Category: medicine and health

The reported benefits and dangers of chiropractic

May 21, 2026 • 10:40 am

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

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

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

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

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

Part of the paper’s abstract:

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

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

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

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

 

From the article:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New paper by Ruuska et al: Gender reassignment does not reduce psychiatric morbidity in gender-dysphoric youth

April 13, 2026 • 10:00 am

It’s one of the commonplaces that young people who have gender dysphoria (“GD”) will experience both reduced psychiatric problems and reduced suicides if they proceed on to gender reassignment (GR) via “affirmative care”. The suicide claim was dispelled in 2024 by the Finnish investigators given below, who showed that both GD and GR, when compared to controls, do not show increased suicide beyond that predicted from psychiatric problems alone (they used controls).  That dispels the common claim by gender activists pushing GR: “Do you want a dead son or a live daughter?” (That’s for transitioning to female gender, but it can be reversed.)

A new paper from the same group, published in Acta Paediatrica, looks not at suicide but psychiatric “morbidity” (psychiatric problems).  The study was large, controlled, and takes advantage of the fact that in Finland every doctor visit is recorded for every citizen because of the country’s national health system.

The upshot is simple: children and young people (they used subjects up to 23 years old; henceforth called “subjects”) who sought treatment for GD had significantly more severe psychiatric problems and were referred far more often for “specialist level” treatment than were controls.  Those GD subjects were parsed into two groups: those who were given gender reassigment, and those who were not. The conventional wisdom is that if you have GD, then gender reassignment should significantly alleviate their dysphoria, measured by a reduced need for specialist psychiatric treatment.

The conventional wisdom was wrong: gender reassignment didn’t alleviate psychiatric compared to GD people who didn’t get reassignment. The conclusion is that gender reassignment, with its deleterious side effects, was not a good way to improve quality of life, at least measured by the need for psychiatric intervention.

Here’s how the term “gender reassignment” is used in the paper:

Medical GR interventions included masculinising/feminising hormonal treatments, chest masculinisation, and/or genital surgery (vaginoplasty/phalloplasty/metoidioplasty).

These treatments are all irreversible except that removed breasts can be restored by replacements.

Click below to access or download the pdf, or you can see the original paper online here.

As I mentioned, the sample size was large: there were 2,083 GD subjects who presented themselves for treatment, and for each of these subjects the investigators chose eight controls, four males and four females matched to the GD subjects by age and place of residence. The final controls numbered 16,643.

Here are the percentage of subjects who sought specialist-level psychiatric treatment between 2011-2019 (differences from 1996-2010 were in the same direction, but far more people who sought GD treatment had a history of specialized treatment in the later period. The authors don’t know the reason for the rise in GD-associated psychiatric difficulties, but it matches the rise in gender dysphoria in other places, including the U.S.

GD subjects

Sought specialized psychiatric treatment before the presentation for GD (“index date”):  47.9%
Sought specialized psychiatric treatment ≥2 years after the presentation for GD:               61.3%

Controls

Sought specialized psychiatric treatment before the presentation for GD (“index date”):  15.3%
Sought specialized psychiatric treatment ≥2 years after the presentation for GD:               14.2%

This shows that GD subjects, whether or not they went on to GR, initially had about three or more times the rate of psychiatric difficulties than did the controls. That is not new, as GD is generally related to psychiatric difficulties, and it’s likely that some people look for gender reassignment as a way to alleviate their gender dysphoria, or even as a way to alleviate general mental difficulties.  But GD subjects in general did not in general show a lessening of psychiatric difficulties after their presentation; in fact, the rate was increased by about 13.4%.

The important figures, though, are those showing whether or not GR treatment alleviated psychiatric difficulties. After all, that is the rationale for gender-reassignment treatment, whether it be hormones or surgery.  Here is Table 3 from the paper, with the last two columns being the important ones. They’re divided up by sex, and “GR-” means GD subjects not given gender reassignment, while “GR+” means GD subjects who were given gender reassignment. Click table to enlarge; I’ve put a red rectangle around the area of most importance:

This shows that GD subjects, both those who transitioned to female and those who transitioned towards male, did not have a reduction in psychiatric treatment contact (all contact, whether “specialized” or not) after their transition began or was completed. Au contraire: the psychiatric treatments went up sixfold for those transitioning to female genders and 2.5-fold for those transitioning towards male.

If you look at the third and four data columns, you can see the percentages of GD subjects who got psychiatric treatment for GD but who did not go on to reassignment. Curiously, the psychiatric treatment was more frequent in this group than in the group that went on to reassignment, but only before the data of first consultation for GD.

This difference between the third and fourth and the fifth and sixth data points on the first line is curious.  But what’s important here is that there is no marked alleviation of psychiatric contacts for GD subjects who went on to reassignment. They continue to consult psychiatrists, and at about the rate of GD subjects who didn’t go on to reassignment. Again, we don’t see the mitigation of psychiatric difficulties in GD patients that go on to surgery or hormones.  Since those procedures have deleterious side effects (anorgasmia and pronounced difficulties after surgery on genitals or even breasts), there is not a strong case to be made for gender reassignment of gender-dyphoric patients, at least in terms of alleviating mental illness.

The first two columns show the data for both male and female controls. Since they didn’t have consultations for GD, the “index date” for controls was given as the date that their matched GD subjects first had a consultation.  And, as expected, their psychiatric visits were far less numerous than the GD subjects two years after the index date (though the low levels of consultations for GR+ subjects compared to GR-subjects before the index date is still curious, and I may have missed the authors’ explanation).

This is just a cursory interpretation I’ve made after reading the paper twice, and I may have missed some data that feed into the authors’ conclusion below. What’s clear is that GD is associated with psychiatric disorders, though it may not be causal, and that gender reassignment does not improve mental health compared to dysphoric subjects who didn’t get reassigned.  All this suggests that “affirmative care” that puts GD subjects on the path to GR doesn’t, at least in this study, have the salubrious effects that are touted—as measured by the intensity of psychiatric treatment. Gender-reassigned subjects continue to suffer from mental disorders at a rate threefold to fivefold that of controls without gender dysphoria, so GR doesn’t come close to giving subjects the mental stability of controls.

The last paragraph of the paper gives what the authors see as the “Clinical Implications” of their results:

Regardless of gender, adolescents suffering from GD present with excessive psychiatric morbidity. Subsequent to medical GR, psychiatric treatment needs appear to increase. It should be noted that in some individuals, medical GR appears to be linked to deterioration in mental health. Possible mechanisms and vulnerable subgroups should be explored in future studies. The effects of medical GR and the expectations of the patient must be addressed before commencing the treatment. The considerable severe psychiatric morbidity prior to contacting the GIS, and its increase over time, suggest that for some of these adolescents, GD may be secondary to other mental health challenges. This underscores the need to thoroughly assess and appropriately treat mental disorders among those seeking GR before and after undergoing irreversible medical treatments. Psychiatric needs must be adequately met.

 

h/t: Christopher

Coyne’s new law

March 10, 2026 • 3:04 pm

This law, which is mine, is derived solely from watching the NBC Evening News, which is interrupted by a lot of ads for drugs aimed at older people (for COPD, cancer, dry eyes, heart problems, etc.). That alone tells you who the target demographic is, and also that young people don’t watch the t.v. news (they get it, of course, from social media).  Here’s my rule:

It’s coming now.  . . .

Here it is:

At least half of new medicines advertised on t.v. have the letters “x”, “y”, or “z” in them. 

Here’s a table from Cornell University of the frequency of letters in the English language, based on a sample of 40,000 words. The total frequency with which x, y, or z appear among letters is 1.35%.  Calculating the frequency of, say, random six-letter names that don’t contain such a letter would be about (0.987) to the sixth power, or about 0.95, or 95%.  But of course that is an underestimate, as a drug name is unlikely to have two or more of those three letters, and it has to have a vowel. I don’t know how to do the proper math, which is impossible given that the names are made up, but I have to conclude that drug manufacturers think their wares will sell better if they have one of the Three Letters.

(There may be some miscalculations here, or other sites may give slightly different )

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

February 25, 2026 • 9:30 am

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

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

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

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

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

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

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

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

A few excerpts:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Canada expands criteria for assisted suicide (“medically assisted dying”) beyond terminal illness

January 27, 2026 • 10:30 am

Assisted suicide, also known as “medical assistance in dying”, or MAID, has been legal in Canada since 2016 when the country’s Supreme Court ruled that “eligible adults with grievous and irremediable medical conditions” were entitled to medical assistance to end their lives.

In 2021 the permitted conditions for MAiD were expanded to this standard:

9.1.5 the person has a grievous and irremediable medical condition. These criteria are met only where the provider and assessor are of the opinion that:

(a) the person has a serious and incurable illness, disease, or disability;
(b) the person is in an advanced state of irreversible decline in capability; and
(c) the illness, disease, or disability or that state of decline causes the person enduring physical or psychological suffering that is intolerable to the person and cannot be relieved under conditions that the person considers acceptable.

(You can read the current MAID standards here.)

In the past MAID was largely restricted to people with a terminal illness, but now it includes patients with a medical condition that may not be terminal but causes physical or psychological sufffering that is intolerable. This thus includes people who want to end their lives because they’re suffering psychologically and/or physically with a medical condition and have found no relief. (“Depression”, however, does not qualify you in Canada for MAID; you must be suffering from a medical condition in a way that is intolerable. Nor can “depression” be listed on the death certificate—only the antecedent medical conditions that cause suffering.)  Similar standards apply in the Netherlands; however, in that country intolerable and irremediable mental distress itself qualifies you for euthanasia. (Subramanya wrote about this in a previous Free Press article, “I’m 28. And I’m scheduled to die in May.“)  The Guardian gives the Dutch standards:

Under Dutch law, to be eligible for an assisted death, a person must be experiencing “unbearable suffering with no prospect of improvement”. They must be fully informed and competent to take such a decision.

How is euthanasia performed in Canada ? The National Standards say this (these are limited to adults over 18 of sound mind, though if you have dementia you can order MAID in advance so long as you do it when you are in a period of compos mentis):

There are 2 methods of medical assistance in dying available in Canada.

Method 1: a physician or nurse practitioner directly administers a substance that causes death, such as an injection of a drug. This is sometimes called clinician-administered medical assistance in dying.

Method 2: a physician or nurse practitioner provides or prescribes a drug that the eligible person takes themselves, in order to bring about their own death. This is sometimes called self-administered medical assistance in dying.

Subramanya’s new article in The Free Press discusses the case of Kiano Vafeian, a 26-year-old Canadian who was blind and struggling with Type 1 diabetes with attendant severe neuropathy.  This had made hin depressed and he asked for MAID. He eventually got it and died from one of the two methods above. His death certificate said that his MAID was prompted by blindness and severe peripheral neuropathy; depression was not listed.  You can read the story, if you subscribe, by clicking on the screenshot below, or reading the free archived article here.

People are alarmed by assisted suicide, and the opponents are often religious.  Regardless, the proportion of all deaths that occur by MAID in Canada is in the range of 5-7%, and are rising. Here’s a graph of the increase from the article:

And the fate of requests for MAID. Note that most are approved.

You will be familiar with the reasons for objections to euthanasia. For very religious people, it is often that people should die when God wants them to go, regardless of their suffering (I call this the “Mother Teresa objection”). More rational people see MAID as a slippery slope, especially for someone like Kiano who wasn’t terminal. The new conditions, they say, will lead people who could otherwise lead tolerable lives to be euthanized in a moment of despair. (I’ll put some of the quotes below.) But of course, doctors have to testify that the euthanized patient did meet the criteria, so presumably they would investigate whether any depression could be cured (this is what they do in the Netherlands).  It’s not clear that Kiano was treated for his depression, though it’s implied, but to my mind I can understand how blindness and diabetes in a young man, with the diabetes slowly destroying his body, is sufficient to ethically permit euthanasia.

Kiano’s mother objected to his euthanasia because he seemed to have moments of enjoyment before he was put to sleep: he went to Mexico on vacation, joined a health club, and got a nice condominium in Toronto with a full-time caregiver paid for by mom. But it wasn’t enough.  He requested and got MAID on December 30, 2024.

Here are some opinions of non-relatives opposed to Kiano’s MAID:

Sonu Gaind, a University of Toronto psychiatry professor, told me that the fastest-growing category in the country’s MAID statistics is not cancer, heart disease, or any specific illness. It is a catch-all labeled as “other.” MAID deaths in the “other” category nearly doubled to 4,255 in 2023 from a year earlier, adding up to 28 percent of all assisted-suicide deaths, Gaind’s research found.

When I told Gaind about Vafaeian and what he had been through, Gaind responded: “I’m not denying his suffering, but it doesn’t paint a picture of someone who is constantly suffering. That contradiction should trouble people.”

He said that Canada’s assisted-suicide system “has been set up so that if the person says their suffering is intolerable, assessors will say, ‘Who am I to question that?’ ”

and

David Lepofsky, a blind lawyer and disability-rights advocate in Toronto, said that focusing on suffering rather than pain invites broad, subjective interpretations—and that the MAID process lacks any independent safeguards before death is delivered. “Blindness doesn’t cause pain,” Lepofsky said. “Millions of us live good, independent lives.”

and

Ramona Coelho, a family physician and member of Ontario’s MAID Death Review Committee, said provincial oversight reports increasingly show in general that the person’s suffering appeared to be driven less by medical decline than by loneliness, social distress, and fear of the future. “Young people relapse, and they also recover,” Coelho told me. Allowing government-sanctioned assisted suicide “during periods of acute vulnerability risks mistaking transient suffering for permanent decline.”

However, a doctor who performs MAID says this:

These are not people who seek assisted suicide “because of mental illness alone,” Wiebe insisted when we talked. “They have other things. . . . That’s what all of my experience is.”

Remember that chronic depression is a medical condition that is sometimes incurable and causes the same intolerable suffering specified by Canadian law (read the Subramanya’s previous [archived] account of a Dutch woman who requested and got euthanasia on the basis of severe and untreatable depression).

Some physicians object to MAID because their brief is to save lives (“First, do no harm”), but that is misguided. Throughout the U.S., for example, physicians often end the lives of suffering terminal patients by giving them an overdose of morphine. This is MAID, though it’s not given for depression. In 12 American states, though, including Illinois, assisted dying is legal.

The objections to Kiano’s euthanasia seem to me misguided—based on someone’s subjective opinion of the sufferer’s feelings. Gaind questions whether Kiano’s suffering really is intolerable.  He doesn’t seem to understand that such people can have, or act out, moments of seeming normality. Lepofsky, also blind, avers that his own sightlessness is tolerable to him, so why isn’t it tolerable to Kaiano? (He seems to forget that Kiano is suffering from painful effects of type 1 diabetes.) And Coelho doesn’t realize that proper treatment of people seeking MAID for mental illness might not cure severe depression.  In the case of 28-year-old Zoraya ter Beek in the Netherlands, the woman had tried many types of treatment and drugs for mental illness, and none of it worked. She wanted to end the pain of living, which had gone on for years, and I can fully understand that. (She died with assistance in 2024.)

It seems to me that the Canadian law doesn’t go far enough: it should consider mental illness alone sufficient grounds for euthanasia IF it is intolerable and doctors have been unable to relieve it over a substantial period of time. If doctors recognize that, who are other people to say that the mental distress is tolerable?

I think it’s time to realize that we should let some people go even if they are not medically terminally ill, for to do otherwise is to allow suffering that can’t be cured.  I am not worried about a “slippery slope,” which can be avoided with proper medical supervision before euthanasia. I am more worried about people suffering their whole lives and not being allowed to have a peaceful death with dignity. The alternative is a self-inflicted end by hanging, jumping from a building, or lying down in front of a train. Is that what we want?

I will add a poll:

Should assisted dying be allowed for people who don't have terminal illnesses but have a condition causing irremediable physical or psychological suffering?

View Results

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“Progressives” appear to whitewash female genital mutilation

December 17, 2025 • 10:20 am

This is an example of how horrible cultural practices are excused—or made to seem less harmful—by “progressives” (read “the woke”) when they’re characteristic of minority groups. In this case the practice is one of the cruelest and most misogynistic forms of behavior around—female genital mutilation (FGM), especially in its most damaging form, infibulation (there are three forms of FGM; see below).  I

This issue came to my mind when I saw this tweet:

Here’s the article in the Times of London referred to in the tweet; click to read.

 

And that led me to an essay in the Journal of Medical Ethics (below) highlighted in the above article.

The Times article above seems toi me a pretty accurate characterization of the Journal of Medical Ethics (JME) article, though a bit hyperbolic:

Laws that ban female genital mutilation (FGM) are harmful and “stigmatising” towards migrant communities, academics have claimed in a British Medical Journal publication.

The essay argues that criticism of FGM, which involves cutting or removing females’ genitals for non-medical reasons, is “sensationalist” and based on “racialised stereotypes”.

It draws an equivalence between FGM in Africa and a trend for cosmetic genital procedures in the UK and US whereby women undergo surgery to create a “designer vagina”.

The article was published in the BMJ’s Journal of Medical Ethics, and its 25 co-authors include academics at the University of Cambridge, the University of Bristol and Brighton and Sussex Medical School.

FGM has been illegal in the UK since 1985, but remains commonplace in areas of Africa, Asia and the Middle East, with the highest prevalence in Somalia.

It can cause severe pain, harm and long-term health problems, and organisations including the United Nations support bans and recognise it as a violation of women and girls’ human rights.

However, the article suggests that laws that ban FGM, including in the UK, are “causing harms to people” and can “objectify girls and women as passive victims”.

It says: “Laws against ‘FGM’ in Western countries have resulted in the marginalisation of migrant communities, reinforcing exclusionary practices and contributing to their social stigmatisation. While intended to protect, such legislation can serve as a tool of exclusion, deepening the divide between these communities and the broader society.”

The article claims that critics of FGM “ignore similar practices that have long been customary in powerful countries of the Global North”. It compares FGM to a rare type of cosmetic surgery called labiaplasty, which is offered by surgeons in Western nations.

Now if you read the original article below, you’ll see that though the authors admit here and there that female genital mutilation is harmful, their purpose is really to rename it, as “female genital modification as well as to reduce bigotry against cultures that practice FGM.

This authors argue that conflating FGM with other forms of genital surgery, such as that performed on transgender males or females in the “Global North” causes confusion and confused social policy. They also say it leads to discrimination against people who practice it in their native countries in the “Global South”, like Somalia, but after those people immigrate to the “Global North”.  Yes, they do say FGM is harmful, but so are these other surgeries, including circumcision.  But the article’s real result, I think, is to de-stigmatize the practice as a whole when the authors try reduce discrimination against cultures that practice FGM in their native lands.

A few quotes from the essay above:

One might also point to the tyranny of ‘types’ promulgated by the standard tale. Despite being the least common, infibulation (the sewing together of the outer labia, type 3) has come to stand for all forms of female genital practices in the popular imagination. Thus, communities that practise other forms, such as some Shia Muslims, who reportedly excise a small amount of skin from a girl’s prepuce, the so-called clitoral hood, as a religious duty and rite of inclusion, are immediately deemed ‘mutilators’.35 While some Shia and some Sunni Muslims argue that a notion of gender equality underlies the practice—in communities where both boys and girls undergo ritual circumcision—the use of the term ‘mutilation’ shuts down meaningful dialogue.

In contrast, boys who undergo circumcision, whether performed by so-called traditional operators or medically trained personnel, are rarely considered victims of mutilation, and the various forms of male genital practices—some as altering as infibulation—elude equivalent scrutiny.

. . . . Recent quantitative and qualitative research reveals that affected migrants who expect a permanent future in the Global North overwhelmingly opt to stop their cultural or religious female genital practices. Nevertheless, the belief persists that migrants are committed to preserving these traditions, and stories of ‘FGM’ practices after immigration abound in public discourse and news reporting, despite a lack of evidence, and indeed evidence to the contrary. Such misrepresentation and stereotyping fuel suspicion towards minority communities and families, resulting in harmful consequences for the girls and families involved.

, , ,We have written this critique to expand that conversation. Over the past four decades, great damage has been done to the process of rational policy formation by misleading and sensational media coverage of affected women from practising communities in the Global South. In concert with anti-FGM activist organisations, mainstream newspapers in North America, Europe and Australia have firmly fixed in the minds of their readers a typifying ‘dark continent’ ‘female genital mutilation’ image based on the atypical practice of infibulation, which should not be confused with the far more common forms of female genital practices that continue to prevail in many African and South-East Asian societies, and which are gaining in popularity among cosmetic surgeons and majority populations in North America and Europe (although never under the label ‘genital mutilation’—the expression ‘designer vagina’ is sometimes used).

Additionally, while reading the mainstream media coverage of ‘FGM’, one would never know that the custom does not selectively pick on women. Almost without exception, wherever there are female genital modifications, the local social norms regarding genital alteration are gender inclusive or gender equal and approvingly call for male genital modifications as well. Political patriarchy may have rather little to do with it.

Now FGM is illegal everywhere in the “Global North”, and this article says that the practice here is very rare. There are actually three main types of FGM as classified by WHO. All are harmful, and I list them below. First, though, is the practice really rare in the “Global North”? It’s very hard to find data as cases are, for obvious reasons, not often reported.  I first consulted ChatGPT, whose data must of course be taken with a grain of salt. But it does give references, a few of which I’ve checked to see if they say what they’re alleged to say; the ones I’ve checked do.  I also add below a link from Ayaan Hirsi Ali, who has founded an anti-FGM organization (she was a victim) and she gives statistics as well.

First, from the bot, when I asked it “how common is female genital mutilation in the West”?

Female genital mutilation/cutting (FGM/C) is much less common in Western countries than in the regions where the practice has traditionally been concentrated (mainly parts of Africa, the Middle East, and some countries in Asia), but it does occur in the West — largely within migrant and diaspora communities from countries where FGM is prevalent. World Health Organization+1

Here’s an overview of how common it is in the West:

📊 General Western Prevalence

  • Overall Western prevalence is low compared with high-prevalence countries in Africa or the Middle East. In most Western populations, FGM is very rare or nearly absent overall, and national prevalence rates are typically well below 2 % of the general female population. However, estimates can vary based on methods and data limitations. Political Islam Center

🇪🇺 Europe

  • At least ~600,000 women and girls residing in European countries are estimated to have undergone FGM, with an additional ~130,000–190,000 girls and women at risk in some European Union countries. FGM/C Research Initiative

  • The largest numbers of FGM survivors in Europe are found in the UK, France, Italy, Spain, Germany, the Netherlands, and Sweden. FGM/C Research Initiative

  • Because most European countries do not collect comprehensive health data on FGM, these figures are estimates drawn from community surveys, health systems data, and extrapolations. End FGM

🇺🇸 United States

  • Estimates suggest that hundreds of thousands of women and girls in the U.S. either have undergone FGM or are at risk, mostly because they or their parents come from countries where the practice is common. PRB

  • For example, one estimate identified over 500,000 women and girls at risk or already cut based on countries of origin with high FGM prevalence. Political Islam Center

🇨🇦 Canada and Other Western Countries

  • Canada and other Western nations also report thousands of women and girls who have undergone FGM, again primarily within immigrant communities. For example, the CSPII FGM Index estimated Canadian prevalence at around 0.47 % of the female population — substantially lower than in high-prevalence countries. Political Islam Center

🧠 What This Means

  • In the general Western population, FGM prevalence is very low because the practice is not part of mainstream Western culture or norms.

  • Most cases in Western countries occur in migrant communities from regions where FGM is traditionally practiced.

  • Due to legal bans and active public health and human rights efforts, Western countries also focus heavily on prevention and protection to reduce incidence.

In the Anchorage Daily News, Ayaan Hirsi Ali writes what’s indented blow, making claims about people living with FGM in the U.S. It’s not clear how often the mutilation was done before immigration, but I suspect that a lot of it is done in America, especially because you don’t have to have it done by a doctor. See below.

. . . . Alaska is one of nine states without a specific FGM ban, and the costs of that inaction are real. According to a groundbreaking study published by AHA Foundation in 2023, 10,020 women and girls in the Western United States have ancestral ties to countries where FGM is practiced. Of these, approximately 2,780 are at high risk of being cut or already living with FGM and 750 are living with Type III FGM, the most severe form, in which the genital area is sewn almost completely closed. A significant percentage (23.2%) of the Type III FGM population is living in Alaska. These survivors face chronic pain, complications during childbirth and lifelong trauma — often without access to medical care or emotional support.

Perhaps I should have put what follows up first, but here are the four types of FGM classified by The World Health Organization (WHO). Hirsi Ali refers above to three forms; she’s talking about the first three.

The World Health Organization (WHO) classified FGM into four broad categories in 1995 and again in 2007:

Type I: Partial or total removal of the clitoris and/or the prepuce.

Type II: Partial or total removal of the clitoris and labia minora, with or without excision of the labia majora.

Type III: Narrowing of the vaginal orifice by cutting and bringing together the labia minora and/or the labia majora to create a type of seal, with or without excision of the clitoris. In most instances, the cut edges of the labia are stitched together, which is referred to as ‘infibulation’.

Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.

FGM is condemned by a number of international treaties and conventions, as well as by national legislation in many countries. Article 25 of the Universal Declaration of Human Rights states that “everyone has the right to a standard of living adequate for health and well-being,” and this statement has been used to argue that FGM violates the right to health and bodily integrity. With FGM considered as a form of violence against women, the UN Convention on the Elimination of All Forms of Discrimination against Women can be invoked. Similarly, defining it as a form of torture brings it under the rubric of the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment. Moreover, since FGM is regarded as a traditional practice prejudicial to the health of children and is, in most cases, performed on minors, it violates the Convention on the Rights of the Child. An interagency statement on FGM, issued by 10 UN organizations, was issued in 2008.

Now all are harmful, and the first two either completely remove or considerably diminish the possibility of any sexual pleasure, which is one of the reasons they’re done. So all three are harmful.

What about circumcision? I’ll leave that aside for this post as it’s not as harmful as these forms of FGM, and isn’t banned. But many readers feel that that, too, is genital mutilation, and one can make the case that it shouldn’t be done until the prospective circumcisee is old enough to give permission. If people want to discuss that, please do so in the comments.

Now onto one form, infibulation, which I hadn’t read about in detail before. The details came from the following tweet:

Here are the details from that tweet. NOTE: THE BIT IN ITALICS IS DISTURBING AND YOU MAY NOT WANT THE DETAILS:

I just read in more detail about female genital mutilation, which Somalis perform on 99% of girls in their country.

It’s possibly the worst thing I’ve ever read.

Here it is below so you can read it too; although I would advise you not to.

But it is important to understand how alien and horrible Somali culture is.

These are acts such that if they happened to a single Danish girl in Denmark, they would be rightfully seen as the most gruesome and grotesque mistreatment ever. It would be a news story running for decades, and the perpetrator would be the most hated man in the country.

This is what every family in Somalia inflicts on their daughters.

Not 5000 years ago in the bronze age. Right now. The Somali immigrant that came here last week had this done to his daughter.

“The process begins with the girl being forcibly restrained; often held down by several female relatives, including her mother or aunts, to prevent movement amid her screams and struggles. The excisor, using crude tools like a razor blade, knife, or broken glass, starts by slicing off the clitoral glans (the sensitive tip of the clitoris) and the surrounding clitoral hood, exposing raw nerve endings and causing profuse bleeding as blood spurts from the severed arteries. Next, the labia minora (the inner vaginal lips) are completely excised, followed by the labia majora (the outer lips), with chunks of flesh being cut away in jagged, imprecise strokes, leaving behind a mangled, bloody wound where the vulva once was. Shock sets in from the excruciating pain, described by survivors as feeling like being torn apart alive, with waves of burning sensation radiating through the body.

Once the removals are complete, the excisor repositions the raw edges of the remaining labia majora and stitches them together over the vaginal opening using thorns, acacia needles, or coarse thread, creating a tight seal. This narrows the opening to the size of a matchstick or pinhole, just large enough for urine and menstrual blood to trickle out slowly, often leading to immediate complications like urinary retention, where the girl strains in agony to pass even a few drops. The stitching is done without regard for hygiene, increasing the risk of tetanus or other infections as pus forms in the festering wound. If the girl faints from blood loss or pain, she’s revived with slaps to continue the ordeal.

Immediately after, the girl’s legs are bound tightly together from hips to ankles with ropes or cloth strips to immobilize her and allow scar tissue to form over the next 40 days, during which she lies in excruciating discomfort, unable to move without tearing the stitches. Swelling balloons the genital area into a throbbing, inflamed mass, and fever often spikes as infection takes hold. Hemorrhage can be fatal if not stemmed, sometimes by packing the wound with herbs, animal dung, or ash, which only exacerbates the sepsis. Survivors recount nights of unrelenting torment, with the pain so intense it induces vomiting, hallucinations, or loss of consciousness.

The aftermath is a lifetime of suffering: the scarred seal must often be cut open (deinfibulation) for intercourse or childbirth, reopening old wounds and risking further tearing, excessive bleeding, or even death during delivery. Menstrual blood pools behind the barrier, causing chronic infections and foul odors; urination becomes a drawn-out, burning process; and sexual activity turns into a source of dread, with friction against the rigid scar tissue feeling like sandpaper on raw skin. Psychological scars run deep, manifesting as PTSD, depression, or a profound sense of bodily violation.”

Again, this is the most brutal form of FGM. Presumably most readers know why FGM is performed. It is “cultural,” but the cultural reasons are often explicit. It’s done to preserve virginity for marriage, as in some cultures you have to be a proven virgin to be married. It’s also done to control women’s sexuality so they don’t experience too much (or any) sexual pleasure; presumably this keeps them from wanting sex.

At any rate, although I’m not implying that the authors above are justifying FGM, I think they are minimizing its harms by saying that it leads to bigotry against people from cultures that practice FGM, even when they’re immigrants.  Read the paper if you wish and see if you agree.  But for sure people must agree that FGM has to stop; it’s the medical equivalent of wearing burqas, but much, much worse. The WHO is doing what it can to stop the practice, but it’s still very common in some places.

Everyone, and not just feminists, should be aware of it and speak out against it at appropriate times.  No, we shouldn’t demonize, say, the Somalis in America just because FGM is common in Somalia.  But I think it does no good at all to try to change the words to “female genital modification.”

Somebody asked Grok about the frequency of FGM in the U.S. and I have put the answer below the fold Again, it is hard to estimate numbers or frequenies.

Click “Continue reading” to see what Grok says:

Continue reading ““Progressives” appear to whitewash female genital mutilation” →

Proprietor’s miscellany

November 1, 2025 • 8:25 am

Here is some information about my sleep test and a few miscellaneous photos from Chicago. Readers’ wildlife photos will return tomorrow, so keep sending them in!

First, wish me luck; next Tuesday I am taking a home sleep test, which involves the items shown below (you also need the right app on your phone). It used to be that to take a sleep test you’d have to spend the night in the hospital, all wired up to various devices. How can you sleep normally under such conditions? But things have changed for the better. After all, it’s much better to sleep in your own bed, which is what you can do with the equipment below.

Here’s the kit:

  1. A watchlike device that apparently transmits data to the hospital through your phone. You wear it on your non-dominant hand.
  2. The data come from the tubular device fastened to one of your fingers, as well as an electrode that you tape (using the medical tape provided) to the little hollow at the base of the front of your neck. You can use any finger on your non-dominant hand save the thumb.
  3. Your cellphone, which has to be within fifteen feet of the watch.

So, you put the battery in the watch, put the watch on your wrist, put the finger device on your finger, put the electrode on your throat, and then press “begin” on your app. Then you go to sleep—or try to. You have to record for seven hours at the minimum.  At the end you press “stop recording” on the phone app, and wait while the data (presumably mostly indicating your breathing) is transmitted to the hospital. In a few seconds it should be over, and you can discard the whole kit.

It appears to be designed to detect sleep apnea, but there is no sign I have the condition, as nobody has ever reported me snoring or waking up gasping for breath, and sometimes I’m up all night not able to sleep, with no breathing problems at all.  But the doctors tell me you can have sleep apnea without knowing it (I find this nearly impossible to believe when I’m awake all night breathing normally), but they won’t treat me further unless I take this test.  So be it: my own view is that the cause of my insomnia is pure anxiety.

And some miscellaneous photos taken on my walk home and to work. First, fall is here (don’t forget to set your clocks back tomorrow):

Given the number of immigrants in Chicago, with many surely undocumented, ICE is a big deal. There have been attempted apprehensions in Hyde Park, which have led to signs like the one below, on the door of a local bakery that employs Hispanics.  There are also other signs taped to lightposts that aren’t so polite, saying “F-ck ICE” and saying that ICE are Nazis. Note that in the sign below, ICE is depicted as a hungry alligator.

And good news for lovers of Botany Pond: Yesterday afternoon three of the five turtles put back in the pond (they were removed when the pond was drained several years ago), were sunning themselves on a warm rock yesterday afternoon. I haven’t seen them sunning themselves for a couple of weeks, so I think they’re getting used to the pond. They look healthy, no? I suspect the other two were either swimming around or were ensconced in their “turtle dens” on the pond bottom.