Inflexible Minds

Nearly eight thousand endocrinologists from all over the world met in New Orleans for 5 days and speakers at each session were drawn from well known, highly published researchers and clinicians working on the topics they discussed. 

If you pay your money, you can attend and even as a wee little humble country endocrinologist, you can go up to the microphone and ask your question of the giant on the stage.

My first question was prompted by the comment from the professor who was discussing weight loss diets which included intervals of severely restricted caloric intake, alternating with less severe restrictions. She began by saying that she was from Wisconsin where 65% of the population is obese, so she had no chance to find human beings who were willing to severely calorie restrict for her studies, so she studied mostly rats. 

I rose to point out that she had on her campus a cohort of young men who had engaged in severe calorie restriction from roughly age seven for 6 months of each year until they were 22 and they were spending 4 years on her campus: The wrestlers. 

She blinked like a deer in the headlights and asked the other doctors on the stage what I had said. "The wrestling team," one of them explained. "Oh," she said, clearly having no idea what I was talking about and that was her entire interest in the proposition. 

I have long thought the caloric privation of this group of human beings ought to be studied systematically. There is a theory that diabetics who are intensively controlled with weight reduction and sugar control, if only for a year or two will have a "legacy" effect lasting many years. If this is true, what happens to the young men who have been rigidly controlling their weight and diet? Do they have a legacy effect after they finish their wrestling careers?

No interest in that on the part of the scientists.

Another professor talked about adrenal nodules which have been called "Non functioning" for decades, meaning they do not over produce any of the hormones made by the adrenal gland.  They have been thought to be inert, just sort of like calluses, a lump in the bread dough. But this professor showed a slide demonstrating these nodules make the usual array of adrenal hormones, just none in excess. I asked whether we should not drop the term "non functioning" since they clearly did function, just not excessively. Again, the professor seemed stunned. But we've always called them non functioning adenomas. 

But the best was the testosterone lectures. The professor went through the very common problem of young men who "abused" testosterone, usually "gym rats" who take industrial doses of testosterone they get illicitly at the gym, but when their supplier runs out, they often stop their injections and allow their blood levels to fall to very low levels. It takes a while for the testicles, which have shut down while a tidal wave of exogenous testosterone from the bottle has been washing through, to restart and to fire up endogenous production. During that recovery period, the man can go to his primary care nurse and ask for a testosterone level, which is temporarily low, and then they get referred to the endocrinologist so they can get prescriptions for testosterone to inject.

Of course, this game is easy to recognize: The patient comes in looking like Arnold Schwartzenager, his testes often small and atrophic, complaining of "low T." The professor described a variety of lab studies to confirm all this, and much discussion ensued about who to deal with these drug abusers. 

These men are in some ways like anorexia nervosa patients, who look in the mirror and no matter how thin they are the anorectics see a fat person; the same is true for the testosterone abusers; no matter how muscular and bulky they get, they see themselves as under muscled.  Doctors from other countries described how they treat these patients in clinics alongside psychiatrists. 

Then I visited the talk by the doctor from Mt. Sinai Hospital (NYC) who talked about how he replaces testosterone in his patients who are female to male transgenders and how he relentlessly increases the dose of testosterone, raising their blood levels to "levels we see in androgen abusers" but this is necessary to achieve the goals of facial hair growth,  voice deepening, muscle development.

After the session, I emailed the professor who had spoken about "androgen abusers" and asked whether he would agree that the folks treating transgenders were not also "androgen abusers," both the doctors and the patients. 

He replied that this was using testosterone for "gender affirming" goals and only if the patients were attempting to become overly muscular would he think of this as androgen abuse.

The fact is, political/value thinking has driven the approach to "transgender medicine."  The suicide rate among transgender patients has remained between 25 and 30% for 30 years.

If we embarked on any other sort of therapy for patients which was attended by a 30% mortality rate, would we be permitted to persist? 

The transgender clinic folks say transgenders commit suicide because they are so abused by an intolerant society.

But is it not also possible transgender commit suicide at such astonishing rates because the underlying disorder is itself, a severe psychiatric disease? Are we actually helping these folks by giving them what they ask for? 

It is also remarkable how wide the range of therapy: Some female to males do not want voice changes but just to "seem more masculine" and so they are given just a little testosterone. Others receive super doses if that's what they want.  Some receive testosterone but continue to have vaginal intercourse, and need contraception so they don't get pregnant.

When discussing placing IUD's in these patients, one of the treating physicians remarked the whole procedure of placing the IUD was very traumatic for the patient, presumably because it was a reminder of their underlying anatomy--in a patient who is having vaginal intercourse!

Much was made of the idea that we all ought to be careful to elicit what "pronoun" the patient prefers to refer to himself/herself with. Females to males often want to be referred to as "him." This should be scrupulously complied with. 

Some "binary" patients (those who identify with both or neither gender) want to be referred to as "they."

My mind is clearly too inflexible to accommodate all this. It all struck me as the inmates in charge of the asylum. And that is just what the transgender clinic folks would object to: We are not superior to these patients and it is patronizing to even question whether we should not give them anything they wish. 

Which means, of course, we have to give the transgender all the testosterone he desires but we refuse this to the male who wants to "abuse" testosterone to get the effect of increased muscle mass. 

MAGA, MAGA, All Come Home

Bill Nye recently asked Alexandria Ocasio-Cortez how she planned to deal with those who were afraid of change.

This, in essence, is the question of the current era: Mr. Trump won, if he won on anything, on the idea that we have to go back to a better time: Make America Great Again, was a call to return to the times when father went off to the factory with his lunch pail, while mother stayed home with the kids and they had a car and two weeks summer vacation and everything was just swell in America. 

While we cling to the past we should remember that the Czar, before World War I, called for a convention of nations in order to get everyone to agree to not seek new knowledge, new technology to make guns shoot farther or to develop more powerful weapons, because he realized his government could not spend the money an arms race would require.

He knew, on some level, that any army or navy of the modern age could defeat any army or navy of preceding ages simply because their technology is better. So the mighty wooden British Navy of the 1700 and early 1800's would be utterly destroyed by any Navy, say, the Italian Navy of 1940, without the loss of a a single ship or life by the Italians, simply because of technology.

There is a wonderful scene in "Master and Commander" in which Jack Aubrey, the captain of a British man of war examines a wood model of the ship he has battled and been nearly wrecked by, the double hulled French ship, and he remarks, "What a marvelous modern age we live in!"  He could not even imagine iron ships under steam power. He was so masterful handling his wooden ship, which he had joined as a 13 year old, and had bled into its wood enough that he felt it was a relative, he could not make the mental leap into an age where none of what he knew, the wind, the sails, the management of sailors aloft, using the wind gauge, firing mussel loaded cannon, would be rendered totally irrelevant to winning a battle at sea.

And yet, less than 60 years later the iron clad ships of the American civil war would render wooden ships impotent. 

Small changes, like the rifling of gun barrels, changed the equation on the battle field, and another small change, the machine gun did even more,  but physics would ultimately make these incremental advances seem almost quaint.
It was only 76 years between Custer's last stand and the dropping of the atomic bomb on Hiroshima. All that in the lifetime of a single man.

Those who could not embrace the notion of change were, literally, incinerated.

Now we are asked to hold fast, to in fact, turn around, about face, toward a sweeter, happier nation, an Ozzie and Harriet, a Leave It to Beaver past.

Pre vaccination polio, iron lung ward

But consider that past, a past when "White Supremacy" was the official motto of the Alabama Democratic Party (1966) and before the state of Mississippi had not ratified the 13th amendment abolishing slavery (1995!) and 1923 when the Mississippi supreme court found it legal for that state to expel from all-white schools two children whose great-aunts were rumored to be married to coloreds on the grounds that the law was intended to "prevent race amalgamation" and, the court approvingly noted the law meant to insure "the broad dominant purpose of preserving the purity and integrity of the white race."  Oh, this too, was America, as Louis Menard has noted in his New Yorker article "In the Eye of the Law." 

In Plessy v Fergusson, a case decided in 1896, the Court argued "We consider the underlying fallacy of the plantiff's argument to consist in the assumption that the enforced separation of the two races stamps the colored race with a badge of inferiority. If this be so, it is not by reason of anything found in the act, but solely because the colored race choose to put that construction on it." 

As if there could be any other construction put to it.

Not until Antonin Scalia did mental contortions to explain why "A well regulated militia" did not mean the authors of the Second Amendment were saying guns did not not belong to individuals but to organizations intended to defend the state, was there such transparent idiocy from the Court. 

But this was all an effort to keep change at bay.

In 1896, there were 130,334 colored voters registered in Louisiana; by 1904 there were only 1,342. This was not because colored voters had left the state; colored voters were stripped of their right to vote in that America of former greatness. 
That was "Jim Crow." That was the counter revolution to the 2nd American Revolution which freed the slaves and gave all men the right to vote regardless of race.

In 1930, Birmingham, Alabama passed a law making it illegal for a White and a Black person to play dominoes or checkers together. In 1932, Oklahoma outlawed baseball clubs, one Black one White, playing baseball within 2 blocks of one another.  

For a period of 50 years there were something like 10 lynchings of Blacks in the South every week. 

So this is the America we seek when we want to Make America Great Again.

We want to go back to wooden ships, and muskets and a time when hate rule supreme in the 14 states of the former Confederacy and in Western states like Oklahoma, and in the mountain states and the high plains states which now comprise the Red States. 

Read Howard Zinn, Oliver Stone. Read real American history. Watch "Platoon," and "Full Metal Jacket."  There you will find the real MAGA. 

Humankind cannot stand too much reality, T.S. Eliot warned, and we can see that in full bloom in Mr. Trump and his core.  
These are the fearful, the cowering, who are terrified of what the future may bring, who cleave to a past where you got points for being white, where simply being white guaranteed you always had someone below you in America.

 Make America Hate Again. That's the real message. And it's a message of weakness. "Home of the free. Land of the Brave." Not for Trump who sees MS-13 in every immigrant family presenting itself to the Southern border. 

MAGA. 

Sacred Heart: Audacity Incarnate

It's that time of year again: The warrant articles marathon.
Rather than a town meeting, Hampton, NH has a day when residents show up at Winnacunnet High School and vote on a tome of articles concerning funding for schools, police, fire department and whether or not Mrs. Jones should be allowed to plant petunias on the far side of the sidewalk, which is ground actually owned by the town.

Sequestered in among all the weeds is a nasty little piece of work, warrant number 5 in the SAU category, having to do with schools.

The local Catholic school, Sacred Heart, located behind the Miraculous Medal church, has 39 children who live in Hampton but whose parents enrolled them in the Catholic school.

Now the Catholic school has presented a bill, it hopes the good people of the town will vote to pay for those 39 students x $998=$38,922. The school argues that if those children attended Hampton public schools, it would cost the town $15,000 to educate each of these kids, so the town is actually getting a break and saving money as a result of the efforts of Sacred Heart.

Of course, the immediate objection was this would be a violation of Church/State, a local government sponsoring a religious school

But that is not actually the most outrageous argument here: The basic premise is wrong.  It's accounting flim/flam on the part of the Church.

Paid For Lovely School, Hampton, NH

It would cost the town of Hampton not a single dime more if all 39 of those students attended Marston Elementary, the Hampton Academy or Winnacunnet High. Those kids have already been paid for: the teachers are already in place to teach them; the buildings are already constructed (or, in the case of the Academy, under reconstruction at great cost); the facilities are already supported by Hampton taxpayers and now taxpayers are being asked by Sacred Heart parents to pay for their own private school.

Hampton public school could use 39 more students

If Hampton had a community swimming pool, would the parents of Sacred Heart  ask the town to reimburse them for the private swimming pools they had built in their own backyards, on the grounds that the town no longer had to pay for the use of the community pool by the children of the homeowners with private pools?

And why not ask the town to pay for the country club memberships on the grounds that country club golfers are no longer burdening the public golf course?

Lovely public school

The possibilities are rich and expansive. 

How about the cost of landscaping your home, on the basis the town no longer has to pay for roadside beautification?

Really spiffy school could use more Catholic kids

If this warrant article passes, Mad Dog will seek a lawyer willing to sue the town to prevent this payment. The warrant article may slip by, but the courts should have something to say about this boondoggle, which even in the age of Trump, is just one absurdity too far.