Why Evolution is True is a blog written by Jerry Coyne, centered on evolution and biology but also dealing with diverse topics like politics, culture, and cats.
I’ll make this post short as it’s about a medical (or rather, dental) procedure.
A few days ago, an old crown on one of my lower molars popped off, and there wasn’t much tooth left (when some of it sticks to the inside of the crown, you’re screwed). The dentist was closed, but there was no pain (I later found that I’d had a root canal in the tooth), and when I called after hours my dentist told me to come in today. Of course, it was my birthday. And as I was scheduled for an hour and a half, I figured they planned to to pull the tooth. For me, that means getting an implant.
Dental implants, though pricey, are a fantastic advance in the practice. Right after they pull the tooth (which was painless for me, though time-consuming because they had to dig out the roots), they drill a titanium screw into your jaw, as well as filling the tooth hole with bone-graft material (I think they use powdered pig bone or human cadaver bone). After three months, the titanium has integrated with the bone, and they make a crown to put atop the screw. The results sort of look like this:
Afterwards, it looks and feels like a normal tooth, and requires just the usual care: brushing and flossing (though you dab a bit of disinfecting solution around it each night).
Because I have familial soft teeth (but great gums), this is the third implant I’ve had, and it’s not a big deal save the hit in the pocketbook, and the results are great. I’ve never had a problem with an implant.
I also quite like my dentist, whom I’ve had since I first came to Chicago. When they closed the excellent dental clinic at the U of C hospital, where he was head, he went into private practice and I followed him. Of all the dentists I’ve had in my life, he’s by far the best; a miminalist, a kind and skillful man, and very patient when there’s a difficult procedure, as there was today. (As he told me when I asked if he’d ever met a tooth he couldn’t extract, he replied, “The tooth never wins”.)
He’s also the official dentist of the Chicago Blackhawks hockey team, which means he has to be at every game (hockey players are always busting their teeth). I was told there’s a dental clinic in the United Center, where the Blackhawks play.
By the way, if you haven’t been to the dentist during the pandemic: things have changed. There is constant sanitizing, temperature-taking, and wearing of personal protective equipment. I was told that there have been no covid incidents in this dental practice, which has about four dentists and a passel of assistants and hygienists.
Anyway, I’m in no pain, but have to take antibiotics for a week and have a couple of stitches in the gum. At my age, it could be worse! But it is my birthday, which was noted by the receptionist with surprise when I made my next appointment. It’s not the best of birthdays, as I can’t eat and drink exactly what I want, but I’ve simply postponed the final day of Coynezaa until next week.
One problem with going to the dentist is that I pass about three Dunkin Donuts stores on the way (it’s downtown), and I can’t have a donut on my way there because I don’t want food in my mouth when I arrive, and afterwards I’m usually not supposed to eat for a while. Normally I’d treat myself to a donut after a medical procedure
But others don’t have to eschew the donuts. Rather, they chew them, and today I saw this classic scene on my way to the dentist.
Note the parking space in front is “reserved for police vehicles.”
Reader Jim Batterson sent me this 25-minute video with the comment:
I know you prefer to read rather than watch a video, but I wanted to make you aware of a 24-minute YouTube video from Vince Racaniello, a virologist at Columbia University who leads a cast of virology geezers and one younger immunologist in a weekly zoomcast production of “This Week in Virology”. He did this standalone presentation to rant a bit on the way that this latest variant in the UK is being hyped to the world. I think he does a pretty good job for any viewer who has had a biology course in the past five or so years.
The point is that viruses are mutating constantly, and yet none the coronavirus mutations have yielded a new “strain”—that is, a mutant type that has new biological properties. The property touted for the new virus is its purportedly increased “spreadability”, but, as Racaniello notes repeatedly, that simply hasn’t been demonstrated. As he shows, you can get some variants spreading more widely than others simply by accident: the variant may not have any effect on spreadability itself but can increase in frequency as a byproduct of “superspreader events”—the main way the virus spreads—because only a small subset of all viruses get passed to other humans.
Racaniello then shows the changes in the new mutant “strain”, noting that only one of the several mutants in the spike protein is even a candidate for a change in spreadability, but there is not an iota of evidence that any of those mutations actually make the strain more spreadable. Nevertheless, all of us are inundated with media scare stories about this “superspreader virus”.
Racaniello’s point is that though there are epidemiological data showing a correlation between the presence of the mutant in some areas and a greater spread of the virus, that’s just a correlation without evidence of causation. And there could be several causes, including accidents. To show this mutant is a “super virus”, you simply have to do lab experiments; epidemiological correlations show nothing.
Racaniello doesn’t rule out that this mutant spreads faster than its ancestors, but he’s not convinced it is, and doesn’t think that we yet have a reason to be concerned. In fact, he suggests that the changes in the new strain may make it less spreadable. Let me add that Racaniello knows what he’s talking about, as he’s co-author on a well known textbook of virology.
Like all good scientists, Racaniello isn’t declaring that this virus is “neutral” compared to its competitors—he’s simply saying that we don’t have any data suggesting it’s more nefarious. In fact, the same story happened earlier with a different mutant that spread widely, but nothing ever came of that. We need experimental cell-culture data from the lab on viral shedding, and that doesn’t exist.
His final comment:
“We should move on from the scary headlines, and get ahead with vaccination programs, which are underway—and that is going to be the way we get away from this pandemic.”
Anyway, this is a good and clear mini-lecture, and listening to it should calm you down a bit if the media have gotten you worried.
My GP has written another post on vaccines, this time on the new Moderna vaccine, which has just been approved by the FDA. Click on the screenshot to read it, or you’ll likely be satisfied with the conclusions and unanswered questions below, which were remarkably similar to his take on the Pfizer vaccine.
That’s because, except for a difference in storage conditions (the Moderna vaccine requires far less cold than does the Pfizer one), the trials show both are about equally effective (94.1% for Pfizer, 95% for Moderna, which are probably not statistically significant. Both are also mRNA vaccines that inject the code for making part of the virus’s spike protein into the body, where part of the protein is made, activating antiviral antibodies, and then the mRNA is degraded. (See below for an article about how these vaccines work.) There’s a slightly higher incidents of side effects with the Moderna vaccine as well: muscle pain and joint pain after the jabs are about 20% higher for Moderna’s vaccine (an incidence of around 40%) than for Pfizer’s (incidence about 20%). But these aren’t severe side effects.
The Pfizer vaccine was tested on individuals older than 16, while Moderna’s on individuals older than 18, so efficacy in that two-year age range remains an unanswered question for Moderna.
Finally, the two doses of Moderna’s vaccine were spaced 28 days apart rather than Pfizer’s 21, but this may not be important since there seems to be a leeway of a few days. Consult your doctor.
The overall take (these quoted from the post):
The vaccine is highly effective in preventing symptomatic COVID-19 infection.
The vaccine is safe. Adverse reactions, both local and systemic, are mostly minor. Though the study hasn’t yet gone on long enough to prove there are no serious long-term adverse affects, such adverse affects, if they exist, are likely to be rare and non-life-threatening based on other Phase I and II studies of other RNA vaccines.
We recommend everyone who is eligible to receive the vaccine should receive it when it becomes available to them.
It very well may take all of 2021 to get everyone who’s willing to be vaccinated to receive the shots, which means it likely won’t be until early 2022 that life returns to pre-pandemic normal. In the meantime, continue to wear a mask when indoors with anyone you don’t live with, wash your hands frequently, and refrain from dining indoors at restaurants.
And the unanswered questions:
While suggested by the study, still left unproven is whether BNT162b2 prevents severe COVID-19 infection, whether it prevents COVID-19 infection after just one dose, and whether it prevents COVID-19 infection in subjects who’ve already had COVID-19.
The study didn’t look to see if the vaccine prevents asymptomatic infection. Nor did it assess whether subjects who developed COVID-19 despite vaccination are less likely to transmit the virus. Thus, it’s not yet clear how effective the vaccine will be in containing the spread of the infection.
The study hasn’t gone on long enough to tell if subjects who were vaccinated yet still contracted COVID-19 have a lower risk of long-term effects of COVID-19.
We don’t yet know if the vaccine reduces the risk of dying from COVID-19.
There was insufficient data to draw conclusions about safety and efficacy of the vaccine in children younger than 18, pregnant or lactating women, and patients who are immunocompromised.
We don’t yet know how long immunity lasts and whether or not booster shots will be necessary.
As far as which one you should take, I think Alex’s recommendation would be to take whichever one is offered to you. The news last night said that big pharmacies like CVS may well stock both types, in which case you should consult your doctor.
Here’s a new NYT article by Jonathan Corum and Carl Zimmer about how Moderna’s vaccine works (click on the screenshot; I think the article is free for all). It’s a comic-book-like series of graphics which are very good, and I’ve put a summary at the bottom.
You’ll have to click on the screenshot below, perhaps twice, if you want the whole story in one place.
A few years ago I got an email from a colleague who was disturbed about the anti-science attitudes of the New Yorker, which include an emphasis on “other ways of knowing” —often through the arts and literature. But first I’ll repeat my colleague’s analysis:
The New Yorker is fine with science that either serves a literary purpose (doctors’ portraits of interesting patients) or a political purpose (environmental writing with its implicit critique of modern technology and capitalism). But the subtext of most of its coverage (there are exceptions) is that scientists are just a self-interested tribe with their own narrative and no claim to finding the truth, and that science must concede the supremacy of literary culture when it comes to anything human, and never try to submit human affairs to quantification or consilience with biology. Because the magazine is undoubtedly sophisticated in its writing and editing they don’t flaunt their postmodernism or their literary-intellectual proprietariness, but once you notice it you can make sense of a lot of their material.
. . . Obviously there are exceptions – Atul Gawande is consistently superb – but as soon as you notice it, their guild war on behalf of cultural critics and literary intellectuals against scientists, technologists, and analytic scholars becomes apparent.
Today’s topic, though, is “other ways of knowing through folk wisdom“. In particular: ways of healing used by indigenous people. Now this shouldn’t be rejected out of hand; after all, many modern remedies, like quinine, derive from plants used by locals. But that doesn’t imply a wholesale endorsement of “the collective lived experience” touted in this video about plant-based healing. For the “collective lived experience”, after all, sometimes includes shamanism and, in the example below, “spiritual elements” as a way of curing disease. And here the disease that “lived experience” tackles is something the Siekipai of Ecuador have never experienced: Covid-19.
Reader Jeff Gawthorpe saw a New Yorker video at the link below; I’m not sure whether you’ll have free access, but you will using the yahoo! finance link at the bottom, where the video was republished.
Jeff is about as distressed as I by the fulminating wokeness of the magazine and delivered his critical “review” of the video, which I asked if I could put up in full, including his name. (I don’t like paraphrasing other people’s words, especially when they’re as good as the analysis below). Jeff said that was fine, and so here is his take, indented. I have to say that I agree with it, and have a few comments of my own at the bottom.
Around 30 minutes ago I happened across a dreadful video on the New Yorker‘s website, which drove my temptation to meet head with keyboard through the roof. This piece of ‘journalism’ was entitled: “Fighting COVID-19 with Ancestral Wisdom in the Amazon”. And yes, It’s as bad as it sounds: unscientific, irresponsible nonsense. Complete tosh.
The message which the piece attempts to convey is that COVID-19 can be dealt with by ‘lived experience’, ancient ‘ways of knowing’, and a few bits of boiled tree bark. Then, if you hadn’t had enough already, Just before the end, a caption pops up saying: “With a new stock of plants, the Siekopai are prepared to address future outbreaks of the virus according to their traditions.” Urrrhhgg.
You’ll notice that they are canny enough to maintain a degree of plausible deniability by making no definite claims. To me this demonstrates the very worst of journalism:
Conveying mistruths to support an ideology
Lacking the courage to commit to claims by asserting them as supportable facts
That’s bottom of the barrel journalism at the best of times, but now it’s irresponsible, reckless even. It presents a clear message that indigenous knowledge and ancient wisdom are perfectly acceptable ways of dealing with the pandemic. At no point is it mentioned that these ‘remedies’ are not backed by evidence, clinical or otherwise.
As you know, many western societies have huge anti-vax movements which often distrust and denounce mainstream medicine. Unfortunately, this video just adds fuel to the anti-vaxers fire. By failing to mention that these plant ‘remedies’ have zero efficacy, they are providing implicit support to the anti-science, anti-vax groups. Worse still, they are acting like digital snake oil salesmen, imbuing members of the public with false confidence that that they can avoid or fight off this virus with a couple of well chosen tree bark specimens. It’s dangerous, irresponsible nonsense.
Click below to see the video:
My own comments are few. First, it looks like the “remedy” includes cinchona bark, the source of quinine, as a palliative (the remedy seems directed at symptomatic relief rather than a cure).
Second, even “lived experience”, while useful, is no substitute for double-blind clinical trials. Granted, the Siekipai can’t do that, but they sure as hell should take the vaccination when it gets to them. And, like Jeff, I think it’s totally irresponsible of The New Yorker to present this video without any kind of caveat. After all, when Trump skirts the truth, they don’t hesitate to correct him. I guess “lived experience of indigenous people” is a different matter—it’s not as if they’re recommending drinking bleach or anything.
My GP, Dr. Alex Lickerman, has once again put up a coronavirus post on his practice’s website, and allowed me to reference it here. It’s timely because it’s all about the new Pfizer vaccine. (A ICU nurse in New York may have been the first to get the shot.) How effective is it, and how do we know that? Is it safe? What about kids under 16, who weren’t part of the clinical trials? And pregnant women, who also weren’t tested? Since this is a mRNA rather than a killed-virus vaccine, should we have extra concerns about safety? What adverse reactions have been reported? If you were already infected, does the vaccination also reduce your risk of getting reinfected? When will “normal” people who aren’t healthcare workers or nursing-home patients be able to get their jabs?
Alex has kindly agreed, as he has before, to answer readers’ questions about the new vaccine, so put your questions in the comments section below and he’ll address them as he has time. Alex has read all the relevant scientific literature, as well as the data from the vaccine trials, so ask away! But do read his 4-page summary beforehand, as it has a lot of information.
I’m not going to put up his whole post; you can go to his site to see it, which you can do by clicking on the screenshot below:
I’ll just post Alex’s recommendations, followed by his list of “unanswered questions” (indented). The short message: GET THE SHOT AS SOON AS YOU CAN!
CONCLUSIONS
The vaccine is highly effective in preventing symptomatic COVID-19 infection.
The vaccine is safe. Adverse reactions, both local and systemic, are mostly minor. Though the study hasn’t yet gone on long enough to prove there are no serious long-term adverse affects, such adverse affects, if they exist, are likely to be rare and non-life-threatening based on other Phase I and II studies of other RNA vaccines.
We recommend everyone who is eligible to receive the vaccine should receive it when it becomes available to them.
It very well may take all of 2021 to get everyone who’s willing to be vaccinated to receive the shots, which means it likely won’t be until early 2022 that life returns to pre-pandemic normal. In the meantime, continue to wear a mask when indoors with anyone you don’t live with, wash your hands frequently, and refrain from dining indoors at restaurants.
UNANSWERED QUESTIONS
While suggested by the study, still left unproven is whether BNT162b2 [Pfizer’s name for the vaccine] prevents severe COVID-19 infection, whether it prevents COVID-19 infection after just one dose, and whether it prevents COVID-19 infection in subjects who’ve already had COVID-19.
The study didn’t look to see if the vaccine prevents asymptomatic infection. Nor did it assess whether subjects who developed COVID-19 despite vaccination are less likely to transmit the virus. Thus, it’s not yet clear how effective the vaccine will be in containing the spread of the infection.
The study hasn’t gone on long enough to tell if subjects who were vaccinated yet still contracted COVID-19 have a lower risk of long-term effects of COVID-19.
We don’t yet know if the vaccine reduces the risk of dying from COVID-19.
There was insufficient data to draw conclusions about safety and efficacy of the vaccine in children younger than 16, pregnant or lactating women, and patients who are immunocompromised.
We don’t yet know how long immunity lasts and whether or not booster shots will be necessary.
Ripped from the headlines of CNN! Click on the screenshot to read:
Many of us know that the FDA is meeting Thursday to decide whether to approve the Pfizer vaccine for general use. If the approval occurs, vials of vaccine will be making their way across the U.S., ready for immediate transfer into the arms of Americans.
Now, judging by the headline above, it looks almost certain that the FDA will indeed approve the vaccine in two days, and the first ranks of Americans will start getting vaccinated. Who gets it first appears to vary from state to state, but, rightly, healthcare workers and nursing-home patients (and their carers) will almost always be the first in line—and that’s what the FDA recommended as well. After all, if the vaccine is safe and effective, why wouldn’t it be approved?
The good news gets even better: it appears that some immunity is conferred even after the first dose, which appears by itself to be 50% effective (two are required for the 95% effectiveness). Flu vaccine—the single shot we should all have gotten already this year, is only between 40% and 60% effective. “Effectiveness” is the reduction of risk that you get when you are vaccinated.
From CNN:
An advisory committee to the US Food and Drug Administration on Tuesday released a briefing document detailing data on Pfizer and BioNTech’s Covid-19 vaccine candidate, which will be considered this week for emergency use authorization in the United States.
The document confirms that the vaccine’s efficacy against Covid-19 was 95%, occurring at least seven days after the second dose – an efficacy that had been previously reported by Pfizer. The proposed dosing regimen for the vaccine is to administer two 30-microgram doses 21 days apart.
However, the document also notes that the vaccine, called BNT162b2, appears to provide “some protection” against Covid-19 following just one dose.
The document describes the efficacy of Pfizer’s vaccine in the time between the first and second dose as 52.4%, but the document notes that “the efficacy observed after Dose 1 and before Dose 2, from a post-hoc analysis, cannot support a conclusion on the efficacy of a single dose of the vaccine, because the time of observation is limited by the fact that most of the participants received a second dose after three weeks.”
In other words, “the trial did not have a single-dose arm to make an adequate comparison.”
The document goes on to detail the safety profile of the vaccine as “favorable” and notes that the most common adverse reactions to the vaccine have been reactions at the injection site, fatigue, headache, muscle pain, chills, joint pain and fever.
Severe adverse reactions occurred in less than 4.6% of participants, were more frequent after the second dose and were generally less frequent in older adults as compared to younger participants, according to the document. The document adds that swollen lymph nodes also may be related to vaccination.
That’s good enough for me, and I’ll be taking the shots as soon as my doc recommends it—which I presume will be as soon as I’m permitted to get them.
A STAT-Harris Poll published last month, however, showed that the proportion of Americans willing to get vaccinated depends on the vaccine’s efficacy, but only weakly. Below are those data in graphic form. What’s disturbing is that if the vaccine were 50% effective, only 60% of Americans would be likely to get the shots. And even with over 90% effectiveness, which is the case with all the vaccines about to hit the market, the willingness rises to only about 63%—a pathetically low figure. I’ve heard that the acquisition of herd immunity in the U.S. to coronavirus requires that 70% of Americans have immunity; even counting those who were infected, the figures on willingness to get vaccinated doesn’t give us that level of immunity. However, it will protect those smart people who get the shots.
So here’s the question: assuming you can get the shots because you don’t have a condition that bars them, are you going to get vaccinated? (I’m assuming that the Pfizer vaccine, or one with similar effectiveness, is the one on offer.) If not, why not?
Lately we’ve been talking about several issues related to transsexual people, in particular the senses in which they can or should be distinguished from people of their biological sex, including their participation in sports; possible effects (or lack thereof) of hormone treatment; and recent books that call for caution in supporting and medically treating gender-dysphoric teenagers who may later regret actions taken when they weren’t capable of informed consent. While I think the discussion has been rational and certainly not “transphobic”, I’ve nevertheless been the recipient of a spate of emails, often nasty ones, excoriating me for promoting an “anti-trans” agenda. I’ve resisted the temptation to respond with recommendations for self-copulation.
The last issue, treatment of young children (mostly girls), is the subject of today’s post. It turns out that yesterday Britain’s High Court ruled that children under 16—and perhaps those between 16 and 18—might have to have a court ruling before they’re allowed to take “puberty blockers”, a somewhat reversible treatment that stops puberty in its tracks. Taking these blockers is usually the first step in further transitioning involving irreversible treatments like cross-sex hormone treatment or surgery. The court ruled that under-16s are largely incapable of giving “informed consent.” You can read about this case in the three article below from the BBC, The Guardian, and The Times of London (click on screenshots to access articles).
From the BBC:
From The Guardian:
From the Times (paywalled):
The High Court decision came in a case brought by two people against the Tavistock and Portman National Heath Service Trust, the clinic in England that counsels and treats those who consider themselves transsexual. One of the cases was brought by Keira Bell, 23, shown in the pictures above. She was treated with puberty blockers at Tavistock after she was referred there at 16, and regrets it. (I’m not implying that most teenagers later regret such treatment, as I have no data on that, but I suspect most of them have no regrets. Nevertheless, if an appreciable number do, that’s a reason for caution.)
The other person bringing the case was “Mrs. A”, the mother of a 15-year-old autistic girl who is awaiting treatment at Tavistock “Mrs. A.” is worried that her daughter will “get it wrong” before she can make a mature decision.
There are a fair number of young girls who have sought and received treatment at Tavistock: the paper reports that, in the last year, 161 children were referred to the Gender Identity Development Services (GIDS), and of these three were 10 or 11 years old and 95—nearly 60%—were under 16. The Times notes that those seeking treatment involve “a disproportionate amount of girls and young women.” These numbers have been growing rapidly, from 97 children and young people referred to the clinic compared to 2,591 in 2018. Here’s a plot I showed recently:
Here’s a plot from a paper in the Archives of Sexual Behavior showing the number of people referred each year to the UK’s Gender Identity Development Service. It shows the strong rise in referrals of adolescent females compared to males, and some rise in children as well. In the last 7 years it seems to have gone from fewer then 40 to over 1700 in adolescent females—a roughly 43-fold increase!
We don’t know the reason for this rapid increase: among suggested causes are a freer climate that allows children to express their gender identities, or a faddishness that turns troubled or confused children to a form of treatment that is heavily supported and often makes them into a type of hero.
Regardless, here’s the papers’ summary of the High Court ruling (you can read the full ruling here); this is from The Guardian:
In their decision, Dame Victoria Sharp, president of the Queen’s bench division, Lord Justice Lewis and Mrs Justice Lieven, said a child under the age of 16 may only consent to the use of medication intended to suppress puberty “where he or she is competent to understand the nature of the treatment”.
Such an understanding must include “the immediate and long-term consequences of the treatment, the limited evidence available as to its efficacy or purpose, the fact that the vast majority of patients proceed to the use of cross-sex hormones, and its potential life-changing consequences for a child”.
The judges said there would be enormous difficulties for young children weighing up this information and deciding whether to consent to the use of puberty blocking medication.
“It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers,” the judges added. “It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.”
For treatment of those over 16 it is normally presumed that they have the ability to give consent. But in gender reassignment cases where puberty blockers may lead to subsequent surgical operations, the judges said: “Given the long-term consequences of the clinical interventions at issue in this case, and given that the treatment is as yet innovative and experimental, we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment.”
The NHS, which is appealing the judgement, has immediately stopped the inception of puberty-blocking as well as cross-sex hormone treatment, and issued some statements. From the BBC:
An NHS spokesperson said: “We welcome the clarity which the court’s decision brings. The Tavistock have immediately suspended new referrals for puberty blockers and cross-sex hormones for the under-16s, which in future will only be permitted where a court specifically authorises it.”
In September, the NHS announced an independent review into gender identity services for children and young people.
The Tavistock and Portman NHS Trust said it was “disappointed by today’s judgment and we understand that the outcome is likely to cause anxiety for patients and their families”.
It added: “Our first duty is to our patients, particularly those currently receiving hormone blocking treatment, and we are working with our partners, University College London Hospitals NHS Foundation Trust and Leeds Teaching Hospitals NHS Trust, to provide support for patients concerned about the impact on their care.”
In contrast, groups like the “trans children’s charity Mermaids” decried the decision:
Lui Asquith, from trans children’s charity Mermaids, said the ruling was a “devastating blow” and “a potential catastrophe for trans young people across the country”.
The charity said: “We believe very strongly that every young person has the right to make their own decisions about their body and that should not differ because somebody is trans.”
You can see more about Mermaids’ reaction here. But their last statement skirts the question that the Court was asked to decide: How old must you be before you are capable of making a medical decision that may be irreversible? And it’s not just trans people to whom this applies: what if a 13-year-old boy wanted his penis removed because he didn’t like it? Should he be able to make “his own decision about his body”?
I think that reasonable people should agree that there is an age below which a child isn’t deemed capable of making a medical decision like this one, even if they feel strongly that they are transsexual. Surely 6 is too young and 20 sufficiently old to make a “mature” judgement. But it’s also clear that children differ in the level of “maturity”, so there might be some flexibility (though there isn’t in things like drinking ages). The court, in ruling that 16 is a cut-off point, was surely being subjective, and they realized it, for they affirmed that even older teenagers might require a court judgment to begin puberty blockers. For those younger than 16, it seems reasonable to me to wait until they turn 16 until they can give “informed consent,” or be able to bring their case to legal judgement.
Those who think that 10-year-olds should be able to make their own decisions, and take puberty blockers or cross-sex hormone treatment at will (counseling is surely required), seem to me unreasonable. After all, courts have set age limits for other decisions that require “informed consent”, like age limits for statutory rape (in Illinois, 17 is the legal age of consent for sexual acts. If you’re 16, are you too young to consent to sex but old enough to have your sex transformed to another?) It’s a sign of the valorization of all desires to be transsexual that a charity like Mermaids wants anyone, no matter how old, to have their own decisions not just respected, but acted upon.
I’m not turning this site into a report on my health—which is very good, thank you—but I will post any additional bills I get for my hernia surgery, just so you can see what American healthcare costs. And today I will report that I got the second in the series of two shots designed to prevent shingles (Shingrix). After the first jab, you need to get the second between two and six months later. I had another immunization against shingles a couple of years ago—Zostavax—but that shot is apparently passé. The immunizations for shingles were free.
The first Shingrix shot I got, three months ago, gave me flu-like symptoms, and I was out of it for a day (but I still went to work!). This morning’s is already taking effect, with my poor arm hurting like I was punched hard, and the bodily languor starting to set it. I’m going to take some Tylenol and lie down.
But my doc recommended the shots highly, as does the CDC. From what I hear from those who have had shingles, it’s a dreadful and painful malady—far worse than a couple of malaise-inducing jabs. If you’re over 50, get the series. Don’t let my kvetching put you off.
And. . . there’s another series of two shots coming up, perhaps in the Spring, that I’m really looking forward to!
I was amazed to read, in the Qullette article below, this sentence:
Between 2016 and 2017, the number of females seeking gender surgery quadrupledin the United States.
But the reference cited did indeed show this (the actual increase was 3.88-fold), while the number of males seeking gender reassignment surgery was not only absolutely lower, but increased much less (41%) over a year. If you go back further, the rise is even more dramatic (graph below):
Here’s a plot from a paper in the Archives of Sexual Behavior showing the number of people referred each year to the UK’s Gender Identity Development Service. It shows the strong rise in referrals of adolescent females compared to males, and some rise in children as well. In the last 7 years it seems to have gone from fewer then 40 to over 1700 in adolescent females—a roughly 43-fold increase! Clearly, some phenomenon is happening that needs an explanation.
These kinds of surgeries are manifestations of gender dysphoria: the distress caused when one’s felt gender identity conflicts with one’s sex at birth. The rate of this dysphoria in adolescent and teenage women has risen to the extent that it could be considered an epidemic, which is what some people think it is: a manifestation of cultural influence that drives many young girls to not only identify as males, but to undergo medical treatment to become hormonally and physically more like males. Shrier’s thesis is that many of these woman would have become lesbians, or reversed their desires, had not gender dysphoria constituted a sort of fad, one seen as a heroic syndrome supported by all kinds of medical and psychological professionals.
In the new book below, which has just entered the Amazon top 100 list, Abigal Shrier, a writer for the Wall Street Journal who also has degrees from Columbia and Oxford and a law degree from Yale, is raising the alarm not about adults who are transgender and undergo medical treatment—Shrier’s fine with that—but about adolescent and teenage girls who claim a different gender identity and then are universally “affirmed” by psychologists, sociologists, and doctors, many undergoing transitions before or while they’re in their teens. It’s undeniable that many of these who transitioned later have second thoughts or regrets about the process, but many of the medical procedures, including hormonal treatments, cause irreversible and injurious changes in the body.
You can get the book, which I’m doing, from Amazon, despite their refusal to take paid ads for it (more on that below). And its popularity, and overall positive customer reviews, come despite the refusal of mainstream media to advertise or even review this book, which seems to me an important one.
Shrier, as I said, deals only with gender dysphoria in young girls and teenage girls, and only one form: “Rapid onset gender dysphoria” (ROGD). Her thesis, as laid out in the Quillette article below (click on screenshot), is this:
What I aim to do, as a journalist, is to investigate cultural phenomena, and here was one worth investigating: Between 2016 and 2017, the number of females seeking gender surgery quadrupled in the United States. Thousands of teen girls across the Western world are not only self-diagnosing with a real dysphoric condition they likely do not have; in many cases, they are obtaining hormones and surgeries following the most cursory diagnostic processes. Schoolteachers, therapists, doctors, surgeons, and medical-accreditation organizations are all rubber-stamping these transitions, often out of fear that doing otherwise will be reported as a sign of “transphobia”—despite growing evidence that most young people who present as trans will eventually desist, and so these interventions will do more harm than good.
The notion that this sudden wave of transitioning among teens is a worrying, ideologically driven phenomenon is hardly a fringe view. Indeed, outside of Twitter, Reddit, Tumblr, and college campuses, it is a view held by a majority of Americans. There is nothing hateful in suggesting that most teenagers are not in a good position to approve irreversible alterations to their bodies, particularly if they are suffering from trauma, OCD, depression, or any of the other mental-health problems that are comorbid with expressions of dysphoria. And yet, here we are.
As I said, Shrier has no issue with adults who, after deciding they’re transgender, decide to have surgery and assume the non-birth gender. She’s solely concerned with the young: why is this suddenly happening, who is supporting it among adults, and what harms can it cause?
Because even raising these questions is considered taboo in today’s political climate, there has been a concerted effort to “erase” Shrier’s book—to pretend it never existed by refusing to advertise or review it. It came to public attention largely because Shrier was interviewed by Joe Rogan on his wildly popular podcast. Even Spotify, which hosts those podcasts, called the interview (as well as Rogan and Shrier) transphobic and threatened to walk out. (See the Rogan-show video here; I recommend it as a substitute for the book if you want to hear about the controversy).
I was able to find only one long-form review of Shrier’s book—one by a feminist writing in Feminist Current, who, despite a few quibbles, praises the book highly. Click on the screenshot to read Megan Mackin’s review:
Between Mackin’s and Shrier’s pieces, you can read about all the attempts by the media (and others) to pretend Shrier’s book doesn’t exist. They include these:
Amazon refuses to host paid ads for the book on its site, though it allows paid ads for books praising medical transitions for teenage girls.
The book wasn’t even reviewed by Publisher’s Weekly and Kirkus, two of the most important pre-publication venues for calling attention to books.
As I mentioned, Spotify employees, calling both Rogan and Shrier “transphobes”, threatened to walk out. Fortunately, the Rogan show episode is still up.
The National Association of Science Writers removed Sean Scott from their discussion group because he had said, without having read the book, that it “should hopefully shed some overdue light on a very sensitive, politically charged topic that potentially carries lifelong medical consequences.” Really offensive and transphobic, right?
Parents started a GoFundMe account to support Shrier, but GoFundMe closed the account twice, though they’re happy to host fundraisers for teenage girls who want transition surgery.
As Mackin notes, “Shrier contributes frequently to the Wall Street Journal, and among her degrees is a Juris Doctor from Yale University. She is a skilled writer who offers complex ideas with accessible delivery. It is possible the media would have covered her work had she resorted to obfuscating postmodernist jargon. Shrier has received no reviews from the established liberal press — not from the New York Times, The Atlantic, the Kirkus Review, nor any other mainstream online publications. Amazon, which still sells and thus profits from Irreversible Damage — garnering rave reviews there — has refused to allow sponsored ads to promote the book.
And, finally, this just happened. Someone beefed to Target that they were carrying Shrier’s book, and Target removed it.
Thank you so much for bringing this to our attention. We have removed this book from our assortment.
To my horror, I've learned that @AbigailShrier's book has been removed from @Target. I've read it. Every grown-up who is in a position of looking after teenage girls (parents, teachers, therapists, religious leaders, coaches, etc) should read this book.
At any rate, despite the lack of media support for Shrier’s bestselling book, she is not casting herself as a victim; in fact, her ending of the Quillette piece is measured and rational, but passionate as well:
I want to be clear about something. I don’t believe that I’ve been harmed by these suppression efforts. I am not entitled to book reviews by any media outlet. I sold plenty of books without Amazon’s “sponsored ads.” Joe Rogan (and Megyn Kelly, who also had me on) have much larger platforms than the outlets that pretended this book doesn’t exist. And while this topic has become a fascination of mine, I am no activist. I will pursue other subjects and write other books.
But there is a victim here—the public. A network of activists and their journalistic enablers have largely succeeded in suppressing a real discussion of the over-diagnosis of gender dysphoria among vulnerable girls. As you read this, there are parents everywhere being lectured to by authority figures about how they have to affirm their daughter’s sudden interest in becoming a boy—no questions asked. From Amazon to I Am Jazz, everyone is telling them that transition is the path to happiness, and those who question this narrative are bigots. So they stare at their shoes and let the conversion therapy take its toll.
This is what censorship looks like in 21st-century America. It isn’t the government sending police to your home. It’s Silicon Valley oligopolists implementing blackouts and appeasing social-justice mobs, while sending disfavored ideas down memory holes. And the forces of censorship are winning. Not only because their efforts to censor leave almost no trace. They are winning because, thus far, most Americans have been content to surrender virtually every liberty in exchange for the luxury of having products delivered to their door. Most would happily submit to the rule of Big Tech, so long as their Netflix isn’t disrupted.
At some point, it will cross each of our minds to question an item on the ever-growing list of unsayables. We will find ourselves smeared, or blocked, or the target of a woke campaign. And we will look for support from those with only a dim recollection of why they once cared about free speech. Those who will note tyranny’s advance with the pitiless smile of a low-level bureaucrat already anticipating the door-delivered Cherry Garcia and hours of uninterrupted streaming: “You brought this on yourself, didn’t you?”
Here’s the end of Mackin’s review, the only thoughtful and longish review I could find anywhere (there are, of course, short reviews on Amazon and GoodReads):
Shrier — not a radical feminist — understands the need for a transfer of feminist ideas, which may encourage other women to take a deeper look. Girls’ lives matter. I give Shrier credit for authoring this necessary book. It is the first to put the many pieces together clearly and accessibly. Read Irreversible Damage and share it with others — it is a brave and daring book that ought to be part of the public discussion.
(Mackin also discusses the many people who profit financially and professionally from affirming, both psychologically and medically, the self-diagnoses of girls as gender dysphoric.)
It’s shameful that a book like Shrier’s is publicly erased by mainstream media and stores like Target because it somehow is seen as “transphobic”. No matter what your preconceptions are, or what you’ve read about girls transitioning before or as teenagers, this book seems like a must-read. It’s a dereliction of duty that major journalistic outlets haven’t reviewed it and that medical associations so readily affirm medical treatment of gender dysphoria in the young. This is how deeply cowed we have become by wokeness, part of which is the universal glorification of gender dysphoria, whose sufferers are seen as heroes. (That may, in fact, partly account for its rapid spread.) When those sufferers are in their teens, though, society should be moving a lot more carefully than it’s doing now.
All too often our Cancel Culture tries to eliminate discussion of issues that are vital in deciding how we should think and act as social beings. The attempts of many to pretend that this book doesn’t exist, and therefore avoid Shrier’s difficult questions, is a reprehensible example of that culture.
I’m not a doctor, of course, nor do I play one on television, but I know that there are physicians among the readers here. They, as well as non-doctors, particularly those in countries with government medical care, might be interested in the itemized statement I got for my hernia surgery exactly a week ago. The total bill was $64,476.34. $513.00 of that was for the curbside COVID testing required before I went into surgery during a pandemic, and the remainder, totaling $63,963.34, was for the surgery itself —including all the supplies and drugs.
Here are the bills; I’ve removed personal information. I won’t of course have to pay more than a small fraction of these costs, as I have a good medical plan through the University (as well as Medicare), but those without insurance and Medicare would have to pay it all.
The COVID testing:
And the surgery bill (below). What impressed me was the high cost of anesthesia—nearly ten thousand dollars—as well as the mesh that’s in my belly to hold my guts in ($2,421.37 for a 10 x 15 cm piece), and also “robotic supply,” which I take to be whatever stuff they had to attach to the robot to operate on me ($9,657.00).
I also didn’t know that the operating room is billed in 15- or 30-minute increments, at $2,284 per fifteen minutes after the first half hour (nearly $12,000 for 30 minutes). Presumably that covers the costs of the surgeon, anesthesiologist, and other personnel in attendance—and, of course, profit to the University of Chicago Hospital.
Look at all the drugs I got: 24 of them! I think the Propofol is what put me to sleep, but as for the function of the rest, well, as I said, I’m not a doctor. I have to say that even a dollar for two acetaminophin (Tylenol) is way too expensive given that I can buy then for a bit more than 1 cent per tablet at Walgreen’s.
At the end is the superglue they used to close me up (“Adhesive Dermabond mini”). They didn’t use any stitches on the outside, so there’s still a veneer of glue over each of my three robotic punctures that will wear off. That glue cost $118.23.
And of course I had to look up “neuromuscular blocking drugs”, which are these:
In clinical use, neuromuscular block is used adjunctively to anesthesia to produce paralysis, firstly to paralyze the vocal cords, and permit intubation of the trachea, and secondly to optimize the surgical field by inhibiting spontaneous ventilation, and causing relaxation of skeletal muscles. Because the appropriate dose of neuromuscular-blocking drug may paralyze muscles required for breathing (i.e., the diaphragm), mechanical ventilation should be available to maintain adequate respiration.
I guess I was intubated, though I don’t see any charge for tubes.
Now, can you know these prices in advance so you can comparison shop among hospitals? The answer is NO. While hospitals differ drastically in their costs, it would be nearly impossible to get a figure for the entire operation in advance. Some hospitals, like the Surgery Center of Oklahoma, will quote you a flat price (and for them, my redo surgery would have been free), and that price, for hernia surgery similar to mine is, I’m told, about $4,500: only 7% of what the bill was above. Nor are these cheaper hospitals worse at what they do: there seems to be little correlation (or even a negative correlation) between the price of a procedure and the quality of the facility and the doctor. (My doctor at the U of C, by the way, was excellent and has a superb record, but more on doctor-shopping later.)
What about the costs above? Are those the sticker costs that then get discounted when billed to the insurance companies (i.e. are they they the so-called “Chargemaster list prices” for each item), or are they the already-discounted costs given to my insurance company? I have no idea. It’s as if you went to the grocery store and there were no prices on the food items, and then after a month you get a bill saying, “This is what you have to pay for groceries.” After talking to my doctor, who will answer your questions below, I’m convinced that the entire medical system is set up not only to make profit, but to prevent patients from exercising discretionary pricing and comparison shopping.
Why are prices so high? Because there is no incentive for doctors and hospitals not to raise prices given that most patients have insurance, don’t know what they’re going to pay, and because hospitals negotiate a flat percentage rate for reimbursement, which differs among insurance companies—a rate that applies regardless of what a procedure costs. So, for example, if the insurance company negotiates having to pay 50% of the “Chargemaster price” used by the hospital (these rates are secret, of course), then the hospital can simply raise the price of its procedure, so it will get more money from the insurance company and the patient’s co-payment.
Things aren’t made better, I’m told, by the Affordable Care Act, which sets a roughly 20% maximum on what each insurance company can keep for profits, salaries, and operating expenses, with the rest going for their customers’ healthcare. That leads to an inexorable raising of premiums and doctor/hospital prices, which go up in tandem. There is no brake to this system.
Can you at least comparison shop among doctors and hospitals to see who has the best record of surgical or medical outcomes? The answer is also a big NO. Those records are required to be kept by law, but patients have no access to them. You have to either find a doctor who has access to these records (they have to pay for such access), or rely on word of mouth.
What’s the solution? Government insurance may help, but isn’t a panacea. In Canada, I’m also told, prices are lower, but the country is hemorrhaging doctors because of the low salaries, resulting in a severe doctor shortage and interminable waits for medical care except in emergency situations.
Now this is a very complex process, but American healthcare appears to be broken in ways that very few of us know about. I may have made a few errors in this post, and will strive to fix them.
Also, my physician, Alex Lickerman, who’s a private primary-care doctor and deeply concerned with the rising costs of American medical care, has consented to answer readers’ questions in the comments below as he has time. You can ask him about how to comparison shop, why American healthcare is a big rip-off, what he sees as the fix for American healthcare, and why the Canadian system, at least, isn’t working very well. (Much of the information above I got from him.) Or ask anything else.
This started out as a simple presentation of my medical bill, but may wind up as a discussion of the outrageous costs of American healthcare, and whether there’s a good fix. Have at it, and do pose questions for Dr. Lickerman.
