Browsing Date

June 2015


Bench to Bedside: How the Supreme Court Decisions this Week Affect Endocrinologists

June 28, 2015 • By

June 25 and 26, 2015 stand as Morality Markers for the United States. How does the ruling on the Affordable Care Act (King v. Burwell) and marriage equality (Obergefell v. Hodges) affect ethical issues in everyday endocrinology?

The ACA Ruling:

This ruling was about healthcare access for millions of American patients. The question was whether patients who purchased health insurance through the federal exchanges — in states refusing to set up their own exchanges—could keep their subsidies. Several states refused to set up their own exchanges due to partisan politics. But keeping federal subsidies is what made this care accessible for patients. After the ACA passed, endocrinologists were starting to see the impact on the uninsured. For the first time, they were seeing new patients with prolonged and severe endocrine diseases that had gone undiagnosed and untreated. Patients first presenting with severe diabetes and hypothyroidism were finally getting access to care; patients with aggressive thyroid cancers were able to get surgery and post-surgical treatment. Had the Supreme Court ruled in favor of the plaintiff, the payment structure that enabled truly affordable health insurance premiums, would have gone away, affecting care for untold thousands of endocrine patients in dramatic ways.

Now that major challenges to the ACA are over, we still need to work on improving the law:

Nor is the law immune from sabotage:

Marriage Equality:

Surrogate decision-making is governed by state law, and many states follow the family hierarchy surrogacy laws, in which surrogate decisions are automatically designated to family members on a hierarchy unless otherwise stated in Advance Directives. The first family member on the hierarchy is typically the legal spouse. However, in states that had banned, or did not recognize same sex marriage, same sex spouses needed to specifically designate one another in Advance Directives, which was a burden heterosexual couples did not need to assume. While endocrinologists are not typically engaged in critical care, many endocrine patients require surrogate decision-makers, particularly when hospitalized. Here are some common examples:

  • Poorly controlled diabetes patients
  • Thyroid cancer patients requiring surgical management
  • Impaired hypothyroid patients (See:

Finally, gay  patients who are married no longer have to worry that their spouses will be passed over as a surrogate decision-maker when they do not have full capacity.


Ethics of Authorship: What’s So New About the Upcoming Clinical Practice Guidelines for Menopause : They’re Written by Women

June 14, 2015 • By

When I attended the 2015 Endocrine Society meeting in San Diego, I was struck by the sessions about the upcoming clinical practice guideline on menopause (Treatment of Symptoms of the Menopause): they were authored by women. Here’s an interview with Cynthia Stuenkel, MD, Chair of the Menopause Clinical Practice Guidelines Taskforce for the Endocrine Society:

Ethically, does gender really matter when it comes to producing evidence-based practice guidelines on menopause? Yes. It does when it’s about menopause.

When considering beneficent therapies for peri and post-menopausal women, it’s still difficult for male practitioners to understand and appreciate subtle and nuanced qualitative differences in menopause symptoms. The most caring and sensitive male practitioner has still never experienced an ordinary period and cramps, flooding, hot flashes, and bloating. And for many women reaching their career peaks in peri- and post-menopause, it’s difficult for males to imagine these symptoms while chairing a meeting or making a major presentation. Several professional women in this phase of life pack plenty of red clothing (pant suits, dresses, or skirts) when traveling because of the unpredictable nature of their menses.

From a medical sociological perspective, women bond over their uterine experiences. Transgendered females (who transitioned from males) have noted the differences in intimacy between female and male friendships, for example: women talk about their bodies. Women who don’t know each other may immediately share information about the state of their uterine health in a public bathroom or private boardroom.

Clinical practice guidelines authored by female experts in menopause hormone therapy may help to ensure that patients’ reported symptoms help to guide goals of treatment. At the same time, patients may begin to place trust in evidence-based guidelines for hormone therapy when they can no longer just brush them off as a “male-dominated industry”.