Category: health

Luana Maroja encounters “Fat Studies”

June 15, 2026 • 9:45 am

“Fat Studies” is not a pejorative term, but rather an activist branch of academia with an agenda, including the claim that being fat is not unhealthy, and is a sign of oppression by the weight-deprived.  Particularly disturbing—and detrimental to health—is the persistent assertion that fatness (or whatever you want to call obesity) is not injurious to health.”Healthy at all sizes” is the mantra.

But a gazillion medical studies show that this is an arrant lie.  Now it’s not good to point out to someone that they’re fat, for, as Grania once told me when she was alive, that is a thoughtless, hurtful, and even useless remark. “Fat people,” she said, “know that they’re fat.” There should be no social stigma attached to the condition. But neither should we silently accept assertions that fatness is not harmful to health.  For lives can be saved by pointing out the dangers. Stigmas are one thing, empirical distortions another.

There’s a Wikipedia article about the “Fat acceptance movement,” which it also calls “fat pride, fat empowerment, fat liberation, and fat activism.”  And Fat Studies even has its own eponymous academic journal.  It’s an open-access journal, and you can see the latest issue here.  Scanning the articles, you immediately see the field’s ideological bent. These are simply the first five articles I saw, and they’re not just about fatness, but, vis-à-vis intersectionality, also connect fatness to all other purported forms of oppression (note the use of “playful” and non-standard language, a characteristic of postmodernist writing):

Luana Maroja has been fascinated by this field, I suppose because of its plethora of antiscientific assertions. She recently went to two lectures at the school where she teaches, Williams College, and wrote about them in the article below, just published on the Heterodox STEM site. Click the screenshot to read for free, or find the article archived here. It’s written in an objective, reportorial fashion, but what she heard was appalling.

I’ll reproduce a couple of excerpts below (indented):

Public confidence in higher education has dropped sharply in recent years. The main contributors appear to be a lack of ideological diversity in colleges and universities, constraints on open inquiry, and the erosion of empirical standards in parts of the academy. Here I describe two college-sponsored events dealing with “fat studies”—one in late 2024 and another in April 2026—which I attended out of simple curiosity about this academic discipline. Here is an account of the claims made at these events taken from my notes.

Lecture 1:

My biology and pre-med students were particularly intrigued by a Gender Studies talk that promised to “interrogate the false association between fat and unhealthiness” (see workshop description below). Being new to “fat studies,” I was curious to see more about this claim. Two years later, I decided to attend a second event, wondering whether the messaging had shifted in the age of Ozempic and following the 2024 elections. What I encountered may sound satirical, but it was not. The speakers were dead serious. I have kept the speakers’ names private; my aim is not to mock individuals but rather to show the persistence of anti-scientific perspectives in this field at my college. Both cases exemplify the ideological erosion of science that has led Americans to lose confidence in their colleges and universities.

. . .The event opened with identity: the speaker stated that she identified as “fat, white, and used they/them pronouns.” I learned that “obese,” “BMI,” and “weight” are seen as pejorative terms that should never be used. She added that it was bigoted to suggest that obesity is mainly a lower-socioeconomic-class issue tied to the inability to afford healthy food. This view, we were told, wrongly assumes that the foods fat people eat are unhealthy and that being fat is bad. We were then asked to “pair-share” with colleagues in the room, about our emotions and body image and recount when we first developed the idea that being fat is bad.

The speaker next wrote down the roots of “fatphobia” on the board (see figure below). Body mass index (BMI), she said, was invented to discriminate against fat people, and its origins lie in capitalism. White people were blamed for creating the notion that “whites are thin” as a way of oppressing black people. Medicine was described as another culprit: there is no such thing, we were told, as a “healthy diet.” Instead, “a healthy diet is what you like to eat.” Further, children were described as having an innate ability to sense how much food and what kind of food they need. The research on whether processed foods affect health was described as unclear. What ultimately harms fat people, the speaker claimed, is oppression and dieting. Anti-fatness, we learned, goes hand in hand with every other system of oppression: “Whenever we are talking about anti-fatness, we are also talking about white supremacy”.

The medical system was described as actively discriminatory: “When fat people come into the hospital with cancer, they are told to lose weight before being screened,” and waiting-room chairs are too small. These forms of discrimination, rather than physiology itself, were said to explain the observed correlations between fatness and health problems.

Here are some of the lies purveyed by the speaker, and the evasions they use when called out:

At this point people began asking questions. I inquired about animal studies: surely, fat rats do not die at higher rates because of fatphobia? The reply was nonsensical: “everyone knows fat is protective in rats.” A student noted the well-documented correlation between cardiovascular disease and fatness. The speaker asked for references. When he responded that there were thousands, she reminded the room that “correlation is not causation” and that people die from oppression and from being forced into diets.

. . . The speaker proceeded to write the word “Science” on the board under the heading “institutional problems.” She later stated that genetics, not food consumption, explains body weight: “People can be 15 pounds above or below their genetic makeup and no more or less.” This was another nonsensical idea, easily contradicted by looking at the recent past: just a couple generations ago people of every demographic group were skinnier than they are today, and the genetics of those groups could not have changed much in such a short time. The exchange illustrated how data-based questions were repositioned from a legitimate inquiry to an expression of overt bigotry.

A graph from Luana’s article (she made it) showing the rise in obesity over the last 35 years, which may reverse if Ozempic and other such drugs become prevalent. Note, though, that. as you see below, some Fat Studies people object strenuously to weight-loss drugs.

Oy! There’s more, including graphics and photos, but let’s move on to Lecture #2:

My second encounter with “fat-studies,” in April 2026, was a talk sponsored by the Dively Fund (created to support LGBTQ events, although the talk contained almost no LGBTQ content). It was billed as “A conversation on Blackness, Queerness, Gender, Fatness, Disabilities and Their Intersections.” Attendance here was higher—roughly 20 students plus three adults, myself included.

As before, I approached the talk with genuine curiosity; I wondered whether this corner of “studies” would adapt or remain unchanged in the era of Ozempic and recent shifts in public discussions of obesity.

Some of the speaker’s themes overlapped with those of the first event, including the claim that “good and healthy” food is simply whatever you like to eat. There was also a brief and negative reference to Ozempic: “GLP-1s are terrible because they make fat people appear suicidal for not wanting to lose weight.”

The rest of the talk took a very different direction. Because the content was somewhat disjointed, I will share some direct quotes. We were told that “fatness was invented to prepare individuals for war by the Nazis” (though the speaker later added that it was invented by the slave trade). “Body fascism is now practiced in France, USA, Israel and Britain.” “The ideal body is militarized to displace and violate black people.” “Fat fascism is about the subjugation of the slave and slave-adjacent (Palestinians).” “The Jewish body is imposed on Palestinians by starvation and the denial of junk food [which is the kind of food they would like to eat].” “This subjugation did not begin with Trump; it began with democracy and those elected to represent society.” Michelle Obama’s healthy-lunch initiatives were cited as a pre-Trump example. “Fatphobia is the making of the slave.” “Fatness has been projected onto African flesh.” “You are not men or women; you are just fat or thin in a ship hold” (referring to slave ships). “After Nazis, COVID, HIV, [and] slaves, one must prove they are fit and not crippled—this is how ableism started.” “Nationalists don’t believe cripples have the right to exist.” “Freedom requires the death of our desires.” “Our love keeps us in shackles. We need to divest from love to bring the revolution” (though the speaker added that his love for his people was too strong to relinquish).

Double oy!

Luana’s message is at the end:

When college-sponsored events list ‘Science’ itself as an institutional problem, they expose a deep split in how people view knowledge and truth—and in what these events are really selling. The talks confirmed this split: questions were met not with counter-evidence but with accusations of bigotry, rote reminders that ‘correlation is not causation,’ or outright commands to stop speaking—along with preposterous assertions that flouted basic standards of evidence. Such tactics do more than mislead audiences; by violating the very norms of reason and evidence that people have long accepted as good science, they accelerate the erosion of public trust in both science and higher education.

When people like (recently) the AAUP say that faculty should control the college curriculum, stuff like this calls that claim into doubt.  “Academic freedom” does not give professors the right to purvey lies to students, especially lies that are harmful to one’s well-being. And believe me, this kind of stuff is not only the subject of academic journals, but has made its way into the classroom. Grok, in a half minute of trawling the internet, came up with at least six universities that have courses on Fat Studies, including Harvard University. Here’s one from Southern Oregon University(click screenshots to enlarge):

And one from where I held my first job, The University of Maryland:

The intersectionality and postmodernism that pervade these courses are clear.  “Fatness as a social justice issue”, “fat liberation,” and so on. As I said, Fat Studies courses can be useful if they trace historical oppression against obesity, and thereby help dispel social stigmas against fatness. But I’d bet a pile of dosh that these courses do a lot more than that!

Oh, and shame on Williams College and its Gender Studies program for promoting speakers who lie about science.

Statistical misreporting on a new cancer drug: “survival times” misconstrued as “survival rates” or “death risks”

June 2, 2026 • 9:30 am

Last night on the NBC News (and also on the same station the night before) I heard a report on a new cancer drug touted as being almost miraculous. The drug was called daraxonrasib, was described as working by blocking a mutated promoter of tumor growth in people with metastatic pancreatic cancer—a notoriously fatal disease (the median survival period after diagnosis of this stage is about 3-6 months, and the five-year survival rate is 3.2%).  But the news confused survival time with survival rate, saying something like “the drug doubles the survival rate. . . .from 6 months to 13.2 months”. (I may have gotten the figures wrong as I’m working from memory.)  I knew that something was wrong, as metastatic pancreatic cancer is almost always fatal, so the survival rate, which the percentage of people still alive after a specified period of time (often five years), cannot be expressed in months. 

Sure enough, this mistake, expressing the effects as a doubling of survival rate, was not only misleading, but widespread.  It’s easy to find similar errors in the press; just google the drug name and “survival rate”:

From CBS News (click all screenshots to read):

An excerpt (all excerpts are indented). I’ve put the confusing bits in bold:

A new, experimental medication nearly doubled overall survival rates for patients with advanced pancreatic cancer, according to the results of a study published Sunday.

Researchers say the findings are a significant marker of progress toward treating a notoriously deadly type of cancer, for which there have historically been limited effective options for therapies.

The drug is called daraxonrasib and it blocks a mutated protein that fuels tumor growth in more than 90% of pancreatic cancer cases — a target that had eluded treatment for decades.

“While not curing the cancer, it is a very large step forward,” said Dr. Zev Wainberg, of the University of California, Los Angeles, who helped lead the study.

The research team found that taking the medication, as a daily pill, reduced the risk of death by 60% for patients with metastatic, or spreading, pancreatic cancer who had previously received treatment. That was compared with survival rates of patients receiving standard chemotherapy, according to UCLA Health.

It randomly assigned the experimental drug or more chemotherapy to 500 patients whose metastatic cancer had quit responding to prior treatment. The findings were published in the New England Journal of Medicine and presented Sunday at the American Society for Clinical Oncology meeting in Chicago.

Those taking daraxonrasib lived for a median of 13.2 months compared with 6.7 months for chemotherapy recipients. While that may seem like a small improvement, Wainberg said it marked the first drug to show a substantial advantage over chemotherapy.

 Note that while CBS says that it reduces the risk of death by 60%, there are NO DATA showing that. The risk of death is again nearly 100%, though survival time increases by a bit more than two. Also, “survival rates” have not been doubled. There are no data on that, at least not in the article. 

From USA Today:

Excerpt:

An experimental drug nearly doubled the overall survival rates of pancreatic cancer patients, according to the results of its latest clinical trial.

The drug, daraxonrasib, targets the gene mutation behind most pancreatic cancer diagnoses.

In the phase 3, randomized trial, published in the New England Journal of Medicine on May 31, researchers found patients who received the drug lived a median of 13.2 months compared with 6.7 months for those who received chemotherapy.

They use “rate” but give “times.”

It’s easy to find similar conflations. This one, less excusable because of the venue, is from The Clinical Trial Vanguard:

They give the results correctly but characterize them as showing “death risk”:

A 60% reduction in the risk of death—HR 0.40—in previously treated metastatic pancreatic cancer is not a number the oncology community has seen before, in any phase 3 trial, in any line of therapy. That is the threshold RASolute 302 crossed. Revolution Medicines enrolled 500 patients, randomized them between once-daily oral daraxonrasib and investigator’s choice of standard cytotoxic chemotherapy, and watched median overall survival reach 13.2 months on the experimental arm versus 6.6 months on chemotherapy in the RAS G12 mutant population. Doubling median OS in second-line pancreatic ductal adenocarcinoma, a disease where incremental gains have defined ambition for decades, reframes what the endpoint space for this indication even looks like.

Nope; the chance of dying within a year or two remains about the same, I’d guess.

. . . and a post from someone on Facebook (I won’t give a name), touting a “60% reduction in the risk of death”. That’s wrong: the risk of death is probably still about 100%

The BBC gets it right, however:

This is correct:

A pill has been found to almost double the survival time for advanced pancreatic cancer patients, with experts describing the trial as a game changer.

The drug, called daraxonrasib, appears to be a breakthrough in managing a disease that has the highest mortality rate of all major cancers.

It helps prevent the spread of cancer by locking onto and shutting off the mutated KRAS gene, which is in more than 90% of pancreatic tumours and spurs cancer growth.

The trial, which included 500 patients in North America, Europe, and Asia, found the average survival time for patients on chemotherapy was 6.6 months, compared with 13.2 months for patients on daraxonrasib. It also caused fewer side-effects.

One other point: if “death risk” is meant to say “death risk over the course of the study,” then that might be accurate. But then the journalists must clarify it.

There are two points to be made, and they’re obvious. First, more than a few science/medicine journalists, including some writing on medical websites, don’t understand statistics, mistaking “rate” for “time”.  I asked a science-friendly doctor if this mistake is common, and he replied, “All the time. Sometimes, I’m not sure it’s an unintentional mistake.”

Which leads us to the second point: this kind of conflation could provide false hope for cancer patients and their families. Knowing that you will live, on average, 6½ months longer if you take the new drug is a very different thing from knowing that you will still die with near certainty. It’s easy for one to think—and this is what I thought when I heard the teaser on television—that the drug will reduce the chance of dying by half.  Seriously, journalists, please brush up on your statistics, for this one is not rocket science!

Should we allow people who aren’t terminally ill to undergo medically assisted dying?

May 28, 2026 • 9:00 am

Are people suffering from a persistent, debilitating, and apparently incurable psychiatric condition, such as incapacitating suicidal depression, entitled to physician and/or government assistance in dying? (This procedure is also called “physician-assisted suicide”, or “medical assistance in dying”: MAID).  Of course anybody can kill themselves without the help of doctors or the government, but I’m talking about formal programs, often involving ingestion or injection of pentobarbital or secobarbital. This is available for those suffering from apparently incurable and suicidal mental illness in five countries: Belgium, the Netherlands, Switzerland, Luxembourg, and Spain (see details below the fold). All of these countries require, as is proper, a rigorous vetting program by mental-health professionals and doctors to see if all recourses have been tried and if the patient truly want to die and sees no point in living.

One alternative, legal everywhere and mentioned in the piece below, is voluntary stopping of eating and drinking (VSF), which, depending on what you do, will cause death within a week or two.  Some countries, like the Netherlands, will give hospice care to mentally ill people who are not approved for MAID but choose VSF, helping those patients ease out of life when their bodies start to shut down.

While physician-assisted suicide is legal in many places, including 11 states in the U.S., as well as Washington D.C.—laws permitting it have recently passed in Illinois and New York, and will take effect this summer—these are all for people suffering from terminal medical conditions.  The U.S. and all countries other than the five listed above do not allow physician-assisted suicide for other coniditons, whether or not the government assists or helps pay for it.

For a number of reasons I list below, MAID for psychiatric conditions has become quite controversial,  While I tend to side with those who allow it, I also agree that stringent medical and psychological vetting is necessary before a doctor is allowed to help someone die who has such conditions.  In the Free Press article below, author Rupa Subramanya first describes the death of Iris Dekker in the Netherlands, and then discusses the many issues around the procedure.

Click to read, though you’ll have to be a subscriber.

One gets the feeling from the posted article above, which is generally objective, that Subramanya really does oppose MAID for psychiatric conditions, and partly for religious reasons.  In a new hourlong conversation with Coleman Hughes, however, Subramanya pulls no punches; she clearly doesn’t think MAID is ready for primetime.  Coleman is a bit more in favor of it, but also has reservations.

First, a bit about Iris Dekker, who sought MAID in the Netherlands after over a decade of deep depression and suicidality.  She in fact tried to kill herself twice, once by hanging and once by cutting, but her parents found her in both cases and aborted the attempt. She also had a physical condition that may have been related to her mental illness:

Depression was not new to the Dekkers. Omar [Iris’s father] has a history of it, as do other members of his family. But Iris’s was different. Her symptoms were psychological and physical—a condition called functional neurological disorder, associated with severe psychological distress and depression. It often presents with symptoms like paralysis, seizures, and chronic pain, and was once referred to in medical psychology as hysteria. Iris had spent more than two years in a wheelchair after a seizure left her unable to walk.

In the end, after she had tried everything, including electroconvulsive therapy and ketamine treatment, Iris asked for MAID. But she became worse while waiting for approval and so practiced VSF until she died, with her pain palliated by physicians, at age 19.  Her parents didn’t want her to die, but in the end realized that there was no likelihood of a cure, and supported her. The end:

Watching her fade away, Omar felt the full weight of what was happening. He recalled the final night with his daughter as he held her in his arms and listened to her breathing. “In my heart, as a father—and also as a nurse—I was thinking, I have to do something,” he said. “And at the same time, I knew: No. This is what she wants.”

In her final moments, Iris could no longer speak or respond. When she took her last breath, Omar saw a smile on his daughter’s face.

“She looked so happy,” he said. “I couldn’t give her more love than letting her go.” Iris died on March 1, five days before her 20th birthday.

Letting go of those we love is very hard. We take it for granted that it’s humane when we’re dealing with pets who have terminal medical issues, but we cannot know when animals are undergoing unbearable mental suffering. But humans can tell us.

*********

It seems obvious, as I said, that Subramanya doesn’t like the idea of MAID, nor does she say how it could be implemented properly.  Statements like these are what makes me feel that way:

The Dekkers agreed to talk to me in detail about their daughter’s decisions—and theirs. They also showed me medical records for Iris. I tried to understand how loving parents could be persuaded that the best decision for their daughter was an early death. What I found was a system that turns young people’s ambiguous wishes into a diagnosis of incurable depression. The process raises questions about the treatment not only of a few teens like Iris who choose to die by euthanasia, but countless others who are confronted with the idea that their psychological suffering is beyond help.

. . .With each failure, Iris and her parents heard the same conclusion from specialists: Her condition was “treatment resistant,” and doctors had exhausted their options. In fact, the conclusion that depression such as Iris’s can be incurable is itself controversial among psychiatrists. As one recent paper in Psychological Medicine noted, clinicians “cannot accurately predict long-term chances of recovery in a particular patient with treatment-resistant depression.”

In the podcast with Coleman, Rupa makes it clear that while she’s not opposed to assisted dying, she is pretty much opposed to the process when it’s applied to psychiatric illnesses or even, as is legal in Canada, to people who have incurable suffering from a medical condition, like going blind or having diabetes.  I won’t counter her arguments, though I disagree with many of her claims. I just want to list below some of the reasons people oppose MAID for purely psychiatric conditions.  All of these save the first are mentioned in either the article or in the podcast. I have made the list and give my reactions to it.

1.) Religious reason #1: only God can take a life or determine when someone should die, suicide is against religious dictates, etc. I will not deal with this because I don’t believe there are gods and thus don’t think these reasons are worth considering seriously. But they are of course worth countering and discussing. I simply won’t entertain the proposition that “God knows best.”

2.) You can never tell when depression might be alleviated; many people who tried to kill themselves because of depression have later recovered and think their suicidal ideation was mistaken. True, but for someone like Iris Dekker, who had tried everything, saying “you might get better” is letting someone suffer forever despite having made a gazillion attempts to find a reason to live. Note that Subramanya reports that psychiatric MAID is rare even where legal:

Even in countries that have been at the forefront of assisted dying, psychiatric euthanasia is still rare. The Netherlands had 174 cases of psychiatric euthanasia in 2025—about 1.7 percent of its euthanasia deaths and 0.1 percent of deaths overall. Of the 338 euthanasia applications received at the Euthanasia Expertise Center in 2025 from patients younger than 30 that involved psychiatric suffering, only 11 were approved. None were minors.

This worry can be alleviated by a process of rigorous vetting, which, given the statistics above, seems already in place. While it of course cannot guarantee that someone allowed MAID could some day recover from psychiatric illness, if they’ve tried many ways to get better and yet still remain suicidal after years, it seems cruel for someone else to say that we should let them live because we don’t know what would happen. It is in effect trying to control someone else’s existence.

3.) The slippery slope argument: MAID for mental illness will lead not only to expansion of the process to those who don’t really qualify, but also, as Rupa says, “people who were socially isolated, people who were homeless, people who were on disability and people who just felt a great sense of despair.”

Again, this can be alleviated by rigorous vetting, and by involving doctors and therapists who aren’t in the business of willy-nilly approving candidates for MAID, just as there should be procedures preventing doctors from prescribing opioids for no good reason. Of course no system is perfect, but when you see someone like Iris Dekker, who has suffered greatly for years and wants to die–and has tried to die by her own hand–slippery-slope arguments need to be contested.  There’s no need to go all the way to the bottom of the slope once you step off the summit.

4.) Laws like Canada’s that allow MAID if you’re suffering not from terminal illnesses, but from other medical conditions, are not supportable because you can’t judge what is “intolerable suffering.” 

Again, rigorous vetting is the best way to deal with this.  Who better than (objective) mental-health professionals and doctors can judge whether suffering is “intolerable”. especially when multiple drug and/or psychiatric regimens ahve been tried?

5.) The social argument (from Rupa): suffering should be solved and endured collectively rather than by personal choice. 

Here’s what Rupa says;

We’re fully rational actors making these decisions entirely on our own. But in reality, our choices are shaped by our relationships with people. It’s shaped by the environment that we’re in, and it’s shaped by economic conditions, whether we feel loved, supported, or abandoned. So his argument is that autonomy is never fully independent because we make decisions within this context. I think with Canada, and then you have a political class in a place like Canada that is more than happy to enable all of these things. And so I feel like all of these things have come together in Canada, in the Netherlands as well.

I don’t really understand this argument, but it figures in the example of Rupa’s father (see below). If someone is suffering and can’t be cured, why should this be a problem that can’t be solved by the individual?  And of course the state does get involved when MAID is considered.

6.) Different doctors have different standards for “intolerable suffering.” Further, at least in Canada, some doctors, says Rupa, tend to get on oversight committees who are on board with MAID, so the procedure becomes easier to get. Rupa says this:

I think that some of the doctors I’ve spoken to think that they’re basically God. they feel powerful in making these decisions one doctor I spoke to she’s a prolific maid provider in British Columbia in Vancouver and she loves the limelight she loves talking about the patients she’s euthanized over the years and she started off I think she was a she went from delivering babies to now euthanizing people and she told me look and she said this elsewhere as well that I like to push the boundaries as much as I can when it comes to medical assistance anddying and that was pretty extraordinary to me. [JAC: remember, this is a transcript taken from the podcast, so there are infelicities of speech as well as outright errors in transcription.]

Again, choose well known and objective physicians; that is the best you can do. And of course usual more than just two or three doctors. Remember that MAID for mental illness is not yet legal in Canada.

7.) Hastening death is “the path of least resistance”, and in many cases may be less expensive and time-consuming than treatment for years and years. Here’s another quote from Rupa:

You do have cases where people can change their minds, but eventually the system decides that it should be the option. There was another case of a man with cancer who became delirious and very unresponsive in hospital. And according to this report, the doctors aroused him, shook his head and interpreted his blinks and the responses he was mouthing as consent and then proceeded to kill him that very same day. So basically, what all of this tells me is that. . .  there’s a medical culture now which is hastening death. And, you know, as one ethicist put it to me, he said this is the path of least resistance now.

If the law is made with the input of ethicists, this should be prevented. Again, the solution seems to be rigorous vetting and oversight rather than letting people suffer forever. And of course you can give control over your medical treatment to others via “do no resuscitate” orders and the like (I have these).

8.) MAID “normalizes” euthanasia and suicide.  Another quote from Rupa:

Hughes: Are you saying because of MADE, we’re entering this culture of normalization of suicide? And because of that, Some young people, they form that expectation that like, yeah, I have a right to die because of this culture. And then if they get rejected, they seek other means where like maybe in the past, without that culture of normalizing euthanasia and suicide, maybe they wouldn’t have even gone down the road. Is that sort of what you’re implying?

Subramanya: Yeah.

“Normalizing euthanasia” does not necessarily mean making it the go-to option.  And we are talking about euthanasia, not “regular” suicide.

9.) Religious reason #2: One role of religion should be to keep people off the slippery slope. Here’s an exchange from the podcast:

Hughes: But if you don’t have a religious view that life is sacred and that suicide is a sin, then it’s possible to talk yourself into it and kind of reason your way into ending your life if you really are at a low point and you are suffering, right? Is that what this is?

Subramanya: Yes, I think religion is certainly one institution when you look at the fact that as I mentioned earlier We’ve become a very individualistic society where suffering is no longer done communally, it’s not experienced communally, but on your own, where previously, you know, you’d go to the church or to the temple or to the mosque or whatever religion you belong to. But now, you know, a lot of us live in isolation, especially young people, you know, who are, I think, we’re still seeing some of the effects of the pandemic rapidly. right now where young people have been struggling with loneliness and alienation and mental health issues and then where suicide is not treated as something that you prevent but increasingly something that you facilitate so religion for sure. If you’re talking about how institutions once played a very important role in making us feel connected, that’s changed quite a bit.

Subramanya seems to have forgotten that it is also religion that’s been the main obstacle to any form of MAID, even for terminal illness (Mother Teresa is one example of someone who thought Jesus will take people when he’s ready). Is Subramanya suggesting that we should try to foist religious solutions onto someone seeking MAID?  Too late: religion is disappearing now, and you don’t go proselytizing someone who is suffering.

When Subramanya tells this story about her father, who found a reason to live, she seems to use it as an example of why anyone, however ill, can find a reason to live.  But people differ in how they bear suffering:

. . . I learned that my father in India was diagnosed with primary central nervous system lymphoma. They found a cyst in his brain and he needed a very urgent brain biopsy. As I was writing about Keanu’s death, this 27-year-old young person with type 1 diabetes and blindness and that he had given up on life, I was watching my own father fight desperately to hold on to his. And five months later, my father can’t speak because the part of the brain on which they operated controls speech. He has undergone chemotherapy and radiation.

He’s doing really well. His cancer is in remission. But what strikes me most is Not just merely his resilience, it is his desire to live. I mean, despite the pain and exhaustion, the loss of speech, the humiliations that he’s experienced, that serious illness brings about in people. You mentioned your mother who had who died of cancer. He’s soldiering on. He still loves life. And he wants more time. He’s fighting for every single day. And he finds joy in ordinary moments.

So, you know, for me, you know, as someone who’s written quite extensively about death, I look at my father and I wonder like what Why is he so different from someone who is 73 years old here in Canada, perhaps given a similar diagnosis and chooses made? Or why does a 28-year-old give up on life? And I don’t think my father in India is an outlier in the sense that he wants to live as much as possible. I think in places like India, you still have strong cultural family ties. I think religion continues to be extremely important. And I think these are factors, these are things that are increasingly, they’re disappearing in the West.

Once again we see religion mentioned as a way to keep people off the slippery slope of MAID. But what if you are not religious and cannot force yourself to believe? Someone like me, for instance.

In the end, I see both the article and podcast (not Hughes) infected with religiously-tinged arguments. I’ve long viewed the Free Press, while ideologically appealing in several ways, as too soft on religion—too eager to see it as caulk for our “god-shaped” holes.  This article may be one example.

Click on “continue reading” below to see descriptions of the five countries medical assistance in dying is legal for those with psychiatric issues:

Continue reading “Should we allow people who aren’t terminally ill to undergo medically assisted dying?” →

The reported benefits and dangers of chiropractic

May 21, 2026 • 10:40 am

“Chiropractic” (a name that in my mind should really be “chiropracty”) is a form of treatment for various disorders in which the cure supposedly comes from mechanical manipulation of the body, especially the spine. It is considered “alternative medicine,” and, as Wikipedia says, is of dubious efficacy for everything:

Many chiropractors (often known informally as chiros), especially those in the field’s early history, have proposed that mechanical disorders affect general health, and that regular manipulation of the spine (spinal adjustment) improves general health. A chiropractor may have a Doctor of Chiropractic (D.C.) degree and be referred to as “doctor” but is not a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.). While many chiropractors view themselves as primary care providers, chiropractic clinical training does not meet the requirements for that designation. A small but significant number of chiropractors spread vaccine misinformation, promote unproven dietary supplements, or administer full-spine x-rays.

There is no compelling evidence that either primary or maintenance chiropractic adjustment is effective for any symptoms or diseases, including low back pain. A 2011 critical evaluation of 45 systematic reviews concluded that the data included in the study “fail[ed] to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.” Conclusions about cost-effectiveness are limited by low-quality studies, uncertainty about efficacy, and insufficient evidence.

There is not sufficient data to establish the safety of chiropractic manipulations. It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases. There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation.Several deaths have been associated with this technique  and it has been suggested that the relationship is causative, a claim which is disputed by many chiropractors.

Here’s the meta-analysis article referenced by Wikipedia, click to access:

Part of the paper’s abstract:

Results Forty-five systematic reviews were included relating to the following conditions: low back pain (n=7), headache (n=6), neck pain (n=4), asthma (n=4), musculoskeletal conditions (n=3), any non-musculoskeletal conditions (n=2), fibromyalgia (n=2), infant colic (n=2), any medical problem (n=1), any paediatric conditions (n=1), carpal tunnel syndrome (n=1), cervicogenic dizziness (n=1), dysmenorrhoea (n=1), gastrointestinal problems (n=1), hypertension (n=1), idiopathic scoliosis (n=1), lateral epicondylitis (n=1), lower extremity conditions (n=1), pregnancy and related conditions (n=1), psychological outcome (n=1), shoulder pain (n=1), upper extremity conditions (n=1) and whiplash injury (n=1). Positive or, for multiple SR, unanimously positive conclusions were drawn for psychological outcomes (n=1) and whiplash (n=1).

Conclusion Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition

Based on the reports of fatalities associated with this procedure (see here for one study of 26 deaths from arterial dissection associated with neck manipulation), I would avoid this therapy: as the paper says, “The risks of this treatment by far outweigh its benefit.”

A new article in the NYT, however, while warning people of using chiropractic for most things, says that it can be useful in alleviating lower back pain.  Click below to read it and you may find it archived here (I can’t access it). We thus have a contradiction between the paper and the analysis above.

 

From the article:

While chiropractors often refer to themselves as doctors, their degree is different from medical doctors.

To practice in the United States, chiropractors typically attend a four-year program where they take courses in basic science and lifestyle and nutrition counseling. They also learn how to perform manual adjustments, which involve putting pressure onto the joints and creating a deep stretch in the tiny muscles that connect the spine’s vertebrae, said William Lauretti, a professor of integrated chiropractic therapies at Northeast College of Health Sciences and a spokesman for the American Chiropractic Association.

(The popping sound heard during this adjustment is a result of gas being released from the fluid that surrounds your joints. While satisfying, Mr. Lauretti said the sound is not the goal of the adjustment.)

After training, chiropractors must pass a national board exam to be eligible for state licensure.

What chiropractors can and can’t do depends on where they practice. For example, in Oregon chiropractors are legally allowed to deliver babies (though they do so rarely) and perform very minor surgery, like stitches and removing skin tags. New York, which has stricter laws for chiropractors, requires them to focus to spinal conditions.

Many insurers will cover many services offered by chiropractors, including adjustments, nutrition counseling and X-rays. Medicare coverage is more stringent, often only covering adjustments, though chiropractors are lobbying Congress to change this.

The paper does say that they’re of some use for lower back pain, in contrast to the Wikipedia article, but I would still consult a genuine M.D. for any pain. As for neck pain, I myself would stay far away:

Chiropractors advertise their services for a wide range of conditions: back pain, arthritis, diabetes, asthma and ear infections. But what the research says chiropractors are effective at treating is doesn’t necessarily match up.

There’s robust evidence that shows chiropractic adjustments can be mildly to moderately effective at managing lower back pain, said Christine Goertz, a professor of musculoskeletal research at the Duke Clinical Research Institute and a licensed chiropractor. An analysis of 47 randomized controlled trials — often considered the gold standard of scientific evidence — determined that manual manipulation was equally effective as treatments like acupuncture or massage therapy.

The article referenced above is from the British Medical Journal, and you can find it here. Back to the NYT:

And the risks of side effects are low compared to some other common interventions, like anti-inflammatory medications and corticosteroid injections. Fractures or other serious complications from spinal manipulation are possible but rare, occurring in roughly 1 per 2 million manipulations, according to one study.

For that reason, spinal manipulation is often recommended as a first line of treatment for low back pain, including in guidelines from the World Health Organization and the Department of Veterans Affairs.

“It is at least as good as, or maybe a little bit better than, other care options for low back pain,” Dr. Goertz said. (Though, as skeptics note, treatments for lower back pain are not very effective in general.)

There is less evidence supporting the use of chiropractic treatment for neck pain. A review of six studies found that chiropractic adjustments did improve acute neck pain. However, the researchers noted that more research was needed to draw any firm conclusion, since many of the studies had only a small number of participants and other limitations.

Some doctors advise against manipulating the neck because of the potential risk of arterial dissection, in which vessels that supply blood to the brain are torn. This can lead to stroke or death. Some analyses have suggested an association between neck adjustments and this injury, but it’s not clear there is a causal link.

I don’t know of a causal link between the spine’s position and stuff like diabetes and ear infections, so I would never go to a chiropractor for anything. But I’m sure some readers have, and perhaps they’ve been helped, though there’s no blind test with individual readers’ cases. If you have experience with chiropractic, describe it below. Note: I am not touting this therapy; use your own judgement. As I said, I will never use it myself.

The article ends with a section on what you should look for if you’re shopping for chiropractors, but I’ll let you read that yourself.

The last Nazi newsreel before the end of WWII, with the last video of Hitler

April 8, 2026 • 10:30 am

This video showed up as a “suggestion” when I was watching YouTube (no, I’m not a Nazi), and I was curious to see what the last German propaganda newsreel of WWII showed. Among other things, which are explained in the 12½-minute clip, is the last video taken of Hitler, showing his left hand shaking violently (5:34), a symptom medical historians have attributed to Parkinson’s disease. (This bit wasn’t shown in the final video.) Hitler committed suicide on April 30, 1945—just five weeks after this newsreel appeared in German cinemas.

The footnotes show the direct translation, but there’s English narration of what’s going on in the video beginning 48 seconds in.

There’s a Wikipedia article on the newsreel series called, Die Deutsche Wochenschau, and here are two paragraphs from it:

Die Deutsche Wochenschau (German for ‘The German Weekly Review’, lit. ‘The German Weekly Look‘ or ‘The German Weekly Show‘) is the title of the unified newsreel series released in the cinemas of Nazi Germany from June 1940 until the end of World War II, with the final edition issued on 22 March 1945. The co-ordinated newsreel production was set up as a vital instrument for the mass distribution of Nazi propaganda at war. Today the preserved Wochenschau short films make up a significant part of the audiovisual records of the Nazi era.

. . . Among the many notable scenes preserved by the newsreel are the Nazi point of view during the Battle of Normandy, the footage of Hitler and Mussolini right after the 20 July plot, and the last footage (No. 755) of Hitler awarding the Iron Cross to Hitler Youth volunteers in the garden of the Reich Chancellery shortly before the Battle of Berlin. Its last documentary, Traitors before the People’s Court, depicted the trial of the accused in the 20 July plot, and was never shown.

It’s fascinating to see how, with the Russians closing in on Berlin, the German people were not told of it but instead were misled to think that they might successfully resist the enemy.

Jesse Singal’s op-ed in the NYT: A turning point in “affirmative care”?

February 25, 2026 • 9:30 am

For two reasons I think that Jesse Singal‘s long op-ed (really a “guest essay”) in today’s NYT will mark a turning point in public and professional attitudes towards “affirmative care.”  First, the NYT saw fit to publish a piece showing that many American medical associations have promoted “affirmative care” of gender-dysphoric adolescents, despite those associations knowing that there was little or no evidence for the efficacy of such care.  Indeed, it seems that some of those associations lied or dissimulated about it, all in the interest of pushing a “progressive” ideology. As we know, left-wing “progressives” have been in favor of immediately accepting a child’s self-identification as belonging to its non-natal gender, so that teachers, parents, therapists, and doctors have united to start such children on puberty blockers and, later, surgery and hormones.

The NYT, while it has published pieces questioning the evidence for affirmative care, has been reluctant to come out as strongly as Singal does in the essay. That America’s Paper of Record deems this worthy of publication is news in itself.

For a number of reasons, most concerned with recent evidence (e.g., the Cass Review), the rah-rah affirmative therapy treadmill is grinding to a halt.  As Singal relates, recently two American medical associations—the American Society of Plastic Surgeons (ASPS) and now the powerful American Medical Association (AMA)—have admitted that we don’t know whether a gender-dyphoric child will “resolve” as gay or non-trans without medical intervention, and also that there should be no surgical intervention aimed at altering the gender of minors.

Singal has long called attention to these problems, and for his troubles he’s been branded a “transphobe,” shunned and blocked on social media.  There was even a petition to ban him from the site Bluesky, though, thank Ceiling Cat, it didn’t work.  Now, at long last, his views are getting a respectful airing, and society is coming to realize that the American zeal for “affirmative care”—not shared so much in Europe—is not only misguided but harmful.

The second reason is that the author ID says this about Singal:

Jesse Singal is writing a book about the debate over youth gender medicine in the United States and writes the newsletter Singal-Minded.

Although he’s already written one book. The Quick Fix: Why Fad Psychology Can’t Cure Our Social Ills, this is his first book on gender medicine, and if it expands on the theme of this article, it will be a landmark work with the potential to create big changes in gender medicine and how we view it.  Yes, it’s true that gender ideologues will oppose the article and upcoming book, but they have long put ideology over science, a strategy that is a loser, as we know from the failures of creationism and intelligent design.

Click on the headlines to read the article at the NYT, or find it archived for free at this site.

A few excerpts:

It didn’t matter that the number of kids showing up at gender clinics had soared and that they were more likely to have complex mental health conditions than those who had come to clinics in years earlier, complicating diagnosis. Advocates and health care organizations just dug in. As a billboard truck used by the L.G.B.T.Q. advocacy group GLAAD proclaimed in 2023, “The science is settled.” The Human Rights Campaign says on its website that “the safety and efficacy of gender-affirming care for transgender and nonbinary youth and adults is clear.” Elsewhere, these and other groups, like the American Civil Liberties Union, referred to these treatme

. . .The science doesn’t seem so settled after all, and it’s important to understand what happened here. The approach of left-of-center Americans and our institutions — to assume that when a scientific organization releases a policy statement on a hot-button issue, that the policy statement must be accurate — is a deeply naïve understanding of science, human nature and politics, and how they intersect.

At a time when more and more Americans are turning away from expert authority in favor of YouTube quacks and their ilk — and when our own government is pushing scientifically baseless policies on childhood vaccination and climate change — it’s vital that the organizations that represent mainstream science be open, honest and transparent about politically charged issues. If they aren’t, there’s simply no good reason to trust them.

And then Singal documents how organizations representing mainstream science and medicine haven’t been so trustworthy. The American Academy of Pediatrics (AAP) has been particularly  vocal—and clueless—in relentlessly pushing affirmative care:

A 2018 policy statement by the American Academy of Pediatrics provides a useful example of how these documents can go wrong. At one point, it argues that children who say they are trans “know their gender as clearly and as consistently as their developmentally equivalent peers,” an extreme exaggeration of what we know about this population. (A single study is cited.) The document also criticizes the “outdated approach in which a child’s gender-diverse assertions are held as ‘possibly true’ until an arbitrary age” — the A.A.P. was instructing clinicians to take 4- and 5-year-olds’ claims about their gender identities as certainly true. It’s understandable why the Cass reviewers scored this policy statement so abysmally, giving it 12 out of 100 possible points on “rigor of development” and six out of 100 on “applicability.”

Policy statements like this one can reflect the complex and opaque internal politics of an organization, rather than dispassionate scientific analysis. The journalist Aaron Sibarium’s reporting strongly suggests that a small group of A.A.P. members, many of whom were themselves youth gender medicine providers, played a disproportionate role in developing these guidelines.

Dr. Julia Mason, a 30-year member of the organization, wrote in The Wall Street Journal, with the Manhattan Institute’s Leor Sapir, that the A.A.P. deferred to activist-clinicians and stonewalled the critics’ demands for a more rigorous approach. Dr. Sarah Palmer, an Indiana-based pediatrician, told me she recently left the A.A.P. after nearly 30 years because of this issue. “I’ve tried to engage and be a member and pay that huge fee every year,” she said. “They just stopped answering any questions.” This is unfortunate given that, as critics have noted, in many cases the A.A.P. document’s footnotes don’t even support the claims being made in the text.

In the face of a lack of studies supporting their preferred ideology, organizations like the American Psychological Association (APA) have waffled, weaseled, and dissimulated, sometimes making contradictory statements.  Here’s one example (the AMA has also changed its stand but wouldn’t give Singal an interview). Bolding is mine:

The A.P.A. presents a particularly striking case of why transparency is important. In 2024 it published what it hailed as a “groundbreaking policy supporting transgender, gender diverse, nonbinary individuals” that was specifically geared at fighting “misinformation” on that subject. But when I reached out to the group this month, it pointed me to a different document, a letter written by the group’s chief advocacy officer, Katherine McGuire, in September in response to a Federal Trade Commission request for comment on youth gender medicine.

The documents, separated by about a year and a half (and, perhaps as significantly, one presidential election), straightforwardly contradict each other. The A.P.A. in 2024 argued that there is a “comprehensive body of psychological and medical research supporting the positive impact of gender-affirming treatments” for individuals “across the life span.” But in 2025, the group argued that “psychologists do not make broad claims about treatment effectiveness.”

In 2024 the A.P.A. criticized those “mischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence.” In 2025 it cautioned that gender dysphoria diagnoses could be the result of “trauma-related presentations” rather than a trans identity and that “co-occurring mental health or neurodevelopmental conditions (e.g., depression, anxiety, autism spectrum disorder) … may complicate or be mistaken for gender dysphoria.” It seems undeniable that the 2025 A.P.A. published what the 2024 A.P. A. considered to be “misinformation.” (“The 2024 policy statement and the 2025 F.T.C. letter are consistent,” said Ms. McGuire in an email, and “both documents reflect A.P.A.’s consistent commitment to evidence-based psychological care.”)

Behavior like this should anger anyone wedded to evidence-based medicine and science, especially because the APA simply lies when it says that its stand has been consistent all along. And the APA is not alone in its bad behavior.  Other organizations are digging in their heels, maintaining unsupportable positions in the face of counterevidence—all because of the ideology that people can change sex and we should believe them when they say they are really of a different sex than their natal one. This is wedded to the view that surgery and hormones designed to change gender have been proven to be safe.

I should add here that many adults who have transitioned are nevertheless happy with the outcomes of their treatments. But note that Singal’s forthcoming book is about youth gender medicine. This is the focus of the controversy, and few people (certainly not me) would deny adults the right to go ahead with surgery and hormones, though perhaps the public shouldn’t have to pay for it.

Singal’s conclusion, which I hope is the theme of his book, is short and sweet:

Should we trust the science? Sure, in theory — but only when the science in question has earned our trust through transparency and rigor.

  It looks like most medical organizations should not be trusted until they start speaking the truth.

Kathleen Stock on female genital mutilation, cultural relativism, and a recent (odious) paper in The Journal of Medical Ethics

December 20, 2025 • 11:00 am

Over at UnHerd, philosopher Kathleen Stock, formerly of the University of Sussex, critiques a paper in The Journal of Medical Ethics that I discussed recently, a paper you can read by clicking below. (You may remember that Stock, an OBE, was forced to resign from Sussex after she was demonized for her views on gender identity. These involved claims that there are but two biological sexes, and her cancellation was largely the result of a campaign by students.)

As I said in my earlier post, this paper seems to whitewash female genital mutilation (FGM), and does so in several ways. The authors think that the term “mutilation” is pejorative, and is more accurate and less inflammatory than saying “female genital modification”, which covers a variety of methods of FGM, some much more dangerous than others, as well as cosmetic genital surgery on biological women or surgery on trans-identifying males to give them a simulacrum of female genitalia. (There is also circumcision, which some lump in with the more dire forms of FGM.)

The Ahmadu et al. paper also notes that anti-FGM campaigns in Africa, where the mutilation is practiced most often, have their own harms. As Stock comments in the article below,

And so our co-authors — the majority of whom work in Europe, Australasia, and North America — tell us that anti-FGM initiatives in Africa cause material harms. Supposedly, they siphon off money and attention that could be better spent in other health campaigns, and they undermine trust in doctors.
They also cause young women to consider genital cutting as “traumatising” in retrospect, we are told, where they would not otherwise have done so. Even though some who have been subject to it can experience “unwanted upsetting memories, heightened vigilance, sleep disturbance, recurrent memories or flashbacks during medical consultations”, there is allegedly no actual trauma there, until some foreign aid agency tells them so.

And if you don’t believe Stock, here’s a small part of the section of the Ahmadu et al. paper trying to push the word “trauma” out of descriptionos of FGM:

Most affected women themselves rarely use the word ‘trauma’ to describe their experiences of the practices. If they describe the experiences in negative terms, they may use words such as ‘difficult’ or ‘painful’, but some of them may simultaneously describe the experience as celebratory, empowering, important and significant. This may even accompany experiences of pain, but this pain, when made sense of in its cultural context, does not equate to trauma.

Researchers and clinicians often use the mostly biomedically based DSM-5 (the current version of the Diagnostic and Statistical Manual of Mental Disorders) to assess trauma, with a focus on post-traumatic stress disorder (PTSD). While narratives of women who have experienced a cultural or religious-based procedure may contain descriptions of symptoms that fall into the PTSD nosological category (such as ‘unwanted upsetting memories’, ‘negative affect’, ‘nightmares’ or heightened sensations, vigilance or sleep disturbance), the cross-cultural validity of PTSD as a construct and its use in migrant populations has been widely contested, because it applies Western cultural understandings to people who do not necessarily equate the experience of pain as directly causing trauma.

That is first-class progressive whitewashing! As Stock describes :

[Anti-FGM campaigns] also cause young women to consider genital cutting as “traumatising” in retrospect, we are told, where they would not otherwise have done so. Even though some who have been subject to it can experience “unwanted upsetting memories, heightened vigilance, sleep disturbance, recurrent memories or flashbacks during medical consultations”, there is allegedly no actual trauma there, until some foreign aid agency tells them so.

Finally, Ahmadu et al. note that anti-FGM campaigns, and the term “mutilation”, have led to unfair stigmatization of some groups in the West that practiced FGM in their ancestral countries (and still practice it in the West, though to a much lesser extent). You could argue, for example, that it leads to bigotry in the West against those of Somalian ancestry, as FGM is rather common there. And I agree that it’s unfair to stigmatize an entire group because some of them practice FGM. Only the perpetrators should be punished and the promoters rebuked. But the practice should be loudly decried, and aimed at communities who employ it.

In her article, Stock rebukes the article as a prime example of “cultural relativism,” the view that while people within a given culture can judge some acts more moral than others, considering different cultures one cannot judge some as having behaviors more moral than do others.  One might, if one were stupid, criticize this as forms of ethical appropriation. So, say the relativists, we shouldn’t be too quick to judge those in Somalia who practice infibulation of young women.

You can read Stock’s article by clicking below, but if you’re paywalled you can find the article archived here.

Stock is not a moral relativist, at least when it comes to genital “modification,” a term she opposes.  I’ll put up a few quotes, but you should read the whole piece, either online or in the archived version:

Progressives are notoriously fond of renaming negatively-coded social practices to make them sound more palatable: “assisted dying” for euthanasia, or “sex work” for prostitution, for instance. The usual strategy is to take the most benign example of the practice possible, then make that the central paradigm. And so we get images of affluent middle-class people floating off to consensual oblivion at the hands of a doctor, rather than hungry, homeless depressives. We are told to think of students harmlessly supplementing their degrees with a bit of escort work, not drug-addicted mothers standing on street corners. Perpetually gloomy about human behaviour in other areas, when it comes to sex and death the mood becomes positively Pollyanna-ish.

Similarly, the authors of the new FGM article are apparently looking for the silver lining. Some genital modifications enhance group identity, they say, and a sense of community belonging. And as with euthanasia and prostitution, they want us to ignore the inconvenient downsides. But at the same time, there is a philosophical component here mostly absent from parallel campaigns. It’s cultural relativism — which says that strictly speaking, there are no downsides, or indeed upsides, at all.

That is: from the inside of a particular culture, certain practices count as exemplary and others as evil. Yet zoom out to an omniscient, deculturated perspective upon human behaviour generally, and there is no objective moral value — or so the story goes. All value is constructed at the local level. Worse: when you zoom back into your own homegrown ethical concerns after taking such a trip, they seem strangely hollow. Like an astronaut returning to Earth after having seen the whole of it from space, everything looks a bit parochial.

Stock lumps the authors into three groups, which she calls “the Conservatives” (no genital surgeries of any type), the “Centrists” (okay with circumcision for males but no surgery on females), and “Permissives” (people who think that “it is up to the parents to decide what is best for their children, and that the state should refrain from interfering with any culturally significant practices unless they can be shown to involve serious harm.” [that quote is from the Ahmadu et al. paper]. These conflicting views lead to the tension that Stock and others can perceive in this paper. What are the sweating authors trying to say?

Cultural relativism, while in style among progressives, is a non-starter. You can see that by simply imagining John Rawls’s “veil of ignorance” and ask imaginary people who have not been acculturated to look at various cultures from behind that veil and then say which culture they’d rather live in. If you are a young girl, would you rather be in Somalia or Denmark? If you’re gay, would you rather be in Iran or Israel? And so on.  Here’s Stock’s ending where she asserts that not all forms of “genital modification” should be lumped together or considered equally bad:

Meanwhile in the Anglosphere, anti-FGM laws allegedly cause “oversurveillance of ethnic and racialised families and girls” and undermine “social trust, community life and human rights”. All these things, it is implied, are flat wrong. This sounds like old-fashioned morality talk to me. But then again, if old-fashioned morality talk is permissible, may not we also talk explicitly about the wrongs of holding small girls down to tables and slicing off bits of them, or sewing them up so tight that they are in searing agony? These things sound like they might undermine “social trust, community life, and human rights” too.

Rather than be a relativist about morality, it makes more sense to be a pluralist. There are different virtues for humans to aspire to, and they can’t be ranked. Sometimes there are clashes between them, resulting in inevitable trade-offs (honesty vs kindness; loyalty to family vs to one’s community; and so on). There are very few cost-free moral choices in this life. Equally, some virtues will vary according to cultural backdrop. The local environment may partly influence which virtues are paramount. For instance, family obedience and respect for elders will be stronger in places where close kinship ties help people to survive.

But still, there is always a limit on what behaviours might conceivably count as good; and that limit is whether they actively inhibit a person’s flourishing, in the Aristotelian sense. The most drastic and bloody forms of FGM obviously do so. They lead a little girl to feel distrust and fear of female carers; predispose her to infections and limit her sexual function for life; cause her pain, nightmares, and panicky flashbacks for decades.

With minimally invasive genital surgeries involving peripheral body parts, matters are not so clear. But whatever the case about those, you can’t just assume in advance that all genital modifications are equal, so that discriminating between them by different legal and social approaches is somehow “unfair”. If cultural relativism were really true, there would be no such thing as unfairness either. It would just be empty meaninglessness, all the way down. Academics with heroic designs on the English language should be careful not to fall into ethical abysses, even as they tell themselves the landscape around them is objectively flat.

Here Stock comes close to equating “more moral” with “creating more well being,” a position that Sam Harris takes in The Moral Landscape, and a position I’ve criticized. But here the niceties of ethics are irrelevant. There is simply no way that forcing FGM upon girls can be considered better than banning it.