grendel-khan
i'm sorry, but it's more complicated than that
Housing Poster. Series index here.
User ID: 197

It genuinely worries me that this is the strength of the evidence base on which doctors are heavily implying to parents, "Give your kid this drug or they will kill themselves."
And here, we're back to the beginning. While it matters what the right thing to do is given the pitiful state of the evidence we have (Scott just posted about people dying from an overabundance of caution), I firmly agree that I'd much, much rather know whether the use of puberty blockers in certain instances prevent suicide than not know.
As it stands now, we're either endangering a lot of kids' mental health and very lives, or we're performing nontrivial medical procedures on them that, while not "sterilizing children and making lifelong medical patients of them", aren't actually necessary. I think the evidence leans more toward the former, you think the latter, but the confidence interval is disconcertingly wide.
She may yet prove a liar, but Hannah Barnes, chronicler of the Tavistock's implosion, considers Reed's story basically plausible.
Maybe we're doing Reference Class Tennis here, but the thing this reminds me of is people making outlandish claims about Planned Parenthood, i.e., that they're coercing women into getting abortions so they can sell the parts on the black market, which turn out not to be nearly as spicy as originally reported.
Mainly it looks like you're citing violations of WPATH's standards. You'd think the solution would be to enforce the agreed-on standards, not essentially ban this class treatment altogether. The solution to Kermit Gosnell, for example, wasn't to shut down Planned Parenthood, because performing a service badly doesn't mean that the service shouldn't be provided.
Thanks! I'd previously seen the difference between the Swedish model and WPATH recommendations, and kinda dead-ended there, because I'm not a researcher, just a layman trying to do my homework. (For example, I don't know how you could ethically do an RCT on puberty blockers in children and adolescents.)
I do notice that the NICE report excludes Turban et al. (the strongest evidence I'm aware of that puberty blockers reduce the risk of suicide) with the explanation "Intervention – data for GnRH analogues not reported separately from other interventions". (I don't understand why the criteria were set to exclude nearly every study.) On page 19 and following, it relies entirely on de Vries et al. (2011), which is a prospective study of seventy people, to conclude that "This study provides very low certainty evidence that treatment with GnRH analogues, before starting gender-affirming hormones, may reduce depression." So, in plain terms, it looks promising, but we don't have enough information to have a strong opinion.
It looks like the state of evidence is different now than it was in 2018. These questions are, generally speaking, answerable, and it looks like the best information we have indicates that puberty blockers reduce the risk of suicide in adolescents with gender dysphoria. Perhaps a good use of time would be to develop better diagnostic tools so that dysphoric adolescents who will likely not pursue transition aren't offered puberty blockers, and those who likely will, are.
While I think "civil war" isn't the right lens through which to examine most divisions (can you imagine all the boomers fighting all the millennials, somehow?), I think you might be interested in Ilforte's two-by-two matrix of left/right, build/retreat, as a lens.
I pointed to congressional votes.
This doesn't indicate what you think it does. Again, the started reason is that government involvement doesn't help and stated exceptions don't actually work. Which looks to be the case!
I don't think anyone out there with clout is stating that they want women to be able to abort at forty weeks on a whim the same way major organizations on the right say they want rape victims to be forced to carry to term.
Is this some sort of gish gallop of cases that maybe actually happened (almost certainly exaggerated in some area)?
These are the cases that I linked above; did you follow the links? I think I've described them pretty reasonably.
OTOH, we have the case of Kermit Gosnell, who is not even a 1 of 1.
The position here, which makes sense to me, was that if you make abortion hard to access, women will go to less reputable providers, not that Kermit Gosnell was a great guy doing a good job.
Many of the things that abortion activists feel are "onerous" regulations are simply reaction to his practice
These rules, which are somewhat obsolete in the wake of Dobbs since the point was to make abortion less accessible, date to well before Gosnell's crimes were discovered, and they go well beyond what would be required for safety.
I think they just really like abortion and the idea that a woman can change her mind about child rearing at any time.
Okay, but why do you think that? Yglesias is pointing to the stated positions of mainstream conservative interest groups. You're pointing to what, exactly?
This is just a weaponization of womans tears argument.
You're referring to Richard Hanania's idea that women get what they want by pitifully crying so that men will look or feel like monsters by not acceding to their demands?
I understand that you're citing your own lived experience here, but maybe we can do better than that? "Woman's tears" didn't help the 13 year old who's now raising a baby. "Woman's tears" didn't make it so the woman carrying a corpse didn't have to fly halfway across the country and pay twenty-five thousand dollars to save her own life. But the people putting these policies in place were very clear that Shirley these things would not be allowed to happen. Or that Shirley, it would happen to someone else. (If you can stomach reading an advocate's view, here's Jill Filipovic explaining why abortion policy is so hard for precisely that reason.)
The world you're describing, where women can easily just cry to get whatever they want, does not appear to be the world in which we live, certainly not in terms of abortion policy.
Medical care for the indigent and elderly is an extraordinarily popular policy. While I'm curious about why you think it's "destructive", either way, I don't think you need an extra explanation about "women's tears" to explain why very popular policies are hard to dismantle.
I don't think there's the symmetry you think there is. Institutions on the right are specifically very keen on women in those circumstances carrying to term.
On the left, it's not so much the idea that women in the 40th week can and should and would just change their minds like that, but rather that in situations like, say, this one, having the heavy hand of the government involved will just make things worse. And that narrowly written exceptions don't actually help, given situations like this.
The idea is, if I understand correctly, that the heavy hand of the law will just make things worse, because the Shirley exception is not an actual usable piece of law.
Nobody is impressed with the substance of Biden's answers. Nobody even really cares what they were. Obviously, we all already know what Biden's policies are and what his candidacy means. For that matter, nobody cares what the substance of Trump's answers was either.
Maybe the folks here do, because we're all policy wonks ignorant of politics. But I've run into people in the wake of the 2016 election who didn't know what Clinton's position was on opioids, or on Appalachian economic development, or on climate policy, or on Net Neutrality.
This is enough of a problem that if you explain Republican policies in a reasonably objective way to people, they'll frequently think that you're making things up, because of course no one would do something that evil. (Example, example, example.)
The modal voter isn't nearly as well-informed as you seem to think they are. I don't know to what extent the debates would inform them on policy (I've written elsewhere on the potential value of the format), but the starting place isn't where you're describing it.
I guarantee you that the doctors did not do that in this case.
I'm not a doctor, and I'm certainly not an expert in communicating with people. But is that how doctors communicate in other circumstances? Does a doctor who notices that you smoke simply provide dry info and leave it at that? From what I can tell, standards around informed consent focus on whether or not information has been provided in a legible way to the patient or caregiver, not on the fastidious maintenance of strict neutrality.
I don't know how this was presented, and neither do you. But it's a stretch to say that it was presented meaningfully differently from how other medical procedures are offered, i.e., it reflects the standard of care in medicine generally. And if your issue is with the standards for informed consent, why tie it to a controversial set of procedures where the public, at least, absolutely does not agree about the risks and benefits?
In short, the dialogue looks like this to me:
A: Caroline was unethically pressured into approving puberty blockers for her child.
B: It looks like that pressure took the form of explaining risks and benefits.
A: Anything going beyond a bare recitation of the facts is undue pressure.
B: That's a standard that medicine, in general, does not meet.
It looks like either you're holding gender-nonconforming medical interventions to a uniquely high standard, or you're expressing a general issue you have with medical-ethical standards in an unnecessarily controversial manner.
The host of the podcast retweets groups of vandals who slash car tyres and smash people's headlights.
The Tyre Extinguishers, so far as I can tell, encourage people to deflate tires, as shown in the linked thread. I'm not saying that Aaron Naparstek has never retweeted a violent extremist, but he's not doing so here. If he has, let me know.
I'm not very public facing, I'm moderate in my approach but radical in my goals, and I absolutely disavow violent extremism.
There is, however, violence involved here. The arms race making vehicles larger and taller means that every life saved by an SUV costs four lives outside of the vehicle. Pedestrian deaths are steeply rising after falling for decades. I think that's worth caring about as well.
I understand that you have a visceral distaste for living in a city, and would rather have a lawn and a driveway and plenty of air between your walls and your neighbors'. These are all nice things! But people also seem to dislike having to drive to get anywhere, to enjoy the economic benefits of agglomeration, and the various other benefits of living in cities.
Ideally, people who like cities can live in cities, and people who like cars and driveways can live in suburbs. But nearly every place in the country is designed for cars and driveways. Maybe a little of the residential land could be set aside for city living? (Because right now, in cities, almost none of it is.)
And we can all agree not to dehumanize the people who want to live differently?
And that Shirley exception post is [...] a rebuttal of an argument I've never seen.
I saw this this week, and I thought of you.
Rather than stay at the hospital to wait for infection to set in, Farmer went home to wait, monitoring her temperature and her pain. On Aug. 4, she called her state senator, Bill White, and explained her situation to an aide.
He told her, "That’s not what the law was designed for. It’s designed to protect the woman’s life."
"It’s not protecting me. We have to wait for the heartbeat (to stop). There’s no chance for a baby; she’s not going to make it. It’s putting my life in danger. We have to wait for more complications. I’m 41, it’s not something I can recover from quickly. I could lose my uterus, there’s a lot of things that could happen," Farmer said she remembers telling him. "We just want to move on, we just want to grieve."
The aide told her he would reach out to Attorney General Eric Schmitt, and also connected her with Choices Medical Services, "which is basically an anti-abortion clinic" in Joplin, Farmer said. She never heard back about what Schmitt said.
Sorry, can you be clearer about what you think is "false for the majority"?
I understand that you may not have seen that precise argument... but it's in the quotes upthread. “You can’t get rid of it.” “I guess I thought that, you know, he would not do this, he would not take health insurance away knowing it would affect so many peoples lives." Surely this bad thing can't actually happen.
As it's written:
Once upon a time, I believed that the extinction of humanity was not allowed. And others who call themselves rationalists, may yet have things they trust. They might be called "positive-sum games", or "democracy", or "technology", but they are sacred. The mark of this sacredness is that the trustworthy thing can't lead to anything really bad; or they can't be permanently defaced, at least not without a compensatory silver lining. In that sense they can be trusted, even if a few bad things happen here and there.
There absolutely is disbelief that awful things could actually happen; you see it everywhere. Surely it won't be that bad. Surely people will be reasonable. Surely it will work out for the best.
I think you're being overly narrow in what you think of as The Shirley Exception.
Yes, but the contents also matter, and this is just lazy of you. Who do you think is going to write about this sort of thing? The right?
Yglesias is pointing out that the stated positions of conservative interest groups (e.g., no abortion even in cases of rape our incest) are sometimes really unpopular (per Gallup polls quoted by the FRC), and conservative politicians have become quite good at tiptoeing around this.
DFP did some surveys that discovered that Republicans specifically had some weird ideas about the party's platform; a majority thought they had a healthcare plan that would protect people with pre-existing conditions and opposes the rollback of certain environmental protection rules, nearly half thinks they want to expand Medicaid. These are all wrong. People don't know the party's platform.
The Vox article involved Sarah Kliff interviewing a lot of people who had lost their healthcare under Republican policies, who said things like:
“We all need it,” Oller told me when I asked about the fact that Trump and congressional Republicans had promised Obamacare repeal. “You can’t get rid of it.”
Or:
“I guess I thought that, you know, he would not do this, he would not take health insurance away knowing it would affect so many peoples lives,” says Debbie Mills, an Obamacare enrollee who supported Trump. “I mean, what are you to do then if you cannot pay for insurance?”
What part of this do you think is fake or misleading? A significant portion of voters don't know their party's platform, and won't believe it if you tell them because it sounds bad.
Perhaps I've been unclear. I also dislike vandalism. Not as much as I dislike violent extremism, but I find it distasteful and I don't endorse it. I'm providing some context for why people feel so strongly, but I'm not endorsing vandalism. I hope that clears things up.
There is no way to bring a person back on their original development trajectory after they have been affected by blockers.
Well, yes, in a very literal sense, there's no such thing as an action without consequences in the most general sense, but the drugs do not appear to be horribly dangerous in the general sense, which is why they're used for kids who are going through puberty at the wrong time.
For scale, I'd point out that we regularly perform surgery on healthy adolescents, as well as on infants, sometimes in ways that make them very definitely infertile, but despite considerable activism, this hasn't become nearly as much of a major issue, likely because these things are done to make children more gender-conforming, as opposed to less.
The level of concern about potential bone-density impacts, for example, seems disproportionate compared to the way we disregard much more serious issues when no one involved is gender-nonconforming.
Keep in mind that the reports that these reports are untrustworthy, are themselves untrustworthy.
Reed's claims are pretty straightforward: the standards of care that the clinic was supposedly following were flagrantly violated. This should be, in theory, simple to resolve, modulo medical privacy issues. The fact that people who were at the clinic says that their experience doesn't match what she reported seems at least somewhat relevant.
Why is it ethical to RCT every other medication before it gets approval?
You're right; I'm not sure what I was thinking. I guess you'd enter adolescents with gender dysphoria into a study, and either give them puberty blockers or a placebo, would be hard to keep secret from the patients. But I'm reminded of AIDS patients desperately trying to beat the blinding system in the AZT trials. ("There were also stories of patients from the 12 centers where the study was conducted pooling their pills, to better the chances that they would get at least some of the drug rather than just placebos.") And a story I can't find right now about a teenager who stole HRT from their mother back in the sixties or seventies.
My concern is less that people are ignoring the evidence we have (as you point out, the best we have is an uncontrolled retrospective study), and more that the people fighting the use of puberty blockers in teenagers have no interest in answering these questions. I see this in the pre-emptive excuse-making; if we did do an RCT and puberty blockers saved lives, maybe the whole thing is still social contagion?
Finally, there being a positive signal in the literature that blockers may reduce suicide risk does not justify scaring the parents into allowing blockers for their kids. Far more confidence is needed to make such statements ethically.
And here we're back to the beginning. If you say, "a massive uncontrolled retrospective study found that kids who present with the symptoms your kid is presenting with were less likely to commit suicide when given this treatment", are you "scaring the parents into allowing blockers for their kids"?
Okay, that's fair! So, to be clear, this is a question of fact, and if the best estimate we currently have says that puberty blockers are, in particular circumstances, linked to a lower risk of suicide, then you wouldn't have an objection?
they have no evidence that it reduces the risk
I'm aware of Turban et al. (2020) and Tordoff et al. (2022). Note that as of 2018, a literature review concluded that "the psychosocial effects of gender-affirming hormones in transgender youth have not yet been adequately assessed". So at that point, the right thing to tell patients and parents would be different. But it looks like you can reasonably say that puberty blockers are indicated in certain circumstances, and not using them carries an increased risk.
Thank you so very much! Honestly, it's very motivating to not feel like I'm yelling into a void about this stuff, so the fact that you're here and reading means a lot to me.
Hey, I'm really sorry to have not replied here; I've been off themotte for a while.
From what I can tell, investors require parking because they believe that it's required to make the units sellable, so, yes to your first guess. It's an amenity like any other. And while all said they'd require parking in the area in question, many of them said that they wouldn't put in parking if the area was better-served by bike or transit infrastructure.
Are folks here familiar with Scary Pockets? They do a lot of funkified covers, e.g., "Crazy", "I Want It That Way", "Toxic", and many, many others.
Ideally, it would work like that. And with the Carpenters' union, it has; back in 2023, they broke off from the Building Trades and cut a deal where they'd settle for "prevailing wage" (pay union rates, whether you hire union workers or not) rather than "skilled and trained" (hire only union workers). It raises costs significantly, but it doesn't essentially make the bill a dead letter, which is what the Trades consistently push for.
Thank you for the heads-up; fixed!
an unverified twitter account claiming to be the child in question is saying, despite all the facts in the article being correct, that they don't place the same emotional valence or cause and effect on it that the mother in the story does
First, there are no verified accounts on Twitter any more. The legacy policy required that accounts be "authentic"; the new policy requires that accounts be "non-deceptive", but in no way actually checks that.
Second, they don't claim that "all the facts in the article [are] correct". From the article:
Within a semester, Casey went from all As and Bs to a report card dotted with Ds and Fs.
From the thread:
The article mentions that my grades dropped from A’s and B’s to D’s and F’s in a semester. This is a completely exaggerated statement. My grades were on a steady decline since 2020 due to unrelated mental health concerns.
From the article:
Caroline assumed counseling at the center would help Casey sort things out. But in retrospect, she says, what the psychologist at the center did was solidify the idea that Casey needed medical intervention for his gender distress.
From the thread:
I was in counseling with the Washington University transgender care center in which I was treated amazingly by my counselor. She was a friend to me and offered a great amount of support. This was taken away when my mom revoked consent for the Supprelin.
The article doesn't make any effort to determine that the effect of counseling was, if the counselor recommended or encouraged medical intervention, just repeats Caroline's opinion. It leaves an unchallenged implication; the kid denying it is meaningful.
They especially and annoyingly split hairs in that they admit the doctors said trans teens kill themselves without treatment, but the doctors never said they would specifically. See, totally no longer pressuring the parent!
Is there a way to give informed consent here that isn't pressure under this rubric? Hey, if you don't get this shot, you're much more likely to die of COVID, but we're not pressuring you, right? Doctors are supposed to explain risks and benefits to the patient for any procedure; how can they provide information without "pressuring" someone?
Great question! To the extent that there's a long-term goal or vision, it fits with the concept of an abundance agenda. It's what Laura Foote talks about at rallies.
YIMBY policy progress, from 50k feet, seems slow and intermittent - caught up in the tangle of state and local politics, regulation and courts.
This is a really good point. For example, SB 9 overturned single-family zoning by (with a lot of caveats and complications) allowing duplexes (and, kinda, fourplexes) wherever you could build a house. Livable California (our statewide NIMBY organization) was terrified. And yet it kinda... went nowhere. Almost no one took advantage of the law, and there's a cleanup bill, SB 450, this year to hopefully change that.
We have a reasonably good idea of the size of the shortage (McKinsey, Legislative Analyst's Office, UCLA.) We have a pretty quantifiable idea of the effects of supply on rents, and the effect of rents on homelessness.
The state has decent reporting for some things; see here (page eight, select Structure Type as Accessory Dwelling Unit) to see the effect of the 2017-era ADU liberalization, driving annual construction numbers from less than a thousand to up to twenty thousand. SB 35 streamlined about three thousand units per year in its first two years of implementation; SB 423 looks to greatly expand that.
So, tl;dr, there's a quantifiable housing gap, we know how much housing the state is producing, and getting the latter to reach the former is a reasonably proxy for "we're winning".
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I agree that Tordoff et al.'s work is of lesser quality, and that there simply doesn't exist gold-standard evidence on this issue. I find Turban et al.'s work more convincing.
To be clear, we're talking about puberty blockers, which "are falsely claimed to cause infertility and to be irreversible, despite no substantiated evidence".
The WPATH standards, which are on the radical side of global medical opinion (Scandinavian rules, as @arjin_ferman points out, are much more restrictive) emphasize social transition, then possibly puberty blockers, then possibly cross-sex hormones, then possibly surgery. To the extent that it looks like this standard of care isn't being followed, those reports are themselves untrustworthy.
If you're upset about something going on in the world, it behooves you to make sure you're clear on what's actually going on.
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