April 27, 2010 – 10:22 PM
I'm so disappointed in Frontline. I think this episode represents a deviation from their usually excellent reporting. The episode is entitled The Vaccine War. While they do come out on the side of vaccines being safe, it irritates me that they present the issue as if there are 2 sides to it. This is the the danger of reporting on issues where nut jobs like Jenny McCarthy have a substantial voice. Just because a particular group speaks loudly about an issue doesn't mean that their position has any merit. I think Frontline would've done better to have left this one alone.
For christ's sake, people, just vaccinate your kids. There are way more important things to burn calories worrying about than the theoretical risks of vaccines. On the flip side, these parents do have a point. We haven't seen a new case of polio in this country since the 1970's. So, chill out, medical profession. If some parents don't want to vaccinate their kids, we have more important things to worry about as well.
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 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.
After coming a remarkable third place in this year's Tour de France, Lance Armstrong was gracious enough to answer some questions from Dr. Sanjay Gupta - medical correspondent for CNN. Wait a second, doesn't Lance Armstrong's cycling comeback and amazing result at the Tour de France fall into the category of sports? Why is being interviewed by CNN's medical correspondent? Well, Dr. Gupta may be an excellent neurosurgeon but it he was worth his salt as a reporter, perhaps he might have leveraged some his medical expertise in order to shed some light on the doping allegations that have plagued the all star cyclist. Here is the relevant excerpt from the interview:
GUPTA: One of the things you mention -- you talked a lot about during the whole tour was surprise test for doping. They just come and surprise you.
ARMSTRONG: They're not surprises any more.
GUPTA: Not surprising -- 40, I think over 40 tests.
ARMSTRONG: They're 50 -- they're 50 now.
GUPTA: What do you say to the critics? What do you say to the skeptics now at the end of the tour?
ARMSTRONG: Look, I've done this a long time. And I've been at the highest level now since 1992 until 2009. I've been tested more than anybody else. If I can take four years off and come back at the age of 38 with more controls than anybody else on planet Earth and get third in the hardest sporting event in the world, I think we've answered the questions.
Bravo. That's hard hitting stuff, Dr. Gupta. Why does everyone continue to dance around the core issue, namely, the man takes testosterone? He had testicular cancer. He had his testes removed. He has the unique privilege of being allowed to take testosterone. Dr. Gupta doesn't consider that maybe the general public might be interested in what Lance Armstrong's testosterone level is? What if it turns out to be much higher than average but still within the "normal" range? Should other athletes be allowed to supplement in order to bring their testosterone level up to that of Lance Armstrong's? To be honest, I don't even know if these anti-doping labs even test levels, or if they just test urine for banned substances. Maybe if CNN had sent an actual reporter, he or she may have reported on these things.
Anyway, I think this is just one further example that serves to highlight how futile, Draconian and ultimately ridiculous our policies are with regard to doping in competitive sports. As I've said many times before, decisions regarding taking hormones or any other drug are medical decisions and should be kept between an athlete and his or her doctor. Doping is only considered "cheating" because it is against the rules. Change the rules and it won't be cheating anymore.
Much has been made of the fact that technology now makes it extremely easy for teenagers to send pictures of their genitalia to one another. I, for one, think this is fantastic. Sending fully or partially nude pictures to your boyfriend or girlfriend, or "sexting," represents the ultimate in safe sex. There is virtually no other sexual activity that incurs a literally 0% risk of pregnancy or transmitting sexually transmitted diseases.
Unfortunately, our current laws have not yet caught up with the technology and teenagers around the country are being hit with child pornography charges. This makes no sense whatsoever. The point of child pornography laws is to prevent children from sexual abuse and exploitation. Clearly, there need to be laws protect children from being used in child pornography. But, let's think clearly about this. The bad thing that we are preventing is not the production of any image containing the nude bodies of teenagers. What we are preventing is child abuse. By prosecuting teenagers who send each other naked photos, we are criminalizing normal sexual behavior.
Adolescents are quite skilled at getting themselves into all kinds of trouble and need our help in so many ways. We don't need to further mess up their lives by punishing them for what is normal, healthy activity.
So that I can satisfy my technology fetish without having to support Apple, I am hotly anticipating the release of the palm pre. Just wanted to mention it in case any devoted readers need gift ideas :)
February 26, 2009 – 7:10 PM
I've written more than once about my belief in not creating more problems for than they have already. To that end, one of the easiest way to avoid labeling patients with additional problems is to refrain from screening them for things that they don't need to be screened for. To review some basic principles, we screen patients for conditions that are:
a) asymptomatic
AND
b) conditions for which intervention at an earlier stage of the disease improves morbidity and/or mortality
Therefore, we should not be in the habit of screening for things like drug abuse because drug abuse is a condition that fails to meet our first criterion. Drug abuse is not asymptomatic. Calling up your dealer, paying him for drugs and then using those drugs to get high are all symptoms of drug abuse.
Even though to the common wisdom is that we should screen, in practice I don't think anyone really does. We may ask more in depth questions regarding drug and alcohol use of patients whom we have a reason to suspect of having a drug/alcohol problem or in patients who come in with a different problem which we suspect might be caused or exaccerbated by drug or alcohol use. And this is perfectly appropriate. But, sweet lord, there is no need to screen every patient.
On an unrelated note, I'm reading Watchmen in anticipation of the movie. This is my first graphic novel experience and so far Watchmen has not disappointed. I'll give a final review when I'm done.
