Category: medicine

“The latest from the asylum”: New Zealand nurses directed to foster, accept, and prioritize indigenous culture, including specious “ways of healing”

December 13, 2024 • 10:00 am

The bit in quotes in the title may be a bit mean, but it’s the title an anonymous reader gave in an email linking to several articles from a New Zealand site (here, here, and here). The articles describe a new set of standards for registered nurses in the country, standards that I read in the official government document (see below).

Why this seems “asylum-ish” is because the standards are almost entirely directed to prioritizing and catering to the indigenous Māori population of the country, even though they are in a minority of the population (16.5%) compared to Europeans (70%) but also very close in numbers to Asians (15.3%, with most of the remainder being Pacific Islanders).  The standards direct New Zealand nurses to become “culturally competent”, which is okay if it means being sensitive to differences in psychology of different groups, but is not okay if it means medically treating those groups in different ways, or having to become politicized by absorbing the Treaty of Waitangi or learning about intersectionality.  And that is in fact the case with the new standards, which also prompt NZ nurses to engage in untested herbal and spiritual healing, including prayers.  The whole thing is bonkers, but it takes effect in January.

As one of the articles says, “critics argue that these changes prioritise ideology over practical skills.” And I suspect you’ll agree after you read the relatively short set of official standards given below. Here’s an excerpt from one of the articles in the news:

The updated Standards of Competence require nurses to demonstrate kawa whakaruruhau (Māori cultural safety) by addressing power imbalances in healthcare settings and working collaboratively with Māori to support equitable health outcomes.

The standards place a strong emphasis on cultural competency, including the need for nurses to establish therapeutic relationships with individuals, whānau [Māori extended families], and communities. They must also recognise the importance of whanaungatanga (building relationships) and manaakitanga (hospitality and respect) in fostering collective wellbeing.

One of the more significant additions involves requiring nurses to “describe the impact of colonisation and social determinants on health and wellbeing.” Additionally, nurses must advocate for individuals and whānau by incorporating cultural, spiritual, physical, and mental health into whakapapa-centred care (care focused on family and ancestral connections).

The new Standards of Competence have faced sharp criticism from some nurses, who argue the requirements impose ideological perspectives and unnecessarily complicate training processes.

However, none were willing to speak on the record for fear that voicing their concerns could jeopardise their employment.

The standards are unbelievable, so extreme in their catering to indigenous peoples that they seem racist against everyone else. But don’t take my word for it: simply click on the document below and look it over. It’s no wonder that many nurses are flummoxed by the new directive, which, as usual, is heavily larded with indigenous jargon that many (including Māori) don’t understand.  The language is simple virtue flaunting.

The very start of the standards promotes the 1840 Treaty of Waitangi (“Te Tiriti o Waitangi”)—an agreement between some (not all) Māori tribes and the British governance that established three principles. First, Māori would become British citizens with all the rights attending thereto. Second, the governance of New Zealand would remain in the hands of Britain and British settlers (“the Crown’). Finally, the Māori would be able to keep their lands and possessions and retain “chieftainship” of their lands.

Even though this agreement was never signed by all indigenous tribes on the island, it has assumed almost a sacred status in New Zealand, with a newer interpretation that goes something like this: “The Māori get at least half of everything afforded by the government, and their ‘ways of knowing’ would be considered coequal to modern knowledge (including in science and medicine). Further, Māori, as ‘sacred victims’, would get priority in educational opportunities and, in this case, medical treatment.”

If you read The treaty of Waitangi, you’ll see it says nothing of the sort. It simply establishes rights of governance and possession in a deal between Europeans and Māori. But the Māori have used it to inflict considerable guilt on the non-Māori population, to the extent that you simply cannot question the interpretation of the treaty above, or of the increasing forms of “affirmative action” for Māori, because people who raise those questions, like the baffled nurses above, risk losing their jobs. This is the reason that virtually every academic and citizen who writes to me from New Zealand about the fulminating and debilitating wokeness of the country asks me to keep their names confidential.   The fear of questioning what’s happening in that country is almost worse than the burgeoning affirmative action towards a small moiety of the population. Granted, the Māori have been discriminated against and had it bad for a while, but those days are really over now, and it’s time to treat everyone according to the same rules. And of course nurses know that they have to have different bedside manners towards different patients. But that doesn’t mean that they must treat some of them with chants and prayers.

Well, on to the rules. And they begin, in the very first directive, by emphasizing the importance of the Treaty of Waitangi!. I’ll post screenshots as well as text, and will highlight some bits in red. Here’s the first page of “standards of competence”. Te Tiriti doesn’t take long to appear!

“Pou” are “standards”. Here are the first two. Note that the introduction to the document doesn’t say explicitly that these standards are culture-directed and a subset of other standards of nursing skill. No, these are just “the standards.”

Pou one: Māori health. Reflecting a commitment to Māori health, registered nurses must support, respect and protect Māori rights while advocating for equitable and positive health outcomes. Nurses are also required to demonstrate kawa whakaruruhau by addressing power imbalances and working collaboratively with Māori.

Pou two: Cultural safety Cultural safety in nursing practice ensures registered nurses provide culturally safe care to all people. This requires nurses to understand their own cultural identity and its impact on professional practice, including the potential for a power imbalance between the nurse and the recipient of care.

The two pou expanded, which are directives about how registered nurses are supposed to behave.

Under standard (pou) #4, called “Pūkengatanga [expertise] and evidence-informed nursing practice”, we see this.

What is Rongoā? Ask the Museum of New Zealand, which describes it as “Māori medicine”, characterizing it like this:

In traditional Māori medicine, ailments are treated in a holistic manner with:

  • spiritual healing
  • the power of karakia [prayers of incantations]
  • the mana [supernatural essence] of the tohunga (expert)
  • by the use of herbs.

In other words, nurses are supposed to allow patients to choose their own therapy, even if it includes untested herbal remedies, spiritual healing, supernatural power, and prayers. Is it any wonder that nurses are both confused and opposed to this?

It goes on and on in this vein, consistently outlining standards of care that favor Māori, and then ending with a glossary heavily laden with woke and postmodern terms, Again, these are being given to registered nurses (no, not shamans) to tell them how they must behave. A few items from the glossary, which have no clear connection with nursing:

 

Again, as far as I can determine, these are not just standards for nurses to become culturally sensitive, but appear to be general standards for nurses that want to be qualified as nurses. And the standards have become so ideological and political that—and I don’t say this lightly—they seem pretty racist, favoring one group over another and telling nurses to afford indigenous people care and treatment that others don’t get. Is there to be no cultural sensitivity towards Asians, who have their own form of indigenous herbal medicine?

Here are some sentiments expressed by Jenny Marcroft, the Health Spokesperson for the New Zealand First political party.

It goes without saying that it nurses must do all this stuff to practice their skills, many might be compelled to leave New Zealand and practice overseas, something that the country can’t afford to happen. And so, because opponents of this stuff are silenced, the country, immersed in wokeness, continues to go downhill.

Biden administration lets Medicaid pay for Native American “traditional medicines”

November 5, 2024 • 10:00 am

Just yesterday I wrote about the drive in New Zealand to integrate indigenous medicine (Rongoā Māori, or RM) with modern (often called “Western”) medicine.  The problem is that RM not only uses  spiritual treatments (prayer, singing, dunking the sufferer in water) but also herbal remedies, and neither of these have been tested for efficacy using randomized, controlled, double-blind testing. This is the gold standard used in modern medicine to test the efficacy of drugs and (sometimes) surgery. Without such tests, we simply can’t say that a medical intervention actually works.

But the drive to sacralize indigenous “ways of knowing” is strong, and has spread from New Zealand across the Pacific, where it is growing in both Canada and the United States.  Although it’s one thing—and still a bad thing—to prevent scientists from examining bones and artifacts found on land claimed to be “owned” by indigenous people, it’s a different thing entirely to start treating people with indigenous medicine. Although everyone can decide whether or not they want to be treated with scientifically tried-and-true procedures versus quackery like homeopathy, or even seek religious “cures,” children can’t make such decisions. They are subject to the whims and faiths of their parents, and in Faith Versus Fact I document some horrible deaths of children  propagandized into religious healing by their parents.  (Jehovah’s Witnesses, for instance, are forbidden to receive blood transfusions because of a wonky interpretation of the Bible.) At least when you take your kids for their vaccinations, you can be almost certain that they’ll acquire immunity to infection.

As I said, this kind of harmful sacralization of medical “ways of knowing” is on our doorstep, and below is an op-ed from the WSJ (by the editorial board) reporting that the Biden Administration has approved funding for “traditional health care practices of Indigenous people.”  And it doesn’t seem to matter exactly what those healthcare practices are! It can be herbs, prayer, touch, chanting, and so on. The government will pay for it!

Click below to read the short piece, which I’ve reproduced almost in its entirety, or find it archived here.

The “housing” bit is tangential, reporting that “the Administration is letting states use federal Medicaid dollars to pay for low-income housing, mini-refrigerators and food. A Biden executive order last month gave states a green light to use Medicaid to pay for ‘gun violence prevention’ counseling.”  I don’t have such strong feelings about that, though it does seem a tad outisde the ambit of what Medicaid is for.

But main part of the article, given below, is about government funding for what seems like quackery.  And if you want to argue that this op-ed is “fake news” because it comes from the op-ed section of the paper (yes, that section leans right), you can find the same information in an NPR article from October 19 of this year.

A long excerpt (bolding is mine):

The Biden Administration is trying to woo Native Americans whose votes could be pivotal in Western states. One pre-election gambit is to let Medicaid pay for Native American “traditional medicine.”

The Health and Human Services Department last month approved requests by Arizona, California, New Mexico and Oregon to use federal Medicaid funds to cover “traditional health care practices” of indigenous people. “We are extending access to culturally appropriate, quality health care in Tribal communities,” said HHS Secretary Xavier Becerra.

HHS says the Medicaid approvals are “the latest action demonstrating the Biden-Harris Administration’s commitment to support and invest in Indigenous communities across the country.” In short, this looks like another income redistribution scheme.

HHS doesn’t plan to restrict the types of traditional medicine that Medicaid will cover, nor the types of “healers.” Each tribal “facility can tailor provider qualifications for their traditional health care practitioners,” HHS says.

An American Medical Association brief on the state Medicaid proposals says “traditional healers are often identified in their Tribal community by their innate gift of healing” and “typically work informally.” Their “healing services” could include sweat lodges, prayers, purification rituals, songs, dance, herbal remedies and shamanism.

One healer who advocated for Medicaid coverage told the Salt Lake Tribune in February that he sometimes prescribes a “special ceremony against the negative energy of diabetes.” Herbs, he said, are also a favorite remedy for chronic illnesses including cancer plus a “special expression of prayer to the deities that made those herbs.”

Herbal remedies may have their uses, but Medicaid is supposed to cover evidence-based treatments. HHS says “demonstration projects” can determine if traditional medicine improves health outcomes. But lack of access to modern medical care—not lack of traditional remedies—is why Native Americans suffer more disease and worse health outcomes.

The last paragraph is correct in both assertions: Medicaid isn’t supposed to pay for quackery (seriously: “sweat lodges, songs, dance and shamanism”?) and Native Americans do lack sufficient access to modern health care.  The first bit is documented here:

Alternative treatments that haven’t been proven in scientific studies usually aren’t covered by Medicaid. Some procedures, such as chiropractic treatments and acupuncture, are sometimes covered. These treatments are more likely to be covered if they are recommended or prescribed by a doctor. Other alternative treatments that are occasionally covered include massage, pain treatments, and nutrition therapy. Some treatments, such as herbal and homeopathic therapies, are usually not approved for Medicaid payment.

Well, I’m not so sure that many chiropractic therapies, or any form of acupuncture, has been “proven in scientific studies”. But your tax dollars are paying for it! Now get ready for your tax dollars to pay for sweat lodges, songs, dances, and ceremonies. And you don’t even have to live in Arizona, California, New Mexico and Oregon to be dunned for quackery. The fund for Medicaid comes from all of us.

 

h/t: Frau Katze

Pamala Paul: Ideology impedes gender treatement in U.S.

July 13, 2024 • 10:45 am

If you’ve followed this website regularly, you’ll know that the UK’s Cass Review, which evaluated and criticized the NHS’s treatment of gender dysphoria, has been widely accepted in the UK, causing the country to slow down on “affirmative care”, following the lead of other European countries.  No longer will the NHS run a conveyer belt from childhood gender dysphoria to universal acceptance by therapists that a dysphoric child needs to transition, and from there on to puberty blockers, other hormones, and then, perhaps, surgery.  (See here, and here, for example.)

Despite the realization of European doctors and therapists that unbridled “affirmative care” is not only dangerous, but isn’t very effective, the United States has resolutely ignored Cass’s review, persisting in offering affirmative care despite the paucity of evidence that it works. Even the Biden Administration, with its increasing wokeness, has been lax about dealing with gender issues.

This is all discussed in a new article by NYT op-ed writer Pamela Paul—a thorough and sensible piece of reporting that will nevertheless infuriate gender ideologues and all the “progressive” NYT writers who beef on the paper’s Slack channel.

Gender issues are one thing that the Biden administration has fouled up, and here’s one example from Paul.  (WPATH is The World Professional Association for Transgender Health, which isn’t very attuned to what the rest of the world is doing, but obstinately fights for affirmative care, no matter what):

The Biden administration has essentially ceded the issue to the progressive wing of the Democratic Party, incorporating gender-affirming protocols into Department of Health and Human Services policy. Moreover, recently revealed emails indicate that President Biden’s assistant secretary of health, Dr. Rachel Levine, a pediatrician and transgender woman, successfully pushed WPATH to remove age requirements from its guidelines for gender medicine before their publication, because — mixing political and public health concerns — she thought supporters of gender treatment bans might cite them to show that the procedures are harmful. (WPATH’s draft guidelines had originally recommended age minimums of 14 for cross-sex hormones, 15 for mastectomies, 16 for breast augmentation or facial surgery and 17 for genital surgeries or hysterectomies.)

Now there are no guidelines! Surgery and hormones at any age!

Paul is heterodox and brave, but her piece is now the third I’ve seen where the NYT reports objectively and sometimes critically on affirmative care. The progressive staffers, of course, got in a tizzy about the previous pieces, and Paul’s will increase their ire even more. But the fact that a Left-leaning paper is willing to publish stuff like this—it’s well referenced, too—may signal a sea change in the attitudes of “progressivists” towards affirmative care in the US. Click to read; you can also find the piece archived here archived here:

I’ve written about nearly all of what Paul says, but if you haven’t followed the controversy, her piece is the place to start.  As I’ve said, I think that in a decade or two Americans will look back at the dosing and mutilating of American adolescents and ask, “What were we thinking?”  Of course many people are happy with their medical transitioning, but remember that many cases of gender dysphoria in children and adolescents who aren’t treated with affirmative therapy tend to “resolve,” often with the young people becoming gay.  If you can cure dysphoria that way rather than by permanently changing bodies with hormones and surgery, then that’s surely a route worth investigating.

Here’s a long quotation from Paul’s piece, which is itself long:

Imagine a comprehensive review of research on a treatment for children found “remarkably weak evidence” that it was effective. Now imagine the medical establishment shrugged off the conclusions and continued providing the same unproven and life-altering treatment to its young patients.

This is where we are with gender medicine in the United States.

It’s been three months since the release of the Cass Review, an independent assessment of gender treatment for youths commissioned by England’s National Health Service. The four-year review of research, led by Dr. Hilary Cass, one of Britain’s top pediatricians, found no definitive proof that gender dysphoria in children or teenagers was resolved or alleviated by what advocates call gender-affirming care, in which a young person’s declared “gender identity” is affirmed and supported with social transition, puberty blockers and/or cross-sex hormones. Nor, she said, is there clear evidence that transitioning kids decreases the likelihood that gender dysphoric youths will turn to suicide, as adherents of gender-affirming care claim. These findings backed up what critics of this approach have been saying for years.

“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” Cass concluded. Instead, she wrote, mental health providers and pediatricians should provide holistic psychological care and psychosocial support for young people without defaulting to gender reassignment treatments until further research is conducted.

After the release of Cass’s findings, the British government issued an emergency ban on puberty blockers for people under 18. Medical societies, government officials and legislative panels in Germany, France, Switzerland, Scotland, the Netherlands and Belgium have proposed moving away from a medical approach to gender issues, in some cases directly acknowledging the Cass Review. Scandinavian countries have been moving away from the gender-affirming model for the past few years. Reem Alsalem, the United Nations special rapporteur on violence against women and girls, called the review’s recommendations “seminal” and said that policies on gender treatments have “breached fundamental principles” of children’s human rights, with “devastating consequences.”

But in the United States, federal agencies and professional associations that have staunchly supported the gender-affirming care model greeted the Cass Review with silence or utter disregard.

There’s been no response from the Department of Health and Human Services, whose website says that “gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents” and which previously pushed to eliminate recommended age minimums for gender surgery. Nor has there been a response from the American Medical Association, which also backs gender-affirming care for pediatric patients.

When I reached out to H.H.S. officials, they declined to speak on the record. The A.M.A. referred me to the American Academy of Pediatrics and the Endocrine Society. The Endocrine Society, the primary professional organization of endocrinologists, told me, “the Cass Review does not contain any new research that would contradict the recommendations made in” the society’s own guidelines. (Cass’s mandate was to assess the quality and importance of existing research.)

Who is to blame for the situation in America? Ideologues—and those include WPATH, the many doctors and therapists who push affirmative therapy onto young people, and, of course, the Biden administration, especially Rachel Levine. It is worth considering that it may have been unwise to put the issue of age limits (i.e., none) on affirmative care and surgery into the hands of a transgender woman.

Why is this happening in the U.S. while Europe has taken a more cautious and sensible attitude towards this type of therapy? Paul gives several reasons, which includes more pervasive “progressive” ideology in the U.S., the fact that centralized medical care like that in Europe makes it harder to “give patients what they ask for” (and no, not all kids who ask for gender transitioning should automatically get it), and the litigious climate of the U.S., which make doctors hesitant to change course because they could get sued for admitting they were wrong.

I’m a big fan of Paul, not because she’s “antiwoke,” but because she’s sensible and has the courage to speak truths that will get her demonized in the fraternity of NYT “progressives”.  And, of course, because we tend to have confluent opinions.  We also agree on how gender dysphoric young people should be treated, and I’ll finish with Paul’s take, which agrees with the conclusions of The Cass Review:

The Cass Review recommends a more holistic approach to treating gender dysphoria in kids. This involves untangling gender discomfort from common pre-existing conditions like autism spectrum disorder and A.D.H.D. and treating it alongside frequent comorbidities, which include anxiety, self-harm and eating disorders. A mental health counselor can help children with any difficulties during puberty and in coming to terms with their sexual orientation — without pathologizing either.

The goal throughout is to help. This includes working with kids to understand the causes of their gender dysphoria, relieve its symptoms, help resolve it or, in a case that proves persistent, consistent and insistent, help kids understand the pros and cons of pursuing gender reassignment for when they enter adulthood.

Once again we see ideology not only impeding science, but screwing up people’s lives.

WPATH and the U.S. government try to interfere with research on gender care

June 30, 2024 • 10:30 am

Below are three articles, the first one in The Economist, the second in the NYT, and the latest from Colin Wright’s Substack site, showing that both the U.S. government and WPATH (World Professional Association for Transgender Health: the most influential organization dealing with doctors and therapists who provide care for gender dysphoric and trans people) have been pressuring scientists to get rid of minimum age limits for “affirmative care”. (WPATH, by the way, though purporting to be a “World Professional Association”, is influential only in North America, having almost no bearing on transgender care in other countries.)

As you know, “affirmative care” is that form of care for gender-dysphoric adolescents that guides and pressures them to become trans people, affirming (rather than exploring) their feelings that they’re in the wrong bodies. Beyond cursory “rah rah” therapy, the program then gives adolescents puberty blockers that supposedly pause their development to give them time to decide, and then urges hormonal treatment and—sometimes—top or bottom surgery.  It’s the “affirmative” part—the idea that the child’s views and desires must be catered to—that bothers many of us.  Involved in this are three issues:

1.)  Are adolescents to be trusted with making decisions about medical care that can affect their lives in a major way, decisions that involve taking hormones and having surgery that can sterilize them and (in the case of bottom surgery) lead to severe complications?  Shouldn’t there be a minimum age limit for making such decisions?  According to the NYT article below, the Biden administration had issued draft guidelines, but these were never enacted. (To my mind, these guidelines seem way too young. 17 for genital surgeries and 14 for hormone treatments?)

The draft guidelines, released in late 2021, recommended lowering the age minimums to 14 for hormonal treatments, 15 for mastectomies, 16 for breast augmentation or facial surgeries, and 17 for genital surgeries or hysterectomies.

Now, it appears, many people want NO age minimums, and that includes the U.S. government.

2.)  The long-term effects of puberty blockers on adolescents are not known very well. In some European countries the use of such blockers as regular therapy is banned, and blockers are employed only in clinical trials.

3.)  The bulk of cases of gender dysphoria resolve themselves on their own, without dysphoric people needing hormones or surgery before puberty, and many on hormone therapy stop that therapy, which may not (as gender advocates say) be completely irreversible. Many of these children resolve as homosexuals, which involves neither medicine nor surgery.  As Pamela Paul of the NYT noted, with links:

Studies show that around eight in 10 cases of childhood gender dysphoria resolve themselves by puberty and 30 percent of people on hormone therapy discontinue its use within four years, though the effects, including infertility, are often irreversible.

Europeans are taking a more watchful approach to these questions, but somehow in the U.S. many gender activists want no minimum age limit for affirmative care (including the use of blockers when kids are quite young), only perfunctory therapy for gender-dysphoric adolescents (perhaps only a single session), and make decisive (and erroneous) pronouncements that puberty blockers are not only perfectly safe, having no long-term effects, but are also completely reversible.

This first report, from the Economist (click to read) shows that WPATH tried to impede the work of scientists and researchers working on reviews of transgender issues, reviews meant to inform WPATH’s own guidelines for transitioning. In other words, WPATH wanted researchers to come up with only those results that the organization wanted, results that buttressed affirmative therapy.

Both this article and the NYT article resulted from discovery documents and emails released in a court case challenging Alabama’s ban on transgender medical care for minors.

Here are some experts showing how WPATH resisted systematic analysis of relevant data. (WPATH adamantly denied the results of the NHS’s Cass Review in England, which put considerable brakes on affirmative care in the UK).

Court documents recently released as part of the discovery process in a case involving youth gender medicine in Alabama reveal that WPATH’s claim was built on shaky foundations. The documents show that the organisation’s leaders interfered with the production of systematic reviews that it had commissioned from the Johns Hopkins University Evidence-Based Practice Centre (EPC) in 2018.

From early on in the contract negotiations, WPATH expressed a desire to control the results of the Hopkins team’s work. In December 2017, for example, Donna Kelly, an executive director at wpath, told Karen Robinson, the EPC’s director, that the WPATH board felt the EPC researchers “cannot publish their findings independently”. A couple of weeks later, Ms Kelly emphasised that, “the [WPATH] board wants it to be clear that the data cannot be used without WPATH approval”.

There was then a negotiation stipulating that WPATH didn’t have to approve the data, but could offer review and feedback to the researchers without “meddling” in publication:

Eventually WPATH relented, and in May 2018 Ms Robinson signed a contract granting WPATH power to review and offer feedback on her team’s work, but not to meddle in any substantive way. After WPATH leaders saw two manuscripts submitted for review in July 2020, however, the parties’ disagreements flared up again. In August the WPATH executive committee wrote to Ms Robinson that WPATH had “many concerns” about these papers, and that it was implementing a new policy in which WPATH would have authority to influence the EPC team’s output—including the power to nip papers in the bud on the basis of their conclusions.

But only one review was ever published, about the effects of hormone therapy on transgender people, and, six years later, there are no more articles published, despite the fact that the EPC group has enough data for SIX more reviews.  Something fishy is going on, but what it is we don’t know. (Bolding below is mine.)

No one at WPATH or Johns Hopkins has responded to multiple inquiries, so there are still gaps in this timeline. But an email in October 2020 from WPATH figures, including its incoming president at the time, Walter Bouman, to the working group on guidelines, made clear what sort of science WPATH did (and did not) want published. Research must be “thoroughly scrutinised and reviewed to ensure that publication does not negatively affect the provision of transgender health care in the broadest sense,” it stated. Mr Bouman and one other coauthor of that email have been named to a World Health Organisation advisory board tasked with developing best practices for transgender medicine.

Since WPATH is all out for affirmative care, and demonizes those who call for caution (e.g., the Cass Review), the bit in bold above looks like arrant interference by WPATH with the scientific process.  One could lump WPATH’s behavior in this case along with attempts by other ideologues to make reality comport with ideology—what I call the “reverse appeal to nature”, or “What we consider good and moral must be seen in nature.”

But what seems even worse, at least to American liberals, is that officials in the Biden Administration, including the trans woman who is the assistant secretary for Health and Human Services, have tried to get WPATH to drop all its guidelines for age minimums.  And the pressure worked! WPATH has no more age guidelines.

Click below to read the NYT piece, or find it archived here


Some excerpts (I’ve added a link to Levine):

Health officials in the Biden administration pressed an international group of medical experts to remove age limits for adolescent surgeries from guidelines for care of transgender minors, according to newly unsealed court documents.

Age minimums, officials feared, could fuel growing political opposition to such treatments. [JAC: That apparently means that age limits indicate that there are issues involved with decisions to undergo such treatments. But this is not a political issue!]

Email excerpts from members of the World Professional Association for Transgender Health recount how staff for Adm. Rachel Levine, assistant secretary for health at the Department of Health and Human Services and herself a transgender woman, urged them to drop the proposed limits from the group’s guidelines and apparently succeeded.

Now WPATH, an organization to which many American doctors and therapists adhere, has no age guidelines at all.  If an eight-year-old girl says she feels like she’s in a boy’s body, then affirmative care could begin immediately, and hormones administered soon thereafter. And surgery at any age!

Now I’m not sure about the ethics of a trans woman in the government —or any person, be they cis or trans—pressuring a professional organization to drop age limits for “adolescent surgeries”, but it doesn’t sound kosher.  No bureaucrat should be applying any pressure. for this is an issue best left to doctors and medical ethicists. Yet the pressure from Levine and her office was constant:

The email excerpts released this week shed light on possible reasons for those guideline changes, and highlight Admiral Levine’s role as a top point person on transgender issues in the Biden administration. The excerpts are legal filings in a federal lawsuit challenging Alabama’s ban on gender-affirming care.

One excerpt from an unnamed member of the WPATH guideline development group recalled a conversation with Sarah Boateng, then serving as Admiral Levine’s chief of staff: “She is confident, based on the rhetoric she is hearing in D.C., and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out.”

Another email stated that Admiral Levine “was very concerned that having ages (mainly for surgery) will affect access to care for trans youth and maybe adults, too. Apparently the situation in the U.S.A. is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them.”

There are a lot more emails that I haven’t read, but here’s one more bit showing that even within WPATH there was dissent about removing age limits:

In other emails released this week, some WPATH members voiced their disagreement with the proposed changes. “If our concern is with legislation (which I don’t think it should be — we should be basing this on science and expert consensus if we’re being ethical) wouldn’t including the ages be helpful?” one member wrote. “I need someone to explain to me how taking out the ages will help in the fight against the conservative anti-trans agenda.”

The international expert group ultimately removed the age minimums in its eighth edition of the standards of care, released in September 2022. The guidelines reflected the first update in a decade and were the first version of the standards to include a dedicated chapter on medical treatment of transgender adolescents.

The fact is that we know very little about the long-term effects of various medical interventions on the health and mental well-being of gender-dysphoric adolescents. And with WPATH and the government trying to impose their own dictates on what the results should be, gender care in America looks dire.  Like any other branch of medicine and therapy, it should be informed by science, not ideology, and ideologues should not be dictating how the scientific results should turn out. Yet WPATH continues to make statements without evidence, preferring anecdotes:

The final WPATH guidelines state that distress about breast development in particular has been associated in transgender teenagers with higher rates of depression, anxiety and distress.

“While the long-term effects of gender-affirming treatments initiated in adolescence are not fully known, the potential negative health consequences of delaying treatment should also be considered,” the guidelines state.

“Gender-affirming surgery is valued highly by those who need these services — lifesaving in many cases,” Dr. Bowers said.

I’m pretty sure the “lifesaving part”, as epitomized in the advice given parents of gender-dysphoric children, “Do you want a live son or a dead daughter?”  Gender dysphoria is often accompanied by depression and other mental issues, and there’s no evidence I know of that gender-dysphoria alone causes suicide in the absence of affirmative care.

UPDATE: I’d missed this article from Reality’s Last Stand, but it’s highly relevant. Click below to read it:

 

An excerpt, noting that apparently the NYT had even more damning emails but didn’t publish them (bolding below is the author’s):

Last night, I had drinks with a friend I hadn’t seen in a long time, determined not to talk about The Issue. But a few minutes before I arrived, I found out that The New York Times had decided not to publish a part of a story about the World Professional Association for Transgender Health—an advocacy group that creates “standards of care” for trans medicine, which American medical groups avow to adhere to (they don’t) and claim are evidence-based (they aren’t).

That part of the story would have discussed recently unsealed WPATH documents, subpoenaed by the state of Alabama, as part of a lawsuit, Boe v. Marshall. Alabama parents, medical providers, and a Birmingham pastor named Paul Eknes-Tucker sued the state because of its ban on “gender-affirming care” for minors—and the criminalization of those who practice it.

. . .The emails show that Hopkins did conduct a systematic review, and that—like all the other SRs—it found diddly squat in terms of evidence supporting the efficacy of hormones and surgeries. But WPATH prevented Johns Hopkins from publishing these reviews because they didn’t come to WPATH’s preferred conclusions. WPATH hid this very important information from the entire world, then published standards of care saying an evidence review was impossible. And a government agency knew this!

We are talking about kids and the most invasive possible interventions here. We are talking about venerable academic institutions and government agencies and censorship and secrets.

. . . Turns out, there’s a whole heckuva lot more of these damning emails. The New York Times had access to them but chose not to cover them. A source told me this is because no one from Johns Hopkins would comment on the record. The documents will be available via the LGBT Courage Coalition tomorrow (I will add a link and start a thread when it’s up), but I had a chance to preview them. If you have not yet had what GIDS whistleblower Anna Hutchinson called her “holy fuck!” moment, now’s the time.

After discussing the concessions the Johns Hopkins researchers made to WPATH, apparently deep-sixing six review papers, author Davis says this:

Can you believe the John Hopkins folks agreed to this? This is not science. WPATH is not credible. And this is why we in America are the outliers: we’re not basing guidelines on systematic reviews, or reality. We’re basing them on an activist group’s political agenda, and even the HHS knows there’s no good evidence. In fact, AHRQ was asked to review guidelines for treating gender dysphoric youth back in 2020, because, the request said:

There is a lack of current evidence-based guidance for care of children and adolescents who identify as transgender, particularly regarding the benefits and harms of pubertal suppression, medical affirmation with hormone therapy, and surgical affirmation. While these are some existing guidelines and standards of care,2, 5-6 most are derived from expert opinion or have not been updated recently so a comprehensive evidence review is currently not available.

What did AHRQ decide, after communicating with the Hopkins researchers?

The EPC Program will not develop a new systematic review because we found protocols for two systematic reviews that addresses portions of the nomination, and an insufficient number of primary studies exist to address the remainder of the nomination.

Basically, they said someone was already doing it, and there wasn’t enough evidence to sort through. But the someone already doing it had already agreed to put science aside and only discuss benefits, not harms.

In future years the suppression of scientific research on gender medicine in America will be seen as a scandal. And besides unforeseen damage to people’s lives, we can expect a spate of lawsuits.

Both WPATH and the Biden Administration bear the blame for the latest series of missteps.  In its efforts to placate the progressive Left (something I didn’t predict when Biden was elected), the Biden Administration has badly mishandled issues of sex and gender.

h/t: Rosemary

Readers’ wildlife photos

May 29, 2024 • 8:15 am

Today the wildlife is H. sapiens medicalensis: portraits of medical workers taken by reader Christopher Moss in the hospital where he works as a doctor.  To show how intrepid he is, he took one of these when he himself was hospitalized for a bone marrow transplant. (Normally he’s a doctor there.)

Christopher’s captions are indented, and you can enlarge the photos by clicking on them.

These are all portraits taken on film, with a variety of cameras. Many are taken on a weekend morning after rounds at the hospital, when I used to torment the nurses and fellow docs by taking a camera into the hospital. I see there are notices all over the place now declaring photography forbidden except with permission of the micro-managing administrators, so there can be no more such photos.

Emily. Pentax 645N, 75mm/f2.8, Tri-X @400, HC-110, Nikon 9000 scan:

Holly. Nikon F6, 85mm/f1.4, Ilford XP2 @200, Rodinal 1:100 semi-stand:

Treva. Rolleiflex 2.8GX, Rolleinar 1, HP5+ @400, TMax Dev, Imacon 848 scan:

Terry-Lynn. Rolleiflex 2.8GX, HP5+, TMax developer, Imacon 848 scan:

Khaled. Nikon F6, Nikkor 85mm/f1.4, XP2 @ ISO200, Rodinal stand, Imacon 848 scan:

Dan. Nikon F6, Nikkor 85mm/f1.4, XP2 @ ISO200, Rodinal stand, Imacon 848 scan:

Elaine and Chelsie. Nikon F6, Nikkor 85mm/f1.4 AFD, TMax 400 at 400ISO, TMax developer, Imacon 848 scan

Brenda. Leica M7, Summarit 75, TMax400, Rodinal stand, Imacon 848 scan.

Lockdown lunacy. I was not allowed to shave because of a bleeding tendency! Nikon F6, 50/1.4, XP2 @200, HC-110, Nikon 9000 scan:
Post-BMT and hairless! Nikon F6, XP2 Super, Diafine, Nikon 9000 scan.

Thomas. Hasselblad 503cx, Sonnar 250mm/f5.5, TMax 100, Diafine, Nikon 9000 scan:

Hasselblad selfie. Hasselblad 500c/m, Distagon 50/4, XP2 Super pushed to 3200, HC-110, Hasselblad X1 scan.

Dawkins and Sokal on the dumb ideological ploy maintaining that human sex is “assigned at birth”

April 9, 2024 • 12:30 pm

What a pair! The renowned biologist and the hoax-exposer/mathematician, teamed up to attack the medical profession’s new and woke tendency to deny the existence of biological sex as a reality. (Yes, all animals have exactly two sexes, which are not made up by society.) This eloquent op-ed is in the Boston Globe, and you can click below to read it for free, or find it archived here (h/t Mark, Barry).

It’s the “sex assigned at birth” meme, which any fool knows was made up to pretend that biological sex doesn’t really exist in nature, but is merely a “social construct”. This is the same risible meme taken apart by Alex Byrne and Carole Hooven in a recent NYT op-ed. As Alan and Richard note below, the distortion of reality was made for ideological reasons—by gender activists who want to see biological sex as a spectrum, and that is based on the the insupportable view that if you distort biology, transgender or transsexual people will not be “erased”. But, as I’ve said ad infinitum, you don’t need to distort biology to justify treating such people with civility and respect, and to confer on them the same moral value as everyone else has.

The excerpt from the above speaks for itself, but has a lot of useful links to show how well the termites have dined.

The American Medical Association says that the word “sex” — as in male or female — is problematic and outdated; we should all now use the “more precise” phrase “sex assigned at birth.” The American Psychological Association concurs: Terms like “birth sex” and “natal sex” are “disparaging” and misleadingly “imply that sex is an immutable characteristic.” The American Academy of Pediatrics is on board too: “sex,” it declares, is “an assignment that is made at birth.” And now the Centers for Disease Control and Prevention urge us to say “assigned male/female at birth” or “designated male/female at birth” instead of “biologically male/female” or “genetically male/female.”

After discussing the biological definition of sex, which, as you know well by now involves differences in developmental systems that produce gametes of different size and mobility, Sokal and Dawkins give a sharp rap on the knuckles of the medical establishment. I’ve put the last two paragraphs in bold; the penultimate one shows the trend and motivation, while the last one shows the damage.

Much is speciously made of the fact that a very few humans are born with chromosomal patterns other than XX and XY. The most common, Klinefelter syndrome with XXY chromosomes, occurs in about 0.1 percent of live births; these individuals are anatomically male, though often infertile. Some extremely rare conditions, such as de la Chapelle syndrome (0.003 percent) and Swyer syndrome (0.0005 percent), arguably fall outside the standard male/female classification. Even so, the sexual divide is an exceedingly clear binary, as binary as any distinction you can find in biology.

So where does this leave the medical associations’ claims about “sex assigned at birth”?

A baby’s name is assigned at birth; no one doubts that. But a baby’s sex is not “assigned”; it is determined at conception and is then observed at birth, first by examination of the external genital organs and then, in cases of doubt, by chromosomal analysis. Of course, any observation can be erroneous, and in rare cases the sex reported on the birth certificate is inaccurate and needs to be subsequently corrected. But the fallibility of observation does not change the fact that what is being observed — a person’s sex — is an objective biological reality, just like their blood group or fingerprint pattern, not something that is “assigned.” The medical associations’ pronouncements are social constructionism gone amok.

. . .For decades, feminists have protested against the neglect of sex as a variable in medical diagnosis and treatment, and the tacit assumption that women’s bodies react similarly to men’s bodies. Two years ago, the prestigious medical journal The Lancet finally acknowledged this criticism, but the editors apparently could not bring themselves to use the word “women.” Instead the journal’s cover proclaimed: “Historically, the anatomy and physiology of bodies with vaginas have been neglected.” But now even this double-edged concession may be lost, as the denial of biological sex threatens to undermine the training of future doctors.

The medical establishment’s newfound reluctance to speak honestly about biological reality most likely stems from a laudable desire to defend the human rights of transgender people. But while the goal is praiseworthy, the chosen method is misguided. Protecting transgender people from discrimination and harassment does not require pretending that sex is merely “assigned.”

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It is never justified to distort the facts in the service of a social or political cause, no matter how just. If the cause is truly just, then it can be defended in full acceptance of the facts about the real world.

And when an organization that proclaims itself scientific distorts the scientific facts in the service of a social cause, it undermines not only its own credibility but that of science generally. How can the public be expected to trust the medical establishment’s declarations on other controversial issues, such as vaccines — issues on which the medical consensus is indeed correct — when it has so visibly and blatantly misstated the facts about something so simple as sex?

 

Read also Byrne and Hooven; click below (or read it archived here):

Finally, the infamous Lancet cover:

The New England Journal of Medicine apologizes for not recognizing the attack on Jews in Nazi Germany

April 5, 2024 • 9:55 am

Well, here we are ninety years after the Nazis began persecuting Jews in Germany, and I guess the prestigious New England Journal of Medicine (NEJM) is feeling guilty for having completely ignored that persecution until the war was nearly over (1944). No matter that none of the editors of the journal back then are still active, much less alive: they still feel that a long apology is in order.

I guess I don’t mind their late mea culpa (it’s five pages long), and I’m not even sure a medical journal should take political stands, but in this case the Nazis affected the practice of medicine in Germany. For one thing, they fired more than 3,000 Jewish doctors, and, of course, later sent them to the camps. And the Nazi doctors were, of course, often complicit in medical outrages, like the euthanasia of the mentally ill and the gruesome and torturous experiments on inmates in concentration camps.  One could, I suppose, make a Kalven-like case that the Nazis were indeed hurting the practice of medicine (though in a different country), and so their crimes fall under the ambit of NEJM.

And so the NEJM editors, recognizing that other journals, like the Journal of the American Medical Association and Science, did call out Nazi atrocities, are trying to catch up. Unfortunately, they coopt the language of DEI to explain the journal’s ignoring of Nazi atrocities.

Here’s how the journal begins its admission of ignorance, willful or otherwise. I’ve put links to key articles they reference that are on the Internet rather than their footnotes:

Hitler was first specifically mentioned in the Journal in 1935, in an article by Michael M. Davis, a noted American health expert and reformer, and his collaborator Gertrud Kroeger, a leading German nurse. Yet between this article and 1944, when Nazi war crimes were first explicitly acknowledged in an editorial, the Journal remained all but silent regarding the deeply antisemitic and racist motives of Nazi science and medicine and the threat to the “ideals” of civilization. . . .

Articles on Germany or Nazis in the 1930s and 1940s are overwhelmingly about the compulsory and oversubscribed sickness insurance system, “socialized medicine,” and “quackery,” not the persecution and mass extermination of Jews. In fact, when it did address Nazi “medical” practices, the Journal enthusiastically praised German forced sterilization and the restrictive alcohol policies of the Hitler Youth.

Finally, the Nazi Reckoning after 14 years:

But when the Allied powers liberated the concentration camps, it became clear, as the so-called Doctors’ Trial (1946–1947) categorically demonstrated, that the medical profession in Germany embraced Nazism’s antisemitic and eugenic ideology8 and was deeply complicit in the implementation of mass extermination. The crimes of the Nazi state could no longer be ignored. The first Journal article explicitly damning Nazi medical atrocities is a 1949 article by Leo Alexander, a Viennese-born American neuropsychiatrist, who gathered evidence for the trial of the Nazi doctors at Nuremberg.More articles would be published from the 1960s onward, as scholars started documenting the atrocities committed by medical doctors, and especially after the Declaration of Helsinki of 1964, which established a number of ethical principles regarding human experimentation.12

The journal admits that it was an “outlier” in this respect, but then goes into excruciating and tedious detail into the one article it wrote in 1935 by Davis and Kroeger—an analysis of German “socialized medicine”. Click on screenshot below to get the pdf. Be warned, it’s a snoozer, even though it approves of socialized medicine.  I’m not sure why NEJM even mention this article save that it was attacked two weeks after publication in a letter to the editor, whose author, Joseph Muller, claimed that the Davis and Kroeger piece was propagandistic and “unworthy to appear in our periodical”.

The criticism:

Davis and Kroeger’s article did not go unchallenged. In a letter to the editor published 2 weeks later, Joseph Muller, a dermatologist and an active member of the Massachusetts Medical Society (which owned and still owns the Journal), complained about the Journal using Davis and Kroeger’s article “as a propaganda organ for half cooked world improvers.”21 The article, he claimed, was “neither medical nor scientific, but contains plenty of propaganda and is therefore unworthy to appear in our periodical. It is remarkable by omission of facts rather than by its statements.” Moreover, he wrote, the omission “that more than three thousand medical men were deprived of their means of supporting themselves should open the eyes of the American medical profession to one great danger of State Medicine.” Though Muller showed sympathy for the Jewish doctors, however, the real crux of his critique was not Nazi genocidal atrocities but — remarkably — the danger that socialized medicine could hold sway over the profession, a long-held concern among American physicians about “state medicine.”

As we see below, first author Davis answered Mueller’s criticism in a very brief response that basically swept away Nazi atrocities (Kroeger didn’t answer; the journal said she was a Nazi sympathizer). Its heart is this:

The deplorable repressive policy of the Hitler government in respect to Jewish physicians had no bearing on the main point which the article was intended to bring out, namely, that the organized medical profession of Germany has, by the actions described in the article, been placed in a more responsible position than ever before with respect to the medical services under German health insurance.

In other words, “who cares about the Jews, we were talking about medical insurance”.

Well, what we have is medical history, and of course it wasn’t just doctors who ignored what the Nazi regime is doing. Many people had no idea about the camps, though ignorance of the persecution of the Jews should have been evident to any thinking person.  But the apologia could have occupied but a single page, saying just what I said above.  Sadly, the piece goes on and on, and finally drags in DEI-like elements in trying to explain the exchange of letters above as well as the journal’s failure to cover the medical atrocities of the Nazi regime (bolding is mine):

Davis’s brief response to Muller’s attack is important in that it reveals what have come to be understood as critical elements of structural racism: unconscious bias, denial, and compartmentalization. In his rejoinder, Davis tried to bring some clarification to his omission by denying the relevance to his argument of discrimination against and persecution of Jews.  , , For Davis, the expansion of medical power was thus more important than the fact that this gain in power came at the expense of thousands of Jewish physicians. Moreover, it did not matter to Davis that the doctor whom he described as the “guardian of the health interest” of the German people had to be “Aryan” to be able to practice.1 As we now know, however, this reliance on the benevolent and altruistic physician to act in accordance with the Hippocratic Oath was insufficient to prevent the atrocities committed by physicians in the Nazi death camps.

And later, there’s this, called “moral blindness”:

And beyond Davis, how do we account for the virtual silence of the Journal about these issues over the ensuing decade? Part of the answer lies in denial, compartmentalization, and rationalization, all of which depend on structural and institutional racism — deep historical, often unrecognized, bias and discrimination that serve the status quo.

Well, we don’t know whether Davis’s (or the NEJM’s biases) were unconscious, and is it really news that many Americans didn’t like Jews in the 1930s and 1940s? Those were the years of the popular antisemitic radio broadcasts of Father Coughlin, and of the equally popular antisemitism of Charles Lindbergh, American Hero. And yes, there was structural and institutional racism, most familiar to academics as the “Jewish quotas” in many universities instituted in the 1920s, and lasting for at least three decades.

This history is well known and well documented, save for the possibility of “unconscious” bias, a dubious concept that remains controversial. Regardless, I find it somewhat bizarre that the NEJM feels the need to apologize so many years afterwards, when during WWII it was simply following the American Zeitgeist that preferred to ignore the plight of European Jews. And equally bizarre is that it coopts the language of DEI to implicate structural and institutional racism, which of course was simply the racism put in place by Hitler and many Germans after they whipped up sentiments against the Jews. Is anything accomplished by using modern concepts that are arguable (“structural racism” and “unconscious bias” as a cause of inequities) rather than what’s really at issue here: the fact that not many people cared about the Jews during WWII?  I’m just glad they didn’t mention “the inequities affecting Jewish doctors due to structural racism and unconscious bias.”