DanBC

> As these interventions are made widely accessible you can bet that there will be significant numbers of people that regret their decision, but in many cases the effects of medical intervention will be partially or fully irreversible. Imagine how many people may have such regrets if this is done at scale without long and careful study.

There's quite a lot to unpick here.

1) Rates of regret for transition are lower than most other medical treatment. You're applying a lot of scrutiny to regret, which is fine, but you're only applying that scrutiny to trans care. You're not applying the same scrutiny to eg cancer treatment.

2) Why is regret such a horrific prospect to you? You see someone going through gender affirming care, and then regretting it, and then being forced to live with the result, and this is horrific to you. I don't understand why you don't apply the same standard to the people who are denied access to gender affirming care - the people who are forced to live with the results of not getting the care they need. Why is one situation so terrible and the other is good?

3) In general we allow capacitous people to make choices about healthcare. We tell them what's involved, we tell them about the risks, and then we let them make the decision. We allow people to make unwise decisions, even if those decisions will cause their death. If a person has a necrotic gangrenous leg their doctors will say "we need to amputate this or you will die" but that person is allowed to say "I'd rather die than have you amputate my leg". Why are people okay with bodily autonomy unless it's a trans person getting trans healthcare?

There's also quite a few points you've made that are based on out of date, or misinterpreted, information. Stuff like bone density has been debunked - trans people have reduced bone density before they start gender affirming medical treatment. At the moment people think that the bone density problems are caused by lack of access to sport and exercise.

People forget that the UK government is defunding the English NHS, and there's a good chance this won't happen because the budget got cut.

https://twitter.com/ncarding/status/1589642773011263489?s=20...

I think the point being made is that health is devolved, and this story affects NHS England, but not the other NHS systems in Wales, Scotland, or NI. This is a common problem with reporting on the NHS - journos often say "The UK NHS" when they mean England.

(It's arguable about whether, and how much, an arms-length-body is directly managed by the department of health and social care but I don't think we're going to agree. People who are interested in the detail can read more here: https://www.nao.org.uk/wp-content/uploads/2017/09/2017-Short... (It's a bit out of date, there's been some consolidation)).

No, they did not. They only did psychological assessment, and then referred on to endocrinology who would then do their own assessment and decide whether or not to prescribe PBs.

Here's the NHS England stand commissioning contract. On page 17 there's a flow chart, and you can see that after the assessment phase there's a box that says "Refer to Endocrinology Clinic + ongoing GIDS input", and that box exists because GIDS have never prescribed PBs, they referred children on to an endocrinology service who did their own assessment and made their own decision about whether or not to prescribe. Page 18 has a further flow chart that explains the endo referral process. Page 19 describes the referral and separate assessment process used by the endo service. Page 25 gives further details about referral to the endo liaison team.

https://www.england.nhs.uk/wp-content/uploads/2017/04/gender...

From the link you provide: "A standardised set of psychological questionnaires used in the GIDS clinic was completed at the time young people were deemed potentially eligible and referred to the medical clinic." and "Young people were considered for recruitment after lengthy assessment, spending an average of 2 years and up to 6 years within the GIDS psychological service before being referred to the endocrine clinic for assessment to enter the study." - I mean, come on.

One of the lead authors of the link you've provided: "Gary Butler". He's Professor Gary Butler, who works for the Department of Paediatric and Adolescent Endocrinology, at University College London Hospital NHS Trust. This is the service that provides endocrinology assessment and, if necessary, prescribing.

He doesn't work for Tavistock and Portman NHS Foundation Trust.

From one of the references in your link: https://adc.bmj.com/content/103/7/631

> Support for children and adolescents up to the age of 18 years has been provided through the Tavistock and Portman NHS Trust in London for over 20 years. The GIDS was nationally commissioned by NHS England in 2009 and extended to Leeds in 2012, providing regular outreach clinics in other areas of the UK. Endocrine evaluation and support has been provided through University College Hospital London for over two decades, and Leeds Children’s Hospital since 2013. Care is provided according to an agreed service schedule,3 taking into account international guidance from the World Professional Association for Transgender Health (WPATH)4 and the recent guidelines from the Endocrine Society.5

Puberty blockers would be "endocrine evaluation and support".

If anything, the UK has been an outlier because so few children had access to PBs, far fewer than in other countries. https://pubmed.ncbi.nlm.nih.gov/18667644/

GIDS at Tavistock and Portman never prescribed PBs. That prescribing was done, independently, by endocrinology services in other organisations.

> or that he's just plain wrong. The greatest problem many have with Singal is that he is not following a prescribed narrative.

No, it really is as simple as him being plain wrong.

The unsafeness of the Tavistock clinic had nothing to do with puberty blockers - Tavi didn't prescribe[1] any puberty blockers to any child. And while the clinic provided by Tavistock is closing there will be many other clinics opening. Provision of gender affirming care to children is being expanded.

[1] This is the big problem with threads like these. You can just lie and no-one knows any different because there's so much disinformation being spread. You shouldn't spread disinformation, and you should feel bad about doing so.

The fact that you don't understand the basics (that Tavistock didn't do any prescribing) but you feel confident enough to comment is peak fucking HN. Bunch of dunning kruger cunts.

> 6 drinks a day, every day,

One glass of wine, 125 ml, at 8%, is one UK unit. Half a .75l bottle of wine at 14% would be 5.25 units.

It's not unusual in the UK for people to drink half a bottle of wine each evening, and then more on the weekends.

We drink a lot. It causes a lot of harm.

This is a fundamentally dishonest headline. The Cass Review hasn't said that it's a phrase; she's encouraging more treatment in more treatment centres.

But not in the actual Cass Review interim report. The reporting was so bad she's had to issue a clarification letter.

"Hormone specialists" are endocrinologists are are qualified, trained, registered, doctors working within their expertise, and when they prescribe meds to a small number of people they're prescribing meds that are licenced to prevent puberty in children (albeit not in trans children) -- this is considerably better licensing that most paediatric meds.

No, it just means if you do it you need to pay for it, and the Conservatives have in real terms cut funding and increased bureaucracy.

I think people need to understand that colorectal cancer isn't one thing. There are a range of cancers that occur in the colorectal system.

Finding a cancer earlier (in terms of staging) is probably a good thing. But finding a cancer earlier (in terms of age of the patient) possibly means they have a harder to treat, more aggressive, cancer. This might be why there's diminishing returns on population screening in younger people. Older people have easier to treat cancers and pre-cancerous polyps.

> because every single additional person showing up for a screening is a net win

We can't say that from this study.

Colonoscopy does appear to be one of the screenings that reduces mortality. (That's why this is such a surprising result and is getting a lot of attention). But that does not mean that colonoscopy screening is useful for people in their 40s. There's a lot of discussion about the benefits and risks of colonoscopy screening for people in their 50s. Colonoscopy, especially as it's practised in the US with heavy sedation, is not risk free.

> The collapse here wasn't a slow event anyway, it has very clearly been triggered by lockdowns/vaccines

Absolutely fucking mental mate.

I don't use a stream deck but I use a 4 key programmable keyboard in MS Teams meetings to turn on and off the microphone, the camera, and to put hand up and down.

I don't use Teams enough for the muscle memory for the keyboard shortcuts to kick in, but I use it often enough that this little keyboard is useful.

There's a difference between forcible treatment, and being kept in a room wearing nothing but anti-ligature clothing, with none of your belongings, no blankets, no furniture, food being provided through a hatch in a door, etc.

It's great that you've met a couple of people with severe mental illness that had good experience of care - most people do. But it's not relevant to what I said.

Solitary confinement is torture, which is why it's banned unless there's no other option. In the English system seclusion is used far too often, and often as a first not last resort. This is also true for restraint and rapid tranquillisation. There are national and local programmes of work trying to reduce use of force, and we've even had a recent law change to prevent the use of force in mental health units. The new law recognises that people's human rights were being abused.

https://www.legislation.gov.uk/ukpga/2018/27/enacted

https://www.gov.uk/government/publications/mental-health-uni...

https://restraintreductionnetwork.org/

We're reforming the mental health act because we recognise that people's human rights are not respected, and to improve the use of advance directives and reduce the use of compulsory treatment, especially the use of force: https://commonslibrary.parliament.uk/research-briefings/cbp-...

> one could just look at other countries for examples to evaluate whether this idea would present a terrible slide into authoritarianism. For example, in the UK: https://www.nhs.uk/mental-health/social-care-and-your-rights....

The English system unambiguously leads to abuse. We see autistic people held for years in secure services because it's thought they pose a risk of harm to others, but often that risk is evidenced by behaviours they exhibit while under severe restriction in hospital. I'd argue that if you put anyone in a locked room with nothing but anti-ligature clothing and keep them there for a month they'd act aggressively. See also the many documentaries about abuse, eg Winterborne View, St Andrews, Edenfield Centre, TEWV, etc etc.

> Their apparent addiction to hiring full time diversity officers on six figure salaries is a neuralgic one, not so much because of the scale of the waste (small) but because it's so obviously waste, so easy to fix and so obviously designed purge the NHS of anyone who isn't ideologically pliant, regardless of the political cost of provoking large numbers of taxpayers and voters.

Here's a member of staff, a black man, who was attacked by a patient. He defended himself. The patient made a complaint, and the staff member was disciplined and dismissed.

He took the case to employment tribunal, claiming that the original attack was racist, and that the complaint was racist, and that the following investigation did not account for that racism and so was itself racist.

He won, because there was clear evidence that what he said was true. He got a 7 figure pay out.

https://www.theguardian.com/money/2018/nov/23/former-nhs-tru...

You've said that fewer people die under a privatised healthcare system - the US has worse outcomes, lower life expectancy, because of its private health care. You're simply wrong.

That guy could have got emergency health care - he could have walked into an MIU, or an ED, or he could have called 999.

> The sad thing is, cases like that one are increasingly not a mere outlier.

There's a million healthcare contacts per day. So far you've highlighted one where the patient got terrible care. It made national news because it's an outlier. Where are all the others?

> The NHS is not regulation of health care. Most countries have heavily regulated but private healthcare

You brought up de-regulation. Here's what you said:

> If done properly privatisation and deregulation could just save it.

There's no point continuing the discussion if you can't keep up with your own arguments.

Germany spends quite a lot more than England. Depends how you measure (per capita there's a big difference; percentage of GDP the difference is smaller).

Another thing that's really affecting the English NHS at the moment is Brexit - it's making it very difficult to recruit and retain staff, which has pushed up staff costs because of the spend on locum doctors and agency nursing staff.

But, really, the main problem is 12 years of a Conservative government that does not believe in tax-funded public services. Cameron and May were bad, but Johnson and Truss have been catastrophic for the NHS.

> I have no doubt they waste tremendous amounts of money.

Do you have any examples?

> If done properly privatisation and deregulation could just save it.

How do you de-regulate healthcare without killing people?

We already have private providers of NHS healthcare, and they usually hand the contracts back because they can't afford to do it for the money. We could experiment by paying private providers more money, but if we're doing that why not just give the money to NHS providers?

No, it didn't. The only things that worked were increasing the price and providing nicotine replacement treatment.

The watershed is a good example that supports my point.

We have law that says "don't advertise to children", and that's quite tricky so if a beer company says "we only placed ads in programmes that aired after 9pm which had adult themes" they're in the clear. If they place ads in shows at 7pm that are aimed at families they're in trouble.

The YouTube version is the channel saying "I have no idea who watches my channel because YouTube won't and can't tell me", advertisers saying "We advertise with YouTube, we expect them to place the ads responsibly, and we can't rely on YT analytics because COPPA means many children watch while logged into a parents account" and YouTube saying "we don't care, it's entirely the responsibility of the channels and advertisers".

It's this last "we don't care" bit that is causing problems. As the watershed example shows you don't have to have a bullet proof solution. You just need to make some good faith attempt to create conventions around ad placement that reduce the numbers of alcohol ads being served to children.

> The problem here is that “harm” is subjective

Sure, but we have national laws, regulations, and cultural norms that specify harms and YouTube just shrugs their shoulders and says "we don't care".

> When you deal with the scale that YT are operating at, automating content moderation is the only cost effective way.

At some point the Silicon Valley excuse of "we can't afford to do it" is going to run into dumb but powerful regulators who simply do not care and who will impose strict law to force it to happen.

YouTube has managed to persuade some regulators that the advertisers and the channel owners are solely responsible for ad placement, and that YouTube (which controls which products can be advertised, which places the ads, which takes most of the money for the ads, which has contracts with the advertisers and the channels where ads are placed, which earns most of its revenue through ads) has nothing to do with ads. That's worked for them in the US, but it's a fact that regulators in other countries are losing patience.

For example, YouTube needs a way to stop alcohol being advertised to children.

At the moment YouTube are saying that it's the responsibility of the drinks company and the channel to stop this happening. That works in the US, but it doesn't work in Europe, and YouTube saying "we don't know how old people are because COPPA" is met with "so what? It's still a problem, and you need to fix it".

All the research we have shows, very clearly, that shaming people does not work.

I had to edit the title quite a lot to get it to fit the HN limits. Sorry. I'm not great at doing that, so if you think there's a better title email HN and get them to change it. The full title is "Suicide numbers during the first 9-15 months of the COVID-19 pandemic compared with pre-existing trends: An interrupted time series analysis in 33 countries".

On HN there's a reasonably frequent assertion: measures taken to control pandemic, especially lockdown, caused an increase in death by suicide.

There's considerable lag in suicide statistics (mostly because of the way suicide is defined and the way the data is collected), but early research didn't show a rise in most places, and that remained true even when they used a quicker and looser definition of suicide. (Suicide is usually defined as a death following self injury where the intent is to die. A looser definition might be death after self injury where the intent is not known.)

The submitted article is a pretty comprehensive look at suicide data from a large number of countries. The findings and interpretation are clear.

--- Findings

We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well.

Interpretation

Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue.

> The NHS is a disaster and the reason isn't because of "privatization"

You're in luck. Current UK government believes in privatisation of public services, massive tax cuts, and funding those tax cuts by massive cuts in public spending.

They've released one mini-budget, and that was so bad they crashed the UK economy. The pound is at the lowest it's been in decades; the Bank of England is taking emergency measures to try to stabilise the economy

Almost everyone describes this as a disaster, and even traditionally right wing fiscal sources are saying we need to adequately fund public services and those need to be paid for by some kind of taxation.

There's a reason you don't hear much about purely private healthcare: where ever it's tried it fails. In England we have private provision of private services, and these serve a very narrow niche where people are either treated for minor things, or treatment is begun and then they're discharged back to the NHS when their money runs out; we also have private provision of NHS services and that fails because they can't provide the service for the money available or because they're just terrible (see countless CQC reports).

I feel like tutorials should make it clear when they're giving you correct technique or some quick and dirty hack.

One of the images shows damaged insulation and too much solder. https://content.instructables.com/ORIG/FES/OFV3/KZ7C3ZX0/FES...

Lots of the joints in the images are sub-standard. This method is fine if you're happy bodging something together, but it's not great.

> Other nations with "good health care" seem to [...] have long wait times at the ER,

How are you measuring wait times? How are you defining Emergency Departments?

In England there's a 4 hour target for people to be seen, treated and then discharged (or for a decision to admit to be made). Currently the English NHS is meeting that target for 75% of all attendances. This has declined from a 95% rate a few years ago, and it's seen as a massive problem.

https://www.england.nhs.uk/statistics/statistical-work-areas...