Bigmouth Strikes Again: Carrie Marshall's blog

Carrie’s books | Carrie’s band

Category: Health

Scare stories and newspaper nonsense

  • Tourism, large tables and Tinder dates

    Helen Rosner, the New Yorker’s roving food correspondent, is a great writer. And this is a great article: although it’s about New York I think it has resonance here too. It’s called The Uncertain Promises of Indoor Dining in New York City.

    This grinding moral calculus leaves us with a fallacious sense of personal responsibility and misplaced blame. In recent months, I’ve seen chefs and restaurateurs lash out on social media at those whom they deem insufficiently supportive of the industry’s return. Those declining to eat in restaurants during the pandemic, they argue, are complicit in the economic suffering of their businesses and employees. (The crisis is unimaginably severe, and the stress is nearly unbearable, but such a position seems rooted more in existential terror than in logic.) There are, of course, ways to be supportive without prioritizing capital over safety: early in the pandemic, when the mass extinction of small businesses was looming, I purchased more logo-emblazoned sweatshirts, coffee mugs, and tote bags than one human ever ought to own, and encouraged everybody I knew to do the same. Still, it is obvious that restaurants will not be saved by T-shirt sales alone. I’ve found a measure of relief in a simple piece of advice passed along by a friend: pick three businesses that matter to you and your community—a manageable number—and then pour everything you can into making sure they come out O.K. on the other side. But, in September, during a Zoom conversation I had with the chef David Chang to promote his new memoir, he put the same idea in more dire terms, invoking philosophy’s infamous trolley problem: “I think ninety per cent of independent restaurants are going to die,” he said. “We need to start to choose which ones we want to prop up.”

  • Lots of food isn’t labelled

    The UK government’s decision to relax food standards to allow imports of poor quality, appallingly produced and potentially hazardous US beef, poultry and pork is disgusting, of course, but some people are arguing that it isn’t a big deal: we can just read the labels and choose not to buy it.

    But that’s only true for raw food that we buy in shops. As Jay Rayner points out on Twitter, there are lots of places where food won’t be labelled: cafés, restaurants, canteens, pre-made sandwiches…

    Not in food service it wont: that sandwich you buy on the run, that school meal your child eats, that lunch you get served in hospital; indeed in any food service operation. No labeling at all.

  • Why trans people go private

    There’s a good piece by GenderGP head of patient services Adi Ni Dhálaigh Gourdialsing in PinkNews about trans people accessing private healthcare.

    In 2016, the Women and Equalities Commission bravely and unreservedly found that: “The NHS is failing in its legal duty under the Equality Act in this regard. There is a lack of continuing professional development (CPD) and training in this area amongst GPs. There is also a lack of clarity about referral pathways for Gender Identity Services. And the NHS as an employer and commissioner is failing to ensure zero tolerance of transphobic behaviour amongst staff and contractors.”

    Fast forward to 2020 and little has changed. We still have: No NICE guidelines on the medical interventions available for gender incongruence; no standards of medical education set for this area of healthcare by the General Medical Council; no continuing professional development (this is the responsibility of the Royal Colleges and Postgraduate Deaneries); no agreed standards of care for NHS trusts and clinical commissioning groups; no UK-wide medical guidelines; and healthcare that is provided in super-specialised clinics, which are supposed to cater for just 500 patient cases per year.

    I’ve been involved in a few consultations about trans healthcare recently and absolutely none of the issues being raised in the consultations are new. Trans people go private or self-medicate because in many parts of the UK the NHS tells them to wait nearly six years before they can discuss getting any kind of treatment.

  • Intended consequences

    The anti-trans mob and their evangelical Christian pals are behind a judicial review that could have chilling effects on young women’s access to contraception. That’s not a potential unintended consequence. It’s the whole point.

    Stonewall’s Nancy Kelley, writing in the i Paper:

    If [we] chip away at the idea that children and young people are not fit to know what’s best for them, we open the door towards eroding Gillick Competency. ‘Gillick’ was a case in 1985 which established that young people under the age of 16 can consent to their own medical treatment, without the need for parental knowledge or permission.

    Gillick is a cornerstone of children and young people’s rights and helps ensure young people can access the healthcare service they may need, including abortion, contraception or sexual health services.

    So, this case isn’t just about healthcare for trans young people, it’s about a much wider issue: whether we believe children and young people have a right to treat their bodies as their own.

    The lawyers representing the people bringing the case say it would push Gillick to ‘breaking point‘. This would give a green light to those who want to use this an opportunity to roll back the healthcare rights of not just LGBT young people, but all young people.

    Getting rid of Gillick is a key goal of the religious right, who do not want any teenagers to have access to contraception or sexual health services. The anti-trans women hoping the verdict goes against the NHS are either willing accomplices or deeply, deeply stupid.

  • This is what cancelling looks like

    This week, the BBC and The Times both went after the private GP service GenderGP, an ongoing target of the anti-trans mob.

    I’ve written about GenderGP before: it’s a practice that enables trans people to access healthcare privately when the NHS expects them to wait for many years for an initial assessment. I’m a former patient, so I can attest that while it isn’t perfect it is also serious and professional in its prescribing. It certainly isn’t handing out HRT like sweeties.

    The reporting was full of innuendo but didn’t find anything significant to report. Despite this, the UK’s pharmacy regulator has responded to the bad publicity and removed GenderGP’s ability to prescribe HRT to trans people with immediate effect.

    Overnight, thousands of trans adults have had their private healthcare stopped – not because GenderGP has been proven to have done anything wrong, but because two of the most powerful media outlets in the country have targeted it.

    The anti-trans mob, of course, are rejoicing about this. Removing life-saving trans healthcare from thousands of adults, as far as they’re concerned, is something to celebrate.

    Trans people will continue to need medicine. By shutting down safe, legal services, all that’s going to happen is that trans people will turn to possibly unsafe services instead. If you’re one of the people affected, there’s a good thread of (safe) options here.

    Once again this gives the lie to the idea that any of this is about ‘reasonable concerns’ or ‘protecting women’. These people want us dead.

  • Bad journalism

    I’ve been listening to the You’re Wrong About podcast, this time about the infamous Ford Pinto. It seems that almost everything I thought I knew about it was incorrect and largely based on a single Mother Jones article.

    The podcast makes an interesting point about that, and about journalism more widely: a lot of bad journalism comes from writers who are operating in good faith, or at least partial good faith. They believe that they have uncovered something so huge that they must tell the world. That belief can cause a kind of myopia.

    Journalism is as much about what you choose to leave out as what you choose to put in. Let’s say you’ve got a whistleblower from inside an organisation with a suitably salacious tale. If it’s a really good story, if it’s the kind of story that’ll have people gasping over their morning paper, how much consideration will you give to the things that contradict or cast doubt over what the whistleblower is telling you?

    People like to be heroes, and journalists are no exception – so if you think you’re the hero who’s going to break the story, you’re not going to consider that perhaps you’re being misled, or seeing connections that aren’t there, or ignoring evidence that shows that you’re not the hero here but the villain.

    The MMR scare is a good example of that. How many journalists telling their readers of the entirely invented dangers thought they were doing Pulitzer-worthy public service journalism? And how many lives have been destroyed by the anti-vaccination movement they helped spawn?

  • Doctors say trans rights

    The BMA’s annual conference has called on the government to protect the rights of trans and non-binary people both in healthcare and in wider society.

    Dr Helena McKeown, Chair of the BMA representative body, said:

    The BMA supports transgender and nonbinary individuals’ equal rights to live their lives with dignity which includes the right to equal access to healthcare. We oppose discrimination of all kinds and are committed to ensuring universal access to healthcare for all on the basis of clinical need.

    While the BMA has numerous policies affirming our support of LGBT individuals, [The agreement to this new policy means] that, for the first time in our history, we now have a BMA-wide policy giving specific attention to the needs of transgender and nonbinary individuals. Receiving any medical treatment can be stressful for patients and so it is important for individuals to receive healthcare in settings they feel comfortable with. This applies to transgender as well as cis individuals.

    The BMA hasn’t, however, clarified whether trans women have pelvises.

  • What gender doctors don’t tell you

    I posted yesterday about my experience of being on decapeptyl, which stops my body making testosterone. I get an injection every 12 weeks, and without fail the final week is horrible: I feel stupid, sluggish and sad.

    By coincidence, a trans person I know was talking online about decapeptyl and the massive mental dip they get in the week or so before a top-up. When I replied along the lines of “oh my god! Me too!”, another trans woman I know said she gets it too. It turns out that between us, everybody we know about who’s taking decapeptyl feels like absolute crap for the week or so before their levels are topped up, and considerably worse if they don’t get their top-up at the 12-week mark.

    I’ve written before that there’s an incredible lack of research into trans-related healthcare, and this is a good example: it seems that there’s something going on here, but there’s no indication of what it might be. Online there’s some evidence of decapeptyl having negative effects for cisgender men (who take it for prostate cancer) and cisgender women (who take it for endometriosis) including severe mood swings and depression, but I can’t find anything relating to what I and other trans people are experiencing. Could decapeptyl have interactions with the other medications we take? I can’t find an answer to that.

    I got my 12-week injection today, a week late. I’ll feel better very soon. But I don’t know why.

  • The system is cruel

    Every twelve weeks, I feel like shit. It coincides with the injection cycle for one of my medications, which stops my body from making testosterone; in the week or so before each injection I feel sluggish and stupid and short-tempered and sad.

    I don’t know if it’s connected or a coincidence, if it’s a genuine physical thing or psychosomatic, because from what I’ve read of the medication, once I’ve been on it for a year or so – and I’ve been on it for longer than that – my testosterone levels shouldn’t rise significantly towards the end of each 12-week cycle. But I keep a diary and the dates match; more so this month because I couldn’t get a 12-week appointment so I’ll be getting my top-up today, at the 13-week mark. I definitely feel even more sluggish, even more stupid, even more short-tempered and even more sad than normal.

    Despite all that, I woke up in a brilliant mood yesterday – and then I got some more good news. I was offered a last-minute appointment with my gender clinic (GIC) doctor.

    I was due to see her three months ago, but all trans healthcare basically stopped in Spring this year because of coronavirus. In the meantime I’ve had to do my own endocrinology to ensure a prescription change hasn’t messed up my hormone levels: my practice nurse did the blood test, send the bloods to the labs and I then compared the results with the desired levels. My prescription seems to be okay, but the gender clinic doesn’t know that yet.

    It’s not just monitoring. There are some very important healthcare things I need to speak to my GIC doctor about, so when I got a call asking if I could do a telephone appointment at 10.15am I said yes.

    It wasn’t ideal, because I was due to go on air at the BBC at 10.45. But it was a really important call, so I told the team that I might not be off the call in time to go on air; my friend and colleague Louise was happy to cover for me.

    So I quickly collated all the things I wanted to discuss with the doc – blood test results, weight loss details, a few other bits and bobs – and I waited for her call.

    And waited.

    And waited.

    And waited.

    At 10.30, I called the clinic to see if there was a problem. We’ll call you right back.

    They didn’t call me right back.

    I finally got a call one minute before I was due to go on air, but it wasn’t my doctor. It turns out that there had been a mistake, the doctor hadn’t been available after all, I can talk to her in October. By this time it was too late to go on the radio, so of course I’m not going to get paid for my non-appearance.

    The bungled appointment cost me money and wasted time, but it also really upset me. Most of my interactions with the gender clinic (GIC) have left me crying with frustration, and this was no exception: getting the appointment made me feel that after months of waiting, I could finally put some important wheels in motion. It’s much worse to be promised an appointment and not get it than not to have an appointment at all. As we all know, it’s the hope that kills you.

    If the October appointment goes ahead it will be nearly a year since I’ve been able to discuss my healthcare; longer still since I’ve been able to do it with somebody competent*. That’s a long time to be in limbo.

    This is normal. The COVID stuff is making it worse, but the system is cruel. Here’s Heather Paterson, CEO of SAYiTSheffield:

    A person I know has just received [a] surgery referral letter, still with indeterminate waiting time, 6 years after their initial GRC referral. Which was some time after mental health referral. Which was after a wait from GP referral. Which was after years of building up to come out, tell anyone or approach services.

    They have been actively fighting a system for over a decade that has thrown hurdles in their way at every step, and over the past few years been navigated while having to see anti-trans stories in the press EVERY DAY and groups actively organising to try and take their rights to live their life taken away.

    I am so happy for them that they have managed to survive this process so far and can finally see a glimmer of light at the end of the tunnel, and so filled with rage for those who couldn’t make it that far.

    So if you think people are transitioning on a whim, that they are coming out and in surgery weeks/months later, think again.

    I’m amazed so many people actually survive this lengthy, quite frankly barbaric system.

    * My prescription change was to undo a serious mistake made by my previous gender clinic doctor, about whom I ended up filing a formal complaint and a request to be reassigned.

  • “A devil’s bargain”

    Writing for Jezebel, Katelyn Burns tells an extraordinary story of medical malpractice, litigious surgeons and people whose lives are changed irrevocably by medical mistakes: When Surgeons Fail Their Trans Patients. Warning, it’s pretty graphic in places.

    It’s important to note that the vast majority of trans people’s surgeries have positive outcomes: gender reassignment surgery has an exceptionally low regret rate. But there is still regret, usually because of unsatisfactory surgical outcomes, and some surgeons do appear to have significantly higher rates of negative outcomes than others.

    This is something that needs to be talked about, but trans people rightly fear discussing such personal things in public.

    Burns:

    …speaking out after a traumatic experience, in a moment when so few are able to access care, can either be weaponized by anti-trans activists or interpreted by advocates as a step back.

    …When she posted about her experience with Dr. Rumer on message boards in an attempt to warn other potential patients, Carlie’s words were reprinted on anti-trans forums.

    I haven’t experienced anything like the women in the article have, but nevertheless I’ve chosen not to post some personal things about my own healthcare for that very reason. Discussion forums and Facebook groups for trans people have an ongoing problem with fake accounts mining them for anything they can use against trans people.

    …the environment can make it difficult for many trans people to find recourse, or warn others about bad surgical experiences. It’s a system that makes frank public discussion about surgical outcomes nearly impossible to have.

    Some anti-trans activists create opposition to access to trans-affirming care by claiming treatments are experimental or too risky to be ethical, another obstacle when patients consider speaking openly about their experiences with individual surgeons. Though regret rates remain low and, and as Dr. Schechter says, “the risks and the complications are commensurate with the risks and complications of other similar procedures,” anti-trans disinformation has become a serious problem in many corners of the media.

    Although the article is about the US system, much of it applies to the UK too.