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."
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?
That’s a good take on DeSantis but still sits just below the best take I’ve seen on him
He’s a right wing Elizabeth Warren, the more you think about it the more accurate it is only I don’t think he’ll go as deep into the Primary calendar as she did
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
Well *I* clicked on that Onion link and laughed very, very loudly. Even more than at the headline itself.
https://twitter.com/LilNasX/status/1653227885069475843?s=20
Lil Nas X speaking to the press - I agree, he’s fantastic
Most enjoyable. Apart from the toe cheese bit. Those two readers need reporting to the RSPCA 🤢
That’s a good take on DeSantis but still sits just below the best take I’ve seen on him
He’s a right wing Elizabeth Warren, the more you think about it the more accurate it is only I don’t think he’ll go as deep into the Primary calendar as she did
Oh dear Helen, you write with nuance on the Trans issue in a US publication, I don’t envy your mentions this week
I think Nick Cave is perhaps the wisest man in England.
This is frightening and overtly powerful at the same time.
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