bcl05

Read this thread. It’s not long.

https://www.washingtonpost.com/sports/2022/09/16/stephen-strasburg-injury-recovery/ Such a sad article. He'll always be a hero for 2019, but also one of the biggest "what might have been..." Really feel sorry for him.

If the documents are unclassified (which they clearly are not, but this is the argument from the MAGA idiots), then they are publicly available via FOIA, right?

I don't think that trans people would consider gender-affirming care "elective" or "cosmetic." There is extremely clear evidence of the significant burdens of untreated gender dysphoria, including an extremely scary suicide rate. These symptoms, including depression and suicidality, are dramatically improved with gender-affirming care. Some would (convincingly, to me), consider this medical care life-saving. Comparing it with tattoos and piercing seems callous and ignores the experiences of trans people.

There are a lot of different ways that these things get established, hard to have a sweeping generalization. Sometimes, there are randomized controlled trials in children that really establish with good scientific rigor the best practices, even if a medication remains "off label." Sometimes the disease process in children is similar enough to adults that we can just use more size/age based dosing for the same indications as in adults. Sometimes, the pathophysiology/mechanism of disease is very different and we need to make bigger jumps in reasoning. Often there may be practice guidelines, case reports, clinical trials, etc, that can establish best practices that are really a separate process from FDA labeling and approval. Sometimes we are very sure that the medications we use are the right ones, and sometimes we are just making our best, most educated guess. Regarding hormone blockers, the idea of waiting til after puberty and some marker of adulthood would be, in my view, a huge disservice to these patients. The entire point of these treatments is to conform their external bodies to their view of their gender. The simplest and least damaging way of doing that, in my view, is to block puberty from happening in a discordant way from their identified gender in the first place. The alternative is doing bigger and more dangerous and more painful and less effective surgeries after discordant puberty, not to mention the psychologic/psychiatric toll of going through a discordant puberty. The American association of pediatrics and American psychiatric association have both been very clear that we think this the way of doing the least harm for these patients and giving them the best chance at doing well as adults. It certainly won't be the best option for everyone, and being trans is going to be challenging regardless of how we treat, but every expert I know who cares for these patients feels passionately that we need to be doing more for them as children and adolescents, not less. I don't personally see many trans patients, but I'm close friends with some MDs who do, and they all feel very strongly about it.

The idea that since the use of puberty blockers for trans minors is "off label" and therefore outside the mainstream or "experimental" is absolutely wrong. Many, many medications were not formally tested in children, because Pharma companies don't want to study kids (for many reasons - it is more complex from a norms/variables standpoint, the dosing changes by age/size are more complex, the consent issues are more complex, etc), so the FDA applications are very commonly for ages 18+. I prescribe many medications to children that are technically "off label" but are standard of care and have been for many years.

I'm halfway through Kim Stanley Robinson's Ministry for the Future. I can hardly put it down. The first chapter is one of the most harrowing things I've read in a long time. Really interesting, and highly recommended.

Put this in the MLB thread, but it really belongs here: Been reading and watching Vin Scully stuff all morning. This one is incredible. This is the transcript of his call of the 9th inning of Koufax's no hitter. Some of the most evocative and brilliant sports writing you'll ever see, and he just did it on the fly, off the top of his head. The man was a true artist and genius with words. https://www.salon.com/1999/10/12/scully_koufax/

Been reading and watching Vin Scully stuff all morning. This one is incredible. This is the transcript of his call of the 9th inning of Koufax's no hitter. Some of the most evocative and brilliant sports writing you'll ever see, and he just did it on the fly, off the top of his head. The man was a true artist and genius with words. https://www.salon.com/1999/10/12/scully_koufax/

I don't think so much that the Lerner's are cheap, but their timing on the sale couldn't be worse. Of course Soto wouldn't sign with a team long-term, not knowing who the ownership is. They're also weird, doing all these deferred and oddly-structured contracts. The bottom line is that they have let some incredibly talented and likeable players leave, and now we are the worst team in baseball. 2019 was a magical joyride, but it sure feels like a long time ago now.

The only good thing about today is that they tore the band-aid off fast and got it done early. Now I can turn off twitter and wallow in misery for the rest of the day undisturbed.

Albies at 7/35, Acuna at 8/100, both signed before they broke out. Olsen at 8/168 and Riley at 10/212 both underpaid too. I hate them so much.

Acuna, Riley, Albees, and Olson for the foreseeable future for TOTAL of 55mil/yr. Damn the barves. And launch Boras into sun.

I can’t recommend this article enough. Fair warning, it’s harrowing. https://www.theatlantic.com/ideas/archive/2022/08/pregnancy-birth-complication-abortion-life-of-mother/671006/

This is both evil and stupid. They don't even define "biological sex" (which doesn't have a simple definition).

Corbin today: 0.2 7 6 6 1 0. Amazing how bad he's been.

This might be the greatest political evisceration I’ve ever seen

This country, most especially the gun advocacy crowd, has conflated emergency response with public safety. Instead of preventing tragedy by removing dangerous weapons, we need more weapons out there to respond when tragedy "inevitably" comes. It's stupid, backwards, and killing people.

I hate this so much. I put about 80% of the blame on Boras, but the Lerners have some role here too. Terrible time to be selling the team and adding that much uncertainty. The best way to approach this would be just ask Soto what he wants and give him everything. There is basically no feasible contract that would not be worth getting this guy locked up for the next 10+ years.

This Banda case highlights the complexity of this debate and the efforts to ban trans athletes, or even to define "women". While sex/gender is straightforward for many people, there are lots of folks who do not simply fit in easy to define categories. (full disclosure, I'm a geneticist, and see patients with complex genetic disorders, including disorders of sex differentiation/DSDs all the time). Most, but not all, women have 46 chromosomes, including 2 X chromosomes and no Y chromosomes. Most, but not all, men have 46 chromosomes including one X chromosome and one Y chromosome. There are women with Y chromosomes and testes who may not even know it. The most common cause of this that I see (though certainly not the only thing) is CAIS, complete androgen insensitivity syndrome, which is the result of a genetic variant leading to lack of response to testosterone. With this condition, the external genitalia/appearance are completely "female" in appearance, so these girls are assigned "female" at birth. They typically don't have internal uterus/fallopian tube/ovaries, and have testes. Their testosterone levels are sky high, though their body is not masculinized (since they don't respond to testosterone). Typically, these girls are diagnosed as teenagers when they don't have typical puberty/menses. Girls and women with this are otherwise entirely healthy and normal. Most often, these patients feel like girls and have no ambiguity in their gender identity. I suspect just about everyone has met folks with this and not known it. What sports leagues do they belong in? There are lots of 46XX, anatomically typical women with genetic variants in some of the enzymes that produce steroid hormones that lead to greater than normal amounts of testosterone (most common cause is called congenital adrenal hyperplasia/CAH, but there are others). These women are generally healthy, though they can have some issues with infertility. They typically have greater muscle mass than other women and may have other stereotypically masculine features/bone structure/etc. They are over-represented at the highest levels of women's sports. What leagues do they belong in? I saw a patient recently who had mosaicism, with some of their cells having XY and some with no Y chromosome. Genital exam was mostly phenotypically male, but gonad biopsy has mixed ovarian and testicular features. When this kid grows up, what sports league do they belong in? I could go on and on and on about different examples of patients of mine that blur the lines between the reductive male/female dichotomy. Biology is just way more complicated than people realize. The whole idea that simply splitting athletes into "male" and "female" will make everything fair and even doesn't really reflect reality. First, while male/female is simple for many people, that isn't true for everyone. Also, there are tons of biological factors that give advantages or disadvantages to certain athletes, why is gender/sex different? I am very glad there are women's/girl's sports. I want as many people to have the experience of teamwork and the joys of competition as possible. I don't see an easy way to categorically define women or men that accounts for all the variables. It seems the easiest thing to do is allow people to compete where they identify. i think about these biological categories all the time, and there are really no simple answers. I default to kindness and inclusion wherever possible.

There is a little salty language at the end, but this is hilarious and heartbreaking at the same time. Worth a watch.

The crazies on the court weren't satisfied with just being a dire threat to women's lives, now they are a danger to the whole damn planet.