I’ve got a lot of thoughts about medical scandals swirling around in my head (and on the page—I’m currently reworking the WPATH piece with a friend’s help)… but I’d love to hear what you think:
What conditions—beyond your basic human fallibility—make medical scandals possible?
What conditions make it possible to stop a medical scandal, ideally before it gets as far as the medical scandal currently known as ‘gender-affirming care’ has gone?
I have a lot of thoughts on this because we have lived it and my daughter can tally about what happened.
1) A diagnosis or condition that is very difficult to treat, doesn’t have a clear treatment path, and/or doesn’t have a clearly understood cause. Lobotomies took hold because there were basically no effective treatments for severe mental illness; repressed memories because it’s hard (probably impossible) to pinpoint a single, concise, all-explaining cause for the general malaise and unhappiness that brought those women to the therapist; difficult to treat chronic pain and the opioid crisis; facilitated communication and the challenges of nonverbal autism; the explosion in gender dysphoria and affirmation provides an easy explanation for the very challenging cases of highly emotionally disregulated, anxious, depressed, self-harming, teen who is resisting and not responding to all the psych meds and hours of therapy they’re being treated with. Affirmation and the transition checklist provide a way forward and the short-term improvements (eothout considering the effects of placebo, getting what they want, love bombing, an instant community, sudden power and control over what is happening in their lives and the people around them) convinces the professionals they must be doing the right thing.
2) you need a cultural environment that makes believing in the treatment a moral issue. Opioid crisis: not treating the pain was a moral issue; repressed memories and the satanic panic: believe women, believe the children; gender identity : the new civil rights
3) Piggybacking on #1, I think you need a moral failure in the past. For lobotomies: the scandal of how badly people were being treated in asylums; opioids: people suffering and women and minorities not having their pain taking seriously; repressed memories and satanic panic: a history of ignoring child abuse; facilitated communication: a history of sending autistic children to asylums to be forgotten and abused; gender identity : the failures of psychiatry with gays and lesbians
4) There needs to be some level of institutional buy-in, even if it’s not complete. Colleges taught facilitated communication; police and DAs investigated, charged, and prosecuted daycare stories that were literally impossible; gender identity - basically every institution. This creates the chain of trust problem that Dr. Steven Levine has talked about.
5) Money may be part of it, but I don’t think money and greed create most scandals. I think money and greed just follow scandals as opportunities.
If you have not listened yet, I highly recommend the podcast series “Sold a Story.” Seriously, stop what you’re doing and start listening now. It’s about how a completely unproven method of teaching children to read has been promoted and used for years, with devastating costs and harms done to millions of children. It’s got every feature of a medical scandal but because it’s in a different context - education - it really helps you see these patterns because they’re not in narrative we expect.
I agree with the other comments wholeheartedly and also think the social environment is a big factor. Part of the issue causing the opioid epidemic was that doctors were getting bad reviews (both internally and from patients online) if they didn't control pain, so they went with opioids. I suspect some had doubts (not many since I think most doctors are by and large rule followers and straight-line thinkers), but the external pressure was significant enough to ignore those doubts.
In this case, we have huge social/political pressure (fear of reprisal and being branded a bad person, and the related professional and personal fallout). Hearing from gender clinicians — primarily gay men, there's a lot of correcting past injustices in terms of how gay men and boys were treated. Conversion therapy and the like, stories of being rejected by family. I haven't been in contact with lesbian clinicians, but I suspect there is overlap. This is personal for them, which blinds them to reality and critical thought.
There's also the issue of self-validation for LGBTQ+++ clinicians. Consciously or unconsciously, trans adults need trans kids to validate their issues as "born this way" immutable rather than as a fetish. Sick people sacrificing children for their own gain, like the glorious Rachel Levine.
The pediatrician who was secretly helping my kid take hormones is an edgy, GNC woman. I'm sure she believes the entire narrative and sees herself as a savior for my poor abused child. There is a lot of virtue-seeking/self-validation as a noble warrior. This requires actively ignoring anything to the contrary and is slightly different that the god complex.
I do think contemplating that you may have severely harmed vulnerable children keeps clinicians from even hearing anything critical of the Affirmative Care model, and is keeping this from crumbling long past its expiration date.
I think the overriding thing to remember is the "god complex" that many Drs have (or had) that they can fix things and are often resistant to feedback. Combine that with a medical need (morning sickness/contraception/mental illness) that an existing medication or new procedure can purport to address - so Thalidomide, Dalkon Shield, Dysphoria/teen angst and which initially seems to work. Then you have the $ and concern about admitting liability, coverup etc. What makes the gender stuff so crazy is that you have the entire gender ideology/queer theory movement in the mainstream non medical discourse. And the social contagion - women weren't taking Thalidomide cause they saw it on tiktok.
I think part of the dynamic is often that it’s harder to admit error in a medical context than many other contexts, because what error necessarily entails here is harm: illness, disfigurement, even death or risk thereof.
Hi Eliza, I work in a teaching hospital as a department director, serve on the ethics committee and the IRB, and I have one word for all of it:
Incentives.
Doctors, hospital administrators and corporate executives are, by definition, a well-educated bunch, and are going to lean liberal. What's the incentive, socially, to go against the collective progressive narrative? What's the disincentive to do so? When communities lean one way or another, the person farthest out on the left or the right gains status as being the most committed. (See: Congress, US, attempt to elect a Speaker.)
What's the financial incentive for watchful waiting rather than "sell drugs and procedures now?" Hint: it's surgeries that pay for hospitals to stay open.
Publish or perish: many medical residents or doctors doing fellowships are required to do research as part of their training. Professors- at medical school or other universities- have to publish or risk not getting tenure, funding, or promotions. Nobody wants to read "we don't know exactly what's going on, so watchful waiting is probably the most prudent approach for now." (That could apply to trans kids, some cardiac interventions, small tumors, all kinds of problems.) Journals want to publish positive results that confirm the biases of their communities- what's anybody's incentive not to publish results that grab attention and affirmation of being on the Right Side Of History? Nobody in the entire medical community- except the insurance companies- has an incentive not to take action.
As a white, middle-class, suburban or urban teenager, when the constant message is that cisgender white folks are at the top of the oppressor food chain, what's the incentive to not be just another cisgender white kid? What's your incentive, as a psychologist or physician, not to offer services to middle-class kids with good insurance? (It ain't Medicaid kids getting top surgery at 16.)
Hospitals are among the most intensely hierarchical organizations in the world, save perhaps the military and the Catholic Church. You're a middling doctor, what's your incentive here? To get noticed, to do something different, get on media, be something that the health system can advertise. You want to climb the ranks? Gotta get noticed by the higher-ups.
Drug companies. That's so obvious nothing more need be said.
IRB's - what's their incentive? To protect the institution from Federal censure, not actually to ask "is this research moral, or necessary, or congruent with a positive vision of humanity and society?" I've seen literally hundreds of studies designed to show a statistical improvement over current drugs or treatments, which often doesn't translate into meaningful clinical benefit. For example, a new drug gives a 5 or 8 percent improvement in survival time for a particular cancer- that's statistically great- but it might only mean another couple of weeks to live, perhaps with dire side effects, and great cost for the new drugs. All the incentives skew towards more treatment, more cost, more studies P-hacked to show some positive effect.
I'm not saying that people don't honestly believe they're doing the right thing. It's just that incentives can be a powerful motivator of confirmation bias and groupthink.
One component that plays a part in some scandals is that in the U.S. ( I don't know about elsewhere) the approval of new drugs is a highly-regulated process, but the introduction of new surgical techniques is unregulated. I think there may also be lower standards for implanted medical devices than drugs.
A defense of surgical procedures regulation
Mattia Andreoletti & Federico Bina
Theoretical Medicine and Bioethics volume 43, pages155–168 (2022)
Abstract
Since the advent of drug regulation in 1962, regulatory agencies have been in the practice of using strict standards to test the safety and efficacy of medical treatments and products. Regulatory agencies, such as the FDA, demand two full-fledged Randomized Clinical Trials demonstrating the safety and effectiveness of drugs to grant its marketing authorization. On the contrary, surgical treatments are left completely unregulated. There are several reasons explaining this difference, and all of them point to the difficulty of conducting well-designed RCTs in surgery...
My perspective is as a retired nurse. I used to work on a cardiac stepdown unit where many patients received post-procedure care after receiving cardiac stents in same-day surgery - a procedure I later learned was often performed for no benefit on the basis of what turned out to be insufficient evidence.
I also worked briefly as a Surgical ICU nurse on a unit where for some reason I kept seeing back surgery patients who were often on their second and sometimes even their third surgery. I later stumbled across a terrific 2002 New Yorker article that explained the overuse of surgery to treat chronic back pain.
While the focus of the article is not on a procedure that has become a scandal in the popular mind it does a great job of illuminating some of the underlying dynamics that prevents medicine from self-correction.
Dr. Atul Gawande also wrote a number of excellent articles that were published in the New Yorker years ago which touch on some of the dynamics at play in medical scandals.
For example;
Overkill
An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?
This shows has an impoverished city in Texas became captured by a group of doctors that learned how to game the Medicare/Medicaid system for personal gain. (Compare the possible role of Medicaid payment and also Obamacare regulations on private payers for gender-affirming care???)
"Compared to El Paso, Gawande discovered that Medicare patients in McAllen received 40 percent more surgeries and two to three times as many pacemakers, cardiac bypass operations, carotid endarterectomies and coronary stents. Per-capita spending on home-health services was five times higher than in El Paso. Yet there was nothing to indicate that patients in McAllen were sicker or received more expensive services than Medicare recipients across the country—they just received more services."
I love your articles and tweets, and I'm aware you focus more on the social and psychological factors that drive demand. But I think that some of the factors that drive 'supply'/medical practice are relevant, too.
I'd also like to mention a very recent and I think very relevant medical scandal that has received very little attention - the overprescription of antipsychotics to children, especially impoverished children on Medicaid, and most especially children in foster care. I stumbled across this several years ago while looking for articles on the overuse of Ritalin in children.
Here's NPR in 2015 reporting that "In 2011, the federal Government Accounting Office found nearly 1 in 4 children in foster care was taking psychotropic medications, which include antipsychotics, antidepressants, mood stabilizers and stimulants.
Hundreds of children were found to be taking five or more psychotropic medications at a time, and thousands were prescribed doses that exceeded FDA-approved guidelines. "
"Very young kids also medicated: Hundreds of foster children 5 and younger have been prescribed psychotropics, although federal health officials say the drugs are not safe for the very young and other states actively discourage the practice. "
I looked into this several years ago and don't have references to everything I read back then handy, but I did find a few now for evidence. But IIRC it became such a huge issue that it was officially investigated by both the federal government, several states, and Canada, and that states such as CA (and maybe Medicaid???) placed limits on doctors in a way that seems like it would be very relevant to the current 'Wild West' atmosphere of pediatric gender-affirming care. I'm thinking in particular of a doctor in Canada who has admitted to treating a large number of trans children who are in foster care, as well as an article I just read yesterday about how one of the poorest communities in England had the highest number of teenage girls referred to the Tavistock clinic.
"Key Findings: Growth in antipsychotic use was evident across almost every diagnosis; however, most children taking antipsychotics (65%) were receiving them for diagnoses lacking regulatory approval for use, such as ADHD and conduct disorder."
City educators are violating the law by banning students with behavior problems from schools if their parents refuse orders to give them Ritalin or other drugs, the head of a child-advocacy group charged yesterday.
Chaifetz said many parents call her office in a panic because they think the city’s Administration for Children Services will take custody of their kids.
I'd love to see you connect these recent pediatric medical scandals to the pediatric gender scandal. It's astonishing the antipsychotic scandal happened so recently (~2015) but has been so thoroughly memory-holed. While almost no members of the general public are aware of it, you'd think that pediatric medical associations, medical boards, etc. would remember this scandal and would be motivated to proceed more cautiously because of this in the present controversy. I often read Twitter comments comparing the present craze to the lobotomy scandal, but never these more recent scandals just 10-20 years ago.
Well, one obvious condition that makes medical scandals possible is when there is a path that is wide open for shrewd people to make money. Processes or laws need to be in place to stop greedy and exploitive people who are drawn to manipulating society, regardless of the harm done, to create wealth. Those people will always be among us. It's like tempting people to steal in a company by not having safeguarding processes and accountability around money. Without anti-polluting laws, people would pollute if they could turn a profit. It's the same with medical scandals, though the laws would be requiring rigorous scientific protocol as a safeguarding method.
I would add that I have noticed many commenters on the trans medical scandal have asserted that lawsuits are coming, and that this will halt the scandal. But I have found no one who is assessing the question, in a substantive way, why lawsuits have not been forthcoming until now, and what legal barriers may be preventing lawsuits in the future.
One issue, mentioned by Scott Neugent, who appeared in “What is a Woman,” is the lack of standards of care, which makes it prohibitively expensive to take cases on contingency.
Helen Lewis has said, if I recall correctly, that the problem is that the statutes of limitation are too short, compared to the length of time for regret to manifest into detransition.
If legal barriers are in fact preventing lawsuits, then the solution will be legislation that removes those barriers. This seems like a more effective approach than banning procedures outright, or otherwise regulating the medical community through legislation.
Jan 4, 2023·edited Jan 4, 2023Liked by Eliza Mondegreen
I think I understand what you mean by the "gender-affirming care" scandal, though most people would not see a scandal there. The idea that feeling like the opposite sex means that you should try to transition to the opposite sex (which isn't actually possible) is probably what you mean. The problem, as I have said before, is that transgender activists are using the same arguments that gays used to get their rights, but those arguments don't apply. Gay people are discriminated against because of their identity, and for no other reason. Trans people would have us believe that they are also discriminated against for their identity, but the situation is far more complicated than that. No one can prove that a gay man is not gay, or that he "chose" to be gay, so any discrimination against him is based on his identity. On the other hand, a man who feels like a woman (i.e., a trans woman) may believe that he is also being discriminated against because of his identity, but there is ample evidence that he is NOT an actual woman and therefore doesn't deserve the rights of women. Society needs to find a way to accept trans people as they are without pretending that reality is not what it is. Thus, let them behave as women in society, but not impinge on women's private spaces or other rights (rights which are based on sex). Even if we accept the idea of "gender identity", society needs to recognize that biological sex is what determines rights, not just the way people feel about themselves.
So that's my view, that the current situation is based on a misunderstanding of how rights should be determined. Biological sex is real. Gender identity is just a feeling.
(Note: My Substack site hasn't been launched yet.)
Lobbying the DSM-5 and ICD-11 editors to reclassify mental health conditions so that they no longer need to be addressed has made the current medical/surgical gender reassignment scandal possible.
As the DSM-5 states in the case of 'spirit possession', what is considered bodily disassociation is culturally determined. A paradox exists whereby gender identity disorders are considered serious enough to warrant invasive treatment, yet are culturally determined as non-illnesses. The difference between 'two-spirit' and 'dissociative identity disorder' is all in the labelling, it seems.
While some activists will draw the false equivalence of the removal of homosexuality from the DSM, the crucial difference is that gay men demanded to be reclassified so that they would not be forced to take hormones or receive genital surgeries as corrective punishments. In the reclassification of gender identity disorder as gender dysphoria, those same corrective punishments were rebranded as 'gender affirmative health care'. As Chomsky noted, consent can be manufactured.
Jan 5, 2023·edited Jan 5, 2023Liked by Eliza Mondegreen
There are 3 major scandals which took years to resolve: 1. Lobotomies for treatment of depression, often in women. 2. Thalidomide as a mild sedative, caused deformation of limbs in the children whose mothers took it during pregnancy) 3. DES (Diethylsilbestriol) used to "prevent miscarriage" and then found to cause cervical cancer in the daughters in adulthood. All 3 disproportionately affected women and took decades to be debunked.
Lo and behold, trans ideology is disproportionately affecting women; trans widows like myself and girls who think they need to abandon female identity in puberty.
The medical profession is infused with male prejudices, even and especially in medicine affecting women. Here, I present the story of 2 trans widows who ended their lives, not told publicly anywhere else but Ute Heggen YouTube channel:
As for why these scandals take so long to see the light of day? Ritual conditioning and manipulation by those who profit. Hannah Arendt: the banality of evil Thanks, Eliza, for this discusssion
There will be others who offer more insight on the specific medical aspects. However, perhaps I could take a step back and come at this from another angle. Your question made me think of other scandals, or indeed any kind of 'craze' or even 'meme' that takes off.
What does that need to grow and survive?
Take for instance, the phenomenon of the 'Child Prodigy' (bear with me..).
What does it take for a Child Prodigy to thrive, and become famous? For instance - a musical prodigy. It isn't enough just to be talented. You actually need quite a number of things, and people in place: astonishing talent; supportive, driven parents; some money (e.g. for piano lessons); a public willing to listen, and revere the child; travel opportunities; connections. I'm thinking of Mozart, where all those elements were in place. There may well have been other prodigies at the time who we have never heard of, because some of those elemenst were missing.
Returning to the medical scandal, perhaps it's worth casting the net really wide and considering all the elements that need to be in place for such a scandal to grow, not just the narrow medical aspect.
We would need a huge variety of people to buy into it, spread the word, and not raise any awkward questions: Hospital doctors and nurses obviously, but also GPs, hospital administrators, educators, teachers, parents, marketing departments, journalists, bloggers, tweeters, actors, TV presenters, teenagers etc etc..
And crucially, the people who buy into it, who really believe in it, need to be in a position of either power or influence in society.
The more diverse the groups of believers, and the more influence they have, the better chance for the scandal to gain a wide foothold.
Even better if the true believers are those generally trusted, on whose authority and expertise we often depend and whom we don't generally question (Doctors, Teachers, Judges).
The experts provide the authority, the teenagers spread the word.
Leaders and footsoldiers. Priests and congregations
Our lives are generally better when we do trust those experts (doctors, teachers, judges),
but our unwillingness to question those authority figures can, occasionally, be disastrous.
It’s veering away from the topic a bit but I think that once you start campaigning it is hard to stop. So groups like Stonewall and the sense of historical outrage they and supporters felt at gay and lesbian treatment had to go somewhere. Bringing that back to the discussion, I would say that a scandal like this needs determination on the one hand and selective blindness on the other. This isn’t a mistake caused by a single under-tested drug, but a prolonged episode of collective hysteria, and I think that just as people are loath to challenge a doctor’s view, they are equally loath to challenge a lesbian or gay campaigners expression of injustice. Maybe that’s it, in this case, the “doctors” are the LGBT campaigners, diagnosing our children.
I am appreciating the thoughtful discussion below! I agree with the points on incentives, accountability, especially. Here is what I am struck by the Gender Identity movement/industry:
1. The lack of concern/investment on behalf of the government for its people, and I mean that in a non-idealistic way. I would think that a government, selfishly, would be invested in a healthy, well functioning populace. That would have implications for education, health, strong social bonds etc. That, at least in the US, there seems to be a decided exploitation of people - with profit overwhelmingly outweighing well-being, seems like a really bad long term strategy. Both the opioid crisis and this trans health business are shocking to me when considering what it means for the US' long term viability. What is a country if its people are addicted, sick, and isolated? Sure, that makes them manipulatable, and easier to control - but what kind of country operates on that basis?
2. The degree to which we are disembodied as a population. The Trans talking points are so nonsensical (e.g. men can be women, we can be born in the wrong body, extreme medicine and surgery can change one's sex) that for them to take root, people need to mistrust their own sense of reality. Having worked hard as an adult to be more embodied - the idea of wrong-sex hormones and the removal of healthy organs hits me in my gut and I can feel the horror of it. I imagine that if more of us could feel our own responses, there would be fewer buyers of this ideology. What is saddest to me about this is the vicious circle of it. The more we fuss with our connection to self, the less of a grip we have on our own experience, and the more we are susceptible to this or future manipulation. Essentially, GI is a pro-disembodiment movement.
Many medical scandals in the modern era are caused by greed on the part of doctors, hospitals, and manufacturers of medical equipment and drugs. The US health services system does not have enough checks and balances. Often times millions and billions of dollars are spent on procedures that have no efficacy and in fact cause harm. The FDA or the CMM folks don't discover it. Oftentimes, ethical physicians and/or government employees become whistleblowers. Even then, the companies or individuals get the equivalent of a slap.on the wrist. A company that has profitted several billions of dollars for equipment or drugs who is fined 10 million- it's the cost of doing business. We need to see companies going bankrupt and some folks going to prison. Our nation is too soft on white colkar crime and this is a major example of it. Sadly, many peoples' lives and health are sacrificed before these issues are cleared up. I do want to point out that I don't believe all docs are greedy. Even some of the professionals pushing dangerous drugs and procedures on children think they are helping them. The gold standard is randomized double blind placebo control studies. Instead, we are experimenting on children and not even keeping simple records or doing long term follow up. Follow the money.
You are familiar with the historical record and I am not. But here is my hypothesis.
Medical scandals flourish when there is no accountability. The medical community is self-regulating and cannot provide accountability for its own individual and collective actions. In the absence of accountability, the medical community will pursue its financial interests unchecked by any disincentives.
In our society, the available means for accountability is the legal system. If the legal system is not providing a check on medical practices, scandals will flourish.
Medical scandals are halted when the legal system provides accountability through lawsuits. The lawsuits provide the financial disincentives that change the financial calculus. The financial reward from continuing to pursue the scandalous practices must now be weighed against the financial risk of lawsuits.
My understanding is that this dynamic explains first the flourishing and then the termination of recovered memory syndrome. Consult the historical record of this and other evidence that
Beyond human fallibility, a top-down agenda makes a medical scandal like the scale of WPATH/trans gender ideology possible. Jennifer Bilek has already described the money path. As far as doctors and a fair amount of the public accepting it, I think there's a tendency for people, including professionals, to accept information from sources and people they trust without much, if any, question. I assume for most it's a shortcut to accept "mainstream" sources of information, but it can become a rabbit hole of accepting one false concept after another. When discrepancies appear, the choice is to accept cognitive dissonance or risk unraveling their belief system, in whole or part. Those who are not deceived and speak up are marginalized. Any time I see someone disagreeing with something, especially something medical, and they are denounced as if they are a blasphemer, I know we are dealing with a scandal/religion. Truth can bear scrutiny.
Looking back at the piece you linked at the top ("Who's going to write the history books?"), I don't think we can overestimate the impact of social media on all fronts of this issue. In terms of eventual accountability and whether there will be any retribution, we have receipts this time around and there are A LOT of angry parents who have gone through the hell of being forced to witness the medically- and socially-celebrated sterilization and mutilation of their beloved children, not to mention estrangement. We're not going to let this fade without a fight. In terms of how this contributed to the current scandal's rise and longevity, nothing compares to what influencers and SM sites have been able to accomplish or the power of the SM mob in terms of directing the MSM narrative.
This is probably the most interesting and informative comments section I’ve ever read--thanks to all who have contributed and thanks, Eliza, for creating such an environment. I’ve been struggling with strong feelings about this issue (a young woman I’ve known since childhood just had her breasts cut off). I’ve worried I’m falling into a pit of outrage, fear, and horror, never to climb out. But reading your work and now the thoughtful analytical commentary here is giving me hope and much constructive food for thought. Thank you, everyone!
The Gender Identity Medical scandal is part of a very big, very well-funded, very manipulative strategy develop by the slickest PR minds on the planet. It can't be viewed outside of that context. The Gender Cult has intentionally hitched a ride on popular causes (gay rights, fighting sexism, Black Lives Matter, etc.) It has pushed thru tons of laws quietly, taken over key organizations, created new ones. It has suppressed any and all voices of reason. My Hitchhiker's Guide lays out this Big Picture stage-setting for public willingness to ignore the nightmare of genital mutilation surgeries, puberty-blockages, etc: https://caroldansereau.substack.com/p/hitchhikers-guide-to-the-transgender
See also my exposé showing what's taught in schools: https://caroldansereau.substack.com/p/the-anti-science-disaster-of-gender Kids are told bald-faced lies about biology and they are taught that it is loving to embrace the Gender madness and hateful and bigoted to question it. They are told that "being yourself" is the noblest of goals and that trans identification is the ultimate authenticity. They are denied absolutely any information about the downsides of medicalization, and are led to believe that only bad people oppose it. This undermining of rationality has been happening in the schools for many many years now, with most people unaware of what's happening.
The conditions that made the Gender Identity medical scandal possible stem from the accumulation of wealth in the hands of the few.....while most people struggle to get by day to day. The ultra-wealthy (who own media outlets, elected officials, PR firms, and much more) can implement elaborate strategies to foster acceptance of whatever they want. Unless and until we demand and win true democracy...economic democracy...we can expect scandalous situations to thrive all around us.
Mechanical, materialistic cosmology based on abstract mathematics. Materialism is a belief system, and orthodox “science” authorities are its priesthood. The application of technology doesn’t equal “Science.” Most of what constitutes medical treatment is business, the application of medical technology for profit, so it seems to me that is why it is so exploitative of the population, from its acute expressions in repeated horrific scandals to the chronic ongoing litany of abuses committed by the medical industrial complex. I’m in the U.S.A. where it’s particularly obnoxious. Pro-Nature bodily association could perhaps be part of the solution? I keep contact with electronic devices within strict boundaries, as my particular strategy for combatting it, and am so very glad there are writers, professionals, and activists out there to draw strength from. ❤️
Made possible by broad support from our professional organizations (I’m a social worker/ therapist) and a cultural climate that favors the healthcare intervention in question. Also broad or intense & loud support for the group that is apparently being helped by the intervention. And of course, industry (profit) here in the US.
Eliza, I know at one point you were asking for articles on Facilitated Communication. I just read the most detailed piece I've ever read on this topic. It's the FC chapter in this book:
Chasing the Intact Mind: How the Severely Autistic and Intellectually Disabled Were Excluded from the Debates That Affect Them Most https://a.co/d/blbSGyd
I haven’t read “The body keeps the score” but it sounds anecdotal and for a large part just good storytelling. Please no more recovered memories or hidden trauma!
I believe in patriarchy and capitalism. And it to be at the core of this and many other problems. I think analyzing the world from this starting point anwers a lot of questions including yours. But its a lot of work. Especially the zeitgeist in which certain ideas flourished and why. But i think essentially we are on a constant spiral moving further and further away from humanity into more and more compartmentalization of the human experience. Each part of the experience being exploited as soon as its existence is discovered and gains a wider audience (this process being increasingly faster and faster). There is a constant predatory aspect and a submission and control aspect. Translated into the practical world i see the upbringing, the introduction of children into the world as we currently understand it at the core. There is no common ground at the heart of teaching but competition, no individuality but homogenization, no critical thinking but obedience, no equality but authority, no common understanding of goods but assembling of ownership, no finetuning into intuition but the body as a thing only to be understood by outside authorities.. these are all factors that later allow these specific problems to surface.
We live in a time where critical thinking and analysis seems to vanish. Thoughts and ideas are now a currency which prohibits further exploration before they are being shared.
Also there is the idea of the pendulum going back and forth. Looking back into history reveals often times that we were at similar stages before and then the pendulum swung back... within that momentum ideas to fix the specific problems at that time were listened to and in parts implemented. But never forever.. so its good to have good ideas, but they need to be spoken and heard at the right time.
But there are "markers" that let us examine where we stand as a human species. Those are the experiences of the "weakest" not new technologies.
So the implementation of "victims" experiences into any law that concerns their experience is a must, to be able to change things. The people that directly carry the consequences of each decision being made need to be equally on the table where decisions are being made. That means a redefinition of the word victim or the experience of victimhood and total abolishment of the practice of victim blaming in its entirety.
(2) "desire" having become the cornerstones of human rationality: this means that if a person desires to modify something about their healthy body, it is not considered a good thing to prevent that.
Great question. I've also been thinking about this a lot but still in formulation phase. Some rough sketches of social contagion generally.
- bystander effect (people seeing other people doing nothing)
- moralistic fervour taking over (people convinced they are on the right side will not respond to evidence against their view due to potency of 'religious' feeling.
- because above group has their identity intertwined with ideas, any challenge will be felt as an existential threat and resisted. Eg a surprising number of people in doomsday cults double down on beliefs even after embarrassing failure of world to end.
- Power of novelty. Humans have a bias towards novelty, fashions. Increased exposure to novelty naturally leads to gloss coming off and a new switch. In this respect articulating a new gender treatment could encourage a switch, or a new generation resisting previous ideas as passe. I feel identity markers such as the myriad of ever evolving pronouns, or even the underlying self-focus of current social media itself could become cool to resist for future generations.
- the allure of progress narratives, we want to think our society is progressing, for liberals this takes form of increasing acceptance, inclusion. Other medical treatments have progress of medicine narrative.
- four P's (Promoters, Press, Public, Politicians). These are the preconditions of financial bubbles but neatly capture the relevant domains. Various levers are being pulled here and now seems better than even 1 year ago. Obviously a cascade of these can occur on the way down as on the way up.
Underlying it all is ideas like Rene Girard's mimesis, where it becomes apparent how much of our beliefs are just looking to others, and work on social conformity/tribal belonging, where the cost to not confirming is a kind of existential death of identity and so is subconsciously avoided.
Poverty of thought, suppression of questions and discussion, focus on image over quality of care, politics, insurance companies tend to provide better coverage for medicalizing treatment (drugs, etc.) over talk therapy, over-worked and underpaid staff, insurance can also cause practitioners to over-diagnose or inappropriately diagnose in order to get services reimbursed.
Cutting out third party payers makes clinicians more likely to diagnose honestly. Encouraging diversity of thought in clinical settings is helpful. Compensating staff fairly and giving adequate time off goes a long way toward increasing quality of care.
The gender affirmative model has become institutionalized in our public school systems over the last 5 years …. It will change only if parents take back the reigns from schools, government, and medicine.
The nation and state works to codify the concept of the “transgender child” within school systems, suggesting parents don’t need to - or should not know - about their children’s gender dysphoria.
For example, in Illinois, the GA passed the Confidentiality Act in 2018, allowing children between the ages of 12-17 to be seen by a psychologist w/o parental consent for at least 5 times. Parents may not even discover their child is dysphoric until their child - with a doctor’s order - is ready for affirmative treatment.
Then our federal CDC - ignoring FERPA law - the last week of 2022 sends resources to all schools suggesting how to treat transgender students … and not tell parents. Suggesting all school staff must be “measured” or “assessed” for their degree of “inclusivity” of the “transgender child”.
Any adult who works with children in public schools now know they can not reveal to parents, but must affirm kids with pronouns and new names. Or they’ll lose their jobs.
The following relveals that I am not a medically trained person so not versed in the language and ideas.
Very glad you are doing this work. Abandoning the precautionary principle in favour of speed of delivery of a drug to save money, earn money, beat the competition, create a name for oneself and a company. As well as being affected in utero by Diethylstilbestrol (see link above), I was anorexic, that is, I had body dismorphia ... These days I am supposing it is actually much more difficult to go against the prevailing narrative i.e. what becomes the mob. Thank you for some very interesting posts about medics needing to affirm themselves through their patients.
Commenting a second time, I would summarise my answer as “when doctors stop being allowed to do their job”. In this case, they have been ousted by LGBT gender ‘specialists’, in the opioid crisis, doctors are pressurised into excessive pain relief, with thalidomide, doctors fell prey to pressure from big pharma (I think) and with the MMR / autism scandal, doctors were powerless in the face of media hysteria. Let doctors be doctors and do the doctoring they specialise in.
With the scandal surrounding Andrew Wakefield and his claims that the MMR vaccine caused autism, his original findings weren't able to be replicated. But by the time that was discovered, the media had pushed the story for years. Concerned parents didn't know what to believe. In 2004, evidence came out that Wakefield manipulated evidence. The paper was withdrawn completely in 2010. However, suspicious parents didn't care and still blamed MMR for causing autism despite evidence to the contrary. To this day, a significant number of people don't trust the vaccine.
Had Wakefield not connected with a media enthusiastic about spreading a scary story, then his malfeasance would have done no damage. If the public hadn't been so gullible and scientifically illiterate, then few people would have accepted his findings especially after they were called into question.
That whole story reminds me a lot about the distrust regarding COVID vaccines. Those stories were fed by a conservative media to a conservative audience who gullibly accepted whatever scary tale was told to them.
In both these cases, the scandal wasn't really stopped. The media largely moved on to other scary stories. But, a large section of the public continues to believe the nonsense. That's despite overwhelming evidence on the safety and efficacy of vaccines. That's despite hundreds of millions of people who have taken those vaccines first hand with typically no problems.
Fortunately, gender-affirming care is not a topic the media have spent a lot of time highlighting. Compared with the overall population, only a tiny percent of people have sought it out. Most people don't know or care about it. Lawsuits targeted to stop providers from offering the care may be enough to stop society from thinking about it altogether.
My cynical take is that this medical scandal will finally be brought to its knees when advocating for detransitioners becomes a popular way to virtue signal. We have to beat them at their own and redirect their "social justice" efforts to the real victims of medical harm.
The pelvic mesh scandal seemed to be related to medical devices that had been used for one thing then being used for another thing ‘on the nod’ with sometimes disastrous results. Other issues identified were defensiveness of surgeons, a lack of transparency about financial and other incentives received by doctors, poor recording of treatments and tracking of outcomes, poor handling of complaints etc. The IMMD Safety Review (Cumberlege Review) in the UK looked at safety of pelvic mesh and in two drugs and is a brilliant report - https://www.immdsreview.org.uk/Report.html
1. Patriarchy: Someone needs to serve the needs of their family and communities but women have said: “We’re not emotional support humans and draining ourselves like this emotionally and financially isn’t fair or sustainable. Men left the home in the Industrial Revolution, so why are we still stuck here. We’re done.” Which I love. But then if women lean half out at home so they can lean half in at work/personal development and achievement, men have to lean half out at work and lean half back in at home. Luckily many men disillusioned by unfulfilling work want to be more involved in their family and don’t want to be emotionally distant fathers who are expected to waste their life at their job all day, and are now “leaning out” of work and stepping back into home life in a way that is helping end the whole financial and societal power drain on women. The issue is that it is still hard to find those men who do love their careers and are willing to make any sacrifices to them to share career/home balance with their female spouse. Many men just refuse, forcing the woman totally into the home or totally out (where the family care is offloaded to poor women who then don’t get to care for their children at all). Hopefully if more men fight for work/life balance is, we can achieve the total destruction of the unnatural patriarchal “home vs public life” dichotomy that has imprisoned so many women, and we can create a gender-egalitarian society with more caring community from the ground (immediate family unit) up (nation). Anyone with mental illness or even just regular struggles needs unpaid care from family/friends/community and relying on beleaguered moms who have sacrificed their whole life’s worth of personal discover by and development to be therapists and doctors for their kids with no societal support isn’t sustainable. And kids who don’t have moms who have the time or money to do that just drift and attach themselves to whichever movement provides that care and community. 2. Capitalism. The issue in a competitive capitalist environment is that it isn’t lucrative to spend the proper amount of time and resources on mental health when you can just drain insecure and unbalanced people from their financial resources with an endless stream of material items (or procedures) that promise (but don’t deliver) happiness, beauty, confidence, power, youth, a sense of identity and purpose, etc.
I have a lot of thoughts on this because we have lived it and my daughter can tally about what happened.
1) A diagnosis or condition that is very difficult to treat, doesn’t have a clear treatment path, and/or doesn’t have a clearly understood cause. Lobotomies took hold because there were basically no effective treatments for severe mental illness; repressed memories because it’s hard (probably impossible) to pinpoint a single, concise, all-explaining cause for the general malaise and unhappiness that brought those women to the therapist; difficult to treat chronic pain and the opioid crisis; facilitated communication and the challenges of nonverbal autism; the explosion in gender dysphoria and affirmation provides an easy explanation for the very challenging cases of highly emotionally disregulated, anxious, depressed, self-harming, teen who is resisting and not responding to all the psych meds and hours of therapy they’re being treated with. Affirmation and the transition checklist provide a way forward and the short-term improvements (eothout considering the effects of placebo, getting what they want, love bombing, an instant community, sudden power and control over what is happening in their lives and the people around them) convinces the professionals they must be doing the right thing.
2) you need a cultural environment that makes believing in the treatment a moral issue. Opioid crisis: not treating the pain was a moral issue; repressed memories and the satanic panic: believe women, believe the children; gender identity : the new civil rights
3) Piggybacking on #1, I think you need a moral failure in the past. For lobotomies: the scandal of how badly people were being treated in asylums; opioids: people suffering and women and minorities not having their pain taking seriously; repressed memories and satanic panic: a history of ignoring child abuse; facilitated communication: a history of sending autistic children to asylums to be forgotten and abused; gender identity : the failures of psychiatry with gays and lesbians
4) There needs to be some level of institutional buy-in, even if it’s not complete. Colleges taught facilitated communication; police and DAs investigated, charged, and prosecuted daycare stories that were literally impossible; gender identity - basically every institution. This creates the chain of trust problem that Dr. Steven Levine has talked about.
5) Money may be part of it, but I don’t think money and greed create most scandals. I think money and greed just follow scandals as opportunities.
If you have not listened yet, I highly recommend the podcast series “Sold a Story.” Seriously, stop what you’re doing and start listening now. It’s about how a completely unproven method of teaching children to read has been promoted and used for years, with devastating costs and harms done to millions of children. It’s got every feature of a medical scandal but because it’s in a different context - education - it really helps you see these patterns because they’re not in narrative we expect.
I agree with the other comments wholeheartedly and also think the social environment is a big factor. Part of the issue causing the opioid epidemic was that doctors were getting bad reviews (both internally and from patients online) if they didn't control pain, so they went with opioids. I suspect some had doubts (not many since I think most doctors are by and large rule followers and straight-line thinkers), but the external pressure was significant enough to ignore those doubts.
In this case, we have huge social/political pressure (fear of reprisal and being branded a bad person, and the related professional and personal fallout). Hearing from gender clinicians — primarily gay men, there's a lot of correcting past injustices in terms of how gay men and boys were treated. Conversion therapy and the like, stories of being rejected by family. I haven't been in contact with lesbian clinicians, but I suspect there is overlap. This is personal for them, which blinds them to reality and critical thought.
There's also the issue of self-validation for LGBTQ+++ clinicians. Consciously or unconsciously, trans adults need trans kids to validate their issues as "born this way" immutable rather than as a fetish. Sick people sacrificing children for their own gain, like the glorious Rachel Levine.
The pediatrician who was secretly helping my kid take hormones is an edgy, GNC woman. I'm sure she believes the entire narrative and sees herself as a savior for my poor abused child. There is a lot of virtue-seeking/self-validation as a noble warrior. This requires actively ignoring anything to the contrary and is slightly different that the god complex.
I do think contemplating that you may have severely harmed vulnerable children keeps clinicians from even hearing anything critical of the Affirmative Care model, and is keeping this from crumbling long past its expiration date.
I think the overriding thing to remember is the "god complex" that many Drs have (or had) that they can fix things and are often resistant to feedback. Combine that with a medical need (morning sickness/contraception/mental illness) that an existing medication or new procedure can purport to address - so Thalidomide, Dalkon Shield, Dysphoria/teen angst and which initially seems to work. Then you have the $ and concern about admitting liability, coverup etc. What makes the gender stuff so crazy is that you have the entire gender ideology/queer theory movement in the mainstream non medical discourse. And the social contagion - women weren't taking Thalidomide cause they saw it on tiktok.
I think part of the dynamic is often that it’s harder to admit error in a medical context than many other contexts, because what error necessarily entails here is harm: illness, disfigurement, even death or risk thereof.
Hi Eliza, I work in a teaching hospital as a department director, serve on the ethics committee and the IRB, and I have one word for all of it:
Incentives.
Doctors, hospital administrators and corporate executives are, by definition, a well-educated bunch, and are going to lean liberal. What's the incentive, socially, to go against the collective progressive narrative? What's the disincentive to do so? When communities lean one way or another, the person farthest out on the left or the right gains status as being the most committed. (See: Congress, US, attempt to elect a Speaker.)
What's the financial incentive for watchful waiting rather than "sell drugs and procedures now?" Hint: it's surgeries that pay for hospitals to stay open.
Publish or perish: many medical residents or doctors doing fellowships are required to do research as part of their training. Professors- at medical school or other universities- have to publish or risk not getting tenure, funding, or promotions. Nobody wants to read "we don't know exactly what's going on, so watchful waiting is probably the most prudent approach for now." (That could apply to trans kids, some cardiac interventions, small tumors, all kinds of problems.) Journals want to publish positive results that confirm the biases of their communities- what's anybody's incentive not to publish results that grab attention and affirmation of being on the Right Side Of History? Nobody in the entire medical community- except the insurance companies- has an incentive not to take action.
As a white, middle-class, suburban or urban teenager, when the constant message is that cisgender white folks are at the top of the oppressor food chain, what's the incentive to not be just another cisgender white kid? What's your incentive, as a psychologist or physician, not to offer services to middle-class kids with good insurance? (It ain't Medicaid kids getting top surgery at 16.)
Hospitals are among the most intensely hierarchical organizations in the world, save perhaps the military and the Catholic Church. You're a middling doctor, what's your incentive here? To get noticed, to do something different, get on media, be something that the health system can advertise. You want to climb the ranks? Gotta get noticed by the higher-ups.
Drug companies. That's so obvious nothing more need be said.
IRB's - what's their incentive? To protect the institution from Federal censure, not actually to ask "is this research moral, or necessary, or congruent with a positive vision of humanity and society?" I've seen literally hundreds of studies designed to show a statistical improvement over current drugs or treatments, which often doesn't translate into meaningful clinical benefit. For example, a new drug gives a 5 or 8 percent improvement in survival time for a particular cancer- that's statistically great- but it might only mean another couple of weeks to live, perhaps with dire side effects, and great cost for the new drugs. All the incentives skew towards more treatment, more cost, more studies P-hacked to show some positive effect.
I'm not saying that people don't honestly believe they're doing the right thing. It's just that incentives can be a powerful motivator of confirmation bias and groupthink.
,
Refusal to run randomized control trials.
One component that plays a part in some scandals is that in the U.S. ( I don't know about elsewhere) the approval of new drugs is a highly-regulated process, but the introduction of new surgical techniques is unregulated. I think there may also be lower standards for implanted medical devices than drugs.
A defense of surgical procedures regulation
Mattia Andreoletti & Federico Bina
Theoretical Medicine and Bioethics volume 43, pages155–168 (2022)
Abstract
Since the advent of drug regulation in 1962, regulatory agencies have been in the practice of using strict standards to test the safety and efficacy of medical treatments and products. Regulatory agencies, such as the FDA, demand two full-fledged Randomized Clinical Trials demonstrating the safety and effectiveness of drugs to grant its marketing authorization. On the contrary, surgical treatments are left completely unregulated. There are several reasons explaining this difference, and all of them point to the difficulty of conducting well-designed RCTs in surgery...
https://link.springer.com/article/10.1007/s11017-022-09569-0
My perspective is as a retired nurse. I used to work on a cardiac stepdown unit where many patients received post-procedure care after receiving cardiac stents in same-day surgery - a procedure I later learned was often performed for no benefit on the basis of what turned out to be insufficient evidence.
I also worked briefly as a Surgical ICU nurse on a unit where for some reason I kept seeing back surgery patients who were often on their second and sometimes even their third surgery. I later stumbled across a terrific 2002 New Yorker article that explained the overuse of surgery to treat chronic back pain.
https://www.newyorker.com/magazine/2002/04/08/a-knife-in-the-back
While the focus of the article is not on a procedure that has become a scandal in the popular mind it does a great job of illuminating some of the underlying dynamics that prevents medicine from self-correction.
Dr. Atul Gawande also wrote a number of excellent articles that were published in the New Yorker years ago which touch on some of the dynamics at play in medical scandals.
For example;
Overkill
An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?
By Atul Gawande
May 4, 2015
https://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
The Cost Conundrum
What a Texas town can teach us about health care.
By Atul Gawande
May 25, 2009
https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum
This shows has an impoverished city in Texas became captured by a group of doctors that learned how to game the Medicare/Medicaid system for personal gain. (Compare the possible role of Medicaid payment and also Obamacare regulations on private payers for gender-affirming care???)
"Compared to El Paso, Gawande discovered that Medicare patients in McAllen received 40 percent more surgeries and two to three times as many pacemakers, cardiac bypass operations, carotid endarterectomies and coronary stents. Per-capita spending on home-health services was five times higher than in El Paso. Yet there was nothing to indicate that patients in McAllen were sicker or received more expensive services than Medicare recipients across the country—they just received more services."
https://insideangle.3m.com/his/blog-post/ten-years-after-the-cost-conundrum-how-much-has-changed/
I love your articles and tweets, and I'm aware you focus more on the social and psychological factors that drive demand. But I think that some of the factors that drive 'supply'/medical practice are relevant, too.
I'd also like to mention a very recent and I think very relevant medical scandal that has received very little attention - the overprescription of antipsychotics to children, especially impoverished children on Medicaid, and most especially children in foster care. I stumbled across this several years ago while looking for articles on the overuse of Ritalin in children.
Here's NPR in 2015 reporting that "In 2011, the federal Government Accounting Office found nearly 1 in 4 children in foster care was taking psychotropic medications, which include antipsychotics, antidepressants, mood stabilizers and stimulants.
Hundreds of children were found to be taking five or more psychotropic medications at a time, and thousands were prescribed doses that exceeded FDA-approved guidelines. "
https://www.npr.org/sections/health-shots/2015/10/08/446619645/calfornia-approves-laws-to-cut-use-of-antipsychotics-in-foster-care
"Very young kids also medicated: Hundreds of foster children 5 and younger have been prescribed psychotropics, although federal health officials say the drugs are not safe for the very young and other states actively discourage the practice. "
https://extras.mercurynews.com/druggedkids/index.html
I looked into this several years ago and don't have references to everything I read back then handy, but I did find a few now for evidence. But IIRC it became such a huge issue that it was officially investigated by both the federal government, several states, and Canada, and that states such as CA (and maybe Medicaid???) placed limits on doctors in a way that seems like it would be very relevant to the current 'Wild West' atmosphere of pediatric gender-affirming care. I'm thinking in particular of a doctor in Canada who has admitted to treating a large number of trans children who are in foster care, as well as an article I just read yesterday about how one of the poorest communities in England had the highest number of teenage girls referred to the Tavistock clinic.
https://www.courts.ca.gov/documents/BTB24-1G-12.pdf
https://unherd.com/2023/01/blackpools-forsaken-children/
https://www.dailynews.com/2016/08/13/californias-foster-care-prescribers-fuel-the-medication-of-vulnerable-kids-with-antipsychotics/
"Key Findings: Growth in antipsychotic use was evident across almost every diagnosis; however, most children taking antipsychotics (65%) were receiving them for diagnoses lacking regulatory approval for use, such as ADHD and conduct disorder."
https://policylab.chop.edu/project/understanding-and-addressing-antipsychotic-prescribing-practices-medicaid-enrolled-children
NYT's: Still in a Crib, Yet Being Given Antipsychotics
https://www.nytimes.com/2015/12/11/us/psychiatric-drugs-are-being-prescribed-to-infants.html
NYT's: This Teen Was Prescribed 10 Psychiatric Drugs. She’s Not Alone.
https://www.nytimes.com/2022/08/27/health/teens-psychiatric-drugs.html
Also, speaking of the pediatric Ritalin scandal 20 years ago, the role of the schools in driving that seems very relevant;
NYT's: SCHOOLS' BACKING OF BEHAVIOR DRUGS COMES UNDER FIRE
https://www.nytimes.com/2001/08/19/us/schools-backing-of-behavior-drugs-comes-under-fire.html
The Guardian: Schools forcing children to take drug, parents say
Health fears ignored as Ritalin prescriptions soar
https://www.theguardian.com/uk/2001/apr/22/tracymcveigh.theobserver
City educators are violating the law by banning students with behavior problems from schools if their parents refuse orders to give them Ritalin or other drugs, the head of a child-advocacy group charged yesterday.
Chaifetz said many parents call her office in a panic because they think the city’s Administration for Children Services will take custody of their kids.
https://nypost.com/2002/08/09/schools-pill-oried-parents-forced-to-drug-kids-activist/
I'd love to see you connect these recent pediatric medical scandals to the pediatric gender scandal. It's astonishing the antipsychotic scandal happened so recently (~2015) but has been so thoroughly memory-holed. While almost no members of the general public are aware of it, you'd think that pediatric medical associations, medical boards, etc. would remember this scandal and would be motivated to proceed more cautiously because of this in the present controversy. I often read Twitter comments comparing the present craze to the lobotomy scandal, but never these more recent scandals just 10-20 years ago.
Well, one obvious condition that makes medical scandals possible is when there is a path that is wide open for shrewd people to make money. Processes or laws need to be in place to stop greedy and exploitive people who are drawn to manipulating society, regardless of the harm done, to create wealth. Those people will always be among us. It's like tempting people to steal in a company by not having safeguarding processes and accountability around money. Without anti-polluting laws, people would pollute if they could turn a profit. It's the same with medical scandals, though the laws would be requiring rigorous scientific protocol as a safeguarding method.
I would add that I have noticed many commenters on the trans medical scandal have asserted that lawsuits are coming, and that this will halt the scandal. But I have found no one who is assessing the question, in a substantive way, why lawsuits have not been forthcoming until now, and what legal barriers may be preventing lawsuits in the future.
One issue, mentioned by Scott Neugent, who appeared in “What is a Woman,” is the lack of standards of care, which makes it prohibitively expensive to take cases on contingency.
Helen Lewis has said, if I recall correctly, that the problem is that the statutes of limitation are too short, compared to the length of time for regret to manifest into detransition.
If legal barriers are in fact preventing lawsuits, then the solution will be legislation that removes those barriers. This seems like a more effective approach than banning procedures outright, or otherwise regulating the medical community through legislation.
I think I understand what you mean by the "gender-affirming care" scandal, though most people would not see a scandal there. The idea that feeling like the opposite sex means that you should try to transition to the opposite sex (which isn't actually possible) is probably what you mean. The problem, as I have said before, is that transgender activists are using the same arguments that gays used to get their rights, but those arguments don't apply. Gay people are discriminated against because of their identity, and for no other reason. Trans people would have us believe that they are also discriminated against for their identity, but the situation is far more complicated than that. No one can prove that a gay man is not gay, or that he "chose" to be gay, so any discrimination against him is based on his identity. On the other hand, a man who feels like a woman (i.e., a trans woman) may believe that he is also being discriminated against because of his identity, but there is ample evidence that he is NOT an actual woman and therefore doesn't deserve the rights of women. Society needs to find a way to accept trans people as they are without pretending that reality is not what it is. Thus, let them behave as women in society, but not impinge on women's private spaces or other rights (rights which are based on sex). Even if we accept the idea of "gender identity", society needs to recognize that biological sex is what determines rights, not just the way people feel about themselves.
So that's my view, that the current situation is based on a misunderstanding of how rights should be determined. Biological sex is real. Gender identity is just a feeling.
(Note: My Substack site hasn't been launched yet.)
Lobbying the DSM-5 and ICD-11 editors to reclassify mental health conditions so that they no longer need to be addressed has made the current medical/surgical gender reassignment scandal possible.
As the DSM-5 states in the case of 'spirit possession', what is considered bodily disassociation is culturally determined. A paradox exists whereby gender identity disorders are considered serious enough to warrant invasive treatment, yet are culturally determined as non-illnesses. The difference between 'two-spirit' and 'dissociative identity disorder' is all in the labelling, it seems.
While some activists will draw the false equivalence of the removal of homosexuality from the DSM, the crucial difference is that gay men demanded to be reclassified so that they would not be forced to take hormones or receive genital surgeries as corrective punishments. In the reclassification of gender identity disorder as gender dysphoria, those same corrective punishments were rebranded as 'gender affirmative health care'. As Chomsky noted, consent can be manufactured.
There are 3 major scandals which took years to resolve: 1. Lobotomies for treatment of depression, often in women. 2. Thalidomide as a mild sedative, caused deformation of limbs in the children whose mothers took it during pregnancy) 3. DES (Diethylsilbestriol) used to "prevent miscarriage" and then found to cause cervical cancer in the daughters in adulthood. All 3 disproportionately affected women and took decades to be debunked.
Lo and behold, trans ideology is disproportionately affecting women; trans widows like myself and girls who think they need to abandon female identity in puberty.
The medical profession is infused with male prejudices, even and especially in medicine affecting women. Here, I present the story of 2 trans widows who ended their lives, not told publicly anywhere else but Ute Heggen YouTube channel:
https://www.youtube.com/watch?v=YQk0ekQKv84&t=1s
As for why these scandals take so long to see the light of day? Ritual conditioning and manipulation by those who profit. Hannah Arendt: the banality of evil Thanks, Eliza, for this discusssion
There will be others who offer more insight on the specific medical aspects. However, perhaps I could take a step back and come at this from another angle. Your question made me think of other scandals, or indeed any kind of 'craze' or even 'meme' that takes off.
What does that need to grow and survive?
Take for instance, the phenomenon of the 'Child Prodigy' (bear with me..).
What does it take for a Child Prodigy to thrive, and become famous? For instance - a musical prodigy. It isn't enough just to be talented. You actually need quite a number of things, and people in place: astonishing talent; supportive, driven parents; some money (e.g. for piano lessons); a public willing to listen, and revere the child; travel opportunities; connections. I'm thinking of Mozart, where all those elements were in place. There may well have been other prodigies at the time who we have never heard of, because some of those elemenst were missing.
Returning to the medical scandal, perhaps it's worth casting the net really wide and considering all the elements that need to be in place for such a scandal to grow, not just the narrow medical aspect.
We would need a huge variety of people to buy into it, spread the word, and not raise any awkward questions: Hospital doctors and nurses obviously, but also GPs, hospital administrators, educators, teachers, parents, marketing departments, journalists, bloggers, tweeters, actors, TV presenters, teenagers etc etc..
And crucially, the people who buy into it, who really believe in it, need to be in a position of either power or influence in society.
The more diverse the groups of believers, and the more influence they have, the better chance for the scandal to gain a wide foothold.
Even better if the true believers are those generally trusted, on whose authority and expertise we often depend and whom we don't generally question (Doctors, Teachers, Judges).
The experts provide the authority, the teenagers spread the word.
Leaders and footsoldiers. Priests and congregations
Our lives are generally better when we do trust those experts (doctors, teachers, judges),
but our unwillingness to question those authority figures can, occasionally, be disastrous.
It’s veering away from the topic a bit but I think that once you start campaigning it is hard to stop. So groups like Stonewall and the sense of historical outrage they and supporters felt at gay and lesbian treatment had to go somewhere. Bringing that back to the discussion, I would say that a scandal like this needs determination on the one hand and selective blindness on the other. This isn’t a mistake caused by a single under-tested drug, but a prolonged episode of collective hysteria, and I think that just as people are loath to challenge a doctor’s view, they are equally loath to challenge a lesbian or gay campaigners expression of injustice. Maybe that’s it, in this case, the “doctors” are the LGBT campaigners, diagnosing our children.
I am appreciating the thoughtful discussion below! I agree with the points on incentives, accountability, especially. Here is what I am struck by the Gender Identity movement/industry:
1. The lack of concern/investment on behalf of the government for its people, and I mean that in a non-idealistic way. I would think that a government, selfishly, would be invested in a healthy, well functioning populace. That would have implications for education, health, strong social bonds etc. That, at least in the US, there seems to be a decided exploitation of people - with profit overwhelmingly outweighing well-being, seems like a really bad long term strategy. Both the opioid crisis and this trans health business are shocking to me when considering what it means for the US' long term viability. What is a country if its people are addicted, sick, and isolated? Sure, that makes them manipulatable, and easier to control - but what kind of country operates on that basis?
2. The degree to which we are disembodied as a population. The Trans talking points are so nonsensical (e.g. men can be women, we can be born in the wrong body, extreme medicine and surgery can change one's sex) that for them to take root, people need to mistrust their own sense of reality. Having worked hard as an adult to be more embodied - the idea of wrong-sex hormones and the removal of healthy organs hits me in my gut and I can feel the horror of it. I imagine that if more of us could feel our own responses, there would be fewer buyers of this ideology. What is saddest to me about this is the vicious circle of it. The more we fuss with our connection to self, the less of a grip we have on our own experience, and the more we are susceptible to this or future manipulation. Essentially, GI is a pro-disembodiment movement.
Many medical scandals in the modern era are caused by greed on the part of doctors, hospitals, and manufacturers of medical equipment and drugs. The US health services system does not have enough checks and balances. Often times millions and billions of dollars are spent on procedures that have no efficacy and in fact cause harm. The FDA or the CMM folks don't discover it. Oftentimes, ethical physicians and/or government employees become whistleblowers. Even then, the companies or individuals get the equivalent of a slap.on the wrist. A company that has profitted several billions of dollars for equipment or drugs who is fined 10 million- it's the cost of doing business. We need to see companies going bankrupt and some folks going to prison. Our nation is too soft on white colkar crime and this is a major example of it. Sadly, many peoples' lives and health are sacrificed before these issues are cleared up. I do want to point out that I don't believe all docs are greedy. Even some of the professionals pushing dangerous drugs and procedures on children think they are helping them. The gold standard is randomized double blind placebo control studies. Instead, we are experimenting on children and not even keeping simple records or doing long term follow up. Follow the money.
You are familiar with the historical record and I am not. But here is my hypothesis.
Medical scandals flourish when there is no accountability. The medical community is self-regulating and cannot provide accountability for its own individual and collective actions. In the absence of accountability, the medical community will pursue its financial interests unchecked by any disincentives.
In our society, the available means for accountability is the legal system. If the legal system is not providing a check on medical practices, scandals will flourish.
Medical scandals are halted when the legal system provides accountability through lawsuits. The lawsuits provide the financial disincentives that change the financial calculus. The financial reward from continuing to pursue the scandalous practices must now be weighed against the financial risk of lawsuits.
My understanding is that this dynamic explains first the flourishing and then the termination of recovered memory syndrome. Consult the historical record of this and other evidence that
Beyond human fallibility, a top-down agenda makes a medical scandal like the scale of WPATH/trans gender ideology possible. Jennifer Bilek has already described the money path. As far as doctors and a fair amount of the public accepting it, I think there's a tendency for people, including professionals, to accept information from sources and people they trust without much, if any, question. I assume for most it's a shortcut to accept "mainstream" sources of information, but it can become a rabbit hole of accepting one false concept after another. When discrepancies appear, the choice is to accept cognitive dissonance or risk unraveling their belief system, in whole or part. Those who are not deceived and speak up are marginalized. Any time I see someone disagreeing with something, especially something medical, and they are denounced as if they are a blasphemer, I know we are dealing with a scandal/religion. Truth can bear scrutiny.
Looking back at the piece you linked at the top ("Who's going to write the history books?"), I don't think we can overestimate the impact of social media on all fronts of this issue. In terms of eventual accountability and whether there will be any retribution, we have receipts this time around and there are A LOT of angry parents who have gone through the hell of being forced to witness the medically- and socially-celebrated sterilization and mutilation of their beloved children, not to mention estrangement. We're not going to let this fade without a fight. In terms of how this contributed to the current scandal's rise and longevity, nothing compares to what influencers and SM sites have been able to accomplish or the power of the SM mob in terms of directing the MSM narrative.
This is probably the most interesting and informative comments section I’ve ever read--thanks to all who have contributed and thanks, Eliza, for creating such an environment. I’ve been struggling with strong feelings about this issue (a young woman I’ve known since childhood just had her breasts cut off). I’ve worried I’m falling into a pit of outrage, fear, and horror, never to climb out. But reading your work and now the thoughtful analytical commentary here is giving me hope and much constructive food for thought. Thank you, everyone!
The Gender Identity Medical scandal is part of a very big, very well-funded, very manipulative strategy develop by the slickest PR minds on the planet. It can't be viewed outside of that context. The Gender Cult has intentionally hitched a ride on popular causes (gay rights, fighting sexism, Black Lives Matter, etc.) It has pushed thru tons of laws quietly, taken over key organizations, created new ones. It has suppressed any and all voices of reason. My Hitchhiker's Guide lays out this Big Picture stage-setting for public willingness to ignore the nightmare of genital mutilation surgeries, puberty-blockages, etc: https://caroldansereau.substack.com/p/hitchhikers-guide-to-the-transgender
See also my exposé showing what's taught in schools: https://caroldansereau.substack.com/p/the-anti-science-disaster-of-gender Kids are told bald-faced lies about biology and they are taught that it is loving to embrace the Gender madness and hateful and bigoted to question it. They are told that "being yourself" is the noblest of goals and that trans identification is the ultimate authenticity. They are denied absolutely any information about the downsides of medicalization, and are led to believe that only bad people oppose it. This undermining of rationality has been happening in the schools for many many years now, with most people unaware of what's happening.
The conditions that made the Gender Identity medical scandal possible stem from the accumulation of wealth in the hands of the few.....while most people struggle to get by day to day. The ultra-wealthy (who own media outlets, elected officials, PR firms, and much more) can implement elaborate strategies to foster acceptance of whatever they want. Unless and until we demand and win true democracy...economic democracy...we can expect scandalous situations to thrive all around us.
Mechanical, materialistic cosmology based on abstract mathematics. Materialism is a belief system, and orthodox “science” authorities are its priesthood. The application of technology doesn’t equal “Science.” Most of what constitutes medical treatment is business, the application of medical technology for profit, so it seems to me that is why it is so exploitative of the population, from its acute expressions in repeated horrific scandals to the chronic ongoing litany of abuses committed by the medical industrial complex. I’m in the U.S.A. where it’s particularly obnoxious. Pro-Nature bodily association could perhaps be part of the solution? I keep contact with electronic devices within strict boundaries, as my particular strategy for combatting it, and am so very glad there are writers, professionals, and activists out there to draw strength from. ❤️
Made possible by broad support from our professional organizations (I’m a social worker/ therapist) and a cultural climate that favors the healthcare intervention in question. Also broad or intense & loud support for the group that is apparently being helped by the intervention. And of course, industry (profit) here in the US.
Eliza, I know at one point you were asking for articles on Facilitated Communication. I just read the most detailed piece I've ever read on this topic. It's the FC chapter in this book:
Chasing the Intact Mind: How the Severely Autistic and Intellectually Disabled Were Excluded from the Debates That Affect Them Most https://a.co/d/blbSGyd
I haven’t read “The body keeps the score” but it sounds anecdotal and for a large part just good storytelling. Please no more recovered memories or hidden trauma!
I believe in patriarchy and capitalism. And it to be at the core of this and many other problems. I think analyzing the world from this starting point anwers a lot of questions including yours. But its a lot of work. Especially the zeitgeist in which certain ideas flourished and why. But i think essentially we are on a constant spiral moving further and further away from humanity into more and more compartmentalization of the human experience. Each part of the experience being exploited as soon as its existence is discovered and gains a wider audience (this process being increasingly faster and faster). There is a constant predatory aspect and a submission and control aspect. Translated into the practical world i see the upbringing, the introduction of children into the world as we currently understand it at the core. There is no common ground at the heart of teaching but competition, no individuality but homogenization, no critical thinking but obedience, no equality but authority, no common understanding of goods but assembling of ownership, no finetuning into intuition but the body as a thing only to be understood by outside authorities.. these are all factors that later allow these specific problems to surface.
We live in a time where critical thinking and analysis seems to vanish. Thoughts and ideas are now a currency which prohibits further exploration before they are being shared.
Also there is the idea of the pendulum going back and forth. Looking back into history reveals often times that we were at similar stages before and then the pendulum swung back... within that momentum ideas to fix the specific problems at that time were listened to and in parts implemented. But never forever.. so its good to have good ideas, but they need to be spoken and heard at the right time.
But there are "markers" that let us examine where we stand as a human species. Those are the experiences of the "weakest" not new technologies.
So the implementation of "victims" experiences into any law that concerns their experience is a must, to be able to change things. The people that directly carry the consequences of each decision being made need to be equally on the table where decisions are being made. That means a redefinition of the word victim or the experience of victimhood and total abolishment of the practice of victim blaming in its entirety.
Conditions: (1) medicine that makes a profit.
(2) "desire" having become the cornerstones of human rationality: this means that if a person desires to modify something about their healthy body, it is not considered a good thing to prevent that.
Conditions to stop it... No idea.
Great question. I've also been thinking about this a lot but still in formulation phase. Some rough sketches of social contagion generally.
- bystander effect (people seeing other people doing nothing)
- moralistic fervour taking over (people convinced they are on the right side will not respond to evidence against their view due to potency of 'religious' feeling.
- because above group has their identity intertwined with ideas, any challenge will be felt as an existential threat and resisted. Eg a surprising number of people in doomsday cults double down on beliefs even after embarrassing failure of world to end.
- Power of novelty. Humans have a bias towards novelty, fashions. Increased exposure to novelty naturally leads to gloss coming off and a new switch. In this respect articulating a new gender treatment could encourage a switch, or a new generation resisting previous ideas as passe. I feel identity markers such as the myriad of ever evolving pronouns, or even the underlying self-focus of current social media itself could become cool to resist for future generations.
- the allure of progress narratives, we want to think our society is progressing, for liberals this takes form of increasing acceptance, inclusion. Other medical treatments have progress of medicine narrative.
- four P's (Promoters, Press, Public, Politicians). These are the preconditions of financial bubbles but neatly capture the relevant domains. Various levers are being pulled here and now seems better than even 1 year ago. Obviously a cascade of these can occur on the way down as on the way up.
Underlying it all is ideas like Rene Girard's mimesis, where it becomes apparent how much of our beliefs are just looking to others, and work on social conformity/tribal belonging, where the cost to not confirming is a kind of existential death of identity and so is subconsciously avoided.
Poverty of thought, suppression of questions and discussion, focus on image over quality of care, politics, insurance companies tend to provide better coverage for medicalizing treatment (drugs, etc.) over talk therapy, over-worked and underpaid staff, insurance can also cause practitioners to over-diagnose or inappropriately diagnose in order to get services reimbursed.
Cutting out third party payers makes clinicians more likely to diagnose honestly. Encouraging diversity of thought in clinical settings is helpful. Compensating staff fairly and giving adequate time off goes a long way toward increasing quality of care.
The gender affirmative model has become institutionalized in our public school systems over the last 5 years …. It will change only if parents take back the reigns from schools, government, and medicine.
The nation and state works to codify the concept of the “transgender child” within school systems, suggesting parents don’t need to - or should not know - about their children’s gender dysphoria.
For example, in Illinois, the GA passed the Confidentiality Act in 2018, allowing children between the ages of 12-17 to be seen by a psychologist w/o parental consent for at least 5 times. Parents may not even discover their child is dysphoric until their child - with a doctor’s order - is ready for affirmative treatment.
https://www.isba.org/sections/mentalhealth/newsletter/2018/06/childrenandmentalhealthlaw
And the IL State Board of Education in “non-regulatory guidance” 2020 suggests as well that schools can keep such information from parents.
https://www.isbe.net/Documents/ISBE-Guidance-Supporting-Transgender-Nonbinary-Gender-Nonconforming-Students.pdf
Then in 2021-22, Chicago’s Lurie Children’s visits schools to train teachers how to treat transgender children … and to not tell parents.
https://www.lths.net/cms/lib/IL01904810/Centricity/ModuleInstance/759/Gender%20Development%20Presentation.pdf
Then our federal CDC - ignoring FERPA law - the last week of 2022 sends resources to all schools suggesting how to treat transgender students … and not tell parents. Suggesting all school staff must be “measured” or “assessed” for their degree of “inclusivity” of the “transgender child”.
https://www.cdc.gov/healthyyouth/disparities/mai/pdf/LGBTQ_Inclusivity-508.pdf?s_cid=tw-zaza-1364
Any adult who works with children in public schools now know they can not reveal to parents, but must affirm kids with pronouns and new names. Or they’ll lose their jobs.
Restated: consult the historical record of this scandal, and other medical scandals for evidence that either supports or contradicts this hypothesis.
https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/des-fact-sheet
The following relveals that I am not a medically trained person so not versed in the language and ideas.
Very glad you are doing this work. Abandoning the precautionary principle in favour of speed of delivery of a drug to save money, earn money, beat the competition, create a name for oneself and a company. As well as being affected in utero by Diethylstilbestrol (see link above), I was anorexic, that is, I had body dismorphia ... These days I am supposing it is actually much more difficult to go against the prevailing narrative i.e. what becomes the mob. Thank you for some very interesting posts about medics needing to affirm themselves through their patients.
Commenting a second time, I would summarise my answer as “when doctors stop being allowed to do their job”. In this case, they have been ousted by LGBT gender ‘specialists’, in the opioid crisis, doctors are pressurised into excessive pain relief, with thalidomide, doctors fell prey to pressure from big pharma (I think) and with the MMR / autism scandal, doctors were powerless in the face of media hysteria. Let doctors be doctors and do the doctoring they specialise in.
With the scandal surrounding Andrew Wakefield and his claims that the MMR vaccine caused autism, his original findings weren't able to be replicated. But by the time that was discovered, the media had pushed the story for years. Concerned parents didn't know what to believe. In 2004, evidence came out that Wakefield manipulated evidence. The paper was withdrawn completely in 2010. However, suspicious parents didn't care and still blamed MMR for causing autism despite evidence to the contrary. To this day, a significant number of people don't trust the vaccine.
Had Wakefield not connected with a media enthusiastic about spreading a scary story, then his malfeasance would have done no damage. If the public hadn't been so gullible and scientifically illiterate, then few people would have accepted his findings especially after they were called into question.
That whole story reminds me a lot about the distrust regarding COVID vaccines. Those stories were fed by a conservative media to a conservative audience who gullibly accepted whatever scary tale was told to them.
In both these cases, the scandal wasn't really stopped. The media largely moved on to other scary stories. But, a large section of the public continues to believe the nonsense. That's despite overwhelming evidence on the safety and efficacy of vaccines. That's despite hundreds of millions of people who have taken those vaccines first hand with typically no problems.
Fortunately, gender-affirming care is not a topic the media have spent a lot of time highlighting. Compared with the overall population, only a tiny percent of people have sought it out. Most people don't know or care about it. Lawsuits targeted to stop providers from offering the care may be enough to stop society from thinking about it altogether.
My cynical take is that this medical scandal will finally be brought to its knees when advocating for detransitioners becomes a popular way to virtue signal. We have to beat them at their own and redirect their "social justice" efforts to the real victims of medical harm.
The pelvic mesh scandal seemed to be related to medical devices that had been used for one thing then being used for another thing ‘on the nod’ with sometimes disastrous results. Other issues identified were defensiveness of surgeons, a lack of transparency about financial and other incentives received by doctors, poor recording of treatments and tracking of outcomes, poor handling of complaints etc. The IMMD Safety Review (Cumberlege Review) in the UK looked at safety of pelvic mesh and in two drugs and is a brilliant report - https://www.immdsreview.org.uk/Report.html
A comment in the BMJ here
https://www.bmj.com/content/370/bmj.m3099
Sorry if this has already been mentioned in the comments
1. Patriarchy: Someone needs to serve the needs of their family and communities but women have said: “We’re not emotional support humans and draining ourselves like this emotionally and financially isn’t fair or sustainable. Men left the home in the Industrial Revolution, so why are we still stuck here. We’re done.” Which I love. But then if women lean half out at home so they can lean half in at work/personal development and achievement, men have to lean half out at work and lean half back in at home. Luckily many men disillusioned by unfulfilling work want to be more involved in their family and don’t want to be emotionally distant fathers who are expected to waste their life at their job all day, and are now “leaning out” of work and stepping back into home life in a way that is helping end the whole financial and societal power drain on women. The issue is that it is still hard to find those men who do love their careers and are willing to make any sacrifices to them to share career/home balance with their female spouse. Many men just refuse, forcing the woman totally into the home or totally out (where the family care is offloaded to poor women who then don’t get to care for their children at all). Hopefully if more men fight for work/life balance is, we can achieve the total destruction of the unnatural patriarchal “home vs public life” dichotomy that has imprisoned so many women, and we can create a gender-egalitarian society with more caring community from the ground (immediate family unit) up (nation). Anyone with mental illness or even just regular struggles needs unpaid care from family/friends/community and relying on beleaguered moms who have sacrificed their whole life’s worth of personal discover by and development to be therapists and doctors for their kids with no societal support isn’t sustainable. And kids who don’t have moms who have the time or money to do that just drift and attach themselves to whichever movement provides that care and community. 2. Capitalism. The issue in a competitive capitalist environment is that it isn’t lucrative to spend the proper amount of time and resources on mental health when you can just drain insecure and unbalanced people from their financial resources with an endless stream of material items (or procedures) that promise (but don’t deliver) happiness, beauty, confidence, power, youth, a sense of identity and purpose, etc.
yes, often unbelievable in retrospect. (... repeating many points made by others)
enabling factors:
1. therapy gives clear & 'desired' result.
(eg. opioids, hormones/blockers, thalidomide, (?)valproate: see Sean Lintern pieces)
2. 'off-label' prescribing normalized, without oversight or research (GnRH agonists)
3. safety/efficacy & professional approval (thalidomide), or illusion of same (GnRHa)
4. medically or socially vulnerable patient group: pregnant women (thalidomide, valproate,
puerperal fever in 1800's); teenagers (GnRHa, Magdalene laundries etc.).
5. belief: elegant/expensive lab studies, pandemic hopes, ideology, urgent need.
eg. molnupiravir (antiviral) looked great in lab studies, proved largely ineffective in more recent
Covid clinical trials; possible waste of $Billions, with potential danger of creating new variants.
6. profit & medical prestige. eg. 1980's discovery that stomach ulcers are often due to bacterial
infections: v. slowly acknowledged (treatments got cheaper & textbooks re-written).
but faster than recognition of puerperal fever as a hospital-transmitted infection in 1800's.
7. media aversity to 'niche' (women's health) or 'toxic' (trans) issues.
8. magic unicorns: objective studies and follow-ups are optional !
9. language denying basic humanity (eg. untermensch, fallen women), or basic aspects of humanity
(avoiding or redefining 'sex', 'male/female' & 'fertility', where these basic concepts are necessary),
due to puritanism, kindness, ideology or style guides.
10. 'gender-is-performative' and '... sounds transphobic': two up-market soundbites that protect flaky
ideas from outright ridicule by our elite opinion-formers in the performing arts, media/politics,
academia/medicine and science journalism.
prevention:
1. independent, transparent clinical trials, & follow-ups.
2. determined & persistent individuals: clinicians, researchers, journalists, campaigners.
(eg. thalidomide, opioids, helicobacter)