RUTHFULLY YOURS

https://getpocket.com/explore/item/why-therapy-is-broken?utm_source=pocket-newtab-en-us

An hour a week in a shrink’s office is increasingly treated as a prerequisite for a healthy, happy life. There, we imagine, friends learn new coping skills and enemies realize the errors of their ways. Everyone is “healed.” Therapy has been marketed as a panacea for all kinds of issues, from fixing a bad personality to ending racism. Refusing to seek treatment becomes a red flag, while fluency in “therapy-speak” is all but mandatory. Professional help has even infiltrated our leisure hours: Reality TV shows like Couples Therapy, podcasts from This Is Dating to Where Should We Begin?, and “therapy in a box” card games, some actually designed by psychoanalysts, abound.

Unfortunately, as anyone who’s actually tried it can tell you, therapy often sucks.

Anywhere from 50 to 75 percent of people who go to therapy report some benefit—but at least 5 percent of clients get worse as a result of treatment. (For people from marginalized groups, harmful outcomes may be even more common.) The remainder report no clear benefit at all. Plenty of would-be clients go once and, feeling alienated, never return. Others keep trying, even as it becomes clear they aren’t really getting what they need, whatever that is.

But the American mental health care system has hardly acknowledged the existence of bad therapy, let alone taken steps to fix the problem. Instead, in the wake of the Covid-19 pandemic, which sent the demand for therapy soaring, the American Psychological Association and other organizations seemed to prioritize the quantity of available appointments over the quality of any resulting therapy. The rise of app-based mental health care, like BetterHelp and Talkspace, has only made this landscape harder to navigate.

The result is that everyone is telling everyone else to go to therapy, but “nobody really creates space to have dialog about, ‘OK, if it doesn’t work, let’s talk about why,’” says psychotherapist Ben Fineman, cohost of the Very Bad Therapy podcast with Carrie Wiita. That’s partly out of fear of uncertainty, which therapists dislike as much as anyone, and partly because reforming mental health care is complicated. But ignoring these shortcomings is only perpetuating the suffering therapy promises to heal.

https://www.nationalreview.com/2024/10/how-to-fight-the-lefts-politicization-of-medicine/

A new study challenges one of the more popular reasons cited for introducing left-wing ideology into medicine, and it outlines an agenda for making health care apolitical.

‘A sick society must think much about politics, as a sick man must think much about his digestion,” C. S. Lewis wrote. “To ignore the subject may be fatal cowardice for the one as for the other.” In the national delirium of a presidential election, the maladies of politics impose themselves on our minds to an even greater degree.

Unfortunately, the current state of the medical field is not much of an analgesic. In recent years, left-wing ideology has thoroughly penetrated medicine. But new research undercuts one of the more popular academic buttresses of this blatant politicization. It’s more than enough to make one wonder if a movement that bills itself as pro-health might actually be iatrogenic.

Health care has not been immune from the whole-of-society effort by the Left to take control of institutions and subordinate them to its aims. Medical schools, journals, professional societies, continuing-education courses, and other institutions of the medical field now tilt left, as I documented last year.

Examples abound. The official publication of the American College of Emergency Physicians recently published a case for DEI in medicine. Harvard’s School of Public Health is offering a “Settler Colonialism” course. The Cleveland Clinic is currently being investigated for possible discrimination against white patients. The important roles academia and the government play in the medical field make this reality sadly unsurprising.

It still may have been a surprise to some when a related research paper became fodder for the Supreme Court. In her dissent from the Supreme Court’s majority opinion that overturned affirmative action last year, Justice Ketanji Brown Jackson wrote that the practice “saves lives” (indirectly), citing a 2020 study to claim that high-risk black newborns are twice as likely to live if they have a black physician. What the study actually found was that half as many black newborns died while being treated by a black physician as when treated by a white physician, while the survival rate was above 99 percent in either case.

https://issuesinsights.com/2024/09/25/women-children-disabled-pay-the-price-for-obamacares-medicaid-expansion/

Obamacare greatly expanded Medicaid eligibility. As a result, about 20 million able-bodied, working-age adults who were previously ineligible are now enrolled in the program. 

But as a new report from the Paragon Health Institute makes clear, their gains have come at the expense of the pregnant women, children, and people with disabilities that Medicaid was established for. 

The harm to these legacy beneficiaries, and to taxpayers, will only mount unless Congress fixes the perverse incentives that Obamacare created for the nation’s flagship health program for the poor.

Obamacare directed states to expand Medicaid eligibility to able-bodied adults earning up to 138% of the federal poverty line. Forty states and the District of Columbia have complied.

Previously, eligibility had been restricted to vulnerable people — like nursing home residents with virtually no assets, or minor children, or pregnant women who lacked other health coverage. 

Obamacare incentivized states to enroll able-bodied adults by having the federal government cover most of the cost. 

For the legacy Medicaid population, the feds normally pick up between half and three-quarters of enrollees’ health care costs; states foot the rest of the bill. For the expansion population, Washington initially picked up 100% of the cost. Now the federal government covers 90%. 

https://www.city-journal.org/article/hhs-has-misled-on-gender-medicine

In 2015, the Centers for Medicare & Medicaid Services (CMS) accepted a formal request to initiate a national coverage analysis for “gender-reassignment surgery.” When making these coverage determinations, CMS is legally obligated to evaluate relevant clinical evidence and answer the question: Is the evidence sufficient to conclude that the application of the item or service under study will improve health outcomes for Medicare patients? In June 2016, CMS released its 109-page analysis, which it made open for public comment. The agency published its final decision memo two months later. The differences between the two documents were revealing—and disturbing.

At first sight, the summaries of both memos seemed similar. Each mentioned that the CMS was not issuing a national coverage determination on “gender-reassignment surgery” for Medicare beneficiaries with gender dysphoria. Such determinations, the CMS said, would continue to be made by local contractors on a case-by-case basis. On closer examination, however, the final document included substantial changes. These were not corrections. They amounted to a systematic effort to scrub any reference to the evidence of the harms associated with these surgeries.

The agency’s shifting analysis of gender surgery is glaring enough. But it is just one of several examples, between 2016 and the present day, of how key figures and agencies within the U.S. Department of Health and Human Services have misled the American public about the evidence for “gender-affirming care.”

Start with the tale of two memos. To conduct a proper analysis of the clinical evidence, CMS identified a large number of publications related to “gender-reassignment surgery.” As CMS explained:

Studies with robust study designs and larger, defined patient populations assessed with objective endpoints or validated test instruments were given greater weight than small, pilot studies. Reduced consideration was given to studies that were underpowered for the assessment of differences or changes known to be clinically important. Studies with fewer than 30 patients were reviewed and delineated, but excluded from the major analytic framework. Oral presentations, unpublished white papers, and case reports were excluded. Publications in languages other than English were excluded.

Thirty-three publications, ranging from 1979 to 2015, were eventually identified and included.

https://www.nationalreview.com/2024/08/the-voter-registration-guide-will-see-you-now/

A worrisome new consensus in the medical community holds that doctors should be as concerned with politics as they are with medicine.

‘We again discussed . . . the importance of voting and the safety, security, and effectiveness of voting by mail.”

These probably aren’t the words you’d expect to see in a medical record. Yet that’s what a medical professional at a prominent northeastern hospital wrote earlier this year after seeing a patient. The record, a de-identified version of which was provided to my organization, shows a new and profoundly concerning trend in medicine: Leftists are making the doctor’s office a major cog in their voter-registration and turnout machine.

The movement has been building since at least 2020, growing out of the woke fixation with so-called “social determinants of health.” This concept holds that medical professionals should be as concerned with welfare, housing, and climate policy as they are with diagnosing illnesses and prescribing medications.

As the argument goes, such policies affect patient health, so health care has a duty to shape them. In 2022, the American Medical Association — which is thoroughly captured by woke ideologues — passed a resolution asserting that “voting is a social determinant of health.”

Statements from such influential sources signal to medical employers and educators that doctors should make voter registration a central part of their work. Medical journals are applying further pressure by publishing a slew of opinion articles and tendentious studies arguing that voter registration in medical settings will improve health equity.

Having practiced and worked in academic medicine for 50-plus years, I know that when the New England Journal of Medicine says jump, the medical establishment collectively leaps.

https://www.city-journal.org/article/covid-public-authorities-pushing-health-practices-contrary-to-medical-and-scientific-knowledge

Times have changed. Two years ago, tennis great Novak Djokovic could not play in the U.S. Open tournament. It was not because he had Covid-19 and posed a danger to fellow athletes and fans. Djokovic could not come into the country because of President Biden’s proclamation banning the entry of unvaccinated noncitizen air travelers into America.

Now, U.S. sporting officials let American sprinter Noah Lyles compete at the Olympics with an active case of Covid-19, putting his fellow athletes at risk of contracting the disease and impairing their performance.

Lyles tested positive on Tuesday. But he was allowed to run the 200-meter semi-final on Wednesday and the final Thursday, despite having a fever. It was hard not to notice Lyles talking with and hugging other athletes, exposing them at a time when he was surely contagious. Yet, Lyles said that he never considered withdrawing from the event. Nor did he notify anyone of his condition outside of the USA Track & Field medical staff that allowed him to compete.

Lyles was not alone. The World Health Organization reported that at least 40 Olympic athletes have tested positive for the virus. Yet the International Olympic Committee has removed all requirements for health measures or notifications. And the Paris Olympics officials have likewise taken a hands-off approach, letting athletes and teams determine for themselves how to respond to infection.

Amid this change, however, one finds a Covid constant: public authorities have consistently promulgated health requirements that have been, and remain, contrary to medical and scientific knowledge. Imposing a vaccination requirement on noncitizen air travelers, but not citizens and other types of travelers, made zero sense. Moreover, it has long been clear that the vaccine’s primary utility is to protect the person vaccinated from severe disease—the guard against infection is limited and short-lived; thus, vaccine mandates could not be justified as protecting the public.

Public authorities also seemed intent on denying the existence of natural immunity resulting from earlier infections. In Djokovic’s case, he had already had Covid twice. It was common medical knowledge that natural immunity is generally as good as or better than vaccine immunity, though, in the case of Covid, the public health authorities tried to ignore this for years. By April 2022, even Anthony Fauci acknowledged that natural immunity was just as protective as vaccinations for Covid.

https://www.city-journal.org/article/a-consensus-no-longer

The main justification for “gender-affirming care” for minors in the United States has been that “all major U.S. medical associations” support it. Critics of this supposed consensus have argued that it is not grounded in high-quality research or decades of honest and robust deliberation among clinicians with different viewpoints and experiences. Instead, it is the result of a small number of ideologically driven doctor-association members in LGBT-focused committees, who exploit their colleagues’ trust. Physicians presenting different viewpoints are silenced or kept away from decision-making circles, ensuring the appearance of unanimity.

As the U.K.’s Cass Review pointed out, the World Professional Association for Transgender Health (WPATH) and the U.S. Endocrine Society were especially important in forging this consensus, and they did so by citing each other’s statements, rather than conducting a scientific appraisal of the evidence. The “circularity” of this approach, says Cass in her report to England’s National Health Service, “may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.”

Perhaps because it has never really depended on evidence, this doctor-group consensus has shown remarkable resilience in the face of major system shocks, including several whistleblowers, revelations from court documents that WPATH manipulated scientific evidence reviews, the Cass Review, a bipartisan commitment in the U.K. to roll back pediatric medical transition, and a growing international call for a developmentally informed approach that prioritizes psychotherapy over hormones and surgeries.