HUB's LIST of medical fun facts

“Science is always discovering odd scraps of magical wisdom
and making a tremendous fuss about its cleverness.”
– Aleister Crowley

. . . Transgender treatment
The anguished cries about a “transgender epidemic” that’s “mutilating our children” and “corrupting our women sports” has been so loud and so persistent that the issues have reached the U.S. Supreme Court. Twenty six states have passed laws banning or severely restricting transgender medical care (aka “gender-affirming care”).  The Supreme Court began hearing oral arguments on Tennessee’s banning of humoral and other non-surgical treatment last month. How big a problem is this?   

A Harvard study of 5 million U.S. patients aged 8 to 17 years of age showed that only 926 adolescents with a gender-related diagnosis received puberty blockers (which buys time to evaluate the patient’s request for gender change) from 2018 through 2022.. Only 1,927 trans patients had received hormones. That is fewer than 0.1% of all 5 million youths in the insurance claim databases. The study did NOT look at surgery among transgender adolescents since it is so extremely rare among them.

Many studies of gender-affirming medical care have shown that it has significant mental health benefits for trans dysphoric patients, including reducing depression and marked reduction in suicide rates. So what is the fuss all about? Politics? Fear of disrupting established norms? Imagined threats? For a well-balanced essay on the personal dilemmas of this fuss about gender-affirming care check out the Boston Globe op-ed by Ethan Lieb, professor at Fordham Law School, December 22, 2024, “The Political Is Personal”.

. . . New Jersey drones
… which then spread all up and down the East coast. Aliens? Spy crafts? Amazon and Fed Ex deliveries? Hysteria? Scientific American has posed one answer, “cosmic pareidolla”. Translated into regular English: “the human brain loves to see patterns that aren’t there”. Using examples of Linus seeing things in the clouds, believers of the man in the moon, the 2 dots and a curve that we all recognize as a smiley face, and the face of Vladimir Putin he once saw in his shower curtain, the author makes the point that “our brain is wired to see faces”. He loses me when this astronomer author moves on to many stellar examples of seeing other kinds of patterns that are not there. He concludes, “Our brain is extraordinarily good at seeing patterns. . . and our imagination allows us to make the leap of connecting many of these findings into the rules and laws of reality as we know it”. (Plait, SciAm Oct. 2024)  By the way, what ever happened to those drones? Did they disappear from earth or just from the front page and TV?

. . . Houses for the homeless
In Boston 25% of homeless adults went to an ER with a drug-related problem in 2022. The average cost of a hospital stay in Massachusetts in 2022 was $3,500 a day. Could a health insurer ever be persuaded that covering the cost of housing a homeless addict was in its interest?

A two year pilot project with Boston Medical Center and WellSense Health Insurance (Boston Globe Jan. 13, 2024) showed that covering the cost of short term housing for addicts in sober homes reduced emergency room visits by 54% and inpatient hospitalizations by 60%. The estimated cost to WellSense was expected to be about $5,200 per person for 6 months of sober housing. More than half of the addicts left the program sober before 6 months, so the cost of the housing to the insurance company was actually less than estimated. Seventy five per cent (3/4) of the participants were able to stay sober while in the homes which far exceeded the sober rate in traditional addiction recovery programs.  A Blue Cross 2020 study showed that housed adults had significantly lower total health care costs per person than the unhoused persons.    

But Housing First programs are being criticized and threatened in many parts of the nation. Perhaps because many do not require sobriety as a housing requirement. They are focussed on “harm reduction” ( less drug related anti-social behavior) rather than addiction recovery. Housing First programs house homeless adults to help them vie for and keep jobs, receive social and mental health services, and develop more stable independence. So what is the fuss all about? Politics? Money? Corporate stakeholders stance?

. . . Vitamin D supplements
After years of considering that almost everyone above the Mason-Dixon line on the East coast was vitamin D deficient, of instructing pediatricians to draw vitamin D levels on their healthy patients, and of touting the vitamin as a reducer of cardiac risks or even of ameliorating inflammation, of course, the scientific tune has changed dramatically. The Endocrine Society this year proclaimed new guidelines for Vitamin D which deleted the concepts of “sufficiency” and “deficiency”, disowned “normal” blood levels of vitamin D, stated that supplemental vitamin D has no benefit in normal people, even with “low levels”, and recommended against routine testing of its level. Supplemental vitamins D (more than dietary D) is recommended only for pregnant women, people with “high-risk pre-diabetes”, and healthy adults over 75 years of age for its unproven but potential benefits. That is a 1000 IU tablet a day for us elders, sorry, older persons. In any case, “clinicians should stop checking and following vitamin D levels in healthy patients”. That’s that end of that fuss. (NEJM Journal Watch Sept. 1, 2024)

. . . ZOOM learning
Zooming was essential during the pandemic, but as we returned to talking face-to-face at meetings or in the classrooms we realized that something had been missing. Multiple studies have shown that non-verbal cues are essential for effective communication; 7 percent of meaning is communicated through spoken word, 38 percent through tone of voice, and 55 percent through body language signals of facial expressions, gestures, eye contact, tone of voice, and posture.  Teachers’ direct experiences with learning through face-to-face social interaction has fed the fuss about the deficiencies in classroom learning in ZOOM school.

A neurologist from Columbia University in a recent essay opines that medical students and trainees do not learn as well using a virtual medium because very helpful visible cues to learning are lost in teleeducation. “As any resident can attest, there is no more powerful didactic force than an attending’s piercing gaze”. The missing physical cues are particularly helpful in group discussions like clinical conferences where complex decision-making is the content rather than discrete and testable facts. As a neurologist, he  pins this key link between social interaction and enhanced learning on the medial prefrontal cortex, another affirmation of the teachers’ recognition of the social interaction deficiency of ZOOM learning. “As a species with a brain that is adapted to face-to-face interactions [see “New Jersey drones” above], humans ultimately need face-to-face pedagogy”. (NEJM Dec. 19/26, 2024, p.2286)