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                                                            Letters to the Editor

                                                                         Permanente Journal,                                       TPJ,

                                                                           I am an internist at KP MAPMG. Just loved                  I read, with interest, the Ethics article “Engender-
                                                                         the photos in the Fall 2001 issue. Wow!                   ing Differences: Ethical Issues about Intersex” in the
                                                                                                                                   Fall 2001 Journal. I was impressed with the logic
                                                                         Susan Houseman, MD                                        behind waiting to assign gender to these children,
                                                                         Internal Medicine, Washington, DC                         especially given the uncertain effects of prenatal
                                                                                                                                   and early neonatal hormone exposure on sexual
                                                                                                                                   differentiation of the brain. It may be easier to offer
                            The Permanente Journal,                                                                                that advice from an ethical standpoint than a
                                                                                                                                   parental one, as the reality of having ambiguous
                                                                         Dear Dr Alman,                                            genitalia and gender would be a difficult one for
                              I haven’t found time to invest much
                            thought to The Permanente Journal                                                                      any family. I was disturbed, however, to see the
                                                                            I enjoyed your recent article in The Permanente        recommendation on Dr Fausto-Sterling’s part
                            until now, but this issue (Fall 2001) is
                                                                         Journal (Fall 2001). It reminded me of when, as           regarding management of the presented case of a
                            outstanding, informative, interesting, and
                                                                         an Internist, I used hypnosis in my practice at           child with XY/XO dysgenetic gonads. Her advice
                            some entertainment with nice photo-art. I
                                                                         Kaiser Permanente (KP) many years ago. I was              to wait until after puberty to see how the child
                            especially enjoyed the article on patient
                                                                         trained to use hypnosis by Jack Watkins while in          develops and to what extent the Y-chromosome-
                            profiling by Renate Justin. Dr Justin, who
                                                                         my residency at the VA hospital, so when I started        bearing dysgenetic gonads can produce hormones
                            is ‘retired,’ obviously combines a keen
                                                                         practice at KP, it was just one of the tools I used.      ignores the real risk of gonadoblastoma. Although
                            sense of observation and reflection with
                                                                            In 1991, I published an article1 that showed a 25%     the data set is not complete, numerous peer-
                            a fluid style of expression. I hope she
                                                                         increase in the time the cardiologist was able to         reviewed articles1-3 describe a risk of malignancy of
                            will be encouraged to continue her
                                                                         keep the balloon inflated compared to the controls.       5% by the age of 14 and 16% by the age of 20 in
                            medical writing.
                                                                         More interesting, was the fact that Norepinephrine        children with mixed gonadal dysgenesis, such as
                                                                         levels were higher in the hypnotized group. I think       the case presents. The chance that any meaningful
                            Yossef Aelony, MD
                                                                         further studies are needed in this area.                  hormone production would result from these
                            Internal Medicine, Harbor City, CA
                                                                            In 1970, with Stan Abrams, I published an              gonads is small, and I am aware of no reports that
                                                                         article2 on the validity of polygraph tests with          evaluate the potential of dysgenetic gonads to
                                                                         the use of hypnosis. It proved that hypnosis              contribute to bone density or development of
                                                                         could fool the lie detector.                              secondary sexual characteristics. I believe that the
                                                                            As an aside, an interesting patient of mine was        correct ethical argument would be that the parents
                            Dr Brian Alman,
                                                                         having trouble selling her artwork. What she              must be informed of the risk of malignancy and the
                                                                         liked to paint didn’t sell; what she didn’t like to       uncertain role of the gonads in sexual differentia-
                              I enjoyed your article on Medical
                                                                         paint did sell. I asked her to bring in her art           tion of the external genitalia, bone density, and
                            Hypnosis in The Permanente Journal
                                                                         materials. In a trance I asked her to do a                gender preference. In addition, parents need to
                            (Fall 2001). It surprised me that positive
                                                                         drawing from the left side of the brain and later         know that the majority opinion, based on the
                            change took place in the case studies
                                                                         to do a drawing from the right side of the brain.         evidence that currently exists, remains that children
                            without delivering commands. I, like
                                                                         Her drawings were completely different, as was            with dysgenetic gonads containing a Y-chromo-
                            many others, assumed hypnosis was a
                                                                         the way and the tools she used to draw them. I            some-bearing cell line have bilateral prophylactic
                            matter of repeating commands to the
                                                                         didn’t tell her what to do with her art, but on           gonadectomy prior to the onset of puberty.
                            subject until they were ingrained in their
                                                                         her next visit she told me those two art forms
                            subconscious. How wrong I have been.
                                                                         combined in her mind and she was now happy                Kenneth A Faber, MD
                              I plan to read the book you recom-
                                                                         selling her art. I imagine I was more relaxed             Chief, Reproductive Endocrinology and Infertility
                            mended, “The February Man,” to
                                                                         then with my patients than the doctors are now.           Colorado Permanente Medical Group
                            understand more about this captivating
                            subject. I also want to read your book
                                                                         Edwin J Weinstein, MD, PhD
                            on self-hypnosis so I can use it to
                                                                         Retired                                                   References
                            remove some of my blocks. I practice in
                                                                         Northwest Permanente                                       1. Gourlay WA, Johnson HW, Pantzar JT, et al. Gonadal
                            Internal Medicine for Kaiser Permanente
                            in Atlanta, Georgia and receive The                                                                        tumors in disorders of sexual differentiation. Urology
                            Journal at my office in Atlanta. I hope                                                                    1994 Apr;43(4):537-40.
                                                                         References                                                 2. Trouche V, Hernadez E. Neoplasia arising in
                            you continue to contribute your expertise.
                                                                          1. Weinstein EJ. Use of hypnosis before and during           dysgenetic gonads. Obstet Gynecol Surv 1986
                                                                             angioplasty. Am J Clin Hypn 1991 Jul;34(1):29-37.         Feb;41(2):74-9.
                            Gail Gibson Vest, MSN, FNPC
                            Internal Medicine, Alpharetta, GA             2. Weinstein EJ, Abrams S. Gibbons D. The validity        3. Verp MS, Simpson JL. Abnormal sexual differentia-
                                                                             of polygraph with hypnotically induced repression         tion and neoplasia. Cancer Genet Cytogenet 1987
                                                                             and guilt. Am J Psychiatry 1970 Feb;126(8):1159-62.       Apr;25(2):191-218.

                        4                                                                                                                 The Permanente Journal/ Winter 2002/ Volume 6 No. 1