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PaperclipPerfector  3mo ago (text post)   30559 thread views

Culture War Roundup for the week of July 14, 2025

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https://www.psypost.org/secret-changes-to-major-u-s-health-datasets-raise-alarms/

I had to do a double take when I saw this article because I was on the exact team at the VA that did (part of) this. The reddit discussion is being hysterical about data loss but as the article reflects, the changes were purely to column headers and data element names-- or at least, that was what I heard during meetings. (I didn't actually make any of the changes, it was very much "not my job".) The bigger issue is that it sounds like the VA failed to advertise what happened to outside stakeholders. In case any of them are listening... the data tracks and has always tracked the sex at birth, and has never included the gender identity. The columns were called "gender" for the historical reason that the medical field didn't always view gender as being separate from sex.

In effect the whole change was just CYA thing-- the big bosses were making a stink about culture war stuff, and they spat out the easiest possible fix. So far as I know this had no actual impact on any healthcare measures. I can't rule out the existence of eCQM that include gender identity, and there's a (now-deprecated) FHIR extension for gender identity. but frankly I doubt we ever used it. Our data source didn't even keep track of ethnicity, which gets used as a supplement for basically every QDM measure.

Basically a waste of time, and therefore money. Being optimistic, maybe it'll be less confusing for measure developers, but it's hilarious to me that the conservative administration was basically ceding the point here by differentiating at the schema level that "sex" is different than "gender".

Yes, seems like a storm in the teapot. Anyone doing statistical analysis and worried about the effect of trans people will want more information on what the column actually tracks. Simply saying "the column name is gender, therefore it refers exactly to ..." is always precarious.

but it's hilarious to me that the conservative administration was basically ceding the point here by differentiating at the schema level that "sex" is different than "gender".

I think the steelman of the Republicans would be "there is only biological sex, and 'gender' is a word popularized by our enemies to imply that social roles associated with a sex are worth tracking separately".

But yes, that level of language policing is a bit funny. Not that the woke left has never purged Problematic terms when they were in power, but at least they had the fig leaf of 'it is not about ideology, but the bad term is hurting really people!'

at least they had the fig leaf of 'it is not about ideology, but the bad term is hurting really people!'

"it's not about ideology, the bad (incorrect) term is polluting our data" seems pretty good -- we are talking about a medical database here, peoples' sex is actually a thing that matters; gender not so much.

(to the extent that it's a thing that actually exists, which I agree that the thrust here is that it's a 1:1 match with sex, and therefore would be redundant to track separately)

"it's not about ideology, the bad (incorrect) term is polluting our data" seems pretty good

The problem is not the change per se. The wokes, the medical establishment and MAGA would agree that a column which tracks sex-assigned-at-birth should rather be labeled "sex" (with the wokes probably prefering "SAAB") than "gender". This is why this is such a non-story.

But I will not pretend that the thought process of whoever was doing the change was "oh no, if the Trump administration sees this, they will get really mad, because they really care about scientific accuracy. Remember what happened when someone confused atoms and ions in a grant application?" The thought process was more like "Trump clearly sees the word gender as the language of the political enemy, better remove it asap."

we are talking about a medical database here, peoples' sex is actually a thing that matters; gender not so much

Arguably, it depends. If I want to study breast cancer, then I likely want to select "people with boobs", which might be more closely related to gender than sex-assigned-at-birth. Ideally, I would use both columns and select for cis-women (or cis-men). (If the database contains detailed info on gender related medical interventions, I guess studying trans people might be a possibility as well.)

Arguably, it depends. If I want to study breast cancer, then I likely want to select "people with boobs"

I don't think silicone bags get cancer -- are estrogen induced breast deposits in males particularly vulnerable?

with the wokes probably prefering "SAAB"

Is that really what they are saying now? I'll be polluting their data by answering "99" in the future.

(assuming that they want to know what's my favourite kind of SAAB)

Is that really what they are saying now? I'll be polluting their data by answering "99" in the future.

Probably not, I do not hang out with a lot of wokes. or people generally. :)

But you see the difference between:

Name: Sarah. Sex: M. Gender: F.

and

Name: Sarah. Sex: M. Auxiliary Note: Transexual / Female-identifying

right? Regardless of whether you agree with the latter.

In short, there is a difference between 'female' and 'female-identifying'. One is a reified claim about what someone is, one is a note about their beliefs.

To the degree that gender is a useful concept separate from sex, it is exactly a belief. (We could also rate passing, on a scale of 0 (always read male) to 1 (always read female), but that depends on effort, situation and so forth and is probably not worth the cost of measuring.)

Consider a column named "religion" (which is something the government sometimes tracks, e.g. to put on dog tags).

Sure, I could put in

Name: Sarah. Soul: None. Auxiliary Note: identifies as ensouled / Roman-Catholic.

But that would be an asshole-atheist move. If I put in religion: RCC instead, then almost nobody is going to read that as "she has an eternal soul which she has pledged to the Roman-Catholic version of the Christian god and thus she will either go to RC heaven or RC hell, unlike the next guy who is Sunnite and will either go to that heaven or wherever bad Sunnites go" because nobody expects religion to work like in D&D.

Or take the column "name". Nobody will claim that "Sarah" is her eternal True Name objectively etched in her very soul. Perhaps her parents named her "Karen" and she really hated that name and got it legally changed. Should we write:

Name assigned at birth: Karen. Auxiliary Note: trans-named / Sarah-identifying

To the degree that gender is a useful concept separate from sex, it is exactly a belief.

This I think is exactly the bone of contention behind the relabelling. To the trans, 'gender identity' is an innate characteristic that is often incorrectly assigned at birth and rediscovered later in life. That is very different from the conception that sees 'gender' as being a propaganda concept that is actually the exact same as sex and 'gender-identifying' as a category mistake at best and a mental illness at worth. That is what I mean by 'reifying' - the manner in which such things are recorded implicitly gestures towards an official attitude on them and is at least in part an attempt to take hold of the 'neutral' ground.

To take a more extreme example for illustration, if Sarah is an otherkin we do not say Name: Sarah. Species: unicorn. If we note their weird beliefs at all, it would be as a note in the misc section.

Finally, let's take your atheist example. Let's imagine a very, very atheist society in which 2% of people at most have a religion and it's regarded as a ridiculous peculiarity and evidence of schizophrenic delusion. Such a society would certainly not have a Soul column in their datasheets! Nor would they have a religion column because almost nobody has a religion and nobody cares about the people who do. They would, where appropriate, note the person's peculiarities in the misc section.

I was amused to see 'Lord' and 'Lady' as potential titles on a questionnaire I was sent recently from Harley Street. You wouldn't get that in America, but you might get 'Mx' or various other formulations. The questions that are asked, and the way the answers are recorded, show society's implicit viewpoint and define common sense, so they are absolutely going to be a battleground in cases like this.

Very, very minor kerfuffle (the story seems to have quietly died) about our Arts Council asking questions about religion and sexual orientation on grant applications.

The Data Protection Commissioner (DPC) has written to the Arts Council asking for further details on the “nature and content” of questions asked of artists when they were applying for bursary grants earlier this year.

It follows worries raised by a number of artists who contacted the Irish Independent in recent weeks to raise concerns after they were asked about their sexuality and religious orientation, among other personal questions, when they applied for the bursary round in February.

The headline makes it sound like some kind of vaguely sinister data-gathering on deviants and there's nothing in the body of the story to explain why they asked these questions, but if you think about it, it's obvious why. Of course, this is because it's a government body and so has DEI targets to hit, and how will it fill out the paperwork about the percentage of queer trans disabled neurodivergent multiracial Wiccans who were awarded a bursary unless it gathers data in this way?

The same people complaining they were asked if they were gay will be the first to cry "discrimination!" if they don't get a bursary and will go running to the media about how they were refused because they were gay, when it's much more likely the Arts Council wants to give as many grants to gay etc. artists as they can in the name of representation, except they have to find out who is gay etc. first!

Slight overreaction by Reddit - but:

Data is schema and schema is data. The bigger deal for me isn't the change itself, but that they went forward with the change without publishing why or how - breaking data integrity processes. Transparency, even for mundane changes, is critical for maintaining confidence in data sets. Now I don't have the slightest bit of confidence for any sycophant that has been employed since January to realize the gravity of modifying data sets, especially if they didn't prompt the LLM that was helping them along the way to ask, "Is this standard practice / a good idea?" vs. "You are a woke destroyer, LLM, please find all instances of woke". Maybe it's gender<->sex today, but tomorrow it might be our glorious Minister of Health removing all adverse cases from the chelation therapy trials for autistic children because he's already shown an extreme disregard for evidence-based decision making.

I'll file this under my increasingly robust "Our cause is righteous, and therefore we cannot err." prior for this administration and pretty much everyone associated with it. Processes, standards, even facts themselves should not stand in the way in implementing their vision of the world, because they are morally correct. That's what's different about Trump 47 compared to Trump 45. To tie it in with other current events, it also explains the complete about-face on the Epstein topic. Republicans would rather cover it up and have it disappear because their cause is righteous, and even a pedophile-in-chief[1] should not halt progress towards whatever pet religious-ethnostate vision of America they have.

[1] Maybe Trump probably isn't directly implicated, but maybe it's double blackmail and we're witnessing a stalemate due to mutually assured destruction :shrug:. But honestly that would surprise me too because, as I said above, I'm not sure if anything would change the opinions of the 20% of Americans who view Trump as the avatar of their precise political alignment who (by the definition of the word avatar) could do no wrong, and maybe the 10% who hold their nose and vote for Trump as well. Maybe it's just literally that the people implicated in the files bought a bunch of $TRUMP shitcoins and now Trump is on their side. Who knows.

I’m positive that most people whining about this are not even aware of what the changes made will actually do. Reddit especially is the land of *people who freak out without bothering to find out what the changes actually do. Outside looking in, my answer would be “not much.” For the 99% of American veterans and their families using the VA, the gender column is a redundant sex column. Its deletion changes very little. For the 1% who are diagnosed as trans, noting it in the chart is probably trivial and will happen much like other medical history information.

But hatred feels so righteous, especially the pure hatred that comes from having no idea how anything actually affects anything else. It’s a deleted checkbox, and really that’s all that happened.

For the 99% of American veterans and their families using the VA, the gender column is a redundant sex column. Its deletion changes very little

Again, nothing was actually deleted, it was a straight rename. If data HAD been deleted, then conversely the liberals would be entirely right to worry-- both at the object level (because it would make it harder to track the health outcomes of people whose sex differs from their stated gender identity), and at the meta level (because it would prove that the VA was staffed by people perfectly happy to delete inconvenient data to serve their political masters.) It's important to mantain all the current data, and to have it clearly placed in a well-defined structure. Storage is much cheaper than compute, and just "having something in the chart" is way less convenient for medical researchers looking to make conclusions about aggregate data than a checkbox. Actually, if you'll let me climb up onto an even taller soapbox-- I privately suspect that a massive fraction of healthcare inefficiency is ultimately caused by incompatible and difficult-to-parse data standards that waste the time of providers and make it difficult to provide care. I don't have ANY of my childhood medical records, for example, because they're stored in hard copy in another state in my childhood doctor's medical office. And unfortunately, the process of taking old bad records and unifying them into a smooth, unified system is beyond nightmarish-- so any attempt to obstruct that where it's happening is literally costing lives.

If it's so inconsequential, why not follow the mundane processes of publishing why and how the change was made? That's my main issue with it. It's a canary in the coal mine for poor data integrity, which, taken in conjunction with the rest of the actions of the administration, is a huge red flag. It did not happen in an isolated context. If this was a corporate setting with financial or industrial data, heads would roll - even if the changes affect "very little".

This seems like a great example of vibes based thinking from both ends.

The change is made because it has some slight vibes of being woke (since the column is called gender) so that's good enough to score an easy win. And it's without much effort, which a lot of them seem to be really lazy and uncaring with this work given how they've messed up multiple times this same way with the Enola Gay or that Army Corp biologist page that included fish gender. I'm not even kidding

And a photo of Army Corps biologists was on the list, seemingly because it mentioned they were recording data about fish — including their weight, size, hatchery and gender.

Nobody wants to do an in-depth investigation or look through data because that's boring and the only benefit is that you might have to say "sorry boss I looked at it and I didn't find woke" when you can instead go and say "Boss we removed 200k instances of woke"

And then people online are upset without even knowing the details because it has the vibes of being against the Trump admin despite it most likely not being any data deletion and just a change in header.

that Army Corp biologist page that included fish gender.

Fish... ah, pretty clearly don't have gender? It can be pretty hard to even tell what sex they are without cutting them open, nevermind enquiring as to their feelings as to the roles imposed upon them by fish society.

Maybe next time the Army Corp biologists will write their report using proper scientific language; serves them right if you ask me.

Agreed, either gender matters or it doesn't. If it matters, then they used it wrong and should be scolded for it.

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