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 ā well, the young Nick Cave was, in all due respect to the young Nick Cave, young, and like many young people, mostly demented, so Iām 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 āprimum non nocereā 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 ātransitionā 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 ātomboysā and āeffeminate menā, some of whom do come out as lesbian/gay with time. Given the fact that there has been a recent high level controversy over ārapid onsetā 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 thereās a lot of sexual reassignment surgery done in Iran. It is less dangerous to just say you are a man in a womanās 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?
Would take a novel to explain and I would have to double my medication. lol. Basically the tariff committee of our doctorsofbc set new fees....you can imagine the bs with every specialty thinking their work is the most important....add in a health minister who wants to get re-elected....and...voila.....insanity. It is why the eye guys doing cataracts and retina get a 10X. Best stop now as I am getting unstable.
Cheers,
Mark
Btw most breast surgeons I know think they won't operate in 10 years as some fancy imaging will pick up earlier and earlier lesion which will then have electrons or photons applies by radiologists.
Thatās a good take on DeSantis but still sits just below the best take Iāve seen on him
Heās a right wing Elizabeth Warren, the more you think about it the more accurate it is only I donāt think heāll go as deep into the Primary calendar as she did
Ah then I commend your diligence! (But Iāve been writing about this issue since I was at the New Statesman, which I left in 2019). By chance I was just reading Politico this morning, where Asa Hutchinson, Republican governor of Arkansas, about why he vetoed a ban sent to him by the state house: āWell, I hope it showcases to people that I think for myself. I try to follow the Constitution. ā¦ Whenever you look at health care decisions ā whether you're thinking about whether the children should be vaccinated or whether the children should have other kinds of health care ā I think there's a limited role of the state. And so if it had been a bill that focused on the extreme, such as transgender or gender reassignment surgery, I would have signed a reasonable bill in a minute. But the extreme bill that I viewed as unconstitutional didn't have a grandfather clause, and took away parental decision making. I said it was a step too far.ā
That feeling that the bills are too widely drawn was echoed by Leor Sapir and Corinna Cohn. They donāt necessarily think theyāre goodāto them, though, theyāre better than the alternative. Whereas I see the bills as part of a vicious circle that just makes the left more determined to fight its corner.
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 ā well, the young Nick Cave was, in all due respect to the young Nick Cave, young, and like many young people, mostly demented, so Iām a little cautious around using him as a benchmark for what I should or should not do."
I loved that bit. Young Helen was very similar. Old Helen will probably think the same about Middle Aged Helen.
Excellent. Really. Thank-you.
A British Columbia comment or two.
Medicine has a long history of not following the āprimum non nocereā 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 ātransitionā 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 ātomboysā and āeffeminate menā, some of whom do come out as lesbian/gay with time. Given the fact that there has been a recent high level controversy over ārapid onsetā 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 thereās a lot of sexual reassignment surgery done in Iran. It is less dangerous to just say you are a man in a womanās 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
Why would the payment be higher for a gender related mastectomy than for a malignancy related one?
Would take a novel to explain and I would have to double my medication. lol. Basically the tariff committee of our doctorsofbc set new fees....you can imagine the bs with every specialty thinking their work is the most important....add in a health minister who wants to get re-elected....and...voila.....insanity. It is why the eye guys doing cataracts and retina get a 10X. Best stop now as I am getting unstable.
Cheers,
Mark
Btw most breast surgeons I know think they won't operate in 10 years as some fancy imaging will pick up earlier and earlier lesion which will then have electrons or photons applies by radiologists.
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, heās fantastic
Most enjoyable. Apart from the toe cheese bit. Those two readers need reporting to the RSPCA š¤¢
Thatās a good take on DeSantis but still sits just below the best take Iāve seen on him
Heās a right wing Elizabeth Warren, the more you think about it the more accurate it is only I donāt think heāll 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 donāt 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.
Do subscribe to my newsletter if you like content of these sorts..... https://kallolpoetry.substack.com/p/he-consumed-me-everyday-so-i-devoured
I donāt mean to embarrass you, but I would suggest you Google me.
I am filing a bug report with Substack about the fact that I can only like Helen's comment once
Ah then I commend your diligence! (But Iāve been writing about this issue since I was at the New Statesman, which I left in 2019). By chance I was just reading Politico this morning, where Asa Hutchinson, Republican governor of Arkansas, about why he vetoed a ban sent to him by the state house: āWell, I hope it showcases to people that I think for myself. I try to follow the Constitution. ā¦ Whenever you look at health care decisions ā whether you're thinking about whether the children should be vaccinated or whether the children should have other kinds of health care ā I think there's a limited role of the state. And so if it had been a bill that focused on the extreme, such as transgender or gender reassignment surgery, I would have signed a reasonable bill in a minute. But the extreme bill that I viewed as unconstitutional didn't have a grandfather clause, and took away parental decision making. I said it was a step too far.ā
That feeling that the bills are too widely drawn was echoed by Leor Sapir and Corinna Cohn. They donāt necessarily think theyāre goodāto them, though, theyāre better than the alternative. Whereas I see the bills as part of a vicious circle that just makes the left more determined to fight its corner.
I do enjoy when ppls sanctimonious ranting is the first thing you see, makes the decision you block so much easier
I really do wish self-awareness was something that was handed out by God more liberally and not parcelled out only to select ppl