Tory claims "sex change" surgery is a choice

[Natasha]

Tory claims "sex change" surgery is a choice

http://www.pinknews.co.uk/news/articles/2005-8048.html
6/20/2008

"Ms Harman, who is also the Secretary of State for Equality, told Mr
Pritchard he "misunderstands the situation.

"It is not a question of choice: if someone needs to have gender
reassignment surgery, it is a question of necessity for them."

[Sephirah]

I'm really not sure where I stand on this.

Being in the UK, I can sort of understand where the Conservative MP is coming from. Which isn't to say that I think he's right. But the situation in the NHS is pretty bleak. It's a postcode lottery of which drugs you can have access to and which you have to pay for privately. Especially with regard to high-cost cancer drugs and alzheimers medication. Some of these drugs have been cancelled because they weren't found to be cost effective. And people are dying because they don't have access the drugs they need.

Speaking personally, if I was considering going the route of the NHS treatment, I would choose to go privately if that meant someone else would get a cancer treatment that could save their life. Afterall, we are pretty lucky in the UK to be able to get the procedure essentially free (even if you do have to lose every shred of your humanity and jump through more hoops than a trained circus animal to qualify).

This is just my personal view. I can also see the Minister's point of view, and I agree that the need to have GRS isn't a choice, it's a necessity. But it isn't life threatening, and there are other roads that can be taken to achieve my goal. Plus, I have time. It's not as though I might die from not having the surgery.

"Many of my constituents do not have access to Alzheimer's drugs or cancer drugs, but neither of those diseases do they have through choice."

That was a very unfortunate choice of words. And one that's likely to raise more than a few heckles. But I can see the intent behind the words. I think what he's saying is that people make a conscious decision to start treatment for Gender Dysphoria, and they do so without being forced to by any time constraints. Whereas people with conditions like Alzheimers or cancer need to get treatment and can't afford to wait or save up to go privately.

[Keira]

If a drug is not efficient / cost, it means the drug is only marginally
better than another cheaper drug. Of course, the drug companies
are not happy because they're essentially drug pushers and they're
the ones pushing the PR for a "broken" NHS or any other system
which does not select their wares.

The truth is when a drug is not chosen its usually because it offers
marginal improvement over an existing one at 10x the cost or more.

Often, the money spent on that drug (and hundreds of others like that),
will impact end to end treatment of patients. Which can have a huge
impact on overall morbidity in the health system.

In a public system, you
try to raise the health of everybody in the system, and sometimes,
most often rare, it means a patient doesn't get the most up to date
treatment (doesn't mean they get crap treatment).

Of course, when
your suffering a debilitating disease, every shred of hope, even at the
highest of cost, is something you want. But, even there,
is that latest greatest all its cracked up to be (see Vioxx debacle).

For example, if that new medication
has a 35% improvement over a 5 year period for 40% of patients
(25% for 25% of patients)  of patients  compared to a med
with 30% improvement over that period for 80%, is it better or not.
Not so easy a choice is it?  (that's not even putting the
money aspect into the equation).

One is better for a smaller % of people than the next for a broader range (not to mention the whole thing about older medication's interaction with other medications and their side effects being better understood).

In general, NHS and other like systems need tweeks rather than overhaul.
I dealt with the US system for 5 years of my life (and 35 in Canada), and
believe me, the US system is the most terrible possible. Even if you
are insured it doesn't mean your insured enough, or that they won't
pull the rug under your feet when you need it most.

[jenny_]

I'm really not sure where I stand on this.

Being in the UK, I can sort of understand where the Conservative MP is coming from. Which isn't to say that I think he's right. But the situation in the NHS is pretty bleak. It's a postcode lottery of which drugs you can have access to and which you have to pay for privately. Especially with regard to high-cost cancer drugs and alzheimers medication. Some of these drugs have been cancelled because they weren't found to be cost effective. And people are dying because they don't have access the drugs they need.

Speaking personally, if I was considering going the route of the NHS treatment, I would choose to go privately if that meant someone else would get a cancer treatment that could save their life. Afterall, we are pretty lucky in the UK to be able to get the procedure essentially free (even if you do have to lose every shred of your humanity and jump through more hoops than a trained circus animal to qualify).

This is just my personal view. I can also see the Minister's point of view, and I agree that the need to have GRS isn't a choice, it's a necessity. But it isn't life threatening, and there are other roads that can be taken to achieve my goal. Plus, I have time. It's not as though I might die from not having the surgery.

I don't agree with you.  I'm not sure that it can be said that denial of treatment isn't life threatening, considering the suicide rate amongst pre-op transsexuals (20-30% from what i've read).  But even if that wasn't the case, the nhs does treat loads of non-life threatening things such as hip replacements, knee reconstructive surgery etc.  But like GRS, they are both necessary to improve quality of lives.

Also theres the argument that the nhs isn't free, and that we all pay for it out of NI and that includes us, so we should have the right to treatment.

"Many of my constituents do not have access to Alzheimer's drugs or cancer drugs, but neither of those diseases do they have through choice."

That was a very unfortunate choice of words. And one that's likely to raise more than a few heckles. But I can see the intent behind the words. I think what he's saying is that people make a conscious decision to start treatment for Gender Dysphoria, and they do so without being forced to by any time constraints. Whereas people with conditions like Alzheimers or cancer need to get treatment and can't afford to wait or save up to go privately.

I think your maybe being a little generous in giving him the benefit of the doubt.  I came to quite a different understanding of what he intended to say from "...and the fact that sex changes are a matter of choice" 

And he wouldn't be the first Tory MP to believe that GRS was a matter of choice - Edward Leigh springs to mind, though Leigh did go a lot further in making his feelings felt.

[tekla]

I don't know about the surgery but voting Tory is a choice, so don't do it.

[Sephirah]

I don't agree with you.  I'm not sure that it can be said that denial of treatment isn't life threatening, considering the suicide rate amongst pre-op transsexuals (20-30% from what i've read).  But even if that wasn't the case, the nhs does treat loads of non-life threatening things such as hip replacements, knee reconstructive surgery etc.  But like GRS, they are both necessary to improve quality of lives.

That's very true, and I'm with you all the way there. But how often is mental distress taken into account when deciding what is or isn't feasible? What I meant was that it isn't physically life-threatening in that you're going to drop dead if you don't have it, regardless of how you may or may not feel about it. Granted, it may be critically important to the person involved, and I completely understand that. Which is why I said it was just my personal view (that if I were in that situation, it wouldn't be life-threatening to me). I didn't mean to speak for everyone and apologise if that's how it came across. To a lot of people it will be a matter of life or death, and may be the only chance they have, so to deny them would be condemning them, in effect, to a death sentence. But it's a death sentence ultimately by their own hand.

The thing is, gender dysphoria and gender reassignment surgery may not be a choice for any transgendered person, but suicide definitely is. You have to make the choice to take your own life (and I've been on that knife-edge a fair few times). The denial of treatment itself won't kill people, it's their reaction to that denial based on their mental state that will make that Sword of Damocles fall. And not everyone who gets told they can't have the procedure on the NHS will go down that route. Some may see it as another hurdle to be overcome and re-evaluate their options.

I'm just trying to look at the issue from both sides. This one, though, strikes me as headline-grabbing and sensationalist because that's what the Tory MP thinks people want to hear. Unfortunately, with the levels of prejudice in society and the far more common news bulletins about people whose 90-year-old mother died from Alzheimers when she could have lived for another five years if she'd only had access to these newer drugs, that may well be the case. 

If GRS cost the same to the NHS as things like hip replacements or knee reconstructions then we wouldn't even be talking about it, especially considering the relatively small number of people who have GRS procedures on the NHS. I think it's the cost issue that it all boils down to. Keira makes a really good point about the efficacy of drugs and whether newer ones really offer a massive benefit over cheaper ones, not to mention society's innate fear about diseases like cancer and the desire to have the best treatments available, whether they're only marginally better or not.

Comparing treatments that affect one in three people to treatments that affect one in twelve thousand, and implying that the latter means the former suffers... that isn't fair and it's like saying that just because a comparatively small percent of the population is transgendered, that must mean we choose to be that way. I think this MP is looking for a convenient scapegoat for the refusal by PCT's to supply very expensive drugs, and giving Joe Public a target other than the politicians to blame. If it wasn't GRS it would be something like homeopathy that would be in the firing line. A minority procedure that people can be ignorantly persuaded to believe is superfluous.

I can understand his core argument, that the entire NHS is a balancing act and there are priorities to be considered, but the guy didn't do himself any favours by putting it across that way.

Also theres the argument that the nhs isn't free, and that we all pay for it out of NI and that includes us, so we should have the right to treatment.

That's the best argument right there, and makes everything else pretty much irrelevant. I totally agree. We shouldn't have to go elsewhere when we pay into the system for just such a time when we need to use it. I bet I must've already contributed the cost of GRS just through NI. But the government says that the NHS is "free at the point of need" which it kind of is, I mean you don't just use up to your NI contribution and then they kick you out the door. If you need hundreds of thousands of pounds worth of surgery then you can theoretically have it, regardless of whether you've paid enough NI or have been on benefits your whole life.

I think your maybe being a little generous in giving him the benefit of the doubt.  I came to quite a different understanding of what he intended to say from "...and the fact that sex changes are a matter of choice" 

And he wouldn't be the first Tory MP to believe that GRS was a matter of choice - Edward Leigh springs to mind, though Leigh did go a lot further in making his feelings felt.

Yeah, I tend to hope people aren't so dumb closed-minded that they'd say stuff like that in public without it being some kind of misunderstanding. I have a habit of giving people the benefit of the doubt. It's better for my stress levels.

[jenny_]

To a lot of people it will be a matter of life or death, and may be the only chance they have, so to deny them would be condemning them, in effect, to a death sentence. But it's a death sentence ultimately by their own hand.

The thing is, gender dysphoria and gender reassignment surgery may not be a choice for any transgendered person, but suicide definitely is. You have to make the choice to take your own life (and I've been on that knife-edge a fair few times). The denial of treatment itself won't kill people, it's their reaction to that denial based on their mental state that will make that Sword of Damocles fall. And not everyone who gets told they can't have the procedure on the NHS will go down that route. Some may see it as another hurdle to be overcome and re-evaluate their options.

Yeah, I accept that suicide requires a deliberate action to do, and so technically it's a choice.  But I don't think its a choice in the same way other things are choices.  For starters, their mental state does make any sort of rational decision, difficult at best.  Also if their are no good alternatives (or the person can't see any good alternatives), then that diminishes the choice as well.  I mean they might not want to die, but commit suicide because they see no other alternative.

Also, from personal experience, I'm not so sure that a decision to commit suicide can be all that clear cut. I used to have a big problem with self-harm, which of cause is completely different to attempting suicide.  But the differences between the two, physically, are a little fuzzy.  I mean there have been times when i've been suicidal, and don't really know if I was self-harming or attempting suicide.  I genuinely haven't a clue what i "chose" to do.  I'm not sure that i did.  I mean i chose to physically harm myself granted, but i didn't care whether i lived or died.  If I had died from that, could you say whether or not i'd chosen to die?

Um... sorry for being emo, i'll be happy again now!

I'm just trying to look at the issue from both sides. This one, though, strikes me as headline-grabbing and sensationalist because that's what the Tory MP thinks people want to hear. Unfortunately, with the levels of prejudice in society and the far more common news bulletins about people whose 90-year-old mother died from Alzheimers when she could have lived for another five years if she'd only had access to these newer drugs, that may well be the case. 

If GRS cost the same to the NHS as things like hip replacements or knee reconstructions then we wouldn't even be talking about it, especially considering the relatively small number of people who have GRS procedures on the NHS. I think it's the cost issue that it all boils down to.

Yeah I think that the MP is just trying to be sensationalist and find a scapegoat.  Initially his point about costs seems reasonable.  But I don't think that the facts support his views on costs.

I read (can't remember where) that the cost to the nhs per (MTF) surgery was £3,000 (bit more for FTM), but even if it was £10,000 it still isn't much compared to other treatments!  These high-cost cancer drugs cost far more than this (some are like £20k-£30k).  Since a lot of PCTs are rationing GRS to one patient per year, stopping them won't even save enough to be able to pay for these new drugs for an additional patient!

Also, it ignores the costs of non-treatment.  The high proportion of TSs suffering from depressive illnesses still needs to be treated.  The nhs is paying about half the amount for my hormones as they did for my anti-depressants!  Also I know a TS who was in casualty weekly from self-harm/attempted suicide.  They've probably spent more fixing her up than they would have done on hormones and GRS.

Yeah, I tend to hope people aren't so dumb closed-minded that they'd say stuff like that in public without it being some kind of misunderstanding. I have a habit of giving people the benefit of the doubt. It's better for my stress levels.

Ahhh, you're really sweet. 
I try to do the same, but believing Tories aren't close-minded idiots is going to far!

[Rachael]

But it isn't life threatening, and there are other roads that can be taken to achieve my goal. Plus, I have time. It's not as though I might die from not having the surgery.

Yes it is.

and many have.

[Keira]

Well, I do not agree that you don't have the
choice but to kill yourself if your denied NHS care.
Internet DIY is so low in cost (and you can pay
from an internet cafe with and paypall if you
don't have any internet) that even someone
on the dole could pay for it (Yeah, I can't
say, but its that cheap).

The ops is costly, but usually, once you've transitioned with the
HRT, you should feel better and be able to work towards
the ~5000 pounds needed
(the british pound is insanely high) to pay for an ops
in Thailand at the lowest priced good doctor
without any letter or therapist involved.

The HRT and transition and move towards the end point SRS
usually removes the immediate suicidal tendency.


If your so suicidal that you can't even see these options, you
probably have some unresolved problem about transitioning
and possibly other problems in parrallel too.

[JENNIFER]

May I have your permission to offer my own experience on this matter?  Was that a yes?   Excellent 

I have been in transition for 3 years, I had my initial psychiatric assessment within weeks of telling my doctor etc, i was referred to Charing Cross soon after.  My local NHS Primary Care Trust ( PCT ) are the fund holders and they decided that I would not be allowed to progress on NHS funding due to the fact that protocols were suspended due to merger of services. Ultimately, those protocols were scrapped.

My GP ( family Doctor ) refused to let it rest and he made a fuss, persistently writing letters saying that his judgment had been questioned and that it was unacceptable to him and his patient that treatment was denied and that current law had been breached.

To cut the story short to save moderator annoyance, the situation improved greatly and I am now a fully financed patient at Charing Cross gender clinic, I am so happy about this and things are moving along quickly.  I cannot consider private sector treatment because I cannot work due to disability following several strokes, I have to accept what has been granted to me by the state and I do so with thanks.

People have mentioned things such as suicide etc, I cannot and would not dare to offer an opinion there save to say that there is no single standard owing to the fact that there is an infinate variety of human being, we each have our own views, feelings and needs.  I am content tonight with my life, yes, I want more, I want SRS asap, a new face, better skin, girl lips, long hair on all of my scalp, bigger boobs, a sweet voice and I could go on but those are incidentals to the fact that I am at peace with myself for the only time in my life. 

[jenny_]

Well, I do not agree that you don't have the
choice but to kill yourself if your denied NHS care.
Internet DIY is so low in cost (and you can pay
from an internet cafe with and paypall if you
don't have any internet) that even someone
on the dole could pay for it (Yeah, I can't
say, but its that cheap).

Yes, you and I both know the costs of internet DIY, but that doesn't mean everyone knows how easy that option is, particularly those people who are only just coming to terms with who they are. 
Hypothetically, imagine somebody who's been struggling to supress their gender identity issues all their life, finally plucking up the courage to go their gp, and tell him everything they've been feeling.  Imagine the situation where the gp (and/or pct) turns round to them "sorry but we don't think your problems are of a high enough priority to treat".  Its not just denial of care.  To somebody struggling with low self-esteem, trying to come to terms with who they are, it can come across as not taking them seriously, or not deeming them worthy of treatment.

Of course, theres a load of information on the internet, but still not everyone will know enough of the alternatives.  Also specifically on hormone DIY, there is a lot of people who speak (very forcefully) against it.

The HRT and transition and move towards the end point SRS
usually removes the immediate suicidal tendency.

If your so suicidal that you can't even see these options, you
probably have some unresolved problem about transitioning
and possibly other problems in parrallel too.

Yeah, to an extent that may be true.  But to absolve doctors etc, of all responsibility if a transsexual commits suicide, when those doctors have been refusing (necessary) treatment, goes to far imo.

I personally think that it is too easy to just say that any person who attempts/commits suicide must have some deep unresolved issue.  It could never be simply because of the way that people treat them...

And I'm pleased that you were strong enough to cope with your identity and transition, and to see all the options.  But that doesn't mean everyone is, and it doesn't mean gender dysphoria in itself is powerful enough to course deaths.

[Keira]

What I'm saying is that somebody suicidal needs to be taken
off the ledge because just giving them HRT, even if
a doctor did it, will not solve what took them there.

They need paid for therapy, a support group, more
than anything else.

Most TS "off the metaphorical street" so to speak are pretty
messed up by years of denial, so messed up that just
HRT alone will not help. Most time, when entering support
groups, they have an incredible aggressivity, a me against
the world mentality; they have to believe first someone
can help them, learn to trust others and their own feelings
before moving forward with anything. I should know,
I was like that and I've seen plenty of others entering
support groups in 15 years.

[jenny_]

Yes, if somebody is suicidal then therapy etc, is gonna probably be helpful.  But if it is the gender dysphoria itself that is the problem leading to thoughts of suicide, then HRT and transition are the necessary treatments for it.
Granted, just prescribing HRT won't magically solve all the problems, but it will surely help.  And likewise, denying treatment will make the issues worse, which of course could be life-threatening.

Also to say a condition isn't life-threatening if treatment is refused by the nhs because its possible to obtain hormones otherwise, does kind of miss the point.  The point is that if no treatment is given whatsoever (regardless of whether its nhs,private,diy) then that can lead to inevitable suicide in some transsexuals.  Hence no treatment = life-threatening

[tekla]

You Americans who want government health care better read this stuff real well.