of he Human Genome Project.

Placebos believed to be expensive may work better than those believed to be cheaper.

One or two of those 10 genes may be associated with what’s in your wallet.   The Washington Post (1/29/16, Bernstein) “To Your Health” blog reports that investigators “found that the patients performed better on motor skills tests when they believed they were on the expensive drug, an effect that increased when they were given the expensive placebo first.” The Los Angeles Times (1/29/16, Kaplan) “Science Now” blog reports that investigators “also used functional MRI scans to assess the patients’ brain activity and found that the ‘cheap’ placebo prompted more action than the ‘expensive’ one.” The blog adds that “to the researchers, this was a sign that the patients expected less from the placebo they believed cost less, so their brains responded by doing more work.” (Huh ???) There is much more to the placebo story; a story too complex to tell in a single paragraph or understand from a single study..

Outdoor activity for prevention of myopia in children (at least in Chinese children)

The prevalence of myopia (nearsightedness) increases throughout childhood, particularly during and after puberty. Myopia often progresses as children grow older and high levels of myopia are associated with an increased risk of sight-threatening complications later in life (eg, myopic macular degeneration and retinal detachment). In a study published in JAMA; 314, October 2015 , 1913 school children in China were randomized (by school) to an additional daily 40-minute outdoor class or usual activity . The cumulative incidence rate of myopia over three years was lower in the intervention group compared with the control group (30 versus 40 percent). This is the first study to suggest an effective preventative strategy.

Increasing the amount of time children spend outdoors is a simple intervention and could be a strategy to reduce the risk of developing myopia and/or slow its progression. The effect was related to just being outdoors and had nothing to do with sports or activity.This is yet another good reason to reinstitute recess periods in elementary schools. The mechanism of the preventative effect of being outdoors is unclear. Some think that lack of exposure to sunlight for long periods is associated with myopia. Myopia is more common in high-income regions of the world presumably because those people spend less time outdoors.  “Myopia, once believed to be almost totally genetic, is in fact a socially determined disease,” and is increasing in prevalence. (SciAm June 2016, p.80)

Speaking of outdoor eyesight

Wade Boggs, whose number was just retired by the Boston Red Sox, shared “better than normal” visual acuity with fellow Baseball Hall of Famer Ted Williams. “Normal vision” (20/20) is being able to see at 20 feet what most people see at 20 feet. As the letter size increases going up the Snellen chart (designed in 1862) the denominator number increases. If you have 20/100 vision you can see clearly at 20 feet what most others can see at 100 feet. Wade Boggs’ visual acuity during his baseball career was 20/12. He could see the blue dot of the MLB logo on the ball as it rotated toward him! That and several other factors apparently accounted for his superb hitting. (Wade’s favorite game as a child was the early video “Pong” which was one of several hand-eye-coordination games that he played.)

Ted Williams, the other fantastic Red Sox hitter, had 20/15 vision. He could see the stitches on the hurtling baseball. The two had very different batting stances and styles, but were good friends. After several attempts by Ted to “correct” young Wade’s stance and swing they resolved to mostly talk about fishing.

Speaking of video games

PCs are apparently passé to babies. Most are using smartphones or tablets. In a 2013 survey of nearly 1500 U.S. parents 40% of children UNDER 2 years of age used a mobile device, an increase from 10% in 2011. (66% watched TV – no increase since 2011) Most of this was probably due to the rapid increase in smartphones in those families. Smartphone use of educational media for children up to 8 yo. in lower-income families tripled between 2011 and 2013 while PC use decreased. The same study revealed that 28% of parents felt that children’s device use decreased the time they spent with their kids while 12% felt it increased their time with them.

A study of over a thousand 13-17 year olds by the same Common Sense Media organization revealed that in 2012 the  vast majority of teenagers had their own cell phone (82%) including 41% who say they have a “smart” phone, meaning they can use it to “check email, download apps, or go online.”  Cell phone ownership varied by age (74% of 13 to 14-year olds, compared to 87% of 15 to 17-year-olds), and by income (74% of lower-income youth, compared to 84% and 86% of middle- and upper-income youth). There were no significant differences in cell phone ownership by race or by parent education. Surprisingly, the teenagers who were surveyed preferred face-to-face communication (49%) over texting (33%), but other studies have shown that the fear of being “left out” seems to compel the use of social networking via devices.

Read the rest of this entry »


Vol. 142 February 15, 2016 Tech Update

February 15, 2016

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A drop of blood for 100+ tests!
A company called Theranos, founded by a Stanford University drop-out, has developed a nanotechnology system for testing a finger prick of blood for anything from standard cholesterol level to still-developing genetic analysis. It is being test marketed in California by Walgreens pharmacy. Theranos plans to charge 50% of the Medicare/Medicaid reimbursement for the tests.

HealthSpot Station : A walk-in kiosk in a mall or drugstore with high-def video conferencing, a stethoscope, a thermometer, and a blood pressure cuff for immediate evaluation of non-emergencies; they accept insurance, including Medicare.

A 3-D printer creates a bioresorbable airway splint for an infant
A two-month old infant with congenital anomalies of the trachea and surrounding blood vessels had a local collapse of his tracheobronchial tree which could not be kept open with conventional ventilation. A hose, similar to the design of a vacuum cleaner hose, but much smaller of course, was fabricated by a 3-D printer. Seven days after insertion, weaning from his artificial ventilation was started. He was discharged from the hospital 21 days later after corrective vascular surgery.

Wearable fitness monitors – a $2 billion business
The early ones only counted steps. In the rush to self-quantify ourselves more and more measurements have been added to these wrist bands that now talk to our smartphones. Three different wrist bands can give three different counts. Sleep scientists pooh-pooh the wrist-worn sleep monitors. But, people buy them … as motivational devices, not scientific ones. If you add on the seductive social networks to share your data with all your friends, you have entered into the realm of what some would call  “fitness by humiliation”. If you subscribe to conspiracy theories you might wonder where all that personal data ends up? Who looks at it? Who owns it? No one knows. No one does, … yet.  In the spirit of full disclosure I admit that last year’s Christmas present of a Fitbit bracelet sits on my bureau, not my wrist.  I discovered that I took about 3000 steps a day, every day. It never changed, and it didn’t count my Pilates exercises well, so I took it off.

Maybe my doctor should have texted me
A Johns Hopkins study showed that 81% of 48 men and women with risk factors for heart disease receiving an automated, “personalized” text message “from their doctor” successfully reached their 10,000 steps a day goal. Only 44% of those in the control group who received no messages met that goal. Sample message: “Jon, you are on track to have a VERY ACTIVE day! OUTSTANDING! We might as well call you LeBron James!” (I kid you not. You can’t make this stuff up.)

First to market telemedicine for profit- aka “Uber for Doctors”
FIRST OPINION – For $9 a month a patient can text health questions to a pre-matched physician any time of day and expect a response in 5 minutes.

TELADOC – Your insurance company offers you a video or phone consult with a physician 24/7.

DOCTOR ON DEMAND  – An app that connects doctors with patients who are sick to help them decide if they have to be seen by a health professional or just need to take an Advil. Medical histories are stored in an encrypted database.

FIRST LINE – For $25 up front and $15 a month you get unlimited consultations by video chat or messaging. New participants get 24 hours (total) of free texting with a doctor anytime between 8 a.m. and 10 p.m. A house call is available for $199. No insurance coverage…yet.

PCP iPhone cartoon

“There’s an app for it” – before you contact a doctor
ResApp – Determines the cause of a cough by listening to you cough into the phone. Has 90% accuracy in diagnosing pneumonia or asthma. (Ed. note: pediatricians have been making these diagnoses over the phone for years; plus croup of course)

Priori – Predicts bipolar episodes before they happen. It is always “on” and monitoring the speed and patterns of the patient’s speech when he/she is using the phone normally. Doctors will receive an alert based on the speech patterns when intervention is needed. In Beta testing this year.

ApneaApp – Diagnoses when the sleeping patient periodically stops breathing by bouncing inaudible sonar waves off the patient’s body back to the phone. The reflected waves are analyzed to determine if sleep apnea is occurring. It was correct in 32 out of 37 tests in a sleep lab, and is about to be tested in the home setting.

In honor of Valentine’s Day – a few random facts about sex (some from the Framingham Study)
Sexual intercourse burns only about 85-150 calories, though it can get your heart rate up there in the “aerobic” range.
Heart rate and blood pressure peak very early in the act.
Having sex is about the equivalent of walking up two flights of stairs.
Men who had intercourse twice a week had a lower risk of cardiovascular events then those who had less frequency.
Having a heart attack during sex is about a million to one risk if you are a non-smoker and non-diabetic.

HAPPY PRESIDENTS’ DAY
I probably should have written about a few Presidential medical fun facts … like Garfield’s death resulting from medical malpractice, etc. … Maybe next year.


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. 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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