November 17, 2018 - November 23, 2018
Science Says: Sex and gender aren’t the same
National Center for Transgender Equality, NCTE, and the Human Rights
Campaign gather on Pennsylvania Avenue in front of the White House in
Washington, Monday, Oct. 22, 2018, for a #WontBeErased rally. Anatomy at
birth may prompt a check in the “male” or “female” box on the birth
certificate - but to doctors and scientists, sex and gender aren’t
always the same thing. (AP Photo/Carolyn Kaster)
Washington (AP) - Anatomy at birth may
prompt a check in the “male” or “female” box on the birth certificate -
but to doctors and scientists, sex and gender aren’t always the same
The Trump administration purportedly is considering
defining gender as determined by sex organs at birth, which if adopted
could deny certain civil rights protections to an estimated 1.4 million
But variation in gender identity is a normal part
of human diversity, the American Academy of Pediatrics, or AAP, stresses
in a new policy that outlines how to provide supportive medical care for
Here are some questions and answers about what can
be sometimes blurry lines.
Q: Aren’t sex and gender interchangeable
A: Sex typically refers to anatomy while
“gender goes beyond biology,” says Dr. Jason Rafferty, a pediatrician
and child psychiatrist at Hasbro Children’s Hospital in Rhode Island,
and lead author of the AAP’s transgender policy.
Gender identity is more an inner sense of being
male, female or somewhere in between - regardless of physical anatomy,
he explained. It may be influenced by genetics and other factors, but
it’s more about the brain than the sex organs.
And transgender is a term accepted across science
and medical groups to mean people whose gender identity doesn’t match
what Rafferty calls their “sex assigned at birth.”
Q: How early can people tell if they’re
A: It’s normal for children to explore in
ways that ignore stereotypes of masculinity and femininity. Rafferty
says it’s whether those feelings and actions remain consistent over time
that tells. Sometimes that happens at a young age, while for others it
may be adolescence or beyond.
Regardless, the pediatricians’ policy calls for
“gender-affirmative” care so that children have a safe, nonjudgmental
and supportive avenue to explore their gender questions.
Q: What kind of care might they need?
A: Transgender people of all ages are more
likely to be bullied and stigmatized, which can spur anxiety and
depression and put them at increased risk for suicide attempts.
For children, medicine to suppress puberty may be
considered, to buy time as the youth grapples with questions of gender
Q: Can’t a genetic test settle if someone’s
male or female?
A: “It’s not like we’re going to find a
magic transgender gene,” Rafferty says, noting that a mix of genes,
chemicals and other factors contribute but is not well understood.
Generally, people are born with two sex chromosomes
that determine anatomical sex - XY for males and XX for females.
But even here there are exceptions that would
confound any either-or political definition. People who are “intersex”
are born with a mix of female and male anatomy, internally and
externally. Sometimes they have an unusual chromosome combination, such
as men who harbor an extra X or women who physically appear female but
carry a Y chromosome. This is different than being transgender.
More deaths seen for less invasive cervical cancer surgery
Carla K. Johnson
New evidence about a cancer
operation in women finds a higher death rate for the less invasive
version, challenging standard practice and the “less is more” approach
to treating cervical cancer.
The unexpected findings are
prompting changes at some hospitals that perform radical hysterectomies
for early-stage disease.
The more rigorous of the two
studies was conducted at more than 30 sites in a dozen countries. It
found women who had the less invasive surgery were four times more
likely to see their cancer return compared to women who had traditional
surgery. Death from cervical cancer occurred in 14 of 319 patients who
had minimally invasive surgery and 2 of 312 patients who had open
Results were published online
Wednesday by the New England Journal of Medicine.
Radical hysterectomy is standard
treatment for women with early-stage cervical cancer. Rates are
declining because of widespread screening. The number of operations has
fallen, too, to several thousand a year in the United States. Some women
with early-stage cervical cancer are choosing fertility-sparing
techniques, treatments not included in the new research.
In both studies, researchers
compared two methods for radical hysterectomy, an operation to remove
the uterus, cervix and part of the vagina. The surgery costs around
$9,000 to $12,000 with the minimally invasive version at the higher end.
Traditional surgery involves a cut
in the lower abdomen. In a newer method, a surgeon makes small incisions
for a camera and instruments. Patients recover faster, so laparoscopic
surgery, which has been around for more than a decade, gained popularity
despite a lack of rigorous long-term studies.
It’s not clear why it failed to
measure up. Experts suspect there may be something about the tools or
technique that spreads the cancer cells from the tumor to the abdominal
Some hospitals went back to
traditional hysterectomy after the results were presented at a cancer
meeting in March.
“We immediately as a department
changed our practice and changed completely to the open approach,” said
Dr. Pedro Ramirez of the University of Texas MD Anderson Cancer Center
Ramirez led the more rigorous
study, which randomly assigned 631 patients to one of two surgeries.
After 4½ years, the rate of those still living without disease was 86
percent with less invasive surgery and 96 percent with traditional
The experiment was halted early
last year when the higher death and cancer recurrence rates showed up.
The original plan was to enroll 740 patients in the study, which was
funded in part by surgical device maker Medtronic.
The other study looked at 2,461
women with cervical cancer who had radical hysterectomies from 2010
through 2013. It found a 9.1 percent death rate after four years among
women who got minimally invasive surgery compared to 5.3 percent for
“We’re rethinking how we approach
patients,” said study co-author Dr. Jason Wright of New
York-Presbyterian Hospital. “There’s a lot of surprise around these
The research is “a great blow” to
the technique and the findings are “alarming,” said Dr. Amanda Fader of
Johns Hopkins Kimmel Cancer Center. She said Johns Hopkins Hospital in
Baltimore has stopped doing less invasive hysterectomies for cervical
cancer until there is more data.
While some patients with small
tumors might do as well with minimally invasive surgery, “surgeons
should proceed cautiously” and discuss the new information with
patients, Fader wrote in an accompanying editorial.
November 10, 2018 - November 16, 2018
At many hospitals worldwide,
you don’t pay, you can’t leave
Detained patients lie on beds in the Kenyatta National Hospital
in Nairobi, Kenya on Monday, Aug. 6, 2018. At east Africa’s
biggest medical institution, and at an astonishing number of
other hospitals around the world, if you don’t pay up, you don’t
go home. (AP Photo/Desmond Tiro)
Nairobi, Kenya (AP) -
Doctors at Nairobi’s Kenyatta National Hospital have told Robert
Wanyonyi there’s nothing more they can do for him. Yet more than
a year after he first arrived, shot and paralyzed in a robbery,
the ex-shopkeeper remains trapped in the hospital.
Because Wanyonyi cannot pay
his bill of nearly 4 million Kenyan shillings ($39,570),
administrators are refusing to let him leave his fourth-floor
At Kenyatta National
Hospital and at an astonishing number of hospitals around the
world, if you don’t pay up, you don’t go home.
Around the world, many
hospitals detain patients if they cannot pay their bills.
The hospitals often
illegally detain patients long after they should be medically
discharged, using armed guards, locked doors and even chains to
hold those who have not settled their accounts. Even death does
not guarantee release: Kenyan hospitals and morgues are holding
hundreds of bodies until families can pay their loved ones’
bills, government officials say.
An Associated Press
investigation has found evidence of hospital imprisonments in
more than 30 countries worldwide, according to hospital records,
patient lists and interviews with dozens of doctors, nurses,
health academics, patients and administrators. The detentions
were found in countries including the Philippines, India, China,
Thailand, Lithuania, Bulgaria, Bolivia and Iran. Of more than 20
hospitals visited by the AP in Congo, only one did not detain
“What’s striking about this
issue is that the more we look for this, the more we find it,”
said Dr. Ashish Jha, director of the Harvard Global Health
Institute. “It’s probably hundreds of thousands, if not millions
of people, that this affects worldwide.”
During several August
visits to Kenyatta National Hospital - a major medical
institution designated a Center of Excellence by the U.S.
Centers for Disease Control and Prevention - the AP witnessed
armed guards in military fatigues standing watch over patients.
Detainees slept on bedsheets on the floor in cordoned-off rooms.
Guards prevented one worried father from seeing his detained
Kenya’s ministry of health
and Kenyatta canceled several scheduled interviews with the AP
and declined to respond to repeated requests for comment.
Health experts decry
hospital imprisonment as a human rights violation. Yet the
United Nations, U.S. and international health agencies, donors
and charities have all remained silent while pumping billions of
dollars into these countries to support their splintered health
systems or to fight outbreaks of diseases including AIDS and
“People know patients are
being held prisoner, but they probably think they have bigger
battles in public health to fight, so they just have to let this
go,” said Sophie Harman, a global health expert at Queen Mary
University of London.
Hospitals often acknowledge
detaining patients isn’t profitable, but many say it can
sometimes result in a partial payment and serves as a deterrent.
Festus Njuguna, an
oncologist at the Moi Teaching and Referral Hospital in Eldoret,
about 300 kilometres northwest of Nairobi, said the institution
regularly detains children with cancer who have finished their
treatment, but whose parents cannot pay.
“It’s not a very good
feeling for the doctors and nurses who have treated these
patients, to see them kept like this,” Njuguna said.
Still, many officials
openly defend the practice.
“We can’t just let people
leave if they don’t pay,” said Leedy Nyembo-Mugalu,
administrator of Congo’s Katuba Reference Hospital. He said
holding patients wasn’t an issue of human rights, but simply a
way to conduct business: “No one ever comes back to pay their
bill a month or two later.”
Global health agencies and
companies that operate where patients are held hostage often
have very little to say about it.
The CDC provides about $1.5
million every year to Kenyatta National Hospital and Pumwani
Maternity Hospital, helping to cover treatment costs for
patients with HIV and tuberculosis, among other programs. The
CDC declined to comment on whether it was aware that patients
were regularly detained at the two hospitals or if it condones
Dr. Agnes Soucat of the
World Health Organization said it does not support patient
detentions, but has been unable to document where it happens.
And while WHO has issued hundreds of health recommendations on
issues from AIDS to Zika virus, the agency has never published
any guidance advising countries not to imprison people in their
Many Kenyan human rights
advocates lament that hospitals continue to hold patients
despite what was seen as a landmark judgment in 2015.
Back then, the High Court
ruled that the detention of two women at Pumwani who couldn’t
pay their delivery fees - Maimuna Omuya and Margaret Oliele -
was “cruel, inhuman and degrading.” Omuya and her newborn were
held for almost a month next to a flooded toilet while Oliele
was handcuffed to her bed after trying to escape.
Earlier this month, the
High Court ruled again that imprisoning patients “is not one of
the acceptable avenues (for hospitals) to recover debt.”
Omuya said she is still
psychologically scarred by her detention at Pumwani, especially
after another recent run-in with a Nairobi hospital.
Several months ago, her
youngest brother was treated for a suspected poisoning. When
Omuya and her family were unable to pay the bill, the situation
took a familiar but unwelcome turn: he was imprisoned. Her
brother was only freed after his doctor intervened.
November 3, 2018 - November 9, 2018
Immunotherapy scores a first win against some breast cancers
undated fluorescence-colored microscope image made available by the
National Institutes of Health in September 2016 shows a culture of human
breast cancer cells. For the first time, one of the new immunotherapy
drugs has shown promise against breast cancer in a large study that
combined it with chemotherapy to treat an aggressive form of the
disease. (Ewa Krawczyk/National Cancer Institute via AP)
Marilynn Marchione, AP
For the first time, one of
the new immunotherapy drugs has shown promise against breast cancer in a
large study that combined it with chemotherapy to treat an aggressive form
of the disease. But the benefit for most women was small, raising questions
about whether the treatment is worth its high cost and side effects.
Results were discussed
Saturday at a cancer conference in Munich and published by the <Italics>
New England Journal of Medicine. <Italics>
Drugs called checkpoint
inhibitors have transformed treatment of many types of cancer by removing a
chemical brake that keeps the immune system from killing tumor cells. Their
discovery recently earned scientists a Nobel Prize. Until now, though, they
haven't proved valuable against breast cancer.
The new study tested one from
Roche called Tecentriq plus chemo versus chemo alone in 902 women with
advanced triple-negative breast cancer. About 15 percent of cases are this
type - their growth is not fueled by the hormones estrogen or progesterone,
or the gene that Herceptin targets, making them hard to treat.
Women in the study who
received Tecentriq plus chemo went two months longer on average without
their cancer worsening compared with those on chemo alone - a modest
benefit. The combo did not significantly improve survival in an early look
before long-term follow-up is complete.
Previous studies found that
immunotherapies work best in patients with high levels of a protein that the
drugs target, and the plan for the breast cancer study called for analyzing
how women fared according to that factor if Tecentriq improved survival
The drug failed that test,
but researchers still looked at protein-level results and saw encouraging
signs. Women with high levels who received the combo treatment lived roughly
25 months on average versus about 15 months for women given chemo alone.
That's a big difference, but
it will take more time to see if there's a reliable way to predict benefit,
said Dr. Jennifer Litton of the MD Anderson Cancer Center in Houston. She
had no role in running the study but enrolled some patients in it, and
oversees 14 others testing immunotherapies.
"We're really hopeful that we
can identify a group of women who can get a much bigger and longer
response," she said.
Another breast cancer
specialist with no role in the study, Dr. Michael Hassett at Dana-Farber
Cancer Institute in Boston, said he felt "cautious excitement" that
immunotherapy may prove helpful for certain breast cancer patients.
Side effects need a close
look, both doctors said. Nearly all study participants had typical chemo
side effects such as nausea or low blood cell counts, but serious ones were
more common with the combo treatment and twice as many women on it stopped
treatment for that reason.
Three of the six deaths from
side effects in the combo group were blamed on the treatment itself; only
one of three such deaths in the chemo group was.
Cost is another concern.
Tecentriq is $12,500 a month. The chemo in this study was Celgene's
Abraxane, which costs about $3,000 per dose plus doctor fees for the IV
treatments. Older chemo drugs cost less but require patients to use a
steroid to prevent allergic reactions that might interfere with the
immunotherapy. Abraxane was chosen because it avoids the need for a steroid,
said one study leader, Dr. Sylvia Adams of NYU Langone Health.
The study was sponsored by
Roche and many study leaders consult or work for the company or own stock in
EU drug agency urges approval for dengue vaccine
London (AP) - Europe's
drug regulator has recommended approving the first vaccine for dengue
despite concerns about the vaccine's wide use and a lawsuit in the
Philippines alleging that it was linked to three deaths.
The European Medicines Agency
said last Friday it had adopted a "positive opinion" of French
pharmaceutical company Sanofi's Dengvaxia. The vaccine is the world's first
against dengue, which sickens about 96 million people annually.
The mosquito-spread virus is
found in tropical and sub-tropical climates across Latin and South America,
Asia, Africa and elsewhere. It produces a flu-like disease that can cause
joint pain, nausea, vomiting and a rash. In severe cases, dengue can result
in breathing problems, hemorrhaging and organ failure.
There is no specific
treatment for dengue and there are no other licensed vaccines on the market.
Earlier this year, the World
Health Organization said the vaccine needs to be dealt with "in a much safer
way" and should be given mainly to people who had dengue before. The vaccine
is licensed for use in about 20 countries.
The U.N. health agency said
there were "significant obstacles" in using the vaccine and that a rapid
test should be developed to determine if people had previously been infected
Sanofi previously warned that
people who had never been sickened by dengue were at risk of more serious
disease after receiving the vaccine. The company said it expected to take a
100 million-euro loss based on that news.
The Philippines was the first
country to introduce a national dengue immunization program - which it
halted after Sanofi's announcement last year. The government also demanded a
refund of more than 3 billion pesos ($59 million) from Sanofi. In February,
the Philippines said the vaccine was potentially linked to the deaths of
three people: all of them died of dengue despite having been immunized
The country imposed a
symbolic fine of $2,000 on Sanofi and suspended the vaccine's approval,
charging that the drugmaker broke rules on how the shot was registered and