Tag Archives: Medicine

Posts that relate to medicine in some way.

Presidential Memorandum – Hospital Visitation

The White House
Office of the Press Secretary
For Immediate Release
April 15, 2010

Presidential Memorandum – Hospital Visitation

MEMORANDUM FOR THE SECRETARY OF HEALTH AND HUMAN SERVICES

SUBJECT: Respecting the Rights of Hospital Patients to Receive Visitors and to Designate Surrogate Decision Makers for Medical Emergencies

There are few moments in our lives that call for greater compassion and companionship than when a loved one is admitted to the hospital. In these hours of need and moments of pain and anxiety, all of us would hope to have a hand to hold, a shoulder on which to lean — a loved one to be there for us, as we would be there for them.

Yet every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides — whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a good friend. Members of religious orders are sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf. Also uniquely affected are gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives — unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated.

For all of these Americans, the failure to have their wishes respected concerning who may visit them or make medical decisions on their behalf has real onsequences. It means that doctors and nurses do not always have the best information about patients’ medications and medical histories and that friends and certain family members are unable to serve as intermediaries to help communicate patients’ needs. It means that a stressful and at times terrifying experience for patients is senselessly compounded by indignity and unfairness. And it means that all too often, people are made to suffer or even to pass away alone, denied the comfort of companionship in their final moments while a loved one is left worrying and pacing down the hall.

Many States have taken steps to try to put an end to these problems. North Carolina recently amended its Patients’ Bill of Rights to give each patient “the right to designate visitors who shall receive the same visitation privileges as the patient’s immediate family members, regardless of whether the visitors are legally related to the patient” — a right that applies in every hospital in the State. Delaware, Nebraska, and Minnesota have adopted similar laws.

My Administration can expand on these important steps to ensure that patients can receive compassionate care and equal treatment during their hospital stays. By this memorandum, I request that you take the following steps:

1. Initiate appropriate rulemaking, pursuant to your authority under 42 U.S.C. 1395x and other relevant provisions of law, to ensure that hospitals that participate in Medicare or Medicaid respect the rights of patients to designate visitors. It should be made clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy. You should also provide that participating hospitals may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. The rulemaking should take into account the need for hospitals to restrict visitation in medically appropriate circumstances as well as the clinical decisions that medical professionals make about a patient’s care or treatment.

2. Ensure that all hospitals participating in Medicare or Medicaid are in full compliance with regulations, codified at 42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee that all patients’ advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients’ representatives otherwise have the right to make informed decisions regarding patients’ care. Additionally, I request that you issue new guidelines, pursuant to your authority under 42 U.S.C. 1395cc and other relevant provisions of law, and provide technical assistance on how hospitals participating in Medicare or Medicaid can best comply with the regulations and take any additional appropriate measures to fully enforce the regulations.

3. Provide additional recommendations to me, within 180 days of the date of this memorandum, on actions the Department of Health and Human Services can take to address hospital visitation, medical decisionmaking, or other health care issues that affect LGBT patients and their families.

This memorandum is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

You are hereby authorized and directed to publish this memorandum in the Federal Register.

BARACK OBAMA

Update: ACP being called on their lies

This is a follow-up to my 4/6/10 post Fraudulent Representation of Medical Opinion by Fundie Quacks as reported by the Gay & Lesbian Medical Association:

“On April 12, Dr. Gary Remafedi, MD, MPH, a University of Minnesota researcher, wrote a letter to the American College of Pediatricians holding them accountable for misusing his research. The American College of Pediatricians (ACP) – not to be confused with the 60,000 member American Academy of Pediatrics (AAP) – has distributed over 10,000 letters to school superintendents containing factually inaccurate information about sexual orientation and gender identity and promoting unsupported and potentially dangerous “reparative therapies” for LGBT students. The ACP is a small advocacy group masquerading as a legitimate medical organization. Founders of the ACP left the AAP after the organization adopted policy rejecting the use of ‘reparative therapy.’

“Last week, the AAP sent letters to state chapter leaders warning them about the letters and the activities of the ACP. This week, AAP state chapters will be distributing letters to state education officials, advising education officials that the ACP’s campaign, “does not acknowledge the scientific evidence regarding sexual identity, sexual health, sexual orientation, or effective health education.” The letter also directs education officials to a report, Just the Facts About Sexual Orientation and Youth: A Primer for Principals, Educators, and School Personnel, a resource developed by the AAP in collaboration with the American Psychological Association (APA) and other prominent national professional associations. The AAP urges education officials to reference this document in communications to school superintendents and other educators in their states.”

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Fraudulent Representation of Medical Opinion by Fundie Quacks

Tom Benton, MD and his flock of other quacks (American College of Pediatricians) have stooped to a new low in their attempt to confuse the public regarding LGBT youth: they recently mailed their innocuously appearing yet truly virulent “Facts About Youth” to school superintendents across the country under the guise of medical expertise. Contrary to the cohesive opinion of numerous reputable medical and mental health organizations Dr Benton peddles the snake oil ideas that same-sex sexual attraction is learned, pathological and treatable.

This counterfeit group of fringe fanatics should not be confused with the renown American Academy of Pediatricians which in fact completely disagrees with the assertions, misrepresentations and frank lies being perpetuated by Dr Benton et al:

An estimated 2 to 5 percent of adolescents are homosexual, the same percentage as among adults. Scientists generally agree that several factors converge to form a person’s sexual orientation. But there is increasing evidence that human beings may be genetically predisposed toward heterosexuality or homosexuality. These tendencies may even be established prior to birth, just as gender, hair color and complexion are all preprogrammed. Contrary to what some believe, we do not choose to be straight or gay. Come adolescence, a person is innately drawn toward one sex or the other.” – American Academy of Pediatricians

For further reading about Dr Benton’s sleazy organization and its assertions I highly recommend the excellent 4/5/2010 Box Turtle Bulletin post by Timothy Kincaid: “Bogus ‘American College of Pediatricians’ distributes deliberately fraudulent anti-gay propaganda to schools.

CNN anchor Kyra Phillips is another perpetrator of misinformation. Under the guise of “balanced” reporting, Kyra recently interviewed Richard Cohen (right), an unlicensed “ex-gay therapist”, in her segment “Homosexuality -is it a problem in need of a cure?” As evident in the photo, one of the ways Cohen “cures” is by encouraging men to hold each other in semblance of father and child and thus address the supposed childhood trauma sustained from being raised by an emotionally-distant father. First asserted by Irving Bieber, MD in the 1960s as the cause of homosexuality, this hypothesis has long since been debunked but remains central dogma of the anti-gay fringe.

Quacks like Benton and Cohen will always exist but the pseudoscience they espouse should be recognized for what it is: snake oil “evidence” that only appear on the surface to support their baseless beliefs. They do not represent the other side of the coin nor the counterweight to a mass in balance. They are in fact nothing more than angry flies buzzing around a mountain of scientific evidence they would rather ignore.

The nation’s leading professional medical, health, and mental health organizations do not support efforts to change young people’s sexual orientation through therapy and have raised serious concerns about the potential harm from such efforts.” American Psychological Association

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Say NO to infant male circumcision!

Newborn male circumcision is the most common surgical procedure performed in the U.S. Many people believe that there are tangible health benefits to male circumcision but, the truth is no medical society in the world recommends it. In fact, the American Medical Association calls the surgery “non-therapeutic.” What’s worse, over 100 babies die as a result of complications from circumcision in the U.S. each year.

The Centers for Disease Control (CDC) is developing public health recommendations for the U.S. on male circumcision – ignoring the serious risks such as hemorrhage, infection, surgical mishap, and death – in favor of highly debatable and inconclusive research.

The CDC is the foremost expert on public health in our country and, as such, has a responsibility to share the truth about circumcision.

I just took action, signing a petition to the CDC, demanding the organization release a truthful statement on the harms and risks of circumcision.

If you believe as I do, that we should protect newborn babies from harmful and unnecessary surgery, then say NO to infant male circumcision!

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Walk on heels, run on toes

Multiple times in the past I have attempted to pick up running only to have to abandon it a few months later. I enjoy the sense of freedom it offers and the simplicity of the exercise but why does it have to hurt so much? Shin splits, knee pain, hip pain, wondering how this high-impact activity is going to affect me down the road… I guess my body just isn’t cut out for running… or so I thought.

Humans evolved to walk on our heels (unlike most other mammals) to save energy and thus be able to cover vast distances. However running on our heels is high impact and damaging. New research coming out of places like Harvard suggest that we should run on our toes. Of course they are quick to add the disclaimer that more research is needed and that they are not advocating that the traditional way of running should be discontinued, but I find the concept fascinating. By running on our toes we make use of our massive Achilles tendons and calf muscles to absorb shock instead of our bones and joints. Could it be that after all these years of failed attempts at running the problem was simply relying on artificial cushioning from modern running shoes to protect my joints instead of my own shock absorbers? I don’t know but I’m going to do some experimenting of my own and find out!

Cool new “barefoot” products are starting to be marketed for people like me who want to be able to re-experience the joy of going barefoot while protecting our skin from abrasions and germs. FiveFinger shoes by Vibram (pronounced VEE-bram) are one such product that looks promising. I’m going to buy myself a pair and see if my body was meant to run after all!

DSM-5 pathologizes gender variance

The much anticipated 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the renown American Psychiatric Association (APA) continues its misguided tradition of pathologizing gender variance. And they have newly expanded the patient base by including intersex individuals who reject their sex of rearing. Mounting evidence continues to demonstrate that gender is hardwired into our brains at a very early age. Indeed most children know their gender identity by age three and adamantly attest to it; no amount of social pressure, environmental factors or psychiatric persuasion can alter this. For individuals whose bodies do not match their gender identities, the only “cure” (normal variation is not disordered and thus does not necessitate cure) is gender reassignment either by physical presentation alone or aided by hormones and/or surgical modification.

According to the APA, “For a mental or psychiatric condition to be considered a psychiatric disorder, it must either regularly cause subjective distress, or regularly be associated with some generalized impairment in social effectiveness or functioning.” Thus in 1973 the APA concluded that “Clearly homosexuality, per se, does not meet the requirements for a psychiatric disorder since, as noted above, many homosexuals are quite satisfied with their sexual orientation and demonstrate no generalized impairment in social effectiveness or functioning.” It is baffling to me how these same conclusions do not apply to gender variance. Both the homosexual and the gender variant are capable of living full rich lives; only they who deny their inner truth and they who are socially tormented for revealing it are so impaired.

And why include the intersexed? After being surgically modified as infants and subsequently forced into living within the socially imposed system of binary gender roles these individuals are somehow disordered for rejecting this suppression? Apparently the medical community who altered them and inaccurately chose their sex of rearing cannot be at fault. What a travesty it is that the medical community continues to rubber stamp society’s aversion to gender minorities by pronouncing them disordered and thus justifying their mistreatment.

Another pregnant man steps forward

Scott Moore and his husband, Thomas, have decided to follow in the footsteps of Thomas Beatie and Ruben Coronado by going public about Scott’s very much wanted pregnancy and impending delivery in order to raise awareness.

While pregnancy among trans men actually occurs with some frequency it has only recently been brought to public attention. And unfortunately the medical community is often just as startled, befuddled and prejudiced as everyone else.

In the article linked above Scott speaks to the difficulty he had obtaining appropriate prenatal care: “We didn’t want everyone to be shocked when a man turns up to give birth. We found it very difficult to get a doctor and midwife at first. It was hard when people didn’t want to treat me… No pregnant person should be denied healthcare just because they are a man.”

Now granted, a portion of the hesitation Scott encountered in finding a provider was likely related to the lack of established treatment guidelines for pregnant trans men, the inherently increased risks to both father and fetus and the medical-legal liability to be assumed by the would-be provider. Even the standards of care published by the renown World Professional Association for Transgender Health (WPATH) are silent on this issue. But the fact remains that few providers make the effort to educate themselves regarding the medical needs of individuals with atypical gender experience and there has yet to be published even one case report in the Medline (Ovid) primary literature database regarding trans men and pregnancy. Clearly medical providers have a long way to go in meeting the needs of this neglected population.

So what should a trans man considering pregnancy do? First of all, do your research early on and find a provider before you get pregnant. Second, testosterone should be discontinued at least 6 weeks prior to pregnancy in order to prevent its deleterious effects on a potentially female fetus. Elevated levels of androgens like testosterone can masculinize external female genitalia as well as brains with potential social, sexual and gender identity consequences. In the event that an inadvertent pregnancy occurs, testosterone should be discontinued immediately if termination is not desired.