Friday, November 02, 2018

Nonsense-Based Health Care - in the Service of Political Ideology and Sectarian Beliefs

As an advocate for evidence-based medicine, I am used to disagreeing with officials at US government health agencies on the finer points of evidence and its interpretation.  However, it's 2018, and things are very different.  Now the current regime, and those who back it, have produced a rising tide of outright nonsensical assertions about medicine and health care used seemingly in service of  ideological or sectarian gain.

So let me list some cases, starting with the most recent, and working backwards in time.

Fox News Pundit Said Asylum Seekers Are Infected with Smallpox

This week, as discussed on Vox was:

the statement on Fox News — by an ex-ICE agent — that the migrant caravan of 4,000 men, women, and children mainly from Central America is going to bring smallpox to America.

'They are coming in with diseases such as smallpox, leprosy, and TB that are going to infect our people in the United States,' the former agent, David Ward, said this week.

This is just ridiculous nonsense.  As the Vox article stated,

There is no smallpox in circulation anymore. That’s been true since 1980, when a major global vaccine effort wiped the virus from the planet.


The risk of leprosy — now called Hansen’s disease — being imported from Latin America is similarly remote. And while some foreign-born people do have higher rates of TB, the Centers for Disease Control and Prevention (CDC) screens for TB in people moving to the US.

In case anyone is not convinced, see the CDC page on smallpox (which so far has escaped rewriting by any political appointees, apparently.)

Why would Fox News put this silliness on the air?  The Vox article suggested:

This particular kind of xenophobic fear-mongering, which Donald Trump spread as a presidential candidate, is now surfacing again as we approach the midterms, in an apparent ploy to rile up the conservative base.
So this is medical and epidemiological nonsense purely in service of short-term political gain.

Department of Health and Human Services (DHHS) Suggests Erasing Gender Dysphoria and Denying the Existence of Intersex and Ambiguous Genitalia

In October, 2018, per the New York Times,

The Trump administration is considering narrowly defining gender as a biological, immutable condition determined by genitalia at birth,

In particular, the Department of Health and Human Services (DHHS),

argued in its memo that key government agencies needed to adopt an explicit and uniform definition of gender as determined 'on a biological basis that is clear, grounded in science, objective and administrable.' The agency’s proposed definition would define sex as either male or female, unchangeable, and determined by the genitals that a person is born with, according to a draft reviewed by The Times. Any dispute about one’s sex would have to be clarified using genetic testing.

'Sex means a person’s status as male or female based on immutable biological traits identifiable by or before birth,' the department proposed in the memo, which was drafted and has been circulating since last spring. 'The sex listed on a person’s birth certificate, as originally issued, shall constitute definitive proof of a person’s sex unless rebutted by reliable genetic evidence.'

If carried out, this policy, again coming from the lead US government health care and public health agency, would deny the existence of gender dysphoria.  Per the Washington Post,

In 2013, the American Psychiatric Association’s diagnostic bible adopted 'gender dysphoria' to describe the symptoms and distress experienced by transgender people, eliminating the older designation of 'gender identity disorder.' This change in the Diagnostic and Statistical Manual marked a turning point in the treatment of people who felt they were in the wrong body, and a growing recognition that such feelings were not a mental illness.

The discussion of gender dysphoria on the APA website is here.

There are two other big problems with the proposed DHHS definition of gender.  First, it seems to deny the existence of intersex disorders.  These are defined (via Medline) as

a group of conditions where there is a discrepancy between the external genitals and the internal genitals (the testes and ovaries).

These include four categories:
46, XX intersex
46, XY intersex
True gonadal intersex
Complex or undetermined intersex
Second, the DHHS proposed policy seems to deny that fact that some babies are born with ambiguous genitalia.  The Mayo Clinic summary of this condition states,

Ambiguous genitalia is a rare condition in which an infant's external genitals don't appear to be clearly either male or female. In a baby with ambiguous genitalia, the genitals may be incompletely developed or the baby may have characteristics of both sexes. The external sex organs may not match the internal sex organs or genetic sex.

Ambiguous genitalia isn't a disease, it's a disorder of sex development. Usually, ambiguous genitalia is obvious at or shortly after birth, and it can be very distressing for families.

Although these conditions in toto are not common, they are not rare. I would assume the pseudo-experts in charge of the DHHS policy actually know nothing about the biology of sex and gender. But their idea of dichotomizing a person into male or female based on genitalia which may appear ambiguous, or may not correspond to either the person's chromosonal make-up, internal anatomy, or endocrine environment does not make any sense.

As an aside, the WaPo article noted,

At HHS, the issue is being driven by Roger Severino, the agency’s director of civil rights, who has long been critical of the Obama administration’s expansion of transgender rights.

The NY Times article noted that

Mr. Severino, while serving as the head of the DeVos Center for Religion and Civil Society at the Heritage Foundation, was among the conservatives who blanched at the Obama administration’s expansion of sex to include gender identity, which he called 'radical gender ideology.'

In a post on people in health care or public health leadership positions in the Trump regime who are without any qualifications in biomedical science, health care, or public health, we noted that Mr Severino is a lawyer without any such qualifications.  We noted then that Mr Severino and one of his colleagues seemed bent on imposing beliefs of one particular religious group on the management of health care and public health for all citizens of the US, regardless of whether they subscribe to such beliefs.

So the definition of gender now being proposed by DHHS staff seems designed to further a particular set of religious beliefs about gender, but without any consideration of the relevant medical science, or of the interests of people who do not share those religious beliefs.

US District Cout Nominee Said Contraception Causes Cancer and Violent Deaths

In April, NPR reported on a US Senate confirmation hearing for Wendy Vitter, nominated by Trump for a US District Court seat,

Vitter sought to distance herself from a brochure she had appeared to endorse while leading a panel at a pro-life conference in 2013. The panel was called 'Abortion Hurts Women,' and the brochure promoted a variety of unsubstantiated claims linking birth control pills to breast cancer, cervical and liver cancers, and 'violent death.'

On this last point — violent death — the brochure alleged that women who take oral contraceptives prefer men with similar DNA, and that women in these partnerships have fewer sexual relations, leading to more adultery, and 'understandably ... violence.'

Note that

All of these claims have been debunked by leading medical and scientific organizations, as Democratic Sen. Mazie Hirono of Hawaii observed.

'You urged the audience to distribute the materials making these dangerous claims. ... Do you believe the claims that Dr. Lanfranchi makes that abortion causes breast cancer and that birth control causes women to be assaulted and murdered?' she asked.
The reason that Vitter backed these dubious claims was not clear.  She claimed to be "pro-life," and had worked for the Catholic Church.  One might suspect that she was interested in propagating religious beliefs about birth control, even if doing so could adversely affect the lives of people who did not share such beliefs.

Former Senator, Television Commentator  Suggested CPR as Good Treatment for Catastrophic Bleeding After Gunshot Wound

In March, the Washington Post reported that former Republican Senator Rick Santorum

suggested live on CNN that learning CPR was a better way for young people to take action in response to a mass shooting, rather than protesting gun violence and asking “someone else to solve their problem” by passing a “phony gun law.” The panel on CNN’s 'State of the Union' show was discussing the March for Our Lives, which drew upward of 800,000 people to the Mall on Saturday to demand gun-control legislation.


'How about kids, instead of looking to someone else to solve their problem, do something about maybe taking CPR classes or trying to deal with situations where there is a violent shooter and you can actually respond to that?' Santorum said.

CPR, of course, does not do a lot of good for someone who is rapidly losing his or her blood volume due to a bullet wound.  A number of physicians pointed this out, forcefully,

Heather Sher, a Florida-based radiologist who examined the gunshot wounds of at least one Parkland, Fla., shooting victim on the day of the shooting, called Santorum’s comments 'gobsmackingly uninformed.'

'CPR is not effective with catastrophic bleeding,' she said on Twitter. “Speechless! Learn CPR! Everyone should for cardiopulmonary arrest. But for gunshot wounds, a) attend stop the bleeding course by trauma surgeons or b) pass #gunreform (helpful hint: option b is the better option.)”

Jo Buyske, executive director of the American Board of Surgery, described Santorum’s comments as a 'dangerous and wrong message,' saying on Twitter, 'Mr. Santorum, CPR doesn’t work if all the blood is on the ground.'

And Rebecca Bell, a pediatric critical care doctor at the University of Vermont Medical Center, broke it down in layman’s terms:

'Here are some stats made simple for Rick Santorum,' she said on Twitter. 'Survival rate of pulseless trauma victims who get CPR at the scene: VERY, VERY LOW.'

'Survival rate of people who don’t get shot in the first place: MUCH, MUCH BETTER.'
Presumably Mr Santorum was more interested in promoting his ideological opposition to any further gun regulation than understanding the medical context of his pseudo-clinical comments.  Although it probably would do some general good for society if more people could be trained in CPR, training high school students would likely have zero effect on the outcomes of school shootings.

Republican Majorities in Kansas, Utah, Idaho Legislatures Proclaim that Pornography is a Public Health Hazard

In February, the Topeka (KS) Capital-Journal reported,

The Kansas Senate approved a nonbinding resolution Tuesday declaring proliferation of pornography a public health crisis that normalizes violence against women, corrodes interest in marriage and serves as a gateway to human trafficking.

Also in February, the Washington Post noted that in 2016 the Utah State Senate passsed, at the behest of Republican Sen Todd Weiler, a resolution that

declare[d] pornography 'a public health crisis.' That nonbinding resolution, unanimously passed by both chambers of the state legislature, warned 'this biological addiction leads to increasing themes of risky sexual behaviors, extreme degradation, violence, and child sexual abuse images and child pornography.'

In March, according to the AP, per the Spokane (WA) Spokesman,

A group of Idaho lawmakers on Friday approved a proposal declaring pornography a public health risk.

'Pornography has and does have adverse impacts on all members of society. It leads to the abuse men, women and children, destroys marriages and has impacts on young and old,' said Rep. Lance Clow, a Republican from Twin Falls who is backing the resolution. 'Families are being torn apart by this epidemic.'

The problem is that there is no good evidence that pornography has important negative effects on public health, or is an addictive disorder.  As the WaPo pointed out,

David Ley does not buy it. The Albuquerque-based clinical psychologist and author of 'The Myth of Sexual Addiction' said those who have adopted the public health framing are 'cherry-picking the research.'

He pointed out that the American Psychiatric Association’s diagnosis guide, the Diagnostic and Statistical Manual of Mental Disorders, does not include pornography addiction. And yet Utah, he noted, has numerous porn addiction treatment programs.

In an article in the latest edition of the peer-reviewed journal 'Porn Studies,' Ley argues that people who seek treatment for porn addiction actually view less erotica than average, but guilt associated with religiously based sexual values creates an internal conflict with the pleasure they get from watching it, so “they just feel worse about it.'

Furthermore, the WaPo article also suggested that the notion that pornography is a public health crisis and/or an addictive disorder comes from more religious beliefs rather than evidence about public health.

About 60 percent of Utahns and nearly 90 percent of the state’s lawmakers are members of the Church of Jesus Christ of Latter-day Saints, which has declared 'depiction, in pictures or writing, that is intended to inappropriately arouse sexual feelings' to be 'a tool of the adversary,' the descriptor Mormons often use for Satan.
Again, people are free to have these religious beliefs, but should politicians impose these beliefs on those who do not subscribe to them, in a country which supposedly bars government support of particular religions?  And should they do so at the risk of distracting from real public health problems?


Since 2016, we have seen increasing attempts to distort or ignore medical science, clinical and epidemiological research findings to support the political ideology of the ruling party and the religious beliefs of their extreme fundamentalist supporters.  As we have discussed, most recently here, the Trump regime has seen fit to put ill-informed people in positions of power in health care and public health agencies.  Some of these people have put their political and/or religious agendas ahead of the public's health.  Our examples above show a continuing inclination by the administration, its sympathizers in state governments, and its enablers in the media to distort or ignore science and research again to promote idological or religious beliefs. This promotion is likely to be at the expense of patients and people who do not share these ideological views or religious beliefs. 

These trends endanger the mission of US government health related agencies, and are hostile to the notion that health care and public health should serve all people, regardless of their religious beliefs, race, ethnicity, or sex.

Furthermore, these trends undermine fundamental principles of US government enshrined in the Constitution, including prohibiting the government from establishing a religion or preventing the free expression of any religion, and equal application of the laws and provision of due process to all people, again regardless of their religious beliefs, race, ethnicity or sex. This is obviously hugely dangerous, (and made more so by the regime's and its allies' threats to other core values of US society, to US law, and the US Constitution.)

To prevent the decline and fall of US health care, and maybe the entire US experiment in representative democracy, health care professionals, academics, patients and citizens concerned about health care will have to join up with the larger populace to defend our core values while they still have any force. 

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