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Posts posted by wathe

  1. I think it depends what you mean by "doctor". She has a PhD, so she is entitled to use the title "doctor".  Her RDN credential makes her a health care professional.  So she is someone who sees patients in a clinical context, and uses the title "doctor", but isn't a (medical) doctor in the colloquial healthcare sense.  

    Under which regulatory body does she hold her licence to practice?  That will probably answer your question.

    (Just like those with PhD's in nursing can use the title "doctor" and treat patients, but they are practicing as nurses, they are not medical doctors).  It can be confusing for patients.  ETA here they could get themselves into trouble if not very careful, the title doctor is protected here in the context of healthcare.


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  2.  I really think that much of the explosion in numbers of rapid onset gender dysphoria in girls is a reaction to how miserable female adolescence can be in a patriarchal and misogynistic society; and that the (relative) social acceptability of being a transgendered person presents a way out.  There also definitely does seem to be a certain amount of social contagion.

    Hating being a girl is not the same thing as being transgendered, but assuming a transgender identity might seem like a good way out for some hate-being-a-girl adolescent girls.  I think we will see a lot of de-transitioning in this population the next 10 years of so.  Along with suing of medical professionals who affirmed and assisted with physical transition (medical/surgical), that in retrospect, wasn't  indicated..

    Of course transitioning, including medical/surgical, really is the right choice for many transgendered people.  My worry is that many of the adolescent girls presenting as ROGD actually aren't transgendered, and that a policy of affirming without doing all the hard psychological work is really very harmful.

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  3. A few posters have alluded to family culture, and I think there is something to that.  My parents and DH's parents were very near to 30 before their first kid, and my grandparents were 25 for one set and 34 for the other at age of first kid.  All my cousins who've had kids were also in their 30's at the time of first kid.  And fewer than 50% of my cousins had kids at all.  Neither DH nor my sibs have kids, and aren't terribly likely to now (late 40's) - though DH's aunt and uncle adopted his cousin when they were just shy of 50, so still possible, of course.

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  4. 1 hour ago, regentrude said:

    I gave birth to my first child shortly before my 29th birthday. Does that count as delayed?
    My pregnancy happened exactly when I planned it: after I had completed my PhD and a two-year postdoc in a foreign country.
    I am very happy with that decision. I got to complete my education and travel before having family responsibilities.

    I lived in a country with universal healthcare where I did not pay a penny for prenatal care or birth, extensive fully paid maternity leave, three years job guarantee with parental leave, subsidized childcare. That did not affect the timing of my pregnancy because I wanted to complete my education first. (The fact that I decided not to embark on a career that made full use of this education is not relevant)

    There's a lot we, as a country, could do to make having children less of a financial risk for young mothers: paid maternity leave, universal healthcare, parental leave with job guarantee, child sick days, subsidized child care for low income families.... This won't get highly educated women to have children younger because it just takes a long time to get an advanced degree and doing so while mothering is very, very hard, but it would go a long way encouraging mothers who feel they cannot afford to get pregnant. Nobody should have to forgo having children because the cost of birth and the loss of postpartum income make that unaffordable.

    Universal healthcare here too.  Prenatal care and birth cost zero dollars out-of-pocket (other than the cost of parking!).  Maternity leave is less than what you describe, but not terrible (job guaranteed for up to 18 months combined pregnancy and parental leave, much of it paid).

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  5. First kid at 35 here.  I spent my 20's and early thirties in school and establishing my career.   No regrets.

    Almost all of my female colleagues have also delayed childbearing well into their 30's, so I don't really feel like and outlier.  

    I think my kids have benefitted from having parents who are well established - both financially and maturity-wise.  

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  6. 5 hours ago, Pen said:

    thank you! 
    your post crossed mine and the publication answered several of my questions — about National versus Provincial rules for example


    How did age 12 for consent to these vaccines emerge?
    The Ontario row (I think you are in Ontario) seems to indicate age 16 as being presumed as usually being capable of making medical decisions.  (And I also think age 16 is a better fit for a lot of children than 12– plus it is at least in states typical driving age with driving responsibilities.) 

    and I am still wondering how exactly the dialogue — especially with a child — patient works, what’s said about risks in ways a child can understand and so on?


    If it were later to turn out that there was not effective dialogue or appropriately informed consent, who gets into troubles for that? The physician who should have had a dialogue? The nurse who gave the injection? The national care system? 


    Quick reply:  There is no age of consent in my province.  The Health Care Consent Act, which governs consent, presumes capacity in all persons, including minors, unless there is reason to believe otherwise.

    The Substitute Decisions Act, presumes capacity above age 16 - that act is more about assigning powers-of-attorney though, I think. 

    People, especially minors,  may be capable of some decisions (ie vaccine) but not others (ie major surgery).

    Presuming that 12yo's are capable is within the letter of the law here, and makes it easy for public health to get vaccines into arms in schools. 

    The person getting the consent is evaluating the capacity of the person they are getting consent from while they are having  the consent discussion.  In covid mass vax clinics, the 12 year old is almost always accompanied by the parent of guardian (I've yet to see one unaccompanied), and the consent discussion is generally shared, with both parent and child involved.    It does mean that 12 year olds aren't forced to have vaccines they refuse, even if their parent wants them to have it (and, less commonly, that 12 year olds can opt to get vaccine, even if their parent doesn't want them to have it.  Though in practice, it would be hard for a 12 year old to book a vaccine appoinment and get themselves there without adult help)

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  7. 6 hours ago, SKL said:

    All of the sites we've used required consent, including parent/guardian consent for any minor.

    Just for clarity:

    Our sites also do require explicit consent.  The difference seems to be in how it's documented. 

    As a vaccinator, I ask, explicitly, "Do you consent to receive Pfizer covid 19 vaccine today?", and the patient says,"Yes!", and I tick the consent box on the electronic medical record, and administer the vaccine.  Or they say, "No", I document that they've declined, and I don't administer the vaccine to them - I've had a few decline.

    I can't remember the legal reasons why it's like this here, something to do with paper consent forms and signatures for minor procedures not meaning much in court, I think (link at end of post).  I mean, if the patient went to all trouble  and hassle to book an appointment, come to a covid vaccine clinic, sit in my chair, and roll up their sleeve and let me give them a needle, it's because they want the vaccine  (implied consent).  We still do get explicit consent, though.

    The minor consent thing really is different here, and it's caused some issues/controversy with immunization programs in schools.  Kids get HPV and Hep B series in grade 7 here.  The kids 12+ consent for themselves, unless there is an obvious capacity issue (ie developmental delay.) Parents are notified, but parental consent is not required.  I actually disagree with this.  I don't think that most 12-year-olds are capable of consenting to medical procedures for themselves (mine certainly isn't IMO).  The work around is that some parents will just have their kids stay home "sick" on vaccination day.  (I'm very pro-vaccine.  My boys will both get their HPV just as soon as they are eligible.  We homeschool, so I will have to arrange this myself)  

    From a Canadian medico-legal website (just because I find the differences between US and Canada interesting):

    Consent may be confirmed and validated adequately by means of a suitable contemporaneous notation by the treating physician in the patient's record.

    A consent form itself is not consent

    Consideration of a consent form to be signed by the patient should not obscure the important fact that the form itself is not the "consent." The explanation given by the physician, the dialogue between physician and patient about the proposed treatment, is the all important element of the consent process. The form is simply evidentiary, written confirmation that explanations were given and the patient agreed to what was proposed. A signed consent form will be of relatively little value later if the patient can convince a court the explanations were inadequate or, worse, were not given at all.

  8. 38 minutes ago, Pen said:

    thank you! 

    someone I know - where two family members had very different reactions  - (eta- both adults so not really right for 12 to 15 thread, but I hope you will answer if you know the answer) raised a different issue which was whether at some sites (USA) where less experienced people are doing the administration and especially with whichever type requires dilution (I can’t recall if it was Pfizer or Moderna) whether the mixing is thoroughly done by all people administering it, could one person may get more of the active ingredients part  while spouse perhaps gets more of the diluent? 

    I don't think so.

    Ours are mixed by hospital pharmacists, who definitely know what they are doing, then distributed to the vaccinators for administration.  The mixing is done very carefully, as per strict protocols.  

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  9. 32 minutes ago, Ausmumof3 said:

    That’s really surprising to me.  We’ve never had a vaccine that doesn’t involve a consent form.  Is it possible that one is being signed when they book an appointment?

    Quite sure.  DS and I got our vaccines through the same clinic.  No physical signing of anything (I also haven't ever physically signed anything for the kids childhood vaccines.  Those were verbal consent at the family doctor's office.  Consent was explicit, and documented in the chart, but no signatures)

    ETA the process is completely paperless.

    ETA again:  I do sign for flu shots at work, but I think that's because they're administered by my workplace and they are tracking who's had one and who hasn't.

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  10. @Pen

    I administer mRNA vaccines at a mass vaccination site.  Nobody is getting placebo!

    Our process doesn't involve any signatures.  Consent to receive vaccine is verbal.  Age 12+ consent for themselves, unless there is a capacity issue.

    Patients register (demographics and insurance) online or by phone when booking their appointment.  Information about the vaccines is available for review at that time.

    In clinic, vaccinators identify the patient, ask the screening questions, answer any questions, get explicit verbal consent for covid vaccine (specifically for either Pfizer of Moderna, whichever product we are using that day), and document all of this electronically.  There are paper copies of the product monograph and product information sheets on site for patients to review if they wish (I have yet to have a patient who has wanted to do this).  After their vaccination, patients get a printed and/or electronic receipt with their name and other demographics, product name, lot number, injection volume, injection site, location of the clinic and name of the vaccinator.  They also get a paper handout with a list of common side effects, a list of symptoms to watch that might suggest a serious reaction, and what to do about them.

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  11. My oldest is 13.  So far, we've gone into the room with him, but I think he might be ready to go alone next time.  He'll decide for himself.

    I do all the booking, since I'm the one driving and I'm the one with the tricky schedule.

    Our family doctor is both sex-matched and race-matched to our kids (well, matched to the POC parent.  The kids are mixed race).  We didn't actively seek this, but I'm glad that's how it's worked out.

    Mine are boys.  But, regarding gynaecologists:  they don't do primary care here.  Pap tests, birth control, STD screening and management and other primary female reproductive health care is all done by family doctors here.  Gyne would be by referral only, generally only for issues that require surgical management or complex medical management.

  12. DH has and electric fly swatter.  He loves that thing.  It makes a very satisfying zapping noise.

    No insecticide in the house!  

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  13. I've tried to inoculate mine (mixed-race kids) by formally studying racism and social justice at home, through a CRT lens.  We homeschool, but DS 13 (finishing grade 7) will likely go to public high school.  I figure that if he already has a thorough grounding in antiracism through a CRT lens at home, then that will be protective against any poorly taught antiracism content that might happen at school.  

    He understands that structural racism is a systemic problem wth historical roots, and not the fault of any one person.

    He understands the concepts of bias (we all have some), privilege (we all hold some), and intersectionality.  

    He understands that privilege is often invisible to those who hold it.  We talk about how our privilege or lack-there-of plays out in real life.  He and his father hold male privilege and I don't, I hold white privilege and they don't.  How structural racism has influenced our family's history.  All of this happens quite organically, without anyone feeling threatened or labelled as an oppressor.  

    He understands that systemic/structural racism is the disease, and that internalized and interpersonal racism are the symptoms.  

    I actually think that mixed families may have an advantage with this.  There are opportunities to do this teaching quite organically at home in a very real-life way that maybe same-race families don't have.

    ETA: One of my kids is white-passing, and the other isn't.  That has also added layers to the conversation.

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  14. Just now, mommyoffive said:


    I would  go with the first dose you can get.  I am in the states and haven't heard of mixing doses here at all so I don't know anything about the science of that.   

    Delta becoming the main strain there this month is so scary.  Ugh.  

    I think so too.  I will feel terrible if he gets VITT though.  But I will also feel terrible if he gets covid while waiting......

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  15. You can weight a bedsheet by picking open the side edges of the top hem (which is usually wide)and sliding a broom handle in there.  Makes it a bit wind-resistant,  and hang nice and straight without wrinkles.

    Edited for clarity:  Hang it upside-down so that the broom handle is at the bottom, of course.

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  16. 9 hours ago, Not_a_Number said:

    Yes, I see that, although that would often wind up with kids with LDs being reviewed. This is why I worry about sticks and not carrots. Perhaps we should make sure everyone gets reviewed and that the process isn't scary... 

    For sure.  But if there is a cut off, it should at lest make some kind of mathematical sense!

    i’m fortunate enough to be in a province that’s very low regulation, so I don’t have any personal experience.  But it seems that 33rd percentile is used as a cutoff to trigger a review in several states , and it just doesn’t make any sense to me to be flagging kids whose test results are well without the range of normal.  

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  17. 14 hours ago, maize said:

    This is NOT true when looking at percentile score. To get 25th percentile you need to score better than 1 out of every 4 students--better than 25 out of every 100 students--either in the actual test group or the sample the test was normed on, depending on how percentile is determine for a particular test.

    This is not at all the same as getting one out of every four questions right, unless the test was normed on a group where for every hundred students answering 100 questions on average one student got 1 correct and 99 wrong, another student got 2 correct and 98 wrong, another student got 3 correct and 97 wrong, etc. with precisely one out of every hundred students getting each possible score. That is an exceedingly implausible scenario.

    Multiple choice tests can be tricky because the "wrong" answers are often specifically chosen to mirror common student errors. My sister teaches at a Title I school where a majority of the students score lower than would be predicted if they filled in the bubble sheet at random--or chose B for every answer. A majority of the students. More than 50%.

    That means that, if her school sample were used to determine percentiles, someone who answered B to every question would be ABOVE the 50th percentile.

    By contrast, if more than half the kids in a group got 3 out of 4 answers right a kid who got 75% of the answers right would score below the 50th percentile for that group.

    We really do need to be careful not to conflate percentile scores with "percentage correct" or even with material mastery. All percentile scores do is compare the test taker's performance with that of other test takers.


    Yes.  Percentile is a measure of rank within a group.  Very different than a percent correct score.

    By definition, one third of kids are going to rank 33rd percentile or less.  33rd percentile is well within the range of normal, statistically speaking (well within one standard deviation from the mean).

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  18. 49 minutes ago, KSera said:

    I agree if they had to place a bet, they thought it was likely vaccinated people weren’t going to transmit Covid. But they can’t lift public health measures  in a pandemic based on a hunch that the research would eventually show something. I really do think it was necessary to wait for evidence rather than changing recommendations based on a guess. (And besides that, again, it isn’t true that fully vaccinated people don’t transmit Covid. They do so at a vastly lower rate, but the fact it’s not 100% illustrates why they really did need to wait and see how well that worked in the real world.)

    Yes.  Because the cost of being wrong would have been very, very, high, and the cost of maintaining the status quo (continue masking) was relatively low.  Also, they did "bet" wrong against asymptomatic/presymptomatic spread being a thing, back in Feb/March 2020 when PPe was in short such supply and public health officials advised the public not to wear masks, and instead to stay home if symptomatic, to cover coughs and wash hands, based on experience with SARS not spreading when asymptotic/presymptomatic.  How wrong they were.  And how hard it was to recover from that, both from a pandemic out-of-control point of view, and a public trust point of view.  


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  19. 5 hours ago, TCB said:

    @wathe do you know anything about so called studies in Canada showing the dangers of Covid vaccinations? Saw something about it on the dreaded FB but no details or links or anything.

    Not until you mentioned it.  

    It looks like Byron Bridle is a PhD who teaches at a veterinary college, with experience in vaccine research.

    A quick google shows him mentioned on this topic recently in tabloid-y newspapers and christian websites - not the sorts of places I read.  The few interviews I looked at seemed somewhat sensational and lacking references.

    I see a few mentions on David Fisman's twitter that debunk Bridle's claims (Fisman is an epidemiologist and actively practising infectious disease specialist who has been super-active in my province's covid response and on social media wrt covid.)

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