Doctors speak with forked tongue
The AAP is, first and foremost, a trade union. “Professional medical association” is a less apt description than “association of medical professionals.” Teachers unions care about education but give their own and their members’ interests priority over those of students. So too the AAP has strong incentives to defend its own interests and those of member doctors—especially those who have publicly endorsed or facilitated sex-trait modification—even when that is harmful to patients.
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Because the AAP apparently recognizes the superiority of systematic reviews, it should defer, while the review process is under way, to the systematic reviews conducted by the U.K. National Institute for Health Care Excellence in 2020 and updated last week. A slew of new systematic reviews touching on a wide range of topics related to pediatric gender medicine is expected to come out in the U.K. well before the AAP systematic review is completed. When they do, the AAP should embrace their findings.
Last August the AAP president said that her organization’s policy was based on “the best science.” But if systematic reviews are the appropriate way to evaluate the evidence, and if every systematic review to date has found that the evidence is exceptionally weak, how can the AAP continue to maintain that its current approach is evidence-based? Mr. Del Monte was evasive on this point. The Europeans, he said, “engaged in their process, we’re engaging in our process.”
Leor Sapir, Second Thoughts on ‘Gender-Affirming Care’
Kill the corporations?
Alan Jacobs offers two quotes on corporations. I’ll only reproduce the second, from James Bridle (2022), though the first reinforces this second:
In the last few years, I have given talks at conferences and spoken on panels about the social impacts of new technology, and as a result I am sometimes asked when ‘real’ AI will arrive – meaning the era of super-intelligent machines, capable of transcending human abilities and superseding us. When this happens, I often answer: it’s already here. It’s corporations. This usually gets an uncertain half-laugh, so I explain further. We tend to imagine AI as embodied in something like a robot, or a computer, but it can really be instantiated as anything. Imagine a system with clearly defined goals, sensors and effectors for reading and interacting with the world, the ability to recognize pleasure and pain as attractors and things to avoid, the resources to carry out its will, and the legal and social standing to see that its needs are catered for, even respected. That’s a description of an AI – it’s also a description of a modern corporation…. Corporate speech is protected, corporate personhood recognized, and corporate desires are given freedom, legitimacy and sometimes violent force by international trade laws, state regulation – or lack thereof – and the norms and expectations of capitalist society. Corporations mostly use humans as their sensors and effectors; they also employ logistics and communications networks, arbitrage labour and financial markets, and recalculate the value of locations, rewards and incentives based on shifting input and context. Crucially, they lack empathy, or loyalty, and they are hard – although not impossible – to kill.
The nominal state and the parastate
Consider the spectacle of a patriotic parade, with lots of flags waving and floats sponsored by various businesses. The Fourth of July parade would be one example, the Pride parade another. In the first, it is the flag of the United States that is flown, and the floats are likely to be sponsored by local businesses and voluntary associations — boring groups like the Chamber of Commerce, the Kiwanis, or the local VFW. In the latter, it will be the rainbow flag flying everywhere, and the floats will be sponsored by global commercial entities like Citibank or Deloitte, as well as NGOs such as the Human Rights Campaign. Local businesses will have a conspicuous presence at the Pride parade as well, indicating their alignment with the moral center of gravity of the whole, to which one feels it is proper to show allegiance (just as in a Fourth of July parade circa 1960, but of course it is a different moral center). In 2023, both parades are conducted, but it is hard to say which has the flavor of officialdom and which is counter-cultural. It probably depends on what part of the country they take place in, and likely corresponds to an urban/rural divide as well.
If the Fourth of July is a performance of national unity, subsuming all to a common allegiance, the Pride parade instead enacts a distinction — between those who are encouraged to be proud (a minority), and those who are enjoined to recognize and celebrate the proud (the majority). It isn’t a hard distinction, because by celebrating the proud, an unproud member of the majority can elevate himself into the circle of affirmation. The proud have a generous and ecumenical spirit that may be accessed through the liturgy of allyship.
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In September 2021, about fifteen thousand Haitian migrants flooded across the Rio Grande in Del Rio, Texas. Border Patrol agents were inconsistent in their response, largely passive under the gaze of so many news cameras, perhaps sensing that their ostensible mission as laid out in law is at odds with the basis on which the ruling party asserts its moral authority: humanitarianism. But at one point, a couple of Border Patrol agents on horseback undertook to prevent some migrants from crossing the river. The long reins of their horses looked enough like whips that they could be designated as such in a national press facing more demand than supply for images that could be tagged white supremacist. (That so many Border Patrol agents are Hispanic did not matter.) Perhaps the really offensive thing about the pictures of men on horseback was that they represented, not a bureaucratic immigration process (with its corresponding sociology) but spirited competence in the realm of material things. Horsemanship. None of the migrants were injured, but these images carried a political hazard. They evoked the founding self-image of the nation, providing an uncomfortable contrast to the managed, surveilled, and softened “human resource” material that is the preferred subject of post-democratic rule. Such energy was being discharged by the horsemen on behalf of the border, that sine qua non of the nation. This was all deeply wrong, from the perspective of the Party.
President Biden was unequivocal: “I promise you, those people will pay. There is an investigation underway right now and there will be consequences.” He meant the Border Patrol agents, not the illegal border crossers. The head of state spoke, not on behalf of the written laws of the state, but on behalf of the party-state, as upholder of the humanitarian morality. Here was a case where the nominal state ran directly up against the party-state, and it was clear where the real power resides.
I believe such episodes are surface manifestations of a deeper contest over the status of the nation as a political form.
Matthew Crawford, Minoritarian moralism, part one of three,
attempt[ing] to make sense of our current regime: how it works, what scripts it relies on to assert its legitimacy, and what the prospects are for its continuance. This first installment establishes the basic logic of the “party-state” and the function of what I am calling its “recognition clients” – sacred cows, more or less.
I’m in a bit of turmoil because Crawford distinguishes
two ideal types of representation: the delegate model and the trustee model. The delegate enters the legislature merely to channel the collective will of his constituents, whereas the trustee answers to the higher authority of his own conscience and understanding.
I cannot recall a time when I was not an advocate of what he calls the trustee model (and which I was wont to call “statesmanship” in those situations where the representative actually “knew better” than his constituents and voted accordingly — at some risk to his office if not his life). I remember heated arguments with my father-in-law, who clearly took the delegate view.
Yet what Crawford describes is the trustee model captured by ideologue technocrats and run amok in the name of their “recognition clients. I wait with bated breath for parts 2 and 3. If Crawford calls for abandoning the trustee model, I pretty sure he’ll lose me.
We are in the grip of a grim, despairing rebellion against reality that imagines itself to be the engine of moral progress.
The end of the world as we know it is not the end of the world.
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Tipsy Teetotaler ن 