Thread on the #keirabell judgement and sorry state of evidence-lead health policy in New Zealand.

We have further confirmation that there is no good evidence of benefit from puberty blockers, and significant risks.

1/11

The judges heard evidence for and against, and testimony from former patients. They ruled that puberty blocking is "experimental", with "very limited evidence as to its efficacy"

An unsurprising finding if you're familiar with the literature.

2/11
This is a continuation of the findings from the national health body reviews from Sweden and Finland. Both find that evidence is insufficient.

3/11

https://t.co/SdNHXYPiCT
A review by the Center for Evidence Based Medicine at Oxford University highlighted the "profound scientific ignorance" on the the use of puberty blockers

4/11

https://t.co/jTnu4jfuUt
A 2018 review by an Australian expert group finds that all studies on the psych effects of puberty blockers have a medium or high risk of bias.

5/11

https://t.co/7L5dLrr5Zo
Ok, what about New Zealand?
Dr Jeannie Oliphant is the lead author of NZ guidelines. She described puberty blockers as "the gold standard for young people." and claims that "we are using puberty blockers very freely up until about till about 20".

6/11

https://t.co/DAeIpJqqCB
The NZ guidelines cite a *single* highly biased study (de Vries et al., 2014) and then claim that puberty blocking is supported by "good evidence"

7/11

https://t.co/pch96L8gVC
The lead author of the original study (de Vries) now believes puberty suppression is not always appropriate.

She believes psychosocial support may be more appropriate for children who have recent dysphoria

8/11

https://t.co/cgHf23gCCS
New Zealand children have the right to not be subject to medical experimentation. Health authorities must uphold the right to informed consent and provide psychosocial support.

9/11
If you know doctors and parents who are considering blocking a child's normal puberty, please forward them the judgement

10/11

https://t.co/nCsHJRhZSh
Thread summarised here ->

11/Fin

https://t.co/N3SdEm0sCK

More from Law

I’ve been reading lots recently about the interaction between First Amendment law and free speech principles with respect to online services in light of the events of the last few weeks.

And I have thoughts (MY OWN). So, I’m sorry ... a thread 1/25

One of the main reasons I think users are best served by a recognition that social media services have 1st Amendment rights to curate the content on their sites is because many users want filtered content, either by topic, or by behavior, or other. 2/

So online services should have the right to do this filtering, and to give their users the tools to do so too. For more detail see our Prager U amicus brief
https://t.co/73PswB9Q7Q 3/

So, I disagree with my friends (and others) who say that every online service should apply First Amendment rules, even though they cannot be required to do so. There are both practical and policy reasons why I don’t like this. 4/

Most obviously, the 1st Amendment reflects only one national legal system when this is inherently an international issue. So it’s politically messy, even if you think a 1st Amendment-based policy will be most speech-protective (though probably only non-sexual speakers). 5/

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A brief analysis and comparison of the CSS for Twitter's PWA vs Twitter's legacy desktop website. The difference is dramatic and I'll touch on some reasons why.

Legacy site *downloads* ~630 KB CSS per theme and writing direction.

6,769 rules
9,252 selectors
16.7k declarations
3,370 unique declarations
44 media queries
36 unique colors
50 unique background colors
46 unique font sizes
39 unique z-indices

https://t.co/qyl4Bt1i5x


PWA *incrementally generates* ~30 KB CSS that handles all themes and writing directions.

735 rules
740 selectors
757 declarations
730 unique declarations
0 media queries
11 unique colors
32 unique background colors
15 unique font sizes
7 unique z-indices

https://t.co/w7oNG5KUkJ


The legacy site's CSS is what happens when hundreds of people directly write CSS over many years. Specificity wars, redundancy, a house of cards that can't be fixed. The result is extremely inefficient and error-prone styling that punishes users and developers.

The PWA's CSS is generated on-demand by a JS framework that manages styles and outputs "atomic CSS". The framework can enforce strict constraints and perform optimisations, which is why the CSS is so much smaller and safer. Style conflicts and unbounded CSS growth are avoided.