Hungarian Rhapsody

 

Returning to the States after a holiday in Franco's Spain, my father said, with some dismay, "Everyone looked so happy in Madrid. Don't they know they are living in a dictatorship?"

Which meant a simple truth had escaped him: People live their lives concerned only about whether they can afford to go out to a good restaurant, buy food, travel,  have a car--"kitchen table" things. They don't give more than 10 minutes thought to abstract issues like democracy, tolerance, and the suffering of other people.

Here in Budapest, Mad Dog looks around and sees smiling faces, people eating at sidewalk cafes, strolling along the Danube--everyone looks so...happy!

Their prime minister, whom they have re elected for 14 years, says Hungary is a Christian nation, which should be ethnically homogeneous and should erect walls to prevent the immigration of undesirables. Views which contradict this prevailing view are said to be disloyal.

And yet, one of the most famous and consequential Hungarians in history did just that: He espoused an unpopular, highly inconvenient view which made the ruling hierarchy look bad.

Semmelweis

He was an obstetrician named Ignaz Semmelweis, who noticed that women died after childbirth of something called puerperal fever, now understood as sepsis, in the maternity wards of Budapest at an alarming rate. Well, they died on certain wards at an alarming rate, but not on other wards. The death row wards were those run by faculty and medical students of the medical college, but the wards where patients were seen only by midwives, this calamity was rare.

He suspected the explanation for this discrepancy had something to do with the fact that the doctors went from doing autopsies, from examining one woman post partum to the next women-- without ever washing their hands.  The midwives did none of this; they simply delivered the babies and sent mother and baby home.

Now, this was about 1850, years before germ theory had gained widespread acceptance, but Semmelweis insisted doctors wash their hands in a solution we now know was a disinfectant, and only then examine a woman after childbirth-- and the rates of sepsis plummeted.

Doctors of that time and place were not happy about having their practices questioned, especially if it meant they were blamed for causing the deaths of their patients, so they punished Semmelweis in every way they could, and he wound up admitted to an insane asylum and he ultimately died at age 47 under murky circumstances, possible homicide. 

Makes one think of Paul McHugh and his campaign against transgender clinics in Baltimore.  Makes one wonder about the risks of challenging orthodoxy anywhere at any time. 

Hilary Cass and Those Uncomfortable Questions: The Orthodoxy of Transgender Medicine

Hilary Cass, a Scottish pediatrician has done a courageous thing: She has insisted on critically evaluating the science behind current medical practice.

Dr. Hilary Cass

And not just any medical practice, a practice which in the commercial medical system of the United States has become a mighty industry, and in the socialized national health systems of Scandinavia, the Netherlands, France and the United Kingdom has skyrocketed into a huge cost and some would say, burden, for those publicly funded systems: Transgender Clinics.

Her report was commissioned and prompted owing to the explosion in demand for transgender care seen across Europe. Some have asked, "Where have all these kids been, until now?" Tens of thousands of children from age 10 to 18 have been brought to clinic by their parents with the chief complaint: I do not feel like a girl, although I was born a girl. I'm in the wrong body. I am the wrong sex for what I am.

This is called "gender dysphoria."

This complaint is not new, but what is new is the vast numbers of children presenting for care.

Some have claimed these kids were always out there in the real world, but like homosexuals, they were in the closet, afraid to report the torment they were going through.

Unlike homosexuals, however, these children are not seeking to be simply left alone; these children are patients because they are presenting themselves asking doctors to help them, and this help takes the form of powerful hormones and, ultimately for some, reconstructive surgery and castration.

More than fifty years ago, patients with a variety of abnormalities in production of various hormones, usually testosterone or its downstream products, were described, and some of these people were born with "ambiguous genitalia" which could not be clearly called either scrotum or vulva, penis or clitoris. Some were born with normal appearing female external genitalia, i.e. vulva, clitoris, but who in fact did not have female internal genitalia (i.e. uterus, ovaries). But these patients could be understood biochemically and ultimately, genetically. 

The current wave of patients presenting to transgender clinics have no such biochemical or genetic abnormalities yet identified.

Curiously, Dr. Cass notes, over the past decade most of the flood of patients have been requesting female to male transition, which was not the case twenty years ago.

When she looked at the data to try to ascertain the fates of kids who had been "transitioned" to the opposite gender, it was not clear, but it appeared many if not most of the preadolescents treated at the clinics had, by age 18, reverted to identifying as the gender they had originally been designated at birth, mostly female.

Simply put, these children had "outgrown" their problem or "got over it." (Not Dr. Cass's words)

I was particularly interested in this report because this whole phenomenon has been such an anomaly in medicine: It is the only session at the Endocrine Society meetings where scientific method, open inquiry and challenging the data and conclusions presented were shouted down and treated as heresy, blasphemy really. To question what was being done in the Transgender Clinic was to declare yourself as one of "them," the censorious world of bigots who, blinded by hate and intolerance, refused to acknowledge the suffering of this cohort of patients.

Paul McHugh, MD

In fact, this reaction was not new or confined to the Endocrine Society: Dr. Paul McHugh was vilified at Johns Hopkins after he questioned the Transgender Clinic programs which included surgery to transform female to male and male to female. Medical students refused to even speak with  him. At Johns Hopkins!

McHugh arrived at Hopkins in 1975  to assume the chair of the Department of Psychiatry, and one of the first things he was asked to do was to integrate psychiatry into the Hopkins Transgender Clinic, which included  plastic surgery, gynecology, urology and endocrinology.  And, being a scientist, he sat down to review the data and one thing leapt out at him: The patients at the clinic were committing suicide (or making serious attempts, not just gestures) at a rate exceeding 45%.  He asked: if you had a program in cardiology or surgery which had a 45% death rate, would you not pause that operation to re-evaluate it? 

Galelio

Hopkins had been doing sex reassignment surgery since 1966, but it was hoping to ramp it up in 1975. McHugh withdrew psychiatry from the program. By 1979, the Hopkins sex reassignment surgery program was discontinued. 

In 2017, McHugh wrote an amicus brief in a Supreme Court case outlining his objections: 

--Policy Should Not be Used to Enforce Bad Medicine — Treating Gender Dysphoria Through Social Transition and Mandatory Gender Affirmation Rests on Unreliable Testimonials

-- Social Transition Encourages a Gender Dysphoric Person to Indulge in a Falsehood, Which does not Address the Root Issues Causing Clinical Distress and Makes it Harder for the Mind to Accept Reality

--Hormone Therapy has not been Proven Beneficial, and there are Harmful Consequences to Artificially Manipulating the Body

--Surgical Intervention has not Proven Beneficial, and there are Harmful Consequences to Surgically Altering Healthy Bodies

--There is Insufficient Scientific Evidence to Support Treating Gender Dysphoric Children as if They are the Opposite Sex

-- Gender Dysphoric Children Suffer from a Psychological Disorder that Can Be Resolved through Therapy in Many Cases

--Gender Affirmation and Medical Intervention for Gender Dysphoric Children is Not Helpful, and Can be Harmful

--Protocols Calling for Social Affirmation, Hormone Treatment, and Sex Reassignment Surgery are a Reflection of Ideology and Activism, Not Evidence Based Medicine

 His basic argument was, and is still, that gender dysphoria is analogous to anorexia nervosa, where a 90 pound woman who is 5'7" looks in the mirror and says, "I'm so FAT!" She has a single "wrong idea" and the child with gender dysphoria is similarly afflicted. He was arguing that the doctors in the Clinic were participating in confirming that wrong idea to the patient and to the patient's family. 

Attending the Endocrine Society meetings some years ago, I went to a session on "Androgen Abuse Syndrome" where cases of men who looked like the Incredible Hulk, with huge musculature, visited clinics asking for testosterone injections because they looked in the mirror and saw themselves as 98 pound weaklings. In Dutch clinics,  patients signed contracts to taper themselves off exogenous testosterone, run on the model of their opiate addiction clinics and their anorexia nervosa clinics. 

My next session was the Transgender Medicine session, where the speakers readily admitted the suicide rates in their clinics had always exceeded 40%, and showed no signs of declining--which they attributed not to anything they might be doing to their patients, but to the pressures society puts on transgender people. 

The doctors in these clinics were using doses of testosterone which were 4-5 times higher than I had ever used to treat males.  I was stunned, and I texted the man from University of Michigan who had led the "Androgen Abuse" session, and he replied, "There is nothing wrong with that, because these doses are being used in gender affirming therapy."

So in one patient, we've got him signing contracts to taper himself off testosterone, and in another patient we are giving patients orders of magnitude higher doses to affirm their new gender.

One case presented was a male to female (still with penis and testicles) and the lesbian partner who wanted expensive IVF treatments to get pregnant. Nobody asked, wait, what kind of sex are they having?

Another case of a female to male was being given testosterone in 5 times the usual dose because menstruation had not been ablated and the monthly menstrual flow was undermining the patient's new identity as a male.

We are not talking science here. We are talking faith.

The problem with complaining about Transgender Clinics is you immediately find yourself grouped with Marjorie Taylor Greene and the "there are only two genders" crowd, or with Abigail Shrier, who wrote a screed calling Transgender Medicine part of a "craze," doing irreparable harm to young people. 

What doctors crave is a pathway to the truth, and the way there is, and always has been, the dispassionate, rigorous pathway and in the case of transgender medicine, this has been discarded by the medical profession, until now, until Dr. Cass published her report.

What to Say When

 

Watching Katie Porter (D-CA) during a hearing in the House of Representatives, when a witness (Lindsey Burke, of the Heritage Foundation)  testifying before the Committee inveighed against Congress "spending other people's money," Rep. Porter made the simple, but devastating observation that the job of Congress is, in fact, to spend other people's money, namely taxpayer money, and if Congress refused to do this job we would "zero out all spending for the Defense Department." And turning to the witness, she asked, "Is that what you want?"

https://www.youtube.com/shorts/3c-qT2wZ9CY

This is just one example of someone who has heard a simple, telegraphic prop, a synecdoche really, where a short hand phrase stands in for a whole, longer argument, and who explodes into a longer, more detailed deconstruction of what that, by logical extension, would actually mean.

So, the Heritage Foundation would like us all to believe that taxation is really government imposed theft, taxes being robbed from citizens, and thus are, ipso facto, illegitimate and taxes should not be collected, because doing so is the crime of theft. 

Of course, as Porter explains, without taxes, without a source of revenue, there can be no government, which the Heritage Foundation would possibly like, but then, even the Heritage Foundation realizes there are some things the government does even the most ardent Republican, libertarian likes: armed forces. 

Built into the macho proponents of strong men, violent men of iron will, is the love of guns and armed forces.

So Porter demolishes that empty phrase: "You are spending other people's money," with the riposte: "Of course we are spending other people's money, and other people want us to spend their money to provide for their defense, and likely, for a variety of other things."

Another phrase adored by people like Marjorie Taylor Green and other gun worshipers is, "If you make guns illegal, only the bad guys will have guns." Or, the spin off, "The best way to deal with a bad guy with a gun, is a good guy with a gun!"

To this, Dominic Erdozain ("One Nation Under Guns") replies: The good guy with a gun is always good, until he becomes a bad guy with a gun.

In fact, as he asserts, citing a welter of gun death statistics, the vast majority of gun deaths, in particular mass shootings, are committed by people who, until they unsheathed a gun, were thought to be good guys--no criminal record, no actionable history to deny or question their right to gun ownership.

But what Erdozain is saying is people who own guns are the people who kill other people with guns. He cites statistics which suggest a very common murder scenario is fathers who shoot to death their own sons. 

Who knew? 

Actual good person with gun

My real point is here, if we know or can identify an argument which is really, at heart, stupid, we can torpedo that particular piece of stupidity if we are prepared. Otherwise, the moment passes and we are left sputtering.

Congressmen like Jamie Raskin seem particularly adept and prepared to blow Ms. Greene out of the water, likely because they have heard it all before. When MGT tells Raskin she will not answer his "stupid questions" he rejoins with, "Well, will you answer my intelligent questions? Or my devastating questions?"

What we Democrats really need is a playbook, a hymnal, filled with Republican tropes, so we can develop our own tropes, prepared in advance, to sink those Republican vessels.

Trumpkin Police: Beyond Law and Order

Sometimes, a picture can speak more eloquently than words. 

Looking at those police goons in Michigan, standing behind Trump, tells you all you need to know about some police departments. 

You could see it in Birmingham, Alabama in that iconic photo of the cop and his police dog--although, as is so often true in life, that photo may have been misleading.

You can see it in Texas with Governor Abbott.

You could see it in Alabama when George Wallace stood in the school house door and declaimed, "Segregation today. Segregation tomorrow. Segregation forever," backed up by his police. 

Today I have stood, where once Jefferson Davis stood, and took an oath to my people. It is very appropriate then that from this Cradle of the Confederacy, this very Heart of the Great Anglo-Saxon Southland, that today we sound the drum for freedom as have our generations of forebears before us done, time and time again through history. Let us rise to the call of freedom- loving blood that is in us and send our answer to the tyranny that clanks its chains upon the South. In the name of the greatest people that have ever trod this earth, I draw the line in the dust and toss the gauntlet before the feet of tyranny . . . and I say . . . segregation today . . . segregation tomorrow . . . segregation forever.

--Governor George Wallace

You see it in the New York City Police.

Police often, but not always, are people who like beating people up. They are frequently resentful. They like tough guy leaders who "have our backs."

Less of that in New Hampshire, but true in many places.

George Orwell got it right in "Animal Farm," where Napoleon the pig takes a brood of puppies from their mothers, raises them and then unleashes them to run his rivals off the farm and to intimidate all the other animals, especially those who might challenge his authority.

Police like the ones standing behind Trump in Michigan ought to be in the mind of every voter walking into that voting booth on November 5, 2024.