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      Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine

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      Dr. Hilary Cass published a landmark report that led to restrictions on youth gender care in Britain. U.S. health groups said it did not change their support of the care.After 30 years as one of England’s top pediatricians, Dr. Hilary Cass was hoping to begin her retirement by learning to play the saxophone.Instead, she took on a project that would throw her into an international fire: reviewing England’s treatment guidelines for the rapidly rising number of children with gender distress, known as dysphoria.At the time, in 2020, England’s sole youth gender clinic was in disarray. The waiting list had swelled, leaving many young patients waiting years for an appointment. Staff members who said they felt pressure to approve children for puberty-blocking drugs had filed whistle-blower complaints that had spilled into public view. And a former patient had sued the clinic, claiming that she had transitioned as a teenager “after a series of superficial conversations with social workers.”The National Health Service asked Dr. Cass, who had never treated children with gender dysphoria but had served as the president of the Royal College of Pediatrics and Child Health, to independently evaluate how the agency should proceed.Over the next four years, Dr. Cass commissioned systematic reviews of scientific studies on youth gender treatments and international guidelines of care. She also met with young patients and their families, transgender adults, people who had detransitioned, advocacy groups and clinicians.Her final report, published last month, concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.” On her recommendation, the N.H.S. will no longer prescribe puberty blockers outside of clinical trials. Dr. Cass also recommended that testosterone and estrogen, which allow young people to develop the physical characteristics of the opposite sex, be prescribed with “extreme caution.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Share Your Story About the Organ Transplant System

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      We want to hear from doctors, nurses, technicians, patients and others with experience in the system. Tell us your experiences below.The New York Times is interested in the organ transplant system.Do you have a tip about irregularities in the system? If so, we need your help.If you are a doctor, nurse, technician or anybody else working on organ transplants, we’d love to hear from you. We are also eager to talk to from medical residents working in those transplant programs. And of course, we also want to hear from patients and their families.Share your story about the organ transplant systemWe will not publish any part of your submission without contacting you first. We may use your contact information to follow up with you. More

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      The History Behind Arizona’s 160-Year-Old Abortion Ban

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      The state’s Supreme Court ruled that the 1864 law is enforceable today. Here is what led to its enactment.The 160-year-old Arizona abortion ban that was upheld on Tuesday by the state’s highest court was among a wave of anti-abortion laws propelled by some historical twists and turns that might seem surprising.For decades after the United States became a nation, abortion was legal until fetal movement could be felt, usually well into the second trimester. Movement, known as quickening, was the threshold because, in a time before pregnancy tests or ultrasounds, it was the clearest sign that a woman was pregnant.Before that point, “women could try to obtain an abortion without having to fear that it was illegal,” said Johanna Schoen, a professor of history at Rutgers University. After quickening, abortion providers could be charged with a misdemeanor.“I don’t think it was particularly stigmatized,” Dr. Schoen said. “I think what was stigmatized was maybe this idea that you were having sex outside of marriage, but of course, married women also ended their pregnancies.”Women would terminate pregnancies in several different ways, such as ingesting herbs or medicinal potions that were thought to induce a miscarriage, Dr. Schoen said. The herbs commonly used included pennyroyal and tansy. Another method involved inserting an object in the cervix to try to interrupt a pregnancy or terminate it by causing an infection, Dr. Schoen said.Since tools to determine early pregnancy did not yet exist, many women could honestly say that they were not sure if they were pregnant and were simply taking herbs to restore their menstrual period.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Biden, Trump and Dr. Bob: the Human Realities of Aging on the Job

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      He had become the local expert on what he called the “unwanted side effects of old age,” so Dr. Bob Ross, 75, rubbed arthritis cream onto his hands and walked into an exam room to see his seventh elderly patient of the day. He had been a doctor in the remote town of Ortonville, Minn., for nearly five decades, caring for most of its 2,000 residents as he aged alongside them. He delivered their children, performed their high school physicals, tended to their workplace injuries and now specialized in treating the wide-ranging symptoms of what it meant to grow old in America.“What’s hurting you most today?” he asked Nancy Scoblic, 79.“Let me take out my list,” she said. “Sore knees. Bad lungs. I’ve got a spot on my leg and pain in my shoulder. Basically, if it doesn’t hurt now, it’ll probably hurt later.”She’d known him for most of her life, first as Bobby, whom her family sometimes babysat, then as Bob in high school, and now as Dr. Bob — the physician who had cared for her grandparents and also her grandchildren, and who almost everyone in Ortonville entrusted with their most vulnerable moments. It was behind the closed door of Dr. Bob’s exam room where hundreds of people filled out their advance directives, took cognitive evaluations and tested out their new walkers and hearing aids. It was Dr. Bob who delivered bad news with a farmer’s directness and then sat with families around a hospice bed for hours when the only thing left to do was to pray.Most of his patients were white, geriatric and still largely self-sufficient — members of the same demographic as the country’s two leading presidential candidates in the 2024 election, 81-year-old Joe Biden and 77-year-old Donald Trump. The conversations at the heart of an election cycle were the same ones unfolding inside Bob’s office: What were the best ways to slow the inevitable decline of the human body? How did aging impact cognition? When was it possible to defy age, and when was it necessary to make accommodations in terms of decision-making or professional routines. These were the questions he asked his patients each day, and also himself.He took Nancy’s hand and helped her onto the exam table, checking for circulatory problems as he felt her lymph nodes and her carotid artery for signs of swelling. He pressed his hands against her abdomen to seek out masses in the liver or enlargement of the spleen. It was the same geriatric exam he conducted at least 25 times each week, as Ortonville’s soybean farmers aged into retirement and America’s baby boomers arrived in his office showing more evidence of cancer, more bruises from falls, more diabetes, more strokes and more signs of memory loss and possible dementia.Bob helps Nancy Scoblic with her coat after an appointment. We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Insurance Companies and the Prior Authorization Maze

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      More from our inbox:Elect the U.S. Attorney GeneralFriendship MemoriesA Leadership GapInsurance companies have weaponized a seemingly benign process to protect their profits, and it’s putting patients at risk.To the Editor:Re “‘What’s My Life Worth?’ The Big Business of Denying Medical Care,” by Alexander Stockton (Opinion video, March 14), about prior authorization:Mr. Stockton’s video captures a current snapshot of an important truth about medical insurance in our country and in doing so does a service to all citizens by making them aware of this threat to themselves and their families.The immediate truth is that medical insurance companies are inadequately regulated, monitored and punished for their greed. In their current iteration they are bastions of greed, power and money. They need to be reined in.But there are other truths as well. Some physicians, just like some pharmaceutical companies, are unable to contain their greed and allow avarice to cloud their judgment, compromise their ethics and in some cases cross the line to Medicare fraud or other illegal activity.Medical care in our country is very big business involving billions of dollars. Without proper controls, regulation and monitoring, malfeasance follows. The challenge in such a complex and multifaceted context is how to implement such controls and monitoring without making things worse.Ross A. AbramsJerusalemThe writer, a retired radiation oncologist, is professor emeritus at Rush University Medical Center in Chicago.To the Editor:The Times’s video exploits tragic outcomes and does not mention basic important facts about the limited yet key role of prior authorization in ensuring that patients receive evidence-based, affordable care.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Oprah Takes on Weight Stigma in the Ozempic Era in New Weight Loss Special

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      In a new special, Ms. Winfrey highlighted how new drugs have changed the way we talk about weight and willpower.Oprah Winfrey, a longtime figure in the national conversation about dieting and weight bias, devoted an hourlong prime-time special on Monday to the rise of weight loss drugs. Her goal, she said, was to “start releasing the stigma and the shame and the judgment” around weight and weight loss — starting with her own, she said.“For 25 years, making fun of my weight was national sport,” Ms. Winfrey said in the show, titled “An Oprah Special: Shame, Blame and the Weight Loss Revolution.”Shame has become a focal point in that conversation as new drugs like Ozempic and Mounjaro, which are widely used for weight loss, shift how people think about treating obesity. When Ms. Winfrey disclosed in December that she was taking a medication to manage her weight, she said she was “done with the shaming” that had followed her through decades of dieting.Many patients who start taking these medications say they have felt shamed for struggling with their weight, and then shamed for taking weight loss drugs, said Dr. Michelle Hauser, the obesity medicine director of the Stanford Lifestyle and Weight Management Center, who was not involved with the special.“People just are constantly getting this message, both internal bias and then external bias from other people,” she said. Some might think, “‘I shouldn’t have to rely on medication, I shouldn’t be dependent on them,’” she added.Dr. Hauser tells patients to instead ask themselves: “Would you tell someone that about their blood pressure medication?”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      A UnitedHealthcare and Mount Sinai Dispute May Force Thousands to Switch Doctors

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      As Mount Sinai Hospital and UnitedHealthcare haggle over pay rates, patients may have to pay out-of-network prices if they want to keep their doctors.Stalled contract negotiations between UnitedHealthcare, the health insurance giant, and Mount Sinai Health System, a leading New York City hospital system, are forcing tens of thousands of New Yorkers to switch doctors or risk paying out-of-network prices.The impasse has dragged on for months. Mount Sinai has sought to raise prices significantly, but the insurance company has refused to agree to pay the new proposed rates. As a result, Mount Sinai’s hospitals are now out of network for patients insured by UnitedHealthcare or Oxford, which are subsidiaries of the same company. But the issue is about to become even more urgent for many patients because many Mount Sinai affiliated doctors — in addition to the hospitals themselves — are about to be removed from UnitedHealthcare’s network, starting March 22. That means patients with United who have employer-sponsored or individual plans will be billed out-of-network rates when they see a Mount Sinai affiliated doctor at a doctor’s office.The negotiations have sent many patients scrambling to find new doctors. UnitedHealthcare says about 80,000 Mount Sinai patients are affected.What Happened?The dispute between the insurance giant and the hospital system is a rare instance in which health care contract negotiations have spilled into public view.Mount Sinai sought to negotiate better rates with UnitedHealthcare, demanding that the insurance giant pay the hospital more for doctor visits and hospital stays. United claims Mount Sinai was asking for rates to go up some 58 percent over the next four years.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Why South Korean Doctors Have Walked Off the Job

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      Physicians say the government’s plan to admit more students to medical school ignores the real cause of doctor shortages: harsh conditions and low wages.Hundreds of interns and residents in South Korea walked off the job on Tuesday, disrupting an essential service to protest the government’s plan to address a shortage of doctors by admitting more students to medical school.While South Korea takes pride in its affordable health care system, it has among the fewest physicians per capita in the developed world. Its rapidly aging population underscores the acute need for more doctors, according to the government, especially in rural parts of the country and in areas like emergency medicine.The protesters, who are doctors in training and crucial for keeping hospitals running, say the shortage of doctors is not industrywide but confined to particular specialties, like emergency care. They say the government is ignoring the issues that have made working in those areas unappealing: harsh working conditions and low wages for interns and residents.Surveys have found that in a given week, doctors in training regularly work multiple shifts that last longer than 24 hours, and that many are on the job for more than 80 hours a week.“The medical system has been collapsing for a while,” said Park Dan, the head of the Korean Intern Residents Association, who resigned from his job at the emergency wing of Severance Hospital in Seoul on Monday. “I couldn’t see a future for myself working in emergency for the next five or 10 years.”The current setup of insurance and government payment systems, Mr. Park added, allows physicians only in a few departments, like cosmetic surgery, to make a decent living.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More