Happy Friday!
Yesterday, the Atlantic published something I’ve been working on for a while—an article on the US child gender medicine debate. I wanted to make the case to the right that the bans (12 states so far and counting) are unduly punitive, counter-productive and might have unforeseen consequences—such as children with severe mental health needs not seeking treatment, or doctors afraid to give it to them.
But I also wanted to make the case to the left that the U.S. is becoming more of an outlier in terms of the approach it favours (“affirmation”), the frequency with which it turns to medical solutions, and the ages at which doctors are allowed to perform surgeries.
Across the world, doctors are expressing caution over side effects, acknowledging the experimental nature of medical interventions, and entertaining the possibility that the recent surge in teenage trans identification is socially driven rather than solely evidence of previous underdiagnosis. That has put much of Europe on a different path from the United States. Either these countries—including some of the most progressive and LGBTQ-friendly nations on Earth—are secretly as right-wing as [Texas governor Greg] Abbott and Florida Governor Ron DeSantis, or they know something America doesn’t.
You can read the rest at the Atlantic here.
Helen
My Part in Vice’s Downfall (Unherd)
And like Isis, Vice was a 2010s phenomenon that wrongly thought it could take on the giants and win. Perhaps that strange kinship between the decade’s two great disruptors is why Vice News was the only western network Isis let embed with them in Syria and Iraq. This isn’t as wild as it sounds – Isis watched us and we watched them. As the Syria reporter for years, focusing on Isis, I watched the terrorist group copy Vice’s style in their videos as Very Online western millennials took over their output, syncing cinematic DSLR footage with hypnotic music and thrilling action sequences.
Young Western Isis fighters and social media influencers were constantly messaging me on Twitter, critiquing my films, and either asking me to join them or threatening to kidnap and behead me next time I deployed. I have the unusual distinction, as a legacy of my time at Vice News, of having featured in three Isis videos, twice using extracts from my films, and once combat footage of them shooting (unbeknown to them at the time) at my Landcruiser. Isis won the video battle: they had the resources of a state behind them, a demonic desire to shock and horrify, and could orchestrate combat for the cameras. But ultimately neither could maintain their exponential growth beyond the 2010s: both had dramatically overestimated their chance of taking over the world.
Well, there’s a comparison I didn’t expect to read this week. This reminiscence by Aris Roussinos is prompted by the news that Vice—once valued in the billions—might file for bankruptcy after failing to find a buyer. It’s been a bad month for new media, with Ben Smith’s book Traffic chronicling the rise and fall of Buzzfeed, which he once edited. (Leah Finnegan, who once edited Gawker, another defunct start-up, reviewed it in The Baffler.)
As for the diagnosis of what went wrong, from having edited a (small) website through most of this time, I think it’s pretty simple. Facebook giveth, and Facebook taketh away. One day great globs of social traffic were raining from the skies, and the next day they weren’t. In the 2010s, journalists were nominally working for buzzy new media start-ups, but actually they were being paid venture capitalists’ cash to work indirectly for Facebook.
The journalism of that era had some large and obvious problems—clickbait worked, and polluted the internet with aggregated crap, write-ups of Twitter pile-ons, and ever-more niche identity content. (An Onion headline from 2012: “Huffington Post Employee Sucked Into Aggegration Turbine”.) But the new era we are in now, with its turn back to direct reader funding, has risks too, the largest of which is audience capture. I can see exactly what you guys are clicking on this newsletter each week, and I could easily go full Niko Avocado and just shovel more of that down your throat. For big organisations, there’s an invisible pressure not to run pieces that will piss off loyal customers.
Quick Links
“Why turn off cruise control on the endless highway of life?”A thread of quotations from Jolyon Maugham’s book. To think, I could have been its ghostwriter.
Oh my god, Rishi. This is like a £35 Cameo.
I agree with this Semafor analysis of Ron DeSantis taking the wrong lesson from Donald Trump’s endless complaints about fake news. DeSantis genuinely loathes the MSM, whereas Trump loves-to-hate them. So DeSantis has genuinely swerved any engagement with the NYT and every TV network except Fox, whereas Trump spent his entire time in office bitching to Maggie Haberman—and, since being evicted from the White House, has invited any old Tom, Dick and Harry writing a book to visit him at Mar A Lago.
Here’s the recorded version of my chat with fellow Atlantic writer Sophie Gilbert and our editor Jeff Goldberg about the coronation (YouTube). I also wrote about the sadly falcon-free coronation for The Atlantic here. Out: feline anal gland musk. In: recycled chairs.
People sometimes ask who my favorite celebrity is, and it’s Lil Nas X. This tweet of his Met Gala costume demonstrates why. He’s young, hot, talented and famous—and a complete troll. (This 2021 NYT profile explores that.)
“I am not a monarchist, nor am I a royalist, nor am I an ardent republican for that matter; what I am also not is so spectacularly incurious about the world and the way it works, so ideologically captured, so damn grouchy, as to refuse an invitation to what will more than likely be the most important historical event in the UK of our age. Not just the most important, but the strangest, the weirdest.” Nick Cave on why he’s going to the coronation (The Red Hand Files).
Cat earwax update: a LOT of readers got in touch about this. Some cats went wild for it; others were unbothered. Two correspondents mentioned that their cats liked their “toe cheese”, which is something I’m going to work very hard to forget I ever heard.
Nepotism corner: My former colleague Tom McTague has a new podcast, with Helen Thompson of Talking Politics. My former colleague Rafael Behr has a new book, called Politics: A Survivor’s Guide, about the tumult of the last few years.
See you next time!
Thanks, Helen, for the Nick Cave link. I think this bit bears repeating too:
"And as for what the young Nick Cave would have thought – well, the young Nick Cave was, in all due respect to the young Nick Cave, young, and like many young people, mostly demented, so I’m a little cautious around using him as a benchmark for what I should or should not do."
Excellent. Really. Thank-you.
A British Columbia comment or two.
Medicine has a long history of not following the “primum non nocere” rule when viewed over the long term because humans are geared for thinking that doing something is better than doing nothing (action fallacy bias). Can this criticism be made of our gender incongruence treatments?
Over the last few decades there has been a definite trend in surgery that is a downward arrow when it comes to invasiveness. Given the fact that there are now over 300 “transition” clinics operating in the USA (1), is our treatment (especially irreversible procedures like mastectomies, orchidectomies, and metoidioplasties) a little too ideologically shifted towards action fallacy?
There are “tomboys” and “effeminate men”, some of whom do come out as lesbian/gay with time. Given the fact that there has been a recent high level controversy over “rapid onset” gender dysphoria treatment (2), might the current incentive structure be skewing treatment?
In Iran it is illegal (punishable by death) to be gay (3). In Iran it is legal to medically change your sex. Consequently there’s a lot of sexual reassignment surgery done in Iran. It is less dangerous to just say you are a man in a woman’s body (or visa versa) than to say you are gay/lesbian. In Iran ideological puritanism has shifted medicine. Could we be somewhat the same?
If an anesthesiologist starts a pre-op assessment of a young patient for bilateral mastectomies, and finds two parents who are accompanying the patient vehemently arguing about whether surgery should be done, should the anesthesiologist call whoever made this call to talk about it or just go ahead with the case?
In the plastic surgery section of the MSP fee schedule a mastectomy in the context of gender alteration pays $1476.26 for a 61054 code but in the general surgery section a mastectomy for malignancy pays $474.13 for a V07472 code. Could this mean there is a financial incentive to do these bilateral mastectomies in younger women on demand?
1https://segm.org/ease_of_obtaining_hormones_surgeries_GD_US
2)https://www.webmd.com/sex-relationships/news/20211129/transgender-docs-gender-affirmative-care-youth
3)https://www.dw.com/en/iran-how-transgender-people-survive-ultraconservative-rule/a-57480850