What Your Doctor Wants You to Know to Crush Medical Debt – by Dr. Virgie Ellington
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First things first: this one’s really only of relevance to people living in the US. That’s most of our readership, but if it’s not you, then apologies, this one won’t be of interest.
For the US Americans, though, Dr. Ellington starts strong with “you got a bill—now get the right bill”, and then gives a step-by-step process for finding the mistakes in your medical bills, fixing them, dealing with insurers who do not want to live up to their part of the bargain, and how to minimize what you need to pay, when you actually arrive at your final bill.
The biggest strength of this book is the wealth of insider knowledge (the author has worked as a primary care physician as well as as a health insurance executive), and while this information won’t stay current forever, its relatively recent publication date (2022) means that little has changed since then, and once you’re up to speed with how things are now, it’ll be easy to roll with whatever changes may come in the future.
Bottom line: if you’re living in the US and would like to not be ripped off as badly as possible when it comes to healthcare costs, this book is a very small, very powerful, investment.
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Can a child legally take puberty blockers? What if their parents disagree?
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Young people’s access to gender-affirming medical care has been making headlines this week.
Today, federal Health Minister Mark Butler announced a review into health care for trans and gender-diverse children and adolescents. The National Health and Medical Research Council will conduct the review.
Yesterday, The Australian published an open letter to Prime Minister Anthony Albanese calling for a federal inquiry, and a nationwide pause on puberty blockers and hormone therapy for minors.
This followed Queensland Health Minister Tim Nicholls earlier this week announcing an immediate pause on access to puberty blockers and hormone therapies for new patients under 18 in the state’s public health system, pending a review.
In the United States, President Donald Trump signed an executive order this week directing federal agencies to restrict access to gender-affirming care for anyone under 19.
This recent wave of political attention might imply gender-affirming care for young people is risky, controversial, perhaps even new.
But Australian courts have already extensively tested questions about its legitimacy, the conditions under which it can be provided, and the scope and limits of parental powers to authorise it.
MirasWonderland/Shutterstock What are puberty blockers?
Puberty blockers suppress the release of oestrogen and testosterone, which are primarily responsible for the physical changes associated with puberty. They are generally safe and used in paediatric medicine for various conditions, including precocious (early) puberty, hormone disorders and some hormone-sensitive cancers.
International and domestic standards of care state that puberty blockers are reversible, non-harmful, and can prevent young people from experiencing the distress of undergoing a puberty that does not align with their gender identity. They also give young people time to develop the maturity needed to make informed decisions about more permanent medical interventions further down the line.
Puberty blockers are one type of gender-affirming care. This care includes medical, psychological and social interventions to support transgender, gender-diverse and, in some cases, intersex people.
Young people in Australia need a medical diagnosis of gender dysphoria to receive this care. Gender dysphoria is defined as the psychological distress that can arise when a person’s gender identity does not align with their sex assigned at birth. This diagnosis is only granted after an exhaustive and often onerous medical assessment.
After a diagnosis, treatment may involve hormones such as oestrogen or testosterone and/or puberty-blocking medications.
Hormone therapies involving oestrogen and testosterone are only prescribed in Australia once a young person has been deemed capable of giving informed consent, usually around the age of 16. For puberty blockers, parents can consent at a younger age.
Gender dysphoria comes with considerable psychological distress. slexp880/Shutterstock Can a child legally access puberty blockers?
Gender-affirming care has been the subject of extensive debate in the Family Court of Australia (now the Federal Circuit and Family Court).
Between 2004 and 2017, every minor who wanted to access gender-affirming care had to apply for a judge to approve it. However, medical professionals, human rights organisations and some judges condemned this process.
In research for my forthcoming book, I found the Family Court has heard at least 99 cases about a young person’s gender-affirming care since 2004. Across these cases, the court examined the potential risks of gender-affirming treatment and considered whether parents should have the authority to consent on their child’s behalf.
When determining whether parents can consent to a particular medical procedure for their child, the court must consider whether the treatment is “therapeutic” and whether there is a significant risk of a wrong decision being made.
However, in a landmark 2017 case, the court ruled that judicial oversight was not required because gender-affirming treatments meet the standards of normal medical care.
It reasoned that because these therapies address an internationally recognised medical condition, are supported by leading professional medical organisations, and are backed by robust clinical research, there is no justification for treating them differently from any other standard medical intervention. These principles still stand today.
What if parents disagree?
Sometimes parents disagree with decisions about gender-affirming care made by their child, or each other.
As with all forms of health care, under Australian law, parents and legal guardians are responsible for making medical decisions on behalf of their children. That responsibility usually shifts once those children reach a sufficient age and level of maturity to make their own decisions.
However, in another landmark case in 2020, the court ruled gender-affirming treatments cannot be given to minors without consent from both parents, even if the child is capable of providing their own consent. This means that if there is any disagreement among parents and the young person about either their capacity to consent or the legitimacy of the treatment, only a judge can authorise it.
In such instances, the court must assess whether the proposed treatment is in the child’s best interests and make a determination accordingly. Again, these principals apply today.
If a parent disagrees with their child, the matter can go to court. PeopleImages.com – Yuri A/Shutterstock Have the courts ever denied care?
Across the at least 99 cases the court has heard about gender-affirming care since 2004, 17 have involved a parent opposing the treatment and one has involved neither parent supporting it.
Regardless of parental support, in every case, the court has been responsible for determining whether gender-affirming treatment was in the child’s best interests. These decisions were based on medical evidence, expert testimony, and the specific circumstances of the young person involved.
In all cases bar one, the court has found overwhelming evidence to support gender-affirming care, and approved it.
Supporting transgender young people
The history of Australia’s legal debates about gender-affirming care shows it has already been the subject of intense legal and medical scrutiny.
Gender-affirming care is already difficult for young people to access, with many lacking the parental support required or facing other barriers to care.
Gender-affirming care is potentially life-saving, or at the very least life-affirming. It almost invariably leads to better social and emotional outcomes. Further restricting access is not the “protection” its opponents claim.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. For LGBTQIA+ peer support and resources, you can also contact Switchboard, QLife (call 1800 184 527), Queerspace, Transcend Australia (support for trans, gender-diverse, and non-binary young people and their families) or Minus18 (resources and community support for LGBTQIA+ young people).
Matthew Mitchell, Lecturer in Criminology, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Senior Meetup Groups Combating Loneliness
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
“I would like to read more on loneliness, meetup group’s for seniors. Thank you”
Well, 10almonds is an international newsletter, so it’s hard for us to advise about (necessarily: local) meetup groups!
But a very popular resource for connecting to your local community is Nextdoor, which operates throughout the US, Canada, Australia, and large parts of Europe including the UK.
In their own words:
Get the most out of your neighborhood with Nextdoor
It’s where communities come together to greet newcomers, exchange recommendations, and read the latest local news. Where neighbors support local businesses and get updates from public agencies. Where neighbors borrow tools and sell couches. It’s how to get the most out of everything nearby. Welcome, neighbor.
Curious? Click here to check it out and see if it’s of interest to you
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Why Going Gluten-Free Could Be A Bad Idea
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Is A Gluten-Free Diet Right For You?
This is Rachel Begun, MS, RD. She’s a nutritionist who, since her own diagnosis with Celiac disease, has shifted her career into a position of educating the public (and correcting misconceptions) about gluten sensitivity, wheat allergy, and Celiac disease. In short, the whole “gluten-free” field.
First, a quick recap
We’ve written on this topic ourselves before; here’s what we had to say:
On “Everyone should go gluten-free”
Some people who have gone gluten-free are very evangelical about the lifestyle change, and will advise everyone that it will make them lose weight, have clearer skin, more energy, and sing well, too. Ok, maybe not the last one, but you get the idea—a dietary change gets seen as a cure-all.
And for some people, it can indeed make a huge difference!
Begun urges us to have a dose of level-headedness in our approach, though.
Specifically, she advises:
- Don’t ignore symptoms, and/but…
- Don’t self-diagnose
- Don’t just quit gluten
One problem with self-diagnosis is that we can easily be wrong:
But why is that a problem? Surely there’s not a health risk in skipping the gluten just to be on the safe side? As it turns out, there actually is:
If we self-diagnose incorrectly, Begun points out, we can miss the actual cause of the symptoms, and by cheerfully proclaiming “I’m allergic to gluten” or such, a case of endometriosis, or Hashimoto’s, or something else entirely, might go undiagnosed and thus untreated.
“Oh, I feel terrible today, there must have been some cross-contamination in my food” when in fact, it’s an undiagnosed lupus flare-up, that kind of thing.
Similarly, just quitting gluten “to be on the safe side” can mask a different problem, if wheat consumption (for example) contributed to, but did not cause, some ailment.
In other words: it could reduce your undesired symptoms, but in so doing, leave a more serious problem unknown.
Instead…
If you suspect you might have a gluten sensitivity, a wheat allergy, or even Celiac disease, get yourself tested, and take professional advice on proceeding from there.
How? Your physician should be able to order the tests for you.
You can also check out resources available here:
Celiac Disease Foundation | How do I get tested?
Or for at-home gluten intolerance tests, here are some options weighed against each other:
MNT | 5 gluten intolerance tests and considerations
Want to learn more?
Begun has a blog:
Rachel Begun | More than just recipes
(it is, in fact, just recipes—but they are very simple ones!)
You also might enjoy this interview, in which she talks about gluten sensitivity, celiac disease, and bio-individuality:
Want to watch it, but not right now? Bookmark it for later
Take care!
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Ashwagandha: The Root of All Even-Mindedness?
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Ashwagandha: The Root Of All Even-Mindedness?
In the past few years, Ashwagandha root has been enjoying popular use in consumer products ranging from specialist nootropic supplement stacks, to supermarket teas and hot chocolates.
This herb is considered to have a calming effect, but the science goes a lot deeper than that. Let’s take a look!
Last summer, a systematic review was conducted, that asked the question:
Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress?
While they broadly found the answer was “yes”, they expressed low confidence, and even went so far as to say there was contradictory evidence. We (10almonds) were not able to find any contradictory evidence, and their own full article had been made inaccessible to the public, so we couldn’t double-check theirs.
We promptly did our own research review, and we found many studies this year supporting Ashwaghanda’s use for the management of anxiety and stress, amongst other benefits.
First, know: Ashwagandha’s scientific name is “Withania somnifera”, so if you see that (or a derivative of it) mentioned in a paper or extract, it’s the same thing.
Onto the benefits…
A study from the same summer investigated “the efficacy of Withania somnifera supplementation on adults’ cognition and mood”, and declared that:
“in conclusion, Ashwagandha supplementation may improve the physiological, cognitive, and psychological effects of stress.”
We notice the legalistic “may improve”, but the data itself seems more compelling than that, because the study showed that it in fact “did improve” those things. Specifically, Ashwagandha out-performed placebo in most things they measured, and most (statistically) significantly, reduced cortisol output measurably. Cortisol, for any unfamiliar, is “the stress hormone”.
Another study that looked into its anti-stress properties is this one:
Ashwagandha Modulates Stress, Sleep Dynamics, and Mental Clarity
This study showed that Ashwagandha significantly outperformed placebo in many ways, including:
- sleep quality
- cognitive function
- energy, and
- perceptions of stress management.
Ashwagandha is popular among students, because it alleviates stress while also promising benefits to memory, attention, and thinking. So, this study on students caught our eye:
Their findings demonstrated that Ashwagandha increased college students’ perceived well-being through supporting sustained energy, heightened mental clarity, and enhanced sleep quality.
That was about perceived well-being and based on self-reports, though
So: what about hard science?
A later study (in September) found supplementation with 400 mg of Ashwagandha improved executive function, helped sustain attention, and increased short-term/working memory.
Read the study: Effects of Acute Ashwagandha Ingestion on Cognitive Function
❝But aside from the benefits regarding stress, anxiety, sleep quality, cognitive function, energy levels, attention, executive function, and memory, what has Ashwagandha ever done for us?❞
Well, there have been studies investigating its worth against depression, like this one:
Can Traditional Treatment Such as Ashwagandha Be Beneficial in Treating Depression?
Their broad answer: Ashwagandha works against depression, but they don’t know how it works.
They did add: “Studies also show that ashwagandha may bolster the immune system, increase stamina, fight inflammation and infection, combat tumors*, reduce stress, revive the libido, protect the liver and soothe jangled nerves.
That’s quite a lot, including a lot of physical benefits we’ve not explored in this research review which was more about Ashwagandha’s use as a nootropic!
We’ve been focusing on the more mainstream, well-studied benefits, but for any interested in Ashwagandha’s anti-cancer potential, here’s an example:
Evaluating anticancer properties of [Ashwagandha Extract]-a potent phytochemical
In summary:
There is a huge weight of evidence (of which we’ve barely skimmed the surface here in this newsletter, but there’s only so much we can include, so we try to whittle it down to the highest quality most recent most relevant research) to indicate that Ashwagandha is effective…
- Against stress
- Against anxiety
- Against depression
- For sleep quality
- For memory (working, short-term, and long-term)
- For mental clarity
- For attention
- For stamina
- For energy levels
- For libido
- For immune response
- Against inflammation
- Against cancer
- And more*
*(seriously, this is not hyperbole… We didn’t even look at its liver-protective functions, for instance)
Bottom line:
You’d probably like some Ashwagandha now, right? We know we would.
We don’t sell it (or anything else, for that matter), but happily the Internet does:
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Food Fix – by Dr. Mark Hyman
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On a simplistic level, “eat more plants, but ideally not monocrops, and definitely fewer animals” is respectable, ecologically-aware advice that is also consistent with good health. But it is a simplification, and perhaps an oversimplification.
Is there space on a healthy, ecologically sound plate for animal products? Yes, argues Dr. Mark Hyman. It’s a small space, but it’s there.
For example, some kinds of fish are both healthier and more sustainable as a food source than others, same goes for some kinds of dairy products. Poultry, too, can be farmed sustainably in a way that promotes a small self-contained ecosystem—and in terms of health, consumption of poultry appears to be health-neutral at worst.
As this book explores:
- Oftentimes, food choices look like: healthy/sustainable/cheap (choose one).
- Dr. Hyman shows how in fact, we can have it more like: healthy/sustainable/cheap (choose two).
- He argues that if more people “vote with their fork”, production will continue to adjust accordingly, and we’ll get: healthy/sustainable/cheap (all three).
To this end, while some parts of the book can feel like they are purely academic (pertaining less to what we can do as individuals, and more on what governments, farming companies, etc can do), it’s good to know what issues we might also take to the ballot box, if we’re able.
The big picture aside, the book remains very strong even just from an individual health perspective, though.
Bottom line: if you have an interest in preserving your own health, and possibly humanity itself, this is an excellent book.
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Scheduling Tips for Overrunning Tasks
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Your Questions, Our Answers!
Q: Often I schedule time for things, but the task takes longer than I think, or multiplies while I’m doing it, and then my schedule gets thrown out. Any ideas?
A: A relatable struggle! Happily, there are remedies:
- Does the task really absolutely need to be finished today? If not, just continue it in scheduled timeslots until it’s completed.
- Some tasks do indeed need to be finished today (hi, writer of a daily newsletter here!), so it can be useful to have an idea of how long things really take, in advance. While new tasks can catch us unawares, recurring or similar-to-previous tasks can be estimated based on how long they took previously. For this reason, we recommend doing a time audit every now and again, to see how you really use your time.
- A great resource that you should include in your schedule is a “spare” timeslot, ideally at least one per day. Call it a “buffer” or a “backup” or whatever (in my schedule it’s labelled “discretionary”), but the basic idea is that it’s a scheduled timeslot with nothing scheduled in it, and it works as an “overflow” catch-all.
Additionally:
- You can usually cut down the time it takes you to do tasks by setting “Deep Work” rules for yourself. For example: cut out distractions, single-task, work in for example 25-minute bursts with 5-minute breaks, etc
- You can also usually cut down the time it takes you to do tasks by making sure you’re prepared for them. Not just task-specific preparation, either! A clear head on, plenty of energy, the resources you’ll need (including refreshments!) to hand, etc can make a huge difference to efficiency.
See Also: Time Optimism and the Planning Fallacy
Do you have a question you’d like to see answered here? Hit reply or use the feedback widget at the bottom; we’d love to hear from you!
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