Why Evolution is True is a blog written by Jerry Coyne, centered on evolution and biology but also dealing with diverse topics like politics, culture, and cats.
My primary-care physician, Dr. Alex Lickerman, discusses the question everyone’s asking: should you get that bivalent booster? (For most people it would be their third booster and the fifth Covid shot). You can access Alex’s post by clicking on the screenshot below. (Be sure to look at the graphs and read it all.)
Alex always looks at the science before he decides what’s to recommend, and by that I mean the primary literature. When I first asked him about whether to get a booster, he said he didn’t know because the data hadn’t been published, and all the existing studies were on antibody levels in mice. Now he looks at more data. I’ll give his conclusion below but do have a look at his post.
My own decision was to get the booster simply because I’m traveling tomorrow, but, as always, consult your own doctor or decide from the data themselves. People tend to get covid on airplanes these days (a friend who just returned from Boston said only 5% of the passengers on her Southwest flight wore masks), and Alex said that it couldn’t hurt me to get one before traveling—but it might not help me much, either.
CONCLUSION: Should you get the bivalent booster? In the absence of human trial data, we might think about this question as follows: We can be reasonably certain that the bivalent booster will produce a level of neutralizing antibodies that diminishes the risk of infection from COVID. We don’t know how long that protection will last, but a fair guess would be from 3 to 6 months. If there is some reason you feel the need to reduce your risk over the next 3 to 6 months, say, for travel, getting the bivalent booster would seem reasonable. On the other hand, if in addition to being vaccinated, you’ve had COVID recently (meaning you’ve been infected with an Omicron variant), likely the same level of protection accrues, obviating the need for the bivalent booster. If your main concern is dying from COVID and you’ve already received the primary series and one or two boosters, your risk is so low that getting another shot would seem superfluous. If you are at high risk for dying from COVID, while there is no data to suggest the bivalent booster might further reduce your risk beyond levels afforded by the primary series and one or two boosters, there is also likely little risk of getting it. In the absence of data to guide us, this would then be a personal decision.
Often Alex answers questions in the comments, so if you have any, put them below. I’ll tell him that he might look at the comments.
Here’s a case where one might want to suppress speech in apparent violation of the First Amendment. But after due pondering, I don’t think it’s a good idea. But I waver, as you’ll see, and even though I come down against the bill, as it may be a bad precedent, I am not sure of my stand.
This has to do with a new California law (not yet signed by Gavin Newsom) that punishes physicians who contradict conventional wisdom about Covid-19, with some of that wisdom specified by law. It applies to words, not to actions.
I found this bill through note and links sent by reader Gary, who said this:
I’ve seen very little discussion of California Assembly Bill 2098. The intention of the bill is good, as are many attacks on free speech, but I, and perhaps you, feel that curbing free speech is generally not the best solution. Under AB-2098, passed in the California Assembly and Senate, but not yet signed by the governor, physicians and surgeons would face disciplinary action if they voiced an opinion contrary to certain facts about COVID-19 and the associated vaccines as determined by the legislature. The disciplinary action could include revoking their license to practice. I despise misinformation and disinformation, but the solution in my opinion, is not punishing those who disagree with the scientific consensus. The solution is the spread of solid information, not the attempted squelching of misinformation.
I think that this bill is going to the governor’s desk with very little discussion or notice. He has three weeks to sign the bill, but hasn’t made his position public. If you think it’s important, you may want to include it in your website.
I’ve put the meat of the bill below. It calls for licensing boards, which are arms of the government, to take action against doctors who “disseminate misinformation or disinformation related to COVID-19, including false or misleading information regarding the nature and risks of the virus, its prevention and treatment; and the development, safety, and effectiveness of COVID-19 vaccines.” In other words, this involves the government suppressing speech, an apparent violation of the First Amendment. But does it fall under the few court-allowed forms of speech that are NOT protected by that Amendment?
The seven points leading to this Diktat are below. These are pretty well established, but they are not absolute facts, as no scientific assertion is beyond questioning. For example, the statement in (c) about the safety and efficacy of COVID-19 vaccines is the best guess we have, but do we know the long-term effects of the vaccines? No, as they’ve been around for only two years. And remember that our knowledge about this disease and about the vaccines, changes almost week by week. Yes, it’s an attempt to protect the health of the public by squelching speech, just as “hate speech” laws are attempts to protect the feelings of the people.
But have a look at the text of the bill from the link above:
LEGISLATIVE COUNSEL’S DIGEST
AB 2098, Low. Physicians and surgeons: unprofessional conduct.
Existing law provides for the licensure and regulation of physicians and surgeons by the Medical Board of California and the Osteopathic Medical Board of California. Existing law requires the applicable board to take action against any licensed physician and surgeon who is charged with unprofessional conduct, as provided.
This bill would designate the dissemination of misinformation or disinformation related to the SARS-CoV-2 coronavirus, or “COVID-19,” as unprofessional conduct. The bill would also make findings and declarations in this regard.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1.
The Legislature finds and declares all of the following:
(a) The global spread of the SARS-CoV-2 coronavirus, or COVID-19, has claimed the lives of over 6,000,000 people worldwide, including nearly 90,000 Californians.
(b) Data from the federal Centers for Disease Control and Prevention (CDC) shows that unvaccinated individuals are at a risk of dying from COVID-19 that is 11 times greater than those who are fully vaccinated.
(c) The safety and efficacy of COVID-19 vaccines have been confirmed through evaluation by the federal Food and Drug Administration (FDA) and the vaccines continue to undergo intensive safety monitoring by the CDC.
(d) The spread of misinformation and disinformation about COVID-19 vaccines has weakened public confidence and placed lives at serious risk.
(e) Major news outlets have reported that some of the most dangerous propagators of inaccurate information regarding the COVID-19 vaccines are licensed health care professionals.
(f) The Federation of State Medical Boards has released a statement warning that physicians who engage in the dissemination of COVID-19 vaccine misinformation or disinformation risk losing their medical license, and that physicians have a duty to provide their patients with accurate, science-based information.
(g) In House Resolution No. 74 of the 2021–22 Regular Session, the California State Assembly declared health misinformation to be a public health crisis, and urged the State of California to commit to appropriately combating health misinformation and curbing the spread of falsehoods that threaten the health and safety of Californians.
I’ve put in bold below the two definitions that make me waver about opposing this bill.
SEC. 2.
Section 2270 is added to the Business and Professions Code, to read:
(a) It shall constitute unprofessional conduct for a physician and surgeon to disseminate misinformation or disinformation related to COVID-19, including false or misleading information regarding the nature and risks of the virus, its prevention and treatment; and the development, safety, and effectiveness of COVID-19 vaccines.
(b) For purposes of this section, the following definitions shall apply:
(1) “Board” means the Medical Board of California or the Osteopathic Medical Board of California, as applicable.
(2) “Disinformation” means misinformation that the licensee deliberately disseminated with malicious intent or an intent to mislead.
(3) “Disseminate” means the conveyance of information from the licensee to a patient under the licensee’s care in the form of treatment or advice.
(4) “Misinformation” means false information that is contradicted by contemporary scientific consensus contrary to the standard of care.
(5) “Physician and surgeon” means a person licensed by the Medical Board of California or the Osteopathic Medical Board of California under Chapter 5 (commencing with Section 2000).
This is what I wrote back to Gary:
I’ll have a look, but remember that the scientific consensus changes rapidly, and who is the legislature to determine what the correct “facts” are? And will they then punish doctors for giving out information about diet, etc. that contradicts the legislature? There’s no end to this, and I’m a bit wary of legislating what information is “absolute truth that cannot be contradicted”.
And I stand by my claim that the government should not be in the business of what doctors say about COVID-19, even if it goes against a world of conventional wisdom. This is freedom of speech, even if emitted by a doctor. Or are they allowed only to pronounce on items not related to medicine, or parrot the latest consensus?
It’s a different matter, however, if a doctor acts in a reckless way, violating professional standards like injecting patients with some Trumpian nostrum to cure COVID-19. In that case it is action, not talk, that causes harm, and boards should have the write to examine a doctor’s conduct and, if necessary, punish them or take away their licenses. Likewise, hospitals should be able to fire them. False advertising, too, is illegal, so a doctor is liable to sanction if he or she advertises cures that are known or demonstrated to be bogus. But advertising is not the same as a doctor simply making a pronouncement. Advertising is luring in patients under false pretenses.
Now I am sort of on the fence about this one, for “disseminating information to patients that you know is false, and doing so with malicious intent”, is indeed malpractice. But that’s already covered by the law. How can you prove that a doctor is doing this with “malicious intent or an intent to mislead”?
This is the same distinction that we see between saying hurtful and “harmful” words like “gas the Jews” or “Jews are acquisitive and in a conspiracy to dominate the world”, which is harmful but legal speech, and causing actual physical harm by hitting someone or inciting predictable and immediate violence against them. The one difference is that patients tend to take their doctor’s advice. But sometimes doctors give bad advice, which is why we urge second opinions on serious matters. A doctor may give bad advice, like “you’d be better off having three stents put in now,” but to me that’s not illegal unless the doctor means it maliciously. The doctor must intend to do harm, and carry that out by treating the patient. And intention is what is nearly impossible to prove in this bill.
To me this bill seems good on the face of it, but creates a precedent where the legislature decides what medical facts are acceptable, and what opinions cannot be uttered. Just remember how advice on diet (and smoking) has changed just in my lifetime. Let’s leave this to the consensus of doctors and their professional organizations, and let it apply only to actions, not to words.
I’m sure some readers will disagree with me, and that’s fine. Have your say below. As I said, I’m of two minds about this bill.
I have nothing in general against “traditional medicine” so long as it’s efficacious. But that’s the rub, for, as the old Q&A goes: “What do you call traditional medicine that works? Medicine.” Thus, if something is being touted, especially by the government, as a useful form of medicine, it should have been scientifically tested to ensure that it does what it does.
Many of our modern drugs do indeed come from plants, but not all of those were used in traditional or “indigenous” medicine: some were found simply by surveying plants by medical scientists looking for useful effects. And of course without testing—with the gold standard being double-blind testing—you can’t tell whether a plant-based drug is better than a placebo.
This lack of testing appears to be characteristic of Rongoā Māori (“RM”), the traditional healing used by Māori in New Zealand, as reported by the article from the University of Auckland shown first below. And that lack of hard evidence for efficacy, while it shouldn’t lead to the banning of Rongoā Māori, shouldn’t lead to its declaration as being equal to modern medicine, nor should it lead to the government’s funding of untested remedies. But it’s already too late.
Since this is New Zealand, testing of Māori claims isn’t needed: tradition and anecdotal health claims are enough. Indeed, criticism of such claims is seen as racist.
And so, as the article below reports, the Kiwi government is funding a $100,000 program to “support injury recovery through Rongoā Māori. The program is funded through the “ACC” (Accident Compensation Corporation), a government body established in the 1970s to oversee the provision of support, treatment and rehabilitation for people involved in accidents. What we have, then, is government support for traditional medicine used to heal accidents.
But this is only the camel’s nose, for as the article below implies, this is just the first step in insinuating traditional healing into regular medical practice guaranteed to all Kiwis by their government.
In fact, in several ways Rongoā Māori is similar to Mātauranga Māori, traditiional “ways of knowing” that I’ve written about at length. Both systems contain a mixture of theology, spirituality, and practical knowledge, both are imbued with fact claims that can’t be tested, and both are touted by their practitioners as deserving equal treatment with modern science.
It is the “equal treatment” that worries me, as neither MM or RM are coequal with science. Parts of MM can be considered empirical truths—”practical knowledge” like how to grow plants or catch eels—but I have no idea whether RM is efficacious in healing, at least beyond having a placebo effect. Finally, both MM and RM involve the ubiquitous valorization of the ways of indigenous people. Traditional customs should of course be taught as aspects of anthropology and sociology, important parts of New Zealand’s history, but shouldn’t be valorized to the point where they’re considered coequal to science or medicine.
What is involved in Rongoā Māori? The two articles below (click on screenshots), as well as the short video, give you an idea.
Here are the major components of RM, considered “holistic healing” with a big dollop of spirituality. This list comes from the two articles above and a few others.
a.) Traditional plant remedies. The second article above gives a list of which plants are used and for what ailments. They must be used in a proper way—not just in their preparation, but ensuring that they’re gathered in traditional ways. Here’s what the second article says
The use of plant remedies does not require regulatory approval as long as they do not contain a scheduled medicine. However, as some pharmaceuticals are derived from plants, it is possible that Rongoā may contain active ingredients. As long as these pharmaceuticals are not purposely added to a remedy no restrictions apply to the use of such plants. Note that some plants, for example St Johns wort, can interact with conventional medicines.
Appropriate tikanga (customs and rites) must be observed during the collection, preparation and storage of Rongoā.
Plant material must be correctly identified, gathered from non-polluted areas and prepared safely and hygienically.
Plants are usually crushed or dried and mixed with water or ethyl alcohol.
Plant remedies should only be prescribed and dispensed by Tohunga [traditional healers] to individual patients. Tohunga will advise on appropriate use.
Plant remedies should not be labelled with therapeutic claims. Labels should contain the ingredient(s), instructions for use, date of preparation, expiry date and who the remedy is prescribed for.
But if they cannot make therapeutic claims, why is the government paying for them? The important question is whether all or any of the drugs are useful in healing the ailments they’re prescribed for. Before you say “they must be, as they’re based on tradition,” be aware that a lot of spiritually-based traditional medicines tested in the U.S. have been shown to be bunk.
I have found no mention of testing for any of these plants. While some of the traditional herbal medicines may be efficacious, I see no sign that they’ve been tested or compared to modern pharmaceuticals that must be and have been tested.
b.) Massage. Massage can be useful in temporary relief, and even chiropractic can be useful for back problems, but the idea of adjusting the body because it’s diseased or out of whack, as evidenced in the articles and the video above, is dubious (I’d say “bunk,” but I’m being kind here.) Look at the video and watch them adjusting the feet of a man with a lower back problem. This is called romiromi, or “body alignment”.
c.) Lunar calendar relationality (maramatka). I don’t know how this is implemented, but it’s a big red flag.
d.)Meditation. Your mileage may very, but I haven’t been prescribed meditation for any accidents I’ve had.
The most fundamental part of rongoā Māori is the traditional spiritual teachings, which can be seen as the basis of all traditional medicine. For Māori, rongoā is a part of the Māori culture from Tāne (God of the forest) who retrieved the three baskets of knowledge from Io (God) with the knowledge and teachings to guide us in this world.
As Māori, we believe we are part of the children of Tāne, along with the creatures of the forest such as the birds, trees and plants and, therefore, we have a strong connection to rongoā rākau. To learn rongoā, people have to become apart of the world of Tāne. They become connected and immersed in the forest, learning about a relationship far beyond the physical elements of the trees and plants. To utilise Te Oo Mai Reia, the healer must become immersed in ancient spiritual teachings while becoming a vessel to achieve the healing through Io alongside the use of physical touch to create balance and shift energies.
This is a form of shamanism.
Now this is all well and good, and if people want to use RM for diseases or healing from accidents, that’s their prerogative. I wouldn’t, but that’s my choice. But what I dislike is the insistence of these articles and practitioners that RM is just as good as modern medicine and should be offered coequally by the government. Here are two quotes from the University of Auckland article:
Located in Dance Studies in the Faculty of Creative Arts and industries, Ngākau Oho will provide a personalised recovery programme for 20 ACC clients and their whānau. In the process, the programme aims to reclaim and normalise rongoā Māori as a viable and everyday healthcare practice.
Recent efforts to address Māori health inequities across the health sector have focused on increasing the number of Māori health professionals and Māori access to culturally relevant rehabilitation services, says Dr Reihana.
Why is this in a dance studio? But wait—there’s more, and this is the worrisome part (my emphasis):
The programme will provide ACC with evidence-based insight on how rongoā Māori would be embedded within established healthcare services.
“We believe the approach we develop will be an innovation that can be used within the health system, and importantly, by Māori health practitioners, providers and whānau, helping ensure that rongoā Māori practices can be a real and easily accessed option for Māori in wellbeing and recovery,” says Dr Reihana.
This implies that RM will indeed become part of the government-funded healthcare system of New Zealand. But what is the “evidence-based insight” that is forthcoming, since there is no mention of controls?
Finally, Donna Kerridge, the RM practitioner shown in the video above, says this:
“I think the Western health and healing system is awesome; it’s not better, it’s not worse.”
This is the insistence on absolute equality that is ubiquitous in both MM and RM, and it’s just wrong. If you have diabetes, do you want traditional herbal medicine or insulin? If you have an infection, do you want plants or antibiotics? Now many Māori do avail themselves of modern medicine instead of or alongside RM, and those people are the savvy ones. But it seems risible to say that RM is exactly as good as modern medicine. It can’t be, because its “testing” is based on anecdotes instead of scientific studies with controls.
I want to add one bit about “alternative medicine” in the U.S. In 1991, the government established the National Center for Complementary and Integrative Health as part of the National Institutes of Health. Its goal was to scientifically study “alternative medicine”, using the kind of controls that all science-based medicine uses. As Wikipedia notes:
NCCAM’s mission statement declared that it is “dedicated to exploring complementary and alternative healing practices in the context of rigorous science; training complementary and alternative medicine researchers; and disseminating authoritative information to the public and professionals.” As NCCIH, the mission statement is “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.”
Since the NCCAM’s founding, over two billion dollars have been spent testing stuff like coffee enemas, intercessory prayer, magnet therapy, and so on. Not one “alternative treatment has worked. You’ll be amused at the examples given in the article about the treatments tested and their outcomes. A screenshot is below (click to enlarge). NOT ONE WORKED! And for the others, no results were ever reported, which means that they didn’t work, either.
Two quotes from the article:
In 2012, the Journal of the American Medical Association (JAMA) published a criticism that NCCAM had funded study after study, but had “failed to prove that complementary or alternative therapies are anything more than placebos.” The JAMA criticism pointed to large wasting of research money on testing scientifically implausible treatments, citing “NCCAM officials spending $374,000 to find that inhaling lemon and lavender scents does not promote wound healing; $750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390,000 to find that ancient Indian remedies do not control type 2 diabetes; $700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406,000 to find that coffee enemas do not cure pancreatic cancer.” It was pointed out that the public generally ignored negative results from testing, that people continue to “believe what they want to believe, arguing that it does not matter what the data show: They know what works for them.” Continued increasing use of CAM products was also blamed on the lack of FDA ability to regulate alternative products, where negative studies do not result in FDA warnings or FDA-mandated changes on labeling, whereby few consumers are aware that many claims of many supplements were found not to be supported.
I’ll take my coffee in the other end, thank you.
And here’s a skeptical take (there are other criticisms given of NCCAM by doctors and scientists):
A 2012 study published in the Skeptical Inquirer examined the grants and awards funded by NCCIH from 2000 to 2011, which totaled $1.3 billion. The study found no discoveries in complementary and alternative medicine that would justify the existence of this center. The authors argued that after 20 years and an expenditure of $2 billion, the failure of NCCIH was evidenced by the lack of publications and the failure to report clinical trials in peer-reviewed medical journals. They recommended that NCCIH be defunded or abolished and the concept of funding alternative medicine be discontinued.
That money hasn’t been completely wasted, for it’s debunked therapies that people insisted would work. And those therapies won’t be approved by the FDA or used by rational doctors. Still, therapies are usually tested clinically when there’s some preliminary evidence that it might work. The tests above were simply based on “folk claims.”
All I’m asking is that Rongoā Māori be tested the same way as the NCCAM tested its putative remedies. If RM treatments aren’t (and they surely aren’t), Kiwi taxpayers should be protesting loudly about wasting their money on subsidizing spiritually-based medicine
Enlightened medical opinion seems to be coming around to the view that for adolescents who want to change gender, i.e. become transsexual, the use of puberty blockers is not necessarily a good way to go. The blockers, which are supposed to stop puberty in its tracks (in a completely reversible way) are given to allow young people a pause to ponder their options. But they are increasingly seen as untested and possibly unsafe. European countries like Sweden, France, and Finland have either limited the use of puberty blockers to “exceptional cases” or clinical trials, or have prohibited their use entirely.
This is all part of a pushback against “affirmative care”: the idea that if a child decides they want to become transsexual, they must be completely supported, with psychotherapy not examining their decision or encouraging throughtful assessment, with parents urged to accept their child’s wishes, and with the medical establishment dispensing whatever hormone therapy or surgery the child wishes.
The problem with this is not that support shouldn’t be given. It’s that children or teenagers who are too young are being pushed by doctors, parents, and peers to make decisions about issues that may involve irreversible medical interventions. European countries vary in the age at which sex reassignment surgery is legal, usually ranging from 15 to 18. For transgender hormone therapy, ages in Europe range from a minimum of 14 up to 18, with most countries having minimums of 16 to 18.
That kind of therapy causes irreversible changes in the body, while genital surgery renders one sterile and often incapable of orgasm. I have no strong views on age limits except that they should be after puberty and not lower than 16. Your mileage may vary.
And I’ve just discovered, through an article in the City Journal, that the American Academy of Pediatrics, which used to be all for “affirmative care”, seems to have suddenly started reevaluating its position. The article notes this:
Moira Szilagyi, president of the AAP, has written that “gender-affirming care . . . doesn’t push medical treatments or surgery; for the vast majority of children, it recommends the opposite.”
This is a welcome development, and marks a reversal of the AAP’s previous policy. That policy was announced in a 2018 Pediatrics article, whose lead author was Jason Rafferty; it argued that “watchful waiting” is akin to “conversion therapy” and should be avoided. “Watchful waiting” refers to an approach that emphasizes psychotherapy as a measure of first (and hopefully last) resort to help minors in distress feel comfortable in their bodies. Its premise, confirmed by 11 studies, is that the vast majority of children with gender dysphoria will desist by adolescence and feel comfortable enough in their bodies not to require medical transition. The Dutch researchers who developed pediatric transition explicitly warned against early transition. Yet transgender activists in the United States have criticized this model, insisting that because transgender identity (i.e., body rejection) is a normal and healthy aspect of human existence, mental health professionals should never steer patients toward a “cisgender” outcome.
If Szilagyi believes that medicalization is the wrong way to go “for the vast majority of children” with gender dysphoria, then this constitutes a de-facto repudiation of the Rafferty statement and the AAP’s previous policy.
Here’s an extract from AAP President Szilagyi’s piece, an an op-ed in the Wall Street Journal called “Academy of Pediatrics Responds on Trans Treatment for Kids: To ‘affirm’ a child or teen means destigmatizing gender variance and promoting the child’s self-worth.”
Regarding Julia Mason and Leor Sapir’s op-ed “The American Academy of Pediatrics’ Dubious Transgender Science” (Aug. 18): In its recommendations for caring for transgender and gender-diverse young people, the AAP advises pediatricians to offer developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience. This care is nonjudgmental, includes families and allows questions and concerns to be raised in a supportive environment. This is what it means to “affirm” a child or teen; it means destigmatizing gender variance and promoting a child’s self-worth. Gender-affirming care can be lifesaving. It doesn’t push medical treatments or surgery; for the vast majority of children, it recommends the opposite.
This isn’t the story that is being told by anti-transgender activists. No European country has categorically banned gender-affirming care when medically appropriate. Contrary to what Dr. Mason and Mr. Sapir claim, the U.K. isn’t moving away from gender-affirming care. It is moving toward a more regional, multidisciplinary approach, similar to what is practiced in the U.S.
This does seem to be a change of policy. “Affirmation” no longer means “go full steam ahead for the gender change” but, properly, to “promote a child’s self-worth.” Further, affirmative care no longer means “pushing medical treatments or surgery; for the vast majority of children it recommends the opposite.”
I’d say that this is a move towards enlightenment, even if it was promoted by what European countries are doing. It’s not clear, though, that this will become the AAP’s official policy.
Nevertheless, some places, like Seattle Children’s Hospital, continue to offer surgery, puberty blockers, and hormones to children as young as nine. Granted, you need parental permission for this treatment, and you can’t get bottom surgery until you’re over 18, but dispensing blockers, drugs, and cutting off the breasts of females younger than 16 is not something I’m a fan of.
This story comes from KOMO news in Seattle, a station and website affiliated with ABC, and you can check its assertions by going to the Seattle Children’s Hospital website on gender care (link below). Click to read:
This is from KOMO:
The gender clinic at Seattle Children’s Hospital (SCH) provides children as young as 9 years old with “gender-affirming medical care,” like puberty blockers, and children in their “mid-teens” with non-genital transition procedures known as “top” surgeries.
We accept new patients ages 9 to 16,” the SCH gender clinic website states. “Patients ages 17 and older and patients who have not yet started puberty will be directed to community resources.”
The website notes that the clinic “primarily provides gender-affirming medical care (such as puberty blockers and gender-affirming hormones)” to patients. Children must receive parental consent for any “gender-affirming” treatment.
“Brief mental health support” is also available, according to the site, but the clinic suggests that “if you are looking for gender-affirming mental health services only, or for ongoing mental health support,” there are better resources that focus solely on that.
Patients must be 18 years or older to receive gender transition surgeries involving genitals, such as vaginoplasties and phalloplasties, according to another page on SCH’s gender clinic website.
Sure enough, the website link given above says this:
We accept new patients ages 9 to 16. Patients ages 17 and older and patients who have not yet started puberty will be directed to community resources. Our clinic primarily provides gender-affirming medical care (such as puberty blockers and gender-affirming hormones). Brief mental health support focused on family decision making and mental health documentation prior to initiating gender-affirming care is also available. If you are looking for gender-affirming mental health services only, or for ongoing mental health support, here are some community resources.
Puberty blockers, with their attendant medical unknowns, are offered to children who have started puberty but haven’t completed it, and those in their “mid-teens” can get surgeries like double mastectomies, breast augmentation, thyroid cartilage surgery, and “facial gender-affirming surgery.” I can’t find the age at which hormone therapy is given, but I presume it’s either after puberty has begun or in one’s mid-teens.
No, puberty blockers are not permanent. If you decide to stop puberty blockers without starting cross sex hormones, your body will start going through the puberty of your sex at birth. You can stop the puberty blockers at any time, but we will work with you on how to do that.
We can safely and legally recommend puberty blockers for you based on our medical experience and judgement and your specific health needs. The Endocrine Society and the World Professional Association for Transgender Health support puberty blockers. The Food and Drug Administration (FDA) approves puberty blockers for children who start puberty at a very young age, but has not approved puberty blockers for transgender children.
But at the same place they say this:
The long-term safety of puberty-blocking medicines is not completely understood. There may be long-term risks that we do not know about yet.
Indeed, this is in line with Britain’s new NHS guidelines to not give hormonal treatment, including puberty blockers, to adolescents under 16. Further, Sweden’s Karolinska institute says this:
In light of the above, and based on the precautionary principle, which should always be applied, it is hereby decided that hormonal treatments (i.e., puberty blocking and cross-sex hormones, see above) will not be initiated in gender dysphoric patients under the age of 16.
For patients between ages 16 and 18, it is hereby decided that treatment may only occur within the clinical trial settings approved by the EPM (Ethical Review Agency/Swedish Institutional Review Board). The patient must receive comprehensive information about potential risks of the treatment, and a careful assessment of the patient’s maturity level must be conducted to determine if the patient is capable of taking an informed stance on, and consenting to, the treatment.
The U.S. is often touted as having the world’s best medical care. But when it distorts the dangers of hormonal treatment, or rushes children and adolescents onto an escalator towards transsexuality without proper therapy and information, it’s a travesty.
Foreign accent syndrome (FAS) is a very rare speech disorder—fewer than 100 cases have been seen in the last century—first described in 1907. In this edition of “60 Minutes Australia,” several such people are highlighted, centering on two Aussies who both developed an inescapable “Irish” accent, one after a migraine and the following a tonsillectomy. (You can find other examples on YouTube, like this one.) The highlight is on Angie Yen, and at 5:47 you can hear a recording of her Aussie accent before the change.
FAS is sometimes temporary and can be treated, though not necessarily cured, with speech therapy. And it’s not exactly the same as a genuine national accent, as a native Irish person might be able to tell with Angie. Wikipedia says this:
To the untrained ear, those with the syndrome sound as though they speak their native languages with a foreign accent; for example, an American native speaker of English might sound as though they spoke with a south-eastern English accent, or a native English speaker from Britain might speak with a New York American accent. However, researchers at Oxford University have found that certain specific parts of the brain were injured in some foreign accent syndrome cases, indicating that particular parts of the brain control various linguistic functions, and damage could result in altered pitch and/or mispronounced syllables, causing speech patterns to be distorted in a non-specific manner. Contrary to popular belief that individuals with FAS exhibit their accent without any effort, these individuals feel as if they have a speech disorder. More recently, there is mounting evidence that the cerebellum, which controls motor function, may be crucially involved in some cases of foreign accent syndrome, reinforcing the notion that speech pattern alteration is mechanical, and thus non-specific.
I was surprised at the emotionality and tears that accompany the meeting of two Aussie women at 10:56, both having FAS of the Irish variety (the condition is significantly more common in women than men). This shows the psychological burden of suddenly losing your own accent. Both seem desperate to resume their old way of speaking.
Towards the end, Angie has an MRI brain scan, revealing both over- and underactive parts of the language center. (Angie again bursts into tears from both relief at the assurance that she’s not faking it—something she was accused of—and inquisitiveness about how she got this way.) The other Aussie woman, Kate, also has disordered activity, though not as severe, perhaps because she’s had the condition longer and is trying to compensate for it.
At the end, with hope that the condition can be mitigated with therapy, the two women share a Guinness (!) with the interviewer. Neither of them can stomach the brew.
Sue Evans was a nurse therapist working at the Tavistock Clinic in London, dealing largely with issues of gender dysphoria in young people. In this piece from Bari Weiss’s Substack (again, subscribe if you read regularly), Evans describes how in the early 2000s the clinic became a place of fulminating “affirmative therapy”, changing its normal procedure of talk therapy to the willy-nilly dispensing of puberty blockers and hormones—all without any thoughtful examination of what was happening. If there was any “social contagion”, it was among the sheeplike employees at Tavistock who jumped aboard a woke juggernaut at the expense the patients’ well being.
Click to read. Because this has already been covered widely, I’m mentioning it for those who haven’t yet read what happened at Tavistock. You are probably aware that after an independent report on the clinic, the NHS has now ordered its closure, with its functions farmed out to several geographically distributed sub-clinics, and with a lesser concentration on “affirmative therapy” and less recommending of drugs to facilitate transsexual changes.
It wasn’t that long after Evans had been working at Tavistock—which I didn’t realize was a clinic specializing largely in talk therapy—before the idea of giving puberty blockers and hormones to gender dysphoric patients swept through the clinic, much to Evans’s dismay, since there was hardly any expertise there in using drugs for gender transitioning.
And then social contagion, stemming from advocacy groups, intensified the pressure to use drugs.
Evans:
The external influence of the advocacy groups increased. Instead of being a clinical, research-focused service where we were learning and developing ideas, it felt like it was a fait accompli that we had to go along with what Mermaids [an advocacy group] and patients wanted—even if we, the mental-health-care professionals, had legitimate questions about the appropriateness of the treatments that patients and patient advocates were demanding.
For example, a weird paradox arose at a conference on transgender health care hosted by Tavistock around 2005: the opening speaker declared that we were no longer supposed to think of gender dysphoria as a mental illness. But we were a mental-health team working at a mental-health facility. What were we supposed to be doing if not treating patients with psychological conditions?
Remember, this was all before the internet took hold of an entire generation of teenagers. There were no online groups dedicated to gender affirmation and coaching kids on what to say to their providers to secure cross-sex hormones. We mostly saw younger boys who believed themselves to be girls from an early age and a few teenagers who felt like they were trapped in the wrong bodies. So, although I felt aware of the gathering force of thinking around the area of gender dysphoria and transgender identity, it was hard to foresee the slow-motion avalanche that would hit over the next two decades.
Yet even what I saw in those years worried me deeply and working on the Gender Identity Development Service started to affect my personal well-being. I would come home with a headache on the days that I worked in the unit, and my heart would beat quickly when I went in the next morning. It felt like every time I raised a concern about us rushing prematurely to prescribe drugs that would have permanent effects on our patients, I’d be met with an eye roll and the unstated “Oh, here she goes again,” or “Can’t she just fit in?”
A concerned Evans went to the clinical director of Tavistock and raised these issues, and this led to an investigation of the clinic—in 2006. Evans didn’t see the results of that investigation until 2019, but it was damning. Sadly, the conclusions were also buried:
It was only in 2019 that I saw the full report when Hannah Barnes, a BBC journalist, obtained it via a Freedom of Information request. It confirmed all the disturbing things I had reported: Our data was poor; it wasn’t being stored properly; and there were not sufficient follow-ups with patients once they left the service—meaning we didn’t know how our patients were faring unless they voluntarily wrote to us.
As we have now learned from more recent whistleblowers, the recommendations in the report were buried, and when any criticism or difficult questions arose in the press, the Tavistock management would repeat the same mantra about how they were “a world-class service.” It’s important to acknowledge that there might have been some staff still struggling to deliver thoughtful, measured care, but the noise around our standards was growing louder.
In the face of an unchanged work milieu, Evans quit her work on gender-dysphoric patients. That’s when an explosion of referrals hit the clinic—mostly biological female adolescents who wanted to transition to the male gender. Later, when one of them—who had been rushed through puberty at 16, went on testosterone at 17, and had a double mastectomy—participated in a lawsuit against the clinic, Evans signed on as a co-claimant. They won, with the ruling that minors under 16 could not give informed consent for puberty blockers (these nearly always lead to hormone injections and full transition). But they lost the appeal.
Then, in September 2021, the government commissioned another report on Tavistock, and this one disbanded the facility, farming out its mission to other clinics and deemphasizing the default use of drugs to transition as well as urging more emphasis on objective but empathic talk therapy as a first line of treatment. This result we all know.
Evans had a rough time of it, but ends on a high note:
I didn’t seek any of this. It has been a pretty stressful few years. When I get a letter from patients or parents from around the world, and they tell me, “Well done, thank you for speaking up, you didn’t give up,” I sometimes get a lump in my throat. It’s been hard to be suspected of being prejudiced when all I wanted was safer clinical practice, more scrutiny and evidence collecting, and improved data storage.
Because what I am is a nurse. And my job as a nurse is to treat all my patients with respect and an open mind. I try to think about who they are as people, and to relate to their experience and empathize with them. I also believe we need to keep an open and curious clinical mind when something is occurring in society that seems novel or not yet fully understood. It should never be that doctors and nurses are unable to question diagnoses and prescriptions.
If my actions all those years ago have made a contribution, then I am proud. I made the right decision to raise my hand to ask another unwanted question.
There will come a time, I think, when this rush to transition, with its attendant use of “affirmative therapy”, puberty blockers, and hormone treatment, will be seen as a crazy era in medicine and therapy. Of course there are people for whom this kind of transitioning is the right thing to do, but what we often see now is madness, with affirmative therapy being pushed not because we have evidence that it’s the best thing to do for gender dysphoria—we don’t have that evidence—but because it’s ideologically “proper.” If someone suggests that they feel as if they might belong in a marginalized group, the philosophy now seems to be to get them in that group as soon as possible, ignoring other outcomes of dysphoria, like homosexuality.
Elizabeth Holmes, the founder of Theranos, was convicted of defrauding investors and will be sentenced in October. Her partner in fraud, Sunny Balwani, was also convicted of fraud, but defrauding patients as well as investors. He’ll be sentenced in November. I predict both will get jail time, though far less than the maximum (20 years for each of them).
In this new piece from 60 Minutes Australia, the scandal of the fake blood machine is reprised, but the centerpiece is two whistle-blowers who came forward to report that the Theranos machine, called “Edison”, supposedly able to diagnose 200 diseases from a tiny amount of blood, didn’t work. Both, Tyler Schultz and Erica Cheung, were scientists given access to the inner sanctum of Theranos. Both quickly discovered that Edison didn’t work and the startup was a big hoax. Eventually, worried about patient safety, both began talking to John Carreyrou, a Wall Street Journal reporter who broke the story on Holmes and Theranos and wrote the definitive book on the scam, Bad Blood. (Well worth a read!) Cheung also testified in court against Holmes and Balwani.
Schultz is involved in another way: his grandfather, ex-diplomat and businessman George Schultz, was both a patron of Holmes and an investor in Theranos. Because of Tyler’s whistleblowing, his relationship with his grandfather was damaged.
What’s new about this is that we get to hear from the whistleblowers themselves, who talked not only to Carreyrou, but to federal regulators and the prosecution. They’re admirable people whose lives were put on hold for a long time (and of course who put themselves out of business) because they valued the truth. They address several questions that have arisen in this saga, including Holmes’s defense that her fraudulent actions resulted from her being manipulated and dominated by Balwani. (Schultz and Cheung both reject that claim.)
If you’ve been following this saga, this is a nice 19-minute video that fleshes it out.
