#online treatment for covid

[natandacat]

Long covid physio is starting tomorrow and I'm already so frustrated...... it's mostly going to be about how to manage PEMs and! I know!! How to!!! I just can't! Because I live alone and I need to eat, clean, and go places sometimes! I have already dropped every single hobby, I do most of my classes online, I physically can't reduce my exertion level further. It's just. I want to do things again. Today I had a 2 hours exam and I ended it with so much fatigue I was slurring my words and had to lay down. On Monday I had to use my extra hour of disabled time during another exam bc I got so weak halfway through I had to stop for 30~40min until I could turn the pages normally again and hold my head up. It's frustrating, and not all of it are the PEMs, so there's a chance that things will get better if my iron levels get higher or we identify what's actually been going on since this summer, but rn I'm frustrated. This sucks a lot!

[puthyflapps]

Crazy how Lyme disease seems to only affect the folk listed on famousbirthdays.com

[religion-is-a-mental-illness]

I am Sage's mother, better known as Nana. I adopted Sage after my son died when she was still a baby. She's been through six foster homes by then, but we loved her and she blossomed into a joyful, lively girl who made music and art.

Puberty began and COVID hit, and she was treated for depression and anxiety, at times very severe. Her teachers shared any concerns with me so her treatment could be adapted.

The transparency ended in August of 2021 when Sage started high school. She started a public high school and she told me that all the girls there were bi, trans, lesbian, emo and she wanted to wear boy's clothes and be emo. Because I saw it as just a phase, it was fine with me.

But at school, she told them something different: she was now a boy named Draco with male pronouns. Sage asked the school not to tell me, and they did not tell me even though I informed them of her mental health history and medication. If I had known, this would be a much different story.

She was terribly bullied. No one told me. But boys followed her, touched her, threatened violence and rape. Something happened in the boy's bathroom but for two days, the school told me nothing. They kept meeting with Sage alone and she became so distraught they called me to pick her up.

That evening, I found a hallpass labeled 'Draco' and Sage told me she was identifying as a boy, and that her counselor said she could use the boy's bathroom. She'd been jacked up against the wall by a group of boys. She was crying, terrified. I said just stay home, we'll figure it out. That was my last conversation with Sage for five months.

The night she ran, she thought, to a young friend she'd met online, she left a note saying she was scared of what would happen if she stayed. The sheriff, FBI, search dogs were called in. I dropped to my knees in prayer. Nine days later the FBI found her in Baltimore. My baby had been lured online, sex trafficked by DC then Maryland. She was locked in a room, drugged, gang raped and brutalized by countless men. It was night. The FBI told us to pick her up in Maryland the next morning.

We packed our cars with blankets and stuffed animals and arrived by 8 am, but we were told we couldn't see her, and were summoned before Judge Robert Kershaw late that afternoon. They didn't even tell Sage that we came for her. We finally entered the courtroom and Sage appears on a huge Zoom screen from a prison cell. She looks tiny and broken, and I cry out 'I love you Sage.' Sage responds 'I love you too, Nana.' But attorney Anisa Khan rebukes us. She is a 'he' and his name is 'Draco' not Sage. We were floored.

Khan accuses us of emotional and physical abuse, that we are misgendering her, even though we just learned she claims to be trans and we're willing to use any name and pronouns to bring her home. My husband was so tearful he kept forgetting the new pronouns, so the judge had the bailiff remove him from the courtroom. I was pleading for my child to be returned and treated for her unspeakable trauma. Judge Kershaw told me, if I use the word 'trauma' again, he would throw me out too.

For over two months, he withheld custody. He housed Sage in the male quarters of a children's home. Sage told me she was the only girl and repeatedly assaulted. She was given street drugs by the other kids and Khan told her she didn't care. She just wanted to win the case and all the way to the Supreme Court if necessary. Khan tried to prove abuse, but we were eventually cleared by both states of all charges.

Sage later told me Khan had told her to lie that we hit her. Khan even had Sage's school counselors testify against us, though they barely knew Sage and they didn't know us at all. Khan told my precious child I didn't want her anymore. I found out Sage never received any of the letters I sent her.

Sage ran from the Children's Home and disappeared for months. They told me she might already be gone forever, but I couldn't give up and I finally found a tip on her social media that led the marshals to her in Texas. She had been drugged, raped, beaten and exploited. This time I was able to be with her for the traumatic rape exam, and to bring her home.

Back in Virginia, she entered the mental health facility that Judge Kershaw had ordered, as it would affirm her as a male. The therapist began pressuring her to have her healthy breasts removed. Sage was too scared to protest, but she asked me to secretly buy her girl's clothes because she wanted to be a girl, but keep them in the car. It took a kind lawyer, Josh Hetzler to secure her discharge.

After almost a year. Sage was finally home. Safe. Alive. Sage is receiving professional trauma care. The first trafficker has already been convicted. Sage has nightmares, panic attacks, rape-related medical issues, but there's hope. I tell her she's not broken she's just scarred. And part of that hope is that in courageously sharing her story, others will be saved.

Sage said she doesn't know who she was back then. She wasn't a boy, she just wanted to have friends. But her school, the judge, the attorney and the doctor were all blinded by their ideology. The consequences for Sage were unspeakable.

Please don't let ideology harm another child. Let parents do our jobs. We know our children best and we love them a million times more.

Thank you.

==

Jesus Christ. This girl was exploited by everybody, except for her parents, who were villainized for literally nothing. It's opposite world.

And the fact that everybody with authority prioritized stupid shit like pronouns and trying to coax her further down into a fake identity, even against her will, and other ideological bullshit over her actual wellbeing is disgraceful.

The judge and attorney need to be disbarred, the therapist stripped of their license, and everyone who conspired to separate Sage from her parents fired.

[covid-safer-hotties]

The US Government Is Shutting Down A Key Covid Website

Tomorrow the US government agency responsible for biomedical and public health research, The National Institutes of Health, will shut down its Covid-19 ‘special populations’ website.

This site hosts a huge amount of information about how to treat covid and long covid in the immunocompromised and in people with HIV, cancer and similar immune supressing conditions - so-called ‘special populations.’

The site is going totally offline.

It’s a shameful dereliction of duty by the NIH which, behind Harvard, is the second largest publisher of biomedical research papers in the world. Doctors and clinicians all over the world use the NIH site for advice and treatment ideas.

And it’s going offline during a massive summer surge of covid infections in the US, a surge that is now topping 1.3 million infections per day. (One of whom was Anthony Fauci, who was infected for the third time last week). A surge killing 750 people a week in the US. Many of whom will be precisely the type of people this website is intended to help clinicians treat.

It’s a scandal.

The message it sends to vulnerable people could hardly be clearer - when it comes to covid, there’s nothing else we can do for you. Sorry. That’s it. We’re done.

It’s so terrifying.

It also sends a terrible signal to the medical community about where we are with covid

and will be materially damaging in efforts to treat vulnerable people, both in the acute stage of the disease and those with long covid.

The move to shut the page down is premised on an entirely false assumption: that we already know everything we’ll ever know about how to manage covid so there’s no point keeping a live web resource because they’ll never be anything to update it with ever again.

This is simply not true. While we know a lot about treating covid four years in, we absolutely do not know everything, not by a long stretch. As evidenced by the hundreds still dying every week in summer 2024. And as for long covid, we know very little about how to treat it. For a start, there is no agreed treatment plan. Absolutely none. But apparently we also know so much about this disease we can start shutting down online resources dedicated to it.

Please imagine for a second if a Trump administration rather than a Biden-Harris administration was doing this.

There would be an outcry.

But this move has so far been greeted by media silence.

It is left to a few disability activists and the covid aware to shout into the social media void.

Not that this is a surprise. This is how it has been for the last two years at least, guided by the business as usual, vax-and-forget strategy. More people have died of covid under the Biden-Harris administration than died under Trump. Despite having vaccines since 2021. You’d never know it by mainstream media coverage.

Some people have written to the director of the NIH, Monica Bertagnolli, and asked them to keep the advice live and up-to-date. If you want to do this her email address is:

monica.bertagnolli@nih.gov

Long Covid Action has archived the site here

Maybe if enough people write to her and enough noise is made the decision will be reversed. Worth a try.

Overall it’s just another grim episode in the handling of the pandemic by the current US administration, an administration who, we should never forget, won power in large part due to the outrage at Trump’s handling of the first nine months of covid.

Solidarity to everyone still trying to protect themselves and their communities from covid against all the odds.

At least we can keep fighting for each other.

[dxmedstudent]

What do GPs do?

For the past few years, there's been a constant undercurrent of hostility towards the medical field in mainstream media, particularly GPs. Especially from certain conservative former doctors who write in to the Torygraph.

One of the charges levelled against GPs is that they are purpotedly ruining the NHS by not working enough hours. They need to be making more time for appointments and are all shirking.

How do GPs work?

GP work is measured in sessions, defined by the BMA as a 4h 10 minute time slot. 3 hours of this is meant to be clinical time, with some admin time for tasks - meant to be at least and hour. Typically, a whole day will involve a session in the morning and a session in the afternoon.

What do GPs do? The BMA breaks it down here. I also find articles by GPs can be useful for explaining. When not talking to patients, we are sending referrals or liaising with specialists about their care. We are checking blood test results and other investigations that were carried out by the practice, and then informing patients. We are filling prescriptions- each time a patient asks for their prescription to be refilled, a doctor or pharmacist is checking the order and whether it is safe to give, abd whether we are monitiring blood tests and keeping the patient safe. We are reading letters from specialists and actioning their recommendations.

However, in reality, multiple surveys reveal that GPs spend significantly more time working than what they are directly paid for. Whilst a 6 session GP should be spending around 24 hours at work, it's closer to 38 hours on average. GPs report spending up to 40% of their working time on admin - much of it being unpaid time outside of the hours they are contractually hired for. I and most GPs I know routinely stay late at work in order to make sure patient care is completed. We're in before 9am and leave between 7 or 8pm.

Add to that that many might have further responsibilities, especially if they are a partner in the practice.

Funnily enough, full time in general practice is considered to be 8 sessions. That's 4 long days. Gone are the days when anyone would consider a 5 day working week for GPs, because the workload is increasingly intense and sessions generate more paperwork than they used to.

Demand Is Increasing

GPs may be moving towards working less sessions, but that's because our work is getting more complex. As patients live longer, with more complicated combinations of illnesses and treatments, and we exist in a society that has progressively defunded social care and benefits, and impoverished our most vulnerable patients, there are more calls on our time abd attention than ever before. Stripped hospital services are increasingly rejecting our referrals, often inappropriately and against actual guidelines. Services are being pushed onto GPs via shared care agreements that would once have been handled by specialist teams in clinic. Services that we heavily rely on to serve our patients are sometimes defunded or disappear as contracts end or are transferred to new providers. Long wait lists lead to exasperated patients repeatedly seeing their GPs to manage issues that can't be managed well in the community.

There's a narrative in the media that appointments are impossible to get, but in reality, nationally GP surgeries are providing more appointments per month than they did before the pandemic. For example, 25.7 million appointments (excluding Covid vaccinations) were delivered by GP practices in December 2023, an increase of 9% compared to pre-pandemic. Practices are trying to find how to offer more appointments on a budget and how to improve access and find alterantive ways to serve patients; for example online forms, so that phone lines are freed up for vulnerable patients. Many practices are also offering longer appointments as many patients have complex needs.

Let's talk Pay

People also assume GPs are rich, but that's not really the case, especially given most of us wrent working full time. Average pay for a session is somewhere between 10k and 12k a year for each session a week that you work, depending on things like seniority and location. So for example, a 5 session GP earning 10k per session can expect to earn 50k a year. That's barely above the London average salary of 44k for a job that requires medical school, often an additional bachelor's degree and then at least 5 years of postgraduate training at minimum. That's more comfortable than a lot of vulnerable people, but it's nowhere near what most people think. Even if someone is paid higher per session and working more sessions, the average is still closer to 80 or 90k for salaried GP roles.

I've found figures that suggest the average GP salary is just over 100k, but that includes people doing separate private work or being partners, where in reality these are different roles that are paid differently. Partners are effectively shareholders in the practice. Locum or private work is much more lucrative and needs to be considered separately from a standard salaried role.

Some Partners may be earning £100k-150 in a good year, but that will be after working a LOT of overtime outside of their clinics, abd is in line with hospital specialists. The proportion of GPs earning more than that are miniscule. And honestly, if someone is working a ton of extra hours with their local LMC or med school or deanery, or doing a ton of locum work in evenings and weekends, I'm happy for them to be earning more money than me. Extra work and hours should be rewarded.

The Gender Aspect

I think we need to address the fact that complaining about doctors choosing to work less than what is defined as full time, often goes hand in hand with people complaining about women having the temerity to work in medicine. Apparently we're devaluing the profession by making it too female, going part time and having children. Why us ut that nobidy cares about whether men are going less than full time to look after their kids, and whether fathers are missing out on their children's upbringing?

As women, many of us are still facing sexism in our working lives. Whilst still having to deal with the fact that even uf we earn more and work longer hours than our menfolk, we usually end up doing the majority of the childcare and housework. Women in medicine are more likely to go less than full time because we are more likely to feel compelled to take on unpaid labour at home. Like our non medical sisters.

For reference, the full time nursing week in the NHS is 37.5h - with some variation between 36-40h depending on where you work. Working part time would benefit nurses, too. The nursing workforce is mostly women, and yet there's not the same outrage about their working hours or going less than full time, because women being nurses is expected. People don't seem to care about nurses' working conditions or the stresses they are under, and honestly most articles ignore the financial stresses or difficulties of most NHS workers because they are normally focused on doctors as a resource that they want to exploit maximally.

We aren't out there trying to police what hours other professions work - or at least, we shouldn't be. So why does the public feel entitled to dictate what hours doctors should be working? It's not like people are being paid for hours they aren't working!

[utilitycaster]

It is not, in fact, kind, generous, or understanding to use the reveal that Critical Role's delays may have had additional root causes to preen about how good a person you are for opinions that you already would have held in the absence of said information. It is, in fact, disrespectful and frankly pretty ghoulish to use it to attack people you disagreed with over opinions of narrative structure. Additionally, assuming Matt and Marisha have been truthful, both the EXU interlude and Downfall have been in the works for a very long time, very possibly pre-dating Sam's diagnosis and treatment plan.

I think everyone in every fandom has been in the position of making a statement that didn't age well given further information. In a way, you can see this as almost an inverse to the common plight of praising a creator who later turned out to be a shitty person. You cannot live your life assuming that every statement you make might one day gain additional unfortunate meaning. You are in fact permitted to dislike that there will be a gap of Bells Hells from June 20th to August 1st. I'm very excited for Downfall! But if you aren't, that's valid. The reason behind this decision is not important. You can dislike a creative decision regardless of how good the reasoning behind it is. The issue with the fandom during the COVID Hiatus wasn't people saying "man, this sucks and I miss the Mighty Nein"; it was people acting like the cast was obligated to compromise their own safety to give the fandom a show. "I wish we had more Bells Hells instead of Downfall" or "I wish the EXU interlude had been scheduled later" are entirely fair statements to make. "Critical Role shouldn't do this to its fans, it's unfair." is not.

More generally: this doesn't hold true in the real world, but online, and especially in fandom, hands down the most unpleasant people outside of outright bigots have always been people who interpret any and all criticism of anything they like as an attack. Invariably they end up actually attacking others because they have decided that everyone who disagrees with them is an acceptable target. Consider whether you are this type of person and if you are, consider doing everything you can to no longer be this type of person.

[jmtorres]

Hi, this is random, but would you mind sharing more about your gut issues/long covid? (I.e. diagnosis, treatment). I have chronic fatigue, and gut issues that are definitely linked to that, but all of my doctors are being extremely useless about it. (No worries if this is not the kind of info you want to share with a total stranger on the internet)

(This is in reference to my comment on this post)

@reptilerex I appreciate you recognizing the sensitivity of this ask, I am going to go ahead and answer it because I feel like the likelihood that you or someone you know (or even others of my readers) are struggling with long covid and finding adequate medical help vastly outweighs the minuscule probability that you've hacked into HIPAA records and are planning to dox me lol

so in the immediate aftermath of my first bout of covid (despite vaxxing and masking regularly, I'm up to two now 😭) my obvious symptoms were fatigue – going to the grocery store would wear me out for 2+ days – and a 20 year-old scar from a car accident reopened, which sounds like some scurvy ass bullshit, and I do wonder if the fact that my friend @niqaeli, who knew that long covid symptoms are highly correlated with MCAS symptoms and was encouraging me to start MCAS otc treatments like vitamin C supplements, helped. (worth noting that while I didn't hear anything about old scars reopening as a covid/post covid thing before it happened to me, but when I told people about it, they were like "oh yeah, that happened to me or someone I know" SO often) My doctor sent me to a wound specialist for that, and they kept poking it trying to figure out if there was some embedded shrapnel that they hadn't realized was in there originally, but ultimately it just healed back over much redder and angrier than the first time.

so then, the fatigue. My doctor had me wait three months because it wasn't officially long covid until three months. obnoxious as hell. I found out the DMV accepts long covid for a disability placard reason and got my doctor to write me a DMV form about how I couldn't walk hardly any distance. she was willing to do that before the three month mark.

I was Johnny on the spot coming back three months after, the first thing she did was send me for a chest x-ray because the obvious/expected reason for fatigue is you're not getting enough O2 in your blood. There was nothing wrong with my lungs and we were kind of at a dead end until I presented my doctor with more options.

I mean, I was kind of like, my PCP is being useless, I have a PPO, why can't I just go directly to a specialist, but it turns out specialist won't take you without a referral because reasons. I had heard rheumatologist is as good at figuring out weird vague shit so I tried to book there but when I told them long covid, they said that wasn't their department. They said I needed to go see an immunologist which sounded wrong to me, but there was a pretty good HIV specialist immunologist in the area that I tried to book with who said no that's not what long covid is. someone recommended a Long Covid Specialty clinic in a city that is 2 to 5 hours away depending on traffic and I knew I wasn't making that drive in my current condition so was like somebody local gotta help me.

so I went back to my PCP and said to her that I had learned from disability communities online that sometimes a rheumatologist can be helpful. And she said OK we can do some blood tests for inflammation markers to see if I can justify a referral to a rheumatologist. (and I thought of my weird scar issue and thought gee I better have some weird inflammation markers)

So I had some inflammation markers pop and I got a referral to a rheumatologist, and they were actually willing to see me. The rheumatologist ordered so many tests, like an unbelievable number of tests. I think they drew like eight vials of blood. Plus other samples. The rheumatologist was basically like let's look for anything and everything.

I had a borderline response on Calprotectin. To quote from the explainer in the test notes:

Calprotectin in Crohn's disease and ulcerative colitis can be five to several thousand times above the reference population (50 mcg/g or less). Levels are usually 50 mcg/g or less in healthy patients and with irritable bowel syndrome.

so I wasn't high enough to qualify for IBD outright from that test results, but I was high enough that it flagged to the rheumatologist, and I had reported a family history (brother has IBD), so he said that was enough to diagnose and started prescribing me for that.

The thing is, rheumatology is an ass backwards way to get an IBD diagnosis and I was having another symptom that I hadn't reported because I was a dumbass and this is the apocryphal frog boiling slowly thing. I was having fairly regular loose stool/diarrhea. if I had told my PCP that could I have gotten a referral to a gastroenterologist and gotten a less ass backwards diagnosis?

I hadn't told my PCP about loose stools for two reasons:

I didn't think it was relevant to the fatigue, and in fact, I still didn't think it was relevant when the rheumatologist called it, and I was really surprised when taking medication for IBD did actually turn out to help the fatigue

I knew I was lactose intolerant, so I thought it was already explained. However, the rheumatologist and I had this exchange:

Him: so do you still drink regular milk or just Lactaid?

Me: Lactaid

Him: then you shouldn't still be having diarrhea

Me:…

I can't remember the first med he started me on because I was only on it for a couple of weeks before we had to switch. (it helped a lot when I could tolerate it but about every three days I had to throw up and then I felt awful and didn't take the med for a couple of days and you can guess how that went.) the one that I went on long-term that actually worked without side effects for me was mesalamine/lialda. I also started experimenting with some dietary changes, the low FODMAP diet is intended for IBS not IBD, but you are still expected to have IBD triggers so I was playing around with that.

for a few weeks, I had incredible improving energy. It was crazy.

then I made what I can only now think of as a mistake in trying to be proactive about my care. because I had stumbled ass backwards into an IBD diagnosis and I felt like I should have gastroenterologist confirm it, and I went to go see my brother's gastroenterologist. he wanted to do a colonoscopy and he asked me to go off the mesalamine for six weeks so that he could see what my colon was like without treatment and it was the worst fucking six weeks of my life. Hated it. colonoscopy results: he didn't see anything fucking wrong and would not diagnose IBD or prescribe mesalamine based on what he found. I said, but the mesalamine improves my symptoms, what does that mean? He said, it means keep seeing your rheumatologist.

I went back to the rheumatologist and told him about the whole debacle with the gastroenterologist and he was like "so how did he explain your inflammation readings?" like CHECKMATE. And he concluded that any lesions I had must be in the small intestine, not the large intestine and so were not seen by colonoscopy.

I kept taking mesalamine. My improvement was slower after the break from it which sucks but I did get back to normal lab work within six months, hallelujah.

Follow up: MORE stuff that might have been avoided if I had gastroenterologist regularly, had gotten an IBD diagnosis from a gastroenterologist, or had mentioned my shitty symptoms in the immediate: the gallbladder bullshit this summer

I had my second round of covid in May and I didn't notice a lot of fatigue coming out of it, though I was more cautious with myself the second time around, but I was sort of holding my breath for what horrible nonsense is going to come out of this now? so then I had what I thought was a really bad case of Gerd that didn't go away for two weeks even though my Gerd usually resolves in like a day. I went to my PCP twice during this period and then ultimately ended up at the ER when I realized my pain was in my side not central anymore and I was worried about appendicitis. It wasn't appendicitis. It was my gallbladder. and it came out that night. overall, I am very happy with how the hospital handled the emergency for instance, I didn't realize until two weeks later that I seriously could've died because they were so calm about it the whole time but like they don't do same-day surgery unless death is on the line, let's be real.

but here's things that could have been helped if I had better gastroenterology care:

I didn't find this out until I was researching gallstones after the fact, and I would like to think a gastroenterologist would have warned me whereas the rheumatologist wasn't super aware of it but: IBD can lead to gallstones because one of the ways a cholesterol gallstone forms is, if you get an imbalance of bile and cholesterol in your gallbladder; your body wants to recycle bile by reabsorbing it at the end of your small intestine, but if you have IBD, sometimes it loses the bile instead of reabsorbing it, and then you get an overabundance of cholesterol, turning into a gallstone the size of a golf ball

I told my PCP it was a case of Gerd that wouldn't go away, but I didn't tell her I was also having diarrhea. Diarrhea is not a Gerd symptom. Maybe if I had just fucking told her she might've recognized or could've sent me to somebody who would have recognized it as a gallbladder symptom before it turned into an immediate emergency

tl;dr don't hide your gut symptoms from your doctor because you "think" you know what's wrong with your guts or that it's not related to your other problems or you're embarrassed or what the fuck ever just tell them that you're shitting yourself because it might turn out to be important

[evidence-based-activism]

Is it true more trans teens attempted suicide after ‘anti trans’ laws passed?

Hello! I am guessing this is in reference to this recent study [1], which made this exact claim. In short, this study has substantial issues that weaken its conclusion severely. These flaws, paired with stronger contradictory evidence, suggests that no, these laws are not connected to increased suicide among transgender teens.

First, the contradicting evidence:

While not in reference to these specific laws, other studies have attempted to determine if there is an increase in suicide following laws aimed at restricting transgender healthcare.

This independent report for the UK NHS [2] found "the data do not support the claim that there has been a large rise in suicide in young gender dysphoria patients" and "the claims that have been placed in the public domain do not meet basic standards for statistical evidence". (They – correctly – also criticize the way "this issue has been discussed on social media", which we will get into later.)

The Cass review [2] was an extensive literature review that found evidence did not support the belief that "hormone treatment reduces the elevated risk of death by suicide in [the transgender youth] population".

This Finnish study on adolescents and young adults [4] took a slightly different approach, attempting to determine if access to "gender reassignment" reduced suicide rates. First, they found "clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for." They also found "medical gender reassignment does not have an impact on suicide risk".

This similar Swedish study on adults [5] found that "sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism" as higher "mortality, suicidal behaviour, and psychiatric morbidity" persists after "sex reassignment".

This Dutch study on adults [6] also found that "the suicide risk in transgender people ... seems to occur during every stage of transitioning".

Importantly, these studies are all reasonably strong and well-designed. The centralized nature of these country's health data allowed for large-scale, representative studies to be performed. The English study [2] reviewed data directly from the NHS, the Cass review [3] was an extensive and through literature review (common myths about the report are debunked here [7]), and the final three studies [4-6] were all long-term (multiple decade), nation-wide cohort studies.

This evidence provides a strong indication that medical gender transition treatment do not reduce suicide risk in transgender populations.

---

So, what are the issues with the US study?

First, this study [1] was not representative. The participants were recruited from "non-probability cross-sectional online survey" via "targeted advertisements on social media" between "2018 and 2022".

Already there are substantial issues:

This study is explicitly noted to be non-representative, drawing conclusions about transgender youth based solely on this study is irresponsible.

The participants were recruited via social media, which past research [8] has shown to be correlated with suicide attempts. Notably, the causality of this relationship is irrelevant in this case, because it is still evidence of a significant confounding variable. (Confounding variables are the primary reason why you cannot determine causality from correlational relationships like the one presented in [1].)

This study overlaps with the COVID-19 pandemic. They claim to have "considered the potential impact of the ... pandemic" and found "minimal evidence" of any impact. This conclusion contradicts substantial amounts of past research including a systematic review and meta-analysis of youth suicide during the pandemic [9], a systematic review and meta-analysis of youth depression and anxiety [10], and an analysis of national suicide data for US youth [11].

Their analysis of the impact of the pandemic used "population-adjusted ... death counts by year as a proxy for the overall impact ... in a given state for a given time period". It's likely this was on of the only data sources they had to evaluate the impact of the pandemic, but that doesn't change the fact that this proxy neglects to consider the isolation, financial stress, and social media use among youth and their families that likely drove their decline in mental health. (See studies [12-15] for some introductory evidence of this.)

Other issues:

They considered only self-report of suicide attempts and serious suicidal thoughts, not actual measurements of suicides or suicide attempts. This adds an additional possibility of response bias. (Notably, this was not a concern for the studies I discussed above, which show no relationship between similar laws and suicide, as they evaluate actual medical report data.)

They found a statistically significant effect for suicide attempts but not for "seriously considering suicide". This is a strange finding, as, if we assume the results are accurate, it suggests that suicide attempts increased following the laws without any corresponding increase in suicidal thoughts. (This will be relevant later, so keep it in mind.)

The don't appear to report an actual incidence rate, which is a significant oversight considering the topic.

The substantial reduction in effect size when considering the total number of reported suicide attempts versus the number of people who reported at least one suicide attempt suggests that the attempts are clustered within a small group of participants.

They found no evidence of the introduction or enactment of additional "anti-transgender laws" had any impact of transgender youth suicide. Again, this is inconsistent with their overall conclusions; if it is the legal restrictions that cause an increase in suicide attempts then you would expect an increase in restrictions to also increase attempts. (Although not necessarily in a linear fashion.)

All in all, this study makes claims that are much stronger than the evidence they provide to support them. Other, stronger studies, contradict the assertion that these sorts of laws increase suicide among transgender youth. (Which is, I should stress, a good thing for the transgender community.)

(And I should also note here that my personal opinion on the morality of these laws is specific to each law/law category. I'm purely presenting the empirical research concerning the relationship between these laws and suicide in this post.)

---

The major confounding factor: social contagion of suicide.

It is, at this point, all but settled evidence that "suicidal behavior is 'contagious' in that it can be transmitted, directly or indirectly, from one person to another" [16]. This is extraordinarily important because it impacts the way we (i.e., society) should talk about and depict suicide. For an unrelated example, this review [17] concludes "portrayals of suicide in entertainment media may increase suicides and attempted suicide in the population". A specific example of this was the increase in suicide rates and admissions among youth, following the release of the "13 Reasons Why" television show [18-19].

And this is well-known by LGBT organizations. In 2017, the Movement Advancement Project (a pro-LGBT think tank), the Johnson Family Foundation (a pro-LGBT organization), and the American Foundation for Suicide Prevention co-authored the second edition of the report "Talking About Suicide & LGBT Populations" [20], which was also endorsed by GLSEN, GLAAD, The Trevor Project, the Transgender Law Center, and the Human Rights Campaign (among others).

Recommendations in this report include [emphasis mine]:

DO encourage discussion about suicide prevention strategies.

DO emphasize the vital importance of resilience

DON’T attribute a suicide death to a single factor (such as bullying or discrimination) or say that a specific anti-LGBT law or policy will “cause” suicide.

DON’T risk spreading false information by repeating unsubstantiated rumors or speculation about suicide deaths or why they occurred.

DON’T talk about suicide “epidemics” or suicide rates for LGBT people. (Remember that sexual orientation and gender identity are not recorded at the time of death, so we do not have data on suicide rates or deaths among LGBT people. In addition, presenting suicide as a trend or a widespread occurrence (for example, tallying suicide deaths that occur in proximity to an external event) can encourage vulnerable individuals to see themselves as part of a larger story, which may elevate their suicide risk.)

DON’T use social media or e-blasts to announce news of suicide deaths, speculate about reasons fora suicide death, focus on personal details about the person who died, or describe the means of death.

DON’T idealize those who have died by suicide or create an aura of celebrity around them.

(They also note that suicide rates cannot be determined by looking at suicide attempts, which is relevant to the above study.)

Please take a moment to consider the extent to which public officials, organizations, and figures are completely disregarding these recommendations in reference to the transgender community. Beyond the anecdotal evidence people involved with or aware of the community are exposed to, this English study [21], this Indian study [22], and this American study [23] all find "poor adherence to responsible reporting guidelines" for the transgender (or "LGBTQ+") community.

Further, as I indicated earlier, the English study [2] directly addresses this sort of irresponsible rhetoric. Failure to comply with responsible reporting guidelines is causing direct harm to the transgender community.

And how does this apply to the first study [1]? It adds in an additional confounding factor: the rhetoric surrounding these laws and their impact on suicide in the transgender community. It suggests that at least some of the observed suicide attempts were precipitated by the social contagion of suicide.

This theory would also explain some of the inconsistencies in the study. That is, it is possible that there was already a subsection of suicidal transgender youth, who, once exposed to increasingly this irresponsible social-contagion-inducing rhetoric, reported (more frequent) suicide attempts. This would account for:

The lack of increase in suicidal thoughts (i.e., those effected were already suicidal).

Why the effect size for the "at least one attempt" is so much lower than the "total attempts" effect size (i.e., the reported increase is concentrated within a small group of people)

Why there is no dose-response relationship between the number of laws and suicide attempts (i.e., it is not the laws so much as the rhetoric surrounding them that is having such a negative impact)

---

Conclusion

Ultimately, there is strong evidence from other countries indicating that similar "anti-trans" laws are not associated with suicide rates. The new American study suggesting otherwise is remarkably weak, and may actually be providing evidence for the social contagion theory of suicide.

Most importantly, the current rhetoric surrounding suicide in the trans community is incredibly dangerous and does a great disservice to all transgender people.

(And again, my personal opinion on the morality of these laws is specific to each law/law category. I'm purely presenting the empirical research concerning the relationship between these laws and suicide in this post.)

I hope this helps, Anon!

References under the cut:

Lee, W. Y., Hobbs, J. N., Hobaica, S., DeChants, J. P., Price, M. N., & Nath, R. (2024). State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA. Nature Human Behaviour, 1-11.

Appleby, Louis. “Review of Suicides and Gender Dysphoria at the Tavistock and Portman NHS Foundation Trust: Independent Report.” Department of Health & Social Care, 19 July 2024, https://www.gov.uk/government/publications/review-of-suicides-and-gender-dysphoria-at-the-tavistock-and-portman-nhs-foundation-trust/review-of-suicides-and-gender-dysphoria-at-the-tavistock-and-portman-nhs-foundation-trust-independent-report.

Cass, H. (2024). Independent review of gender identity services for children and young people.

Ruuska, S. M., Tuisku, K., Holttinen, T., & Kaltiala, R. (2024). All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study. BMJ Ment Health, 27(1).

Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PloS one, 6(2), e16885.

Wiepjes, C. M., den Heijer, M., Bremmer, M. A., Nota, N. M., de Blok, C. J., Coumou, B. J., & Steensma, T. D. (2020). Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972–2017). Acta Psychiatrica Scandinavica, 141(6), 486-491.

Final report – FAQs. (n.d.). The Cass Review. https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/

Sedgwick, R., Epstein, S., Dutta, R., & Ougrin, D. (2019). Social media, internet use and suicide attempts in adolescents. Current opinion in psychiatry, 32(6), 534-541.

Madigan, S., Korczak, D. J., Vaillancourt, T., Racine, N., Hopkins, W. G., Pador, P., ... & Neville, R. D. (2023). Comparison of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation before and during the COVID-19 pandemic: a systematic review and meta-analysis. The Lancet Psychiatry, 10(5), 342-351.

Madigan, S., Racine, N., Vaillancourt, T., Korczak, D. J., Hewitt, J. M., Pador, P., ... & Neville, R. D. (2023). Changes in depression and anxiety among children and adolescents from before to during the COVID-19 pandemic: a systematic review and meta-analysis. JAMA pediatrics.

Bridge, J. A., Ruch, D. A., Sheftall, A. H., Hahm, H. C., O’Keefe, V. M., Fontanella, C. A., ... & Horowitz, L. M. (2023). Youth suicide during the first year of the COVID-19 pandemic. Pediatrics, 151(3).

Felfe, C., Saurer, J., Schneider, P., Vornberger, J., Erhart, M., Kaman, A., & Ravens-Sieberer, U. (2023). The youth mental health crisis: Quasi-experimental evidence on the role of school closures. Science Advances, 9(33), eadh4030.

Jones SE, Ethier KA, Hertz M, et al. Mental Health, Suicidality, and Connectedness Among High School Students During the COVID-19 Pandemic — Adolescent Behaviors and Experiences Survey, United States, January–June 2021. MMWR Suppl 2022;71(Suppl-3):16–21. DOI: http://dx.doi.org/10.15585/mmwr.su7103a3.

Kalenkoski, C. M., & Pabilonia, S. W. (2024). Teen social interactions and well-being during the COVID-19 pandemic. Review of Economics of the Household, 1-48.

Adegboye, D., Williams, F., Collishaw, S., Shelton, K., Langley, K., Hobson, C., ... & van Goozen, S. (2021). Understanding why the COVID‐19 pandemic‐related lockdown increases mental health difficulties in vulnerable young children. JCPP advances, 1(1), e12005.

Forum on Global Violence Prevention; Board on Global Health; Institute of Medicine; National Research Council. Contagion of Violence: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Feb 6. II.4, THE CONTAGION OF SUICIDAL BEHAVIOR. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207262/

Niederkrotenthaler, T., Kirchner, S., Till, B., Sinyor, M., Tran, U. S., Pirkis, J., & Spittal, M. J. (2021). Systematic review and meta-analyses of suicidal outcomes following fictional portrayals of suicide and suicide attempt in entertainment media. EClinicalMedicine, 36.

Cooper Jr, M. T., Bard, D., Wallace, R., Gillaspy, S., & Deleon, S. (2018). Suicide attempt admissions from a single children's hospital before and after the introduction of Netflix series 13 Reasons Why. Journal of Adolescent Health, 63(6), 688-693.

Bridge, J. A., Greenhouse, J. B., Ruch, D., Stevens, J., Ackerman, J., Sheftall, A. H., ... & Campo, J. V. (2020). Association between the release of Netflix’s 13 Reasons Why and suicide rates in the United States: An interrupted time series analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 59(2), 236-243.

Movement Advancement Project, Johnson Family Foundation, and American Foundation for Suicide Prevention. August 2017. "Talking About Suicide & LGBT Populations." 2nd edition. MAP's Talking About LGBT Issues Series. https://www.lgbtmap.org/talking-about-suicide-and-lgbt-populations

Bolzern, J. E., Mnyama, N. L., & McMillan, D. (2019). Responsible journalism, imitative suicide, and transgender populations: A systematic review of UK newspapers. Journal of gay & lesbian mental health, 23(3), 276-288.

Kar, S. K., Menon, V., Mukherjee, S., Bascarane, S., Sharma, G., Pattnaik, J. I., ... & Agarwal, V. (2023). Suicide reporting of LGBTQI+ population in India: An analysis of online media reports of the past decade. Journal of Public Health, 45(1), e95-e103.

Kirchner, S., Till, B., Laido, Z., & Niederkrotenthaler, T. (2024). Suicide-related media reporting with a focus on sexual and gender minority identities: A content analysis of the quality of reporting. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 45(5), 339–347. https://doi.org/10.1027/0227-5910/a000956

[tzifron]

“It feels like shit. It feels like community care is not a thing. The world is so self-centered right now. If something doesn’t immediately affect you personally, then it’s not something to be concerned about,” she said. “I live with severe PTSD. I already lost a child. I’m not willing to lose another child.”  

Hannah Neely, 42, lives in Minneapolis with her husband and two children, ages 10 and 12. She had cancer of the immune system, and between the disease and treatment, her immune system was severely weakened. Before, Neely was a teacher, but she is now too disabled to work. Her husband is a software engineer, although he was recently laid off. 

Neely, her husband and her children wear masks. They do not socialize or eat indoors at restaurants. For a while, her children took classes online through the public school system, but eventually she sent them back to school masked. 

“We go to the store, we go to doctor’s appointments, we go to our kids’ school, but that’s kind of it. And we mask everywhere,” Neely told The 19th. 

In a strange way, Neely feels “lucky” to be a cancer survivor, because it means she doesn’t need to justify her concern about COVID to others. Most people she interacts with do not think she is being unreasonable. 

“I am disabled in a way that is invisible, but sympathetic. I haven’t faced the medical gaslighting people with [chronic fatigue syndrome] have faced. … No medical professionals have ever told me I’m overreacting,” she said. 

Some family and friends have engaged in a sort of wishful thinking. 

“People sometimes say, ‘It’ll be fine. Hannah, I’m sure you’ll be fine. You can’t actually say that with any certainty,” Neely said.

[zyxwl2015]

Excerpts from Lando Norris biography - part III

(There aren't too many behind-the-scenes stories anymore — mostly stating things everyone knows, F1 was postponed due to Covid, online racing happened, F1 resumed, Lando did this in this race, Lando had a new teammate, Lando moved to Monaco, etc etc)

Every one was extremely happy for Lando after his first podium at Austria 2020, including Trevor Carlin: "He is doing everything right and the results are coming and I am very proud of him" and "Lando is the nicest person you could ever meet"

Charlotte recalled in Eifel GP 2020, the marketing team's office was right next to the drivers' room and the walls were paper-thin, and —

We were working in the marketing office and we could hear this giggling from the drivers’ room next door… I went into their drivers’ room to speak to them and they were both lying on the massage bed watching YouTube or Instagram videos together. We all started pissing ourselves laughing at first, but I then said to them, “What the fuck are you doing? Why aren’t you in the garage? Everyone is looking for you!” I was like an ogre telling them off all the time. But that was the point where I and some others in the team realised that they actually enjoyed spending time together.

(Oh my Carlando heart 🥰)

Going into the 2021 season, he started to become more strict with certain things, especially diet and training: he stopped eating pizza, started to do more training and running (even though he "still hates it with a massive passion"), etc, to step up his performance. By summer break there's a noticeable change physically from when he first entered F1

Charlotte on Lando at that point:

When Carlos left, I think Lando got a bit nervous again, because he was a bit like, “Well, this guy’s obviously won seven races. He’s a known quantity, and he’s got a really good reputation.” I felt like Lando’s confidence had grown so much over the two years he had with Carlos. When Carlos left and we signed Daniel, Lando was a bit like, “I’ve really got to step up.” That was when I noticed that Mark, his manager, and Jon, his trainer, were building a positive environment by explaining that Norris had all the tools and experience and should not be putting pressure on himself… I used to call him kiddo, in fact I still do, but that was the time when I thought this guy actually could be really good and it will be really interesting to see the comparison. Some thought Dan would just come in and absolutely smash him, but he didn’t. You could certainly see a change in Lando, just the way he carried himself, the way he spoke, his whole demeanour. He was just so much more confident in himself while being self-deprecating.

(I love Charlotte 🥹)

Charlotte on Lando and Daniel's relationship:

At first, they were both definitely trying to suss each other out. We never thought they would not get on, but they just didn’t spend any time together… There was never any animosity between them, it was just they didn’t hang out. Andreas Seidl would have a meeting with both drivers before the race every Sunday. It’s called a “pre-race objectives meeting” and he would basically lay the law down and tell both drivers they are in it together. You drive for the team, no driver is better than the other, no one gets preferential treatment, you do what’s best for the team result, that kind of thing… Both drivers were team players and we needed that because we knew we were struggling and that Ferrari would be back up there again. Both of them then started spending more time together in engineering meetings and worked really hard on it. I can’t fault either of them. Both their work ethics are just unbelievable … but they started to work together quite a lot and from then, their relationship started to change and they started to get on really well.

McLaren keeps the Monaco 2021 trophy (as always), so Lando keeps the presentation box "because it is the coolest thing, a bespoke Louis Vuitton number" (😂)

Charlotte on Lando's relationship with McLaren team members:

He had worked with the boys for a long time by now, but he knew everyone, not just them by name, but their girlfriends, their wives, their kids, their families, their situation. He’d take the team out bowling or for dinner. I think he really understood the value of trying to galvanise people around him and that made him part of the furniture.

After the accident when he got mugged at Wembley Stadium, Charlotte messaged him saying she's so sorry. The whole McLaren team was being very supportive as well. When Lando went to the factory, he was really subdued, "he was worried because he thought he was going to be in trouble because of the watch getting stolen." Ofc Charlotte gave him a big hug

Charlotte described how different the mood was post Monza vs post Russia, especially during the last few laps, "It felt like the slowest time of my entire life, like watching a slow train crash."

[rumour] Ben Hunt says according to rumours, the contract he signed in mid-2021 (just before Monaco GP) was worth £6m a year, the one he signed beginning of 2022 (current one) was £50m for 4 years

[The End]

[deepdive002]

You have a very wholesome energy on this blog.

Very proud of your resilience, I have multiple family members who struggle with bipolar disorder including my brother and he has unfortunately become very estranged, in and out of jail, difficult to be around if not harmful at times and refuses to seek help or medicate despite all the help and rehab over the years. Sometimes it feels very hopeless and sad, especially the fear that I might have those symptoms too one day, but I am grateful and soothed that there are stories of hope and healing and positivity like yours.

Wishing the best for you and your daughter! 💗

Thanks! 🩷

My bipolar has put me in the hospital 10 times. For better or worse I seem to only get manic episodes. This is tricky because being manic actually feels great. The problem is that you don't get anything done.

Untreated mania would have made getting through college or holding down a job relatively impossible. (It's still very hard, even with treatment.)

The key for me was finding help I liked and respected early in my life.

Drawing the line between where I stop and my insanity starts was a very personal question. I believe an objective scientific definition is best, but the answer may be different for others.

When I talk about my illness, I include a personal request: I ask that if people think I'm acting strangely to go online and look up the latest criteria for a Bipolar I Disorder Manic Episode in the DSM.

(As of the DSM-5, there are 7 symptoms and having 3 or 4 for a week is the threshold for a manic episode.)

If I need help, get me help but otherwise: I need to be allowed to get excited about my life without my friends and family worrying "Oh no! It's happening again."

Resources ☎️

I've been seeing my therapist for about 20 years now.

If you are interested you can probably find him by Googling "Harold L. Boerlin MD, Irvine CA". He's been doing phone visits since COVID.

He may be able to help you even if you don't live in California, if you are willing to fly out for some initial consultations. I actually have no idea how that would work but I can't recommend him enough.

Dr. B is both a psychologist and a psychiatrist. (He has a medical degree from Harvard.)

Letting someone change you fundamentally with medication is a big ask. However had I not decided this is what I want all those years ago, I would probably be homeless and perhaps have very strained relationships with friends and family today. (My family is also amazing by the way.)

Political Advocacy 🇺🇸📢

In my opinion, the mental health care system in the US is on the brink of collapse.

Too many professionals are not trained in hard science and some are handing out diagnosis like candy.

Recent "Mandated Reporter" laws are vague, ineffective and shatter the essential sacred trust between a client and a therapist.

Mental health parity laws for insurance companies do not work and I strongly advocate for MH to be a seperate insurance the way dental and vision are (with well-funded public assistance programs.)

While in the hospital I've seen human beings get "processed" and it is horrific.

I am in awe of the limitless compassion of most whitecoats (my name for them). However, publicly available resources are often not as unlimited.

Sick patients come in on a 5150 for a 3-day hold, yelling and hitting people. They get some food and shelter for a bit but refuse further help.

Then sometimes doctors fall short. They give up and just give the patient a heavy sedative so they will stop yelling and hitting people.

Then the patient doesn't voluntarily extend to 14 day treatment. They get tossed out on the street like garbage and the cycle repeats.

[covid-safer-hotties]

Might be a resource for some of y'all

RTHM Direct is your connection to the latest promising treatments for Long COVID, ME/CFS, POTS and MCAS, right from home. Currently available in: California, Colorado, Florida, Illinois, Maryland, Massachusetts, New York, North Carolina, Ohio, Oregon, Texas, Virginia, Washington. More states to come.

[wildpeachfarm]

the new thing with covid teens, especially on twitter, is you have to assign everything a label. you can’t just be uncomfortable with something happening, it has to be assault. you’re not responsible for your own comfort, that’s someone else’s job (which has been furthered by trigger warnings, not saying those are a bad thing though). if someone doesn’t read something correctly, then they’re automatically an evil malicious person that sought to harm someone. unless they’re queer, neurodivergent, a woman, or a minor (under the age of 21, of course), in which case they are NEVER at fault

oh I 100% agree and caiti was online for 2+ years of her high school and lost a lot of socialization herself which likely contributed to her poor treatment and mislabeling of the whole situation.

And then in addition, the younger group on twitter that also experienced lockdown in their formative years and was chronically on tiktok jumped onto her claims and the use of inflammatory words and it just made the whole thing explode.

I forget if I said this here or on twitter, but the people who were super extreme in their treatment of this situation and ignored the nuance of human interactions were typically the people who never went to college, did highschool from home, and don't go to college/house parties. And so they literally have no framework for how these situations play out in a normal setting and how it can be a pretty easy misunderstanding or a conclusions drawn incorrectly that can simply be apologized for and people move on.

In my experience, the moots who immediately dropped george and called him a SAer and a predator were the ones who finished off their highschool during covid and didn't go to college and didn't party or drink- so they just took caitis words at face value with no prior knowledge of party environments.