When Did Medicine Become a Battleground for Everything?

Tara Haelle

Medscape.com

Originally posted 18 July 23

Like hundreds of other medical experts, Leana Wen, MD, an emergency physician and former Baltimore health commissioner, was an early and avid supporter of COVID vaccines and their ability to prevent severe disease, hospitalization, and death from SARS-CoV-2 infections.

When 51-year-old Scott Eli Harris, of Aubrey, Texas, heard of Wen's stance in July 2021, the self-described "5th generation US Army veteran and a sniper" sent Wen an electronic invective laden with racist language and very specific threats to shoot her.

Harris pled guilty to transmitting threats via interstate commerce last February and began serving 6 months in federal prison last fall, but his threats wouldn't be the last for Wen. Just 2 days after Harris was sentenced, charges were unsealed against another man in Massachusetts, who threatened that Wen would "end up in pieces" if she continued "pushing" her thoughts publicly.'

Wen has plenty of company. In an August 2022 survey of emergency doctors conducted by the American College of Emergency Physicians, 85% of respondents said violence against them is increasing. One in four doctors said they're being assaulted by patients and their family and friends multiple times a week, compared to just 8% of doctors who said as much in 2018. Sixty-four percent of emergency physicians reported receiving verbal assaults and threats of violence; 40% reported being hit or slapped, and 26% were kicked.

This uptick of violence and threats against physicians didn't come out of nowhere; violence against healthcare workers has been gradually increasing over the past decade. Healthcare providers can attest to the hostility that particular topics have sparked for years: vaccines in pediatrics, abortion in ob-gyn, and gender-affirming care in endocrinology.

But the pandemic fueled the fire. While there have always been hot-button issues in medicine, the ire they arouse today is more intense than ever before. The proliferation of misinformation (often via social media) and the politicization of public health and medicine are at the center of the problem.

"The People Attacking Are Themselves Victims'

The misinformation problem first came to a head in one area of public health: vaccines. The pandemic accelerated antagonism in medicine ― thanks, in part, to decades of anti- antivaccine activism.

The anti-vaccine movement, which has ebbed and flowed in the US and across the globe since the first vaccine, experienced a new wave in the early 2000s with the combination of concerns about thimerosal in vaccines and a now disproven link between autism and the MMR vaccine. But that movement grew. It picked up steam when activists gained political clout after a 2014 measles outbreak at Disneyland led California schools to tighten up policies regarding vaccinations for kids who enrolled. These stronger public school vaccination laws ran up against religious freedom arguments from anti-vaccine advocates.

The info is here.

Gender-Affirming Care for Cisgender People

Theodore E. Schall and Jacob D. Moses

Hastings Center Report 53, no. 3 (2023): 15-24.

DOI: 10.1002/hast.1486 

Abstract

Gender-affirming care is almost exclusively discussed in connection with transgender medicine. However, this article argues that such care predominates among cisgender patients, people whose gender identity matches their sex assigned at birth. To advance this argument, we trace historical shifts in transgender medicine since the 1950s to identify central components of "gender-affirming care" that distinguish it from previous therapeutic models, such as "sex reassignment." Next, we sketch two historical cases-reconstructive mammoplasty and testicular implants-to show how cisgender patients offered justifications grounded in authenticity and gender affirmation that closely mirror rationales supporting gender-affirming care for transgender people. The comparison exposes significant disparities in contemporary health policy regarding care for cis and trans patients. We consider two possible objections to the analogy we draw, but ultimately argue that these disparities are rooted in "trans exceptionalism" that produces demonstrable harm.

The info is paywalled here.

Here is my summary:

The authors cite several examples of gender-affirming care for cisgender people, such as breast reconstruction following mastectomy, penile implants following testicular cancer, hormone replacement therapy, and hair removal. They argue that these interventions can be just as important for cisgender people's mental and physical health as they are for transgender people.

The authors also note that gender-affirming care for cisgender people is often less scrutinized and less stigmatized than such care for transgender people. Cisgender people do not need special letters of permission from mental health providers to access care whose primary purpose is to affirm their gender identity. And insurance companies are less likely to exclude gender-affirming care for cisgender people from their coverage.

The authors argue that the differences in the conceptualization and treatment of gender-affirming care for cisgender and transgender people reflect broad anti-trans bias in society and health care. They call for a more inclusive view of gender-affirming care that recognizes the needs of all people, regardless of their gender identity.

Final thoughts:

1. Gender-affirming care can be lifesaving. It can help reduce anxiety, depression, and suicidal thoughts.  Gender-affirming care can be framed as suicide prevention.
2. Gender-affirming care is not experimental. It has been studied extensively and is safe and effective. See other posts on this site for more comprehensive examples.
3. All people deserve access to gender-affirming care, regardless of their gender identity. This is basic equality and fairness in terms of access to medical care.

Gender-Affirming Care for Trans Youth Is Neither New nor Experimental: A Timeline and Compilation of Studies

Julia Serano

Medium.com

Originally posted 16 May 23

Trans and gender-diverse people are a pancultural and transhistorical phenomenon. It is widely understood that we, like LGBTQ+ people more generally, arise due to natural variation rather than the result of pathology, modernity, or the latest conspiracy theory.

Gender-affirming healthcare has a long history. The first trans-related surgeries were carried out in the 1910s–1930s (Meyerowitz, 2002, pp. 16–21). While some doctors were supportive early on, most were wary. Throughout the mid-twentieth century, these skeptical doctors subjected trans people to all sorts of alternate treatments — from perpetual psychoanalysis, to aversion and electroshock therapies, to administering assigned-sex-consistent hormones (e.g., testosterone for trans female/feminine people), and so on — but none of them worked. The only treatment that reliably allowed trans people to live happy and healthy lives was allowing them to transition. While doctors were initially worried that many would eventually come to regret that decision, study after study has shown that gender-affirming care has a far lower regret rate (typically around 1 or 2 percent) than virtually any other medical procedure. Given all this, plus the fact that there is no test for being trans (medical, psychological, or otherwise), around the turn of the century, doctors began moving away from strict gatekeeping and toward an informed consent model for trans adults to attain gender-affirming care.

Trans children have always existed — indeed most trans adults can tell you about their trans childhoods. During the twentieth century, while some trans kids did socially transition (Gill-Peterson, 2018), most had their gender identities disaffirmed, either by parents who disbelieved them or by doctors who subjected them to “gender reparative” or “conversion” therapies. The rationale behind the latter was a belief at that time that gender identity was flexible and subject to change during early childhood, but we now know that this is not true (see e.g., Diamond & Sigmundson, 1997; Reiner & Gearhart, 2004). Over the years, it became clear that these conversion efforts were not only ineffective, but they caused real harm — this is why most health professional organizations oppose them today.

Given the harm caused by gender-disaffirming approaches, around the turn of the century, doctors and gender clinics began moving toward what has come to be known as the gender affirmative model — here’s how I briefly described this approach in my 2016 essay Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates:

Rather than being shamed by their families and coerced into gender conformity, these children are given the space to explore their genders. If they consistently, persistently, and insistently identify as a gender other than the one they were assigned at birth, then their identity is respected, and they are given the opportunity to live as a member of that gender. If they remain happy in their identified gender, then they may later be placed on puberty blockers to stave off unwanted bodily changes until they are old enough (often at age sixteen) to make an informed decision about whether or not to hormonally transition. If they change their minds at any point along the way, then they are free to make the appropriate life changes and/or seek out other identities.

The info is here.

Telehealth Providers Prepare for the Future

Phoebe Kolbert & Charlotte Engrav

msmagazine.com

Originally posted 9 FEB 23

Here is an excerpt:

Telehealth Abortion Care

The Guttmacher Institute reports that, in 2017, medication abortions accounted for 39 percent of all abortions performed. By 2020, medication abortion usage accounted for 53 percent.

Coplon attributes the rise in telehealth medication abortions to COVID, but the continued use of it, she says, “is due to people’s understanding and acceptance, and also providers being more comfortable with providing pills without having the testing that we prior thought we needed.” 

She would know. Since 2016, Coplon has been part of a coalition of researchers, lawyers and other clinicians looking at telehealth medication abortion and ways to increase access to telehealth services. She now serves as the director of clinical operations at Abortion on Demand. 

In 2018, state policies enacted to support reproductive health were almost triple the number restricting reproductive healthcare. It was the first year in at least two decades where protections outpaced restrictions. 

Restrictions were eased even more when the COVID-19 pandemic made social distancing necessary, and lawmakers loosened restrictions, allowing more healthcare to be practiced online via telehealth. However, the landscape completely changed again in June of this year when the Supreme Court overturned the longstanding precedent of Roe in their Dobbs decision. Now, 18 states have abortion bans, 14 of which are total or near total. Eight other states have abortion bans on the books that are currently blocked, and there has been a push from anti-abortion groups to rescind access to telehealth medication abortions altogether. 

Telemedicine abortion has many benefits beyond preventing the spread of COVID-19—which may be why anti-abortion groups have been so quick to target it. Telehealth can make abortions more accessible for those who want and need them, and they tend to be cheaper and easier to schedule quickly. Even before Roe’s fall, patients would sometimes have to travel out of state or drive hours to the only abortion clinic in their state. Now, people living in states with bans must travel an average of 276 miles each way. States without bans have seen a swell of out-of-state patients seeking legal abortions. Bloomberg News estimated Illinois could face an 8,000 percent increase in abortion seekers. Planned Parenthood of Illinois estimated an increase of 20,000-30,000 out-of-state patients. Some clinics are struggling to keep up. For these clinics and patients, Coplon notes, telehealth can make a huge difference in the post-Roe era.

Not only can telehealth provide appointments within just a day or two of scheduling, as opposed to the potentially weeks-long waits at clinics in some overburdened states, it can also help reduce the overall burden on those in-person clinics—freeing up space for their own clients. 

The info is here.