Quotulatiousness

October 18, 2024

Accidentally creating an epidemic of food allergies, from the best of intentions

Filed under: Food, Health, Media, USA — Tags: , , , , , — Nicholas @ 03:00

Jon Miltimore discusses how the unintentional outcome of professional organizations making recommendations to the public without proper scientific understanding created so many of the allergies that now plague youngsters:

“Peanuts, LEAP study (Learning Early About Peanut allergy)” by jlcampbell104 is marked with Public Domain Mark 1.0 .

In 1992, with the help of a grant from the National Institutes of Health, The New England Journal of Medicine published a report on a rare phenomenon: fatal or near-fatal anaphylactic reactions in young people due to food allergies.

Examining a period of 14 months, researchers identified thirteen cases, twelve of which involved asthmatic youths. Six of the thirteen anaphylactic reactions resulted in death, and each case had involved a young person with a known food allergy who had unknowingly ingested the food.

“The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry,” researchers wrote.

The paper said nothing about banning these foods, but concluded that “failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome”.

Nevertheless, food bans followed, and the Centers for Disease Control and Prevention (CDC) began to encourage educators to “consider possible food allergies” during food preparation.

By 1998, the New York Times was reporting on the rise of peanut allergies and the measures school districts were taking to stop them.

“Prodded by parents warning of lethal allergies, by the contentions of some researchers that peanut allergies are on the rise and, not least, by a fear of litigation, growing numbers of public and private schools across the country, including many of New York City’s most selective independent schools, have banned peanut butter from their cafeterias,” wrote Anemona Maria Hartocollis.

“The Biggest Misconception”

When the Times published its article in 1998, the American Academy of Pediatrics (AAP) was not yet issuing recommendations about peanuts or food allergies in infants. But as public concern grew, they decided they had to offer guidelines of some kind.

“There was just one problem,” Marty Makary, a Johns Hopkins University surgeon, noted in a recent Wall Street Journal op-ed. “Doctors didn’t actually know what precautions, if any, parents should take.”

Instead of remaining mum, the AAP followed the lead of the United Kingdom’s Committee on Toxicology and recommended that mothers avoid peanuts during pregnancy and lactation, and that children avoid peanuts until the age of 3.

The decision to make such a sweeping decision in the absence of compelling scientific evidence was a mistake, allergists say, and runs counter to basic immunology.

Dr. Gideon Lack, an allergist at King’s College London, says the collective effort to cocoon children from peanuts and other foods is responsible for what has been described as a “food allergy epidemic”.

The data suggest Lack is right.

In the 25 years since the AAP issued its recommendation, the US (like the UK, which also advised peanut avoidance) has experienced an explosion of food allergies, especially peanut allergies. Data from Mount Sinai Hospital System in New York show that peanut allergies more than tripled in the decade and a half following the AAP’s guidance. In 1997, peanut allergies affected 1 in 250 children in the United States. By 2002, this rate had risen to 1 in 125, and by 2008, it reached 1 in 70 children.

Anecdotally, I only remember one kid in my middle school who had food allergies … and poor Rusty had ’em all. He was known as the “Kid with a thousand allergies” and had to be so careful of what he ate and even what he touched. but this was the mid-1970s and there weren’t formal school guidelines on what we could bring in our school lunch bags or use scented things like deodorant. (It was the 1970s, and a lot of us were just hitting puberty and many of my classmates were new Canadians from poorer countries … we needed the deodorant!)

June 10, 2024

The FDA has a jaundiced view of psychotherapy involving the use of MDMA (aka “Ecstasy”)

Filed under: Bureaucracy, Government, Health, USA — Tags: , , , — Nicholas @ 03:00

Colby Cosh indulges in a minor “I told you so” after the FDA’s expert panel recommended against the agency permitting any medical use of MDMA, despite some experiments indicating it does have therapeutic value:

Ball-and-stick model of the 3,4-methylenedioxy-methamphetamine molecule, also known as MDMA, or ecstasy, a well-known psychoactive drug. Based on the crystal structure of MDMA hydrochloride, as determined by X-ray diffraction.
Color code: Carbon, C: black, Hydrogen, H: white, Oxygen, O: red, Nitrogen, N: blue.
Image by Jynto via Wikimedia Commons.

Hopes for research into therapeutic uses of psychedelic drugs received a setback last week, one that your correspondent saw tripping (geddit?) up the road in advance. An expert panel published its official advice to the United States Food and Drug Administration (FDA) on permitting medical use of MDMA, the synthetic nightclub enhancer that we’re afraid the kids probably still aren’t calling “ecstasy” or “molly”.

There is long-recognized potential for MDMA to be combined with classical psychotherapy in treating emotional disorders, notably post-traumatic stress (PTSD), and now there are some small, limited studies showing evidence of positive effects.

But the FDA’s scientists weren’t very impressed with this evidence, and they voted almost unanimously against creating a therapeutic exception to the illegality of ecstasy, which the U.S. Controlled Substances Act classifies as a “Schedule 1” drug, right next to heroin. The panel’s advice isn’t binding on the agency, which is crawling in somewhat good faith toward recognizing the understudied medical potential of psychedelics. But the vote emphasizes the inherent problems that drugs face, once they are defined in law as “recreational”, in winning over skeptical scientists.

Reason magazine’s great drug-war correspondent Jacob Sullum has a thorough discussion of the issues. The existing research, despite some impressive headline results, has garden-variety issues with dropout rates, follow-ups and occasional researcher shenanigans. But the big problem, which defies easy technical solution, is with scientific blinding of the research subjects.

Scientific trials of the modern kind are predicated upon separating illusory placebo effects from genuine treatment effects. Researchers expect that a high-quality study will have a control group that receives sham treatment or none at all, and good practice requires that experimenters and their guinea pigs are both blind to who is in what group.

News flash: most people can tell whether they’ve been really given a psychedelic drug. Indeed, most doctors can tell whether they’ve given a patient a genuine psychedelic drug, and how much of it. Many placebo-controlled trials on psychoactive drugs, perhaps most of them, thus suffer from an alleged problem of broken blinding. (Have a glance, for example, at Table 2 in this review of blinding procedures in psychedelic studies.)

May 24, 2024

Bernie Sanders finally finds a group of rich people who he thinks shouldn’t have to pay

Filed under: Business, Europe, Government, Health, Politics, USA — Tags: , , , , , , — Nicholas @ 04:00

As Tim Worstall points out, Bernie Sanders’ latest campaign is starkly at odds with his usual “make the rich pay” schtick:

“Bernie Sanders” by Gage Skidmore is licensed under CC BY-SA 2.0 .

It’s possible to think that Bernie Sanders, Senator that he is, is more than a little confused. Well, he’d not be the first elderly politician to suffer that fate. Nor the first socialist. It is necessary for me to be fair here though — one of his honeymoons he took in the Soviet Union. Which makes perfect sense to me — after all, there was bugger all else to do there other than your own wife.

However, here we’ve got him complaining about the cost of the new miracle drugs:

    Bernie Sanders has urged Denmark to rein in its most valuable company, Novo Nordisk, and force it to slash prices on popular weight loss and diabetes treatments Ozempic and Wegovy, taking his fight to lower “outrageously high” drug prices in the United States to the company’s doorstep as its profits soar amid ongoing struggles to meet booming appetite for the revolutionary drugs.

Hmm, dunno how well that’s going to work with the Danes really. Yes, to some extent they’re milder than when they tried to rape and pillage the entirety of Europe but not wholly. My brother worked out in Afghanistan (feeding the troops) and he had a Danish unit rotate through. So he tells me their senior sergeant type carried a double bladed axe on his backpack — it didn’t come back clean from every patrol either. They’re not all equality and gender rights these days, you know?

So, we can imagine a certain portion at least of the Danish population celebrating this rapine of Medicare’s pockets by the simple expedient of selling a weight loss drug that actually works — which is, when we come to think of it, something of an innovation. Fen-Fen didn’t work after all. Hey, you know, Vinland failed but we’ll get ’em this time? We’re charging high prices because we can?

A second pass at the argument would be that the drugs are in fact incredibly cheap. When it was shown that the same drug — semaglutide — works in stopping (that’s “stopping” as in ceased, stopped, dead, like Bernie’s career would if it were ever proven he had taken part in an act of voluntary capitalism) chronic kidney disease. So much so that the very day they announced the trials on the drug were being stopped a year early, so obvious was the success, the share prices of all the dialysis provision companies dropped 20 and 30%. That is, at near whatever price, this drug is a money saver. Which is, you know, good. J Foreigner turns up with this thing that saves America, Americans, lives and money and yet Bernie whines — so like a socialist, eh? Capitalism with markets makes us the humans who are living highest on the hog, ever, but they really never do stop whining about it, do they?

But Bernie’s real complaint is that Americans are paying more to burn off the cheeseburgers than everyone else has to. But from everything else Bernie says about anything at all this is at it should be — the rich should pay.

Back to our basics. The basic drug development problem is that the development of a drug is a public goods problem. It costs $2 billion to get a drug through the FDA and gain approval to actually sell it. Yes, of course we should slaughter much of the regulation that makes it cost that much (personally, against character type, I only recommend capture and humane release for the actual bureaucrats) but that’s another matter. It does. But if everyone can just copy the drug at that point then no one will spend $2 billion. So, OK, patents, so the developers have a decade (the patent is two decades, it takes a decade to gain approval) to make their $2 billion back then anyone can copy it. The price falls to manufacturing cost plus normal profit level and we’re about as good as we can get. This is not a perfect system but for mass market drugs it’s about as good as we’re going to get.

April 15, 2024

Is “Big Trans” in retreat?

Filed under: Health, Media, Politics, USA — Tags: , , , , — Nicholas @ 04:00

In the latest Weekly Dish, Andrew Sullivan considers just how much things have changed in recent years, especially with the publication of the Cass Report on the true medical situation for children being prescribed puberty blocking or opposite sex hormones … and it really doesn’t match the rhetoric we’ve been hearing from activists over the last few years:

Tribalization does funny things to people. If you’d told me a decade ago that within a few years, Republicans would be against Ukraine defending itself from a Russian invasion, and Democrats would be pulling the Full Churchill to counter the Kremlin, I’d have gently asked what sativa strain you were smoking.

If you’d told me the Democrats would soon be the party most protective of the CIA and the FBI, and that Republicans would regard them as part of an evil “deep state,” ditto. And who would have thought that a president accused in 2017 of having “no real ideology [but] white supremacy” would today be doubling his support with black voters, and tripling it with black men? Who would have bet the Dems would go all-in on Big Pharma when it came to Covid vaccines? And who would have thought Republicans who long carried little copies of the Constitution in their suit pockets would lead a riot to prevent the peaceful transfer of power? You live and learn.

But would anyone have predicted that the Democrats and the left in general would soon favor a vast, completely unregulated, for-profit medical industry that would conduct a vast, new experimental treatment on children with drugs that were off-label and without any clinical trials to prove their effectiveness and safety? In the 2016 presidential race, both Dem contenders railed against Big Pharma, with Bernie going as far as calling the industry “a health hazard for the American people.” Back in 2009, you saw MSM stories like this:

    The Food and Drug Administration said adults using prescription testosterone gel must be extra careful not to get any of it on children to avoid causing serious side effects. These include enlargement of the genital organs, aggressive behavior, early aging of the bones, premature growth of pubic hair, and increased sexual drive. Boys and girls are both at risk. The agency ordered its strongest warning on the products — a so-called black box.

Nowadays, it’s deemed a “genocide” if you don’t hand out these potent drugs to children almost on demand. Drugs used to castrate sex offenders and to treat adult prostate cancer have been re-purposed, off-label, to sexually reassign children before they even got through puberty. Big Pharma created lucrative “customers for life” by putting kids on irreversible drugs for a condition that could not be measured or identified by doctors and entirely self-diagnosed by … children.

And what if over 80 percent of the children subject to this experiment were of a marginalized group — gay kids? And the result of these procedures was to cure them of same-sex attraction by converting them to the opposite sex? I simply cannot imagine that any liberal or progressive would hand over gender-nonconforming children, let alone their own children, to the pharmaceutical and medical-industrial complex to be experimented on in this way.

And yet for years now, this has been the absolutely rigid left position on sex reassignments for children with gender dysphoria on the verge of puberty. And for years now, those of us who have expressed concern have been vilified, hounded, canceled and physically attacked for our advocacy. When we argued that children should get counseling and support but wait until they have matured before making irreversible, life-long medical choices they have no way of fully understanding, we were told we were bigots, transphobes and haters.

The reason we were told that children couldn’t wait and mature was that they would kill themselves if they didn’t. This is one of the most malicious lies ever told in pediatric medicine. While there is a higher chance of suicide among children with gender distress than those without, it is still extremely rare. And there is absolutely no solid evidence that treatment reduces suicide rates at all.

Don’t take this from me. The most authoritative and definitive study of the question has just been published in Britain, The Cass Report, by Hilary Cass, one of the most respected pediatricians in the country. It’s 388 pages long, crammed with references, five years in the making, based on serious research and interviews with countless doctors, parents, scientists and, most importantly, children and trans people directly affected. In the UK, its findings have been accepted by both major parties and even some of the groups who helped pioneer and enable this experiment. I urge you to read it — if only the preliminary summary.

It’s a decisive moment in this debate. After weighing all the credible evidence and data, the report concludes that puberty blockers are not reversible and not used to “take time” to consider sex reassignment, but rather irreversible precursors for a lifetime of medication. It says that gender incongruence among kids is perfectly normal and that kids should be left alone to explore their own identities; that early social transitioning is not neutral in affecting long-term outcomes; and that there is no evidence that sex reassignment for children increases or reduces suicides.

How on earth did all the American medical authorities come to support this? The report explains that as well: all the studies that purport to show positive results are plagued by profound limitations: no control group, no randomization, no double-blind studies, no subsequent follow-up with patients, or simply poor quality.

January 16, 2024

QotD: Children and transgenderism

Filed under: Education, Health, Politics, Quotations, Science — Tags: , , , , , — Nicholas @ 01:00

And then there is the disturbing “social justice” response to gender-nonconforming boys and girls. Increasingly, girly boys and tomboys are being told that gender trumps sex, and if a boy is effeminate or bookish or freaked out by team sports, he may actually be a girl, and if a girl is rough and tumble, sporty, and plays with boys, she may actually be a boy.

In the last few years in Western societies, as these notions have spread, the number of children identifying as trans has skyrocketed. In Sweden, the number of kids diagnosed with gender dysphoria, a phenomenon stable and rare for decades, has, from 2013 to 2016, increased almost tenfold. In New Zealand, the rate of girls identifying as boys has quadrupled in the same period of time; in Britain, where one NHS clinic is dedicated to trans kids, there were around a hundred girls being treated in 2011; by 2017, there were 1,400.

Possibly this sudden surge is a sign of pent-up demand, as trans kids emerge from the shadows, which, of course, is a great and overdue thing. The suffering of trans kids can be intense and has been ignored for far too long. But maybe it’s also some gender non-conforming kids falling prey to adult suggestions, or caused by social contagion. Almost certainly it’s both. But one reason to worry about the new explosion in gender dysphoria is that it seems recently to be driven by girls identifying as boys rather than the other way round. Female sexuality is more fluid and complex than male sexuality, so perhaps girls are more susceptible to ideological suggestion, especially when they are also taught that being a woman means being oppressed.

In the case of merely confused or less informed kids, the consequences of treatment can be permanent. Many of these prepubescent trans-identifying children are put on puberty blockers, drugs that suppress a child’s normal hormonal development, and were originally designed for prostate cancer and premature puberty. The use of these drugs for gender dysphoria is off-label, unapproved by the FDA; there have been no long-term trials to gauge the safety or effectiveness of them for gender dysphoria, and the evidence we have of the side effects of these drugs in FDA-approved treatment is horrifying. Among adults, the FDA has received 24,000 reports of adverse reactions, over half of which it deemed serious. Parents are pressured into giving these drugs to their kids on the grounds that the alternative could be their child’s suicide. Imagine the toll of making a decision about your child like that?

Eighty-five percent of gender-dysphoric children grow out of the condition — and most turn out to be gay. Yes, some are genuinely trans and can and should benefit from treatment. And social transition is fine. But children cannot know for certain who they are sexually or emotionally until they have matured past puberty. Fixing their “gender identity” when they’re 7 or 8, or even earlier, administering puberty blockers to kids as young as 12, is a huge leap in the dark in a short period of time. It cannot be transphobic to believe that no child’s body should be irreparably altered until they are of an age and a certainty to make that decision themselves.

I don’t have children, but I sure worry about gay kids in this context. I remember being taunted by some other kids when I was young — they suggested that because I was mildly gender-nonconforming, I must be a girl. If my teachers and parents and doctors had adopted this new ideology, I might never have found the happiness of being gay and comfort in being male. How many gay kids, I wonder, are now being led into permanent physical damage or surgery that may be life-saving for many, but catastrophic for others, who come to realize they made a mistake. And what are gay adults doing to protect them? Nothing. Only a few ornery feminists, God bless them, are querying this.

In some ways, the extremism of the new transgender ideology also risks becoming homophobic. Instead of seeing effeminate men as one kind of masculinity, as legitimate as any other, transgenderism insists that girliness requires being a biological girl. Similarly, a tomboy is not allowed to expand the bandwidth of what being female can mean, but must be put into the category of male. In my view, this is not progressive; it’s deeply regressive. There’s a reason why Iran is a world leader in sex-reassignment surgery, and why the mullahs pay for it. Homosexuality in Iran is so anathema that gay boys must be turned into girls, and lesbian girls into boys, to conform to heterosexual norms. Sound a little too familiar?

Adults are increasingly forced to obey the new norms of “social justice” or be fired, demoted, ostracized, or canceled. Many resist; many stay quiet; a few succumb and convert. Children have no such options.

Indoctrinate yourselves as much as you want to, guys. It’s a free country. But hey, teacher — leave those kids alone.

Andrew Sullivan, “When the Ideologues Come for the Kids”, New York Magazine, 2019-09-20.

January 8, 2024

“[A]ll philosophers, insofar as they were dogmatic, have been very inexpert about women”

Filed under: Health, Media, Politics — Tags: , , — Nicholas @ 03:00

Theodore Dalrymple on the food police and the linguistic distortions forced on traditionally technical and scientific journalism:

The world, said James Boswell, is not to be made a great hospital; but to a hammer everything is a nail, and to doctors and medical journals everything is either a medical problem or a medical solution.

Looking at the website of the Journal of the American Medical Association today, I came across a paper with the title “Effect of an Intensive Food-as-Medicine Program on Health and Health Care Use”. It was published just above “A Young Pregnant Person With Old Myocardial Infarction”.

Could that pregnant person possibly be a woman? Heaven forfend that so prejudiced a thought should occur to us! If it occurred to you, dear reader, I suggest that your brain still needs washing. The word woman is here abjured by JAMA as completely as, say, it would abjure (rightly) the word bitch with reference to a woman. In other words, the word woman is now treated as if it were in itself an insult, a rather strange result of pro-feminist indoctrination.

The paper begins, “A patient in their 30s presented to the hospital …” No doubt I am deeply reactionary, almost a dinosaur in a world of mammals, but is not their the plural possessive adjective, and is not “a patient” singular? If the authors of the paper were really not sure whether the pregnant person was a man or a woman, surely they should have written “A pregnant person in his or her 30s …”? That would have been a step too absurd (so far) even for the editors of JAMA, assuming that the paper in question was published with some kind of editorial oversight. I anticipate further linguistic absurdity in JAMA with a mixture of amusement and irritation; that there will be one is a racing certainty (a Dutch friend of mine was going to write a book about Dutch social policy titled Creative Appeasement).

The paper, by the way, gives new meaning to the first two sentences of Nietzsche’s book Beyond Good and Evil: “Suppose truth to be a woman — what then? Are there not grounds for the suspicion that all philosophers, insofar as they were dogmatic, have been very inexpert about women?”

January 4, 2024

“It is difficult to understand why our politicians are not locked up for life after successful prosecution for crimes against humanity”

Filed under: Britain, Government, Health — Tags: , , , — Nicholas @ 03:00

Part nine of Paul Weston‘s “beginner’s guide to Covid”:

Lockdown was never referred to as “lockdown” in March 2020. We were “asked” to stay at home for a few weeks, thus allowing our health services to get up to speed without being swamped. As we now know, a few weeks became months became 2021.

I simply cannot believe this was not planned. The logistics involved in keeping a country afloat after closing down the economy are extremely complicated. Months – if not years – of planning must have gone into it.

One of the strangest things about the first lockdown in the UK was the enforcement date of March 26, one week after the government declared on March 19 that Covid-19 was being downgraded from a High Consequence Infectious Disease (HCID). The reason given for the downgrade was a low mortality rate …

Anyway, the world locked down. When it became apparent the lockdowns were going to stay in place until a miracle vaccine was discovered, the governments promised us that detailed cost/benefit analyses would be conducted. They never were. But they very much should have been.

The principal reason they should is all to do with deaths. Closing down the country also meant partially closing down health services to non-Covid patients. Inculcating fear meant many people were too scared to go anywhere near a hospital. Patients with cancer and heart problems stayed away, voluntarily or involuntarily. Many died as a result.

On July 19 2020, the Daily Telegraph published an article based on Office for National Statistics figures claiming that 200,000 people could die (mid to long term) in the UK due to lockdowns. Similar figures were published in countries all around the world.

Here is a brutal truth. Governments which locked down essentially stated the following: “We are going to murder XYZ thousand people. We undertake this crime because we think we might save other people from Covid-19 deaths.”

Even more remarkably, the death rates were completely normal before lockdowns were initiated. Lockdowns were not the forced result of having to deal with large numbers of deaths. Rather, large numbers of deaths were the forced result of government-ordained lockdowns. It is difficult to understand why our politicians are not locked up for life after successful prosecution for crimes against humanity.

January 3, 2024

“One of the oddities of trans healthcare is that it masquerades as progressive”

Filed under: Books, Health, History, Politics — Tags: , , , , — Nicholas @ 04:00

In The Critic, Victoria Smith outlines the history of medical misogyny from Aristotle to modern-day “trans healthcare”:

The neglect of female bodies in medicine has a long history. The male-default bias, writes Caroline Criado Perez in Invisible Women, “goes back at least to the ancient Greeks, who kicked off the trend of seeing the female body as a ‘mutilated male’ body (thanks, Aristotle)”:

    The female was the male ‘turned outside in’. Ovaries were female testicles (they were not given their own name until the seventeenth century) and the uterus was the female scrotum. […] The male body was an ideal women failed to live up to.

As Criado Perez notes, this bias lives on in male-centric medical research and undifferentiated treatment recommendations. “Women are dying,” she notes, “as a result of the gender data gap.” The belief that there is nothing specifically different about female people — cut a bit here, add a bit there, and we’re the same as men — has led to our symptoms being ignored and our pain dismissed.

Over the past few years, there have been a number of books — Elinor Cleghorn’s Unwell Women, Cat Bohannon’s Eve, Leah Hazzard’s Womb, to name a few — which have aimed to correct the imbalance. This is important both to save lives and ease suffering, and because, on a very basic level, it is insulting for half the human race to have our bodies treated as lesser, imperfect versions of a male ideal. We are more than that. We exist in our own right.

There are many in medicine, however, who still seem to think that Aristotle was right. Last week, for instance, the World Health Organisation announced it would be developing new guidelines into “the health of trans and gender diverse people”. While this might sound positive, as Eliza Mondegreen notes, many of those leading the development group hold highly regressive views about sex, gender and bodies. It is only possible to believe that a person could change sex if you have not given much consideration to the “second” sex at all.

One of the oddities of trans healthcare is that it masquerades as progressive despite having evolved from — and continuing to rely on — an understanding of sex difference which is regressive, male-centric and superficial. Because no one wants to admit it, this has led to a plethora of articles along the lines of “Here’s Why Human Sex Is Not Binary” and “Sex Redefined: The Idea of 2 Sexes Is Overly Simplistic“. While these claim to be adding extra detail and nuance to our understanding, what they do in practice is revert back to privileging the male default. Sex is all so varied, all so different, they tell us, we might as well not bother setting any standards for what counts as “femaleness”. We’re all just human, aren’t we? Only some bodies have tended to be considered more human than others. Rebranding “the male default” “the sex spectrum” is a sneaky way of insisting, once again, that female people are nothing more than males with a few minor tweaks.

This is the new medical misogyny, built on the back of the old version. Unfortunately, because it positions itself as anti-conservative and even pro-feminist, many writers of texts that address the old version feel obliged to go along with the new. It’s not difficult to see why. Who wants their work to be undermined by bad faith accusations of transphobia? Isn’t it easier just to say “it’s clear that trans women are women” — as Bohannon has done — on the basis that at least this will enable you to challenge the centring of male bodies elsewhere?

July 20, 2023

QotD: Advertising to a semi-captive audience

Filed under: Business, Health, Quotations — Tags: , , — Nicholas @ 01:00

You know how drug companies pay six or seven figures for thirty-second television ads just on the off chance that someone with the relevant condition might be watching? You know how they employ drug reps to flatter, cajole, and even seduce doctors who might prescribe their drug? Well, it turns out that having 15,000 psychiatrists in one building sparks a drug company feeding frenzy that makes piranhas look sedate by comparison. Every flat surface is covered in drug advertisements. And after the flat surfaces are gone, the curved sufaces, and after the curved surfaces, giant rings hanging from the ceiling.

The ads overflow from the convention itself to the city outside. For about two blocks in any direction, normal ads and billboards have been replaced with psychiatry-themed ones, until they finally peter off and segue into the usual startup advertisements around Market Street.

Scott Alexander, “The APA Meeting: A Photo-Essay”, Slate Star Codex, 2019-05-22.

July 6, 2023

“Too many complaints? That’s racism. Too few complaints? Well, that’s racism, too.”

Filed under: Bureaucracy, Cancon, Health — Tags: , , , , — Nicholas @ 04:00

Amy Eileen Hamm reports on how the British Columbia College of Nurses and Midwives (BCCNM) acted on its concern that not enough complaints against their members were being lodged by First Nations people:

As regular readers of Quillette will know, many Canadian institutions have fervently adopted the cause of “decolonization” — a vaguely defined term that one university describes as the dismantling of “assumed Euro-western disciplinary constructs and traditions”. This can mean anything from abolishing musical scales (which “perpetuate and solidify the hegemony of [the] Euro-American repertoire”); to reimagining our scientific understanding of sunlight, so as to correct “the reproduction of colonialism” that has infected “physics and higher physics education”; to assailing the gender binary through a “decolonizing act of resistance”.

That’s the theory, anyway. In practice, institutional efforts at “decolonization” generally translate into affirmative-action hiring programs and policies to mandate symbolic (generally empty) gestures such as land acknowledgements. They’ve also created a cash cow for “specialist” administrators and third-party consultants in what is now known as the “equity, diversity, inclusion, and decolonization” sector. The premise is that decolonization is so difficult and complex that it can only be overseen by said (highly paid) professionals.

My own professional sector, nursing, provides a useful case study. In British Columbia, where I live and work, nurses are licenced by the British Columbia College of Nurses & Midwives (BCCNM), whose offices are located “on unceded Coast Salish territory, represented today by the Musquea?m, Squamish and Tsleil-Waututh Nations.” In other words, Vancouver.

If a patient feels that he or she has experienced “incompetent, unethical, or impaired nursing or midwifery practice”, he or she can complain to the BCCNM through its complaints portal. It’s not a complicated process. You send an email describing what the nurse allegedly did, when the incident occurred, and whether there were any witnesses. If you’ve already complained to someone else, you’re supposed to note that as well, along with your suggestions for resolving the complaint. That’s it.

But apparently, this process is just too onerous — and even dangerous — for Indigenous people. And so the BCCNM has paid C$97,000 to a self-described “boutique business process management firm” called Novatone, which has duly produced a lengthy report on how to “make the BCCNM complaints process safer for Indigenous Peoples.” The same title — mantra might be a better word — appears at the top of all 50 pages: Looking Back to Look Forward: How Indigenous ways of being, knowing, and doing must inform the BCCNM feedback process and reflect the principles of cultural safety, cultural humility, and anti-racism.

(For the benefit of those outside Canada, the mystical-sounding phrase, “ways of knowing”, along with its “being” and “doing” variants, has now entered the official idiom as a means to signify the unfalsifiable shaman-like intuitions that supposedly guide the consciousness of Indigenous people throughout every facet of their existence — including, apparently, complaining about the care they receive from nurses.)

Juxtaposed images from the Novatone report, Looking Back to Look Forward, contrast the “colonial, western, linear” nature of existing BCCNM processes with a “wholistic, relational, culturally informed process” that would supposedly align with Indigenous values.

June 15, 2023

Thursday tab-clearing

Filed under: Cancon, Economics, Government, Health, USA — Tags: , , , , , — Nicholas @ 23:25

A few items that I didn’t feel required a full post of their own, but might be of interest:

April 12, 2023

Institutional Review Boards … trying to balance harm vs health, allegedly

Filed under: Books, Bureaucracy, Health, USA — Tags: , , , , , — Nicholas @ 06:00

At Astral Codex Ten Scott Alexander reviews From Oversight to Overkill by Simon N. Whitley, in light of his own experience with an Institutional Review Board’s demands:

Dr. Rob Knight studies how skin bacteria jump from person to person. In one 2009 study, meant to simulate human contact, he used a Q-tip to cotton swab first one subject’s mouth (or skin), then another’s, to see how many bacteria traveled over. On the consent forms, he said risks were near zero — it was the equivalent of kissing another person’s hand.

His IRB — ie Institutional Review Board, the committee charged with keeping experiments ethical — disagreed. They worried the study would give patients AIDS. Dr. Knight tried to explain that you can’t get AIDS from skin contact. The IRB refused to listen. Finally Dr. Knight found some kind of diversity coordinator person who offered to explain that claiming you can get AIDS from skin contact is offensive. The IRB backed down, and Dr. Knight completed his study successfully.

Just kidding! The IRB demanded that he give his patients consent forms warning that they could get smallpox. Dr. Knight tried to explain that smallpox had been extinct in the wild since the 1970s, the only remaining samples in US and Russian biosecurity labs. Here there was no diversity coordinator to swoop in and save him, although after months of delay and argument he did eventually get his study approved.

Most IRB experiences aren’t this bad, right? Mine was worse. When I worked in a psych ward, we used to use a short questionnaire to screen for bipolar disorder. I suspected the questionnaire didn’t work, and wanted to record how often the questionnaire’s opinion matched that of expert doctors. This didn’t require doing anything different — it just required keeping records of what we were already doing. “Of people who the questionnaire said had bipolar, 25%/50%/whatever later got full bipolar diagnoses” — that kind of thing. But because we were recording data, it qualified as a study; because it qualified as a study, we needed to go through the IRB. After about fifty hours of training, paperwork, and back and forth arguments — including one where the IRB demanded patients sign consent forms in pen (not pencil) but the psychiatric ward would only allow patients to have pencils (not pen) — what had originally been intended as a quick record-keeping had expanded into an additional part-time job for a team of ~4 doctors. We made a tiny bit of progress over a few months before the IRB decided to re-evaluate all projects including ours and told us to change twenty-seven things, including re-litigating the pen vs. pencil issue (they also told us that our project was unusually good; most got >27 demands). Our team of four doctors considered the hundreds of hours it would take to document compliance and agreed to give up. As far as I know that hospital is still using the same bipolar questionnaire. They still don’t know if it works.

Most IRB experiences can’t be that bad, right? Maybe not, but a lot of people have horror stories. A survey of how researchers feel about IRBs did include one person who said “I hope all those at OHRP [the bureaucracy in charge of IRBs] and the ethicists die of diseases that we could have made significant progress on if we had [the research materials IRBs are banning us from using]”.

Dr. Simon Whitney, author of From Oversight To Overkill, doesn’t wish death upon IRBs. He’s a former Stanford IRB member himself, with impeccable research-ethicist credentials — MD + JD, bioethics fellowship, served on the Stanford IRB for two years. He thought he was doing good work at Stanford; he did do good work. Still, his worldview gradually started to crack:

    In 1999, I moved to Houston and joined the faculty at Baylor College of Medicine, where my new colleagues were scientists. I began going to medical conferences, where people in the hallways told stories about IRBs they considered arrogant that were abusing scientists who were powerless. As I listened, I knew the defenses the IRBs themselves would offer: Scientists cannot judge their own research objectively, and there is no better second opinion than a thoughtful committee of their peers. But these rationales began to feel flimsy as I gradually discovered how often IRB review hobbles low-risk research. I saw how IRBs inflate the hazards of research in bizarre ways, and how they insist on consent processes that appear designed to help the institution dodge liability or litigation. The committees’ admirable goals, in short, have become disconnected from their actual operations. A system that began as a noble defense of the vulnerable is now an ignoble defense of the powerful.

So Oversight is a mix of attacking and defending IRBs. It attacks them insofar as it admits they do a bad job; the stricter IRB system in place since the ‘90s probably only prevents a single-digit number of deaths per decade, but causes tens of thousands more by preventing life-saving studies. It defends them insofar as it argues this isn’t the fault of the board members themselves. They’re caught up in a network of lawyers, regulators, cynical Congressmen, sensationalist reporters, and hospital administrators gone out of control. Oversight is Whitney’s attempt to demystify this network, explain how we got here, and plan our escape.

March 30, 2023

“Nothing is as permanent as a temporary government program” … except those few that make your life easier

Filed under: Bureaucracy, Government, Health, Technology, USA — Tags: , , , — Nicholas @ 03:00

At Astral Codex Ten, Scott Alexander reacts to the US government’s new moves to make telehealth less useful for as many people as possible:

“Live telehealth demonstration” by CiscoANZ is licensed under CC BY 2.0 .

Telemedicine is when you see a doctor (or nurse, PA, etc) over a video call. Medical regulators hate new things, so for its first decade they ensured telemedicine was hard and inconvenient.

Then came COVID-19. Suddenly important politicians were paying attention to questions about whether people could get medical care without leaving their homes. They yelled at the regulators, and the regulators grudgingly agreed to temporarily make telemedicine easy and convenient.

They say “nothing is as permanent as a temporary government program”, but this only applies to government programs that make your life worse. Government programs that make your life better are ephemeral and can disappear at any moment. So a few months ago, the medical regulators woke up, realized the pandemic was over, and started plotting ways to make telemedicine hard and inconvenient again.

The first fruit of their labor is DEA-407, which makes it hard for telemedicine doctors to prescribe controlled substances. Controlled substances are drugs like Adderall, Ritalin, Xanax, or Ambien that the government has declared to be potentially addictive. The new rules say that telemedicine doctors can no longer prescribe these (or, in some cases, can prescribe them one time in an emergency).

Why don’t I like this decision? I am a telepsychiatrist. I work with about a hundred psychiatric patients who, for one reason or another, prefer online to physical appointments:

  • Some live in small towns that don’t have psychiatrists of their own
  • Some have agoraphobia, chronic pain, or some other condition that makes it hard for them to go to an office.
  • Some move around a lot and like to be able to see their psychiatrist whether they’re in LA or SF.
  • Some live hundreds of miles away from me, but know and trust me for some reason, and would rather see me than someone closer to them.
  • Some appreciate the fact that I charge lower rates than psychiatrists who have offices, because I don’t have to pay for Bay Area commercial real estate and pass those costs on to my patients.
  • Some work during work hours, and like being able to see me from their office instead of taking half the day off to travel to my location.
  • Some like convenience and dislike inconvenience

As a psychiatrist, a big part of my job is prescribing controlled substances. For example, most guidelines agrees that the first-line treatment for severe ADHD is stimulant medications (eg Adderall or Ritalin). And although psychiatrists hate to admit it, the first-line treatment for temporary crisis anxiety, especially when it’s so bad that the patient isn’t able to listen to your clever plans to solve it with therapy, is benzodiazepines (eg Valium or Klonopin). You can’t be a good well-rounded psychiatrist without the option to sometimes prescribe these drugs.

“Well, your patients will have to find a different psychiatrist, or transition off of them”. Nobody ever finds different psychiatrists. Some of my patients are a bad match for my style or areas of expertise, and I’ve tried very hard to find them different psychiatrists, and it never works. Maybe there are no other psychiatrists in their area. Maybe the psychiatrists in their area don’t take the right insurance, or are too far away from mass transit. Maybe the psychiatrists have six month long wait lists. Sometimes it’s just that my ADHD patients get distracted and forget they were supposed to find new psychiatrists, and I can’t hold their hand literally all the time. As for transitioning off the medications, some patients absolutely cannot function at all without them. Did I mention that if you come off of some of them too quickly, you can literally die?

March 24, 2023

From “railway spine” to “shell shock” to PTSD

Filed under: Health, History, Military, Railways, WW1, WW2 — Tags: , , , , , — Nicholas @ 05:00

At Founding Questions, Severian discusses how our understanding of what we now label “Post-Traumatic Stress Disorder” evolved from how doctors visualized bodily ailments over a century ago:

A shell-shocked and physically wounded soldier in the First World War.

I mentioned “shell shock” yesterday, so let’s start there. Medicine in 1914 was still devoted to the “Paris School,” which assumed nothing but organic etiology for all syndromes. Sort of a reverse Descartes — as Descartes (implicitly) “solved” the mind-body problem by disregarding the body, so the “Paris School” of medicine solved it by disregarding the mind. So when soldiers started coming back from the front with these bizarre illnesses, naturally doctors began searching for an organic cause. (That’s hardly unique to the Paris School, of course; I’m giving you the context to be fair to the 1914 medical establishment, whose resistance to psychological explanations otherwise seems so mulish to us).
They’d noticed something similar in the late 19th century, with industrial accidents and especially train crashes. When a train crashed, the people in the first few cars were killed outright, those in the next few wounded, but the ones in the back were often physically fine. But within a few hours to weeks, they started exhibiting all kinds of odd symptoms. Hopefully you’ve never been in a train crash, but if you’ve ever been in a fender-bender you’ve no doubt experienced a minor league version of this.

I hit a deer on the highway once. Fortunately I was at highway speed, and hit it more or less dead on (it jumped out as if it were committing suicide), so it got thrown away from the car instead of coming through the windshield. The car’s front end was wrecked, naturally, but I was totally fine. I don’t think the seatbelt lock even engaged, much less the airbag, since I didn’t even have time to hit the brakes.

The next few hours to days were interesting, physiologically. It felt like my body was playing catch up. I had an “oh shit, I’m gonna crash!!!” reaction about 45 minutes after I’d pulled off to the side of the road, duct-taped the bumper back on as best I could, and continued to my destination. All the stuff I would have felt had I seen the deer coming came flooding in. Had I not already been where I was going, I would’ve needed to pull over, because that out of the blue adrenaline hit had my hands shaking, and my vision fuzzed out briefly.

The next morning I was sore. I had all kinds of weird aches, as if I’d just played a game of basketball or something. I assume part of it actually was the impact — it didn’t feel like much in the moment, but if it’s enough to crumple your car’s front end (and it was trashed), it’s enough to give you a pretty good jolt. That would explain soreness in the arms, elbows, and shoulders — a stiff-armed, white-knuckle grip on the steering wheel, followed by a big boom. But I was also just kinda sore all over, plus this generalized malaise. I felt not-quite-right for the next few days. Nothing big, no one symptom I can really put my finger on, but definitely off somehow — a little twitchy, a little jumpy, and really tired.

Having done my WWI reading, I knew what it was, and that’s when I really understood the doctors’ thought processes. I really did take some physical damage, because I really did receive a pretty good full-body whack. It just wasn’t obvious to the naked eye. And since everyone has experienced odd physical symptoms from being rattled around, or even sleeping on a couch or sprung mattress, it makes sense — the impact obviously jiggled my spine, which probably accounts for a great many of the physical symptoms. Hence, “railway spine”. And from there, “shell shock” — nothing rattles your back like standing in a trench or crouching in a dugout as thousands of pounds of high explosive go off around you. It must be like going through my car crash all day, every day.

Skip forward a few decades, and we now have a much better physiological understanding of what we now call (and I will henceforth call) Post-Traumatic Stress Disorder (PTSD). There’s a hypothesis that I personally believe, that “shell shock” is also a whole bunch of micro-concussions as well as “classic” PTSD, but let’s leave that aside for now. The modern understanding of PTSD is largely about chemistry. Cortisol and other stress chemicals really fuck you up. They have systemic physical and mental effects. If those chemicals don’t get a chance to flush out of your system — if you’re in a trench for weeks on end, let’s say — the effects are cumulative, indeed exponential.

Returning to my car crash: I was “off” for a few days because my body got a huge jolt of stress chemicals. That odd not-quite-right thing I felt was those chemicals flushing through. Had I gone to a shrink at that moment, he probably would’ve diagnosed me with PTSD. But I didn’t have PTSD. I had a perfectly normal physiological reaction to a big shot of stress chemicals. If I’d gotten into car crash after car crash, though, day in and day out, that would’ve been PTSD. I’d be having nightmares about that deer every night, instead of just the once. And all that would have cumulative, indeed exponential, effects.

He then goes on to cover similar physical reactions to stimuli in modern life, so I do recommend you RTWT.

February 16, 2023

A modern irregular verb: I mis-spoke. You spread misinformation. He has been banned from social media

Filed under: Bureaucracy, Government, Health, Media, Politics, USA — Tags: , , , , , , , — Nicholas @ 03:00

I derive my headline from the original words of Bernard Woolley: “That’s one of those irregular verbs, isn’t it? I give confidential security briefings. You leak. He has been charged under section 2a of the Official Secrets Act.” It was a joke in Yes, Minister, but as Jon Miltimore shows, it’s a model for how the powers-that-be want to treat how information is shared on social media:

As Reuters reported in a recent fact-check, Mr. Gore was guilty of misrepresenting scientific data — or “spreading ‘misinformation'”.

In 2009, many responded playfully to Gore’s faux pas.

“Like most politicians, practicing and reformed, Al Gore has been known to stretch the truth on occasion”, NPR noted, adding that Gore had also claimed he’d helped create the internet.

Today, misinformation is treated in a much different way — at least in some instances. Throughout the COVID-19 pandemic, many writers and scientists who questioned the government’s use of lockdowns, mask mandates, enforced social distancing, and vaccine mandates were banned from social media platforms while others lost their jobs.

San Francisco attorney Michael Senger was permanently banned from Twitter after calling the government’s pandemic response “a giant fraud”. Prior to him, it was former New York Times reporter Alex Berenson who got the boot after questioning the efficacy of vaccines in preventing COVID-19 transmission. Months earlier it was author Naomi Wolf, a political advisor to the presidential campaigns of Bill Clinton and Al Gore.

All of these accounts were reinstated after Elon Musk purchased the company. Twitter is hardly alone, however. Facebook and YouTube also announced policies banning the spread of COVID misinformation, particularly information related to vaccines, which is what got Drs. Peter McCullough and Robert Malone ostracized and banned.

Some may argue these policies are vital, since they protect readers from false information. However, there is nothing that says Big Tech can only ban information that is false. On the contrary, in court proceedings Twitter has claimed it has “the right to ban any user any time for any reason” and can discriminate “on the basis of religion, or gender, or sexual preference, or physical disability, or mental disability”.

Facebook, meanwhile, has argued in court that the army of fact-checkers they employ to protect readers from false information are merely sharing “opinions”, and are therefore exempt from defamation claims.

[…]

What Big Tech is doing is concerning, but the fact that this censorship is taking place in coordination with the federal government makes it doubly so.

In July, in arguably the most anti-free speech pronouncement made at the White House in modern history, White House press secretary Jen Psaki noted the White House is “flagging problematic posts for Facebook”.

“We are in regular touch with these social media platforms, and those engagements typically happen through members of our senior staff, but also members of our COVID-19 team”, Psaki explained. (Today we know that these companies are staffed with dozens of former CIA and FBI officials.)

All of this is being done in the name of science, but let’s be clear: there’s nothing scientific about censorship.

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