Tag Archives: Politics & society

Political and social events in the news that involve LGBTQI and/or women’s issues.

A Public Apology to My Circumcised Son

A Public Apology to My Circumcised Son is another post I came across while catching up on my break. It was posted 11/21/10 on Peachy Keen Birth Services.

“My Little Buster,” the distraught mother writes, “I’m so sorry. How else do I begin this?… As a parent, there will be a million things you will look back on and think ‘Gee… I wish I would have done that differently…’… But how in the hell do I apologize for having part of your genitals amputated for NO MEDICAL REASON? When you were less than 24 hours old!… So for all of the parenting moments I look back upon, wishing I could re-do, having you circumcised is the only one I have utter remorse for. With much, much love, Your Mommy.”

The post struck a cord in me because I too carry this burden, and I echo the sentiments of this mother.

When my son was born in 1998 — in my former life as a closeted, gay, married, mechanical engineer — my ex-wife and I had little discussion on the matter. I am circumcised, my father is circumcised and her father and brother are circumcised. Why wouldn’t we do to our son what was a norm for our family? We didn’t understand the risks. We didn’t understand the permanent damage that we were condoning. We did not understand the history of circumcision in the U.S. nor its root in puritanical aims to deter masturbation. We were simply uninformed and did not understand the gravity of our decision to circumcise our son.

Now it is too late. We stole that choice from him and his body is permanently altered. I have apologized to him. The tears ran down my cheeks. He has forgiven me but at his young age he cannot comprehend the consequences of that decision. Do not repeat our mistakes. Leave your sons whole as nature/god intended them to be. Allow them the autonomy over their bodies that is rightfully theirs alone. Let’s end this barbaric custom of infant genital mutilation!

– James Pate, MD

The Genocide of Intersex People

 

American Grotesque posted The Genocide of Intersex People on 11/28/11. I recently came across it while catching up on twitter and facebook during my holiday break (a true luxury for a resident!). In this post the author discusses the damage perpetuated by the myth of binary gender, its social construction and legal ramification. The author places hir-self in the place of “patients” whose bodies defy the myth and without consent are reconstructed to appear to confirm it. Yet in spite of appearances they remain outside of the binary and their shame and scars and are shrouded in secrecy and silence. Is this moral? Is this fair? Is this just?

“Our lives begin to end the day we become silent about things that matter. [And] In the end, we will remember not the words of our enemies, but the silence of our friends.” ―Martin Luther King Jr

Am I intersexed?

Dear Dr Pate,

I was born with a DSD. Is penoscrotal hypospadias with severe chordee an intersex condition? Am I intersexed?


Dear J,

Your questions are more difficult to answer than one would think. The term “intersex” has changed in meaning over time, more so among doctors than perhaps many who consider themselves to be intersex. From a medical point of view, your condition would not necessarily have been considered an intersex disorder in the past. However, an international consensus reclassified disorders with either abnormal sex chromosomes (ie XO, XXY) or atypical genitalia under the umbrella term “disorders of sex development” (DSD) in 2006. Given that hypospadias is a condition where development of male external genitalia is halted prematurely, this is indeed a DSD. The term “intersex” however is no longer considered to be a contemporary medical word and has been replaced by DSD.

Adults who consider themselves to be intersex generally have a history of ambiguous genitalia, may or may not have been subjected to “normalizing” genital surgeries in infancy and/or childhood, but do not feel that they fit neatly into the binary boxes of male or female. They usually feel that if surgery occurred that it was undesired and destructive. Their gender identity may be the same as their sex of rearing, opposite, a combination, or something else. Adults who identify as intersex are generally offended by the new medical nomenclature “DSD”; they do not feel that their sex is disordered but rather a natural occurrence within the human spectrum. They are also quick to point out that they are not transgender or transsexual and do not feel that they are a part of those communities. Unlike the trans communities, they feel that their gender identities match(ed) their bodies, though they may not match their surgically altered bodies nor the sex of rearing that was chosen for them. The intersex community is still rather small given the shame, embarrassment and mistreatment individuals were subjected to while growing up as well as the continued ignorance of society regarding their existence.

People that continue to be born with chromosome abnormalities and/or varying degrees of genital ambiguity may feel that they are either truly male or truly female with a DSD medical condition, not intersexed. On the other hand, if their gender identity is the opposite of their sex of rearing then they may consider themselves to be trans. Others feel more comfortable with an intersex identity. Thus the matter of what is considered an intersex condition and who considers themselves to be intersex remains quite murky.

There are intersex groups that exist online and occasionally meet in person. If you are interested in chatting with others like you I would recommend checking out Organisation Intersex International (OII). They are “devoted to systemic change to end the fear, shame, secrecy and stigma experienced by children and adults through the practice of non-consensual normalisation treatments for people born with atypical anatomy, and the arbitrary assignment of a particular gender without an informed consultation with the individual concerned.”

Hope this helps and good luck to you. Happy holidays!

Sincerely,

James Pate, MD
https://jamespatemd.com/

Rio Political Declaration on Social Determinants of Health

“Invited by the World Health Organization, we, Heads of Government, Ministers and government representatives came together on the 21st day of October 2011 in Rio de Janeiro to express our determination to achieve social and health equity through action on social determinants of health and well-being by a comprehensive intersectoral approach.”

The Rio Political Declaration on Social Determinants of Health was subsequently adopted with “five key action areas critical to addressing health inequities:

  1. To adopt better governance for health and development
  2. To promote participation in policy-making and implementation
  3. To further reorient the health sector towards reducing health inequities
  4. To strengthen global governance and collaboration
  5. To monitor progress and increase accountability

“We, Heads of Government, Ministers and government representatives, solemnly reaffirm our resolve to take action on social determinants of health to create vibrant, inclusive, equitable, economically productive and healthy societies, and to overcome national, regional and global challenges to sustainable development. We offer our solid support for these common objectives and our determination to achieve them.”

Who’s your “doctor”?

“When I see a bird that walks like a duck and swims like a duck and quacks like a duck, I call that bird a duck.”
James Whitcomb Riley (1849–1916)

As healthcare continues to evolve in the U.S., more and more “midlevel practitioners” are taking on roles formerly provided by physicians. Examples of midlevel practitioners include the physician assistant (PA), doctor of pharmacy (PharmD) and advanced practice registered nurses (APRN) such as the certified nurse midwife (CNM), nurse practitioner (NP), certified nurse anesthetist (CNRA) and doctor of nursing (RN, PhD). Some of these providers may be unintentionally called “doctor” or request that their patients refer to them as such, however it is very important to recognize that they are NOT equivalent to — or substitutes for — the traditional physicians of Western medicine.

What is a doctor?

According to Merriam-Webster, the word “doctor” literally means “teacher”. Given that around 700 years have past since its first use in the 14th century, its modern meaning includes both the academic doctor of philosophy (PhD) as well as the healing art doctors of medicine (MD), osteopathy (DO), podiatric medicine (DPM), dental surgery (DDS), chiropractic medicine (DC), naturopathic medicine (ND) and veterinary medicine (DVM).

What does it take to be a physician?

As delineated above, there are many paths to gaining the title but the training involved and the credentials earned are not equivalent. In Western Medicine there are only 2 types of physicians: the MD and the DO. While they arise from independent roots (allopathy vs osteopathy respectively), the training involved is essentially the same except for minor details that occur during medical school. To become a physician we all must take the same arduous path.

  • Pre-medical school
    • Completion of a Bachelor’s Degree – A 4+ year process in any field of study including the sciences (BS) as well as the arts (BA or BFA). A competitive GPA is generally felt to be 3.6 or higher.
    • Prerequisite course work – Must be completed in biology, chemistry, physics and math in addition to regular course work.
    • The Medical College Admission Test (MCAT)Administered by the Association of American Medical Colleges (AAMC), the MCAT “is a standardized, multiple-choice examination designed to assess the examinee’s problem solving, critical thinking, writing skills, and knowledge of science concepts and principles prerequisite to the study of medicine. Per the Princeton Review, it is a “5-1/2 hour, computer–based test that has the reputation of being one of the most challenging standardized tests.” Over the past 2 years (2010-2011) the average score has been 25 out of 48 possible points. A competitive score is generally felt to be 30 or higher and only around 1/3 of test-takers will achieve this score.
    • Other considerations – Competitive GPA and MCAT scores alone are not enough to ensure admittance to medical school. Other considerations include experiences in leadership, community service, medicine and research as well as letters of recommendation, your personal statement and of course how well you interview.
    • Chances – According to the American Medical Association, “For the 2010-2011 entering class, U.S. medical schools received 580,304 applications from 42,742 applicants, an average of 14 per applicant. There were also 31,834 first-time applicants—up 2.5 percent from 31,063 in 2009-2010.” The AMA also noted that, “American allopathic medical schools enrolled 18,390 first-year students for 2009” and “nearly 13,000 applicants competed for 5,100 available slots” in osteopathic medical schools. So given 23,490 total positions and 55,742 applicants, the chance of acceptance based on these numbers alone is 42%.
  • Medical school – Another 4+ year process for those fortunate enough to gain admittance. Medical school serves to form the foundation of medical knowledge that we build upon in residency. It costs an average of $30,000 per year for tuition alone; it does not include books, supplies and living expenses. Can you drink water from a fire-hose? That’s what it feels like being deluged with information, struggling to retain it and continuing to compete against peers. How well we do has a direct effect on our ability to obtain a residency position not only in a location of our choosing but also in the field of our choosing – surgical residencies (general surgery, OB/GYN, urology, etc) are more competitive than medical residencies (family medicine, internal medicine, pediatrics, etc). In addition there are 2 more standardized tests we must complete — the United States Medical Licensing Examination (USMLE) steps 1 and 2 — that along with yet another personal statement, more letters of recommendation and interviews are evaluated for residency positions. We obtain either the MD or DO degree when we graduate from medical school depending on the program.
  • Residency – All residents are doctors given that we have completed 8+ years of higher education and have graduated with the degree from medical school. First year residents are commonly referred to as “interns”. Residency serves as a kind of apprenticeship or on-the-job-training and thus, in spite of our extensive education, we actually make less money than the nurses with whom we work. Residency can be as short as 3 years or greater than 5 years depending on the chosen specialty.
  • Fellowship – For those of us who want to sub-specialize, yet another level of training awaits (the fellowship) with its own process of evaluation and competition. Those of us who do not complete a fellowship are loosely referred to as “generalists” and those who do so are called “specialists”.

All in all to become a physician you are looking at a minimum of 11 years of rigorous higher education: a bachelor’s degree (4+ years), medical school (4+ years), residency (3+ years) and possible fellowship (1+ years). Now that we have explored what it means to be a physician of Western medicine, let’s discuss the process of becoming a midlevel practitioner.

Types of degrees

  • BA/BFA/BS – Bachelor of arts/fine arts/science (4+ years)
  • MA/MS – Master of arts/science (2+ years following a BA/BFA/BS)
  • PhD – Doctor of philosophy (4+ years following a BA/BFA/BS)

Physician extenders

  • Physician assistant (PA) – 6+ years (BA/BFA/BS plus MS in physician assistance).
  • Nurse practitioner (NP) – 6+ years (BS in nursing plus MS in nursing).
  • Certified nurse midwife (CNM) – 6+ years (BS in nursing plus MS in midwifery).
  • Certified nurse anesthetist (CNRA) – 6+ years (BS in nursing plus MS in nurse-anesthesia).
  • Doctor of nursing (RN, PhD) – 8+ years (BS in nursing plus PhD in nursing).
  • Doctor of pharmacy (PharmD) – 8+ years (BA/BFA/BS plus PhD in pharmacology).

Now I’m really not trying to dis on my fellow healthcare providers. In truth PAs, APRNs and PharmDs are needed to improve the accessibility of healthcare to citizens around the country. I am merely trying to point out that large differences remain between midlevel providers and physicians: their training is less comprehensive, less rigorous and certainly less competitive. To compare the two is to compare a Lexus with a Kia: both are cars but their builds are very different.

Why does this matter?

A recent data brief from the National Center for Health Statistics (NCHS) arm of the Centers for Disease Control and Prevention (CDC) noted that over the past 8 years (periods 2000-2001 to 2008-2009):

  • Outpatient visits attended only by APRNs have increased by 50%
  • People that live outside of major cities are 6 times more likely to be seen by a midlevel practitioner
  • Midlevel practitioners are utilized heavily by general medicine (21%) and OB/GYN (19%) compared to pediatrics (8%) and general surgery (6%)

Summary

As we move forward in the improvement of healthcare delivery in the U.S., it is important that we don’t lose sight of quality as we push for quantity. Most aches and pains and even chronic conditions can be (and probably should be) managed by physician extenders, however under the supervision and guidance of the physicians from whom they extend. To permit the practice of medicine without the physician is egregious and frankly dangerous. The next time you see your “doctor”, make sure you understand what kind of “doctor” s/he is. If you are seeing a midlevel provider, inquire about the supervising physician and how s/he is involved in your care. If there is no physician involved I highly suggest that you find yourself a real “doctor” or be prepared for the increase in medical error that will inevitably come. And in response to Mr Riley, quoted above, I would caution: Beware the decoys! They have become quite sophisticated.

Talk To Me – Kevin McHale for The Trevor Project

Posted on YouTube 8/26/11 but still relevant:

During National Suicide Prevention Week (9/4/11 – 9/10/11), join Kevin McHale and The Trevor Project for “Talk To Me,” a campaign for conversation. Visit our website to learn how you can participate.

And remember: If you or someone you know ever needs help, please call The Trevor Lifeline at 866-488-7386. It’s free, confidential and available 24/7. Or visit http://www.TheTrevorProject.org.

.Related posts

 

Georganne Chapin – End the barbaric cutting of baby boys

Georganne Chapin, NYDailyNews.com, reports that the deranged bill banning the ban on newborn circumcision was recently signed into California state law by governor Jerry Brown. This a powerful whack-a-mole response from overzealous legislators with regard to a ballot proposal floated earlier this year (see my related post, End genital mutilation now). It wasn’t enough that a Superior Judge ordered the initiative off the ballot. Legislators too wanted their chance to thumb their noses at California public opinion and succeeded. Screw the populace!

In her piece, Georganne takes on several of the common excuses people throw around to condone and continue the archaic disfigurement of infant genitalia. Is it really so hard to see that circumcision is at best a cosmetic procedure performed in the absence of patient consent? The foreskin has a role in the health of the body and circumcision quite literally RIPS IT OFF. While severe complications including penile amputation and infant death are rare, it cannot be said loud enough that EVERY CIRCUMCISION IS DESTRUCTIVE.

It is truly a sad day for Californians that their collective voice has been silenced with regard to this issue. Apparently their legislators feel that they are either too ignorant or too profane to permit public debate.

Related posts

Melvin Dwork: WWII vet goes from “undesirable” to “honorable”

Via the Washington Post, the Associated Press reports that World War II Navy veteran, Melvin Dwork, has finally won his decades long fight: changing his “undesirable” discharge for being gay to “honorable”. The change is more than saving face, “he will now be eligible for the benefits he had long been denied, including medical care and a military burial.” This decision is hopefully only the first of many given that over 100,000 soldiers have been discharged since WWII and robbed of their honor and military benefits simply for being gay. “Don’t Ask Don’t Tell” officially dies tomorrow, 9/20/11.

Adults bully 10-year-old UK trans girl

James Connell, Worcester News, reports that adults — not children — are the biggest tormentors of a 10-year-old MTF child in the UK. According to her mother:

“She is within her mind a girl but she has a boy’s body. She is the same as everybody else apart from the fact she doesn’t feel right in her own body. It’s not a phase. It’s not a choice. What child would choose to be completely miserable? I don’t expect people to understand. I just don’t want people abusing my child. I don’t want her to be called a freak. I want her to be left alone.”

Sounds like a reasonable request to me. As is common for other trans kids with supportive parents, she will most likely be protected from puberty and the undesired physical changes that accompany it with the use of hormone blockers. Only after she is old enough to understand the implications of gender reassignment will she be permitted to consent to cross hormone therapy.

NCAA guidelines for trans student sports

Neal Broverman, Advocate.com, reports that the National Collegiate Athletic Association (NCAA) has updated their policy regarding transgender student athletes:

The new policy states that a transgender male athlete “who has a medical exception for testosterone hormone therapy may compete on a men’s team, but is no longer eligible to compete on a women’s team without changing the team status to a mixed team,” according to a press release from the National Center for Lesbian Rights, which worked with the NCAA to develop the new standards. For transgender female athletes, those who have “taken medication to suppress testosterone for a year may compete on a women’s team. Under the new policy, transgender student athletes who are not undergoing hormone therapy remain eligible to play on teams based on the gender of their birth sex and may socially transition by dressing and using the appropriate pronouns that match their gender identity.”