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grendel-khan

i'm sorry, but it's more complicated than that

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joined 2022 September 04 22:05:51 UTC

Housing Poster. Series index here.

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grendel-khan


								

								

								
								
								

								
							
					
 
				


				
i'm sorry, but it's more complicated than that

				
				
				

				

					2 followers  

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					joined 2022 September 04 22:05:51 UTC
				


				
					

					
Housing Poster. Series index here.



				

				

				

				

				

					

					

					
					
					

					
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				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					


Even in 2020 we can see how the election became very close at one point during the night, until Biden's mysterious surge.




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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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?


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I don't understand; do you think that the existence of people with bad ideas who voted blue means that we shouldn't point out when someone is reasoning badly? Do you think that I'm backing that particular conspiracy theory? (I'm not; I only faintly remember hearing it years ago.) Aren't we supposed to sharpen each other, as iron sharpens iron?


"Someone who you remind me of reasoned badly, so you shouldn't complain about me reasoning badly" is a poor approach.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Darrell Owens in The Discourse Lounge, "YIMBYs Triumph In California". (Part of a migratory series on housing, mostly in California, also at theschism.)


This wasn't supposed to be a big year in the Legislature. It's an election year, which means excuses and cowardice and small-c conservatism. It's why there was no SB 827 or SB 50, no mass-upzoning bill. But it was a surprisingly successful year in the Legislature for the YIMBYs, maybe even more so than last year. The governor has yet to sign these, but he's expected to. California has no pocket veto, so if he takes no action, they become law at the end of September.


First, the bills that didn't make it.


    

  • 

    AB 2053 (California Social Housing Act) would have established a state agency to "produce and preserve mixed-income homes that are union built, sustainable, collectively owned, affordable for all income levels, and are financially self-sustaining". It would also have provided a mechanism for the state to engage in counter-cyclical construction when it's cheap and jobs are scarce. It made it through the Assembly, but failed to advance from Senate Governance and Finance by one vote. More here from Alex Lee, the author.
    

    • 

  • 

    AB 2656, which isn't exactly major, but would have outlawed CEQA shenanigans as seen in the 469 Stevenson case in San Francisco by interpreting them as a denial under the Housing Accountability Act. It passed its committees and the Assembly, but disappeared in the Senate Appropriations black hole. This indicates just how much of a third-rail any sort of CEQA reform is.
    

    • 

  • 

    SB 917 (Seamless Transit Transformation Act) passed its votes with near unanimity, but Assembly Appropriations spiked it for unclear reasons. It would have placed a timeline on the harmonization of the more than twenty transit agencies in the Bay Area, covering wayfinding and real-time transit data, establishing free transfers, multi-agency passes, and planning a unified regional network. Streetsblog opines that it will still have a significant impact.
    

    • 



And the major bills that did.


    

  • 

    AB 2011 (Affordable Housing and High Road Jobs Act) allows residential development on commercial sites; as a compromise, it doesn't require union labor, but it does require preference be given to apprenticeship programs. This got the Carpenters' Union on board, though not the broader Trades Union. It requires a certain proportion of subsidized units, and comes with minsterial approval, which means its projects are exempt from CEQA. It could make 1.6-2.4 million more units feasible statewide.
    

    • 

  • 

    SB 6 (Middle Class Housing Act), similar to AB 2011, also allows housing in commercial zones without specific subsidized percentages, but requires union labor and does not provide ministerial approval. Here's a comparison of the two bills.
    

    • 

  • 

    AB 2097 (Parking reform), a reboot of last year's AB 1401, which was lost in Appropriations. There have been some amendments; cities can argue (using a "preponderance of evidence") that they really need parking, unless twenty percent of the housing is set aside for low-income, elderly, or disabled people, or students, or the project is twenty units or smaller.
    

    • 

  • 

    SB 886 (CEQA exemption for student housing) is a CEQA reform that actually did pass; it exempts (certain) student housing projects. This doesn't directly address the UC Berkeley enrollment mess, but it does address one of the underlying causes, which was the city of Berkeley's blocking of student housing.
    

    • 



Matt Yglesias is very excited:




I think it’s possible that California is going to substantially improve its housing situation over the next decade / The key isn’t any one of the bills that’s passed or any specific action taken by the governor or the AG, it’s that they now seem to have a durable political coalition in place that wants to see more homes built and keeps taking new swings at it.




This is something that Owens covers as well. Until now, the Trades have blocked any housing reform which didn't require union labor. But AB 2011 passed without the Trades' approval; the Carpenters' unions (along with public employee unions, teacher unions, and the SEIU) showed up and advocated for the bill. There is now a path to major reform that doesn't require the Trades. Much is possible that previously wasn't.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Great question! The movement in California has tended to focus on more immediate reforms, which is one of the things that sets them apart from the After the Revolution types. But Prop 13 produces a sort of anti-Georgism, where more valuable land is cheaper to sit on. The YIMBYs were very keen on enacting "split roll", which would have repealed Prop 13 for large commercial (non-agricultural) landowners. (Prop 13 itself benefits from stunningly durable popularity.)


You can see Laura Foote (Executive Director for YIMBY Action) regularly mentioning LVT; there's a Stanford-based podcast/radio show not exactly aligned with the YIMBY movement called The Henry George Program; they've interviewed Lars Doucet (author of this ACX review-contest entry) as well as Sonja Trauss (Executive Director of YIMBY Law).


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
See also, previous discussion about more/better police. (This was mid-2020, when the issue was particularly salient.) Another thing that came up was Jill Leovy's Ghettoside (review/summary here), which argues that black Americans are particularly subject to simultaneous over- and under-policing, where the cops hassle and intimidate them for minor infractions but allow murders to go unsolved.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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"?


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of September 5, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Friday Fun Thread for September 16, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Friday Fun Thread for September 16, 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I found some magnificent explorables; I don't remember where I got the link from, but this is a breakdown of a how a mechanical watch works, and it is amazing.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Quality Contributions Report for September 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Hey, cool! I'm flattered; thanks, everyone. A few updates on this year's housing bills, as a thank-you.


    

  • 

    AB 2097 (Parking reform) was signed by the Governor, and will take effect at the beginning of 2023. Governor's statement here.
    

      

    • I attended some developer conferences, and was surprised that financiers will now be requiring parking, though at a considerably lower ratio than cities have been. (0.75-1.2 stalls per unit for market-rate developers; 0.5-0.75 for subsidized; contrast with 2.5-4.5 for cities' requirements.)
      • 

    

    • 

  • 

    AB 2011 (Affordable Housing and High Road Jobs Act), SB 6 (Middle Class Housing Act), SB 886 (CEQA exemption for student housing) were all signed on Housing Bill Day; around forty bills in total. Every California YIMBY priority bill that made it through policy committees was signed by the Governor.
    

      

    • SB 922 (CEQA exemptions for non-car transportation), on the subject of CEQA reform, extended and expanded CEQA exemptions for pedestrian, bike, and transit infrastructure.
      • 

    

    • 



Here's Alfred Twu's annual infographic. It's definitely the biggest year so far for the YIMBYs in California.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					
It's Morning in California. Rather, it's Morning in the legislative season, a time when big ideas seem possible, before they disappear into a swamp of obscure pitfalls and shenaniganry. Here's my understanding of the current roster of big housing bills this year, and the threats and potential involved. See also Alfred Twu's very detailed writeup (PDF).


(Part of an ongoing series on housing, mostly in California, also at theschism.)


Some common themes:


    

  • CEQA, the California version of NEPA, is a problem, and though it's right up there with Prop 13 as a Third Rail in California politics, many of the housing bills this year center around exempting projects from CEQA, especially after a particularly egregious use to block student housing because the students themselves would constitute an environmental impact. (I'm reminded of SourceWatch's very cursed Precautionary Principle chart.)
    • 

  • Last year's AB 2011 was a particularly big deal, not because of its contents, but because Assemblymember Wicks (previously seen here) managed to get the carpenters' union on board. The Building Trades have been adamant in their demands (basically, require that workers on streamlined projects attended a particular union training program), which the YIMBYs consider a dealbreaker. The compromise in AB 2011 was to provide various benefits to any worker on those projects, and to give preferences to graduates of union apprenticeship programs. There's a huge difference in California politics between "the unions oppose" and "the unions are divided". This mainly applies to SB 423, but the model will likely be tried in plenty of other bills.
    • 



The major bills:


    

  • AB 68 (CA YIMBY), the Housing and Climate Solutions Act. (Not to be confused with 2019's AB 68, part of the push to legalize ADUs). This will likely be a two-year bill, but it's a mass upzoning in the vein of SB 827 and SB 50. Those bills failed, so the YIMBYs are taking a different tack: this is a collaboration between California YIMBY and the Nature Conservancy, as it would not only make it easier to build in cities, it would make it harder to build in the wilderness, under the Gain/Maintain/Sustain rubric outlined here. Details are still in flux, but Livable California is furious. Much of how this goes will depend on how labor gets on board.
    • 

  • SB 423 (CA YIMBY), an extension of 2017's SB 35 (previously seen here). The original SB 35 streamlined approvals (including CEQA exemptions) for general plan-compliant projects in cities behind on their housing goals. It was a compromise, which got the Building Trades on board: all-subsidized projects could pay prevailing wage, but market-rate projects had to use "Skilled and Trained" labor, which is extremely scarce. As a result, the only SB 35 projects completed as of this point are subsidized. SB 423 would apply AB 2011-style labor standards to all projects and indefinitely extend the streamlining. The intra-labor fight has been intense. The carpenters are supporting in droves; the remaining trades are stopping just shy of calling them scabs.
    • 

  • SB 4, a revival of 2020's SB 899, which would allow churches and nonprofit schools to build housing on their land. This is enormously popular, and was killed for unclear reasons last time. There's been some remarkable cross-pollination with SB 423 at the Capitol, with religious leaders supporting SB 423 and the carpenters supporting SB 4.
    • 

  • AB 309 (CA YIMBY), a revival of AB 2053, which would take the first steps in establishing a statewide social housing agency.
    • 

  • AB 1630 would exempt student housing within a thousand feet of a school from CEQA, as well as from a variety of building standards such as floor-area ratios, parking minimums, density limits, and height limits under forty feet. This is a direct response to the Berkeley ruling earlier this year.
    • 



These bills will of course change going forward, and some will certainly fail to advance, but this is the state of things at the top of the year.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Quality Contributions Report for September 2022
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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".


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					


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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					


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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					


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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					


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?


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					


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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of April 3, 2023
			
		

	

	

	

		
			

			

				

			

		

			


				

					
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.