I’ve recently been forwarded a document that the Victoria University of Wellington’s Mauri Ora Student Health clinic has been using to blanket deny their patients progesterone, even going as far as to forcibly discontinue the prescription from people already prescribed it.
I normally avoid doing a critique of a specific practice because there are many factors that go in to the decision to prescribe, but I was shocked that this practice would just invalidate a standing prescription without any evidence of harm. Not prescribing because of a lack of knowledge of the correct process or side effects is one thing - a doctor cannot provide informed consent if they themselves are not informed - but to remove an existing medication because they don’t like it is quite another. Imagine if a doctor refused to continue a contraceptive prescription because they had a personal belief against it? In certain circumstances doctors can refuse to prescribe due to personal beliefs, in which case they are required to refer you to someone who will.
So lets pick apart their reasoning to see if there’s anything behind it, because if progesterone is dangerous despite multiplesources saying it should be up to the patient I’d like to know, and I’m sure a lot of others would as well.
The problem with having to get a doctor to prescribe gender-affirming hormone therapy is that doctors are trained to treat diseases. When you’re treating a disease you have a clearly defined goal - curing the disease, or minimising the suffering if it cannot be cured. This also extends to the scientific studies used to formulate treatment options, there is a clear and measurable definition of success. This is critical for normal patient care, doctors want to minimise the harm caused - and lets be clear, all medicines are harmful, just less harmful than what they’re treating - while maximising the effectiveness of the treatment.
This doesn’t work for gender-affirming care though. The effects you get from hormones depend a lot on your genetics and we don’t know enough about those to determine if a treatment is fully effective. In terms of M-F transition, we can’t establish if a certain breast size is the one genetically encoded, or if it has been restricted due to a lack of hormones. For those going F-M, is your voice fully deepened or has it stopped because of insufficient testosterone? Does the hormone level actually matter to either or is there just a threshold? We cannot design a study for this, especially given it would have to run for over 5 years to fully capture all the changes.
All of the uncertainty leads to doctors missing out on one half of the risk calculus - if you can’t tell what the target is you’re stuck with minimising the overall risk rather than balancing it against the effectiveness of treatment.
Now I’ll focus on one of the problems this causes
As always I’m looking at academic papers, so there will be medical language used some of which may be outdated.
When you have more than a handful of pages on your site updating anything shared between them becomes tedious. Things like your site menu, a copyright footer if you have one, perhaps the default header and meta tags.
There were options. You could use a tool like Macromedia Dreamweaver, GoLive CyberStudio, HoTMetaL, or HotDog (one of New Zealand’s .com boom success stories!) to author all your HTML and copy the files you could use their built-in templating features, or copy/paste the changes.
If you weren’t rich enough to use those tools - they did cost quite a bit - you’d either have to roll your own using local scripts, or rely on server-side features.
The most obvious is PHP. This is one of the reasons PHP was created, PHP originally stood for Personal Home Page and was a CGI script. The original PHP syntax was very different to what ended up being PHP3, in fact it was very similar to what I’m about to use.
I’ve updated my website with all the pages, common elements brought to you by Server-side Includes!
As promised, I’m going to go through how the CGI scripts work. This is not a Perl how-to, or even an example of good perl, but more a description of the process of writing any CGI script.
The next instalment in building a website like it’s 1999 - adding some interactivity! After all if people can’t submit things on your website how else will you hear from them?
I’m going to add two critical parts of a 90s website - a hit counter and a guestbook.
The guestbook page now works! It has a completely different style from the homepage, as was the fashion at the time. You have to show off all your design skills.
Yesterday’s post was getting a bit long, so for those who weren’t doing web design in the late 90s/early 2000s here’s some background.
The constraints of 1999
The late 90s were a time of rapid change in the world wide web, the first big browser war was brewing. Netscape Navigator browser got bloated with the Communicator product they were pushing and Microsoft’s bundling of Internet Explorer with Windows rapidly pushed Netscape out of the market. Both implemented parts of HTML4 and CSS 1 and 2 in differently buggy ways, and they both had different ways of using JavaScript to animate elements on the page. Back then we called it Dynamic HTML!
To change from my regular ramblings about healthcare and reading one to many rose-tinted reckons about how things used to be, let’s make a website like it’s 1999!
What this is and isn’t
My aim is to show how you got your site online in 1999, but not to be historically accurate, so
I will be using modern HTML and CSS. Quirks mode belongs in the past
The server software will be modern, because if it wasn’t the server would already be compromised.
I will be using secure methods rather than accurate ones, but I’ll note where this is different.
But I will show how we made websites dynamic and the compromises made when you had limited space!
I’ll make another post on the server setup if you want to follow along. Ask nicely and I might just give you access to TheaNET.