How is trust broken?

It may be by a sudden betrayal, but often you wake up one day and realize that the perfidy has been a long time growing to the point where you finally put the puzzle pieces together.

Despite personal experience with some dedicated and excellent teachers, I reached that point with our educational system some 30 years ago.

It took a little longer with our health care system.  About 25 years ago I began to have my doubts, a slow process that accelerated exponentially over the last three years.  I feel blessed to have two physicians in our own family, but even they, being newly-minted, have a tendency to parrot the official lines they were taught in their establishment med schools.  With time and experience, they will be great, but that doesn't mean I trust them to know best right now.

In the United States, thanks to our well-established educational rights and freedoms, it is relatively easy to obtain a good education while eschewing the conventional educational system.  Not so with medical care.  When you are extracted from an auto accident and taken to the hospital, that is not the time do insist, "leave me alone; I don't trust hospitals."  Even if you really don't trust hospitals.  I suspect that what a doctor told me many decades ago is still true:  Doctors are very good at emergency medicine; it's their approach to health in between emergencies that you can't trust.  I will elaborate in a future post on occasions where the medical establishment has failed in those interstices in my own life.  For now, it suffices to say that, malgré a few wise and compassionate doctors I know personally, my faith in our medical authorities is at an all-time low.

This was driven home to me today in a way that caught me completely by surprise.

I've been sorting through old medical records, and wondered why a urinalysis would be concerned about nitrite levels.  (I also wondered why urinalysis isn't generally done any more.  It's been longer than I can remember since a doctor asked me for a urine sample.  But that's also a question for another day.)

I posed the question to Google, and the Cleveland Clinic answered.

It seemed to me that the Cleveland Clinic should be as good a source as any, but their answer did nothing to bolster my waning confidence.  True, they let me know that nitrites in urine can be a sign of a urinary tract infection, which answered my question.  But the language in which this information was expressed made me want to flee as far as possible from this organization.

Bacteria in your urinary system cause nitrites to form in your pee. The bacteria enter your body through your urethra (the tube that carries urine out of your body). As a result, you develop a urinary tract infection (UTI).

The bacteria may travel to your bladder (the organ that holds urine), causing bladder inflammation (cystitis). From the bladder, a UTI can spread to your kidneys, the organs that make urine. This leads to a kidney infection (pyelonephritis).

Women and people assigned female at birth (AFAB) are more prone to getting nitrites in their pee. In fact, people AFAB are 30 times more likely than people AMAB to get UTIs. That’s because their shorter urethras make it easier for bacteria to enter the urethra and reach the bladder. Also, a person AFAB’s urethral opening is closer to the anus, where stool comes out. Exposure to poop containing E. coli bacteria is a common cause of UTIs.

You've got to be kidding me.  Who do they think they are talking to?  They leave you to infer from the context that "AMAB" probably means "assigned male at birth," yet think they need to explain what a bladder is?

And how am I supposed to have any confidence at all in a medical facility that uses an abomination like "people assigned female at birth"? Of all people, doctors ought to be clear about basic human biology. If the Cleveland Clinic believes that a birthing attendant's pronouncement can determine whether a baby is a boy or a girl, how can I believe anything else they might say?

(I mean, if a Supreme Court justice faltered when being asked to define the term "woman," you would certainly expect my faith in her intelligence and wisdom to be compromised, wouldn't you?  Oh, wait—that really happened, didn't it?)

And what's this "pee" and "poop" business?  Those are slang terms that might be used with very young children, or perhaps among close friends—certainly not by medical professionals who hope to be taken seriously!

Posted by sursumcorda on Wednesday, July 26, 2023 at 8:14 pm | Edit
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I may be missing your point. I assume a baby may be assigned female at birth because that is what their anatomy would indicate, even though hormones or chromosomes may indicate something else and may not be apparent at birth. If their anatomy leads them to be AFAB, then they would be more prone to have a UTI.

I agree the pee and poop business is weird.

Posted by dstb on Wednesday, July 26, 2023 at 10:12 pm

I'm the one who may be missing your point. Except in the case of very rare birth defects, no one assigns "male" or "female"—at birth or any other time. A normal baby's sex is determined very early on in gestation. Which I know you know, which is why I say I'm missing your point. If the doctor had delivered your son and declared, "I'm assigning this one female," you would have been justified in asking, "Are you drunk?"

It's true that I know of an older sibling whose job it was to announce the sex of the new baby right after it was born. He got it right, but afterwards we learned that he had made the decision based on the length of the baby's hair. Still, I don't imagine there are many birth attendants over the age of three who would make that mistake.

Posted by SursumCorda on Thursday, July 27, 2023 at 7:29 am

I believe that if you simply substitute "announce" for "assign" in these modern phrases, you will get the intended meaning.

Posted by joyful on Thursday, July 27, 2023 at 12:20 pm

I agree that the phrase would be more accurate if the "A" were for "Announced," but I think those who use the term would disagree that "announce" is what they mean. If there are people who choose to believe that human beings no longer come in two and only two distinct sexual forms, male and female (again barring the very rare birth defect), that's their business. But it's my business to choose from whom I take medical advice, and buying into the "sex assigned at birth" ideology puts a doctor on the bottom of my "trust" list. I mean, if you can't tell the difference between a boy and a girl, why should I trust you to know the difference between a vein and an artery?

Posted by SursumCorda on Thursday, July 27, 2023 at 1:31 pm

I think "assign" is the correct term because the decision made at birth has long term impacts.

What is considered a birth defect? A child missing part of their heart. I'd say yes. A child whose external anatomy appears like a girl, but whose chromosomes or hormones say a boy...I'm not convinced. I'd say it is a variation and one that is not especially common, but perhaps not as rare as one might think.

I think gender is much more complex than I learned in my biology class in high school.

Posted by dstb on Thursday, July 27, 2023 at 2:51 pm

I would call a "disorder of sexual development" (from the article) a birth defect, yes. Sometimes things go wrong. I'd agree that "assign" is the correct word in the case where (again from the article) doctors choose to "correct" the external genitalia by surgery and therefore must choose to mimic male or female. But in such cases one is "fixing" a birth defect, as one might fix a malformed heart.

Is that a good idea, in the case where (if possible) all the parts are in good working order? I don't know. Quite possibly not, even if some of the parts don't work properly, since the human body is a complex system, and we don't know what else the disorder has affected and how. There is a localized genetic disorder—in the Dominican Republic, I believe, but don't hold me to that—in which some children appear to be normal girls until puberty, but then develop as males. It is a disorder, but one to which their society has apparently adapted, without resorting to surgery or other drastic interventions.

I know that some babies are born with more than five fingers, and the extra digits are usually removed at an early age. Is that a good thing? Perhaps, if the digits are non-functional, and the removal would help the hand develop more normally. But if they work—well, extra digits might be handy. (Sorry, not sorry.)

I'll grant that there are a few, a very few, disorders in which one might make a mistake at birth about the baby's sex. But that's no reason to confuse the world by going away from the binary male/female model that has worked since humans began—and for other mammals long before that. I have a friend whose leg was amputated below the knee due to cancer, a factor important to know for her medical care. But wouldn't you think it crazy if articles written about foot problems kept adding, "unless you're an amputee"?

Posted by SursumCorda on Thursday, July 27, 2023 at 5:04 pm

It's very wholesome to assume the "assigned felae/male" thing is about rare birth defects. Unfortunately, that's not what they mean. It's a political positioning statement.

The Cleveland Clinic is still reeling from getting slapped down by the CDC last year. They thought they would publish their booster numbers, how many injections people had and how their immune systems responded. 50,000 employees. The records clearly showed certain trends that don't fit the proscribed narrative. It's possible the AMA gods are making them do penance.

Posted by Brenda on Sunday, July 30, 2023 at 4:30 pm

However one might interpret the methodology and data from the multitude of new and ongoing studies concerning COVID and the vaccines—or any subject at all for that matter—one thing is absolutely and indisputably clear: Democracy is not the only thing that dies in darkness; science (and thus medicine) are equally victims. Progress is made through openness, sharing, debate, and respecting dissent, all of which is in very short supply these days.

Posted by SursumCorda on Monday, July 31, 2023 at 7:58 am
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