This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
This is one of the topics that really broke my trust with the medical 'experts', along with the covid stuff.
There are some basic common sense things to know about medicine and if someone is going to make a claim contradicting it they need to have a lot of evidence and some damn good explanations.
The idea that halting a major development milestone would be harmless breaks every bit of common sense about child health. The idea that infection with a sickness does not grant any kind of immunity is also insane.
You have to be so so careful with this kind of thinking when it comes to medicine.
First, I'll say yeah everything related to Trans healthcare is fucked and if you put a doctor in a safe space you have a shockingly high likelihood that what they have to say is grossly off-narrative, but what is allowed to be said in public is totally different.
Okay, but-
Medicine is a mix of really obvious common sense things, sometimes with a clearly understood basis (a lot of cardiac physiology is just fluid going through tubes! Easy to model!) and things that are basically the most complicated thing we know about (ex: the brain).
It is not always clear when something is common sense and when it is not. Extremely unclear. To the point where professional medical researchers in a field will get this wrong, stake research and money and decades on something and totally not understand if it was common sense or not.
The classic manifestation of this is blithely labeled "clinical significance." Something can make sense in a lab or a Petri dish, or in a monitored study, but you unleash it on our population you find out it does jack shit.
This came up a lot during COVID - such and such trend medication would appear to have an impact on viral replication in a lab and then you'd give it to people and it would have no impact at all or reduce symptoms by one hour on average or something like that.
Sometimes we'd have a common sense explanation ("oh it's kinda like Tamiflu you just need to give it super early after exposure...so it's mostly useless") sometimes we don't.
Clinical medicine involves a lot of heuristics and experience to help figure out what is common sense and to guess ahead of research because research is slow and expensive and a lot of what we do is never researched because nobody can monetize it or research would be unethical.
It's a mess, but most physicians were just like "oh it's going to be like Tamilfu" from the word go and tuned out, while everyone else in the population didn't even know they had to think that way.
I'm getting a bit unfocused so to bring it back-
Common sense in child health frequently doesn't apply. The field is going to have findings that don't make sense to you (even if I don't agree this is one of them). Consider that for a long time "spanking is good for child development" was common sense. Then it wasn't. I'd bet money the research base for both conclusions is frustratingly unhelpful.
And for your other example-
Looking at the immune system as "oh you get sick and then you get immunity" is like looking at Moore's Law and then assuming it will go on forever. Are you going to be right most of the time? Sure, but does that tell you anything about the nuances of the system or for how long it will apply? No.
Plenty of infectious organisms don't trigger your immune system in a normal way or have weird interactions. For example: Herpesviruses. You have them forever! Does that count as immunity? Or not immunity? Shit I don't know.
TLDR: Common sense applies in medicine in a lot of places but sometimes not in what seems like an obvious place. This causes angst.
It's partly that they flipped all the standards of evidence on their head.
Interventions were considered safe until proven otherwise. Masking young kids in school, widespread adoption of a novel medical treatment (MRNA "vaccines"), puberty blockers, etc.
Covid is basically a flu/cold virus. All intuitions about such things turned out to basically be correct. And there was good evidence that was true in 2020 but they spent nearly four more years dragging it on. Unless you were part of a BLM protest, and then things were fine.
Biology can often be weird and unintuitive I get that. But when it gets weird is when you need more evidence and research, not a political wall of silence saying "you are a bad person if you don't believe us".
I literally cannot imagine a non life threatening scenario where hormone therapies would be allowed for kids. Hormones are definitely one of those systems that we don't understand very well. We know that getting it wrong can even cause life threatening conditions. We correctly vilify anyone giving out steroids to teen athletes, this seems just as dangerous and permanent.
With respect to Trans care-
A finicky part of this discussion is that it's really about two separate issues: 1. "Do we know if gender affirming care helps" 2. "How do we feel about it?"
Common sense is a poor guide because both sides think they have the common sense. Personally I will accept either outcome as to its usefulness, but I use the cheat of "we actively have zero idea because of poor research quality." However when most people talk about this they let question two bleed in, and that includes "what just makes the most sense?" The idea of gender identity problems is very poorly understood, including its natural history and pathophysiology (in large part because of willful blindness by advocates). It should be weird enough and unknown enough that "what makes sense" rarely applies.
With respect to COVID-
A huge problem here is the mixing of political and scientific questions. We (as in the field, but also me specifically on the old forum and with my family and so on) were upfront about lots of COVID stuff that turned out to be true. Most of it was consistent the whole time. Some of this falls into a bit of a medical talk vs regular people talk "it's just a bad flu" scares the shit out of us but most normies do not realize how bad the flu is. That's pretty normal communication problems in a fraught situation.
However when you talk about things like indefinite lock downs or nobody is allowed outside at parks those are political questions that were justified by appealing to science and having politicians (like Fauci) wear a doctor's hat. Additionally we have the problem of mandatory advocacy in the field (seriously it's a required part of medical school and residency training these days and guess which way it always leans) which resulted in a lot of doctors engaging in leftist nonsense hiding under science and medicine but it was leftist bullshit and should be treated as such - it isn't the fault of medicine or doctors its the fault of leftist institutional infiltration.
Medicine works just as well (or not well) as it always has outside the political topics. In the same way that your university or the IRS or whatever does.
The takeaway should not be "medicine is bad and we can't trust public health officials" it should be "medicine and public health officials are people and fall into the same politicking and fear and so on.
From your conversation below. There is a difference between common sense medicine, and common sense applied to medicine. I am more talking about using common sense medicine. Things a practicing family doctor might take for granted after 30 years.
One of those common sense things is that a major medical intervention requires a set of good justifications:
There is a lot of elaboration and nuance for those points. But it feels like they were repeatedly violated for political reasons during the last decade. And it has drastically lowered my trust of medical authorities.
Ah, no major reservations then, although I would recommend my suggested approach of "experts should be listened to with the usual amount of caution except on political topics."
And I naively though children's health and an international pandemic would supersede politics due to the importance of getting them correct. But now I don't know what politics has touched and what it hasn't.
"Will somebody please think of the children" has always been the refrain of moral busybodies lol.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
I mean, if we have zero idea then it's still a scandal anyway.
Yes!
100% going to be a situation where we think of modern gender affirming care as being similar to lobotomy (with the same ignoring the positive side of lobotomies) at some point in the future (could be soon could be later).
I directionally agree with most posters here on this topic.
BUT.
Common sense isn't the right tree to be barking up.
I would say the heuristic understanding common sense is applying the same standards used for non-political or non-controversial interventions to the interventions that are most controversial and politically entwined.
To be direct about it, that seems to be the literal meaning behind the phrase “common sense”; it is the sense making applied most commonly.
That seems to be the heuristic that cjet79 is applying so I’m confused as to why you’d disagree. Am I misunderstanding something?
My point is that the average person's understanding of common sense (or intuition) is generally a poor choice for application to medical topics. This is hurt even more by the fact that it actually works some of the time, so it is common for people to get the impression that common sense works well enough.
I do agree with some of cnet's conclusions, but I'm saying that he's right (when he is, by my reckoning) by essentially accident. While I don't think cjet does this, you see a lot of people overestimating on the topic of medicine with similar thinking.
I understand your point, but common sense isn’t meant to be categorical, but rather a heuristic or a kind of null hypothesis.
We go with the common sense approach until there’s good evidence to the contrary.
Whilst I appreciate your point that some people may allow bias to bleed into what they deem common sense, if you use the heuristic laid out my cjet79 common sense is a valid approach and we should be sceptical of people or institutions that caste it aside without proper evidence.
Tbh, I don’t think we’re disagreeing here; maybe just talking past each other a little.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
I agree with what you're saying but I also agree with cjet79's central point that "if someone is going to make a claim contradicting [most people's common sense about medicine] they need to have a lot of evidence and some damn good explanations."
I think this is true in general, not just in medicine. If you're going to make claims that contradict peoples' common sense, then you need to be prepared to carry a heavy burden of persuasion, and you should empathize with (rather than attack or belittle) those people who are unpersuaded and trust their (perhaps incorrect) common sense. This is where the medical establishment really messed up. Even on issues where I think the establishment is correct (e.g., the covid vaccines are effective, adults should be allowed to medically transition) I still think the establishment has done a horrible job of messaging, and has blamed its failures on the people it failed to convince.
I mean to some extent the fundamental problem is that patients are idiots (also, people are idiots).
For example it is pervasive common sense in the U.S. that doctors in general (and notably for this forum - psychiatrists in specific) are pill pushers first and foremost.
Meanwhile every doctor is trained to and will tell you to make lifestyle modifications and live a healthy life first. If they do not it's not because they don't believe it's because they've given up because nobody listens.
Then patients say they want to do X supplement or go to the chiropractor or whatever in order to maintain health instead of taking medication which the pill pushing doctor wants them on...
Ultimately you do what you can but people will ignore you and believe whatever they want and be resistant to being told what is or is not common sense and what is or is not good evidence.
Convincing people of stuff they don't want to believe is not something that doctors are more magically equipped to do than anyone else, but that is what would be required.
I do think public health is directionally wrong on some of this stuff, but insisting "okay but this time when people are wrong or confused you have to be more careful" isn't helpful.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
I remember even 15 years ago, when all this seemed like a fever dream, the activist claims that "If a child decides they want to, they can just resume a normal puberty" seemed insane to me. My mind automatically went to all the wrestlers I knew in highschool who's growth was stunted from constantly having to make weight for 4 years. There was no catching up on that growth after they quit wrestling. The chip on their shoulder manlet former wrestler stereotype exist for a reason. They were tricked by their coaches into peaking at 15, and sacrificed the stature of an adult and the romantic successes that come with it.
I doubt your typical highschool female athletic encounters this, but I know with Olympic level female gymnast (and other sports) who've been lifers, they often struggle with fertility, though I think it's an open and debated question how much of that is permanent. There does seem to be some risk of permanence if the condition occurs at the wrong time or for a long duration.
So I mean, in the context of these pre-trans examples around how important healthy puberty is, and how you don't get a do-over, it was shocking to me that anyone believed the activist lie that it was "fully reversible".
While I am sure there are nonzero examples of this happening in wrestling, you have causation backwards, unless you were at one of a few programs I doubt almost anyone else on this board could name for a very specific time scenario, no one would agree with this.
That is because wrestlers are little because its one of the sports where being little is a competitive advantage because of weight classes. And thus kids get more into it when they are sick of being shoved around by 6'4'' 300 lb guys on the football field or basketball court.
Of course, wrestling is also a much higher barrier to entry sport than either of those. The number of elite wrestlers who did not start very young (or at least in a combat sport very young) rounds to zero, OTOH there are many elite NFL/NBA athletes who picked up the game as high school freshman. This further makes it a family sport. Short dads who are concerned their kid is also going to be short encourage them to wrestle as that is a sport they will have a chance of excelling at.
And, yes, in season weight cutting does exist, but all the good programs have been managing it extremely well since the 90s. And anything from before that is just as likely to be related to anabolic steroid and other doping use. The fact is that, once you are a good wrestler, there is nothing better for your career than for you to hit a massive growth spurt and surge into the upper weight classes. They are not nearly as competitive as the middle weights from the 130-165ish range. Get above that in high school and more than half the kids you are facing didn't touch a mat until high school. I used to, as a freshman at 125 lbs, beat our starters from the 160-180 lb range (but couldn't beat most of the 130-150 range). Those guys were just kids on the football team and the football coach also was a wrestling assistant. This pattern remains into college where the heaviest classes are not as skilled, and even weight deficits are oft overcome by skills (see Kyle Dake's career).
More options
Context Copy link
Isn't the corollary to this that we should also ban teenage wrestling and gymnastics in addition to puberty blockers?
It is kind of sad that the only group of people with as many long-term health problems as the terminally sedentary are the sports nuts.
More options
Context Copy link
Well there's an important distinction in that one is pursuit of competitive greatness and the other is entirely inwardly focused.
Though perhaps we split the baby and make transition a competitive activity. If you're on the varsity squad, which means you've put in your time and are able to trick a panel of judges into believing you're actually the gender you identify as, you get access to the best equipment and medical interventions.
If you're JV, well good for you, here's a used dress, a Party City wig, some Maybelline, and a couple of balloons.
Parents could rest easier if they could take a look at their kid and know that even if they were susceptible to some dangerous ideas, there's no way they could physically pass as the opposite gender. Or, you just know your kid doesn't have the grit to actually make it to varsity even if they have the figure for it.
More options
Context Copy link
Not particularly? Or maybe properly informed parental consent is good enough? You see this a lot with football now, where the concussion risk is so high that parents won't let their kids play it anymore, and instead encourage other sports.
I'm of two minds about it. I'm a huge proponent of fitness, and I fucking loved the decade I spent in martial arts. The concussion I got from it was not so much fun. Nor the spots I still have in my vision, my torn ankle that aches at night if the sheets are tucked in, or the fact that I broke my right hand twice and the knuckles on my right hand line up different than the knuckles on my left now. But I suppose for a 10 year amateur career, that's not horrible, and those were the choices I made largely as an adult. Nobody rode my ass, I pushed myself exactly as hard as I wanted to, until I didn't anymore. And I wouldn't fault anyone for wanting their kids to do a sport, within the boundaries of safety and reason.
It seems somehow more sinister when coaches are pushing children beyond the limits of safety and reason, with health outcomes they would be in a unique position to be aware of, but which they ignore. And if there were programs or coaches that systematically abused children in that way, I would like to see them banned.
More options
Context Copy link
Elite teenage wrestling / gymnastics (and possibly other sports). Sure, I'd be in favor of that. The benefit of sports is that it gets you off your ass, teaches you discipline, possibly team work, how to git gud, how to deal with failure, etc. etc., If kids are practicing sports to the point of predictable long-term health consequences, then things have gotten rather retarded.
The key is to encourage multi-sport focus rather than elite specialization. IMHO.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
Yeah all the steroids abuse by teen athletes seems like a natural experiment to look at. I'm not even sure steroids are as impactful as hormone therapy, but no one thinks steroids for kid athletes was good idea. The "medical" justification for both is kinda the same too, self hostage taking. "I'll be sad and kill myself if you don't let me take these drugs."
More options
Context Copy link
Just as an anecdote, I do personally know a female former competitive gymnast who is now horribly sad because she's permanently infertile due to the physical stresses she was put through as a teen. Her husband's not in a great place with it either.
Definitely changed my perspective on encouraging my daughters to take up seriously-demanding physical activities.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link