Peter, this is a truly brilliant exploration of the dynamics and ethics. I am saving this for re-reading, and for reference, and will be sending this to a couple people with whom I have an ongoing dialogue about these issues. Thank you very much for this.
From the April study: “Gender-affirming surgery, while beneficial in affirming gender identity, is associated with increased risk of mental health issues, underscoring the need for ongoing, gender-sensitive mental health support for transgender individuals’ post-surgery.”
If a treatment leaves people worse off, in what sense is it medical care and how can it be justified? Insurance should refuse to cover.
Or the review just published within the last week showing that estrogen is extremely harmful for men in multiple domains, increasing stroke risk by a factor of 10, dramatically increasing risk for testicular cancer, increasing risk for cognitive impairment and autoimmune disease etc.
Fantastic article thank you Peter. The points I agree with are too numerous to mention.
I am a retired clinician with a longstanding interest in informed consent, which I believe is an ideal to be strived for but unlikely to be achieved in practice - both for the reasons you mention and for other reasons. The latter include the problem of health literacy and the fact that many (probably most) clinicians focus on “disclosure” rather than “informing”. Disclosure is where the clinician reels off a list of risks (of possible harms) and then asks the patient if they have “any questions”. My conception of “informing” is a two-way communication process via which a patient can demonstrate their understanding by reformulating what the clinician has just said, in their own words. But, in the video recordings and transcripts of surgical consultations that I examined for my PhD research, this rarely happened. Indeed, for complex clinical interventions, it may be a practical impossibility.
Medical practice is regulated when it is clear that the doctors have gone off the rails, which happens with alarming regularity. The landscape around prescribing controlled medications has changed dramatically since the opiate epidemic for example. There are now systems in place for reporting of suspicious orders. That means that if a pharmacist is concerned about your prescribing for any reason they can report you. With the gender issue, it is clear that young adults are also at risk. A 19 year old woman with a history of sexual abuse, cutting, and anorexia should not be medicalized either. The best way to stop the madness with the adults is probably with lawsuits. If a few people win big settlements that would change the calculus for the doctors who are doing all of this so casually.
We are at a very decisive pivot--the question no longer issues an immediate "Of course." Adults need to be offered sound medicine with benefits that are not just ephemeral.
I really do not care what an adult chooses to do with their body. That being said the surgeries and medication are for cosmetic reasons and should not be paid by tax payer dollars. Just like any other cosmetic surgeries. I’m a woman that thinks I should have bigger boobs will government health care pay for them? No they would not.
There is a more direct parallel involving opioids which illustrates both the legislative and non-legislative routes - the treatment of opioid addiction by the prescribing of opioids. This was routine in the nineteenth and early twentieth century. It was prohibited in the US in the 1920s when strict drug controls were first brought in intentionally. By contrast, the UK did not prohibit it, and actually endorsed it, including prescribing heroin to heroin addicts, in a government-commissioned report of 1926.
The US's policy did not succeed in reducing heroin addiction, and later on the policy would be softened, but not overturned, by licensing specific opioids for this treatment - methadone in the 1960s and buprenorphine in 2000.
In UK, opinion did eventually turn against the lax policy of allowing any doctor to prescribe any drug to treat addiction. There were some minor legal changes but mostly this was effected via change within the medical profession. A 1968 law restricted the prescription of heroin or cocaine to treat addiction to doctors with a special license working in drug clinics. But plenty of these licenses were issued. Nonetheless, over the subsequent few decades cocaine prescribing was stopped entirely, and heroin prescribing almost entirely replaced by methadone, with heroin being reserved for particularly intractable cases, as well as continued for legacy patients already on a prescription. This was not a result of legislative change, but of changing attitudes within the medical profession that meant that the disciplinary process was handled in a different way. There was pushback on the change from some doctors in the 1980s, but the medical authorities were more willing to put such doctors through tribunals for irresponsible prescribing. UK ended up in a similar place to US, but with far less government intrusion into medical decision making.
This issue shows there's a uni=party--sure, some conservatives are hands-off libertarians, but others are equally with many liberal and Leftist politicians supported and bought in/ sold out to the machinery of big pharma/ "trans medicine"
There is a rule somewhere in journalism that if a newspaper headline is posed as a question, the answer is always No. "Are we heading for a meltdown?" Saves the trouble of reading the silly thing.
Congratulations therefore for providing a robust exception. "Yes. Of course."
Peter, this is a truly brilliant exploration of the dynamics and ethics. I am saving this for re-reading, and for reference, and will be sending this to a couple people with whom I have an ongoing dialogue about these issues. Thank you very much for this.
From the April study: “Gender-affirming surgery, while beneficial in affirming gender identity, is associated with increased risk of mental health issues, underscoring the need for ongoing, gender-sensitive mental health support for transgender individuals’ post-surgery.”
If a treatment leaves people worse off, in what sense is it medical care and how can it be justified? Insurance should refuse to cover.
Or the review just published within the last week showing that estrogen is extremely harmful for men in multiple domains, increasing stroke risk by a factor of 10, dramatically increasing risk for testicular cancer, increasing risk for cognitive impairment and autoimmune disease etc.
Known for awhile just underlines the utter abdication of medical ethics involved in these “treatment” protocols.
Fantastic article thank you Peter. The points I agree with are too numerous to mention.
I am a retired clinician with a longstanding interest in informed consent, which I believe is an ideal to be strived for but unlikely to be achieved in practice - both for the reasons you mention and for other reasons. The latter include the problem of health literacy and the fact that many (probably most) clinicians focus on “disclosure” rather than “informing”. Disclosure is where the clinician reels off a list of risks (of possible harms) and then asks the patient if they have “any questions”. My conception of “informing” is a two-way communication process via which a patient can demonstrate their understanding by reformulating what the clinician has just said, in their own words. But, in the video recordings and transcripts of surgical consultations that I examined for my PhD research, this rarely happened. Indeed, for complex clinical interventions, it may be a practical impossibility.
Medical practice is regulated when it is clear that the doctors have gone off the rails, which happens with alarming regularity. The landscape around prescribing controlled medications has changed dramatically since the opiate epidemic for example. There are now systems in place for reporting of suspicious orders. That means that if a pharmacist is concerned about your prescribing for any reason they can report you. With the gender issue, it is clear that young adults are also at risk. A 19 year old woman with a history of sexual abuse, cutting, and anorexia should not be medicalized either. The best way to stop the madness with the adults is probably with lawsuits. If a few people win big settlements that would change the calculus for the doctors who are doing all of this so casually.
We are at a very decisive pivot--the question no longer issues an immediate "Of course." Adults need to be offered sound medicine with benefits that are not just ephemeral.
I really do not care what an adult chooses to do with their body. That being said the surgeries and medication are for cosmetic reasons and should not be paid by tax payer dollars. Just like any other cosmetic surgeries. I’m a woman that thinks I should have bigger boobs will government health care pay for them? No they would not.
There is a more direct parallel involving opioids which illustrates both the legislative and non-legislative routes - the treatment of opioid addiction by the prescribing of opioids. This was routine in the nineteenth and early twentieth century. It was prohibited in the US in the 1920s when strict drug controls were first brought in intentionally. By contrast, the UK did not prohibit it, and actually endorsed it, including prescribing heroin to heroin addicts, in a government-commissioned report of 1926.
The US's policy did not succeed in reducing heroin addiction, and later on the policy would be softened, but not overturned, by licensing specific opioids for this treatment - methadone in the 1960s and buprenorphine in 2000.
In UK, opinion did eventually turn against the lax policy of allowing any doctor to prescribe any drug to treat addiction. There were some minor legal changes but mostly this was effected via change within the medical profession. A 1968 law restricted the prescription of heroin or cocaine to treat addiction to doctors with a special license working in drug clinics. But plenty of these licenses were issued. Nonetheless, over the subsequent few decades cocaine prescribing was stopped entirely, and heroin prescribing almost entirely replaced by methadone, with heroin being reserved for particularly intractable cases, as well as continued for legacy patients already on a prescription. This was not a result of legislative change, but of changing attitudes within the medical profession that meant that the disciplinary process was handled in a different way. There was pushback on the change from some doctors in the 1980s, but the medical authorities were more willing to put such doctors through tribunals for irresponsible prescribing. UK ended up in a similar place to US, but with far less government intrusion into medical decision making.
*when strict drug controls were first brought in internationally
What do you think of this article?The supreme courts rulinghttps://www.supremecourt.gov/opinions/24pdf/23-477_2cp3.pdf
This issue shows there's a uni=party--sure, some conservatives are hands-off libertarians, but others are equally with many liberal and Leftist politicians supported and bought in/ sold out to the machinery of big pharma/ "trans medicine"
There is a rule somewhere in journalism that if a newspaper headline is posed as a question, the answer is always No. "Are we heading for a meltdown?" Saves the trouble of reading the silly thing.
Congratulations therefore for providing a robust exception. "Yes. Of course."