Medical Controversy Research Articles

Perspectives on conducting "sex-normalising" intersex surgeries conducted in infancy: A systematic review.

Children with intersex variations continue to be subject to elective, irreversible, "sex-normalising" surgical interventions, despite multiple human rights and legislative bodies calling for their prohibition. Our systematic review aims to understand how medical literature reports rationales for "sex-normalising" surgical interventions conducted in childhood, and how they are contextualised within the medical and social controversy surrounding such interventions. PubMed, EMBASE and CINAHL were searched for English language, peer-reviewed articles reporting primary data on elective, genital, "sex-normalising" surgical interventions conducted on individuals <10 years, published 01/07/2006-30/06/2023 (PROSPERO ID: CRD42023460871). Data on outcomes reported, rationale for the conduct and timing of interventions and acknowledgement of controversy were extracted. Narrative synthesis described rationales and controversy. Risk of bias was assessed using Johanna Briggs Institute Tools. 11,042 records were retrieved, with 71 articles included for analysis. One of the most common outcomes collected in included literature were cosmetic outcomes, primarily reported by surgeons or parents. 62.0% of studies reported no rationale for intervention timing, 39.4% reported no rationale for conduct and 52.1% acknowledged no controversy in intervention conduct. Rationales included parental desire for intervention, anatomical/functional/cosmetic reasons, and a perceived goal of aligning with sex assigned by surgical teams or parents. Controversies addressed included concerns about the quality of interventions, the ethics of intervention conduct and gendered and social considerations. "Sex-normalising" interventions are conducted based largely on rationales that were not adequately supported by evidence, a desire from parents and surgeons to match genital cosmesis typically ascribed to male and female bodies, and a parental desire for intervention conduct. Legislating and medical regulatory bodies should advocate for ending the conduct of irreversible, elective, "sex-normalising" interventions conducted without the full, free and informed consent of the person concerned, to promote and protect the highest attainable standard of health for people with intersex variations.

Obstetrics during the French Revolution: political and medical controversies around the new obstetrical surgery

ABSTRACT During the French Revolution, obstetrics underwent substantial transformations in practice, teaching, and the physical spaces where it was conducted. The revolutionary authorities implemented reforms in French medical institutions that promoted an instrument-centred style and the dissemination of novel surgical techniques in obstetrics. The selection of professors for the obstetrics chair at the newly established École de santé and the appointment of chiefs for the new maternity ward in Paris favoured proponents of a mechanistic approach to labour assistance. This essay explores the theoretical principles and societal pressures that guided these transformative reforms and the remarkable changes they introduced in healthcare and in the practise of medicine and surgery. Furthermore, it examines the consolidation of new epistemological, ethical, and professional boundaries within the context of late eighteenth-century French obstetrics. A critical section of this study focuses on the debate ignited by the contemporaries who voiced concerns that the rise of surgical interventions on pregnant women's bodies might result in unwarranted violence, in a diminishing of midwives’ roles, and in a departure from the tradition of natural childbirth. These controversies among obstetricians highlight significant contradictions within the Revolutionary medical reforms.

Factors Influencing COVID-19 Vaccine Confidence and Uptake in Australian Adults.

In January 2021, Australia initiated a national COVID-19 vaccine rollout strategy but faced setbacks, leading to negative press and media controversy, which may have diminished vaccine confidence. This study aimed to assess the factors influencing vaccine confidence in Australian adults (≥18 years of age) following the administration of a COVID-19 vaccine. Conducted at Blacktown Hospital, Sydney, a cross-sectional survey with 1053 respondents gauged vaccine confidence and influencing factors. The results showed overall high confidence (mean score 33/40). Trusted sources included the Australian Department of Health (77.8%), NSW Health (76.7%), and general practitioners (53.7%), while social media was distrusted (5.9%). The motivations for vaccination varied: university-educated individuals prioritised personal health (X2 = 17.81; p < 0.001), while religious and/or older respondents (≥50 years of age) emphasised community (X2 = 11.69; p < 0.001) and family protection (X2 = 17.314; p < 0.001). Multivariate logistic regression revealed use of the Australian Department of Health website as a trusted source of COVID-19 information as the strongest predictor of high confidence (>30; OR 1.43; p = 0.041), while exposure to fake news decreased confidence (OR 0.71; p = 0.025). The study underscores the importance of reliable health information sources in bolstering vaccine confidence and highlights the detrimental effects of misinformation. Promoting awareness of trustworthy health channels is crucial to combat vaccine hesitancy in Australia.

Social media controversies call for nonprofit leaders to walk a fine line on freedom of expression

Today, it's all too easy for a public utterance by a nonprofit's staff, leadership or board to be taken out of context and used against the organization. Even seemingly benign posts on social media can quickly cause controversy for the group, and spread far and wide before anything can be done about it.

Satire in Eighteenth-Century Medical Discourse: Elizabeth Nihell, Tobias Smollett and the Advent of Man-Midwifery

ABSTRACT This paper examines Tobias Smollett’s scathing assessment in the Critical Review of Elizabeth Nihell’s midwifery treatise, Treatise on the Art of Midwifery (1760), a polemic against the use of instruments in childbirth and the increasing popularity of man-midwifery. This continues with Nihell publishing a response to Smollett’s review, and then Smollett responding to Nihell’s response. The Nihell-Smollett exchange brings discourses surrounding two concomitant medical controversies – the use of instruments in childbirth and the presence of men in the birthing chamber – to the fore, and it is particularly remarkable due to the satirical tone adopted in this exchange, particularly by Smollett. Using Simpson’s model of satirical discourse, this paper explores the textual-linguistic practices adopted by both Smollett and Nihell and elucidates how satire both construes and is construed by rival medical ideologies in mid-eighteenth-century England.

Honest to God in context

This article explores the cultural and social context of Honest to God. It focuses on the media controversy about the book, and broader 1960s debates about permissiveness and secularization.

Feigning Indignance, Reinstating Power: Paradigm Repair and the Publishing of Ingrid Escamilla’s Murdered Body in the Mexican Press

ABSTRACT This study sheds light on the media controversy in Mexico surrounding the publishing of photos of Ingrid Escamilla’s murdered body. Using a theoretical lens that integrates paradigm repair and decolonial feminist thought, we interrogate how four of Mexico’s most read news publications, namely Reforma, El Universal, Excelsior, and Milenio, attempted to reify their journalistic paradigm in the midst of high threat. Through a multimodal critical discourse analysis of 71 news articles, we identified four different processes of paradigm repair that are deeply tied to larger hegemony-building processes. These include diverting responsibility away from media and unto others; making explicit a boundary between “low-tier” tabloid-style newspapers that leaked the photos and “respectable” media that ascribe to Western tenets; sanitizing gore to uphold the paradigm; and an overt focus on a new law proposed by the Mexican state as the “solution” to this “anomalous act.” The study elucidates how these instances of metajournalistic reflection - beyond reinstating journalistic legitimacy and hegemony - produce and reinforce a binary between valid and invalid forms of knowledge and reinforce the media’s institutional alliances to the state.

Transcending texts and contexts: methodology to investigate media controversies

Transcending texts and contexts: methodology to investigate media controversies

Emergency Contraception: Ongoing Medical, Pharmacological, Political, and Ethical Controversies

The aim of the critical analysis is an illumination of unresolved issues on Emergency Contraception (EC). This form of contraception has been offered as an effective method of birth control to women since the end of the last century. At present -- in the post-Roe generation where access to abortion has been restricted -- the interest in EC is increasing. It is important therefore to provide accurate and complete information on which prospective users of EC can rely. Material and Metho The material encompasses documents issued by leading health authorities -- such as the World Health Organization (WHO), the US Food and Drug Administration (FDA), and the US Centers for Disease Control and Prevention (CDC) -- as well as research articles published in high-ranked scientific journals. This material is assessed by a critical analysis which compares the discrepancies in data provided and in claims made. Results The result is evidence of publications containing unreliable claims and conflicting views on some of the most salient aspects of EC such as safety, efficacy, mode of action, drug-drug interactions, legislation on abortion medication, and ethical discussions on the protection of life. Implications Consumers and patients should be critical towards claims made by health agencies and rather rely on high-level research in the area of pharmacovigilance and on publications by legal experts.

Celebrity myth-making: from Marilyn M. to Kim K

ABSTRACT In May 2022, at the annual Met Gala, Kim Kardashian made an appearance in the iconic dress worn by Marilyn Monroe at President John F. Kennedy’s birthday celebration in 1962. Controversy ensued, relating both to the actual wearing of the dress and to the celebrity status of Kim vs. Marilyn and whether Kardashian had the moral and cultural right to wear the dress. In the aftermath of the Met Gala, debates about the ways in which the two stars are perceived emerged, particularly in media. The Kardashians have been a topic for the tabloids for around 15 years, with the initial rise to fame on Kim’s part taking place through a leaked sex tape. The popular image of Marilyn Monroe combined innocence and unattainability while being the ultimate sex symbol of the 1950s and early 1960s. This paper examines the construction of the celebrity myth in relation to Kim Kardashian and Marilyn Monroe as presented in media and research, with focus on the notion of the sex symbol. Kardashian’s recent Met Gala appearance along with subsequent media attention and controversy indicates that further analysis is warranted of the intricate connections between the two celebrities.

Complexity and controversy in media coverage of Human papillomavirus (HPV) vaccination: A qualitative content analysis of news coverage in Denmark 2008–2018

IntroductionTraditional news media play an important, yet notoriously complex role in vaccination communication. News media remain a common source of information about vaccines and potentially influence individual decisions to choose vaccination or not. In Denmark, Human papillomavirus (HPV) vaccination rates remained relatively high until suspected adverse reactions began to receive extensive coverage in the news. Existing research studies associate the decline in HPV vaccination rates with misleading or negative news stories.MethodsWe probed Danish media coverage beyond dichotomies such as misleading vs. informative, or negative vs. positive. We combined quantitative and qualitative approaches to media coverage of the Danish HPV vaccination crisis and recovery. Our research design focused on six national newspapers and allowed us to identify 865 articles published in periods of peak media coverage from 2008 to 2018 (extracted from a total sample of 1,437 articles published between 1991 and 2019). We used qualitative content analysis to discern the main topics covered, and we analyzed contextual factors that affected the meanings of our main topics.ResultsOur results confirm the rise of suspected adverse reactions as the dominant main topic in 2015. However, we find that news stories about adverse reactions were diverse and closely related to other main topics such as conflicts of interests and debate among experts and other stakeholders. In 2017, the media began downplaying suspected adverse reactions when concerns about declining vaccination rates and misinformation by the media were voiced.DiscussionOur findings suggest that controversial media messages about vaccination are hard to classify as either negative or positive but must be interpreted carefully in context of what is known about the controversy. Learning from past media controversies remains important to understanding the media's role in the social construction of risks and benefits associated with vaccination.

"Heroin Mothers," "Methadone Babies," and the Medical Controversy over Methadone Maintenance in the Early 1970s.

This article situates the emergence of sensationalized news reports of "infant addicts" and the concurrently evolving study of neonatal drug withdrawal within the context of the expansion of methadone maintenance treatment (MMT) in the United States. It details how, in the early 1970s, concerns about pregnant narcotic addicts and their infants became part of the politically charged debate over methadone maintenance. The popular press amplified the apprehensions of a vocal group of pediatricians who saw in infants' withdrawal an indication of methadone's inherent harmfulness and potential toxicity. Increased access to MMT and its presumed normalizing effects on reproductive functions augmented these concerns. The ensuing controversy led clinical researchers to define, measure, and systematically study "neonatal abstinence syndrome," whereas the emerging media trope of the infant drug addict effectively undermined the claims made by MMT's proponents about the drug's therapeutic utility.

Mathematical and Statistical Modelling for Assessing COVID-19 Superspreader Contagion: Analysis of Geographical Heterogeneous Impacts from Public Events

During a pandemic, public discussion and decision-making may be required in face of limited evidence. Data-grounded analysis can support decision-makers in such contexts, contributing to inform public policies. We present an empirical analysis method based on regression modelling and hypotheses testing to assess events for the possibility of occurrence of superspreading contagion with geographically heterogeneous impacts. We demonstrate the method by evaluating the case of the May 1st, 2020 Demonstration in Lisbon, Portugal, on regional growth patterns of COVID-19 cases. The methodology enabled concluding that the counties associated with the change in the growth pattern were those where likely means of travel to the demonstration were chartered buses or private cars, rather than subway or trains. Consequently, superspreading was likely due to travelling to/from the event, not from participating in it. The method is straightforward, prescribing systematic steps. Its application to events subject to media controversy enables extracting well founded conclusions, contributing to informed public discussion and decision-making, within a short time frame of the event occurring.

If the evidence is not research, what is it? Egyptian physicians’ explanations of the lack of research citations in their health vlogs

Doctor-influencers have the knowledge needed to understand scientific research, and they have the social media popularity to share it with large audiences. In this article, I explore the treatment of evidence in vlogs by Egyptian doctor-influencers: how they present it and what they use instead of it. I answer the following questions: 1) How do doctor-influencers present evidence on social media? 2) If research is not the evidence, what the evidence is? The data was collected through in-depth interviews with 12 Egyptian doctor-influencers from different specializations; two focus groups; and a critical discourse analysis of 48 of the influencers’ most popular and most engaging videos. I found that the doctor-influencers cited academic research only in the videos about medical controversies, new treatments, misinformation, or common medical mistakes. In most of their videos, the Egyptian doctor-influencers scarcely referred to medical research. This is because they believe that their audiences would not understand the evidence due to their low educational attainment, weak research skills, and the language barrier (as most medical research is published in English rather than Arabic). These findings highlight the challenges of communicating science in societies with a low level of education. In these settings, communicators may need to move beyond mediating research studies on social media and instead focus on simplifying, translating, and connecting evidence-based information to the cultural context.

Constructing the ADHD Child in Historical Children’s Literature

In this article, debates around ideas of childhood and disability will be engaged through the close reading of the retrospective diagnosis of a child with ADHD in an early work of German children’s literature (also widely translated, including into English in 1848), Heinrich Hoffmann’s poem Struwwelpeter. ADHD is one of the most widely diagnosed and medicated childhood developmental disorders of the present day. At the same time, recent debates have raised questions about the diagnostic criteria, the potential side effects and efficacy of medication, and the impact of the current political context on the diagnosis and treatment of ADHD. Drawing on Michel Foucault’s classic arguments about bio-power (2008), as well as the most recent work of critical psychology on childhood developmental disorders, the article draws out both how retrospective diagnoses of ADHD and other disorders, including Autistic Spectrum Disorder (ASD), are defined by current criteria within the political context of the current psychological, cultural, and medical controversies.

Analyzing COVID-19 Vaccine Hesitancy in the United States and Possible Mitigations Through the Lens of Behavioral Economics

During the current pandemic, vaccine hesitation is rapidly spreading through social media controversies. Despite the reassurance of medical professionals, heuristics from behavioral economics impose irrational thinking that leads to false interpretations of the news. This research paper analyzes the effect heuristics have on COVID-19 vaccination rates in the United States through a series of experiments and data analysis. Specifically, I will define confirmation bias, risk perception, availability bias, and status quo bias, and thoroughly discuss their relation to decision making. This paper also strives to explore framing and loss aversion among different age groups and provide refined, age-specific policies that the government can incorporate to increase vaccinations in America.

Networks of Alterity in Syndemic Times: Sociodigital Media Controversy Around Racism in Mexico

ABSTRACT This contribution seeks to contextualize historically a particular conjuncture through which significant changes to the national formation of alterities are expressed and performed by different media outlets and socio-digital networks as the COVID-19 pandemic arrived in Mexico. By analysing three significant media events – which have triggered a broader discussion about racism, ethnicity, mestizaje, media and politics in Mexico – I argue for the need to develop a theoretical framework able to account for the constitutive relations between communication technologies, culture industries and singular articulations of local, regional, and cosmopolitan practices of inclusion/exclusion, at a time when notions of indigeneity, afromexicanidad, whiteness and mestizaje are being reshaped politically.

Un mineur peut-il consentir à un parcours de transition médicale?

As hundreds of so-called transgender children and teenagers enter “medical transition” processes with serious consequences, the relevance of the application of the rules of the Public Health Code relating to patient information and consent must be questioned : to what extent are these young minors capable of understanding the information provided and giving free and informed consent to these programmes?The medical controversies that have arisen concerning the consequences of the medical transition processes, the experimental nature of which has been pointed out, raise serious doubts about the quality, reliability and fairness of the information given. Furthermore, is the complexity of the information communicated to minors who have no life experience, the eagerness of young patients, the influence of social networks, and the censure attached to possible therapeutic alternatives compatible with the capacity to give free and informed consent?Finally, if it is not a question of treating a pathology but of “concretising the right to self-determination”, can we still claim the application of rules specific to the medical field? If there is no medical necessity or very serious medical reason, is it legitimate to accede to a minor's request to irreversibly damage his or her body?In the UK, a thousand families are reportedly preparing to take legal action for medical negligence, alleging that their vulnerable children have been misdiagnosed and placed on a damaging medical transition course. Yet these minors had been found to be ‘consenting’.It is time to weigh up the relevance of the sacredness of the minor's consent.

Media Shaming and Supply Chain Labor Transparency in the Fashion Industry

The fashion industry’s labor scandals have drawn wide attention, with incidents such as the Rana Plaza in 2013 and Boohoo in 2020. Several multistakeholder initiatives have called for more transparency in fashion brands’ efforts to address their supply chains’ labor issues. While recent studies have started to examine some institutional forces (e.g., corporate customers, peer firms, and regulators) driving environmental transparency (primarily on the carbon dimension), we focus on transparency about four problematic labor issues (i.e., modern slavery, living wages, gender disparities, and unionization) and draw attention to a less-studied institutional force: media. We ask whether media exposure might prompt a fashion brand to publicly disclose its policies, initiatives, and outcomes regarding its suppliers’ working and labor conditions—what we call supply chain labor transparency—and when this pressure would be more effective depending on the firm’s board. We used data on 132 fashion brands and retailers provided by the UK not-for-profit organization Fashion Revolution and supplemented it with four archival data sources. The results show that firms whose boards comprise directors with short-to-medium tenure length or include more female directors tend to exhibit more supply chain labor transparency in the wake of media controversies in a previous year. Conversely, firms whose boards are either long-tenured or mainly male have less transparent supply chains. Interestingly, while the effect thresholds for board tenure length are relatively consistent across the four labor issues studied, the thresholds for female representation differ by issue—it takes markedly more female directors to increase transparency about living wages than it does to increase transparency on gender issues. Thus, our study suggests an alternative path for using the broader social system that would advance supply chain labor transparency: media shaming can be more effective when the firm has a “fresh, diverse” board. We also provide guidance for multiple stakeholders including brands, supply chain workers, and social activists.

Association of a Community Population and Clinic Education Intervention Program With Guideline-Based Aspirin Use for Primary Prevention of Cardiovascular Disease

Low-dose aspirin is used for primary prevention of cardiovascular disease in approximately one-third of the US adult population. Overuse and underuse are common and not concordant with guidelines. To test a community and clinic education intervention to improve guideline-based aspirin use for the primary prevention of cardiovascular disease. The Ask About Aspirin project was a nonrandomized controlled trial conducted from, July 1, 2015, to March 31, 2020, using professional education, traditional media, and digital media to improve guideline-based aspirin use. The adult population (aged 45-79 years for men and 55-79 years for women) and primary care clinics in Minnesota were the education targets. The 4 adjacent states were controls. The statewide campaign distributed billboards, newspaper articles and other print material, and radio announcements. An Ask About Aspirin website was heavily promoted. Primary care clinics identified appropriate aspirin candidates, and clinicians received continuing education about aspirin. Guideline-based aspirin use by the target population. Cross-sectional random telephone surveys of 8342 men aged 45 to 79 years and women aged 55 to 79 years were conducted at baseline, 2 years, and 4 years after the intervention. Participation was similar between men and women (baseline: 973 [49%] vs 1001 [51%]; year 4: 912 [50%] vs 930 [50%]). Age during the study also was similar (baseline: 64.7 [IQR, 64.4-65.1] years; year 4: 66.2 [IQR, 65.8-66.5] years). A validated questionnaire evaluated aspirin use. The Ask About Aspirin website had more than 1 million visits; 124 primary care clinics with more than 1000 participating clinicians were part of the education program. Small, nonsignificant increases in discussions with clinicians regarding aspirin resulted (baseline: 341 of 1001 [34%]; year 4: 339 of 930 [36%]; P = .27). Overall aspirin use decreased after the release of new US Preventive Services Task Force guidelines in 2016 and 3 aspirin randomized clinical trials in 2018 suggested reduced aspirin use (baseline: 816 of 1974 [41%]; year 4: 629 of 1842 [34%]; P < .001). Decreases were also noted from year 2 to year 4 in appropriate use (year 2: 597 of 1208 [49%]; year 4: 478 of 1191 [40%]; P < .001) and overuse (year 2: 170 of 602 [28%]; year 4: 151 of 651 [23%]; P = .04). There were no significant differences between Minnesota and the control states. In this nonrandomized controlled trial, a multiyear statewide campaign was not associated with increased appropriate aspirin use for cardiovascular disease prevention. Contextual factors during the project, including guideline changes and media controversy following the new trials, undermined study goals. These findings suggest that although education programs using social media for cardiovascular disease prevention can result in millions of hits, the use of this strategy to encourage behavior change is problematic, even with supportive clinical sites. ClinicalTrials.gov Identifier: NCT02607917.