A New Standard

Proto’s article on the physician as social activist (“Taking It to the Streets,” Spring 2016) focused on Mona Hanna-Attisha’s work in Flint, Mich., and the work of her forebears, such as James Parkinson, Rudolf Virchow and Jack Geiger. The piece was inspirational but also disheartening, as these exemplars are a tiny fraction of physicians. They and others are often attacked for being “political” when they criticize laws or governmental policies that threaten the public’s health. But in truth this is a responsibility of all physicians.

The AMA’s Declaration of Professional Responsibility says that one of those charges is to “advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.” While the medical school courses that the piece cites are important, they will have limited impact until commitment to improving the public’s health, rather than grades or connections, becomes the most important criterion for admission to medical school. We are going to have to work hard and purposefully if doctors like Hanna-Attisha, Parkinson, Virchow, Geiger and their like are to become the norm rather than the uncommon exception.

Joshua Freeman // Chief of Family Medicine, University of Kansas Medical Center, Kansas City, Kan.


Gender Frontiers

Crossing Over” (Spring 2016) cites a prevalence of transgender people in the population of between 1 in 30,000 and 1 in 50,000. Three recent studies found that number may be closer to 1 in 200. The large increase of children coming to gender clinics and a yet-to-be released investigation from a European clinic  support this latter number.

Many clinics still subscribe to trying to treat young children out of becoming transgender, although the number using that method is falling, and one clinic in Toronto that practiced this approach has been closed down. Studies comparing that restrictive attitude against the more supportive, “wait and see” method used with the clinical populations in Amsterdam, for instance, have found that patients in the former experience two to three times the psychological problems and suicidal ideation.

These clinics that don’t foster gender transition in children tend to cite a lone study in support of their approach. But it must be noted that this research was based on fewer than five children, two of whom were not likely transgender to begin with.

Herbert Schreier // Psychiatrist, Children’s Hospital Oakland, Calif.