grendel-khan
i'm sorry, but it's more complicated than that
Housing Poster. Series index here.
User ID: 197
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
Okay, but why do you think that "poll watchers were removed", since the only claims to that effect came from incompetent Trump followers who then recanted?
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
Generally speaking, it would be a strange coincidence if the Biden campaign's malfeasance matched up so impressively well with the media's red-mirage predictions, and had the opposite effect you'd expect on the eventual results, which were much better for Trump than pre-election polling would indicate.
More specifically, this doesn't appear to have happened; the Trump campaign fundraised on that idea, but didn't appear willing to make the same bold claims in actual court.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
This is the quality of the evidence base on which doctors are sterilizing children and making lifelong medical patients out of them.
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.
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?
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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".
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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"?
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
I think this proves too much.
Consider bariatric surgery on an obese patient. It's elective, and it has risks and benefits. It's shown to cut the risk of cardiovascular events like heart attacks and strokes in half. If your doctors tells you, look, we can't tell you that you will die of a heart attack, but people who don't get this surgery die of heart attacks all the time, so no pressure, it's your decision whether you want to have a heart attack, we have no idea if that'll happen, at least we can't tell you whether it'll happen or not because the regulators won't let us, so you can choose anything you like, and please sign here that we totally didn't pressure you about anything like telling you that you'd have a heart attack.
If you think that puberty blockers don't actually reduce the risk of suicide, then that's a real objection, a matter of fact, and someone is right and someone is wrong.
But in the world where puberty blockers do significantly reduce the risk of suicide in teenagers with gender dysphoria, what's the right thing to do? Not tell their parents about it? Informed consent is complicated, but communicating the risks and benefits of an elective procedure has to be part of it.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
Seriously, how did we get a system that is so self defeating?
Remember that feeling. Hold on to it. One thing I've learned from working in this space is that the systems are always stupider and more vile than you think.
One thing that helps is to remember that at this point, a society that builds is not in living memory for any but the very oldest of Americans.
"And some things that should not have been forgotten were lost. History became legend. Legend became myth. And for two and a half generations, the builder's mindset passed out of all knowledge.”
The YIMBYs are envisioning a wonderfully abundant future, and at the same time, doing a lot of Slow Boring of Hard Boards. In practice, the tip of the spear involves showing up at community meetings to politely ask your local officials to knock it off, or calling your legislator to politely ask them to take your local officials' toys away, or to pore over your city's state-mandated reports and politely tell the state that the city is lying. Roughly none of it looks like Punching The Bad People. (There's an excellent, unfortunately Patreon-only, episode of "The War on Cars" interviewing Matthew Lewis that covers a lot of this.)
Sometimes there are wins, and they're worth celebrating. My city's downtown is replacing a closed donut shop with a small apartment building with ground-floor retail. It's only a few stories tall, but it has a cool roof deck, and it'll make our downtown a little nicer. It's only possible because AB 2097 says the city can't require fifteen parking spaces, which would make the project unconstructible. It's not loud, it's not huge, but it's something. And piling up more and more of those will eventually matter.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
The dirty secret is one of the ways France, Spain, Germany, etc. can cheaply build trains, metros, and even housing at times is simple - the federal government has immense powers to step in and say, "sorry, we're doing this, giving you market value for your land, and you have no recourse in the law at all to stop us."
"Moses tore down America's great old cities, Jacobs ensured you could never build great new ones."
I want to emphasize that this is indeed how things used to work in the United States, most notably in postwar New York City, where Robert Moses legendarily used eminent domain to raze neighborhoods to build his projects. (If you have plenty of time, the Henry George Program had an excellent discussion about Moses.) The environmental movement of the sixties and seventies was in large part a backlash to Moses; the edifice of law and regulation they erected made it harder to build bad things by making it harder to build anything.
The tradition that separates us from better-functioning countries dates back seventy years at most.
You see this in our transit projects, where things simply get bogged down because it's much easier to say no or be cautious or add requirements than it is to say yes. You see this in our environmental laws like CEQA and NEPA (the federal version of CEQA), where they're used to delay obviously environmentally-friendly projects (congestion pricing, solar panels, offshore wind) in favor of an environmentally-unfriendly status quo. You see it in the way that these processes provide a foothold, so, for example, labor unions fight against CEQA reform because their process involves threatening obstruction to get labor benefits. And you see it in the infuriating "precautionary principle" which acts as a fully-general excuse for inaction, because you're comparing the worst case of "Life Continues" if you don't do something and "Extreme Catastrophe" if you do.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
I think it's worth trying to empathize with these people. Consider this previous discussion on some comments by Matthew Cortland, where he vociferously argues against the concept of QALYs, because as a disabled person, QALYs value his life less than that of someone who isn't disabled.
On the one hand, it is devastating to be told that you're not an entire person, even in an accounting sense.
On the other, when you're doing a utilitarianism, either you're going to count disabled people less than non-disabled ones, or you're going to see nothing wrong with deafening someone, or blinding them, and so on.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
Thanks! I'm glad folks are interested.
(even if only to keep more Californians in California and not dragging their policies to me)
Now I'm going to be a humorless scold about this; the problems that California has are due to a combination of its policies and its luck. The housing crisis that came to California was a slow burn caused by gradually-applied restrictions on growth which made it so when boom times came, the market couldn't respond. The boom time, in scale and duration, is unique to California, but the policies aren't, which is why Austin is going through the same thing that various California cities do where the rent rises, homelessness surges, and the main response of the city is to obey the very angry citizens and chase homeless people from place to place, trashing their belongings as they go.
The policies are already there. To the extent that California is responsible, it's by displacing people out of the state. Just as in California, the homeless are demonized as outsiders, when they're mostly just people who used to be housed there, but can no longer afford the rent.
grendel-khan
i'm sorry, but it's more complicated than that
6mo ago
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.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
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.
Vague swipes at "liberal judges" aside (it's more of a cyclical thing), I think the reason the federal courts wind up legislating from the bench so much is that Congress is so useless.
On the other hand, the California legislature, while sometimes frustrating, actually does things (see here, here, here, here, and here, for example), so you don't in practice see the thing where the courts say "well, Congress could gainsay us if they wanted to", and the court's ruling stands no matter how politically-charged, because Congress generally has enough veto points to prevent it from doing anything controversial.
You can see a worked example of the California process in this very story, where the courts held that "people talking" is an environmental impact, and the legislature passed an urgency measure near-unanimously to gainsay them. (An urgency measure requires a two-thirds majority and takes effect immediately instead of at the beginning of the following year.)
Had this happened in federal court, I assume we'd just be dealing with the ruling and all of its ridiculous consequences.
grendel-khan
i'm sorry, but it's more complicated than that
1yr ago
Doesn't this prove too much? Attempting to destroy gay or lesbian communities seems bad in the same way; aren't they also "(largely) voluntarily sterile"?
grendel-khan
i'm sorry, but it's more complicated than that
2mo ago
Thank you for the heads-up; fixed!
This is not, and was not, mysterious. It was heavily predicted before the election (Reuters, CNN, NBC, Fox), the explanation (Democrats are more likely to vote by mail, mail-in ballots are counted later) was straightforward, and the only reason this is even a thing is that it was one in a series of Trump's attempts to avoid facing up to his loss.
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