If the regret rate for this necessary, life-saving care is low enough to be minuscule, then why would a longer statute of limitations matter? It should be a cakewalk for the most effective treatment in medicine; 15 years is nothing.
If the regret rate for this necessary, life-saving care is low enough to be minuscule, then why would a longer statute of limitations matter? It should be a cakewalk for the most effective treatment in medicine; 15 years is nothing.
I suspect we would see the same trepidation if the statute were extended for any other treatment as well. It is well known that obgyn has the highest rate of lawsuits-as well as the highest malpractice premiums-in part because they can be held liable for problems in the child for many years after birth.
At first glance you would think that if the doctors really believe in their treatments then there shouldn't be an issue. But the thing is, ALL medical treatments come with some drawbacks. The whole idea of informed consent is that the patient (or guardian) weighs the risks on both sides and chooses the one they wish to live with. The thing is, minds change. People develop regrets once they learn they are in the 1%,10% or 70% who actually have a specific side effect. And to be able to extract money from a doctor (really their insurance company) for those regrets years later? Even people who know they made the choice themselves with all the information may have a hard time refusing once the personal injury lawyers start targeting them with ads.
Doctors generally want to help people. They generally don't want to be held responsible for someone changing their mind 15 years after the fact. Not to mention that after so many years it is very difficult even for the patient themselves to accurately recall their decision process and what they knew or didn't know at the time-memories change constantly little by little.
I understand why people think this is a good solution, but I'm concerned. For one because I worry more laws like this will be passed about other conditions and we will see a mass exodus of providers willing to touch these patients at all with any treatment for any reason. Not to mention the last thing our health care system needs is more costs!
Perhaps you can't. Having worked in multiple branches of medicine (albeit not this one) for two decades, I'm pretty confident that most (of course not all) in any specialty generally want to help and think they are. Doesn't mean they're right. But it looks to me from the outside like the most extreme practitioners in this area have personal experience with this issue and thus feel incredible drive to keep others from suffering as they did. They may be too close to be objective, but that's different than being motivated to hurt kids.
I'd be a lot more sympathetic to this view if their professional organizations didn't circle the wagons around GAC every time the evidence base for it was challenged.
Yes. Where were doctors when claims of blockers being "fully reversible" were made? Where were their professional organizations when it became clear that the drugs used off-label WERE ALWAYS GOING TO BE OFF-LABEL? No research, no proof, no long-term follow up?
Big pharma suckered doctors into this, and doctors should know better. They did not call for research, but rather suppression of it.
Lawyers have been involved in this issue the whole time...they were there advising hospitals and organizations that the risk of liability was low, not because the research and results were sound, but because the laws (est by Democrats) were in place. Stinks of politics and doctors KNOW that puberty serves developmental functions. They know, but they organized to shut down serious science about it. Big pharma will never pay for this, and "clinics" were set to keep using drugs off-label forever until liability came knocking.
I also think this is the case. The other issue is that there has been a strong drive to accept how patients see themselves as valid and to include them in decisions about their care - a very good premise which probably needed boundary setting.
And, additionally, the concept that ultimately what makes life worth living and happy is highly subjective, and forcing someone else's picture of perfection onto another person is at best a crapshoot. So, we need to find ways to respect that people have different views and feelings and thoughts on what they want from life while also finding ways to protect those who need protection. Which starts with figuring out who that is. And that is a problem much bigger than the gender world... Take a look at the psychiatric survivor movement, for example.
I don't think that legislatures should have anything to do with medicine. But in this specific case, medicine has utterly gone off the rails. I'm Ok with the laws, and believe that no child or teen should be getting blockers or cross sex hormones ( lets not forget, the purpose of these hormones is for cosmetic effect. I think we should constantly go back to that fact. It's cosmetic, not medically therapeutic.) Dysphoric kids and teens will be treated with counseling, which is as it should be.
And let us not forget that for a long time we have known that up to 80-90 percent of kids w/ bodily 'gender' distress settle into their bodies by going through puberty and teenhood--they grow out of it--and many just turn out to be LGB. Let kids grow up w/o medical interventions and w/ psychological and emotional support, if need be, to become whole and healthy adults. And continue to expose 'trans' 'gender identity' as the invented and incoherent con that it is.
"lets not forget, the purpose of these hormones is for cosmetic effect. I think we should constantly go back to that fact. It's cosmetic, not medically therapeutic. ". This is an interesting point... it's curious to me that the bans and liability law changes have utterly ignored children and teens who undergo other cosmetic procedures and medications (from nose jobs to Botox to weight loss medications and surgeries even without any complications from obesity-or without being obese at all). Seems to me that those children might be better off being treated with counseling, and one can make all the same arguments about side effects (up to and including death) and long-term regret. However, in that aspect of things, it has been left utterly up to the child in question and their guardians and doctors to make those decisions. I'm curious as to why that is.
Because the whole of USA society believes in those modifications and worships a ghastly imitation post human version of our bodies? And has been exporting that distorted grotesque all over the world since the 1950s.
You make some good points. In this case though I see the uncalled for serious medical interventions on healthy, developing minors and the implications for their future as in a wholly different category than other conditions. I am encouraged that these unjustified interventions will be curtailed and hope that more people will see the utter madness of it but if the fear of liability b/c the insurance companies see the potential exposure is what does it so be it. I hope more states will follow and more insurance companies will refuse to insure these medical interventions for minors and adults too--esp. more vulnerable adults w/ other issues--who need extreme gatekeeping before such brutal hormonal and surgical interventions are undertaken.
A once credible medical profession has allowed interventions that have caused a lot of misery and there will be future misery. In addition, w/ its dystopian butchery, these 'gender doctors' have created patients for whom there are no practitioners to treat them; a male w/ a faux vagina goes to an OB/GYN who is not trained to manage such an iatrogenic construction nor is any other practitioner keen to deal w/ such patients I suspect. And the whole of society will pay for this foray into utter madness and those who have promoted it, facilitated it, and profited from it probably never will and that is the unkindest cut of all.
"Not to mention that after so many years it is very difficult even for the patient themselves to accurately recall their decision process and what they knew or didn't know at the time-memories change constantly little by little."
Great point!
Particularly true when the patient for irreversible body modification treatment is a minor. Often one in a group of friends who also won't remember.
Doctors wanting to help people in general may be true...but there has been a concerted pushback from the health care industry against not only any research about long-term effects of blockers and cross-sex hormones but any discussion of research.
Patient follow up is dismal, and results aren't being tracked well.
Low quality research.
This is not like other conditions in that way. It has not been treated responsibly by providers, but has been promoted on unverifiable claims.
If unsustainable liability is what it takes to put the brakes on whatever helpful impulse led countless doctors to treat minors with poorly researched, harmful drugs and even surgeries, and to not follow up with their patients effectively over time, then so be it.
You may think most of medicine is evidence-based. It is not. Estimates of how much medical practice is based in scientific evidence hover around 20%. In my profession, nursing, it's worse because we have less money & corporate support and fewer years of doing science.
Not sure who you're replying to but I actually agree. Which is why I think singling this particular area out for onerous regulations that will probably have unintended effects and will almost certainly lead to this patient population becoming hot potatoes, is a bad idea... because actually the issues here aren't terribly unique and so this is likely to be a slippery slope. And I think it hasn't been well thought out. The goal here seems to be to drive this area of medicine out of existence. So what happens when these techniques are applied to the 80% of medicine that is not evidence based? Granted, I think there are lots of improvements to be made, but cutting our health care system to a fifth of it's size doesn't seem like the way to do it.
You can bet millions was spent on lawyers to provide risk assessments about this, all across the land, as clinic after clinic was established. You can imagine the number crunchers who said "It's fine...the trans Healthcare legislation is in place, keep using off-label drugs on minors and expand and promote your services to more and more people. Now that ANY other clinical response other than affirmation-only is essentially illegal, you're good to go."
"Onerous regulations.
Not terribly unique."
Parents are being forced in some cases to medicalize their children or lose them, while the poor, beleaguered health care system is working in concert with legislators who were likely bought off by big pharma.
Those harmed by this callous, irresponsible, unproven, profit-motivated treatment will be hot potatoes regardless of whether "gender medicine" clinics are held culpable or not. The sooner the providers are held accountable, the fewer youngsters will be harmed.
Do you have any idea how many off label prescriptions are written every day? Including for children, because treatments that are approved for adults are often used for children without approval. In the vast majority of cases, no one is aware they or their child is getting an off label treatment because they are so widely accepted.
Now, I have a couple questions and I'm pretty sure of the answers but I'm truly interested in learning if I'm wrong.
Can you tell me of any legislation that was passed MANDATING medical gender transition for children, before the bans started? (Of note, one frequent unintended consequence of extreme reactive crackdowns is that the other side cracks down equally extremely).
Also, can you point to any specific instances of a child actually being removed (or even a specific parent who was threatened with removal) for the sole reason of gender affirmation issues? The only one I have seen named is the case of Sage, and from what I've read there seems to have been a lot of other issues in that case. Due to privacy laws pertaining to family court cases, we generally only get the parents' side of the story, and even with that in mind I have seen multiple issues that would have complicated child protection proceedings. (Bear in mind, too, that in that case as well as the still-hypothetical cases that will be impacted by the "gender sanctuary" policies, one complication is that Sage ran away from home and sought gender transition. It is very possible she actually refused to return. In nearly all cases of teenage runaways who refuse to return home, there is an investigation and court proceedings as well as attempts to determine a compromise like kinship placement.)
Also, you are naive if you believe there are only lawyers on one side of this issue. The evangelical right, including their law firms, is cashing in big on this issue right now, and has been heavily involved in things like drafting legislation. Another good reason to try to avoid legislative action: issues that become political in this split country generally raise major dollars for both sides. And they tend to become performances by political interests with families and constituents used as window dressing. Ultimately, those interests care about themselves and often don't give a hoot about the actual issue other than "how can I raise money and elevate my profile with this?"
I'm curious how you think these laws will hold providers accountable? Those who are merely in it for the money will run away before they can get snared by the beefed-up laws. Those who are really, truly trying to help and care about their population will be the only ones who might be harmed. Regardless, the payouts almost never come from the pockets of the providers themselves. It's a bit like trying to hold drunk drivers accountable by charging their insurance companies for the property damage and medical expenses they cause. Might raise their premiums, will also raise everyone else's if there are enough such cases, and soon you see dominos falling in the whole healthcare system.
Blanket legislative action like this is neither wise nor targeted. And it WILL have unintended effects-whether it has any of the intended ones, or not.
I don't agree with what you say but I do think you are right about the problem. Surely the issue with the solution is that it is being pushed by Republicans who are not interested in sorting out the medical industry?
I do think that's a large part of it. Frankly, I think any quick "solution" pushed by either party without both a thorough understanding of the medical industry as well as a vested interest and real actionable plan to solve the systemic issues throughout the health care system is not only doomed to fail but will probably backfire in ways they don't expect.
I think though that people trying to change sex is in such a unique category, that a heightened liability might not carry over to other procedures, as you fear might happen. There is so much тАЬwooтАЭ and тАЬmushтАЭ and mind sets involved in wanting to change oneтАЩs sex and then actually thinking that that is possible. It seems very different from a hip or knee replacement or organ transplant, etc...
Perhaps, especially for some patients. Although I do get the impression that there are some who are well aware of the limitations of medical gender transition. However, I know for sure (because I have met and treated them) that there are people who have highly unrealistic expectations for the procedures you mentioned as well. They may not be best described as "woo" and "mush" but, for example, many people think they will magically become more athletic and thus thinner and have an all-around healthier life with the joint replacement alone. Some people certainly do become healthier after joint replacement but it takes painful rehab followed by all the training anyone else would need-the new joint is just the beginning and is actually a hindrance at first until one recovers from the surgery.
Someone, especially a young person, who has sadly had their social life curtailed by organ failure may picture themselves as having loads of friends once they get their new organ. And young people struggle to really comprehend the expected and possible complications of any procedure including a serious surgery like that. And of course, once they recover sufficiently to be more social (if that even happens) they will still have limitations and may find that just because they are physically healthy enough to have friends sadly doesn't mean they will fit in, especially if they've spent many of their younger years in hospitals and therefore their social development may not be at the same level as their peers.
That's not to say at all that people don't have full lives all the time after these procedures. It's simply a note that unrealistic expectations are rampant in medicine.
If the regret rate for this necessary, life-saving care is low enough to be minuscule, then why would a longer statute of limitations matter? It should be a cakewalk for the most effective treatment in medicine; 15 years is nothing.
I suspect we would see the same trepidation if the statute were extended for any other treatment as well. It is well known that obgyn has the highest rate of lawsuits-as well as the highest malpractice premiums-in part because they can be held liable for problems in the child for many years after birth.
At first glance you would think that if the doctors really believe in their treatments then there shouldn't be an issue. But the thing is, ALL medical treatments come with some drawbacks. The whole idea of informed consent is that the patient (or guardian) weighs the risks on both sides and chooses the one they wish to live with. The thing is, minds change. People develop regrets once they learn they are in the 1%,10% or 70% who actually have a specific side effect. And to be able to extract money from a doctor (really their insurance company) for those regrets years later? Even people who know they made the choice themselves with all the information may have a hard time refusing once the personal injury lawyers start targeting them with ads.
Doctors generally want to help people. They generally don't want to be held responsible for someone changing their mind 15 years after the fact. Not to mention that after so many years it is very difficult even for the patient themselves to accurately recall their decision process and what they knew or didn't know at the time-memories change constantly little by little.
I understand why people think this is a good solution, but I'm concerned. For one because I worry more laws like this will be passed about other conditions and we will see a mass exodus of providers willing to touch these patients at all with any treatment for any reason. Not to mention the last thing our health care system needs is more costs!
"Doctors generally want to help people." Not to be a jerk, but you cannot look at this branch of medicine and walk away with this conclusion.
Perhaps you can't. Having worked in multiple branches of medicine (albeit not this one) for two decades, I'm pretty confident that most (of course not all) in any specialty generally want to help and think they are. Doesn't mean they're right. But it looks to me from the outside like the most extreme practitioners in this area have personal experience with this issue and thus feel incredible drive to keep others from suffering as they did. They may be too close to be objective, but that's different than being motivated to hurt kids.
I'd be a lot more sympathetic to this view if their professional organizations didn't circle the wagons around GAC every time the evidence base for it was challenged.
Yes. Where were doctors when claims of blockers being "fully reversible" were made? Where were their professional organizations when it became clear that the drugs used off-label WERE ALWAYS GOING TO BE OFF-LABEL? No research, no proof, no long-term follow up?
Big pharma suckered doctors into this, and doctors should know better. They did not call for research, but rather suppression of it.
Lawyers have been involved in this issue the whole time...they were there advising hospitals and organizations that the risk of liability was low, not because the research and results were sound, but because the laws (est by Democrats) were in place. Stinks of politics and doctors KNOW that puberty serves developmental functions. They know, but they organized to shut down serious science about it. Big pharma will never pay for this, and "clinics" were set to keep using drugs off-label forever until liability came knocking.
I also think this is the case. The other issue is that there has been a strong drive to accept how patients see themselves as valid and to include them in decisions about their care - a very good premise which probably needed boundary setting.
And, additionally, the concept that ultimately what makes life worth living and happy is highly subjective, and forcing someone else's picture of perfection onto another person is at best a crapshoot. So, we need to find ways to respect that people have different views and feelings and thoughts on what they want from life while also finding ways to protect those who need protection. Which starts with figuring out who that is. And that is a problem much bigger than the gender world... Take a look at the psychiatric survivor movement, for example.
I don't think that legislatures should have anything to do with medicine. But in this specific case, medicine has utterly gone off the rails. I'm Ok with the laws, and believe that no child or teen should be getting blockers or cross sex hormones ( lets not forget, the purpose of these hormones is for cosmetic effect. I think we should constantly go back to that fact. It's cosmetic, not medically therapeutic.) Dysphoric kids and teens will be treated with counseling, which is as it should be.
And let us not forget that for a long time we have known that up to 80-90 percent of kids w/ bodily 'gender' distress settle into their bodies by going through puberty and teenhood--they grow out of it--and many just turn out to be LGB. Let kids grow up w/o medical interventions and w/ psychological and emotional support, if need be, to become whole and healthy adults. And continue to expose 'trans' 'gender identity' as the invented and incoherent con that it is.
"lets not forget, the purpose of these hormones is for cosmetic effect. I think we should constantly go back to that fact. It's cosmetic, not medically therapeutic. ". This is an interesting point... it's curious to me that the bans and liability law changes have utterly ignored children and teens who undergo other cosmetic procedures and medications (from nose jobs to Botox to weight loss medications and surgeries even without any complications from obesity-or without being obese at all). Seems to me that those children might be better off being treated with counseling, and one can make all the same arguments about side effects (up to and including death) and long-term regret. However, in that aspect of things, it has been left utterly up to the child in question and their guardians and doctors to make those decisions. I'm curious as to why that is.
Probably something to do with Botox not leading patients down a medical pathway to sterility in the majority of cases. Just a wild guess.
Because the whole of USA society believes in those modifications and worships a ghastly imitation post human version of our bodies? And has been exporting that distorted grotesque all over the world since the 1950s.
You make some good points. In this case though I see the uncalled for serious medical interventions on healthy, developing minors and the implications for their future as in a wholly different category than other conditions. I am encouraged that these unjustified interventions will be curtailed and hope that more people will see the utter madness of it but if the fear of liability b/c the insurance companies see the potential exposure is what does it so be it. I hope more states will follow and more insurance companies will refuse to insure these medical interventions for minors and adults too--esp. more vulnerable adults w/ other issues--who need extreme gatekeeping before such brutal hormonal and surgical interventions are undertaken.
A once credible medical profession has allowed interventions that have caused a lot of misery and there will be future misery. In addition, w/ its dystopian butchery, these 'gender doctors' have created patients for whom there are no practitioners to treat them; a male w/ a faux vagina goes to an OB/GYN who is not trained to manage such an iatrogenic construction nor is any other practitioner keen to deal w/ such patients I suspect. And the whole of society will pay for this foray into utter madness and those who have promoted it, facilitated it, and profited from it probably never will and that is the unkindest cut of all.
"Not to mention that after so many years it is very difficult even for the patient themselves to accurately recall their decision process and what they knew or didn't know at the time-memories change constantly little by little."
Great point!
Particularly true when the patient for irreversible body modification treatment is a minor. Often one in a group of friends who also won't remember.
Doctors wanting to help people in general may be true...but there has been a concerted pushback from the health care industry against not only any research about long-term effects of blockers and cross-sex hormones but any discussion of research.
Patient follow up is dismal, and results aren't being tracked well.
Low quality research.
This is not like other conditions in that way. It has not been treated responsibly by providers, but has been promoted on unverifiable claims.
If unsustainable liability is what it takes to put the brakes on whatever helpful impulse led countless doctors to treat minors with poorly researched, harmful drugs and even surgeries, and to not follow up with their patients effectively over time, then so be it.
You may think most of medicine is evidence-based. It is not. Estimates of how much medical practice is based in scientific evidence hover around 20%. In my profession, nursing, it's worse because we have less money & corporate support and fewer years of doing science.
Not sure who you're replying to but I actually agree. Which is why I think singling this particular area out for onerous regulations that will probably have unintended effects and will almost certainly lead to this patient population becoming hot potatoes, is a bad idea... because actually the issues here aren't terribly unique and so this is likely to be a slippery slope. And I think it hasn't been well thought out. The goal here seems to be to drive this area of medicine out of existence. So what happens when these techniques are applied to the 80% of medicine that is not evidence based? Granted, I think there are lots of improvements to be made, but cutting our health care system to a fifth of it's size doesn't seem like the way to do it.
Onerous regulations?
Are you for real?
Issues that aren't terribly unique?
You can bet millions was spent on lawyers to provide risk assessments about this, all across the land, as clinic after clinic was established. You can imagine the number crunchers who said "It's fine...the trans Healthcare legislation is in place, keep using off-label drugs on minors and expand and promote your services to more and more people. Now that ANY other clinical response other than affirmation-only is essentially illegal, you're good to go."
"Onerous regulations.
Not terribly unique."
Parents are being forced in some cases to medicalize their children or lose them, while the poor, beleaguered health care system is working in concert with legislators who were likely bought off by big pharma.
Those harmed by this callous, irresponsible, unproven, profit-motivated treatment will be hot potatoes regardless of whether "gender medicine" clinics are held culpable or not. The sooner the providers are held accountable, the fewer youngsters will be harmed.
Why yes, in fact, I am "for real."
Do you have any idea how many off label prescriptions are written every day? Including for children, because treatments that are approved for adults are often used for children without approval. In the vast majority of cases, no one is aware they or their child is getting an off label treatment because they are so widely accepted.
Now, I have a couple questions and I'm pretty sure of the answers but I'm truly interested in learning if I'm wrong.
Can you tell me of any legislation that was passed MANDATING medical gender transition for children, before the bans started? (Of note, one frequent unintended consequence of extreme reactive crackdowns is that the other side cracks down equally extremely).
Also, can you point to any specific instances of a child actually being removed (or even a specific parent who was threatened with removal) for the sole reason of gender affirmation issues? The only one I have seen named is the case of Sage, and from what I've read there seems to have been a lot of other issues in that case. Due to privacy laws pertaining to family court cases, we generally only get the parents' side of the story, and even with that in mind I have seen multiple issues that would have complicated child protection proceedings. (Bear in mind, too, that in that case as well as the still-hypothetical cases that will be impacted by the "gender sanctuary" policies, one complication is that Sage ran away from home and sought gender transition. It is very possible she actually refused to return. In nearly all cases of teenage runaways who refuse to return home, there is an investigation and court proceedings as well as attempts to determine a compromise like kinship placement.)
Also, you are naive if you believe there are only lawyers on one side of this issue. The evangelical right, including their law firms, is cashing in big on this issue right now, and has been heavily involved in things like drafting legislation. Another good reason to try to avoid legislative action: issues that become political in this split country generally raise major dollars for both sides. And they tend to become performances by political interests with families and constituents used as window dressing. Ultimately, those interests care about themselves and often don't give a hoot about the actual issue other than "how can I raise money and elevate my profile with this?"
I'm curious how you think these laws will hold providers accountable? Those who are merely in it for the money will run away before they can get snared by the beefed-up laws. Those who are really, truly trying to help and care about their population will be the only ones who might be harmed. Regardless, the payouts almost never come from the pockets of the providers themselves. It's a bit like trying to hold drunk drivers accountable by charging their insurance companies for the property damage and medical expenses they cause. Might raise their premiums, will also raise everyone else's if there are enough such cases, and soon you see dominos falling in the whole healthcare system.
Blanket legislative action like this is neither wise nor targeted. And it WILL have unintended effects-whether it has any of the intended ones, or not.
I don't agree with what you say but I do think you are right about the problem. Surely the issue with the solution is that it is being pushed by Republicans who are not interested in sorting out the medical industry?
I do think that's a large part of it. Frankly, I think any quick "solution" pushed by either party without both a thorough understanding of the medical industry as well as a vested interest and real actionable plan to solve the systemic issues throughout the health care system is not only doomed to fail but will probably backfire in ways they don't expect.
I think though that people trying to change sex is in such a unique category, that a heightened liability might not carry over to other procedures, as you fear might happen. There is so much тАЬwooтАЭ and тАЬmushтАЭ and mind sets involved in wanting to change oneтАЩs sex and then actually thinking that that is possible. It seems very different from a hip or knee replacement or organ transplant, etc...
Perhaps, especially for some patients. Although I do get the impression that there are some who are well aware of the limitations of medical gender transition. However, I know for sure (because I have met and treated them) that there are people who have highly unrealistic expectations for the procedures you mentioned as well. They may not be best described as "woo" and "mush" but, for example, many people think they will magically become more athletic and thus thinner and have an all-around healthier life with the joint replacement alone. Some people certainly do become healthier after joint replacement but it takes painful rehab followed by all the training anyone else would need-the new joint is just the beginning and is actually a hindrance at first until one recovers from the surgery.
Someone, especially a young person, who has sadly had their social life curtailed by organ failure may picture themselves as having loads of friends once they get their new organ. And young people struggle to really comprehend the expected and possible complications of any procedure including a serious surgery like that. And of course, once they recover sufficiently to be more social (if that even happens) they will still have limitations and may find that just because they are physically healthy enough to have friends sadly doesn't mean they will fit in, especially if they've spent many of their younger years in hospitals and therefore their social development may not be at the same level as their peers.
That's not to say at all that people don't have full lives all the time after these procedures. It's simply a note that unrealistic expectations are rampant in medicine.
USA medicine is an appalling system. What you say merely highlights the fact that the privatised high competition system doesn't work.
I absolutely agree! But that's a problem that needs solving from the root. Which appears to be sadly our of reach in our current political climate.
Exactly!