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BUENOS AIRES — At a time in history when there's more data than ever before, the challenge in healthcare these days is to identify which information to trust. Because unlike with religions, where faith suffices, science requires a formal process to reach credible conclusions. And as science evolves, things that were once considered true cease to be so because of new studies proving the contrary.
A case in point is the recommendation not to carry out the PSA (prostate-specific antigen) blood test concerning prostate cancer. Other truths have fallen by the wayside without being disproven by new evidence, like the recent ban, by Argentina's government drug agency, on the sale of products combining Glucosamine and Meloxicam, medications that had been widely prescribed for treating arthritis.
More troubling still are cases like the one the BBC reported regarding the use of stents to clear blocked arteries. The London-based news service noted how one scientific study — in recommending the use of stents — hid relent data linking the devices to an increased risk of heart attack. Another alarming report published on the website BMJ Clinical Evidence suggested that the efficacy of 50% of medical prescriptions is unknown. In other words, doctors are prescribing treatments without really knowing whether they're useful — or possibly harmful — to patients.
Doctors are prescribing treatments without really knowing whether they're useful to patients.
In addition, as physicians we do not always properly implement recommendations, as shown by the enormous amount of requests for PSA tests or Vitamin D prescriptions. These are specific examples of the gap between scientific evidence and standard practice by healthcare professionals. A study by the American Heart Association recently published in the New York Times concluded that a big proportion of coronary bypass operations and stent placements had been unjustified, needless and inappropriate.
Does all this mean that new technologies are useless? Clearly not. Historically and still now, new technologies have provided considerable improvements in terms of healthcare results. But it is a mistake to assume that new technologies are necessarily better. Tools are thus needed to identify the real innovation, relevant results, and contribution of new technologies compared to existing ones, and whether or not this difference is worthwhile or cost-effective.
In a hospital near Buenos Aires — Photo: Jorge Gobbi
Perhaps the biggest challenge is to do things in the correct order. First we need to identify unsatisfied health needs, then seek out the technologies that would meet them. It shouldn't be the other way around, with new technologies seeking contexts where they might be used, including in non-priority situations for the public.
With that in mind, we should be duly concerned about the procedures used to decide whether or not a medical product or procedure can be marketed in Argentina. First of all, there's just a single barrier in place for such products and procedures: the ANMAT food and drug agency. Not only that, but depending on where those things were previously approved, ANMAT will essentially rubber stamp them. And once authorized, people will be paying for those products and procedures often at prices that do not justify the benefits they offer.
The near future is offering us a proliferation of diagnostic methods described as "precision" diagnoses, or increasingly personalized treatments. Will these prove to be disruptive technologies in managing health problems, or more of the same?
If we really want healthcare improvements, we need systematic processes to evaluate new technologies, estimate their comparative contributions and thus reduce uncertainty in making coverage decisions.
Argentina has spent the past four years debating whether to create a National Evaluation Agency for Sanitary Technologies. But despite an apparent consensus among stake holders, including patients and pharmaceutical industry representatives, no such law has been passed.
It's time to apply a dose of skepticism to new technologies and accept that not everyone can access any treatment, nor do they need to. We must establish the true value of technologies in solving the healthcare problems of the public at large, and avoid situations (like with certain cancer drugs), where the costly treatments doctors prescribe are more beneficial to the oncologists themselves than to their patients.
Truly innovative technologies need to be properly vetted — for the benefit of everyone. It's something we all deserve.
*Lifschitz heads the specialist faculty in healthcare technologies at the University of Buenos Aires School of Medicine.
BUENOS AIRES — At a time in history when there's more data than ever before, the challenge in healthcare these days is to identify which information to trust. Because unlike with religions, where faith suffices, science requires a formal process to reach credible conclusions. And as science evolves, things that were once considered true cease to be so because of new studies proving the contrary.
A case in point is the recommendation not to carry out the PSA (prostate-specific antigen) blood test concerning prostate cancer. Other truths have fallen by the wayside without being disproven by new evidence, like the recent ban, by Argentina's government drug agency, on the sale of products combining Glucosamine and Meloxicam, medications that had been widely prescribed for treating arthritis.
More troubling still are cases like the one the BBC reported regarding the use of stents to clear blocked arteries. The London-based news service noted how one scientific study — in recommending the use of stents — hid relent data linking the devices to an increased risk of heart attack. Another alarming report published on the website BMJ Clinical Evidence suggested that the efficacy of 50% of medical prescriptions is unknown. In other words, doctors are prescribing treatments without really knowing whether they're useful — or possibly harmful — to patients.
Doctors are prescribing treatments without really knowing whether they're useful to patients.
In addition, as physicians we do not always properly implement recommendations, as shown by the enormous amount of requests for PSA tests or Vitamin D prescriptions. These are specific examples of the gap between scientific evidence and standard practice by healthcare professionals. A study by the American Heart Association recently published in the New York Times concluded that a big proportion of coronary bypass operations and stent placements had been unjustified, needless and inappropriate.
Does all this mean that new technologies are useless? Clearly not. Historically and still now, new technologies have provided considerable improvements in terms of healthcare results. But it is a mistake to assume that new technologies are necessarily better. Tools are thus needed to identify the real innovation, relevant results, and contribution of new technologies compared to existing ones, and whether or not this difference is worthwhile or cost-effective.
In a hospital near Buenos Aires — Photo: Jorge Gobbi
Perhaps the biggest challenge is to do things in the correct order. First we need to identify unsatisfied health needs, then seek out the technologies that would meet them. It shouldn't be the other way around, with new technologies seeking contexts where they might be used, including in non-priority situations for the public.
With that in mind, we should be duly concerned about the procedures used to decide whether or not a medical product or procedure can be marketed in Argentina. First of all, there's just a single barrier in place for such products and procedures: the ANMAT food and drug agency. Not only that, but depending on where those things were previously approved, ANMAT will essentially rubber stamp them. And once authorized, people will be paying for those products and procedures often at prices that do not justify the benefits they offer.
The near future is offering us a proliferation of diagnostic methods described as "precision" diagnoses, or increasingly personalized treatments. Will these prove to be disruptive technologies in managing health problems, or more of the same?
If we really want healthcare improvements, we need systematic processes to evaluate new technologies, estimate their comparative contributions and thus reduce uncertainty in making coverage decisions.
Argentina has spent the past four years debating whether to create a National Evaluation Agency for Sanitary Technologies. But despite an apparent consensus among stake holders, including patients and pharmaceutical industry representatives, no such law has been passed.
It's time to apply a dose of skepticism to new technologies and accept that not everyone can access any treatment, nor do they need to. We must establish the true value of technologies in solving the healthcare problems of the public at large, and avoid situations (like with certain cancer drugs), where the costly treatments doctors prescribe are more beneficial to the oncologists themselves than to their patients.
Truly innovative technologies need to be properly vetted — for the benefit of everyone. It's something we all deserve.
*Lifschitz heads the specialist faculty in healthcare technologies at the University of Buenos Aires School of Medicine.
Laura Valentina Cortés, Inès Mermat, Renate Mattar et Hugo Perrin
February 02, 2023
Welcome to Worldcrunch’s LGBTQ+ International. We bring you up-to-speed each week on a topic you may follow closely at home, but can now see from different places and perspectives around the world. Discover the latest news on everything LGBTQ+ — from all corners of the planet. All in one smooth scroll!
This week featuring:
Top athletes coming out
Scotland’s trans violence
EU defends inclusive fairytales
… and more
✉️ You can receive our LGBTQ+ International roundup every week directly in your inbox. Subscribe here.
TW: This content may address topics and include references to violence that some may find distressing.
🇪🇬 In Egypt, Gangs and Police Target LGBTQ+ People Using Dating Apps
The new BBC investigative documentary Queer Egypt Under Attackhas revealed how criminal gangs and Egyptian police officers are using dating apps to target the LGBTQ+ community.
In a two-year-long investigation, journalist Ahmed Shihab-Eldin uncovered the tactics used to lure, and eventually prosecute, LGBTQ+ people in Egypt, where no explicit law against homosexuality exists, but where queer people are more and more at risk of abuse and extortion.
Gangs meet their potential victims on dating apps, where they pretend to be regular people looking for a date, then rob, beat, and extort their victims for money, usually filming these acts and using them to humiliate the victims. The videos often end up online and get millions of views, or they are directly sent to the victims’ families and friends. The police are using the same methods.
While there is no explicit law against homosexuality in Egypt, the crime of debauchery, which is originally a sex work charge, is commonly used to prosecute the LGBTQ+ community. Some of the witnesses interviewed by Shihab-Eldin also declared that they were promised freedom if they in turn became informants and named some of their peers that had the same “perversions”.
🏈 Change Afoot? Top Athletes Come Out In Basketball, Rugby, Tennis
Daria Kasatkina of Russia during the second round of the 2023 Australian Open Grand Slam
A number of high-profile athletes came out this week, such as former pro Australian basketball player Trevor Torrance. Torrance said that he never considered coming out during his career, which coincided with the peak of the AIDS epidemic. “I suffered from anxiety,” he says. “I know I had moments of bouts of depression.”
Russian Tennis Champion Daria Kasatkina also says that being able to come out was a relief to her. “Living in the closet is impossible. It is too hard, it is pointless,” she stated. Kasatkina has also been a vocal critic of the Kremlin and Russia’s war against Ukraine. She officially came out as queer this past summer, but shared in an interview with the Guardian this week that coming out “helped her” and that she is “happy with the outcome.”
Former New Zealand prop Campbell Johnstone has also come out as the first gay All Black. Johnstone said that he has been “leading a double life” and “living a lie” when he came out on television this Wednesday. His coming out has been praised and regarded as “pretty courageous”, especially by All Blacks loose forward Ardie Savea: “He probably doesn’t realize how many people he’s helped internally with what he’s done, so big ups to him.”
🏴 Report Shows Explosion Of Trans Hate Crimes In Scotland In Past 10 Years
Hate crimes committed against trans people in Scotland are rising faster than any other type of hate crime, according to new government statistics published recently, with a 68% increase from 2020–2021 to 2021–2022. Hate crimes targeting the sexual orientation of minorities almost doubled since 2014.
At the center of debates is the Gender Recognition Certificate (GRC), which allows trans people to be recognized properly on many legal certificates. In the UK, trans people must submit a medical diagnosis of gender dysphoria before they can obtain one.
In December 2022, Scotland passed legislation that would have removed it to make the process simpler and more accessible. In January, the UK government blocked the reform for women and children protection.
🇮🇳 Delhi Lawyer Denied Judge Position Because Of “Attachment To Gay Rights”
Kirpal, whose appointment as high court judge has been pending for the past five years, is appalled by the matter and claims that the bench is composed of upper caste, heterosexual men – all of whom are biased, which is not a reflection of the society he lives in.
🇱🇹 EU Says “No” To Warning Label On Lithuanian LGBTQ+-Inclusive Fairy Tales
Cover of a children's book containing LGBTQ+ inclusive fairy tales
The European Court of Human Rights has ruled that imposing a warning label on a children’s book because it contains LGBTQ+ inclusive fairy tales is unjustifiable and violates the right to freedom of expression.
In 2013, the Lithuanian University of Educational Sciences published late lesbian writer Neringa Macaté’s book Gintarinė širdis (“Amber Heart”), containing six fairy tales, two of which had storylines about relationships and marriages between persons of the same sex. After it was published, complaints were submitted and the Lithuanian courts agreed that the book could cause harm to children because of the LGBTQ+ inclusive fairy tales
The Inspectorate of Journalistic Ethics concluded that the book has a negative effect on minors and therefore recommended that the book be labeled with a warning that it might be harmful to children under 14 years of age. But in 2019, the author, who passed away in 2020, took the matter to the European Court of Human Rights. On Tuesday, the European Court of Human Rights ruled that imposing a warning label on a children’s book because it contains LGBTQ inclusive fairy tales is unjustifiable and violates the right to freedom of expression. The court also ordered Lithuania to pay €17,000 to the author’s mother to cover damages and litigation costs.
🇲🇽 Mexico Police Arbitrarily LGBTQ+ People On Grounds Of “Lack Of Morality And/Or Good Manners
In the State of Mexico, phrases such as "lack of morality" are used by the police to harass, extort and arbitrarily detains LGBTQ+ people in public spaces. The findings are shown in an analysis of the 125 municipal governments of the State.
Ricardo Torres, president of Fuera del Clóset A.C. explained “we have been documenting arbitrary arrests, extortion, and harassment by public servants, especially municipal police, for 10 years… And this is something that not only occurs in the State of Mexico, but throughout the country, which uses the figure of ‘lack of morality’ or ‘exhibitionism’ as the perfect excuse for the detention of LGBT+ people."
🇫🇷 France Mourns Bullied Gay Teenage Teenager Who Committed Suicide
Lucas, a 13-year-old gay boy committed suicide on Jan. 7 in Vosges, France. According to his mother, during a press conference last Monday, he was the victim of harassment in the form of teasing and insults due to his homosexuality. A march in memory of Lucas will be held Sunday, Feb. 5.
On Friday, Jan. 27, public prosecutor Frédéric Nahon announced that four students will be tried in the spring for harassing and pushing Lucas to suicide, He also announced the opening of an “incidental investigation against X for non-disclosure of ill-treatment of minors”. During Monday's press conference, broadcast live by the news channels, Lucas' mother said: "It's not just these four young people, it's not just them [...] But it will be the court that will decide. I just want my son to rest in peace and for justice to be done.”
The news has shaken the country with many institutions being scrutinized. One wrote to the French President: “Mr. Macron, stop saying that primary school is "far too early" to deal with questions of sexual orientation and gender identity.“
🇺🇬 Ugandan LGBTQ+ Rights Activist Margaret Sekaggya Receives Lifetime Achievement Award
The U.S. Mission in Uganda has given activist Margaret Sekaggya the Dorothy Ngalombi Lifetime Achievement Award in recognition of her outstanding service and achievements as a human rights defender during the U.S. Mission Alumni Impact Awards Ceremony.
Before she founded the Human Rights and Peace Center, of which she is currently the executive director, Sekaggya served as the Chairperson of the Uganda Human Rights Commission (UHRC), which she also helped establish. Sekaggya was also the first United Nations special rapporteur for human rights defenders.
Sekaggya is also known for having successfully opposed the 2010 Anti-Homosexuality Bill in Uganda that would have imposed on an offender imprisonment of at least five years, and in the case of a non-governmental organization, the canceling of its certificate of registration and criminal liability for its director.
🇬🇧 London’s Trans Inclusive “Vagina Museum” Gets Eviction Notice – Again
The world’s only vagina museum dedicated to “vaginas, vulvas and the gynecological anatomy” currently located in London, UK, has been yet again asked to vacate the premises, less than a year after it moved into its Bethnal Green site.
The museum’s aim since it opened in Camden Market in 2019 has been to promote queer and trans-inclusive education about anatomy, which has subjected the venue to severe transphobia. After welcoming 40,000 visitors free of charge during the past ten months, the Vagina Museum will be closed to the public from Feb. 1 so it can vacate the premises.
🇺🇸 Utah Bans Gender-Affirming Medical Care
The Republican-dominated state of Utah has become the first U.S. state to ban gender-affirming care for young trans people. The new measure, passed into law on Jan. 28, will include gender surgery, puberty blockers, and hormone therapy for minors that had not been yet diagnosed with gender dysphoria.
Utah Governor Spencer Corx affirms that this ban was brought on by a desire for “more and better research” to understand the “consequences” of gender-affirming healthcare. But Brittney Nystrom, executive director of the ACLU of Utah, affirms that this bill “bans access to life-saving medical care for transgender youth in Utah”. Another 18 other states are currently considering similar legislation.
🇳🇱 Dutch Constitution Changed To Ban Sexual Orientation-Based Discrimination
“A disability, or who you fall in love with, should never be a reason to be excluded,” said Habtamu de Hoop, member of the PvdA, a left-wing opposition party in the country.
🇺🇸 Trans Model Laith Ashley Stars As Taylor Swift’s Love Interest In New Music Video
Trans model and actor Laith Ashley is Taylor Swift’s love interest in her new music video. Laith Ashely co-stars as the singer’s love interest in the new music video for “Lavender Haze,” the second single from her 2022 album Midnights. Ashley has previously appeared in campaigns for Barney’s and Diesel, walked the runway for Marco Marco, and was the first out trans member of the “pit crew” on RuPaul’s Drag Race.
Swift’s choice of casting for a video she wrote and directed herself has been defined as “a big moment for representation” by Gay & Lesbian Alliance Against Defamation’s director of trans representation Alex Schmider.