Medicine, like politics, sports, and everything else, has gotten sucked into a 24/7 sound bite culture in which the most complex issues are spun into a few provocative words on news sites, TV, and radio shows. Enraged readers and listeners then weigh in. As the old expression goes, much heat, but little light ensues.
But three recent stories involving medicine are worth a closer look, and cooler heads.
First, consider the story of Michelle Kosilek, a transgender inmate serving a life sentence without parole in the all-male Norfolk prison. In 1990, then Robert Kosilek strangled his wife, Cheryl, and dumped her body in a mall parking lot. Living for nearly 20 years now as “Michelle,” and taking female hormones, Kosilek petitioned the state to pay for her gender-reassignment surgery, and won. Federal judge Mark Wolf recently ruled that denial of the $20,000 surgery would be a violation of Kosilek’s Eighth Amendment rights protecting her from cruel and unusual punishment.
This case, the first in which a judge has ordered a state to pay for such surgery, has received national attention and prompted much outrage. It is, many have said, an example of Democrats and liberals gone wild. Calls for the judge’s removal (and for President Obama’s) abound. The surgery is unnecessary, cosmetic–and even if it isn’t, who cares if a murderer suffers anyway? He’s just trying to get into a female prison for an “easier” incarceration.
The facts are more complicated. For one thing, Judge Wolf was appointed by Republican President Reagan, and his ruling has been opposed by Democratic Governor Deval Patrick. For another, there is ample legal precedent for prisons providing for transgendered inmates’ medical needs, including a 2012 Supreme Court ruling in support of state-funded hormone therapy. The suffering that Kosilek has experienced, and the complexity of his personal history is outlined here.
None of this information makes Kosilek a sympathetic character, and there are thoughtful arguments to be made against paying for her surgery, but it does shed some light on why what seems to many a no brainer of a decision involved a 126 page ruling by Judge Wolf.
Next let’s look at the story of the Worcester primary care doctor who turned away a patient because she was over 200 lbs. The story broke on WCVB and then appeared on CNN and in news outlets throughout the US and abroad. Most who commented excoriated the doctor for prejudice, insensitivity, and abandoning a patient with a serious medical problem (obesity) and accused her of violating the Hippocratic Oath. Some pointed out that physicians have the right to exclude certain patients from their practices. Many doctors, for example, do not accept patients covered by Medicare or Medicaid.
A closer look at the Worcester doctor’s reasons for limiting her practice to svelter patients is surprising, though. It seems that staff members in Dr. Helen Carter’s office had been injured trying to transport obese patients, and she felt that nearby medical facilities were better equipped to treat these patients than hers. Again, room for disagreement, but the doctor hardly sounds like the monster she’s been painted to be.
Finally, news that the U.S. Preventive Services Task Force does not recommend screening for ovarian cancer will no doubt inspire outcry about rationing of medical care, as similar recommendations against prostate cancer screening with the PSA blood test did earlier this year. But the USPSTF’s recommendations are based not on current politics, or debate over the Affordable Care Act, but, rather, years of disappointing data regarding the efficacy of blood tests and ultrasounds in early detection of ovarian cancer.
I wish it weren’t so. I wish there actually were better screening tests for ovarian cancer that would be available except for political obstacles. But there aren’t. Those are the facts.
Suzanne Koven is an internal medicine physician who blogs at In Practice at Boston.com, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50.
