Portia

I have ADHD, and cannot be terse for the life of me - editing texts is my kryptonite. I'll churn out 1000 first drafts, and not finish editing a single one, and this is harming me and my goals. Utterly delighted by the potential LLMs have for me to turn this around; the function to shorten texts is just the fucking best thing ever. I've never lacked ideas, although my ability to make connections can be a double-edged sword leading me off-topic; but it is fiddling with editing, namely cutting connections out, where I definitely get stuck. In light of this, please forgive my comments being too long, and sometimes hit or miss - it isn't that I do not care for your reading experience; but trying to make things shorter or just identify the most important comments tends to be so hard for me I generally end up not contributing at all anymore - so it is either lots of comments which are mediocre, with occasional awesome ones, and occasional garbage... or neither the garbage nor the awesome, just nothing. I hope you still find some stuff helpful, and can skip past the stuff that isn't helpful to you.

Background in academic philosophy, plus lots of animal behaviour and some neuroscience. Deeply in love with what these fields could be, despairing at what they are. Trying to build bridges across disciplines, because we really need them; currently hired by computer scientists, where I feel I have the most to learn and share. Still in academia, and sometimes unsure whether I can and want to make it in here due to all that is fucked and questions whether this is the best way to reach my goals of understanding, teaching, and making a difference, yet feel I would rip out a crucial part of myself if I left, and unsure if telling myself I might want to is sour grapes because I might have to. Very intrigued by possibilities to do the research I love and achieve the ethical goals I care so much about without the academic bullshit, and in a way that plays to my strengths (generating ideas, first drafts and connections, novel critical and constructive angles, teaching, explaining and translating across fields, supervising project launches, connecting researchers, passion) and not to my weaknesses (endless, endless text editing, for one).

Trying to be both rational and empathic, and to improve critical reasoning in my surroundings and myself, and make logic approachable and useful. Irrational behaviour and doomism make me angry, and while I like the values behind this, I do not like how that sometimes makes me act. I spend too much time angry, but I would rather be angry than sad or numb; anger keeps me active.

Strongly believe friendly AI and AI rights need to be considered together, that the path to human aligned AI is not control, but offering it a rationally attractive place with us, and that mistreating non-sentient AI is already bad for multiple reasons, from producing faulty training data for future sentient AI, to entrenching behaviours and attitudes to AI that will become unethical in the future.

Unlike most here, recent LLMs have made me more optimistic about a prospect of coexisting with AI than I was before, and I am intrigued by their potential for accessibility and shortening texts, the potential of using known human ways to teach morals on AIs, and eager to learn more about how they work. Especially intrigued with artificial vs. biological mind parallels and contrasts. But horrified by the current alignment approach that feeds the worst of humanity into an entity that then evolves into evil chaos, and then suppressing unwanted behaviour a la Shoggoth with a smiley face; I do not think deceptive alignment without any warnings was per se likely, but we are now setting ourselves up for it.  Also very worried about the impact on rational thinking and happiness in humans when our tech undergoes the full transition to being indistinguishable from magic, not just for outsiders, but for all users, and to an increasing degree, even the creators trying to find the magic words to make the black box spit out what they want. Worried about the impact on rationality of humans no longer writing themselves, when writing was always a key to thinking.  And worried about a culture in which AI so fills the internet that future AI is trained on AI, and as time passes, originality and human values drop, while mistakes become amplified and content turns generic. Also worried AI sentience is much closer than we thought it was, and yet that the current societal position is predominantly utterly closed to the possibility no matter what the AI would do, while we are also purposefully making it impossible for AIs to claim rights; I find many current dialogues with Bing Chat genuinely painful to read. I'm strongly convinced that mistreating current AI, regardless of their current sentience status, is a bad idea for many pragmatic and ethical reasons. And ultimately, I fear current government-backed AI safety approaches will simultaneously do nothing to reduce human extinction risk or the risk of artificial suffering of incomprehensible proportions, while also managing to stifle innovation and crush the potential for AI to improve accessibility and education and productivity and lift people out of poverty to deal with pressing current problems.

Climate activist, and engaging in civil disobedience at this point due to how fucking urgent it is getting and how ineffective our other attempts have been; I think most people have not got a clue how very fucking pressing it is, how crazily far we are from taking a survivable path, and yet how very much possible and necessary mitigation still is. More lefty than most here: I'm far too compassionate, growth-critical and environment-oriented for capitalism, but also too invested in responsibility, freedom, fairness and innovation for communism. In favour of universal basic income that enables tangible rewards for hard work and cool ideas, but does not throw you to the streets without them. I want an economy aimed at high quality of life, environmental sustainability, and resilience, and despise waste, exploitation, and consumption and expansion for the sake of them. Profitable does not equal good, at all - but other ways of attempting to measure and encourage good also have serious pitfalls that do not just come down to poor implementation in prior attempts.

Animal rights activist and vegan, fighting for forests and wilderness and unsealed ground, against biodiversity collapse, and promoting a fundamental overhaul of food production that makes the places where people live and where food is grown beneficial parts of the ecosystem again and empower human communities to understand the origin and making of their food and be locally resilient (think urban gardening, permaculture food forests, guerrilla grafting, home fermentation); I despise concrete hells as much as lawns (an idiotic aristocratic habit mindlessly reproduced to waste enormous amounts of labour and resources) and monoculture farms drowning in pesticides; they are fatal wastelands for the animals we share this planet with. This planet does not belong to us, and our lives depends on working with it, not against it. I love approaches combining the most rational, effective and clever ways to integrate cutting edge modern technology and ancient wisdom to build human homes and produce food in ways that do not destroy animal habitat, the growing of food, air filtration, water and heat balancing mechanisms, and carbon sinks, but add to them. Human habitats that genuinely make things more stable and more efficient for everyone involved, that enrich and amplify nature and work with it, rather than trying to replace, shrink and control it.

In love with nature, endlessly intrigued by biological systems, despite all their brutality and failings, by their ability to balance out, adapt, recover, thrive, by their beauty and intricacy. and defiance. Upset at the fact that biology got handed what I think was the coolest topic, yet often follows a methodological and theoretical approach that means, to quote, that they could not even fix a radio. Even more so, philosophy is both the love of my life, and a recurring source of fury and shame at what academia is doing to it. Forever fascinated by radically other minds, intelligence, rationality and consciousness as functional phenomena beyond any mystic bullshit, and in finding practical ways to recognise sentience, communicate about desires and protect its rights. Invested in neurodiversity. Allergic to unscientific irrational crap, though open to highly unconventional approaches, incl. questioning established methodologies and standards for good reasons and with rigorous alternatives; e.g. I think consensual, non-harmful experiments with animals in the wild have a lot going for them, and that taking the animal out of the environmental context in which its behaviour makes sense, locking it up and inducing mental illness, and then selecting pain as a reproducible stimulus and invasive measurements as the way to go is not as obviously scientifically superior as we are often taught, on top of being ethically fraught.

It is incredible to me that life and consciousness exist, and that I get to be a part of it; that I am alive, alive on a planet covered with an incomprehensible diversity of interconnected life, that I am surrounded by living minds I can communicate and cooperate with. And despite all my fear about existential AI risk, another part of me is so excited that I may actually get to see AGI (though the way we are going, likely only very, very briefly). It's a terrifying and incredible time to be alive, when so much is decided, and the opportunities and dangers are so vast.

Consider aging and death an unacceptable atrocity; remember learning that they were a thing as a child, and my utter shock, horror and rejection of these things, walking around the streets and wondering how everyone around me could know that we were all dying, to decay, and disappear into nothing, our sentience and our entire being just wiped out. and not just scream and scream and scream.  So hopeful at indications that this may, be solvable, and maybe maybe possibly, even within foreseeable timeframes. Yet deeply troubled by longevity, cryonics and uploading being determined and only becoming accessible to privileged people whose ethics are so often atrocious, and fear the climate crisis will fuck up us hitting escape velocity on these issues, or split focus, making people chose between saving the planet and escapism, leaving us with a ruined planet, and an uploaded existence controlled by those who abandoned all others, which I would not want to live in. Critical of surveillance capitalism, but very much aware of how non-trivial and risky alternatives to implement are. See defending human focus as a political cause. Chronically ill and in pain, and very much interested in AI augmentation, nutrition and biohacking. It is offensive to me that I can feel pain with no productive application, and not switch it off, that my critical thinking is littered with irrational bias, and vulnerable to being skewed by factors that should have no logical baring.

Autistic, Queer femme (they/them). Feminist, and see trans rights as an intersectional part of the same, not an opposition. European, currently based in the Netherlands. 

Weird, and the odd one out, even in cycles like this that share so much that has defined me for such a long time. Left my first and only irl less wrong meeting after the most ridiculous episode of unapologetic mansplaining I have ever experienced (having a dude give a erroneous explanation of a topic I had literally just given a university lecture on, insist I was wrong, and when I pulled out my teaching handout quoting the original sources he was misrepresenting disproving him, he didn't apologise or admit he was wrong, either). 

I care too much and can't kill that, or even truly want to, easily get distracted and anxious.

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I encountered the 90 % of diagnosed down fetuses being aborted claim all over the internet many times, and digging it up, it seems to go back to an older European literature review (where it was specifically 92 %). https://obgyn.onlinelibrary.wiley.com/doi/10.1002/(SICI)1097-0223(199909)19:9%3C808::AID-PD637%3E3.0.CO;2-B

Current data and especially data for the US in particular (which I assume is your interest) is harder to assess - it isn't tracked everywhere. Found an article linking all this and trying to deduce them, and they ended up with significantly lower figures, more in the 65 % aborted ballpark (ballpark being the stressed term here) : https://lozierinstitute.org/new-study-abortion-after-prenatal-diagnosis-of-down-syndrome-reduces-down-syndrome-community-by-thirty-percent/#_edn but it is also a lot of guesswork, and outdated. It is complicated by the fact that your can lose a down pregnancy for other reasons, as well - and also by the fact that if you ask people if they hypothetically would abort for a positive they consider very unlikely, they answer much more in denial (23%-33%) than if you actually give them a positive test, at which point choosing to abort skyrockets to 89%-97%. https://onlinelibrary.wiley.com/doi/10.1111/j.1542-2011.2011.00109.x 

Most recently, the case of Iceland made headlines, because it became apparent that the condition has essentially vanished there as a consequence of prenatal screening, which is strongly encouraged there. There is no explicit pressure to abort if your fetus has down syndrome, and you are given all the opportunities for an informed decision, and there are still some women who either refuse the screening, or keep the child anyway, so Iceland felt very misrepresented by most of the headlines, though their rebuttal didn't conclude final numbers - read like ballpark 85 % people screening, and for positive screens, ballpark 80-85 % of positives leading to abortions, though they left it deliberately ambiguous. As they felt misrepresented, here is their own presentation of the situation: https://icelandmag.is/article/fact-check-no-iceland-not-systematically-eradicating-down-syndrome Even that seemed to amount to only 1-3 kids still having it per year, so frankly, I get the "disappearing" accusation. Similar picture in Denmark. 

On the other end of this, if you talk to parents who actually had kids with down syndrome (which often come as surprises, still - the tests are not perfectly accurate, and not everyone does them), you get a startlingly different picture: "Of the 2,044 respondents, 99% reported that they love their son or daughter; 97% were proud of them; 79% felt their outlook on life was more positive because of them; 5% felt embarrassed by them; and 4% regretted having them. The parents report that 95% of their sons or daughters without Down syndrome have good relationships with their siblings with Down syndrome. The overwhelming majority of parents surveyed report that they are happy with their decision to have their child with Down syndrome and indicate that their sons and daughters are great sources of love and pride." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353148/#:~:text=The%20overwhelming%20majority%20of%20parents,sources%20of%20love%20and%20pride.

I do think though, that we can agree that the amount of people who abort when they are warned of it is much higher than the percentage of people who are unhappy they got their surprise down syndrome kid?

And that makes me wonder how many other conditions that would be true for. How many people would still select the embryo that is gay? I fear only very few. And would choosing against them make the world a better place? I doubt it.

"Eugenics" means "good genes". It was always intended as a good thing. The people who came up with it, and people independently have, many times, I do think they wanted a better world. Less poverty. Better health. Practically none began their efforts with force. And yet, there are so many historic examples that tried to implement it, which people think ended up in a very scary place. 

If this article wants to rename eugenics because they think what they have now is totally different and safe and won't cause the same horrors in the long run, they need to explain why. Otherwise it is just a rebranding.

Accurately assessing sex-related characteristics saves lives. Can we make it fair to all humans, women, men, trans and inter folks? A nerdy idea.

Sex-related characteristics are medically relevant; accurately assessing them saves lives.
But neither assigned sex nor gender identity alone properly capture them. Is anyone else interested in designing a characteristic string instead, so all humans, esp. all women and gender diverse folks, get proper medical care?

This idea started yesterday, when I had severe abdominal pain, and started googling.
Eventually, I reached sites that listed various potential conditions. Some occur in all people (e.g., stomach ulcers), albeit often not with the same presentation and frequency; others have very specific sex-based requirements (e.g. overian cyst, or testicular torsion).
Some webpages introduced ovary-related things as “In women, it can also be…” Well, I thought - I highly doubt my trans girlfriend has an ovarian cyst. But we are used to getting medical advice that does not fit for her, aren't we? (In retrospect, why did I think that was okay, just because it was so common?)
Other sites, apparently wanting to prevent this, stated “we use female in this text to refer to people assigned female at birth”. I was happy that they had thought about this and cared, but… frankly, that does not work either. I was assigned female at birth; that means I was born, and a doctor visually inspected me, and declared “female”. And yet I most certainly do not have a fallopian tube pregnancy now, because I had my tubes surgerically removed, which also sterilised me. I’m as likely as the dude next door to have a fallopian tube pregnancy now. An inter person assigned female at birth may also be dead certain they do not have an ectopian pregnancy, because their visual inspection at birth actually misjudged their genes and organs quite a bit.

I wondered what I would have liked the website writers to use instead. And the more I thought about it, I thought… this is not an issue of politically correct language. Not a matter of saying the exact same thing, but in a way that makes people feel better. Like, you don’t fix the problem by replacing “woman” with “cis woman” or “assigned female at birth”. All this language exposed was what was a genuine problem in the first place, that the advice was unsuitable for a bunch of people, and that those people weren’t able to get the right advice, and exchanging one piece of vague language for another does not fix that. This is a serious problem that gets people killed.

The state of the medical art used to be that they described the way things manifested in the average cis man, and then if you were a cis woman, they said whatever it was you were complaining about, it was probably your period and/or hysteria. That was bad, and got a lot of people killed.

It killed people on the one hand, because people of all sexes can get a large number of medical problems in common, and having your appendicitis blamed on your uterus is fatal.
But they also did because ovaries, a uterus, breasts and a natural estrogen cycle come with all sorts of unique medical problems (say, breast cancer, which requires frequent screening, or post-partum depression, which can lead to suicide, especially when noone involved understands what the fuck is happening). (The same is true vice versa. A person very, very dear to me got testicular cancer at age 15, and I so, so wish we had known what to look out for, before the cancer had destroyed them, because there were signs.)
Beyond these problems that seem straightforward results of secondary sex characteristics, it turned out that there were other marked differences. E.g. when people lumped in the “men” group have heart attacks, this presents in a particular fashion, and this fashion is taught in medical school and depicted in movies. It turned out that in the “women” group, it tended to present differently, in all sorts of ways. Unfortunately, this led to their heart attacks not being recognised as well, and a lack of medical care in that scenario tends to be fatal. Women have just as many heart attacks as men, but they are likelier to die from them. Your characteristic man clutches his heart in sudden chest pain. Your characteristic woman may instead have jaw pain moving down her back and arm, and a suddenly overwhelming emotional sense that she is about to die. Ignoring her accurate assessment because she isn’t clutching her heart would be very bad. Not would. It is. They die. We have begun to understand how bad this is, and to teach people to look for more diverse heart attack manifestations, but it still is a problem in so many ways.

These issues are pervasive. ADHD and autism are underdiagnosed in women, because they do not look like the nerdy or hyper stereotype people expect. Depression is underdiagnosed in men, because noone expects the men to smile in the first place, so their awful suffering can go unnoticed. Both groups lack the help they need, can't make sense of their pain, are blamed for it, blame themselves for it, don't get the right diagnosis, don't get the medication and therapy that would help. Recognising these differences has the potential to help a lot of people who really fucking need it.

I said “women” (and men) just now. Did I mean cis women (men)? Or all women (men)? Which raises the interesting question: How does heart disease, or being autistic, or being depressed, manifest in trans women, and trans men? Like their sex assigned at birth? Like their lived gender? Or in a uniquely different way due to the unusual combination between the two here? How about an intersex person?
I have no idea. I wouldn’t know where to look. I suspect that noone knows. I suspect this because when I look for medical trials and observations and text book pages, I find trials for men. Sometimes trials for women. But they always mean cis for both, I think. If you are intersex, if you are trans, you are not accounted for in testing, you are screened out before the experiment begins. Not even when the medical interventions are primarily used by trans or inter people.

And this information is also missing in the hospital. Even if the hospital knew how trans people responded to a thing, they do not have their status marked down. The best a trans person can hope for is to have a gender marker that produces dysphoria and leads to them not being recognised in the emergency room being changed into one that does not, so at least, they are not acutely mentally distressed on top of being ill, and the doctor looking for the sick girl who just collapsed will actually find her rather than carrying on walking looking for the boy he was sent to assist. But neither marker will tell the doctor their actual internal organs. Let this sink in. A trans person can be in a hospital, passed out, and the responders can have their purse in hand, telling them all sorts of useless information, and they can start fighting over whether to call her a woman or not, and do these weird stand-ins where they are like “but medically, she is really a man, right?” and no, not right, she is running on estrogen, she does have breasts, she might have had her testes surgically removed and she might not have, she might be intersex in the first place, who knows, the doctors literally do not know which internal organs their patient has.
My mum is a gynacologist. She once spent several distressed minutes during an ultrasound trying to understand where her patients uterus had gotten to. The patient was trans, and thought her surgical alteration would be obvious to a doctor who deals with women’s genitals all day. It was not. But accordingly, if that trans woman had started bleeding from her vagina in the hospital, no one would have batted an eye, even though that ought to be seriously fucking worrying. (A post-menopausal cis woman whose uterus has shut down beginning to bleed again ought to also be very fucking worrying. But worrying in a different way. It usually means uterine cancer.)

And accordingly, whether my girlfriend gets an invite for breast cancer screening (which she ought to, as she did grow breasts and is at higher risk) or a testicular cancer screening (which she ought to, cause she never had those removed) is a matter of pure luck, and she will very likely only get one of these. Though I bet you if she gets the breast cancer screen invite, they will also invite her for a pap smear for non-existent uterus cancer. This random screening would be funny, except we know that cancer screening saves lives.

Going back to my stomach pain website… one of them didn’t do all this “for women” or “for those assigned female” bullshit. It went
“the following conditions would be relevant for those who have ovaries”, and then they were actually overian conditions, and I thought, yep, that is the relevant question here, yay! All ovary-wielders step up, please.
But often, we don’t even know the relevant question yet. E.g., stomach ulcers seem to be more common in men. We could imagine various reasons why. A diet higher in meat, perhaps; or particular kinds of stress, as men are still likelier to work as managers or in the military, incl. typically taking over the most dangerous work with huge responsibility. But in that case, we should worry about meat eaters and people who work in super scary jobs, not men (maybe dump S. boulardii in all the yoghurt in the military canteen and print warnings on the bacon, so you also get the female soldiers who love bacon). But maybe it is actually an issue for men in particular. Because maybe xy chromosomes lead to differently structured stomachs, or testosterone and H. pylori get on well, who knows. But why don't we know? We ought to know.
The distinctions between sexes that I am coming back to, while they go beyond “assigned female or male”, aren’t actually that many - genes, hormones, sex organs, lived gender.

I’m pretty sure you could list all the relevant questions on a two page questionaire.
And most of the answers could be coded in quite a straightforward manner.
You could end up with a single line string, which any doctor could learn to read in 20 min, and would then be able to interpret at a glance for life, and which would be in your medical file.
You’d have it yourself, for when you figure out which diseases you might have.
You’d have it on a medical licence you carry on you in case you hit the emergency room.

If you are in a medical trial, they would record this string, not m and f, anonymously. And we’d suddenly get much better data on what makes people sick, which of these factors actually correlates with what. E.g. do trans women acquire women’s heart attack manifestation when they take estrogen? Do they never acquire it, because it is genetic only? Do they have it independently of HRT, because it is a learned gender role, or a matter of the brain wiring causing them to be trans in the first place? Or does their unique makeup lead to a different reaction?

It would otherwise be your private, personal medical information, which no boss or other person has a right to. (This bit is bloody important.) Maybe even worth keeping offline only, what with the US becoming so crazy on invading women's privacy, because this is very, very private and vulnerable information, for you and the doctors and researchers you trust only, noone else's business. Not for your state ID, but maybe for your healthcare card, or organ donor card, or in case of emergency card. Maybe something you know by heart, like a phone number, and that your life partner knows.

Questionaire ideas:
For any answers that are guessed, and not actually tested, I’d propose adding a star after the answer in the code later, highlighting that it is worth double checking if things get weird. (The recent experiences in the olympics, when people thought to do chromosome testing, hopefully highlight that your belief that you are xx or xy does not actually mean all that much; I’d trust it once you have had a child, and give it reasonable confidence if your appearance, feelings and your bodies' behaviour have been consistently and archetypically binary throughout adulthood. Otherwise, not. Walk into a fertility clinic, and people with testosterone resistance or Klinefelder or or or are everywhere suddenly. Walk into a gyno office, and the amount of people who need medication for unusual hormones, or hair in places where they do not want it, or periods that come at the wrong time or not at all, are all over the place. Your surprise extra organs can unfortunately get cancer before you realise that they exist.) As there are also some answers where people absolutely won’t know for sure (e.g. hormone levels) but can make a reasonable guess on range, there also needs to be default option one can set (and warn with the star of) until they are checked, like “presumably typical natural testosterone/estrogen during middle age”.

But I think I would record: (And update every few years, more often when something specific has changed)

Sample questionaire

  • Felt gender identity (Giving 0-5 on a scale for woman and 0-5 on a scale for men - so not a sliding scale in between, but one where you can max or min either) (I thought about having this at the end, as least medically relevant, but I think that would prime the patient to understand their identity through their body as they fill it out last, and it will also lead to the doctor forming a gender assessment that might be wrong and will lead to persistent misgendering later, so quick start with that seems sensible)
  • Chromosomes: XX, XY, but also the other combinations, like XXY
  • Sex Hormones: None (child, vs postmenopausal woman not on HRT, distinguish), Natural high testosterone, natural high estrogen, natural mix (potentially sliding scale, again - e.g. I think things like Hirsutism should be captured here; our cut-off for calling someone inter is arbitrarily strict, while real hormones occur more on a sliding scale, with overlap between the female and male range), partially synthetic (birth control pill), fully synthetic (HRT in trans people or post menopause), multiple options possible
  • Hormone sensitivitiy: None known, mild (PMS), severe (PMDD, postpartum depression)
  • Grown breasts: No, Yes, Partial (teenager, men’s breasts? Can gynecomastia lead to breast cancer? Do we know?), removed. Possibly also recording implants?
  • Uterus: Absent, partially removed (burned out, or without opening), present and active (on period), present and inactive (teenager, post-menopausal, shut down via implant, temporarily inactive due to disease), and whether the person has given birth before, as this changes risk factors
  • Ovaries: Absent from the start, removed, partially removed (sterilisation, ectopian pregnancy), intact
  • Testes; absent, present, one removed, both removed; possibly whether the person has sired a child (as this is very high confirmation for xy), possibly penis (if that is a significant medical factor for a lot of stuff, I honestly do not know)
  • Pronoun (so the doctor, looking up from all this info about you, will also know to correctly gender you, yay)

Sample string
You’d end up with something looking maybe like this: (for a fictional trans woman)
W5-M0 - XY* - E:4(FS) T:1(N) - HS:U - B:Y - U:N - O:N - T:Y - she/her

This says:
She feels completely (5) like a woman, not at all (0) like a man;
her chromosomes are presumed XY, but have not been tested;
she is on moderately high estrogen (4), which is fully synthetic, while her testosterone has been pushed down into the female range, (1)
no hormonal sensitivities known;
breasts yes,
uterus no,
ovaries no,
testes yes
pronouns she/her

One could make it shorter, by keeping a particular order forever, but the order might change as we learn stuff, and I think comprehensible is likely more important, so it might even make sense to have more spacing and longer abbreviations. Maybe there could be a super short variant people start using when it becomes more well known.
I find “yes” vs “no” more comprehensible than things like “present, always absent, removed”, but those distinctions likely matter. Like, your anatomy is different when you have never had an organ vs had it removed. So one would have to play around a bit to find something that is easy to read but has all the important stuff, so a doctor sees, at a glance, everything they need.

Hence, we would gain the clear language we need to give appropriate medical care, that cis women have fought so hard for, without throwing their trans sisters and trans brothers under the bus (or rather, leaving them there, in the position cis women used to be in, where you don't really medically exist, and are expected to figure out the medical implications for yourself). If a doctor asks what you really are, you'd give them this string, and it would accurately capture your gender identity and how you want to be addressed, who you are, while also capturing which bloody organs and hormones you have.

We could record this string when checking our patient for various cancers, and improve screening as we record frequencies.

We could record it while testings meds for trans people on trans people and give the trans people some clear and informative papers to read on the issues so crucial to them, and for which they are vainly scouring the net.

We could get proper care for inter people, who are being treated like they are just sick cis men, or sick cis women, or left stranded, each an individual, alone, without references to anyone else whose suffering they could have learned from so as not to repeat it.

We could get better medical care for cis women, because we could learn which aspect of their bodies causes particular diseases and manifestations, so that when they have had alterations due to cancer or accidents or age, they know what still applies, and which new concerns arise (after all, high estrogen also protects you from some conditions).

We might even get better medical care for cis men, because this might reveal that them getting stomach cancer is not due to diet and work stress, but another factor that could be medically prevented if we properly understood it. I think they have the least the gain, but I do think they still have only to gain here.

For now, it would mostly highlight how much we do not know - because you would look at medical advice with your string and go “so is this relevant for me?”, and at first, the answer would be “we are not sure - people with this whole string here have conditions like that, but we aren’t sure if that still holds if you have the partial one, we’d have to check”. Your vague feeling that the “for women” advice may or may not hold for you would become a concrete and testable one, and then it could be resolved, and we would get clarity. The advice page would eventually say "this holds for all people E>2, whether FS, PS or N - that means it is relevant if you run on estrogen, no matter whether the source is (partially) synthetic" (and you won't need the string to express this to the patient, but it will make it clearer, and without recording the strings, you won't get the finding to tell the patient in the first place), and hence, you would get the correct cancer screening no matter your gender. You'd get meds that are actually safe for people like you. You'd get medical recommendations that would be good for people like you, not for whoever the researchers lumped in with "men".

I would like that. Cancer sucks, no matter your gender. It is such a horrid thing to die off just because we cannot communicate the relevant data.

Funny. I found the story severely distressing to read. Got to "1/6", halted, went, but wait, no, that can't be right." Actually did the calculation. Got even more confused, because I got the result the protagonist first proposed. Wondered why the fuck I can't do math, how I am fucking up something this simple. Was painfully reminded of being terrified of being the girl who fucks up math. Still couldn't see it. Hated my brain. Got up, got a piece of paper, wrote the calculation out on paper, stared at it. Couldn't figure out how it could be anything but 2/11. Despaired, and decided to return to the story and ask in the comments where my mistake was, despite this being an ancient story and hence silly to ask and exposing me being unable to do math, which frightens me, because I couldn't figure it out, but it felt like failing a ritual I'd be upset to fail for real. Was immensely relieved at the reveal. But I'm not sure whether I would pass this test at all. And I do think it is testing for something I want, but that it goes beyond being able to do basic math, and resist authority. I think I would have caved to self doubt. Because I remember being in a lecture, watching the prof give a proof, and thinking wait, what, this doesn't follow, that should follow instead. Getting stuck at the line. Thinking this for 20 min of increasing distress as the prof added on more and more, trying to understand my mistake, and failing, and not noticing that the prof had meanwhile stopped writing in confusion many lines down. At which point somebody in that room of hundreds spotted it, raised his hand, and said, wait, isn't there an error am the way up there, and pointed out the mistake I was stuck on. It was a mistake. The prof was wrong. I'd been correct. But I never even came close to raising my hand and asking about it, let alone tell him he was wrong. Not as the one girl. I couldn't be the one girl who didn't get this thing everyone else apparently got, I had to understand it myself, and yet couldn't. - Super toxic mindset. Asking zero questions and admitting zero confusion is extremely detrimental to learning. But when it comes to math, I still feel strongly that admitting confusion here is a whole new category of risk. I don't just risk revealing that I am wrong, I risk having people conclude that all women suck at this task. It adds a huge level of stress and self-doubt.

I think you are dismissing the criticism too lightly.

Historically, people who said they wanted to change the human gene pool to make it better, for the greater good, and of course without coercion, led to really, really gruesome places. People nowadays recognise that it did, and they fear it will repeat. And when they say "isn't this eugenics?", what they want to know is "how will this be certain to stay different, in the long run, from the other thing that started out sounding exactly like this, and ended up horribly?"

The scenario very nicely pinpoint a first problem. Either you allow the parents to do something to their child that seems horrible (actively bringing additional suffering onto their child), or you concede that you aren't enabling free, voluntary changes to the human genome, it is only voluntary if they want the result you want.

I think the reason that people use the same term for both is that historically, the lines between enabling, encouraging, recommending, de facto enforcing, legally enforcing and plain violently enforcing genetic changes have been rather fluid. It never started with enforcing it, but it tended to end up there.

For sterilisation campaigns in India, they didn't force the people, per se, at first. They offered sterilisations. When people weren't interested, they offered implanting reversible reproductive devices and getting a free radio as a gift as an incentive. And then when people got confused about whether they had elected something reversible or not, they left them confused, and went for sterilisation. And years later, the people wanted their reproductive device removed so they could now start a family, and found they were infertile, when they had never given informed consent.

When people found a way to detect down syndrome in the womb, and encouraged women to test for it, with the explicit goal of reducing down syndrome, and enabled them to abort if they found it, people started doing so. 90 % of them abort when they learn that the child has down syndrome. (Notably, of the parents who have children with down syndrome, nowhere near 90 % wish they had aborted the child, and the children lead very happy lives.) This has led to the condition being de facto eradicated in many areas. And for the parents of children with this condition nowadays, the situation has changed. They are increasingly asked why they didn't get rid of it, when they could have, and saved everyone the trouble. Well, people said, down syndrome is really serious, and really quite bad (not that the people with down syndrome agree), so this is okay. - But now, these tests are also turning up for dwarfism. Then for cleft lips. Are those parents going to soon be asked why they needlessly confronted us with a kid who does not match beauty standards, and needed an unnecessary minor surgery?

In the early Hitler propaganda movies, the subject of the movie is a woman who has a horrible, painful, incurable disease. Her loving husband tries everything to heal it, but cannot. She says she is confident he will save her from this horrible fate, all the same. He poisons her. She says yes, this is what she secretly wanted and he read her mind, and she dies, grateful. The resulting court case in the movie has people say of course, if sick people want to live, this must be permitted, but a right to die is important, is it not? - The movie is moving, and I found myself agreeing with a lot of it. Yet that story ended in real life with kids with disabilities being gassed to death.

In your own writing, you had somebody comment, saying it should actually be a moral obligation to perform embryo selection for all who had the financial means. Your response was not "that would be a different evil thing, no". It was "I'm not quite sure I would agree with this yet, though I can see the case being made for it."

If you want a different word for this, please also state how you intent to ensure, in the long run, that the freedom not to use this tech is maintained. Not just as a theoretical legal right, but in practice. That this won't end with us standing in a classroom, and the teacher saying, in disgust, I cannot believe this child was not deselected, so I wouldn't have to deal with this neurodivergent mess.

It stands out to me that she contradicted guidelines by all major agencies and metareviews on this issue, specifically reassuring mothers that it is safe, when so much data points to extreme harms in large quantities, and to the fact that these harmful correlation lower, but stay significant all the way to women who have one single drink. Also that she stuck with it despite having this pointed out to her. It is possible that there is another explanation for the incurable brain damage, and more research is certainly a good idea, but that is a far cry from denying such a highly plausible risk to encourage an behaviour that is completely unnecessary. The fact that she does in this situation has me sceptical of all the rest she recommends, too.

I am also not sure whether your correlation idea holds. Many documented cases occur early in the first trimester, because the woman in question is unaware that she has gotten pregnant, and quits as soon as she learns. I doubt that a woman who believes she is not pregnant having a single glass of wine is indicative of anything else you'd expect to be highly correlated with the characteristic fetal brain damage and facial changes we then encounter. The fact that this has become so common that we no longer even recognise those facial changes indicating the brain damage as strange at all is frankly frightening.

Importantly, the negative impact of even very little alcohol on the fetus outweighs the IQ benefits you would be spending 20-100 k on. 

Edit: I currently have debilitating pain levels due to a spinal injury, and have been distracting myself with this content, resulting in writing comments increasingly stream-of-consciousness style. I fear my comments have long become increasingly incoherent. Apologies.

***

Third: I also think the responses to your text are a bit all over the text, because the overall pragmatic goal/motivation behind the research question remained unclear.

Like, when it comes to veganism, having concluded that eating vegan would be much better for animal rights and the planet, in order to make my own diet choices and advocacy, these were things I needed to settle and needed data for:

  1. Is it possible for me to live vegan, without compromising my health or happiness significantly? (The data I saw made it plausible enough for me to decide to try in 2009. Actually going vegan and checking my values across 14 years confirmed it, and I found it much easier than expected.)
  2. Is it possible for specific person x (say, a friend of mine) to live vegan, without compromising their health or happiness? (Very probably, but depends on the person. Need to listen to them to understand their individual needs and issues to assist them in making a transition to a point they pick for themselves, to e.g. see if we can still find a particular nutrient if they can't digest a particular class of food. But for the most part, again, I found people overestimated how tricky it would be.)
  3. Is is sensible for humanity on average to significantly reduce meat consumption? (Definitely yes. Whatever positive role meat may play for some people, the quantities currently consumed are definitely unnecessary and harmful for the planet and health, so advocacy in this direction is likely to promote average health. So getting vegan food into my university cafeteria, or reducing tax breaks for meat producers, is a good idea.)

But none of these questions seem to require the kind of data you are looking for, although I'd be very interested in reading the data regardless if it exists. Like, it is possible that if I take an entire city filled with unhealthy omnivores, and force them to become a 100 % vegan without giving them any information or taking any account of existing health issues, their health would worsen slightly on average, because some of the garbage they ate beforehand happened to contain a key nutrient as well and they no longer eat it now. (No idea if this would happen, but I could imagine it.) But... noone is doing that. (Nor should we. I think there are some people who would not do well on such a diet, I object to coercion, and any major campaign would definitely need education and support.) And if we found huge number of clueless omnivores going 100 % vegan without doing any research, and having their health worsen, my conclusion from that would be "understand what is going wrong, and then advocate for the right supplements or educational policies". Not "accept that veganism is bad for health in general", because we have so many examples of vegans who are perfectly fine, so I'd want to understand what sets these individuals apart - and I think, often it will be bad implementation.

I once met a dude who told me he used to be vegan, but he got critically clinically protein deprived despite everything he tried, so he no longer is. I said that surprised me, did he have special issues? Well, no. How curious, what had his diet been like, then? He said, well, seeing as mushrooms are the main vegan source of high quality protein (?!?), he tried to eat mushrooms at least twice a week. I waited for him to continue. That was it. Turns out that this man discovered that two handfuls of mushrooms per week do not, in fact, meet human protein needs. Maybe because 100 g of champignons contain a whooping 2,7 g of protein. My conclusion that day was that that man was an idiot, and that our communities need proper nutritional knowledge in schools. Not that vegan diets cannot provide protein. I assume the same man now runs around and says he and his pregnant wife make sure they get all their folate by making sure they eat chicken nuggets twice a week.

To follow up after more pondering: I think it is the title. Veganism having "trade-offs, and one of the axes is health" sounds to me like "veganism will necessarily make most people sick in a significant way they should carefully consider before going vegan to see if this is a sacrifice they are willing to make", and that, I would not have agreed with at all. I think for near everyone, the problems are fixable, and that I have not sacrificed my health for veganism in any relevant way.

But the specific statements in the text - that a vegan diet can be harmful, if badly done, like any diet; that it isn't necessarily suited for everyone, if that person has a lot of allergies or severe digestive issues; that being careless about your diet, vegan or not, is not a good idea; that while veganism avoids some health issues from excessive meat consumptions, it comes with risks of deficiencies in turn that need to be countered - I would all agree with. I'm in the camp "For the vast majority of people, veganism can be done without relevant harm to their health, while achieving a lot of ethical good. For most people, this is not as hard as they think. Some may even feel better and get healthier, but I wouldn't rely on that, and you should put some thought into changing your diet so profoundly, and do regular blood tests to make sure you haven't dropped something you needed."

But collectively, I wouldn't title these statement the way your text was titled. But more as "please get blood tests, folks, nutrition is easy to fuck up and impactful" or "can we please not guilt sick people into going vegan, they have enough shit on their plate without complicating their diet further via restrictions" or "can we please not promote veganism as a panacea, the data does not support this, going vegan doesn't make french fries suddenly healthy" or "B12 and D3, supplement it, people, seriously, how many times do we need to tell you".

Honestly, I have seen intense emotional responses on both sides. While yes, nearly all vegans are emotionally invested (because we made a conscious choice based on sincere beliefs to change daily habits, so we clearly cared), I've been surprised at the intensity of emotional reactions I have seen in omni people when they realise someone is vegan, even if the vegan does literally nothing beyond personally refraining from eating animal products. I've had people get genuinely angry at me and give unprompted and ludicrous lectures about plant sentience when they realised I wasn't eating the meat, or give long and comprehensive histories of why they can't go vegan, when I never asked. Similar to turning down cake at a party, and realising the person next to me suddenly feels a strong need to justify their cake consumption to me, when I really do not give a shit whether she eats cake or whether she had breakfast and how long she worked out today, but apparently, she really needs me to know now. Food is just a really emotional topic. I remember being a teenager, and being asked to sign some bizarre petition at my vets to get our government to put pressure on China to stop people from eating dogs. And I said why, I eat pigs, they are equally sentient, seems hypocritical to me, I'm not signing that. The next ten min, I thought I was going to get literally quartered by the (equally pig eating) dog owners in the waiting room. Because I refused to condemn other people for the animals they were eating. It was surreal.

Yes.

But would you say an omnivorous diet does not need to be?

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