Category Archives: Health Care

Small and Medium Businesses in Virginia Cited Among Best Healthcare Workplaces Nationally

by James C. Sherlock

There are a lot of problems in Virginia healthcare starting with staff shortages, especially nurses, and our COPN incumbent protection system.

So, it is not an easy thing to compete and grow in the healthcare space.

But two Virginia companies are doing so and succeeding in ways such businesses must, by being great places to work and by avoiding the COPN grinder.

In 2022, no Virginia organization earned a place in Fortune’s 30 Best Large Workplaces in Health Care.  

But we did have two companies in its best small and medium healthcare companies list:

One key to success: neither competes directly with a core business of a COPN-protected monopoly. Continue reading

Use of Cross-Gender Hormones for Gender Transitions in Minors

by James C. Sherlock

In the sometimes murky world of diagnosis and treatment of gender dysphoria in children and adolescents, the following steps generally but not always occur in order, with each potentially serving as an off-ramp:

  1. Diagnosis;
  2. Mental heath support;
  3. Social transition;
  4. Puberty blockers;
  5. Cross-gender hormones; and,
  6. Surgery; often but not always waiting for surgery until a child reaches the age of majority.

That list gets dangerous when it gets to step 4.

What UVa Children’s Hospital requires is the diagnosis before it can proceed. It cites a list of “gender affirming” medical professionals to whom it will refer patients for that diagnosis. Many of them are on staff  I hope they are not as forward-leaning on this diagnosis as their advertising suggests.

The home page of the clinic lists the following services in order:

  1. Puberty blockers that delay sex-related physical changes;
  2. Cross-sex hormones, like testosterone and estrogen;
  3. Referrals for gender-affirming surgeries and voice therapy;
  4. Education about sex and contraception;
  5. Referrals for therapy to help manage anxiety, depression, and ongoing emotional issues;
  6. Help finding resources in the community.

I think those are presented in the wrong order. Therapy should be first. More on that later. Yesterday we discussed puberty blockers.

Today we will focus on cross-gender hormones. Continue reading

Graph of the Day: Maternal Mortality

Source: National Center for Health Statistics, by way of The Virginia Mercury

by James A. Bacon

When writing about “systemic racism” in health care, journalists routinely cite the disparity in health outcomes between White and Black Women. Here in Virginia, the maternal death rate per 100,000 for Black women in 2018 was 37.3 — nearly twice the rate of 14.9 for White women. The disparity has grown even wider since then. That disparity often is presumed, without the need for further proof, to reflect racism.

But could there be other explanations? Virginia health officials will be working over the next two years to understand the disparity by digging into the details of individual cases to get a clearer idea of the factors that might have contributed to the deaths, reports the Virginia Mercury.

Among other factors the team will examine is “noncompliance with appointment.” Is it possible that women who died from pregnancy- or birth-related issues were more likely to have missed their prenatal medical appointments? Could some mothers, for instance, have had difficulty accessing transportation to the doctor’s office or been unable to break free from their jobs? (Or could they have just forgotten about their meetings or otherwise blown them off?)

I’ve never heard this mentioned as a possible factor before. Depending on the findings, the inquiry could change the complexion of the debate. Difficulty in finding transportation is a very different problem than, say, physician racial bias.

Continue reading

“Puberty Blockers Are Wonderful” – UVa Children’s Hospital

by James C. Sherlock

How do people communicate?

Generally by words and visuals and, in person, with body language. The art and science of marketing and sales is one of the bulwarks of any economy — and any political system.

My article on the hard selling of hormone treatments — puberty blockers and cross-gender use of estrogen and testosterone — by UVa Children’s Hospital Transgender Youth Health Services has drawn a lot of attention.

Two of the most famous lines from the video and its transcript are:

Puberty blockers are wonderful. They provide sort of a break.

Well. What child and parent wouldn’t want a break? Is there ice cream?

That enthusiastic endorsement caused me to check out the FDA warnings on puberty blockers.

Wonderful is not the first word that comes to mind. Continue reading

Slick Selling of Child Gender Transitions at UVa Children’s Hospital

by James C. Sherlock

The University of Virginia Children’s Hospital offers a Madison Avenue-quality sales pitch for child gender transition.

As written and smoothly delivered, it deflects any reservation parents may have in supporting such transitions by telling them they have been misled or are being selfish or both.

It helps parents decide by blaming their reservations on myths.

I offer below both a video and a transcript of that sales presentation.

The presenter uses a variation on the closing technique called the “question close.” In this one she both asks the questions — identified as myths — and answers them. The presentation carefully avoids mention of the word sterilization.

I expect that, given the sensitivity of the subject, it is very likely the best technique for closing the sale. Brilliant even.

If that is your goal.

The reputation of UVa hospital likely will be damaged by this exposure of how it sells this particular product. They have earned it. Continue reading

Interview with Virginia’s Secretary of Health and Human Resources on Petersburg Health – Part 1

John Littel, Virginia Secretary of Health and Human Resources

by James C. Sherlock

I have written about the initiatives of the Youngkin Administration to help Petersburg improve the economic situation and quality of life in that city.

Petersburg is last in education of children, last in health outcomes and factors, last in public safety. It is an economic basket case.

The Youngkin administration and the Attorney General are focusing on mitigating the worst case — Petersburg.

They will support the efforts of the mayor, government, non-profits, and industry — including business and the citizens of Petersburg — the way it must be to succeed.

I have applauded the governor’s initiative as both right and brave. These are now what Teddy Roosevelt called “men (and now women) in the arena.” An arena that they created on Monday.

John Littel, the Virginia Secretary of Health and Human Resources, is in the center of that arena. He knows well where the problems lie.  He knows what has been tried and failed to mitigate them.  He granted me an interview.  

He answered a tough question that I will discuss today. Continue reading

A Chance for Petersburg

Credit: Urban News Weekly

by James C. Sherlock

The Youngkin administration is doing an unalloyed good thing the exact right way. In partnership with two Democrats.

The Governor, in an extraordinary joint presentation with his cabinet secretaries and Democratic Mayor Samuel Parham, laid out a plan for broad state help to Petersburg.

Standing on the stage with Democratic State Senator Joe Morrissey.

Parham, speaking to reporters, said

Governor Youngkin is the first to step down here and say that he is going to put all of his resources in a city to move the dial to create prosperity here in the city of Petersburg. Democrats and Republicans working together — that’s what makes Virginia special.

Occasionally. Continue reading

U.K. Suit Demonstrates Legal Jeopardy for Virginia Child Transgender Clinics

by James C. Sherlock

You knew it was coming.

The Times of London has reported the inevitable lawsuit.

Tavistock gender clinic ‘to be sued by 1,000 families’

The Tavistock gender clinic (now closed) is facing mass legal action from youngsters who claim they were rushed into taking life-altering puberty blockers.

I have no idea if the firm that plans the suit will get 1,000 families to join the class. Neither do they.

But everyone knew the suit itself was coming. The defense against this suit, if it ever reaches court, will be severely challenged.

Unless the tort bar retires en masse, such suits are coming to Virginia. Continue reading

Virginia Must Ensure Transgender Medical Treatment Is Safe

by James C. Sherlock

Attorney Hans Bader and I in parallel articles have pointed out the serious questions posed by national and international experts about current medical practices in gender transitions for minors.

Those questions include both the ethics of the diagnosis and treatment processes in use and the safety of the puberty blockers and cross-gender hormones used in those treatments. Hormone treatments are administered to hundreds of minors annually in Virginia in the face of both new FDA warnings and other major open questions about their safety and long-term outcomes.

Virginia taxpayers pay for a lot of these treatments in state hospitals and clinics with state-funded private insurance plans and now Medicaid.

I will recommend the Virginia Secretary of Health and Human Resources organize and oversee practice and research networks in Virginia that mirror the recommendations of the Cass Review in the U.K. to make it safe.

Virginia has the assets necessary to carry out those recommendations and the state has the authority. It must demonstrate the will.

No new law appears necessary. Continue reading

The Left Never Rests (Part 3,783) – Vote Democratic

by James C. Sherlock

We have a glimpse into the near future in Virginia.

For those of my readers who thought that the left in the U.K. would sit still while the Cass Commission examines and reports on transgender care in Britain, think again.

Some transgender activists oppose the requirement for a clinical diagnosis of gender dysphoria before getting access to gender-altering drugs. They also oppose the participation of endocrinologists in the prescription of those drugs.

Takes too long. Too expensive. They might say no.

They have gotten in the U.K. what they demand. Witness a new U.K. National Health System “scheme,” as it is called, that is undoubtedly headed to the Virginia General Assembly.

It removes psychologists and psychiatrists from the loop in gender dysphoria diagnoses and gives the job to general practitioners, who can then directly prescribe hormone therapies without the participation of endocrinologists.

I reported that the Northam Administration added transgender services coverage to Medicaid on its last days in office. Is there anyone at all who doubts this new “scheme” will be added to Virginia Medicaid if the left gets in charge again? Continue reading

Hormone Treatment of Transgender Adolescents in Virginia – New Concerns

by James C. Sherlock

We have discussed at length the controversial policies of the American Academy of Pediatrics (AAP).

It is time to consider the impact of Great Britain’s ongoing National Health Service Review of its transgender support to children and young people.

It offers new concerns about clinical challenges in the diagnosis and treatment of gender dysphoria in adolescent patients, especially the safety of puberty blockers.

And it causes us to discuss what has been going on for years at the University of Virginia Children’s Hospital Transgender Youth Health Services.  

It is a state hospital that has treated hundreds of patients from the earliest stages of puberty with both puberty blockers and cross-gender hormones. Continue reading

Medical Gender Transition in Children – American Academy of Pediatrics Headquarters vs. the World

Courtesy American Academy of Pediatrics

by James C. Sherlock

Who cares for transgender kids the most and is looking out for their best interests?

  • The American Academy of Pediatrics (AAP) headquarters leadership; or
  • Dissenting AAP members and the medical societies of some of the leading nations in the science of medicine?

A reasonable and important question, since Virginia and the rest of the nation need to know what is best for kids before we squabble about who chooses.

An op-ed in The Wall Street Journal by pediatrician Dr. Julia Mason and Leor Sapir, a fellow at the Manhattan Institute, pulled back the curtain on the politicization of AAP headquarters and its suppression of debate on matters of medical treatment of children diagnosed with gender dysphoria.

They take on the efforts by AAP to suppress:

  • both public knowledge of the gaps in the science of child transgender medicine; and
  • efforts in conservative states to regulate on-demand puberty blockers, cross-sex hormones and surgery in children.

Importantly, they revealed that Sweden, Finland and the U.K. have enacted restrictions on medical transition of minors and that medical societies in France, Belgium and Australia are on the verge of doing so.

What do the medical societies and government health services in those countries know that the AAP does not permit discussion of and its scriveners in the American press have not reported? Continue reading

Sorry, Can You Please Explain Again How Systemic Racism in Healthcare Works?

by James A. Bacon

The U.S. healthcare system, we hear with increasing frequency, is systemically racist. Here in Virginia, for instance, we hear that Black women suffer a higher rate of complications in childbirth than White women. But any theory of systemic racism in healthcare needs to explain certain inconvenient facts that I stumbled across recently when reviewing the Kaiser Family Foundation “Virginia Health Care Landscape.”

Perhaps the most meaningful statistic on healthcare status is longevity. The Kaiser numbers floored me. Hispanics — people of color who are widely thought to suffer from less access to healthcare — have the longest life expectancy of any racial/ethnic group in Virginia: 88 years. They are followed by Asians, who live on average 87 years. Whites live 79 years on average, and Blacks 75 years. If the system is racist, why do Asians and Hispanics live so much longer than Whites?

Why aren’t Asians or Hispanics the racial/ethnic yardstick for health rather than Whites? Why is the small, 4-percentage-point disparity between Blacks and Whites played up while the large, 13-percentage-point disparity between Hispanics and Blacks is ignored? Continue reading

Mitigating Nurse, Teacher and Police Officer Shortages in Virginia – An Illustrative Example

by James C. Sherlock

Virginia is currently dealing with big shortages of nurses, teachers and police officers.

If any one doubts that, please consult other conversations that have already been presented on this blog. We have also written here about working conditions for all three professions. Those need to be addressed and, again, have been on this blog. But not in this article.

This article is about state funding to address statewide shortages in professions — education, health care, and law enforcement — without which society cannot function.

College degree programs. The shortages of undergraduate candidates for degrees as registered nurses and teachers are projected to get worse with the “freshman cliff” in 2025.

The “cliff” represents a 15% drop in freshman prospects beginning in 2025 due to the decline in birth rate in the 2008 recession and lasting for years after. Those missing babies in 2008 would have begun entering college in 2025.

Cops. The recruiting of cops has collapsed for cultural reasons including the public trashing and resulting lack of respect for cops and the frustrations and increased dangers (see any article on progressive prosecutors) on the job.

Methodology. I will offer the data on current state budget investments in higher education, K-12 education, health care and law enforcement and recommend targeted investments in new teachers, new registered nurses and new cops.

The Virginia Employment Commission is of no help currently in recruiting for these positions, and needs to re-evaluate and reform its statewide support.

The strategic recommendations are firm. But while I have chosen the numbers of positions and investments in the requirements with some general care, they are used for impact illustration only. Continue reading

Hospitals Continue to Cut Labor and Delivery and NICU Services

Credit Kylie Johnson Photography

by James C. Sherlock

Virginia and the nation continue to see the results of the baby bust.

I wrote yesterday of the baby cliff, the 15% decline in live births that started in the great recession of 2007-09. It continues. And it continues to drive change, much of it not good.

I have written here about such important hospital changes as:

  • the closing of labor and delivery services at Virginia Beach General Hospital and elsewhere in the state; and
  • the consolidation of Neo-natal ICU (NICU) services with the integration of two hospital systems into Ballad Health in Southwestern Virginia and Northeastern Tennessee.

That too is a continuing national trend.

Today’s young people of child-bearing age will find not only fewer places to deliver a child than their parents did, but also to provide specialized care if the baby needs it. Continue reading