God complexes, false urgency, misleading insulin analogies, sunk costs, and pediatric endocrinology
I've been digging into the history of pediatric endocrinology and it's not encouraging — so many of the problems we see with medically transitioning kids have long histories: the same drugs (and the same pharma companies pushing untested off-label uses, funding medical careers, buying up patient advocacy groups, writing continuing medical education programming); the same disdain for evidence-based practice; the same wildly inapt comparisons to insulin (actually life-saving, given to patients who would die otherwise); the same pressures to act quickly before a developmental window closes, rather than wait to be sure; the same claims that treatments are safe and effective and reversible when what little evidence exists shows exactly the opposite; the same God complexes. It explains a lot of the profession's current paralysis — though more doctors are raising concerns — because to say that we might be doing wrong by gender-dysphoric kids would require the field of pediatric endocrinology to say: "Maybe it was wrong when we did these things to short kids, too” (to take just one example).
One of the themes of my research — from medicine to the role of parents — is sunk costs. It's really hard to say: even though I wanted to do the right thing, I did harm. Especially when we're talking about kids, your own or kids entrusted into your care.
That sounds like a fascinating area to research.
Also interesting to hear the term 'sunk costs' in this context. Normally only hear it in relation to economics or accountancy.
But it fits perfectly here.
Most adults really are extremely reluctant to 'write off ' costs. Lots of reasons for that:
We don't like admitting we made mistakes.
We don't like waste, and disregarding sunk costs feels wasteful.
We're also optimistic. We believe if we put the work in, there will be a payoff somewhere down the line. And we're reluctant to give up too easily.
I think this is one of the reasons we need to normalize the idea of being able to change one's mind. We too often are made to feel as though we must stay the course when we make a choice or form an opinion. "Sunk costs" fits because we've made a certain level of investment in the choice/idea and to change course somehow means our investment was lost/for nothing. But that's not true. Is adaptability not valuable? What about acting in integrity with one's values? What about adding new information? What about making a more informed choice based on new info? Are these things less valuable than staying the course with our original choice/opinion?