vorpa-glavo
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User ID: 674
vorpa-glavo
4mo ago
Swimming pools don't give you cities where part of the place is taken by drug zombies.
That's true, but if I recall correctly, when I was looking at different causes of death in the United States, swimming pools turned out to kill a similar number of people (mostly young kids) to accidental gun deaths in the United States annually. Obviously, you'd have to compare the base rate of pool ownership (as well as time spent around the pool) to the rate of drowning to get good numbers on the actual risk of owning a swimming pool, but I wouldn't blame a less risk-tolerant person if they didn't own a swimming pool because they were concerned about the risk of their own kids drowning.
I think the problem with bringing up "safeteyism" is that there is obviously a point in any situation where anyone except the most committed libertarian would eventually agree a law of some kind is necessary for society's well-being. Many regulations are written in blood, and I understand the impulse of a person who is more likely to ask "are the trade offs of enforcing this regulation worth it?" rather than "does this regulation reduce individual liberty?" or whatever. Sometimes it takes an unregulated amusement park ride decapitating the son of a state senator for a law to be written.
I have my doubts about Caplan's framing, mainly because I consider my self an "economically literate" left-leaning person, and I think markets are great at a bunch of things, but I'm also aware of famous market failures where government intervention was useful.
Bank runs are a good example of a market failure that I think the central government is well-equipped to fix with things like FDIC insurance. I'm aware of proposals by committed, principled libertarians for how we could solve bank runs through market mechanisms, but I also think that when something like FDIC insurance has worked reasonably well for the last 90+ years, it seems silly to abandon a form of government intervention that works just because there's some fancy mechanism design that accomplishes the same thing through market means.
I think a lot of market fundamentalists are guilty of "infinite frictionless plane" or "spherical cow" type reasoning. Yes, in a society of rational agents, with perfect information, no transaction costs, and perfect ability to insure against negative externalities, we can arrive at Pareto efficient outcomes through market mechanisms. But that seems to ignore that humans aren't rational agents, we don't have perfect information, there often are transaction costs, and we don't have insurance for all possible negative externalities.
We should use markets where they're empirically known to work, and use government intervention where markets empirically veer the furthest from realizing the ideal models used by economists. I'm okay with using government intervention to prop up and support the market, if it gets us closer to the economist's utopia of Pareto efficient outcomes, since even that sounds like it would be an improvement upon the world where we actually live as far as distribution of resources goes.
vorpa-glavo
5mo ago
The funny thing is, that this sort of damnatio memoriae never seems to actually work. Despite the best efforts of the legal system, we still know about Herostratus of Ephesus. (Though, of course, if wiping out the memory of someone or their manifesto was successful, we'd never actually know, would we?)
vorpa-glavo
5mo ago
I think Sailer's "leapfrogging loyalty" remains the best predictor of what is meant by "right" and "left" so far, but it's far from perfect.
I'm a fan of Scott's Thrive vs Survive theory. It is true that it's kind of hard to construct a good definition of "left" and "right" that perfectly encompasses all the ways we use the term.
Chilling effects don't mean no one will ever do something. When people talk about "chilling effects" on free speech, they're not saying literally zero people will speak their mind, just that fewer will speak their mind than would have without the chilling effects.
There are plenty of examples like the US orchestrated 1954 coup against President Jacobo Árbenz in Guatemala, the 1973 coup against President Salvador Allende in Chile, the backing of the Contras against the Sandinista government of Nicaragua in the 1980s, and the failed Bay of Pigs Invasion of Cuba in 1961. Any Latin American government wanting to be and remain socialist, not only had the challenge of propping up a socialist government but also of resisting US plots, and very few had resources to do both.
Add in the use of Structural Adjustment Programs by the IMF and World Bank, as a means of insuring liberalization of trade and privatization in countries that wanted loans, and you have a recipe where the number of live options for most Latin American countries were quite small. So yes, they had agency, but it was very much constrained by the circumstances of international relations.
vorpa-glavo
5mo ago
I agree that other countries have some agency, but there is a long history of US-backed regime change in Latin America. That can have chilling effects on any government that wants to do something the US won't like.
The United States may have a much more "hands off" form of imperialism, but it is historically willing and able to turn a country into a basket case if it furthers its economic interests. This limits the live options available to countries in Latin America, even if they still have agency within that limited set of options.
vorpa-glavo
5mo ago
It’s questionable whether Joe is Catholic at this point as he’s not in communion with Rome.
Biden seems to have taken communion in Rome as recently as 2021. At least formally, that would seem to imply that Rome considers his opinions to be within the range of acceptable views of Catholic orthodoxy. I'm sure he has a few heretical beliefs (his pro-choice legal stance most notably), but I doubt most people would consider him "non-Catholic" by most definitions. By that standard, most American Catholics are "non-Catholic" since it is common to deviate in opinion and practice on things like birth control, sex outside of marriage, etc.
vorpa-glavo
6mo ago
Personally when something is that frequently out of whack it goes beyond “natural” to something else.
I feel like you're exhibiting the same "representation fallacy" that a lot of left-wing idpol people do. Imagine we're in a spherical cow world where the main cast of every piece of media (be it a commercial or a movie) is 10 people and Hollywood produces 100 high profile movies/commercials in a year, and you're evaluating all of the media produced in the past year for its representativeness of the general population, across a variety of identity categories.
It is going to be trivially true that the media is not going to reflect the general population, either on a case by case basis or taken as a whole. It's just a huge coordination problem. If LGB people are around 5-10% of the population, then to get "accurate" representation, every other movie would need to have a gay person in it. But if their gayness is going to be a relevant trait, then two of our 10 cast members probably need to be gay (so they can be in a gay relationship together), and that is already going to create a wonky balancing problem when it comes to movies that aim to portray gay people.
And the problem only deepens if you consider movies like Moana, which would have 10 polynesian characters in it (thus accounting for 1% of the total characters in spherical cow world's yearly evaluation), when polynesians are around 0.5% of the total population.
I think the "rounding error" problem is always going to be present when it comes to representation in films. I also see it being an issue for panel discussions. I have a female friend who was indignant that professional conferences don't try to have a 50/50 split of males and females on panel discussions, but even ignoring the demographics of certain professions like STEM fields being majority male to begin with, you're always going to have the problem that when putting together a panel discussion, you're presumably prioritizing goals other than equality (such as, "Wouldn't it be nice to have someone who wrote a book about this topic recently?" or "We want to balance the panel with opposing viewpoints, so lets try to find the most prominent person who believes ~X, and see if they're willing to fly out and participate on our dime"), and large professional conferences are also operating under constraints of who will actual attend and who actual wants to be on a panel in the first place. Add in the fact that an odd-numbered panel number will always result in an imbalance of some kind, and I think it's completely unreasonable to want more women (or more anyone) on a panel discussion.
vorpa-glavo
6mo ago
Nothing that I said contradicts your clarification. Hyperdulia is still less than latria.
It goes: latria > hyperdulia > protodulia > dulia. (Or more accurately, latria is qualitatively different than dulia, and not on the same track at all.)
I mean, you could probably make a similarly complicated chart for Christianity to be fair. Make branching paths for Arianism, Nestorianism, Filoque, Transubstantiation, Marian and Saintly devotions, Apostolic Succession, Mormonism, etc.
vorpa-glavo
6mo ago
The framework spawned by therapy culture in the west is particularly bad, mental health awareness is bad, stoicism is probably correct.
I get that you are making a distinction between "therapy culture" and "therapy" proper, but it is worth pointing out that Stoicism's DNA is in CBT by way of REBT's influence on it, with REBT's founder Albert Ellis being influenced by (among other sources) the Stoic philosophers. So Stoicism's influence is part of modern therapy, even if it is not part of modern therapy culture.
vorpa-glavo
6mo ago
Catholic doctrine holds Christ above Mary (right?) but I'm pretty sure most Catholics worship and respect Mary more.
Technically, the Catholic position is to worship (latria) God alone, and to merely respect or venerate (dulia) saints, including Mary. However, because of Mary's special status as the Mother of God and Queen of Heaven, she is offered "hyperdulia" the highest form of respect or veneration.
vorpa-glavo
6mo ago
I mean, sure, people are pragmatic and meta-pragmatic all the time. I don't really see the point of this anti-lab grown meat bill, since I think meat eating is so culturally dominant that it won't be wiped out within our life times just because lab grown meat becomes affordable and widely available. More likely, vegetarianism will remain a costly social signal of a minority of people until the diet becomes indistinguishable from meat eating in terms of price and flavor, and then when it is practically effortless a law might eventually pass that bans animal slaughter altogether.
It's going to be exactly what happened with slavery. Banning slavery when an entire regional economy depends on it is difficult to accomplish, and probably requires a war and imposition of force. Living in a world where everyone has 200 to 8000 energy slaves thanks to electricity and industrialization makes being anti-slavery very easy, basically without cost to the individual. I think I would be more likely to see the point of slavery if I had to fetch my own water, grow, prepare and cook my own food from scratch, clean my clothes by hand, wash my dishes by hand, etc.
vorpa-glavo
6mo ago
Like there is no tactic that makes me instinctively hate someone more than a leftist who wants to mandate outcome B telling people that they shouldn't mandate outcome not-B because "mandates are wrong". It's pure "Darwin says whatever words make the meat puppets do what he wants," with zero respect for the target as a thinking human being.
This seems like a very strange thing to say. A vegetarian leftist who wants to mandate the end of animal slaughter wants to do so because they think it is unjustified violence, comparable to murder. But they understand that their values aren't universally shared, so they come up with more limited animal welfare arguments grounded in more commonly held values in the wider society they belong to. That's not demonstrating "zero respect for the target as a thinking human being" - it's being pragmatic about how to achieve some limited version of their goals and build a coalition in a representative liberal democracy.
Like, if a pro-choice person A is talking to a morally pro-life, politically libertarian person B, of course A is going to appeal to B's political libertarianism when it comes to discussing how the government should legislate around abortion, regardless of what other disagreements they might have. This isn't trying to turn other people into meat puppets to do your bidding, it's respecting and understanding other people enough to try and meet them where they're at in order to achieve a compromise outcome both of you can accept.
vorpa-glavo
6mo ago
I prefer Diogenes the Cynic to C.S. Lewis on this count:
[While masturbating] in public, he wished "it were as easy to banish hunger by rubbing the belly."
While Diogenes is a little intense as an example, I think it's much healthier to think of the sex drive as something natural which needs attention from time to time, rather than making it the central focus of your life, or something shameful. I prefer moderate indulgence to sanctimony.
vorpa-glavo
7mo ago
It's not like Jeremy Bentham was pulling ideas out of thin air at random, he was trying to formalize something that was already informally present in the zeitgeist.
While there might be some truth to that, Jeremy Bentham and John Stuart Mill both came to conclusions that were very unpopular in their day. Jeremy Bentham's idea of decriminalizing gay sex was way ahead of its time, but a very natural consequence of utilitarian reasoning. And John Stuart Mill's arguments for the political equality of women and men was a natural enough idea coming from utilitarianism's universality, but had not yet found widespread acceptance in society. (Reading "The Subjection of Women" is an interesting exercise, because the positions John Stuart Mill has to argue against are often things that basically no one today believes. I think it's hard for a modern person to truly put themselves in the mindset of the kind of positions Mill was arguing against.)
I think we swim in fairly utilitarian waters, and much language around things like victimless crimes and harm reduction come originally from Mill and Bentham.
vorpa-glavo
7mo ago
If you ask me how many billion people I would rather die than my cat, my emotional response is I’m okay losing the three billion+ people in Africa and China and India and such. I don’t know those people. My cat loves me.
Logically though, there’s gotta be a better way to strike a balance between partiality and self-interest, alongside recognizing it’s pretty hard to justify a moral system that values my cat so much. If you recognize that other moral agents exist and that you should seek fair compromises as much as possible, then that seems better than any alternative I’m aware of.
Yeah, as someone who has long been roughly aligned with utilitarianism as an ethical philosophy, I've wondered if it's not better to think of it as one answer to what can happen when a lot of people with policy-making power come together, and want to justify their policy goals in a way that most people would consider "fair."
Basically, if a politician wants to build a road, and they're going to have to tear down your house to do it, it's easier to swallow if they justify their decision by saying they took everyone in the country's well-being into account, and they think the new road is going to do more good than your house in its current location is doing. (It is also easier to swallow if they try to be fair to you by giving you enough money to relocate, so you can reap the benefits of the new road as well.)
I've long wondered if "discounted utilitarianism" or "reflective equilibrium hedonism" would be a better philosophy for individuals to adopt instead. Basically, acknowledging that you don't value the life of 1 foreigner the same as 1 person from the same city, and you don't value that person as much as you do a family member or friend. So you just discount each circle of concern by the amount you don't care about them. You might say, "Well a person from China might make my phone, and that has some value to me, so I value their life at 0.001 times that of one my friends." And then you can do the utilitarian calculus with those decisions in mind. Let the 1-to-1 values be in the hands of politicians and diplomats who have to work out fair policies and justify them to their constituents.
vorpa-glavo
7mo ago
But I think it's unlikely that they truly feel a spontaneous, pre-reflective love for all of humanity.
As someone with consequentialist/utilitarian leanings, I cultivated my utilitarianism as a set of demanding ethical duties that correct the problems of humanity's natural inclinations. I basically think that emotional empathy is "flawed." I don't feel 100 times worse about 1000 strangers dying than I do about 10 strangers dying. And the fact that my emotional empathy is activated more by seeing a video of someone suffering, than reading about that same suffering feels like a flaw of human sociality.
One of the maxims I've tried to live by is to "act as I would if my emotions could accurately reflect differences in scale of suffering to the minute degree required by utilitarianism." It's not perfect by any means - I effectively have to have a set of rules or heuristics that will broadly lead to that result, because I don't have the ability to cognitively process all of the different ways society will go, and I'm still using flawed human hardware and interacting with humans and animals with flawed hardware, but I think it informs my Effective Altruism, and my larger political goals.
But I agree with you, that I don't actually feel a love for all of humanity. I just try to make my actions indistinguishable from the actions of someone who has a spontaneous, pre-reflective love for all of humanity.
Utilitarianism is a stance for reaching moral conclusions, not conclusions of cause and effect. I do not believe economists or political scientists make are in much the business of making assertions of this sort in their academic work -- though you can prove me wrong by citing cases where they do.
I think there's arguably a "descriptive" version of utilitarianism, and a "prescriptive" one.
For an analogy, look at medicine. Medicine as a field of investigation concerns itself with health, and to complete that investigation it tries to find causal relationships between various activities and bodily states of health. There's a descriptive and a prescriptive component to medicine. We pour money into medicine because, broadly speaking, the aggregate demands of humans for health are enough to fund the investigations, but many of the descriptive discoveries could be used to make people healthy or unhealthy.
In the same way, economics as a field of the social sciences is "merely" the descriptive study of how economies work, but the reason we study economies is because we want stable, functioning economies that do a good job of allocating resources and have positive effects on well-being.
As I see it, the "descriptive" part of utilitarianism is the aggregate conclusions of the "descriptive" parts of other fields like medicine, economics, sociology, and psychology, that allow us to answer questions like "If we take action X, what effect will that have on QALY's/preference fulfillment/etc." Those questions are in theory "value neutral" questions, but the reason we are asking the question, and the reason we care about the answer is because enough people think that it is worthwhile field of inquiry. That's the implicit "prescriptive" part - it is derived from the fact that we ask the questions to make a larger policy decision.
vorpa-glavo
7mo ago
Addressing the other parts of your post:
That demand seems arbitrary to me, and "that's what we use for everything" is a perfectly fine justification.
I agree it's "fine" from a CYOA point of view, as in, no one will be able to blame you for using a standard tool used across the industry. But from the perspective of trying to perform a Bayesian update based on the final report, I'm not sure I agree.
A lot of the scientific method in general is a heuristic crystallization of Bayesian approaches, and so I have no doubt that a lot of what is present in GRADE is justifiable across a wide swath of evidence, and comes to largely the same answer as a Bayesian approach would. But I think that if GRADE systematically downgrades some kinds of evidence from being "high quality", which in a proper Bayesian approach wouldn't require any serious adjustment, that can lead to certain evidence being ignored or de-emphasized compared to where it should.
My opinion is that trans activists and researchers wildly oversold the scientific basis for the interventions they were promoting, and sometimes they were outright lying ("puberty blockers are reversible"). They could have just not done that, and tried to gradually accumulate stronger evidence. But the way things are, gender medicine should have never seen such widespread adoption, and people who allowed it should probably be punished.
I think absent any other evidence, just the existence of the Replication Crisis is enough to call a lot of medicine into doubt, and I see no reason why this wouldn't apply to trans healthcare. That the evidence is weaker than often claimed, is almost certainly true. (I'm not sure that that isn't the case for a wide variety of healthcare fields as well though - is trans healthcare uniquely bad, or is it just as bad as medicine as a whole, and do we need to adopt a whole swath of reforms to deal with things like p-hacking, the file drawer effect, small sample sizes, etc.)
I agree with Cass' conclusion, even if I question her methodologies, because I want to see higher quality medical evidence around trans issues, and especially trans kids. I want the medical research to be beyond reproach, whatever conclusions it comes to.
The basic problem with medicine, across the board, is that we're routinely doing barbaric things to be people, and the only justification we can have is that the evidence shows it will have a better outcome for the patient. Chemotherapy involves poisoning a patient with the hope that the poison will kill the cancer faster than it kills the patient. Amputating a limb might be a tough decision sometimes, but it is most justified if a patient would likely die if you didn't do it.
I want the evidence we use in all instances, especially trans healthcare to be airtight so that no one can say we're poisoning people or removing functional limbs or organs for no reason. It'll still be "barbaric", but if it can be justified as much as chemotherapy, then I think trans healthcare will be in a good place.
And the critics are wrong. If you give a treatment to one group, and not give it to another to another, that's still an RCT. Or you can offer an alternative treatment to the control group. It's a plus when you can blind a patient to what they're getting, but it's not a strict necessity. In this case it's probably just as important to blind the researchers when they're assessing results as to blind the patients themselves.
You're right of course. I think the concerns are more nuanced in some areas of medicine.
I doubt it applies to trans medicine, but I have heard of cases where medicine has such obvious positive effects for the sample group early on, that it then becomes unconscionable to not provide it to the control group (mostly in cases involving terminal diseases with quick turn arounds.) This would be one instance where a study initially meant to be a RCT trial for a terminal disease, might turn into an observational study instead.
And I was clearly thinking of double-blinded RCTs being nearly impossible in some cases, which I believe is true in some areas of medicine, but I can admit that GRADE only requires RCTs period for evidence to be considered high quality. That said, reading through the actual GRADE hand book it does seem like Lack of Blinding is considered a risk for study bias, which can drop a piece of evidence one level:
Example 3: High Risk of Bias due to lack of blinding (Downgraded by One Level)
RCTs of the effects of Intervention A on acute spinal injury measured both all-cause mortality and, based on a detailed physical examination, motor function. The outcome assessors were not blinded for any outcomes. Blinding of outcome assessors is less important for the assessment of all-cause mortality, but crucial for motor function. The quality of the evidence for the mortality outcome may not be downgraded. However, the quality may be downgraded for the motor function outcome.
I'm going to edit my original post to reflect this information, but I'll make clear what I'm adding. Basically, it appears to be the case that non-double-blinded RCTs cannot easily be high quality evidence according to GRADE.
Where did you get the idea that the decision was arbitrary?
I tried to search through the report, and they just used GRADE without really explaining why. I suppose "arbitrary" isn't quite the right word, but "unjustified within the report" is probably defensible.
Well, the final report of the Cass Review just dropped. It's getting coverage in mainstream publications like the BBC. Surprising no one who paid attention to the interim report, it concludes that there is insufficient evidence in the realm of trans healthcare for children:
Cass told BBC Radio 4's Today programme that clinicians had been worried about having "no guidance, no evidence, no training".
She said "we don't have good evidence" that puberty blockers are safe to use to "arrest puberty", adding that what started out as a clinical trial had been expanded to a wider group of young people before the results of that trial were available.
"It is unusual for us to give a potentially life-changing treatment to young people and not know what happens to them in adulthood, and that's been a particular problem that we haven't had the follow-up into adulthood to know what the results of this are," she said.
Critics are already jumping on the fact that the report used the GRADE approach to categorize evidence, which only allows randomized control studies to be classified as "high quality of evidence" and which can drop non-blinded studies one level in assessed quality, thus preventing many non-blinded studies from qualifying as high quality evidence. (Bold is edit added later. See ArjinFerman's response below, and my response - original GRADE standards can be found here.) The critics point out that double-blinded randomized control studies just aren't possible in some areas of medicine. For a simple example, if the intervention is something like "cosmetic breast augmentation", then there's logically no sensible control group - since there's no placebo that can make people believe they got bigger breasts when they didn't. (It's worth pointing out that this criticism of GRADE isn't unique to trans activists. The Wikipedia page for GRADE mentions it is criticized in general when it comes to slowly progressing diseases like atherosclerosis, where observational studies are easier to perform than RCTs.)
As a result of the GRADE approach, we read things like this in the report:
Understanding intended benefits and risks of puberty blockers
[...]
There was one high quality study, 25 moderate quality studies and 24 low quality studies. The low quality studies were excluded from the synthesis of results.
My own opinion is that I can partially agree with Cass that I want to see higher quality studies around trans healthcare for children in general, but I think that her methodology (using GRADE) is of the sort that will always say we "don't have enough high quality studies", and so her arguments don't have legs to stand on. A problem I see a lot in studies is using some "industry standard" for investigating a topic, and coming to a result of some kind, but failing to justify why the "industry standard" was the best thing to use here. In a better version of the Cass Review, I would have liked to see a few paragraphs justifying the use of GRADE, and explaining why they used this standard and not some other standard.
I mean, isn't that a thing good scientific reports in general do at all steps of the process? Think of what a critic would claim about your model and methodology, and then explain why your model or methodology is the best one to use in this particular instance. Show that your findings are robust even if you used some slightly different model or methodology, and explain what conditions are necessary for your model or methodology to fail. A quick search through the Cass Review shows that it doesn't seem to have done this. It just used GRADE, didn't really justify the decision, and didn't discuss alternatives or why its arguments are robust under alternative assumptions about the data.
It's a bit circular to arbitrarily use a standard that will say, "there are basically no high quality studies in this medical field" no matter what, and then to conclude in your recommendations to the government, "We need more high quality studies before we do anything more in this medical field!"
vorpa-glavo
7mo ago
As I dive deeper into Ayn Rand’s minarchism, I see how little the government has the moral right to be doing in our lives.
I've read widely in the libertarian, minarchist and anarcho-capitalist traditions, and while I think they are often good at identifying certain problems of government, and I'm convinced by the arguments of Huemer's The Problem of Political Authority and Ellickson's Order without Law that these forms of government could potentially work in the real world, I still find myself more attracted to social democracy as a set of principles for organizing society, especially since it's actually been tried in the real world and seems to work reasonably well.
Don't get me wrong, I'm very sympathetic to the view of government that it is just the largest and most successful gang of thugs in an area, and that there is actually little moral grounding for the idea of political authority. But I'm a pragmatist and a consequentialist, and I'm more willing to shrug and say, "if the big bullies take care of the little bullies and make people more free, that's better than the alternative." I tend to agree with Noah Smith's argument in The Liberty of Local Bullies that there are many "intermediate" groups between the government and the individual that often have just as much power to reduce your liberty as the government does.
Imagine a devout Jehovah's Witness in high school refusing to stand for the Pledge of Allegiance because oaths are against their faith, and constantly being punished by their overzealous home room teacher for it. The only way to resolve the issue in a way that preserves the liberty of the Jehovah's Witness to not say the Pledge is to go over the teacher's head, via school administrators. But what if the school administrators support the teacher over the student? The only way to force the teacher to respect the student's religious freedom is to go a level higher to the government, and hope that they will force fines or other coercive measures in order to protect the student's rights.
I think for freedom to be meaningfully maximized you need a centralized government with enough state capacity to force the local bullies to respect freedom. Obviously, it would be foolish to claim that centralized governments with high state capacity always results in increased liberty, but most of the countries I can think of that are good places to live in are some form of liberal representative democracy with free markets and a government with enough state capacity to secure people's rights, and create money transfers and social safety nets (even the United States.)
vorpa-glavo
7mo ago
I don't know. I've seen several trans skeptical people bite the bullet on trans suicide rates.
The attitude seems to either be "the threat of trans kids committing suicide is emotional blackmail meant to shut down the argument from society and parents and force them to go through with mutilating their child against their will" or occasionally even "if they commit suicide at higher rates, then completely ignoring the issue solves the issue (through the self-removal of trans people from the population.)"
I mean, there's nothing stopping both claims from being true (to the extent they're empirically testable.) It could hypothetically be that social contagion and permissive doctors are allowing large numbers of cis children to ruin their bodies through transition followed by inevitable detransition, and that from a purely medical perspective the most effective way to prevent the suicide of enduringly trans children is to allow them to socially transition and take puberty blockers until adulthood when they can make the choice of whether to undergo hormonal therapy and cosmetic surgery. In that hypothetical world, the difficulty would be with separating cis children from trans children in a reliable way that minimized overall harm to both groups.
The empirical case can only solve so much without models of what is happening. The DSM-V's intro talks about how it models mental disorders, and it basically says that they are useful perspectives for treatment and not necessarily a single "real" disease with a known cause or set of causes. That is, ADHD is "real" to doctors using the DSM to the extent that it has been found that patients coming in complaining about a common cluster of issues, tend to have those issues resolved through a common cluster of treatments. And it's no different for gender dysphoria. When it comes to a gender dysphoria diagnosis today, there is no need for brain tests or an "intersex brain" hypothesis or anything more empirical than, "have they had 2 out of these 6 listed symptoms for at least 6 months?"
Because I believe in federalism as a way to achieve "laboratories of democracy", I support the ability of states like Tennessee to experiment with bans of various kind, regardless of whether I think the bans line up with good policy or not.
That said, I think it's a bit Quixotic to try to prevent all bad outcomes from a system. Law is always about trade offs.
There are a lot of traffic deaths in the United States every year, but it would be insane to limit the speed limit to 10 MPH on all roads, or to spend 100% of the national budget on reducing traffic deaths as much as is theoretically possible via human engineering. Instead, we make cars as safe as we can (within reason), make traffic laws as safe as we can (within reason), and build roads as safe as we can (within reason.) And then we accept that all of those decisions mean that a certain number of people still die in traffic every year.
I'm sure there's some level of regulation on trans medicine, cosmetic surgery, and abusable pharmaceuticals that makes a set of trade offs acceptable to most voters in a given area, but I doubt it would include many provisions for dealing with doctor shopping. I think you can get most of the "benefits" of such a law, by just making it illegal in the state, and not worrying about what rich people do to subvert the law.
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