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Culture War Roundup for the week of March 24, 2025

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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:

  1. Life of the patient is in danger, or severe quality of life impairment.
  2. The efficacy of the treatment is proven to a set of standards.
  3. The side effects are known, disclosed, and understood by the adult patient or the patients' medical guardian.

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.

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.

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.

I guess my point is that common sense as it applies to most people's thinking does not apply to medicine.

We can be annoyed at people for (potentially) getting things wrong, but if your take away is to replace expert opinion with common sense (as has been the case for many, especially here) then you will end up being more wrong.

The better approach is to trust the expert opinion except for the things where they are going to be reliably unreliable, which are easy to guess. COVID medications? Yeah expert opinion got that right. COVID policy? Well yeah doctors got that wrong, they aren't policy people.