Should there be religious exemptions from vaccine mandates?

September 7, 2021 • 9:15 am

The other day I had a bright idea for a post on my drive to the store, and, since my short-term memory has always been lousy, I should have made a note to myself. SInce I didn’t do that, I promptly forgot it, though I knew the topic was interesting.

I was, however, just reminded of what I’d thought of by seeing the title below of a NYT op-ed by Curtis Chang (identified as “a co-founder of Christians and the Vaccine, a consulting faculty member at Duke Divinity School and the C.E.O. of CWR, a management consultancy serving secular nonprofits and government agencies”).

I haven’t yet read this op-ed except for the title, so let me first give my own view before I parse the article.

First, I agree with the title wholeheartedly.  The only people who should be exempted from vaccine mandates are those who might be injured by vaccines, including the immunocompromised.  Now adults above a certain age should be allowed to make medical decisions if those decisions don’t endanger anyone else. Thus, if you have appendicitis and are one of those sects that don’t accept medical intervention (Christian Science is supposed to be one, but members often sneak around the restrictions), it’s okay by me if you reject the operation and endanger yourself. (If you have a wife and kids, however, that may be another matter, largely because the kids, who could be left without a parent, don’t get to choose their faith.)

But with vaccinations, you’re endangering not only yourself by rejecting science-based medicine, but others as well. Thus, if you refuse the Covid shot on religious grounds, you’re endangering other people because you might get infected and spread the virus. Even if nearly everyone else is vaccinated, you could still infect the few who aren’t. Even the Bible talks about rendering unto Caesar. Well, Caesar is the state, and to the state belongs the purview of preventing pandemics and epidemics.

The fact that religious people are allowed to refuse medical care for their kids in some places, or get a slap on the wrist when they do—even when the child dies—is absolutely unconscionable. It’s one of the unjustified forms of “respect” that we afford to religious beliefs. The subject of religion and healthcare is largely the subject of the last chapter of my book Faith Versus Fact, and I tell some horrific stories of those who believe in faith healing letting their children die in the vain hope that God would save them. This should be a felony, and it is in some places, but all too often that unwarranted “respect” for faith gets parents either off the hook or with a minimal sentence. And all too often those parents justify their behavior, even when, by withholding medical care, they’ve killed their own child. As I note in my book (p. 234):

It’s not just the parents who are at fault. Religious exemptions are written into law by the federal and state governments—that is, those who represent all Americans. In fact, 38 of the 50 states have religious exemptions for child abuse and neglect in their civil codes, 15 states have such exemptions for misdemeanors, 17 for felony crimes against children, and five (Idaho, Iowa, Ohio, West Virginia, and Arkansas) have exemptions for manslaughter, murder, or capital murder. Altogether, 43 of the 50 states confer some type of civil or criminal immunity on parents who injure their children by withholding medical care on religious grounds.

As for vaccinations, there should be no religious exemptions for getting them, regardless of the dictate of your faith. That’s because refusing a vaccine is not a decision with purely personal consequences, but can have widespread and deleterious effects on other people. And yet, as I note further in my book (pp. 235-236):

Religious exemptions for vaccinations, allowed in 48 of the 50 U.S. states (all except Mississippi and West Virginia) endanger not only the children who don’t get immunized, but the community in general:  not everyone gets vaccinated, and even those who are don’t always acquire immunity. To attend public schools and many colleges, like the one where I teach, students must show evidence of vaccination for diseases like hepatitis, measles, mumps, diphtheria, and tetanus. The only exemptions permitted are for medical reasons, like a compromised immune system—and religion.

Nor are Christians the only believers who oppose immunization. Islamic clerics in Afghanistan, Pakistan, and Nigeria urge their followers to oppose polio vaccination, declaring it a conspiracy to sterilize Muslims. These efforts may prevent the complete eradication of polio from the human species, something already been achieved for smallpox. Dr. A Majid Katme, spokesman and former head of the Islamic Medical Association of the UK, described by the Guardian as “a respected figure in the British Muslim community,” has come out against all childhood vaccination, claiming that “the case of vaccination is first an Islamic one, based on Islamic ethos regarding the perfection of the natural human body’s immune defense system, empowered by great and prophetic guidance to avoid most infections.”  Taking his advice would, of course, be disastrous.

In all states, immunizations are required for public school enrollment, except for medical, religious and philosophical exemptions. Here’s the latest map (2021) of exemptions, taken from The National Conference of State Legislatures. As you can see, since my book was published in 2015, it appears that four states—Maine, New York, Connecticut, and California—no longer grant religious exemptions for vaccination. That’s good news. Note as well that only 15 states allow philosophical exemptions (the striped ones are also blue, meaning that they allow religious exemptions too). This shows not only that religion gets precedence over philosophy, but also that this precedence makes no sense, since a philosophical exemption is presumably a “reasoned” one (misguided though it may be), while religious dictates come from scripture or authority. Every state in the map below should be white.

Now I’ll read the article, and you are free to at any time by clicking on the screenshot below.

Chang and I largely agree, but diverge in three important ways:

First, though, he notes that the religious exemption comes from Title VII of the Civil Rights acts, which “require American employers to accommodate employees’ religious beliefs.” And those are the grounds on which many people are claiming religious exemption from the Covid vaccination, though Chang believes that these religionists aren’t really doing it on religious grounds (which don’t exist anyway, see below), but are “nonreligious and rooted in deep-seated suspicion of government and vulnerability to misinformation.”

Further, and this is what made me realize originally that this topic deserves a post, how many religions really have dictates prompting their followers to refuse vaccination?  We know about Christian Science, of course, and there are dozens of evangelical Christian sects, largely in the American Northwest, that refuse medical care as part of their faith. But try to find a justification for that in scripture. As Chang notes:

. . . there is no actual religious basis for exemptions from vaccine mandates in any established stream of Christianity. Within both Catholicism and all the major Protestant denominations, no creed or Scripture in any way prohibits Christians from getting the vaccine. Even the sect of Christian Scientists, which historically has abstained from medical treatment, has expressed openness to vaccines for the sake of the wider community. The consensus of mainstream Christian leaders — from Pope Francis to Franklin Graham — is that vaccination is consistent with biblical Christian faith.

Biblically based arguments against vaccination have been rebutted. The project Christians and the Vaccine, which I helped to found, has created numerous explainer videos in an effort to refute attempts by anti-vax Christians to hijack pro-life values, to distort biblical references like the “mark of the beast” and to inflame fears about government control. Christians who request religious exemptions rarely even try to offer substantive biblical and theological reasoning. Rather, the drivers for evangelical resistance are nonreligious and are rooted in deep-seated suspicion of government and vulnerability to misinformation.
Chang is doing a good deed by pointing out the weakness of religious exemptions for vaccination, and by insisting that all employers should get rid of religious exemptions for coronavirus vaccines (he specifies “for Christians”, but I think no religious exemptions should be allowed).

That’s one way we differ. The other is that Chang appears to think that Christians have a “right” to refuse the vaccine in general, though not necessarily to be employed without it:

My plea to my fellow Christians: If you insist on refusing the vaccine, that is your right. But please do not bring God into it. Doing so is the very definition of violating the Third Commandment, “Thou shalt not take the name of the Lord thy God in vain.”

I don’t think there’s a “right” for Christians to refuse vaccines deemed essential by the state. They have no more right to do that than to refuse to pay taxes on religious grounds, nor to send their children to public schools without the required shots (except, of course, for those pesky exemptions).  And not paying taxes is far less harmful to society than walking around with a possibly infectious microbe.  Everyone should be vaccinated for diseases like Covid unless there are medical contraindications. I can see no reason not to. People may say that a few people may suffer serious side effects, but those are far less harmful than living through a pandemic.

Finally, many religious schools allow unvaccinated children to attend, and some parents are sending their children there, or homeschooling them, to get around the normal vaccine requirements (right now only older children must be vaccinated). For safe vaccines, as Covid-19 jabs will surely prove to be for younger children, all children everywhere must be vaccinated, just like adults. After all, even religious children mingle with the general public, and endanger them when they’re unvaccinated.

Of course given my view that religion is man-made and generally detrimental to society (this is of course demonstrated by the last chapter of my book), I would object to any favoritism based on religion that doesn’t apply to secular people. (This doesn’t mean, though, that I favor philosophical exemptions to vaccination!) But you don’t have to go that route when making the argument that nobody should be exempt from a Covid vaccination except on medical grounds. The public health argument is sufficient.

Perhaps you disagree, or have other views. By all means, use the comments to air your thoughts.

An academic paper: Which saint is best to pray to if you’ve got Covid?

August 28, 2021 • 10:45 am

Inquiring minds want to know, and three Europeans (perhaps in cahoots with the divine) have answered:

When a reader sent me this article, and I read the online condensed version (it takes two minutes), I thought it as a joke. But no, it’s for real. You can see the journal site here, and a response to the article is the first one listed on the contents page of the latest issue. I’d love to see the response, or the full original paper (you can see a precis by clicking on the screenshot below).  I’ve archived the article’s precis here in case that for some reason they ditch the article.

 

Okay, I’m going to show you the whole “snippet” of the paper as presented by the journal:

Short report

Which Saint to pray for fighting against a Covid infection? A short survey

Summary

Background

In the absence of a treatment still considered universally effective, and of a vaccine validated by the health authorities, we wanted to know which Catholic saint the European Christian community turned to in the event of infection with Covid-19 to request a miraculous healing.

Methodology

An online survey was carried out on a sample of 1158 adults using social media tools.

Results

All results are presented in this research, with a few saints in the majority, and some dictated by the symptomatology of the Covid-19 infection or the personalities of certain « doctor guru ».

Conclusion

This medico-anthropological study is revealing the psychology of Western patients vis-à-vis the magic-religious means used in the fight against diseases, particularly in the epidemic/pandemic context.

Section snippets

Background

The relationship between religion and medicine is well known in human communities since antiquity. Medieval medicine was based on Hippocratic and Galenic doctrines, but it was also characterized by spiritual and divine influences. So, in European countries, in Middle Ages, Saints’ invocation for the curing of diseases was an usual practice.

Despite, the spiritual and religious dimensions have deviated from medicine after the Renaissance and the Late Enlightenment, the intercession to the Saints. . .

Methodology

We conducted a survey on two of the most used social networks: Twitter and Facebook. The survey was conducted between August 21 and 25, 2020. Each author posted on his Twitter and Facebook page, the following question: “Which saint you would pray for fighting against a Covid infection?”. The total number of followers targeted by the question was 15,840 people (92% from Europe).

Results

A total of 1158 adult anonymous participants (mainly from France and Italy) answered to our question. For obvious ethical reason, no sex, age or cultural background are available. All results are summarized in Table 1.

Discussion

Analyzing the results in more detail, from the survey it emerges that the majority saint is St. Rita (Fig. 1). From a young age, Rita of Cascia (Italy, 1381-1457) dreamed of consecrating herself to God, but she was destined to marry a violent man. Rita’s patience and love changed her husband’s character. After the violent death of her husband and two children from illness, Rita decided to follow the youthful desire by entering the monastery of the Order of Sant’Agostino in Cascia (Italy) [4].

Conclusions

This short medico-anthropological study is revealing the psychology of Western patients vis-à-vis the magic-religious means used in the fight against diseases, particularly in an epidemic/pandemic context. The survey confirms that Catholic people continue to entrust their sorrows, their anxieties and their hopes to the divinity, especially in time of global stress, mainly if it is a suddenly-presented difficulty that have changed the people’s lifestyle. Moreover, the choice of the Saints to. . .

Authors’ contributions

AP had the initial idea of the search and contributed to the survey. AC contributed to the survey. PC wrote the first draft of the manuscript, with significant critical input from all other coauthors. All authors have read and approve the final article. PC is the manuscript guarantor.

Disclosure of interest

The authors declare that they have no competing interest.

So if you don’t get vaccinated, you better start praying to Saint Rita.

This is unbelievably stupid. And their research used subjects garnered from Twitter and Facebook!

Note that this isn’t just a survey of opinion, but is somewhat prescriptive: “In the absence of a treatment still considered universally effective, and of a vaccine validated by the health authorities, we wanted to know which Catholic saint the European Christian community turned to in the event of infection with Covid-19 to request a miraculous healing.”

Elsevier should be ashamed of itself. If anybody has access to the letter of response, I’d love to see it.

h/t: Ginger K

The latest from my doc on the pandemic, vaccinations, masks, and Delta

August 9, 2021 • 12:30 pm

My extremely competent and science-oriented physician, Dr. Alex Lickerman, has written post #14 in his continuing series about the coronavirus and the pandemic. It’s free, and you can read it by clicking on the screenshot below.

This one answers a number of questions that many of us have. I’ll give a precis of the answers at the end, but you need to read the whole thing. After all, immunized or not, it’s your health. I think you’ll find the answers reassuring.  And what I like about this post, as with the others, is that the answers are completely driven by data.  When the data are ambiguous or unclear, Alex lets us know.

Alex has volunteered to answer readers’ questions, so feel free to ask them in the comments section below.

Some of the questions asked and answered (or not answered if we don’t have data):

  • Is the Delta variant of cornavirus more contagious than other strains of the virus.
  • Does the Delta variant cause more severe disease than the other variants?
  • How effective are the vaccines against the Delta variant?
  • How much do we need to worry about “breakthrough infections?  Here I’ll quote something Alex notes:

But here’s the bottom line: the absolute risk of becoming infected to which vaccinated people are being exposed in most situations in which they find themselves will be far less than 7.2 to 28.8 percent.

This does explain, however, why breakthrough infections with Delta can and do occur. But what we care about most—and what the vaccines were really designed to mitigate—isn’t the risk of catching COVID-19. It’s the risk of being hospitalized and dying from it (as well as the risk of developing long-COVID). Here, the CDC data tells the real story: as of this writing (at a time when, as mentioned above, the Delta variant is the dominant strain infecting people in the U.S.), of 164 million people fully vaccinated (with a mix of the mRNA vaccines and the J&J vaccine), 5,285 people have been hospitalized for COVID-19 (which yields a risk of being hospitalized from severe COVID-19 if you’re immunized of 0.003 percent), and of those 1,191 died (which yields a risk of dying from COVID-19 if you’re immunized of 0.0007 percent). When you consider the risks most of us take every day without worrying about them at all—for example, over the course of a year, the odds of getting into a car accident are 3.7 percent on average and the odds of dying in a car accident are 0.3 percent, making the annual risk of dying from a car accident 0.01 percent, which is 14 times the risk of an immunized person dying from COVID-19—our inability to think statistically clearly has us afraid of the wrong things. (This goes for the decision to be vaccinated as well: our annual risk of dying from a car accident turns out also to be 14 times the risk of the most common serious adverse reaction to the vaccines—blood clots with the J&J vaccines—which occurs at the same rate as the rate of death from COVID-19 if you’re fully immunized, a rate of 0.0007 percent.)

  • Does immunity conferred by the vaccines wane over time? If so, at what rate?
  • Should we be looking to get “booster” (third) vaccinations?
  • Can fully vaccinated people spread the variant? If so, should vaccinated people mask up?
  • Is traveling safe now?

And I’ll give you a peek at the answers but, as I said, read the whole piece and then fire away with questions. A quote from the article:

CONCLUSION: It’s hard to know how to think about immunization, the Delta variant, and how we should behave in different circumstances to keep ourselves and those around us safe. We’re all seeing the science unfold in real time, revealing just how messy, uncertain, and difficult it is to figure out what’s really true. But, though it takes time, science ultimately gives us answers we can rely on. We can all argue about what policies make the most sense based on what the science shows, but it’s the science we should all use to help us guide our own behavior. And, as of this writing, the science says the following:

  1. The Delta variant is more contagious than other variants.

  2. The Delta variant may be more dangerous than other variants.

  3. The vaccines are likely somewhat less effective in preventing infection with the Delta variant, but still offer an enormous amount of protection. Breakthrough infections are occurring, but they are overwhelmingly mild.

  4. Vaccinated people probably can transmit the infection but almost certainly at a lower rate than unvaccinated people.

  5. The vaccines remain unbelievably effective at preventing hospitalization and death from the Delta variant, so much so that vaccinated people can continue to live as they did before the onset of the pandemic, with the possible exception of wearing masks to prevent asymptomatic spread to vulnerable people in areas of high prevalence of disease.

  6. A third booster shot for non-immunocompromised people doesn’t make sense at this point in the pandemic. Some people who are immunocompromised may want to consider a third shot.

Why do people think the coronavirus vaccine should be an exception to mandated vaccinations?

August 6, 2021 • 9:15 am

On the news last night, and almost every night, one can see irate parents objecting to their children having to be vaccinated for school (mostly college now), or having to wear masks. And the mantra they cry is “We’re the parents: we make the decisions for our children and know what’s right for them.” Likewise, much of the objection by adults to getting vaccinated centers around the freedom to make decisions that affect their own bodies. While that reason may hold water for things like abortion, it doesn’t work for vaccination, because your “freedom” can make other people sick, whether it be resistance to masks or to the jabs themselves.

Most of you, at least if you’re American, know that vaccinations are required to attend most public schools unless you file a religious objection, and so it’s not up to the parents to decide about getting jabs for their kids. They could, however, send their kids to religious schools, or try homeschooling, if they wish to avoid vaccination.

To check on this again, though, I looked up the public-school vaccination requirements for two states: my own liberal state of Illinois, which has been pretty strict about masks and restrictions during the pandemic, and Louisiana, which has the highest per capita rate of infection and a lot of vaccine resisters. It turns out that the school requirements for vaccination are pretty much the same for both states, and in fact require a fair number of jabs. Here are are for the states, with the links to where I got the data:

ILLINOIS:

Vaccinations

The State of Illinois requires vaccinations to protect children from a variety of diseases before they can enter school. Students must show proof of immunization against up to 12 vaccine-preventable diseases (the number and schedule of these vaccinations depend on a student’s grade and age).

More information about minimum immunization requirements for Illinois can be found here. A summary of State of Illinois immunization requirements by grade follows:

Pre-K: Immunization records that reflect the following:

    • Tetanus/Diptheria/Pertussis – four doses
    • Polio – three doses
    • MMR – one dose
    • Hepatitis B – three doses
    • Haemophilus influenzae type b (Hib) titer – 4 doses
    • Varicella (chicken pox) vaccine – one dose
    • Pneumococcal series, or one dose after the age of 2

Kindergarten: Immunization records that reflect the following:

    • Tetanus/Diptheria/Pertussis – 4 or more doses, most recent must be dated after 4 years of age
    • Polio – 4 dose series with the last dose dated on or after 4th birthday
    • MMR – 2 doses
    • Hepatitis B – three doses
    • Haemophilus influenzae type b (Hib) titer 4 doses – (not required after fifth birthday)
    • Varicella vaccine – 2 doses, first on or after first birthday, second no less than 28 days later

Grade 6: Immunizations as per kindergarten requirements listed above, plus

    • Proof of having received a Tdap booster
    • Proof of having received one Meningococcal vaccine (first dose received on or after student’s 11th birthday)

Grade 12: Immunizations as per grade 6 requirements listed above, plus

    • Proof of having received 2 doses of Meningococcal Vaccine with the second after age 16 (only one dose required if the first dose was received after the age of 16)

All students who are new to a district in any grade will be required to provide complete immunization records.

Exemptions to immunization requirements:

  • Religious: Parents/Guardians requesting religious exemptions from health requirements must complete the required form along with their child’s healthcare provider.
  • Medical: If your child has a physical condition that prevents adherence to the vaccination schedule, their healthcare provider should indicate this on a physical examination form or in written documentation. Depending on your child’s medical condition, this may need to be reviewed on an annual basis.

**************

LOUISIANA:

 

Note: Students can participate in school without the required immunizations listed above if either of the following are presented: 1) a written statement from a physician stating that the procedure is contraindicated for medical reasons; or 2) written dissent from the parent/guardian.

The requirements for both states are pretty much the same, except that Illinois requires flu shots and Louisiana doesn’t. Also, Illinois will exempt kids only if they have religiously-based objections or medical contraindications. In contrast, while Louisiana, like Illinois, allows religious exemptions, it also allows parental exemptions of any sort, and I’m not sure if any written dissent will suffice.

As I wrote several years ago, religious exemptions from vaccination requirements are nearly ubiquitous:

  • 48 states have religious exemptions from immunizations. Mississippi and West Virginia are the only states that require all children to be immunized without exception for religious belief.

That those two states don’t allow religious exemptions is surprising, as they’re both in the South. But good for them: there should be NO religious exemptions allowed for vaccination given that if you get ill you can make others ill. This is a case of rendering unto Caesar what is Caesar’s. And public healthcare is Caesar’s purview, not God’s.

This is only one of many religious exemptions from children’s healthcare that are required; see the post just above (and this one). Being religious gets you a real break if you don’t want to have to give your kids science-based medical care when they’re ill (I wrote about this in Faith Versus Fact.)

What about nonreligious objections? I assume that every state, like Illinois, allows students to be exempt from some vaccinations if they have medical conditions that may make vaccination dangerous, but I haven’t looked that up. What I have looked up is nonreligious and nonmedical exemptions: philosophical or “other” exemptions like those in Louisiana. Here’s what I found:

In 20 of those [48 states that allow religious exemptions from vaccination], you can also avoid vaccination if your exemption is based on philosophical reasons.

So in 48 states you can avoid jabs if you have a religious reason (and I’m not sure how strict they are about what “religion reason” counts), and in 20 you can avoid jabs if you have a philosophical reason. (I imagine that they’re not too strict about what constitutes a “philosophical reason.”) Ergo, religious belief trumps rational thought—though I’m not arguing that there are rational objections to most vaccines. It just shows how much American’s prize religion over philosophy.

In 30 states, then, your children must get vaccinated regardless of the parents’ wishes unless they can make a religious case.

But neither philosophical nor religious reasons constitute, in my view, valid reasons to exempt public-school students from vaccination. In fact, one can argue that all children, regardless of whether they attend public school or not, should be vaccinated unless there are medical contraindications.

The point of all this is that—except for religion—there is no parental “right” to decide whether or not to get their children immunized—not if they want them to go to public schools.  It makes me angry to hear those parents vehemently assert their “rights”, without any apparent awareness that those “rights” deprive other children of the “right to stay healthy by not being forced to go to school with unvaccinated kids.” It’s like the old but true bromide: “Your liberty to swing your fist ends just where my nose begins.”

I feel the same way about masking. Though the data on mask efficacy isn’t as thorough as for vaccine efficacy, if public-health officials in a state look at the data and decide that masks prevent the spread of infections to and fro, there should be no parental “right” to disobey. Parents can of course object and make a data-driven case, but if they fail, well, they’ll have to send their kids to St. Corona’s.

Now parents could argue that the mandated vaccines for school have been around a much longer time, so we know what any deleterious effects might be, while the newer jabs are “unproven”. But if you know the statistics, that objection doesn’t wash much. Yes, there may be longer-term effects of the jabs that we don’t yet know about, but what are the chances of those effects outweighing the substantial protection from illness and death that the vaccines confer?  Well over 95% of people in hospitals with Covid-19 now are unvaccinated.

I am always wary when one invokes “rights” as an argument stopper, for that smacks of objective morality when in fact, as with most things claimed to be “rights”, they are subjective decisions based on a philosophy of social harmony. As a consequentialist utilitarian, I prefer “dicta”—we should make those rules with the most salubrious effects. And I don’t think one can argue that allowing people to avoid avoid vaccination when they have no good reason to do so (unless they are hermits), or avoid letting their kids get vaccinated, is a better alternative than letting everybody decide for themselves.  Now, the U.S. yet has no laws for doing this except for schoolchildren, but I’m in favor of them, particularly laws that you can’t work at company X unless you are vaccinated against coronavirus. I hope Biden mandates this for federal workers.

Call me a hardass; it won’t bother me.

Jennifer Haller, left, smiles as the needle is withdrawn after she was given the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. (AP Photo/Ted S. Warren)

My brilliant idea on how to get people vaccinated

August 3, 2021 • 12:30 pm

If you watch the evening news, as I do daily, you see that virtually all the commercials are aimed at medical problems of the elderly: psoriasis, metastatic cancer, arthritis, and so on. That alone tells you the demographic of people who watch the evening news (all the younger people get their news from Trevor Noah).

But the commercials I find most effective, although I don’t smoke, involve direct testimony from people who got cancer from smoking. They show people whose throats have been largely excised, who have to talk with a mechanical device, who are on permanent oxygen, who show their open-heart surgery scars, or who are on their deathbeds—all telling you that they wish they’d realized the consequences of their behavior. Actually seeing those consequences surely makes people think twice, and it’s for that reason that in some countries they put disgusting pictures of cancer-riddled lungs on the sides of cigarette packs. They wouldn’t have ads like that if they didn’t work.

And then, on the news reports themselves, you see people whose relatives or loved ones have died of COVID, or people who are recovering from a bad case of the virus; and these people often say, “I wish I’d gotten vaccinated.” Last night there was a segment on an unvaccinated woman who was pregnant. She had to be intubated, and while she was under the hospital delivered her 8-week-premature baby. Fortunately, both mom and baby are fine, but she added that she wouldn’t want anybody putting their children in danger like she did.

That inspired me. Why don’t the CDC or NIH turn those pronouncements into advertisements to get vaccinated? It can’t be hard to dig up people who got COVID and were sorry they didn’t get their jabs and who would also be willing to be on television. After all, I see them almost nightly. Or show a man in a hospital bed, recovering from a bad case of the virus, who tells the viewers not to let themselves be put in his position. Or show the relatives, friends, and loved ones of those who died, saying that they’d still have their people with them if they’d been vaccinated.

Surely those ads would inspire people to get vaccinated—at least inspire them more than hearing Anthony Fauci or Rochelle Walensky drone on about the delta variant—talking heads who also appear nightly, taking up far more time on the news. Of course we need to hear what they have to say, but they are not as much as a stimulus as hearing from the unvaccinated, those who got ill, on commercials aimed at the 100 million Americans who refuse to get their jabs.

And don’t tell me that the government doesn’t have the money to pay for such ads. For one thing, the television stations probably wouldn’t charge for them, as they are public-service ads. Second, the government is about to pay people $100 each to get vaccinated, so there’s spare dosh sitting around somewhere. Better invest that money in ads than in direct payments for those who get the needle.

I think this is a very good idea. Do you?

Or, if you have a better idea, or even a different approach, please put it in the comments.

Is now the winter of our discontent?

July 31, 2021 • 12:15 pm

I was talking to a friend last night who told me how worn out she was from the pandemic—and she has family all around her, including two grandkids. That made me realize how worn out we all our from our more-than-a-year sequestration. Nobody has been immune.

And now the specter looms of yet another lockdown and mask festival, this time caused by the delta variant of Covid, which can not only infect those who are doubly vaccinated, but can live in huge numbers in their nasal passages and infect other vaccinated people.  A huge number of Americans are resisting not only getting vaccinated, but also to wearing masks. Some yahoo governmental officials have declared that they won’t even consider mask mandates. All of this this presages another tough time this fall and winter. These are my predictions, and I dearly hope I’m wrong.

a.) There will be another surge in infections, which in fact is starting now, and breakthrough infections will start happening with the vaccinated. Other variants may arise even more dangerous than the delta. Kids will start getting the virus.

b.)  Booster shots will be instituted by the fall, and the smart folks will get them. In fact, I think we’ll need at least an annual COVID shot because immunity is wearing off faster than many thought.

c.) Perhaps more Americans will start wising up about vaccination and masking, but not enough of them. On Thursday heard four healthcare workers on the NBC Evening News explain why they didn’t want to get vaccinated. Healthcare workers! One said she didn’t trust the CDC. Another, confronted with the “facts” about vaccine efficacy, said she didn’t believe them.

d.) We will start having more lockdowns and mask mandates, and people, worn out from the last ones, will be even more resistant than before. Eight of the fifty states have indoor mask mandates. As of now, only two of of them (Nevada and Hawaii), as well as Washington, D.C., include the vaccinated. But of course we know now that the vaccinated can not only get infected, but spread the virus. (The just don’t get as sick as the unvaccinated.)

d.) As schools start to open, and the concert/entertainment festivals start, superpreader events will occur.  (The giant Lollapalooza Music Festival is going on right now in Chicago. You can get in if you wear a mask, but if you’re unmasked, you’re required to show a negative Covid test in the last three days or your vaccination card. But which masked people will  be keeping them on in the huge crowd?)  This all will lead to more lockdowns and other restrictions.

e.) Schools will open soon. Many kids have not been vaccinated, and nobody under 12 is even eligible. What with the Delta variant about, which makes younger people sicker than the previous variants, proper social distancing, air filtering, and mask wearing are essential for live classes. Everybody connected with school is sick of virtual teaching, so schools will desperately try to stay open “live”. This will cause problems, and many schools may go back to virtual classes.

The upshot: the “Summer of freedom” we all expected is dissolving fast, and I suspect we’re facing another wearing Fall and Winter of Restrictions. Many more people in the U.S. will die than would have had they gotten their jabs, and we’re all in for more restrictions, masking, and travel bans.

In short, it’s going to be tough until well into 2022. Such is my prediction, which is mine. It’s depressing. And you don’t have to be a rocket scientist to see it coming.

 

The Delta variant of COVID-19 (caption from NPR), which is more dangerous because it proliferates faster in the respiratory tract and reaches higher numbers: 1,000 times higher than previous variants.

The numerals in this illustration show the main mutation sites of the delta variant of the coronavirus, which is likely the most contagious version. Here, the virus’s spike protein (red) binds to a receptor on a human cell (blue). Juan Gaertner/Science Source

Is being a bit overweight good for you?

July 19, 2021 • 11:45 am

UPDATE: Click on the screenshot to read Flegal’s new essay about what happened to her. Thanks to several readers for sending me the link.

 

______________________

The Sunday edition of the Boston Globe has a free article (click on screenshot below) by Amy Crawford discussing the results of Katherine Flegal and her colleagues on the relationship between weight and health. Flegal was a CDC scientist when she did this work, though she’s now at Stanford. What she and her coworkers did was correlate the relative risk of mortality in five classes of people with different body mass indices (BMIs; which are calculated by one’s weight in kilomgrams divided by the square of your height in meters). The classes are these:

BMI < 18.5, classified as “underweight”
BMI 18.5 to less than 25, classified as “normal weight”
BMI 25-30, classified as “overweight”
BMI 30 to less than 35, classified as “obese”
and BMI over 35, classified (I think) as “morbidly obese”

Flegal et al. also looked at the relationship between weight and mortality in three age classes: 25-59 years, 60-69 years, and 70 years or older. They used mortality data from surveys by the National Center for Health Statistics over three periods of time: 1971-1975, 1976-1980, and 1988-1994, as well as the single year 2000. Since their first paper was published in 2005. there have been more studies and one meta-analysis of all the data (see second screenshot below). Not all the results jibe, but most of them do, at least in showing the most surprising outcome. Read on.

The data, published in the prestigious Journal of the American Medical Association in 2005 (see second screenshot below), showed, with appropriate controls, that while people who were obese or morbidly obese had, as expected, a higher death rate than those of normal weight, as did people who were underweight, people with BMIs of 25-30 (overweight but not obese) had the lowest death rates of all! In other words, you were better off being a tad plump than being “normal”. I had heard this before but hadn’t seen the data.

The Boston Globe article concentrates on the firestorm that the data of Flegal et al. produced, apparently because it went counter to the conventional wisdom that to be the healthiest, you should have the “normal” BMI. The study was apparently sound, and yet a professor of epidemiology and nutrition at Harvard’s School of Public Health took out after the study, calling it “deeply flawed”, and her results were attacked over the years. It was an early example of “cancel culture.”

You can read the Boston Globe article by clicking on the screenshot below:

While it’s true that a few similar studies gave different results, most of them confirmed that a little avoirdupois was good for you, which enraged many people. As the Globe notes (my emphasis):

In 2013, Flegal followed up her 2005 paper with a meta-analysis — a review of published papers — in JAMA. In this research she and her coauthors reviewed 97 studies covering nearly 3 million people. Once again, they found people in the overweight category were least at risk of premature death. And once again, the paper roiled the fields of nutrition and public health, attracting special censure from Willett and his Harvard colleagues.

Willett emailed the CDC director to complain, arguing that the meta-analysis had caused damage and confusion and undermined public confidence in science. “Kathy Flegal just doesn’t get it,’’ he grumbled to a reporter for The Atlantic (“I go by Katherine,’’ Flegal notes). In an interview with National Public Radio, Willett said, “This study is really a pile of rubbish and no one should waste their time reading it.’’

Flegal’s confidence in her data, methods, and findings was never shaken. Still, the attacks took their toll. “There were all kinds of little things—it was like, wow, we’re under siege here!’’ she says. “I lost control of the narrative completely.’’

Flegal retired from the CDC in 2016 and took a part-time role as a consulting professor at Stanford. With more time to reflect on her experience, she finally decided that it was important to share her story. “It’s about getting it off my chest,’’ she says. “But it’s also like, wait a minute, this is not really right! People should know about this.’’

Flegal has now written an essay about her experience of being demonized, but I can’t find it online. I hope a reader can find it for us, and I’ll put it here above the fold. Several people in the article, including Alice Dreger, defend Flegal against the attacks.

Here’s the original study of Flegal et al (click to read, and there’s a free pdf). I’ll show both a graph of the relative risks from the paper, separated by BMI group and age class, and then the numerical data.

First, a plot of the relative risk data, showing that at all age classes it’s higher for people who are underweight, obese, or morbidly obese, set at 1.0 for BMI 18.5 to <25 (“normal”) and slightly lower for BMI 25-30, the “overweight”. The figures in the table below the graph (see below) are more informative.

Figure 1. Relative Risks of Mortality by BMI Category, Survey, and Age

(From paper) BMI indicates body mass index, measured as weight in kilograms divided by the square of height in meters. The reference category with relative risk 1.0 is BMI 18 to <25. Error bars indicate 95% confidence intervals.

And the table of relative risks, “relative” being to people of normal BMI. Notice that the error bars for the overweight often overlap 1, but are consistently lower than 1, suggesting a mortality advantage for being overweight. Note that the relative risk is set at 1 for the “normal class”. Note as well that from BMI 25-30, relative risks are lower, and substantially lower for never-smokers from 25-59 years old.  If you’re between 25-59 and obese, the data also show a reduced relative risk, which is weird, but the rest of the data is as you’d expect.

The authors barely mention the benefits of being “overweight”, mentioning it only twice, and very briefly, and not dwelling on it at all. Did they sense the furor it would cause (my emphasis):

Descriptive data for the 3 survey cohorts are shown in Table 1. The numbers of deaths in the 3 cohorts were 3923, 2133, and 2793, for a total of 8849 deaths. Estimated relative risks are shown in Figure 1 by BMI category, age group, and survey, and relative risks from the combined data set and their SEs are shown in Table 2. Obesity (BMI ≥30) was associated with increased risk, particularly at the younger ages; the relative risks were lower in the oldest group. The relative risk in the overweight category (BMI 25 to <30) was low, often below 1. Relative risks in the underweight category usually exceeded unity (1.00). Relative risks were generally modest, in the range of 1 to 2 in most cases.

They found pretty much the same thing in the data for 2000, with BMIs between 25 and 30 associated with lower relative risks.In general, the authors say that they found less increase in relative risk among the underweight and obese than they expected.

Figure 2. Estimated Numbers of Excess Deaths in 2000 in the United States Relative to the Healthy Reference BMI Category of 18.5 to <25, Shown by Survey and BMI Category

(From paper) BMI indicates body mass index (measured as weight in kilograms divided by the square of height in meters). All estimates are based on the covariate distribution from NHANES 1999-2002, the number of deaths in 2000 from US vital statistics data, and the relative risks estimated from National Health and Nutrition Examination Surveys (NHANES) I, NHANES II, NHANES III, or the combined NHANES I, II, and III data set. Error bars indicate 95% confidence intervals.

Now why, if these data be true, does it seem to be good to have a little excess poundage? Nobody knows, but perhaps “normal” BMI has been improperly defined. It may be the median BMI (I doubt it), but most probably the BMI that doctors think is the healthiest. But it doesn’t seem to be, at least if you consider mortality as the ultimate arbiter of unhealthiness. If I were to hazard a guess, I’d say that in our ancestors, being a bit overweight gave you a selective advantage, as you’d be better able to weather times of famine, and so the evolutionary mortality “setpoint” was set at having a bit more fat than doctors like to see today. But this is just a theory which is mine, and I have no idea whether it’s true.

Below is the meta-analysis by Flegal et al. mentioned above, also published in JAMA, and I haven’t yet read it. I’ll leave that as an exercise for readers (it’s free if you click on the screenshot), who will surely want to discuss this long-known but surprising result. Remember, we don’t know how much confidence we should put in it, as all scientific “facts” are tentative, and later analyses may give different results:

h/t: Tim

Israel can’t catch a break: The rejected vaccine exchange with Palestine

July 16, 2021 • 12:00 pm

There is nothing that Israel can do, however praiseworthy, that isn’t criticized by the Israel- and Jew-haters of the world. What about the free and open gay community in Israel, while at the same time being gay is a criminal offense in Palestine? Well, that’s just “pinkwashing”, something Israel’s accused of doing just to gain the approbation of the world, not because they believe in equal rights for gays.

The latest example of a good deed that Israel tried to do, but was rejected by Palestine, is recounted in the Tablet article below (click on the screenshot). It involves a vaccine exchange with Palestine, which the Palestinians rejected for no good reason. (It reminds me of their repeated rejection of peace overtures.)

This one’s easy to recount. First realize that, according to the Oslo Accords, Israel is not responsible for health care in the Palestinian Territories, including vaccines. Although a lot of people damned Israel for not providing COVID vaccines for Palestine, they didn’t realize that they weren’t supposed to. Palestine is, according to Oslo, responsible for its own healthcare. Nevertheless, when Netanyahu was Prime Minister, vaccine was secretly given to Palestinians, probably the bigwigs in the government.

Now, however, the new Israeli government announced a deal to transfer 1.2 million doses of Pfizer vaccine to Palestine. The vaccines were going to expire at the end of May, the end of June, and the end of August, but were going to be given to Palestine in three batches in return for the Palestinians returning equal amounts of their own Pfizer allotments to Israel in October.  Here’s the announcement from the Israeli Minister of Foreign Affairs.

Palestine agreed to this at first. After all, it’s a win-win situation: Israel has most of its population vaccinated, the vaccines could be used immediately by Palestine while they were still good, and Palestine could replenish the Israeli supply later. Palestine has a low vaccination rate and a high infection rate. They need the vaccine now, not in October.

I suspect this is part of the new Israeli government’s desire to take a softer stance towards Palestine. But, as you might expect, it didn’t work.

After negotiating the deal, Palestine rejected it, and for no good reason. As Tablet explains:

But the deal was short-lived. Mere hours after it was announced, the Palestinian Authority abruptly canceled the entire arrangement. The official reason was that the initial batch of 100,000 vaccines were too close to their expiration dates. The real reason was that they had received extremist backlash on social media over working with Israel.

The conspiratorial notion that Israel deliberately sent unusable vaccines to the Palestinians would later be exposed by events, after both Israelis and South Koreans happily made use of the doses. But it was obviously a lie at the time. The vaccine swap had been in the works for months, and every detail had been carefully vetted by the Palestinian Authority, including the expiration dates. As noted, the entire purpose of the arrangement was to swap soon-to-expire doses for distant doses, so that each population would have vaccines when they most needed them. Naturally, Israel first sent over the doses that expired that month, so that they could be immediately administered. This wasn’t a bait-and-switch, it was the plan. It was a feature—spelled out in the official Israeli statement announcing the deal—not a bug.

The fact that the vaccines were indeed usable comes from the observation that the first rejected batch was used to inoculate Israeli teenagers, while the second batch of 700,000 doses has been traded to South Korea, who is using them now (they also have a high infection rate), and will return the doses when they get their own later. The vaccines were not past their expiration date; they just needed to be used now.

There’s more:

But this arrangement was not explained to the Palestinian population, which allowed extremist and anti-vax elements to turn the public against the supposedly subpar “Israeli vaccines”—a campaign which was no doubt helped by preexisting levels of vaccine hesitancy among Palestinians. Local social media began overflowing with protests against the agreement, and rather than explain how it worked, the Palestinian leadership folded immediately. Of course, had the real issue been the expiration dates of the first batch of vaccines, the obvious solution would have been to renegotiate the deal to exclude them. But that was not the real issue, and so the entire deal was called off.

This reminds me of Abba Eban’s famous quote after the Palestinians had rejected one of the many peace deals they were offered: the Palestinians “never miss an opportunity to miss an opportunity.”

And it’s not just Palestine that’s trying to shift the blame to Israel for this debacle: the Western media and NGOs are helping as well:

But that political failure is unlikely to be rectified anytime soon due to the failures of two other entities that might have pressured the Palestinian Authority to change course: the media and the human rights community.

In June, rather than rebuke the Palestinian Authority for caving to extremists, several prominent NGOs ranging from Human Rights Watch to Physicians for Human Rights went to bat for the vaccine rejection, credulously echoing the false claim that the doses were essentially expired and unusable. These organizations had the contacts and the expertise to understand that this was not the case, but chose not to employ them, instead reflexively putting forward partisan talking points. Had they instead called out the Palestinian Authority for placing politics ahead of public health, its leaders might have altered course.

Here’s a tweet from the director of Human Rights Watch, which hates Israel, blaming that country for the failure:

That’s simply a lie!

Tablet says more:

Meanwhile, the international media did not do much better. Of all people, journalists should reasonably be expected to get to the bottom of whether Israel or the Palestinian Authority was telling the truth about the vaccines. But instead, too many outlets covered the entire affair in “he-said, she-said” terms, as though the truth was unknowable, rather than something that could be determined by careful reporting. The closing of the New York Times dispatch was emblematic of this approach:

Those who accepted Israel’s official position about the donations said the authority’s refusal to accept the vaccines had dented claims that Israel was to blame for the slow vaccination rate among Palestinians. But those who believed the Palestinian position said Israel had acted in bad faith by making the authority an offer that it had no choice but to refuse.

Had the Palestinian Authority originally agreed to accept the vaccines with these expiration dates? Could the doses be administered in time? Or was Israel’s leftist health minister, whose party includes an Arab minister, involved in a sinister scheme to foist unviable vaccines on the Palestinian population? If only there were some journalists around to find out.

There are those, like Human Rights Watch, that hate Israel so much (I wonder why?) that they simply can’t admit that on this one the Palestinians screwed up. Israel tried to do something good for both Palestine and Israel, and would surely save a number of Palestinian lives. When Palestine realized that it would make Israel look good and anger the anti-Israeli-anti-vaxers, they rejected the deal.  Consider that. Both the NGOs and the Palestinians would rather see their people die of COVID than accept the offer from Israel. So now the South Koreans are saved at the expense of Palestinians. (The fate of vaccines expiring in August is not yet known.)

With an attitude like that, it seems useless for Israel to reach out to Palestine to soften the enmity. It now seems as if the Palestinians won’t rest until they occupy Israel and that country disappears. The two-state solution appears to be dead, and is clearly opposed as well by many on the American Left (e.g., the Squad in Congress).

If you’d rather see your own people dead than negotiate a win-win deal with Israel, you are a dysfunctional territory. But we already knew that, for Palestine already uses its civilians as cannon fodder to protect Hamas and its rocket sites from Israeli attacks.

Steven Novella and David Gorski defend their removal of Harriet Hall’s book review (the book: Irreversible Damage by Abigail Shrier)

July 2, 2021 • 9:15 am

On June 22, I reported here that the site Science-Based Medicine (“SBM”) had removed from its site a book review written by one of its editors, Dr. Harriet Hall. I characterized this removal as an “unfair deplatforming” and suspected that the review, of Abigail Shrier’s book Irreversible Damage (about the dangers of medically treating young children—mostly girls—to affirm their new gender identity as boys), had been removed because of public pushback.

The explanation below for the removal, by SBM founders Steven Novella and David Gorski, takes issue with those reasons for removal, and spends most of its space defending the removal on the grounds that, by making erroneous scientific statements (many based on Shrier’s contentions), Hall’s review had violated the strict scientific/medical standards of the site. (Hall’s review is still available at other sites, like this one.)

I haven’t yet read Shrier’s book, but I did read Hall’s review and this post by Novella and Gorski, and so we’re left with dueling opinions.  I don’t really have a dog in this fight (my main concern about transgender issues involve law and ethics, not medicine), and so I’ll suspend judgment for the nonce, even after I do read Shrier’s book. The issues at hand involve reading many, many scientific papers as well as having some medical expertise; the first I am unwilling to do and the second I don’t have. There will be at least one more installment of this SBM “explanation” involving more arcane medical issues.

I recommend that readers read Shrier’s book for themselves as well as the upcoming series of SBM articles, which take serious issue with Shrier’s claims.

Ultimately, this is an issue that the public and the courts must make, but one that must rest heavily on medical and psychiatric data. Whatever you conclude, I think that the publication of Shrier’s book and of Hall’s review were useful for two reasons. First, some of their claims might be correct; even Novella and Gorski agree with Shrier and Hall that much of the research on treatment for transgender children is anecdotal and needs more rigorous studies. Second, it’s only this type of back-and-forth that will clarify the empirical issues under contention, and (I hope) ultimately lead to their resolution. I note, though, that this hope may be vain given the ideological maelstrom around the topic.

But let’s proceed: click on the screenshot to read.

First, Novella and Gorski argue that Hall’s piece was published without review because she was one of the site’s editors (and remains so), but concerns were raised by themselves and other editors that ultimately led to the retraction:

Two weeks ago, one of our editors published a book review that raised concerns with Dr. Gorski and me, as well as at least one other editor, soon after it published. Reading it, we both feared that this book review had probably strayed beyond evidence or expert opinion and thus required a robust response. This was a review of a book by Abigail Shrier titled Irreversible Damage: The Transgender Craze Seducing Our Daughters. This particular book discussed a complex area of medical practice that also happens to be one embroiled in heated political debate. Because of the context of this topic, we believed it especially critical that SBM be perceived as a politically neutral and reliable source of information about the relevant science. Unfortunately, Dr. Hall’s fellow editors were concerned that the review in question did not achieve this goal.

Our first step was to carefully review the article and then discuss our concerns directly with Dr. Hall to hopefully find a solution. The challenge here was that, while we had enough background knowledge to immediately see there were serious problems with the review, none of us are topic experts. Reviews outside SBM by those with expertise in this area seemed to be making valid scientific criticisms of the opinions and claims in Ms. Shrier’s book, which the review took at face value.

Clearly what we needed was time to do a deeper dive on this complex controversy, to wrap our heads around the published evidence, and to vet the claims and arguments on both sides. This is something we would have preferred to do prior to publication, but we no longer had that luxury. Giving an immediate half-baked analysis would not do SBM readers justice. Ultimately, we decided to hit the “pause” button, to withdraw the review for a time while we consulted outside experts and did our own internal review. Since Dr. Hall indicated she would publish her article on an alternate site (and immediately did), we saw no pressing need to leave the article on SBM while this review was underway.

Novella and Gorski (N&G) are highly respected men, and I have no reason to doubt this explanation, so I won’t argue that pressure for social media had anything to do with the retraction.

And here are the claims that Novella and Gorski make about Shrier and Hall’s (S&H’s) putative errors. The characterization of their criticisms are mine, as well as the comments.

a.) S&H argue that the recent rapid increase in the proportion of adolescents seeking transgender transitioning is due to social contagion. That is, S&H claim that it’s become more acceptable to declare that you’re a transgender person, for which you get a lot of affirmation and support, than to say (if you’re a girl) that you’re a tomboy or a lesbian. 

N&G deny the social contagion hypothesis, and say that the increase (which they deny is higher than fourfold) can be solely attributed to both better diagnoses (like autism or ductal carcinoma), and to the number of children and adolescents reporting to gender clinics. This is possible, but I do not rule out social contagion as a contributing factor, especially when one sees the strength of “affirmation” when you say you’re transgender.

b.) S&H neglect the rigorous “standards of care” for children claiming gender dysphoria. And indeed, the World Professional Association for Transgender Health has a list of standards (reproduced in N&G’s piece) that seem rigorous and reasonable, with the possible caveat that use of hormone blockers to stall puberty may not be “fully reversible”. Otherwise, they seem reasonable, so long as the adolescent (and there must be an age limit for medical intervention) has been fully informed of the benefits and risks of medical transition rather than simply subject to affirmation. Similar standards are, say N&G, promulgated by The Endocrine Society.

I have no issue with the standards, though we have to be mindful of what even N&G say:

Of course, these are standards, and not every practitioner adheres perfectly to the standard of care in any aspect of medicine. But we don’t take outliers and use that to criticize the standard or pretend it is typical or common. Interviews with those involved in transgender care indicate that adherence to rigorous standards as outlined above are the norm.

But the question is really how many practitioners adhere to these standards? Shrier, I believe, argues that there are too many exceptions, and I simply cannot judge, nor can anybody. Given the fact that some transgender children get puberty blockers or hormones on the black market, it would be hard to answer this question.

As for whether puberty blockers are “fully reversible”, as the medical standards insist, I’m not so sure about that. Here’s an except from a recent NYT article on puberty blockers (I haven’t listed all the possible harms described in the article, and note of course that there are the psychological benefits of transitioning):

What are the risks?

Puberty blockers are largely considered safe for short-term use in transgender adolescents, with known side effects including hot flashes, fatigue and mood swings. But doctors do not yet know how the drugs could affect factors like bone mineral density, brain development and fertility in transgender patients.

The Endocrine Society recommends lab work be done regularly to measure height and weight, bone health and hormone and vitamin levels while adolescents are taking puberty blockers.

A handful of studies have underscored low bone mineral density as a potential issue, though a 2020 study posited that low bone mineral density may instead be a pre-existing condition in transgender youth. Treatment with gender-affirming hormones may theoretically reverse this effect, according to Endocrine Society guidelines. . .

The impact of puberty blockers on brain development is similarly hazy. The Endocrine Society guidelines point to two studies: A small one published in 2015 showed that the drugs did not seem to impact executive functioning (cognitive processes including self-control and working memory), while a 2017 study of rams treated with GnRH agonists suggested chronic use could harm long-term spatial memory. (Of course, rams are not humans.). . . . .

c.) Gender dysphoria is not a “disorder” like anorexia. N&G argue that, unlike anorexia, gender dysphoria shouldn’t be seen as a psychiatric disorder because the word “disorder” implies that the condition should be cured—and not by allowing gender transitioning. Frankly, I don’t care what you call gender dysphoria, nor do I think that it automatically has to be “cured”, for surely many children do have a deeply ingrained feeling that they are in the wrong body, and many feel better when they do something about it. But using the DSM (the Diagnostic and Statistical Manual of the American Psychiatric Association), which reclassified gender dysphoria from a disorder to “not a disorder” between the DSM IV and DSM V, doesn’t reassure me. The DSM is a pretty subjective and arbitrary way of “diagnosing” mental conditions. I’ve read a fair amount of it and am not speaking from ignorance.

And there are the comorbidities of gender dysphoria: mental illness that often goes along with the condition, both before and after transitioning. These may be correlates and not causations, but it’s worrisome that these conditions often go together. And even if they are merely correlated, one cannot automatically (as many do) argue that gender-dysphoric children must transition because otherwise they’ll kill themselves, or that, after transitioning, a higher rate of suicide among transgender people is evidence that they’ve been harassed to the point of suicide.

d.) Hall’s claims about the proportion of children who “outgrow” gender dysphoria conflates prepubescent children with adolescents. Based on what N&G say, this is a fair criticism. Hall does this conflation, they say, when asserting that some transgender children “outgrow” their desire to have a new gender identity.

e.) S&H, claim N&G, exaggerate the number of adolescents who regret having transitioned.  N&G say the incident of “regret” is 1% or less.

f.) N&G argue that overall, people who transition between sexes are generally happier. They cite several studies showing “a significant improvement in psychological functioning” after a year, as well as a decrease in suicidal ideation and improved quality of life.  I have no quarrel with this, and it’s an important finding.

N&G have a long discussion which goes into other issues, but I think I’ve hit their main issues above. I am trusting that they are fairly representing the literature rather than just citing data that support their claim that transitioning is a good thing that should generally be supported. Because I don’t know the literature, one should leaven this trust by reading Shrier’s book and looking at her own references.

In the end, I have no issue with applying accepted standards of care to adolescents who wish to transition, as well as waiting until they’re of a proper age of consent. I don’t know what that age should be, but it can’t be 2 or 4 years old, and if it’s after puberty, say 16-18, it’s already too late for a nearly full medical transition. The British High Court recently ruled that children under the age of 16 are too young to give informed consent for the use of puberty blockers unless they have parental consent.

In the end, this argument is above my pay grade, though I’ll continue reading about it. In the meantime, the “agreement” between N&G and S&H comes down to this:

Where we agree with Dr. Hall is that the current state of this evidence is far from ideal. Mainly for practical reasons, most of this research is not blinded or controlled. To put this into context, however, most surgical interventions are not studied in blinded trials, and sham surgical interventions are rare. You cannot blind a trans individual to whether or not they received a gender affirming intervention.

But we do agree that given this reality, we need to continue to study and monitor such interventions for both medical and psychological outcomes. This is where an informed medical and ethical discussion should take place, balancing the risks and benefits of interventions given the limitations of the research. There is also a meaningful ethical conversation to be had about the proper age of consent and balancing that with risks vs. benefits of gender-affirming interventions.

In other words, it’s the familiar ending of science papers, “More work needs to be done.” But that’s cold comfort for children who have gender dysphoria now. And it does say that some of Shrier’s contentions are credible and worth investigating.

 

h/t: Jay

Australian woman has tonsil surgery, wakes up with Irish accent

July 1, 2021 • 2:45 pm

Here’s a Brisbane woman whose accent changed from Australian to Irish after her tonsils were removed. This phenomenon is called “foreign accent syndrome” and, as Wikipedia says,

Foreign accent syndrome usually results from a stroke, but can also develop from head trauma, migraines or developmental problems. The condition might occur due to lesions in the speech production network of the brain, or may also be considered a neuropsychiatric condition. The condition was first reported in 1907, and between 1941 and 2009 there were 62 recorded cases.

Its symptoms result from distorted articulatory planning and coordination processes and although popular news articles commonly attempt to identify the closest regional accent, speakers suffering from foreign accent syndrome acquire neither a specific foreign accent nor any additional fluency in a foreign language. There has been no verified case where a patient’s foreign language skills have improved after a brain injury.

Since this involved only the removal of tonsils, it must be either “neuropsychiatric”, or have something to do with the change in her tonsils. Don’t ask me: I’m not a doctor (I just play one in academica).

When you’re so afflicted, you don’t speak a different language, of course, but your accent resembles that of someone from another land speaking your language. And it occurs in languages other than English. It’s usually temporary, but can be persistent, and it’s hard to fix, with retraining in your native accent the usual means of “cure.” You can read about it in various papers here.