Process
Status Items Output None Questions None Claims None Highlights Done See section below
Highlights
id758084591
like much of medical care for people of all ages, it involves an uneasy encounter between science, medicine and the subjective experience of the patient.
✏️ The elusive tension that exists when we talk about medical stuff. We have been conditioned to think of it as science, but so much of it is subjective to the experience of the persons involved (doctor and patient). 🔗 View Highlight
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science is not an instruction manual for medicine. It describes and explains the natural world — it does not tell us what to do about what we find.
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A physician tries to figure out what is going on by examining and listening to the patient, applying scientific knowledge and exercising judgment using the broad world of what we think of as objective knowledge that might explain and offer a guide for how to treat the complaint.
id758084720
most complaints involve an unavoidable subjectivity. Only the person experiencing pain can tell you how severe it is. The same goes for fatigue or malaise, which could result from so many different ailments. Doctors may ask you to rate your pain or fatigue on a scale in an attempt to quantify and therefore render it more objective, but it is still up to you, the patient, to choose where you are on the scale.
id758084723
research has shown that gender often plays a role here, too: Women’s pain has historically been more readily dismissed by physicians.
✏️ A moment of powerful subjectivity that is played off as objective science and medicine. 🔗 View Highlight
id758084793
For years, doctors belittled the suffering of people, especially women, with unexplained pain, fatigue or brain fog. Illnesses like myalgic encephalomyelitis, also known as chronic fatigue syndrome, were dismissed as psychological phantoms. This has continued into the present.
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the realm of the psychological, the subjective evidence — the patient’s account of their interior life — is almost always all the clinician has to go on.
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“It is not easy to deal scientifically with feelings,” Sigmund Freud
👓 quote 🔗 View Highlight
id758085343
did sex reassignment make them more like the kind of citizens society valued most? His unequivocal conclusion was no. “Sex reassignment surgery confers no objective advantage in terms of social rehabilitation, although it remains subjectively satisfying to those who have rigorously pursued a trial period and who have undergone it,
✏️ A researcher Jon Mayer makes a paper that basically kills this field. Purely on the idea that gender reassignment failed to make people objectively fit in, even though they subjectively were happier. 🔗 View Highlight
id758087837
no universally agreed upon definition of what constitutes a good life. How can we expect medical science to deliver answers to such profound, mysterious and fundamentally subjective questions?
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“Like Meyer, Cass is searching for some outcome that would satisfy her beliefs about what successful treatment means.”
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“Pediatric care would all but cease if physicians denied treatments for which the evidence base is imperfect,” a group of scholars and clinicians, including two Yale professors, wrote in a critical analysis of the Cass report.
id758089344
Cass’s report insists that all lives — trans lives, cis lives, nonbinary lives — have equal value, taken in full it seems to have a clear, paramount goal: making living life in the sex you are assigned at birth as attractive and likely as possible. Whether Cass wants to acknowledge it or not, that is a value judgment: It is better to learn to live with your assigned sex than try to change it. If this is what Cass personally believes is right, fair enough. It can charitably be called a cultural, political or religious belief. But it is not a medical or scientific judgment.
id758090357
Cass’s report is a blueprint for how activists can successfully use the imprimatur of science to dispute all manner of health care they do not like. How different is this report from the accounts of activists who claim, contrary to a large body of evidence, that the abortion medication mifepristone is unsafe, or that women are psychologically harmed by abortion?
id758090796
political and legal challenges based on the work of doctors and researchers with no expertise in the field who feel emboldened to weigh the safety of longstanding treatments and demand objective proof of their benefit. Imagine a urologist with no experience in women’s reproductive health being asked to evaluate the safety, benefits and efficacy of birth control, and you get the idea of how unusual the Cass report is.
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Imagine that your health care required objective justification, if access to birth control or erectile dysfunction medications required proving that you were having monogamous sex, or good sex, or sex at all.
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if fertility care was provided only if you could prove that becoming a parent would make you happy, or you would be a good parent.