August 28, 2009 – 11:35 PM
Acting on the results of a recent study which suggests that nearly 2/3 of people with gender identity disorder go undiagnosed, the American Psychiatric Association has recommended routine screening for this condition.
Gender identity disorder, or GID, is characterized by strong and persistent cross-gender identification and persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender-role of that sex. These symptoms often cause significant impairment in social functioning and lead to disastrous wardrobe, make-up and hairstyling choices in patients who do not receive proper counseling.
According to Gail Silverman, APA spokesperson and lead author of the study, "We are just now learning that millions of people suffer needlessly due to GID. When there are effective treatments available such as hormone therapy and, ultimately, anatomy-altering surgery, it's simply unconscionable that we allow so many to go undiagnosed." Dr. Silverman also cited lack of reimbursement as a major barrier to individuals with GID getting help. Currently, less than 1 in 10 insurance providers will cover gender identity services and individuals who do receive treatment - which are now believed to represent less than 30% of those affected with the disorder - can incur out-of-pocket expenses reaching tens of thousands of dollars.
The APA will recommend a list of screening questions to identify those who are at risk for GID which can be remembered using the mnemonic "TRANS." It is recommended that all patients screened at routine intervals.
- Thoughts - Have you ever thought about what it would be like to be the opposite gender?
- wRong - Have you ever felt like you were born the wrong gender?
- Anatomy - Are you distressed by your own primary and secondary sexual characteristics?
- Nervous - Does dressing as your assigned gender make you uncomfortable?
- tranS Sexual - Have you ever gone to see Rocky Horror Picture Show?
Opponents of the new guidelines argue that there is not yet enough data to properly evaluate outcomes for individuals receiving treatment. Psychiatrist Harry Seeward today was quoted as saying, "With the enormous technical obstacles we continue face in the phalloplasty procedure, our efforts must first focus on designing a better penis before we can reap the benefits of early diagnosis of GID."
August 25, 2009 – 7:19 AM
This week's Grand Rounds is hosted over at The Examining Room of Dr. Charles. Check it out.
I plan to have a new post up tonight.
August 20, 2009 – 7:03 PM
You know you reading an excellent book when something you read makes explicit a fact or observation that you didn't even realize you had. This is the case with the current book I'm reading, Michael Pollan's The Omnivore's Dilemma. In specific, at 29 years of age, I still consider myself to be relatively young. Yet, the days when one could easily obtain a mere 12 ounces of soda at one time - common when I was a child - seem to be those of a bygone era. Vending machines now sell soda only in massive 20 ounce packages. Who drinks that much soda at one time? Unfortunately the answer to that question is, more and more people do, thereby contributing to the epidemic of obesity in this country.
The reason why soda companies do this is fairly complicated, but is has to do with the ever falling price of corn. Today, coca cola (or any soda) is made mostly out water and high fructose corn syrup. Since the 1970's, our government has given subsidies to farmers to grow corn thus insentivising them to grow more and more of it. As a result, we have a massive surplus of corn and the price of corn is so low, it sells for less than it costs farmers to grow it. Recall that, after water, corn is the principle ingredient in your coke. What happens if the product you manufacture becomes cheaper to produce? You try and sell it to more and more people. But, we're not talking about cars or computers here. The market for something like soda is what economists call "inelastic." There's a limit to how much humans can drink. But, that hasn't stopped to soda companies from stretching, tugging and inflating the market to a near bursting point. "The price per ounce is as low as ever. Therefore, we're not going to sell you a mere 12 ounces of it. You're going to buy 20 ounces and you'll like it!" And, of course, consumers will buy pretty much whatever is marketed to them.
There's really no reason why anyone should ever drink more than 8-12 ounces of concentrated sugar at a time. In fact, our bodies are exquisitely adapted via the process of evolution to thrive in an environment where no such foodstuff exists. Therefore I propose that, like cigarettes, we add a surgeon general's warning to any concentrated sugar drink that is packaged in quantities greater than 12 ounces. It should read something like this: Consumption of this beverage in one sitting is likely to lead to weight gain, diabetes, loss of teeth, use of poor grammar and impregnation of your mentally challenged girlfriend with your ninth child whom you may name Cletus.
August 19, 2009 – 6:52 PM
There are few runs that are better than those you take after coming off of three days rest and which occur just after a rain in the cool August air. I did the old route I used to take back in college during the summers when I was living at home. Could not be more pleased with how nicely my body responded tonight. But, coming off of a sports medicine rotation, I find myself getting nerveous about my knees - my right knee in particular. It doesn't hurt. Does it? No, it really doesn't hurt at all...I don't think. But I'm nerveous that it might start hurting. Perhaps I'm just paranoid. Since every single patient you see in a sports medicine clinic is there because of some sort of musculo-skeletal injury, I find myself not believing that it is possible to engage in distance running without getting injured. We'll just continue to take it one run at a time.
August 18, 2009 – 9:22 PM
I've been away on vacation, so no blogging for the past few days. I've been watching True Blood and playing with my new Palm Pre. Will have regular new posts beginning tomorrow.
The only thing I didn't like about this movie is that it made me jealous of screenwriters Scott Neustadter and Michael H. Weber.