Health LGBTQ+

“The sign of a severely broken system”

Longreads has an excellent article by Mailee Osten-Tan about the people who travel to Thailand for gender confirmation surgery. It’s great journalism, based on extensive research and interviewing (there’s a behind-the-story piece detailing it all here) and the story Osten-Tan tells is interesting, insightful and empathetic.

Thailand is famous in trans circles, and the more broken the NHS’s trans healthcare becomes the more people will save or borrow the money to go there. The NHS was already woefully underfunded before COVID; now the waiting lists, already horrific, are many months and years longer.

“The effect of the pandemic has been to exacerbate a problem which already existed,” said James Bellringer, an NHS and private GCS surgeon in the U.K. for over two decades, in an email. But even apart from the pandemic, he wrote, the U.K. lacks trained staff to meet the demand for surgeries. “It’s not just surgeons but the gender specialists working in the clinics. Gender has been chronically underfunded everywhere (not just the U.K.) for years, and the elastic has finally snapped.”

One of the saddest parts of the article for me was this bit.

For those who want but cannot afford surgery, the longer they are made to wait, the greater their chance of developing serious mental health ramifications. These often relate to the chronic high levels of stress experienced by trans people over the course of their lives — also known as minority stress — brought on by factors such as poor social support, discrimination, rejection, abuse, and/or violence.The majority of trans women I interviewed… wanted to remain anonymous out of fear of being doxxed, harassed, or targeted by hate speech.

At the risk of sounding like a broken record here, these are the “transgender issues” we should be talking about. But trans people rarely get to speak: the only people speaking in the trans “debate” are the intolerant, the ill-informed and the ill-intentioned.

Health Hell in a handcart LGBTQ+

Not Safe To Be Me

Did you hear about Safe To Be Me? If you’re not on LGBT+ social media, probably not. It was the Conservative government’s sole manifesto commitment to the LGBT+ community, the establishment of an international conference to promote LGBT+ rights.

The problem with that is that right now, one of the worst offenders against LGBT+ rights in Europe is the Conservative government. The UK is no longer topping lists of the best countries for LGBT+ people to live; it’s more likely to be listed alongside Hungary, Russia and Poland as a place where LGBT+ people are the victims of demonisation in the name of right-wing populism.

The final straw for the UK’s LGBT+ community was the government’s plan to abandon its commitment to banning dangerous and discredited conversion therapy.

Conversion therapy is a misnomer. There’s nothing therapeutic about it: it’s a form of torture, physical or mental, designed to try and change someone’s innate sexuality or gender identity. We’ve known since the late 1960s that it doesn’t work and does lasting damage to its victims, and most civilised countries either have or are going to ban it. Such a ban doesn’t affect actual therapy, or informal forms of therapy such as exploring your feelings with a counsellor or religious figure. It just bans torture.

A ban on CT was an easy PR win for the Tories, so long cast as the “nasty party” with regards to the LGBT+ community. But with one eye on the upcoming local elections, the Tories have clearly decided to follow the US Republican example and use culture war tactics to distract from their many failures: that whole “let the bodies pile high” thing, the corruption, the fact that Money Saving Expert Martin Lewis has gone from recommending energy deals to advising pensioners on how not to die from the cold this year.

So the UK Government decided to kill the ban as a signal to the right-wing anti-LGBT+ mob. This was from the very top; the equalities minister wasn’t informed. After the inevitable and very vocal backlash, a backlash the government didn’t expect, it announced a partial U-turn:  it would ban conversion therapy, but only for gay and lesbian people. It would still be okay to torture trans people.

The government clearly hoped that the LGBT+ community would accept the partial win and continue with its support for Safe To Be Me later this year. The government was wrong. The entire UK LGBT+ sector – more than 120 LGBT+ organisations – and all the major sponsors of the conference pulled their support in protest.

It’s not just the LGBT+ organisations who want conversion therapy banned. The British Psychological society wants it banned. The Royal College of Psychiatrists too. The British Association of Counselling and Psychotherapy. The British Medical Association. The mental health charity Mind. And many more. All these organisations want to see conversion therapy banned not just for gay and lesbian people, but for trans people too.

Because torture is torture no matter who you do it to.

Their message was simple and should be uncontroversial: trans people have human rights too. Article 3 of the Human Rights Convention (ECHR) declares that nobody shall be subjected to torture or to inhuman or degrading treatment. There’s no caveat saying “unless they’re trans”. Conversion therapy is clearly in breach of Article 3, which is why the government was going to ban it.

Instead, it messed up and mobilised the entire LGBT+ community. I can’t stress this enough: every single LGBT+ charity and advocacy group stands with trans people here. The only exception is the LGB Alliance, which of course is not a genuine LGBT+ organisation. That made Safe To Be Me untenable and potentially disastrous for the UK government; yesterday, they cancelled it.

For years the right wing press, and shamefully some of the left-wing press too, has peddled the myth that the LGBT+ community is divided over trans rights. There are outliers, as there are in any group of people: there were gay men opposed to equal marriage, for example. But the supposed widespread division is not there. To say otherwise is to perpetuate right-wing culture war bullshit.

But again, we’re getting false both-sidesism here. One one side we have decades of evidence, the testimony of victims, and the entire medical and psychological establishment. On the other, a handful of screeching bigots. These things are not equal, and shouldn’t be given equal airtime or column inches.

Health Hell in a handcart LGBTQ+

Everything is awful

Trans Actual has published the results of its 2021 Trans Lives survey, in which around 700 UK trans adults shared their experiences. The results aren’t surprising but they are saddening.

  • 27% of trans people have been homelessness at some point in their lives. That rises to 36% for both trans BPOC and trans disabled people;

  • A staggering 98% of trans people responding do not think that NHS transition related care is completely adequate

There are significant issues with primary care, too:

    • 45% of trans respondents said that their GP did not have a good understanding of their needs as a trans person, with 55% of non-binary people reporting similar issues.

    • 87% of those answering, overall said that this had impacted them to some extent. This rises, again, to 95% and 92% for BPOC and disabled individuals;

    • Issues with healthcare providers may also have serious consequences, in a time when illnesses such as COVID-19 illustrate graphically how individual decisions, when faced with a highly transmissible virus, can affect the rest of the population, as 57% of trans people reported that they avoided going to the GP when unwell – again, because of lack of understanding and more general discrimination;

    • Even more concerning, 14% of respondents (one in 7) reported that their GP had  refused to provide care or treatment on account of their trans status at least once.

As Jane Fae, journalist and TransActual director, rightly says:

The real scandal here is how comprehensively the media have conspired to ignore this situation, preferring, instead, to produce tens of thousands of words on the largely imagined consequences of reform to the Gender Recognition Act.

Bullshit Health

Salad daze

This, by Amanda Mull for The Atlantic, is brilliant: Don’t Believe The Salad Millionaire.

It’s about the CEO of a salad chain for affluent customers. Said CEO claimed that the solution to COVID wasn’t masks or vaccinations: it’s salad. Americans are too fat, too lazy, and it’s their fault if they get sick.

As Mull writes:

that salad is the ideal medicine for an incredibly contagious respiratory virus might not be a trustworthy argument coming from a literal salad millionaire.

But there’s a wider point here.

More interesting, though, is how telling Neman’s salvational ramblings are of a harmful conviction about health that America’s wealthiest, most privileged class long ago laundered into common sense: that people who, unlike them, end up sick or poor have simply refused to make the right choices and help themselves. Speculating that America’s health-care crisis could be solved if everyone just had to eat some salad is not only lazy and wrong; it’s perpetuating an attitude that is making health—and the pandemic—worse for millions of people.

Although this is a story about the US, it’s just as relevant here: our media and political class has the same contempt. But despite the constant narrative of the undeserving poor, poor people don’t make bad food choices because they are stupid or greedy. They make bad food choices because they’re forced to. Poor people make bad choices because they’re poor.

Research has shown that poor people know what they’re missing from their diets, and they want quite badly to have those things.

Food is expensive. It’s expensive to buy good quality ingredients. It’s expensive to buy cookware and kitchenware. It’s expensive to pay for the energy to heat your food. And it’s expensive in terms of time: time spent preparing, time spent cooking, time spent shopping, time spent getting to and from the shops – shops that in many cases are far away from where many poorer people live.

I love to cook, but I’m doing it in a kitchen full of privilege: I can afford to pay my rent, cover my utility bills and still have enough money left to buy good quality ingredients. I have enough free time that I can afford to spend hours messing around with recipes I don’t know if I’ll even like, and I can make things for the kids in the knowledge that if they don’t like it I can simply whip up something else or get a takeaway. I can afford to waste food. These things are luxuries denied to many people.

I’m reminded of Terry Pratchett’s story about poor people’s boots:

The reason that the rich were so rich, Vimes reasoned, was because they managed to spend less money.

Take boots, for example. He earned thirty-eight dollars a month plus allowances. A really good pair of leather boots cost fifty dollars. But an affordable pair of boots, which were sort of OK for a season or two and then leaked like hell when the cardboard gave out, cost about ten dollars. Those were the kind of boots Vimes always bought, and wore until the soles were so thin that he could tell where he was in Ankh-Morpork on a foggy night by the feel of the cobbles.

But the thing was that good boots lasted for years and years. A man who could afford fifty dollars had a pair of boots that’d still be keeping his feet dry in ten years’ time, while the poor man who could only afford cheap boots would have spent a hundred dollars on boots in the same time and would still have wet feet.

As Mull writes:

The people who benefit most from this belief system tend to be those who have parlayed personal advantages into even more enormous personal wealth; they were born on third base and swear they hit a triple.

Health LGBTQ+

Trans Broken Arm Syndrome

While I’m on the subject of healthcare, this piece by David Oliver for USA Today is very good.

Ever broken a bone? You know your first thought: “Ouch!”

But what if said health care worker was too busy asking about your gender identity instead of focusing on mending your broken bone? Sure, it’s important to record and review medical history, but why would questions about hormone therapy or gender reassignment surgery be relevant in that case?

The entire UK healthcare system for trans people is based on this.

If you’re a cisgender woman who thinks she needs hormone therapy, the steps are:

  • Go to your GP
  • Get a prescription
  • Get monitored by your GP

If you’re trans:

  • Go to your GP (if you’re in Scotland you can skip this step)
  • Get referred to the gender clinic
  • Wait two to five years depending on where you live
  • Undergo multiple assessments to prove you’re not insane
  • Get your prescription approved
  • Wait four months for it to get typed up
  • Get monitored by the gender clinic for two years

Same medicine, same monitoring. But the turnaround for a cisgender woman is a couple of days; for a trans woman, many years.

Health LGBTQ+

Screening saves lives

Inclusive language is a favourite topic of right-wingers and bigoted authors: look at what the silly minorities are demanding now! But the reality is that inclusivity can really be a life or death matter.

Writing in the i Paper, Patrick Strudwick talks to deputy House of Lords Speaker Ian Duncan about the death of his brother Sean, a trans man, from ovarian cancer. Duncan is part of a campaign to encourage trans and non-binary people to get screening, and for the system to be more inclusive so trans and non-binary people are not overlooked.

As Strudwick writes:

trans men are automatically removed from GP surgeries’ lists of patients needing smear tests when they register as male, regardless of the extent of their medical transition. Overall, transitioning can reduce the risk of some cancers and increase the risk of others, which in turn can escape detection because no one is looking for them.

The same thing happens with trans women: I get invitations for cervical cancer screening but I won’t for prostate cancer screening; I don’t have a cervix but I do have a prostate.

Anti-trans activists are blaming us for this, claiming that if we didn’t change our gender markers that wouldn’t be a problem. As ever, this is coming from a place of profound ignorance about trans people’s bodies and healthcare. If we don’t change our NHS gender markers then that throws the system into disarray too: our blood tests are returned as abnormal (this happened to me several times) and we are not invited to screenings for things that do affect us, such as breast cancer screening for trans women.

There’s another important issue around this, which is the often appalling way trans and non-binary people are treated by healthcare providers. I know a few trans men who’ve been utterly humiliated by ignorant or openly transphobic healthcare workers, and that humiliation has very understandably made them wary and even avoidant of the NHS.

Screening saves lives, so this is an area where exclusion can kill people. And so can transphobic healthcare providers.

In 2012, former emergency worker Jay Kallio’s doctor didn’t tell him he had breast cancer: he found out by accident when a lab tech asked him how he was coping. As ABC News reported:

Having to find new doctors delayed the start of chemotherapy beyond the so-called “therapeutic window” for his particularly aggressive form of breast cancer.

Kallio was fortunate: despite the late start the treatment was effective. But other people haven’t been so lucky. One of the most horrific things I’ve ever read is the story of Robert Eads, an American trans man who was diagnosed with ovarian cancer in 1996. More than a dozen doctors refused to treat him, fearing damage to their reputation if they were known to have treated a trans person. By the time Eads found a doctor willing to treat him, the cancer had already metastasized to other parts of his body. Despite very aggressive treatment, he died in 1999 aged 53.

I read somewhere that there are two kinds of people in the world: those who think there is too much suffering, and those who think there isn’t enough. The people railing against inclusive language and inclusive services are in the second camp.

Health Hell in a handcart

Glasgow to exit lockdown in 2093

I know it’s necessary but I’m long past the point of expecting Glasgow’s COVID restrictions to be lifted any time soon: that’s us going into week 38 of the temporary 2-week restrictions that we’ve been living under since September. As Fraser Stewart pointed out on Twitter, there are Glaswegians who fell pregnant at the start of those measures who’ll be due to give birth soon.

Health Hell in a handcart LGBTQ+

A global hate campaign

The horrific new anti-women legislation in Poland, a near-total ban on abortion, is already harming women. The country already had some of the strongest anti-abortion legislation in Europe, and it has now removed the exception for foetal abnormalities. According to the New York Times, 1,074 of the 1,100 abortions performed in Poland last year were for that reason.

Poland’s right-wing government is not the only evil here. Its bigotry and intolerance has been assisted legally and financially by the US Christian Right. As OpenDemocracy reported late last year, Trump-linked religious groups in the US have spent hundreds of millions globally to assault women’s rights and LGBT+ people’s rights: in its report it noted that one organisation had taken part in multiple Polish cases “to defend that country’s conservative policies including against divorce and abortion”.

One of the organisations in the report is the Alliance Defending Freedom, which operates in the UK too: it has been a loud voice against Scots hate crime legislation and against trans people.

The EPF’s [European Parliamentary Forum for Sexual and Reproductive Rights] Neil Datta said: “As Europeans, we cannot sit back and watch what’s happening in the US with distance, thinking that the erosion of democratic norms and human rights cannot happen here. The same US Christian groups pushing for this in the US are now spending millions in Europe trying to achieve the same over here.”

Health Hell in a handcart

100,000 grieving families

You don’t need me to tell you that Boris Johnson lied when he said the UK government had done everything possible to minimise the COVID-19 death toll.

There is a reason we have a death toll exceeding 100,000 while New Zealand has 25, Vietnam 35 and Taiwan 7. As Devi Shridhar writes in the Guardian, we didn’t close our borders, we abandoned community testing, we didn’t lock down quickly enough, we didn’t have enough PPE for key workers and our government messaging has been incoherent and incompetent. So many of the UK’s deaths were completely preventable.

But this is not just about the Government’s incompetence and corruption. It’s also about a media that’s consistently failed in its most basic function, which is to hold power to account. For more than a year, too much of the press has been more interested in parroting the government line, platforming cranks and giving airtime to dubiously funded pressure groups than holding our failing government to account.

Journalist Mic Wright:

Every newspaper front page that heralded ‘Independence Day’ last summer when the first lockdown was eased, every headline that passed on the government’s message that people should get back to offices, every report that passed on demands from bloviating backbenchers and astroturfing groups of suddenly ‘militant’ mums contributed in its own way to reaching that number that is so abstracted in today’s newspapers — 100,000 people have died.

Every puff piece about Boris Johnson and his cute little family, every shot of his future mother-in-law coming to Downing Street, every photo spread about their dog, every column that made excuses for Dominic Cummings, sneered at ‘hipster analysis’ in the early days of this avoidable disaster, or told us about ‘Dishy’ Rishi and how much he cares, contributed to 100,000 people dead.

Every jingoistic throwback pun to a war that none of us fought and to a history that most people misremember contributed to 100,000 people dead, ever ‘Eat Out to Help Out’ promo plastered on a tabloid front-page, every syllable uttered by political hyena Matt Chorley played its part, every Rod Liddle column, every Fraser Nelson quote, every Sarah Vine column oscillating between bafflement at government policy and insidery snideness, every story that poured more shame on celebrities and influencers than the government that got us here shares a piece of the blame.

None of these people will be held to account.

Bullshit Health Hell in a handcart

Conspiracy magnets

Something that’s become really apparent in the final days of the Trump administration is that cranks of a feather flock together. If you believe that the US election has been stolen, chances are you also believe that the COVID vaccine contains microchips, and that furniture shop Wayfair traffics stolen children.

Thanks to Twitter I discovered that there’s a name for this phenomenon: crank magnetism. As RationalWiki puts it:

A sovereign citizen, a creationist, an anti-vaxxer, and a conspiracy theorist walk into a bar. He orders a drink.

The reason for it is very simple. Believing in a conspiracy theory means denying evidence, denying authority, denying reality. And once you do that once, once you decide that despite overwhelming evidence to the contrary the people in authority are covering something up, you’re much more open to the idea that they’re covering other things up too.

To put it simply: once you believe they’re covering up one thing, it’s easy to believe that they’re covering up everything.

For example, if you believe that mainstream medicine is covering up the efficacy of homeopathy or of ancient Chinese medicine, it isn’t much of a leap to believe that mainstream medicine is covering up the links between MMR and autism. If you believe that Big Pharma is being funded by the Jews to turn everybody trans, it’s hardly a stretch to believe that Big Pharma created COVID to sell vaccines or that those vaccines contain microchips.

Once you deny one reality, you can easily end up denying all reality. You can see that in the COVID deniers, in the QAnon craze, in the ludicrous things people believe about marginalised groups.

The conspiracies don’t even need to make sense, or fit with a coherent worldview. Studies have found that conspiracists will happily believe conspiracies that contradict each other – so if you believe that Princess Diana faked her own death, you’re also highly likely to believe that Princess Diana was murdered. The specifics don’t really matter: either way, there’s a cover-up.

It’d be fascinating if it weren’t so frightening.