Meloni is not just a conservative, she is from the far right. And south Italy is not just a nice place to live, that’s where I come from and it’s not a place I would recomand for women to live in. I am a radical feminist, I fight against trans activism as much as you do. But please, it’s not a fairy tale for women first, and for southerners as well : less job, les money, more poverty and more Mafia… Young people here are still leaving to go north or to go live abroad because of unemployment. We deserve to be treated well by foreigners and fellows feminists please.
Thanks for this comment. I have been wondering how the election of Geert Wilders in the NL, Meloni in Italy, the success of Chega in Portugal etc. is going to affect women's rights (unrelated to trans stuff) in these countries. More EU countries will follow them soon, and the European Parliament elections will also be a right wing washout. I know that Meloni is making it hard for lesbians to be parents... are there other examples of what else she will do to reverse the rights of women and girls? Would love to have a conversation about it if you're up for it.
I'm starting a new comment here because this is a different topic and the other one got long. I was struck by the part of the discussion where you discussed who the activists were in Italy, and it was said that the doctors actually were the activists as opposed to outside activists converting doctors. My impression is somewhat different, just from listening to your story. It seems that these doctors are certainly, shall we say, engaged in a niche practice. But, it also sounds like they weren't terribly public about promoting themselves and their efforts since they weren't well known... Except to parents. It sounds to me like the parents are the activists here. If they weren't seeking doctors to prescribe for their kids, the doctors wouldn't be doing this work. It sounds to me like a case where a couple doctors saw a small but passionate "market" for a particular type of practice and decided to provide it, and that the parents and teens were already determined to find such a practice. Sort of like how illegal drugs always seem to be dealt everywhere, at least in the US. Not because anyone is actively promoting them, but more because a customer determined to get something seeks out someone who wants to provide it.
This sounds very plausible. I was thinking about how it contrasts with the UK and Irish versions, which I'm more familiar with: organised and monied NGO groups descend on places like hospitals with boxes full of rainbow lanyards and expensive diversity training packages for staff... very top down. In countries that don't have that, it could be a radicalised staff member - or indeed as you say, "the client" finds a professional who is willing to give them what they want. This could very much be there case in this Italian story. I am in a bunch of Facebook groups where the mothers share the names of the doctors that say "yes". These parents are keeping said doctors in business.
This is interesting to listen to as a health care worker from the US, because our system works very differently. Here, many drugs are routinely prescribed "off-label," which here means a drug that is approved by our FDA for use, but not in the population or for the indication in which it's prescribed. There is nothing illegal about it and in fact most drugs are only approved for one or maybe a few indications but are often used for many more. It's particularly common in pediatrics because it's relatively uncommon for drugs of any kind to be studied in children before approval. After approval for one indication, it's rare for drug companies to go through the difficulty and spend the money to obtain additional approvals because the drug can be used without them. In fact, most drugs prescribed for children here are not approved for use in children at all. If that makes sense. I hadn't realized that "off-label" meant something different in countries with nationalized health systems.
Overall I'm getting the impression that doctors here have much more latitude than they have in national health systems and that therefore a privatized system has far fewer safeguards, although arguably some advancements in medicine are made by doctors who try different regimens with their patients, have success and spread the word through case studies. The differences between systems are fascinating to me to learn about.
I also hadn't realized that it was such a scandal in some other Western countries for kids-or anyone-to be prescribed blockers or hormones without therapy. Here, that's a very controversial subject, but it's extremely uncommon for any medications to be regulated to the extent that anything like that could or would be restricted like that. In fact off hand the only drug I can think of for which therapy is required by the government is methadone when used for drug addicts. While certain hospitals or programs or clinics for various conditions may have their own requirements, patients are free to just go elsewhere.
I think the point is more that in the UK at least, the presumption would be that there has to be evidence for the benefits of the use of medication. With this field, the bar for evidence was dropped.
Understood. My point was that it is not that way in the US at all, and I found it very interesting to learn more about that aspect of other health systems. I personally would like to see the US move more in the direction of an NHS-style system, in general. Although, it seems, and perhaps I'm wrong, that in the private system in the UK there is not the same standard? Meaning, the regulations are set more by the NHS as a body than by the government for all doctors? So anyone who wants to do something different or off-label could simply work outside the NHS in order to have fewer regulations to answer to? Again, that's my impression and may be wrong.
I'm just really interested in contrasting different health systems, and on the implications of those differences for what has become a worldwide effort to regulate this area of medicine.
I think in countries with "socialised medicine", the state plays a bigger part in regulating prescribing because they are (or rather, we are) the ones reimbursing the costs of insured medicine. So for cost-saving reasons as well as anything else, the state will want to make sure doctors aren't handing out meds without good and financially sound reasons. I am a bit famililar with the issue of drug testing in kids - the same applies to pregnant and breastfeeding mothers: because of the ethical minefield involved and in the case of kids, the difficulty in obtaining informed consent, means that most drugs, as you say, have never been tested in these populations. Dosage is guesswork., often based on weight. It's a problem that hasn't found a good solution yet.
Gender GP can still prescribe puberty blockers to British kids because they are a private company based outside of the UK. The meds are not reimbursed at all, they are operating 100% off-grid. I think once you go outside the public system, all bets are off. Agata in the recording seems to have said that there is a protocol for prescribing PBs to kids in Italy, and I assume this means that even thought their use is only approved for eg precocious puberty, they can be prescribed for off-label/other uses as long as it can be justified. I think that's why there is an investigation. To be seen....
Thank you! I agree about the research issues with certain populations. My personal preferred solution would be to simply start gathering data on medications as they're being prescribed to kids, pregnant women etc. It wouldn't involve anyone getting anything they wouldn't already be getting off label. It's not a double-blind controlled study, but it's at least a start. Probably would be easier to get off the ground in a country with a socialized system, as they would have easier access to data on the majority of the population.
Even here in the US, the government is almost always the most common payer in general. This is true of hospital care, in pediatrics generally, and in psychiatry to name a few. Medicare, which covers the elderly and permanently disabled, and Medicaid, which covers low-income children, pregnant women and families in all states and low-income adults in the majority of states, generally pay for a majority and certainly a plurality of care provided in each category, although certainly in outpatient care there are many individual providers that don't accept Medicaid in particular as payment. They certainly have control of a large enough share of the market that they could influence it substantially if they chose to do so. Yet, for whatever reason, our government has largely chosen to stay relatively hands-off in creating regulations that treatment must be proven effective. In cases where they have created certain criteria to pay for certain things, it often does become industry standard just because they control such a large share of the market, but all the examples of this that I can think of are clearly aimed primarily at controlling access to expensive forms of care, as opposed to ensuring patient safety. Which is, to me, a missed opportunity, and quite sad.
This is (one reason) why I sort of cringe internally when I see stories about countries with a socialized system trying to expand the private health care market. Yes, in some cases it might start out looking nicer, but generally speaking when you allow for-profit health care to proliferate, the primary focus of the system becomes profit for the providers and even for the payers. Our private health insurance companies are publicly traded on the stock market and generally do quite well compared to other companies in other industries, meaning they are making people's premiums as expensive as they can while finding ways to pay as little for care as possible. To me, that's pretty disgusting for companies that supposedly exist to make sure people can access health care, and that most people have to rely on completely for such access. Patient safety generally trails far behind the money motive. I certainly recognize the budget issues in socialized systems, but at least-it seems to me-the theoretical purpose of the system is in fact to provide care, as opposed to making money for everyone involved except the patient, who ends up becoming a pawn in the profit game. My impression is that, while the Dutch protocol obviously originated in Europe, that research study was actually quite small and they did in fact have pretty strict criteria for the participants to be placed on the medical pathway. Then, we Americans got hold of the idea, and it started proliferating in our Wild West healthcare arena where safety controls are much more lax. And then we exported that bastardized version back to Europe. Just another gift from America to the world, that ends up looking a lot like a raised middle finger. But I do wonder, if Americans hadn't gotten wind of this when we did, and the Dutch protocol had been implemented first in European systems with better safety controls, if the "standard of care" would look different than it does today.
And yet again I've written a whole novel, so I'm going to start a new comment to ask a simple question: you mentioned Gender GP in your reply, as being outside the controls of the government due to being Incorporated outside the country. My understanding is that there are other private providers of all types of health care that are incorporated within the UK. Do gender-affirming private providers exist that are in fact incorporated and located in the UK, and if so, are the going to be subject to the "new" policy? (Side note here, my understanding is that this is sort of new-old news because it was originally planned a couple? years ago, but is just now actually being implemented.) In other words, does the UK government have ANY regulatory authority to require private providers within the country to adhere to safety protocols, despite the government not paying for the care? I imagine there surely must be some sort of control, like requiring that the doctors be properly licensed and so on. Is that incorrect?
Thank you again for allowing me to pick your brain, and providing some cross-cultural education.
Meloni is not just a conservative, she is from the far right. And south Italy is not just a nice place to live, that’s where I come from and it’s not a place I would recomand for women to live in. I am a radical feminist, I fight against trans activism as much as you do. But please, it’s not a fairy tale for women first, and for southerners as well : less job, les money, more poverty and more Mafia… Young people here are still leaving to go north or to go live abroad because of unemployment. We deserve to be treated well by foreigners and fellows feminists please.
Thanks for this comment. I have been wondering how the election of Geert Wilders in the NL, Meloni in Italy, the success of Chega in Portugal etc. is going to affect women's rights (unrelated to trans stuff) in these countries. More EU countries will follow them soon, and the European Parliament elections will also be a right wing washout. I know that Meloni is making it hard for lesbians to be parents... are there other examples of what else she will do to reverse the rights of women and girls? Would love to have a conversation about it if you're up for it.
I'm starting a new comment here because this is a different topic and the other one got long. I was struck by the part of the discussion where you discussed who the activists were in Italy, and it was said that the doctors actually were the activists as opposed to outside activists converting doctors. My impression is somewhat different, just from listening to your story. It seems that these doctors are certainly, shall we say, engaged in a niche practice. But, it also sounds like they weren't terribly public about promoting themselves and their efforts since they weren't well known... Except to parents. It sounds to me like the parents are the activists here. If they weren't seeking doctors to prescribe for their kids, the doctors wouldn't be doing this work. It sounds to me like a case where a couple doctors saw a small but passionate "market" for a particular type of practice and decided to provide it, and that the parents and teens were already determined to find such a practice. Sort of like how illegal drugs always seem to be dealt everywhere, at least in the US. Not because anyone is actively promoting them, but more because a customer determined to get something seeks out someone who wants to provide it.
This sounds very plausible. I was thinking about how it contrasts with the UK and Irish versions, which I'm more familiar with: organised and monied NGO groups descend on places like hospitals with boxes full of rainbow lanyards and expensive diversity training packages for staff... very top down. In countries that don't have that, it could be a radicalised staff member - or indeed as you say, "the client" finds a professional who is willing to give them what they want. This could very much be there case in this Italian story. I am in a bunch of Facebook groups where the mothers share the names of the doctors that say "yes". These parents are keeping said doctors in business.
This is interesting to listen to as a health care worker from the US, because our system works very differently. Here, many drugs are routinely prescribed "off-label," which here means a drug that is approved by our FDA for use, but not in the population or for the indication in which it's prescribed. There is nothing illegal about it and in fact most drugs are only approved for one or maybe a few indications but are often used for many more. It's particularly common in pediatrics because it's relatively uncommon for drugs of any kind to be studied in children before approval. After approval for one indication, it's rare for drug companies to go through the difficulty and spend the money to obtain additional approvals because the drug can be used without them. In fact, most drugs prescribed for children here are not approved for use in children at all. If that makes sense. I hadn't realized that "off-label" meant something different in countries with nationalized health systems.
Overall I'm getting the impression that doctors here have much more latitude than they have in national health systems and that therefore a privatized system has far fewer safeguards, although arguably some advancements in medicine are made by doctors who try different regimens with their patients, have success and spread the word through case studies. The differences between systems are fascinating to me to learn about.
I also hadn't realized that it was such a scandal in some other Western countries for kids-or anyone-to be prescribed blockers or hormones without therapy. Here, that's a very controversial subject, but it's extremely uncommon for any medications to be regulated to the extent that anything like that could or would be restricted like that. In fact off hand the only drug I can think of for which therapy is required by the government is methadone when used for drug addicts. While certain hospitals or programs or clinics for various conditions may have their own requirements, patients are free to just go elsewhere.
I think the point is more that in the UK at least, the presumption would be that there has to be evidence for the benefits of the use of medication. With this field, the bar for evidence was dropped.
Understood. My point was that it is not that way in the US at all, and I found it very interesting to learn more about that aspect of other health systems. I personally would like to see the US move more in the direction of an NHS-style system, in general. Although, it seems, and perhaps I'm wrong, that in the private system in the UK there is not the same standard? Meaning, the regulations are set more by the NHS as a body than by the government for all doctors? So anyone who wants to do something different or off-label could simply work outside the NHS in order to have fewer regulations to answer to? Again, that's my impression and may be wrong.
I'm just really interested in contrasting different health systems, and on the implications of those differences for what has become a worldwide effort to regulate this area of medicine.
I think in countries with "socialised medicine", the state plays a bigger part in regulating prescribing because they are (or rather, we are) the ones reimbursing the costs of insured medicine. So for cost-saving reasons as well as anything else, the state will want to make sure doctors aren't handing out meds without good and financially sound reasons. I am a bit famililar with the issue of drug testing in kids - the same applies to pregnant and breastfeeding mothers: because of the ethical minefield involved and in the case of kids, the difficulty in obtaining informed consent, means that most drugs, as you say, have never been tested in these populations. Dosage is guesswork., often based on weight. It's a problem that hasn't found a good solution yet.
Gender GP can still prescribe puberty blockers to British kids because they are a private company based outside of the UK. The meds are not reimbursed at all, they are operating 100% off-grid. I think once you go outside the public system, all bets are off. Agata in the recording seems to have said that there is a protocol for prescribing PBs to kids in Italy, and I assume this means that even thought their use is only approved for eg precocious puberty, they can be prescribed for off-label/other uses as long as it can be justified. I think that's why there is an investigation. To be seen....
Thank you! I agree about the research issues with certain populations. My personal preferred solution would be to simply start gathering data on medications as they're being prescribed to kids, pregnant women etc. It wouldn't involve anyone getting anything they wouldn't already be getting off label. It's not a double-blind controlled study, but it's at least a start. Probably would be easier to get off the ground in a country with a socialized system, as they would have easier access to data on the majority of the population.
Even here in the US, the government is almost always the most common payer in general. This is true of hospital care, in pediatrics generally, and in psychiatry to name a few. Medicare, which covers the elderly and permanently disabled, and Medicaid, which covers low-income children, pregnant women and families in all states and low-income adults in the majority of states, generally pay for a majority and certainly a plurality of care provided in each category, although certainly in outpatient care there are many individual providers that don't accept Medicaid in particular as payment. They certainly have control of a large enough share of the market that they could influence it substantially if they chose to do so. Yet, for whatever reason, our government has largely chosen to stay relatively hands-off in creating regulations that treatment must be proven effective. In cases where they have created certain criteria to pay for certain things, it often does become industry standard just because they control such a large share of the market, but all the examples of this that I can think of are clearly aimed primarily at controlling access to expensive forms of care, as opposed to ensuring patient safety. Which is, to me, a missed opportunity, and quite sad.
This is (one reason) why I sort of cringe internally when I see stories about countries with a socialized system trying to expand the private health care market. Yes, in some cases it might start out looking nicer, but generally speaking when you allow for-profit health care to proliferate, the primary focus of the system becomes profit for the providers and even for the payers. Our private health insurance companies are publicly traded on the stock market and generally do quite well compared to other companies in other industries, meaning they are making people's premiums as expensive as they can while finding ways to pay as little for care as possible. To me, that's pretty disgusting for companies that supposedly exist to make sure people can access health care, and that most people have to rely on completely for such access. Patient safety generally trails far behind the money motive. I certainly recognize the budget issues in socialized systems, but at least-it seems to me-the theoretical purpose of the system is in fact to provide care, as opposed to making money for everyone involved except the patient, who ends up becoming a pawn in the profit game. My impression is that, while the Dutch protocol obviously originated in Europe, that research study was actually quite small and they did in fact have pretty strict criteria for the participants to be placed on the medical pathway. Then, we Americans got hold of the idea, and it started proliferating in our Wild West healthcare arena where safety controls are much more lax. And then we exported that bastardized version back to Europe. Just another gift from America to the world, that ends up looking a lot like a raised middle finger. But I do wonder, if Americans hadn't gotten wind of this when we did, and the Dutch protocol had been implemented first in European systems with better safety controls, if the "standard of care" would look different than it does today.
And yet again I've written a whole novel, so I'm going to start a new comment to ask a simple question: you mentioned Gender GP in your reply, as being outside the controls of the government due to being Incorporated outside the country. My understanding is that there are other private providers of all types of health care that are incorporated within the UK. Do gender-affirming private providers exist that are in fact incorporated and located in the UK, and if so, are the going to be subject to the "new" policy? (Side note here, my understanding is that this is sort of new-old news because it was originally planned a couple? years ago, but is just now actually being implemented.) In other words, does the UK government have ANY regulatory authority to require private providers within the country to adhere to safety protocols, despite the government not paying for the care? I imagine there surely must be some sort of control, like requiring that the doctors be properly licensed and so on. Is that incorrect?
Thank you again for allowing me to pick your brain, and providing some cross-cultural education.