#Pediatric Health Risk

[huntquinlan]

every once and a while i remember the wing pregnancy plot and i vibrate with rage for a good minute. star wars revenge of the sith ass plot (derogatory). if she wanted to create drama around it, it shouldn’t have been the wings. it literally could have been anything but the wings. pregnancy is incredibly dangerous in general. elain could have had a vision of something going wrong. nyx simply could have been born prematurely due to the stress of feyre having to find out nesta was kidnapped and is stuck in a death tournament. or he could have just been premature. sometimes babies are. ugh.

[kids-worldfun]

Childhood Obesity: Tips for Parents and Caregivers

by Dr. Shanthi Thomas Shane hardly spoke to anyone at school. At recess time, what did she do? She did not go to the playground. She sat alone at her desk, reading a book. Often, she would long to talk, but it looked as though no one was interested in talking to her. She hated looking at the mirror. Shane had childhood obesity. If you have a child who was obese, what do you do? Important tips…

[surinderbhalla]

Snoring: Hidden Dangers and Health Risks

Snoring might seem harmless, even amusing to some, but the truth is far more serious. Beyond just being a nuisance to your bed partner, snoring could be a red flag for underlying health issues. In this article, we delve into the hidden dangers and health risks associated with snoring, shedding light on why addressing this seemingly innocuous habit is essential. Snoring: Hidden Dangers and Health…

[sayruq]

Dr. Tanya Haj-Hassan, a pediatric intensive care physician who works with Médecins Sans Frontières and co-founded @GazaMedicVoices, has emerged as one of the most prominent voices raising the alarm about the hell Israel has created for Gaza’s healthcare workers. Mary Turfah: Yesterday, I came across a report of a third mass grave unearthed at Al-Shifa Hospital. One month ago, as the first mass graves there were being uncovered, you were interviewed by Sky News. The anchor cited Israeli military sources saying that they had detained “hundreds of Hamas militants” within the complex, then asked you what you thought of that. Could you speak to your response to him, and to this persistent obsession with “militants at Al-Shifa,” when not a single hospital in Gaza has been spared, and when there have been mass graves [seven in total to date] uncovered at multiple hospitals in Gaza? Tanya Haj-Hassan: Yeah. I think my response was something to the effect of, I can’t believe we’re still having this conversation. Everybody from a medical or humanitarian background is so sick of having to respond to these atrocious, preposterous justifications that are being provided for things that are never justifiable. I thought the Hamas and Al-Shifa question was buried a long time ago. There were several weeks where that’s all we were asked about in interviews. There were multiple investigations done that concluded no credible evidence existed to justify the attacks on Al-Shifa. And then, Al-Shifa was targeted again, besieged again. Then, eventually, Al-Shifa started functioning again. The staff were so proud of the fact that they got it functioning again. That second time, the hospital was again besieged and targeted. A lot of the staff were taken out into the courtyard of the hospital, where the male staff were stripped. Israeli soldiers beat several of the healthcare providers. A very, very senior person at Al Shifa, an older doctor, was eventually released and came on foot to Al-Aqsa Hospital. And immediately, he went back to work. I was at Al-Aqsa Hospital when he turned up disheveled, beard down to here, exhausted, having lost I don’t know how many kilos, hadn’t seen his family for five months, didn’t have a phone, didn’t have proper shoes, didn’t have proper clothes. They fled with basically nothing. And many of the other healthcare providers who were taken outside with him were abducted. I think his testimonies of what happened and the amount of work they had put into getting Al-Shifa functioning again made the question of the Sky News anchor even more infuriating. Because that’s the reality I had just come out of, and to hear him then ask a health professional who had spent the last few weeks resuscitating dead and dying children that have been maimed to an extent that I don’t think I’ll ever be able to forget—even though I think for my own well-being, it would probably be good if I would forget some of those images—I found it so insulting. Insulting to me, to the healthcare providers who had risked their lives to stay at Al-Shifa, who had lost 25 percent of their body weight, who were exhausted. Insulting to the health care providers who had been killed at Al-Shifa, fleeing from Al-Shifa, to the civilians who were executed there. It’s insulting to our intellect. It’s insulting to humanity

MT: Last week, it was revealed that Dr. Adnan Al-Bursh, a renowned orthopedic surgeon in Gaza, was tortured to death inside of Israeli prisons, according to eyewitness testimony, after he had been abducted from the hospital where he was providing life-saving care, back in December. Hundreds of medical workers have been killed to date, and many more injured. You said in one interview that doctors and healthcare workers are changing out of their scrubs before leaving the hospital so that they’re not targeted. On top of this, the doctors in Gaza have been working basically nonstop for 215 days. As someone who has worked in Gaza, I was wondering if you could say a bit about what your colleagues are facing day-to-day. THH: I want to start with the abduction of healthcare workers, because it’s so underreported, to the point where myself and my colleagues, medical providers working our own jobs, are doing the investigative work. They’re systematic. There have been at least 240 abductions documented by our group— MT: 240?! THH: At least 240, and I’m not talking about what’s reported by the Ministry of Health, which I believe is an even higher number. We documented that at least 240 healthcare workers have been abducted and detained by Israeli forces, the majority of whom have not been released. And the ones who have been released are providing testimonies of torture, of themselves but also the torture that they’ve witnessed. I’ve taken testimonies. One, a three-hour-long testimony about the torture inflicted on [my friend,] a nurse, for 53 days in custody, accusing him of being part of Hamas, of his family being part of Hamas, even though the fact that he was released tells you he wasn’t part of Hamas. Given the extent to which he was tortured, I’m surprised that he survived. And he has not survived with his physical and mental health intact. He has scars, he has nightmares. He had hematuria, so bleeding when he urinated, for weeks after he was released.

Please read this interview as it sheds light on the horrors doctors, nurses, and other medical workers in Gaza have endured

[macgyvermedical]

Safe States: Trans Youth Health and School Update

This is an updated version of my recent post about safe states. If you are trans and a minor, or are a parent of a trans minor, here is some information you may want to have if you are considering moving from an unsafe state. Please spread this around if you can!

Maps created by Erin Reed at https://www.erininthemorning.com/

The following is general information about states marked “safest states with strong protections”. All states listed have expanded medicaid, which means even if you don't yet have a job in your target state you and your family will still have health coverage (call Job and Family Services in the area you are going to get set up). I always recommend getting a 90 day supply of all medications, including gender-affirming medications, plus an emergency PAPER prescription for all medications before making any move. That way, if you can't get in to see a clinician quickly, you will not run out of medications.

Added to this list is the Gender Identity Policy Tally (how many categories of protection policy a state covers), the number of WPATH pediatric Gender-Affirming Care providers, and whether the state has free online education available, which may be an easier transition for students who may have to switch schools midyear or move around several times prior to living in a permanent location.

State: California

*Cost of Living: 134.5% of US average

Climate Risk: Moderate

Median Rent: $1,856

Minimum Wage: $16/hr (116 hours to make rent)

2020vs2024 Politics: Blue, went 8 points redder

**Gender Identity Policy Tally: 23.25/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 36

Free Online K-12 School Available?: Yes

State: Colorado

*Cost of Living: 105.5% of US average

Climate Risk: Low

Median Rent: $1,594

Minimum Wage: $14.42/hr (110.5 hours to make rent)

2020vs2024 Politics: Blue, went 2 points redder

**Gender Identity Policy Tally: 23.25/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 7

Free Online K-12 School Available?: Yes

State: Connecticut

*Cost of Living: 113.1% of US average

Climate Risk: Low

Median Rent: $1,374

Minimum Wage: $15.69 (87.5 hours to make rent)

2020vs2024 Politics: Blue, went 5 points redder

**Gender Identity Policy Tally: 22.25/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 3

Free Online K-12 School Available?: No (tuition-based schools available)

State: Hawaii

*Cost of Living: 179% of US average

Climate Risk: Low

Median Rent: $1,868

Minimum Wage: $14/hr (133 hours to make rent)

2020vs2024 Politics: Blue, went 6 points redder

**Gender Identity Policy Tally: 17.75/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 1

Free Online K-12 School Available?: No (tuition-based schools available)

State: Illinois

*Cost of Living: 90.8% of US average

Climate Risk: Moderate

Median Rent: $1,179

Minimum Wage: $14/hr (84 hours to make rent)

2020vs2024 Politics: Blue, went 7 points redder

**Gender Identity Policy Tally: 22.5/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 5

Free Online K-12 School Available?: No (tuition-based schools available)

State: Maine

*Cost of Living: 111.5% of US average

Climate Risk: Low

Median Rent: $1,009

Minimum Wage: $14.15/hr (71 hours to make rent)

2020vs2024 Politics: Blue, went 2 points redder

**Gender Identity Policy Tally: 23.5/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 0

Free Online K-12 School Available?: Grades 7-12 only (tuition-based schools available for lower grades)

State: Maryland

*Cost of Living: 119.5% of US average

Climate Risk: Low

Median Rent: $1,598

Minimum Wage: $15/hr (106 hours to make rent)

2020vs2024 Politics: Blue, went 6 points redder

**Gender Identity Policy Tally: 22.75/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 6

Free Online K-12 School Available?: Kent County only (tuition-based schools available elsewhere)

State: Massachusetts

*Cost of Living: 148.4% of US average

Climate Risk: Moderate

Median Rent: $1,588

Minimum Wage: $15/hr (106 hours to make rent)

2020vs2024 Politics: Blue, went 8 points redder

**Gender Identity Policy Tally: 20.25/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 4

Free Online K-12 School Available?: Yes 

State: Minnesota

*Cost of Living: 94.1% of US average

Climate Risk: Low

Median Rent: $1,178

Minimum Wage: $10.85/hr (108 hours to make rent)

2020vs2024 Politics: Blue, went 3 points redder

**Gender Identity Policy Tally: 21/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 6

Free Online K-12 School Available?: Yes

State: New Jersey

*Cost of Living: 114.1% of US average

Climate Risk: Moderate

Median Rent: $1,577

Minimum Wage: $15.13/hr (104 hours to make rent)

2020vs2024 Politics: Blue, went 10 points redder

**Gender Identity Policy Tally: 23.25/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 3

Free Online K-12 School Available?: No (tuition-based schools available)

State: New Mexico

*Cost of Living: 94.2% of US average

Climate Risk: High

Median Rent: $966

Minimum Wage: $12/hr (80.5 hours to make rent)

2020vs2024 Politics: Blue, went 5 points redder

**Gender Identity Policy Tally: 19/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 2

Free Online K-12 School Available?: Yes

State: New York

*Cost of Living: 125.1% of US average

Climate Risk: Moderate

Median Rent: $1,507

Minimum Wage: $15/hr (16/hr for NYC, Long Island, and Westchester), (100.5 hours to make rent)

2020vs2024 Politics: Blue, went 11 points redder

**Gender Identity Policy Tally: 24/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 13

Free Online K-12 School Available?: No (tuition-based schools available)

State: Oregon

*Cost of Living: 115.1% of US average

Climate Risk: Low

Median Rent: $1,373

Minimum Wage: $16.70/hr (but it's complicated) (82 hours to make rent)

2020vs2024 Politics: Blue, went 2 points redder

**Gender Identity Policy Tally: 21/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 9

Free Online K-12 School Available?: Yes

State: Rhode Island

*Cost of Living: 110.5% of US average

Climate Risk: Moderate

Median Rent: $1,195

Minimum Wage: $14/hr (85 hours to make rent)

2020vs2024 Politics: Blue, went 7 points redder

**Gender Identity Policy Tally: 20.25/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 1

Free Online K-12 School Available?: No (tuition-based schools available)

State: Vermont

*Cost of Living: 114.9% of US average

Climate Risk: Low

Median Rent: $1,149

Minimum Wage: $13.67 (84 hours to make rent)

2020vs2024 Politics: Blue, went 3 points redder

**Gender Identity Policy Tally: 20.5/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 0

Free Online K-12 School Available?: No (tuition-based schools available)

State: Washington

*Cost of Living: 115.1% of US average

Climate Risk: Low

Median Rent: $1,592

Minimum Wage: $16.28 (97 hours to make rent)

2020vs2024 Politics: Blue, went 0 points redder

**Gender Identity Policy Tally: 22/26

Number of Pediatric Gender-affirming Care Providers (WPATH): 13

Free Online K-12 School Available?: Yes

*On this scale, 100% is the average COL across the USA. Numbers above 100% mean the state is more expensive than average. Numbers below 100% mean the state is less expensive to live in than average. Pennsylvania, Utah, and Nevada are the states closest to average. Hawaii, at 179% is the most expensive state. Mississippi, at 85.3% is the least expensive state to live in.

**The Gender Identity Policy Tally is a tally by the Movement Advancement Project of 26 different areas in which there can be policy protecting trans and gender nonconforming individuals. The score is a count of how many of these pieces of policy are present in a state. 

References: COL CR MR MW POL PT WPATH K12

[she-is-ovarit]

Trans research and scientific consensus

(2020) - Study of 139,829 students finds that in comparison to other students, transgender identity, especially non-binary identity, is associated more with perpetrating bullying than being bullied. Non-binary identity was most strongly associated with involvement in bullying, followed by [transgender] opposite sex identity and cisgender identity. 

(2023) 21 leading experts on pediatric gender medicine from 8 countries wrote a letter to Wall Street Journal expressing disagreement over how gender dysphoria in youth is treated, voicing concerns against things such as the affirmative model and research conducted outside of the US has found hormonal interventions for gender dysphoria to be without reliable evidence. Among these international experts is Dr. Rita Kaltiala, chief psychiatrist at Tampere university gender clinic and author of several peer-reviewed studies on trans medicine and Finland's top authority on pediatric gender care.

(2023) Landmark study from Denmark on 3,800 transgender patients pulled data from hospital records and applications from legal gender changes and discovered 43% of this group had a psychiatric illness compared with 7% of non-trans group, and despite "gender affirming care" and legal gender changes, still had 7.7 the rate of suicide attempts and 3.5 times the rate of suicide deaths. Researchers state this rate is likely even higher due to missing data.

(2016) Study finds association with increased risk of multiple sclerosis for trans women taking estrogen/reducing testosterone levels.

(2023) Metadata study shows, at best, no improvement for patients in gender-affirming care. "The conclusions of the systematic reviews of evidence for adolescents are consistent with long-term adult studies, which failed to show credible improvements in mental health and suggested a pattern of treatment-associated harms. Three recent papers examined the studies that underpin the practice of youth gender transition and found the research to be deeply flawed. Evidence does not support the notion that “affirmative care” of today’s adolescents is net beneficial."

(2011) Long term follow up of 324 transgender people having undergone sex reassignment surgery in Sweden, found that trans women retained male patterned incidents and rates of violence and had a greater significance and rate of rape and sexual violence than cisgender men. The study also found, "Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group."

(2020) Largest study to date on 641,860 people finds association with autism and "gender diversity", "Gender-diverse people also report, on average, more traits associated with autism, such as sensory difficulties, pattern-recognition skills and lower rates of empathy — or accurately understanding and responding to another person’s emotional state".

(2022) US study examining 10 years of data on 952 people finds large percentages of young adults prescribed hormones for trans identity no longer getting the drugs 4 years later. Discontinuation rate for both sexes combined = 30%. Female discontinuation rate as high as 44%. The standard disinformation pushed is that only 1-2% of people who begin medical transition end up desisting. But these figures show that in this cohort of young adults, the overall rate of discontinuing hormone treatment ranged from a low of 10% to a high of 44% within a space of just 4 years.

Abruzzese et al. 2023 'The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed'

More to come.

[probablyasocialecologist]

While the Cass Review has been presented by the U.K. media, politicians and some prominent doctors as a triumph of objective inquiry, its most controversial recommendations are based on prejudice rather than evidence. Instead of helping young people, the review has caused enormous harm to children and their families, to democratic discourse and to wider principles of scientific endeavour. There is an urgent need to critically examine the actual context and findings of the report. Since its 2020 inception, the Cass Review’s anti-trans credentials have been clear. It explicitly excluded trans people from key roles in research, analysis and oversight of the project, while sidelining most practitioners with experience in trans health care. The project centered and sympathized with anti-trans voices, including professionals who deny the very existence of trans children. Former U.K. minister for women and equalities Kemi Badenoch, who has a history of hostility toward trans people even though her role was to promote equality within the government, boasted that the Cass Review was only possible because of her active involvement. The methodology underpinning the Cass Review has been extensively criticized by medical experts and academics from a range of disciplines. Criticism has focused especially on the effect of bias on the Cass approach, double standards in the interpretation of data, substandard scientific rigor, methodological flaws and a failure to properly substantiate claims. For example, although the existing literature reports a wide range of important benefits of social transition and no credible evidence of harm, the Cass Review cautions against it. The review also dismisses substantial documented benefits of adolescent medical transition as underevidenced while highlighting risks based on evidence of significantly worse quality. A warning about impaired brain maturation, for instance, cites a single, very short speculative paper that in turn rests on one experimental study with female mice. Meanwhile extensive qualitative data and clinical consensus are almost entirely ignored. These issues help explain why the Cass recommendations differ from previous academic reviews and expert guidance from major medical organisations such as the World Professional Association for Transgender Health (WPATH) and the American Academy of Pediatrics. WPATH’s experts themselves highlight the Cass report’s “selective and inconsistent use of evidence,” with recommendations that “often do not follow from the data presented in the systematic reviews.” Leading specialists in transgender medical care from the U.S. and Australia emphasize that “the Review obscures key findings, misrepresents its own data, and is rife with misapplications of the scientific method.” For instance, the Cass report warns that an “exponential change in referrals” to England’s child and adolescent gender clinic during the 2010s is “very much faster than would be expected.” But this increase has not been exponential, and the maximum 5,000 referrals it notes in 2021 represents a very small proportion of the 44,000 trans adolescents in the U.K. estimated from 2021 census data.

7 August 2024

[evidence-based-activism]

Is male circumcision as harmful as female circumcision? I have had multiple discussions about this, but someone said that certain types of FGM are equally or less invasive than MGM

Hi! No, no it is not.

Male circumcision

So, the big question about male circumcisions is if it's ethical or not. A while ago, I would have said, no definitely not, since it's a violation of bodily autonomy. However, someone has since pointed out to me that we do a lot of things to infants (and children) that are technically violations of bodily autonomy.

We consider this morally acceptable because we are providing some intervention that they (the children) are not capable of either requesting or refusing on the basis of it's benefits outweighing the harms. The best example of this, in my opinion, is vaccines. We give children a lot of vaccines because we know that they have (and do) substantially lower the chance of the child getting sick and/or dying from a preventable disease. In this case, the minor violation of bodily autonomy (vaccination of a child) is permitted because waiting until they are able to give their consent would introduce a substantially larger risk of harm.

How does this relate to male circumcision? Given this framework, we could accept male circumcision if (1) there are benefits to the procedure, (2) the benefits outweigh any risk of harm, (3) waiting until the child is able to consent to the procedure is not feasible (i.e., some significant portion of the benefits would be lost).

There is some mixed evidence for these three claims. Evidence in favor includes:

There are a number of reviews [1-3] by the same team that provide support for all three points. In particular this review [3] directly reviews the evidence of "arguments opposing male circumcision", debunking each one in detail. However, the fact that they are all by the same team is less encouraging. The evidence here is substantial, but there's a potential for bias.

That being said, the American Academy of Pediatric [4] also concludes that the "health benefits of newborn male circumcision outweigh the risks".

This Cochrane Review (essentially the highest quality evidence) [5] found male circumcision substantially reduces acquisition risk of HIV by heterosexual men and that incidence of adverse events is very low.

And this review and meta-analysis [6] found the same reduction for HPV.

Evidence against:

This review [7] suggests the benefits of male circumcision may not apply in North American countries

This article [8] claims the same for developed countries in general

This commentary [9] claims the same, suggesting that "from the perspective of the individual boy, there is no medical justification for performing a circumcision prior to an age that he can ... choose to give or withhold informed consent himself"

That being said these papers have also been challenged by advocates for male circumcision [10] and even opponents [9, 11] recognize that the rates of complications are very low, and the rates of serious complications even lower. In addition to that, complication rate was greater for older children [11], which provides support for the third point I highlighted above (i.e., waiting until they are older may introduce more harms than benefits).

And all of that being said, if the procedure is done, it should absolutely be done with some form of pain relief. Thankfully, it appears that the vast majority are performed in this fashion [11].

In the end, there is strong evidence supporting male circumcision for infants in developing countries. There are research gaps concerning if these benefits apply to developed countries (i.e., little work has examined this population specifically), which indicates a need for such research. That being said, with the extremely low complication rate and moderate evidence of benefits, there also isn't a strong argument against the procedure.

---

Female Genital Mutilation

Comparing this to female genital mutilation (FGM) will highlight just how egregious such equivalencies are.

First, a brief detour into biology. Men and women have various embryological precursors that develop into either male or female sex organs. These are called biological homologues, and they are roughly (although not perfectly) comparable. For example, an embryo has the gonad which, during sex differentiation, develops into the ovary in women and the testicle in men [12].

This framework allows us to make some rough comparisons between male circumcision and FGM. For example, it's likely that the "less invasive" form of FGM you were referred to is type 1A [13]. In this type, only the clitoral hood is removed. Both the clitoral hood and the foreskin develop from the prepuce, as they are homologous structures. Notably, even here, male circumcision and FGM type 1A would still only be homologous if (1) FGM type 1A has a similarly low risk profile as male circumcision and (2) male circumcision actually provides no benefits to the infant.

For the first point, we have little to no data on the complication rate of type 1A FGM, specifically because it is essentially never performed in isolation [14]. This is – almost entirely – a theoretical form of FGM. Despite this, even if it were more common it doesn't necessarily follow that the procedures would have a similar adverse effect profile. In fact, one of the most common arguments against male circumcision involves the numerous nerve endings in the glans (head of the) penis, generally in reference to how the foreskin "protects" the penis head or "preserves sensitization" (neither of which are proven assertions). But while the glans penis and glans clitoris have a similar number of nerve endings in absolute terms, the clitoral head is much smaller and therefore much more densely innervated [15]. As a result, it would be much more likely for the removal of the clitoral hood to result in irritation than the removal of the foreskin.

And for the second point, I've discussed the mixed literature on the topic in developed countries. However, most FGM is performed in developing countries (although certainly not exclusively so) [14], and in this context there is strong evidence of a health benefit to male circumcision and absolutely no health benefit to FGM.

To complete the comparisons between FGM and male circumcision in terms of homologous structures [12, 13]:

Type 1B involves the removal of the clitoris with the prepuce (clitoridectomy). This, anatomically speaking, would be similar to removal of (minimally) the penis head.*

Type 2 involves partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. This would be roughly comparable to the removal of the penis head, mutilation/cutting/removal of penile raphe (underside of the penis) with or without mutilation/cutting/removal of the scrotum.*

Type 3 is infibulation, or the narrowing of the vaginal orifice with creation of a covering seal by cutting and apposition the labia minora and/or the labia majora, with or without excision of the clitoris. There is no direct comparison for men, as they do not have a vaginal orifice or any similar structure.

Type 4 is all other mutilation/anything that cannot be categorized as above.

*Note: these comparisons aren't perfect due to differences in how the homologous structures are arranged. For example, removal of the penis head would also impact the urethra, whereas removal of the clitoris would not. That being said, these comparisons are far more accurate than between FGM types 1B - 4 and male circumcision.

To further drive home the differences, FGM results in substantial, severe health complications (unlike male circumcision) and has absolutely no known health benefits (possibly unlike male circumcision). These articles [16-21] go into great detail on this; the complications range from: infection, incontinence, infertility, severe and sometimes chronic pain, pregnancy complications, PTSD and post-traumatic symptoms, other psychiatric disorders, greater risk of STDs, and death.

There is no evidence of any benefits.

---

Conclusion

Hopefully, it's clear that male circumcision and female genital mutilation are in no way comparable.

The opponents of male circumcision often suggest that any violation of the bodily autonomy of infants is morally wrong, but this fails to consider the nuanced situation inherent to infant-hood and early childhood. They are physically and mentally unable of consenting to or refusing any medical procedure, which is why we have a – generally recognized – moral caveat to this principle that allows caregivers to act in the best interests of the child, particularly when waiting for the child to grow older before allowing any intervention would increase the risk of harm. (Childhood vaccinations and, really, any other medical procedure done on children, are other examples of this.)

It's possible that future research may indicate that male circumcision is not associated with benefits in developed countries. (This would remove male circumcision from the category of procedures described above.) Even then, however, it would not be comparable to FGM due to the vastly different complication rates.

I hope this helps you!

References under the cut:

Morris, B. J., & Krieger, J. N. (2013). Does male circumcision affect sexual function, sensitivity, or satisfaction?—a systematic review. The journal of sexual medicine, 10(11), 2644-2657.

Morris, B. J., Kennedy, S. E., Wodak, A. D., Mindel, A., Golovsky, D., Schrieber, L., ... & Ziegler, J. B. (2017). Early infant male circumcision: systematic review, risk-benefit analysis, and progress in policy. World journal of clinical pediatrics, 6(1), 89.

Morris, B. J., Moreton, S., & Krieger, J. N. (2019). Critical evaluation of arguments opposing male circumcision: A systematic review. Journal of Evidence‐based Medicine, 12(4), 263-290.

Task Force on Circumcision, Blank, S., Brady, M., Buerk, E., Carlo, W., Diekema, D., ... & Wegner, S. (2012). Male circumcision. Pediatrics, 130(3), e756-e785.

Siegfried, N., Muller, M., Deeks, J. J., & Volmink, J. (2009). Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane database of systematic reviews, (2).

Shapiro, S. B., Laurie, C., El-Zein, M., & Franco, E. L. (2023). Association between male circumcision and human papillomavirus infection in males and females: a systematic review, meta-analysis, and meta-regression. Clinical Microbiology and Infection, 29(8), 968-978.

Bossio, J. A., Pukall, C. F., & Steele, S. (2014). A review of the current state of the male circumcision literature. The Journal of Sexual Medicine, 11(12), 2847-2864.

Frisch, M., & Earp, B. D. (2018). Circumcision of male infants and children as a public health measure in developed countries: a critical assessment of recent evidence. Global public health, 13(5), 626-641.

Deacon, M., & Muir, G. (2023). What is the medical evidence on non-therapeutic child circumcision?. International journal of impotence research, 35(3), 256-263.

Moreton, S., Cox, G., Sheldon, M., Bailis, S. A., Klausner, J. D., & Morris, B. J. (2023). Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health. World Journal of Clinical Pediatrics, 12(5), 244.

Shabanzadeh, D. M., Clausen, S., Maigaard, K., & Fode, M. (2021). Male circumcision complications–a systematic review, meta-analysis and meta-regression. Urology, 152, 25-34.

26: The Reproductive System . (n.d.). In Anatomy and Physiology (Boundless) . LibreTexts. https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_(Boundless)/26%3A_The_Reproductive_System

Abdulcadir, J., Catania, L., Hindin, M. J., Say, L., Petignat, P., & Abdulcadir, O. (2016). Female genital mutilation: a visual reference and learning tool for health care professionals. Obstetrics & Gynecology, 128(5), 958-963.

WHO, U. O. (2008). Eliminating female genital mutilation: An interagency statement. World Health Organization.

Shih, C., Cold, C. J., & Yang, C. C. (2013). Cutaneous corpuscular receptors of the human glans clitoris: descriptive characteristics and comparison with the glans penis. The Journal of Sexual Medicine, 10(7), 1783-1789.

Utz-Billing, I., & Kentenich, H. (2008). Female genital mutilation: an injury, physical and mental harm. Journal of Psychosomatic Obstetrics & Gynecology, 29(4), 225-229.

Klein, E., Helzner, E., Shayowitz, M., Kohlhoff, S., & Smith-Norowitz, T. A. (2018). Female genital mutilation: health consequences and complications—a short literature review. Obstetrics and gynecology international, 2018(1), 7365715.

Iavazzo, C., Sardi, T. A., & Gkegkes, I. D. (2013). Female genital mutilation and infections: a systematic review of the clinical evidence. Archives of gynecology and obstetrics, 287, 1137-1149.

Berg, R. C., & Underland, V. (2018). Immediate Health Consequences of Female Genital Mutilation/Cutting (FGM/C).

Sarayloo, K., Roudsari, R. L., & Elhadi, A. (2019). Health consequences of the female genital mutilation: a systematic review. Galen medical journal, 8, e1336.

Reisel, D., & Creighton, S. M. (2015). Long term health consequences of Female Genital Mutilation (FGM). Maturitas, 80(1), 48-51.

[covid-safer-hotties]

Experts Call Long COVID in Kids a Public Health Crisis. Why Is It Being Ignored? - Published Aug 26, 2024

For years, public health experts have said that COVID-19 infections in children are “mild.” According to the U.S. Centers for Disease Control and Prevention (CDC), the most common symptoms of COVID in kids are a fever and cough. While some children with the coronavirus are admitted to the ICU and there are pediatric deaths, studies have found that underlying medical conditions including obesity, diabetes, cardiac and lung disorders, increase the risk of severe outcomes.

This research has contributed to how COVID is managed in schools. However, a new study in the Journal of the American Medical Association sheds light on the effect a coronavirus infection can have on children over a longer period. While many people recover quickly from COVID, some don’t, experiencing symptoms that can last for months or years. This condition, known as long COVID, not only affects adults but also children. The new research helps us understand the extent kids experience these debilitating conditions — and how we can treat it.

“This is one of the first large-scale national studies to do research related to long COVID across the entire lifespan, with a particular focus on children and understanding the differences in long COVID in different aged children,” Dr. Rachel Gross, an associate professor in the Departments of Pediatrics and Population Health at NYU Langone and the study’s principal investigator, told Salon.

In the study, led by the National Institutes of Health’s RECOVER Initiative, researchers asked caregivers to tell them about the symptoms that their children or teenagers had been experiencing more than four weeks after a coronavirus infection. For some children in the study, that meant their symptoms went on for three months after their COVID infection. For others, it was up to two years. Researchers looked at the symptoms in those children with persisting symptoms and compared them to children who had never been infected with the coronavirus in the past. They then identified similarities in the prolonged symptoms and found they were distinguishable based on age.

“In school-aged children, we heard commonly that children were experiencing trouble with their memory, focusing, headaches, having trouble sleeping, and stomach pain,” Gross told Salon. “And in the teenagers, we were hearing about symptoms related to fatigue and pain, having body or muscle or joint pain, being very tired or sleepy, having low energy, as well as having trouble with memory and focusing.”

A unique symptom the researchers saw in the teenage group was changes in or a loss of smell or taste. Additionally, researchers found clusters of symptoms that are unique to school-aged children and teenagers. The first were symptoms that affect every organ system in the body.

“These are the children with the highest burden of symptoms,” Gross said, adding that caregivers described these children as having a “lower quality of life and more impact on their overall health.” “The second type of long COVID we also saw across both the ages was predominantly characterized by fatigue and pain.”

Studies estimating its prevalence in pediatric populations are limited and conflicting, estimating up to 25% of children infected with the SARS-CoV-2 virus could go on to develop long COVID. A study published in 2024 estimated that up to 5.8 million young people have long COVID.

“This is a public health crisis for children,” Gross said. “We know that child health is so critically important for how children grow and even as they become adults, that chronic illness during childhood and adverse experiences during childhood greatly affects the adults that they can become.”

Gross said the U.S. will see the “long-term impacts of experiencing long covid In childhood for decades to come.”

Dr. Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California, Davis, told Salon he agreed long COVID is a “public health crisis” for children.

“Some of these kids with long COVID, they are severely affected, they can’t do their normal activities, they fall behind school, they can’t go to school,” Blumberg said. “And then in this study, they highlighted a lot have had some neurocognitive effects, and that really interferes with with learning.”

For Blumberg, the takeaway from this study, he told Salon, is a “call to arms to increase vaccination rates,” which among children, he said are “abysmal.”

According to a recent KFF survey, while both flu and COVID vaccines are recommended for school-aged children, flu vaccination rates were over three times higher than COVID vaccination rates. While COVID-19 vaccines are recommended by the Advisory Committee on Immunization Practices in the pediatric immunization schedule, they aren’t required for school attendance. According to one study published in the journal Pediatrics, vaccination reduced the risk of an acute infection, but it is less clear whether it protects against long COVID. The latest COVID vaccines were approved by the Food and Drug Administration last week, which the CDC recommends for anyone six months or older.

Now, researchers will be tasked with figuring out why long COVID affects children differently based on their age. When it comes to adults, some studies have shown that subsequent COVID infections increase a person’s risk of getting long COVID. The CDC estimates that one in 13 adults in the United States currently have long COVID symptoms.

Gross told Salon she hopes this research raises awareness for both healthcare providers, as well as schools and educators, that “long COVID in children is not rare.”

“That they are likely to have children experiencing these prolonged symptoms within their healthcare systems and their schools,” Gross said. “And that many of the symptoms that I’ve described, trouble with memory and focusing, headache, trouble sleeping, these are symptoms that you know can impact a child and their schooling.”

[robertreich]

The GOP’s Attack on LGBTQ Americans, Revealed 

Republicans don’t seem to care that Ronald Reagan once starred in a film that featured a prominent drag scene or that Rudy Giuliani did a skit in drag with Donald Trump.

Suddenly, they’re trying to ban or restrict drag performances in at least 15 states, with bills so broadly worded that advocates warn they could be used not only to prosecute drag performers, but also transgender people who dare to simply exist in public.

These bans are part of a cynical campaign to demonize the LGBTQ+ community. MAGA politicians are stoking fear over imaginary dangers to distract from how their policies only help themselves and their wealthy donors.

In the first half of 2023 alone, Republicans across the nation introduced a record number of bills to strip away freedoms and civil rights from LGBTQ+ Americans, largely targeting transgender and gender-nonconforming people.

By banning gender affirming care for minors, GOP lawmakers are effectively practicing medicine without a license — overruling the guidance of doctors, the American Medical Association, and the American Academy of Pediatrics. And they’re lying about what gender affirming care even is.

Genital surgery, for instance, is rarely, if ever, done under the age of 18. It’s not even all that common for adults. Politicians like Ron DeSantis are lying about it to scare people.

And the Republican presidential frontrunner has made it clear that trans people have no place in his vision of America.

MAGA lawmakers and pundits falsely claim trans people and drag performers are a danger to children and the public at large, when there is no evidence at all to support that. None. Trans people are in fact four times more likely to be the victims of violent crime.

These scare tactics are dangerous. Recent analysis found a 70% increase in hate crimes against LGBTQ+ Americans between 2020 and 2021, as the surge of these bills began. And that’s only counting hate crimes that get reported. 2020 and 2021 each set a new record for the number of trans people murdered in America.

The cruelest irony is that these Republican bills pretending to protect children actually put some of the most vulnerable children at greater risk. LGBTQ+ kids are more than four times as likely to attempt suicide, especially transgender children. Gender-affirming care reduces that risk. That is why it is life-saving.

Don’t Say Gay laws strip away potentially life-saving support. A teacher discussing sexual orientation and gender identity won’t turn a straight kid gay. But it will make an LGBTQ+ student 23% less likely to attempt suicide.

The tragic truth is that Don’t Say Gay Laws and health care bans will cause more young lives to be needlessly lost.

If Republicans really cared about protecting kids, they’d focus on gun violence, now the leading cause of death for American children. If they were really worried about children undergoing life-altering medical procedures, they wouldn’t pass abortion bans that force teens to give birth or risk back-alley procedures.

What the GOP’s vendetta against the LGBTQ+ community really is, is a classic authoritarian tactic to vilify already marginalized people. They’re trying to stoke so much paranoia and hatred that we don’t notice how they are consolidating power and wealth into the hands of a ruling few.

We need to see this attack on LGBTQ+ Americans for what it is: a threat to all of our human rights.

[grits-galraisedinthesouth]

Dear British Royal Family-

Meghan Markle rejected your offer to physically & emotionally equip her with professional medical support & guidance during pregnancy and after childbirth.

You graciously offered Meghan Markle the best geriatric pregnancy and pediatric health care in the world. Health Care that is NOT afforded to employees, but was offered to her as a member of the family.

Meghan Markle rejected your generous offer in favor of GENDER & PRIVACY preferences which she publicly confirmed to Oprah Winfrey.

During weekly medical appointments with her PRIVATE geriatric obstetrics and gynecological team(s), Meghan Markle was asked to provide updates on her mood and psychosocial wellbeing.

EVERY week for five (5)+ months leading up to birth, Meghan Markle told her PRIVATE medical team(s) that she was emotionally and mentally fit and well.

Meghan Markle told her PRIVATE care team(s) that her moods were normal and she was not experiencing thoughts of harming herself or unborn child.

Meghan Markle told her PRIVATE care team(s) that her moods were stable/good and she was NOT experiencing suicidal ideation or thoughts of harming baby (Archie).

File a lawsuit against the daughter-in-law from hell and sue her arse for defamation of character.

The royal household's gynaecologists Alan Farthing and Guy Thorpe-Beeston, who specialises in high-risk childbirth, were present at the births of all three of William and Kate's children.

A royal source told the Mail on Sunday: "Meghan said she doesn’t want the men in suits. She was adamant that she wanted her own people. It did leave a few of us a little baffled."

But, despite being two of the best in the business, the pair have been denied a leading role in the delivery of Prince Harry's baby.

According to royal protocol, the doctors cannot be excluded from the process entirely, and should anything go wrong in the birth they will be present to step in.

Another said: "It is slightly surprising. These people [the Queen’s doctors] are the best of the best and when it comes down to it, their role would actually be very limited in the birth itself, assuming all goes to plan."

The move to shun the royal gynaecologists could be seen by some as unnecessary extravagance, as the Queen's physicians do not charge a fee and taking on a new team of specialists will cost tens of thousands.

A source explained: "Working for the Royal Household is seen as an honour and attracts other high-profile fee-paying patients."

In another break from royal tradition,is not planning to pose with her newborn baby on the hospital steps like Kate Middleton and Diana, it is understood.

[valkyrie-kun]

i am finishing med school next year, and here are the residencies i would give to atla characters:

aang: definitely something that needs patience and/or insane mental stamina and also is rewarding. pediatrics (gentle soul, both children and parents adore him) or psychiatry (therapy more specifically, not just drug prescribing by the book, because he would make people feel better by making them ✨️feel things✨️ and give them resources to deal with their lives and trauma)

katara: gynecology. she has some experience in aiding childbirth canonically and i just find her being very much interested in women's health and healing (and she has all the right spirits because all these examinations are not comfortable, and i can see her putting everyone at ease with her attitude)

sokka: finished med school. felt meh about mostly everything (he knew he should have went for an engineering school six years ago) joins pharmaceutical company, sells medicine, makes friends with all the other doctors and talks to them f o r e v e r while promoting the new revolutionary drug for BPH, people in the waiting room get pissed for him taking much of their time. later gets involved with drug development, and puts his stem knowledge to use in a way he likes it.

zuko: surgery. the easiest of the gaang. preferably trauma surgery. loves it, cauterization (duh) is the most fun part for him. wears a smart watch that shows his blood pressure go to 180/100 while hammering someone's hip replacement (routine procedure). smokes X packs a day. the textbook personality of a surgeon canonically. once he becomes a parent slows down a bit and passes a night shift to someone else every once in a while

toph: is the one getting passed nightshifts. zuko's collegue, one of the best, tells all men in the operating room to go back to their childhood homes (euphemism). top expert, despite odds not being at her favor when she was born, she senses everything as good (if not better) as someone without an impaired eyesight. takes risks, but knows when is the time to stitch up ("where is liver lily number 2" one of the residents) and call ot quits for now. probably also works for her to be a cardio-thoracic surgeon, idek why.

suki: i think physical medicine/rehabilitation but i see her more in a management position, i think she would handle manageing multiple projects and finances of the department quite well. is very patient and effective with both patients and co-workers. ty lee fits here as well, though not strictly as a leader.

mai: something very clean and logical. ophtalmology, likes the physics of it and likes that it is complex despite being tiny. dabbles in anterior eye segment. smooth operator when in operating room. does botox to both herself and clients on the side

for others inspo is pending.

[magz]

"As Good as Dental Sealants – Scientists Discover Inexpensive Liquid That Prevents Tooth Decay"

Article Date: March 6, 2024.

Highlights:

SDF has emerged as another promising treatment for fighting cavities. Originally approved by the FDA for treating tooth sensitivity, the solution is brushed onto the surface of teeth, killing decay-causing bacteria and remineralizing teeth to prevent further decay.

"A growing body of research shows that SDF—which is quicker to apply and less expensive than sealants—can prevent and arrest cavities, reducing the need for drilling and filling,” said Richard Niederman, DMD, professor of epidemiology & health promotion at NYU College of Dentistry and the study’s senior author.

[...] The study included approximately 4,100 children in New York City elementary schools; more than a quarter of kids had untreated cavities at the start of the study.

[...]

The researchers reported last year in the journal JAMA Network Open that a single treatment of either SDF or sealants prevented 80% of cavities and kept 50% of existing cavities from worsening two years later. The team continued their study for another two years, and in their study published in JAMA Pediatrics, found that SDF and sealants prevented roughly the same number of cavities after children were followed for a total of four years. Moreover, both sealants and SDF reduced the risk of decay at each follow-up visit.

[...]

Embracing SDF for cavity prevention and treatment in schools could keep kids from needing fillings, saving families and the healthcare system money. Yet these programs can only succeed if there are enough health professionals to provide care.

[hearthfire-heartfire]

"In the most comprehensive national study since the onset of the COVID-19 pandemic, a team of researchers that includes a Rutgers-organized consortium of pediatric sites has concluded that long COVID symptoms in children are tangible, pervasive, wide ranging and clinically distinct within specific age groups. Results of the study, funded by the National Institutes of Health (NIH), are published in the Journal of the American Medical Association. “We have convincing evidence that COVID-19 is not just a mild, benign illness for children,” said Lawrence C. Kleinman, a professor of pediatrics and population health expert at Rutgers Robert Wood Johnson Medical School (RWJMS) and the study’s third co-author. “There are children who are clearly disabled by long COVID for long periods of time.” In the early stages of the pandemic, a myth arose and was perpetuated suggesting that because children often developed only mild cases of COVID-19, the risks for young patients were not serious. But this conjecture dissipated amid a rash of data demonstrating that a few children infected with COVID-19 will get very sick and others will suffer an array of health complications long after initial exposure. Broadly defined, long COVID includes symptoms, signs, and conditions – such as aches, fatigue, memory loss and stomach pain – that develop, persist or relapse more than a month after a COVID-19 infection. Worldwide, an estimated 65 million people, including children, live with long COVID. Until recently, most research into COVID-19’s lingering effects focused on adults. To quantify long COVID’s impact on children and determine whether symptoms experienced by the youngest COVID-19 patients differ by age group and from adults, Kleinman and more than 140 researchers throughout the United States crunched data from NIH’s Researching COVID to Enhance Recovery (RECOVER) Initiative, a national effort to survey COVID-19’s long-term impact. As part of RECOVER, caregivers for 5,367 children (898 school-aged children and 4,469 adolescents) completed online surveys about their children’s health in time for this data analysis. Roughly 86 percent of the sample had previously been infected with COVID-19, while 14 percent – the control group – had not. The survey assessed 74 known and potential long COVID-19 symptoms across nine domains: eyes, ears, nose and throat; heart and lungs; gastrointestinal; dermatologic; musculoskeletal; neurologic; behavioral and psychological; menstrual; and general. By analyzing the responses, researchers found 45 percent of COVID-19 infected school-age children (ages 6 to 11) reported at least one prolonged symptom after initial recovery versus 33 percent of uninfected children. Thirty-nine percent of COVID-19 infected adolescents (ages 12 to 17) reported one prolonged symptom, compared with 27 percent of uninfected adolescents.  These differences implicate the virus as a likely causal factor, rather than just having lived through the pandemic. Long COVID symptoms in children also were clustered in patterns distinct from adults and from each other. For instance, the most common symptom in adolescents was loss of smell and taste, followed by low energy, muscle aches and fatigue. For school-age children, memory and focus issues topped the list, followed by stomach pain, headaches and back or neck pain. Children experienced prolonged symptoms after COVID-19 infection “in almost every organ system, with the vast majority having multisystem involvement,” the authors wrote."

oh hey, remember a couple of years ago during the omicron wave when multisystem inflammatory syndrome was driving a lot of kids to go to the hospital?

[religion-is-a-mental-illness]

https://www.wsj.com/articles/most-transgender-kids-turn-out-to-be-gay-gender-affirming-care-conversion-therapy-58111b2e

Most ‘Transgender’ Kids Turn Out to Be Gay

Subjecting them to medical interventions is the modern-day version of ‘conversion therapy.’

By: Roy Eappen

Published: Dec 14, 2023

As a medical professional who happens to be gay, I’ll be celebrating Dec. 15, the 50th anniversary of the American Psychiatric Association’s decision to remove homosexuality from its list of mental illnesses. The longstanding designation was based on prejudice, not medical research, and the revision marked the beginning of the end for so-called conversion therapy, which sought to “cure” gays and lesbians of a nonexistent malady.

Half a century later, the medical establishment is pushing a new kind of conversion therapy under the guise of transgender identity. No one is suffering more than gay kids. In Canada, where I practice, and in the U.S., physicians provide what’s euphemistically known as “gender-affirming care” to patients as young as 8, and the leading transgender health association has opened the door to interventions at even earlier ages. Under this framework, those who feel uncomfortable with their bodies may receive a medical regimen including puberty blockers, cross-sex hormones and sex-change surgeries. These interventions typically stunt, remove or irreversibly modify a patient’s sexual development, genitals and secondary sex characteristics. Any endocrinologist or other physician who rejects this approach is alleged to be endangering the health and even the life of his patients.

But are these patients really “transgender”? Research shows that some 80% of children with “gender dysphoria” eventually come to terms with their sex without surgical or pharmaceutical intervention. Multiple studies have found that most kids who are confused or distressed about their sex end up realizing they’re gay—nearly two-thirds in a 2021 study of boys. This makes sense: Gay kids often don’t conform to traditional sex roles. But gender ideology holds that feminine boys and masculine girls may be “born in the wrong body.”

In this light, “gender-affirming care” looks a lot like conversion therapy. In the past, it took the form of electroshock therapy, chemical castration and even lobotomy. Now it takes the form of rendering teenagers sterile and sexually dysfunctional for life. Clinicians from the main U.K. transgender service referred to prescribing puberty blockers as “transing the gay away”—a play on the description of old-fashioned conversion-therapy as “praying the gay away.” A clinician who resigned from the U.K. service accused it of “institutional homophobia.” Clinicians at the service had a “dark joke” that “there would be no gay people left at the rate Gids”—the Gender Identity Service—“was going.”

Consistent with conversion therapy, physicians are telling young gays and lesbians that something is wrong with them, based on a regressive view of what it is to be male or female. Also consistent with previous efforts to cure homosexuality: The resulting interventions often create lifelong medical problems, both physical and mental. Contrary to advocates’ claims, there’s no evidence that puberty blockers, cross-sex hormones, or surgeries reduce the risk of suicide.

Children who take this road face a lifetime of pain, infertility and anguish. They deserve real mental-health care to address common underlying comorbidities, not mind- and body-altering medical interventions that try to make them into something they aren’t.

Fifty years ago, the medical assault on homosexuals began to end. Now society has been told that accepting transgender identity is the same as accepting gays and lesbians. But it isn’t. Even well-intentioned acceptance of transgender identity disproportionately harms them. One day perhaps professional organizations like the Endocrine Society and the American Academy of Pediatrics will follow the evidence, as the APA did in 1973. Until then, gay kids will continue to suffer from an injustice that was supposed to end 50 years ago.

Dr. Eappen is a practicing endocrinologist in Montreal and a senior fellow at Do No Harm.

==

Reminder:

There's no such thing as "trans kid."