Shuttering the Tavistock

Before long, the closure of Britain’s Tavistock youth gender clinic, the world’s largest, will appear to have been inevitable, and it will be difficult to find any big names who’ll admit to once being its champion. But there was nothing inevitable about the exposure of the Tavistock’s failings. Nor is there any guarantee of success for the more mainstream approach to gender distress urged by paediatrician and service reviewer Dr. Hilary Cass, whose recommendations have been adopted in toto by England’s National Health Service (NHS). So much depends on individuals of character who seek to remedy wrongs and uphold principle, no matter how inconvenient this is for self-regarding institutions.

In truth, the seemingly overnight fall from grace for Tavistock began 17 years ago, when one of its psychiatric nurses, Susan Evans, raised concerns. Since 2009, some 20,000 children have been referred to the clinic, according to The Telegraph. In 2021-22, there were more than 5,000 new referrals, compared with a corresponding figure of 250 a decade ago.

Other whistleblowers and resignations followed Evans’ departure; internal reports were written and apparently ignored; a handful of journalists began serious investigative work despite cries of “transphobia”; critics of rushed medicalisation fought to counter the institutional influence of transgender activists who sought to quickly “affirm” the asserted trans identity of Tavistock patients; and a former patient, Keira Bell, launched test-case litigation, on the basis that her female-to-male teenage transition had been unconscionably rushed by ideologically programmed doctors who should have known better. Crucially, former health secretary Matt Hancock found time, mid-pandemic, to secure the appointment of Dr. Cass, a former President of the Royal College of Paediatrics and Child Health. She was charged with a serious independent review of NHS care of minors who’d been diagnosed with the distress of gender dysphoria that sometimes accompanies identification with the opposite sex.

And so, the stand-alone Tavistock clinic, with its main base in London, is to close next year and be replaced by regional centres more safely anchored in the mainstream mental-health system. Britain’s Conservative government has stood firm behind Dr. Cass, despite the death agonies of Boris Johnson’s leadership. The immediate past health secretary, Sajid Javid, has declared that the closure was “absolutely the right decision based on the independent evidence gathered by [Dr.] Hilary Cass.”

As Health Secretary, I was determined to protect vulnerable children from being failed by gender identity services at the Tavistock.This is welcome news and absolutely the right decision based on the independent evidence gathered by Dr Hilary Cass. https://t.co/QddfRT7z0V— Sajid Javid (@sajidjavid) July 28, 2022

In plain terms, the verdict against the Tavistock is that its staff allowed gender ideology and experimental drugs to crowd out prudent medicine and exploratory psychotherapy that ought to be open to the full range of possible reasons for a troubled child’s distress. An American-style “gender affirming” treatment model zeroed in on a dysphoric child’s supposedly immutable trans soul, and gave too little weight to a patient’s more earthly issues such as psychiatric disorders, struggles with same-sex attraction, autism, or family trauma. Though nobody can prove the existence of a trans soul, gender dysphoria had a history in psychiatric diagnosis that met the bar of health insurers. But the condition is unusual because it involves what is in effect a Cartesian dualist intervention, by which hormonal drugs and surgery are used to make the body’s appearance accord with the mind’s idea of how it should be.

This regimen is known as the Dutch protocol, after the famous Amsterdam gender clinic that pioneered the use of hormone suppression drugs in the 1990s to stave off the natural but (for those afflicted with gender dysphoria) undesired development of puberty. It is still common to hear clinicians and activists describe this as a fully reversible intervention that eases the patient’s distress and allows a period of reflection. In this account, the child has a “breathing space” before the fateful decision whether to begin irreversible cross-sex hormones or to cast off a trans identity as mistaken, and to cease hormone suppression so that puberty can take its course.

But this choice appears to be illusory. On the limited data available, almost all children who begin puberty blockers will go on to lifelong cross-sex hormones. If so, this intervention is not a pause but the first step on a pathway to lifelong medicalisation. And yet children in early puberty—girls as young as nine, and boys only slightly older—are expected to have the maturity to weigh the implications of saying yes to an intervention that may render them unable to have their own children and incapable of the sexual pleasure that is necessary to sustain intimate adult relationships.

Michael Biggs on the history of puberty blockers for gender dysphoria. The 'Dutch protocol' was developed, and widely adopted, using children as guinea pigs. https://t.co/FSCmhxXbt8— TransgenderTrend (@Transgendertrd) December 14, 2020

Like many other gender clinics around the world, the Tavistock has been dispensing these puberty-blocking drugs without clarifying the purpose of this interruption of the physical, psychological, and social rites of passage that turn boys into men and girls into women. In her July 19 letter to the NHS England, Dr. Cass explained that “the most significant knowledge gaps [in the evidence base for paediatric transition] are in relation to treatment with puberty blockers, and the lack of clarity about whether the rationale for prescription is as an initial part of a transition pathway, or as a ‘pause’ to allow more time for decision making.”

Some of the side-effects of these drugs are known—children may miss out on the rapid increase in bone density that is normal in puberty, for instance—but much is unknown. And it seems possible that hormone suppression interferes with the very process of decision-making that it is supposed to enable. Gender activists often dismiss concerns about puberty blockers, claiming that these drugs have been used for many decades without arousing serious medical concerns. But in this regard, they’re referring to the use of such drugs to treat a condition known as central precocious puberty—whereby secondary sexual characteristics begin to appear before age eight in girls or age nine in boys. This is something quite different, because these children are allowed to resume development in sync with their peers, and are not directed toward a lifelong drug regime.

Dr. Cass identifies a crucial uncertainty: the effects of puberty blocking, and the absence of normal sex hormones, on the still developing adolescent brain:

We do not fully understand the role of adolescent sex hormones in driving the development of both sexuality and gender identity through the early teen years, so by extension we cannot be sure about the impact of stopping these hormone surges on psychosexual and gender maturation. We therefore have no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process.
A further concern is that adolescent sex hormone surges may trigger the opening of a critical period for experience-dependent rewiring of neural circuits underlying executive function (i.e. maturation of the part of the brain concerned with planning, decision making and judgment). If this is the case, brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences.

As such, she has urged the NHS to organise the “rapid establishment” of the research arrangements necessary to recruit patients for clinical trials of puberty blocking with follow-up into adulthood. Together with multiple systematic reviews showing the very weak evidence base for medicalised gender change among minors, this only strengthens the argument that puberty blockers should be classified as experimental.

Moreover, researchers must consider the larger question of whether experiments affecting childhood puberty could even be conducted ethically. In an expert report prepared for Florida’s Agency for Health Care Administration, advising against Medicaid subsidies for under-18s transition, paediatric endocrinologist Quentin L. Van Meter concludes that

There is evidence that bone mineral density is irreversibly decreased if puberty blockers are used during the years of adolescence. To treat puberty as a pathologic state of health that should be avoided by using puberty blockers (GnRH analogs) is to interrupt a major necessary physiologic transformation at a critical age when such changes can effectively happen. We have definite evidence of the need for estrogen in females to store calcium in their skeleton in their teen years. That physiologic event can’t be put off successfully to a later date. It is very difficult to imagine ethical controlled clinical trials that could elucidate the effects of delaying puberty until the age of consent.

Last year, the Swedish TV program Mission: Investigate, which had produced the Trans Train documentary series, related the story of a 15-year-old patient, “Leo,” who was belatedly diagnosed with osteopenia—a brittle-bone condition usually observed in the elderly—after four and a half years on puberty blockers. As for effects on the brain, a 2020 “Consensus Parameter” paper collectively produced by 24 international experts in neurodevelopment, gender development, neuroendocrinology, and related fields concluded that

The pubertal and adolescent period is associated with profound neurodevelopment, including trajectories of increasing capacities for abstraction and logical thinking, integrative thinking, and social thinking and competence…The combination of animal neurobehavioral research and human behavior studies supports the notion that puberty may be a sensitive period for brain organization: that is, a limited phase when developing neural connections are uniquely shaped by hormonal and experiential factors, with potentially lifelong consequences for cognitive and emotional health.

(The ambitious research project outlined by the paper—involving multiple gender clinics and more than one comparison group—is yet to begin.)

Paediatric transition is a complex, emotionally charged element within the wider debate over both transgender rights and the extent to which such rights should be permitted to impinge on those of women and children. Britain’s Labour Party has struggled to talk sense on this subject, and at one point last month, it seemed that the next Conservative leader would be Penny Mordaunt, who in 2021 had stood at the dispatch box in the House of Commons and intoned the mantra, “Trans men are men, trans women are women.”

How, then, did the UK manage to devise and enact a credible policy shift toward caution on the issue of medicalised gender change for minors? Are there lessons for countries such as the United States, Canada, Australia, New Zealand, Germany, and Spain, where, so far, dogmatic slogans have trumped critical thought? American trans activists denounce Britain as “TERF Island.” (“TERF” stands for “trans exclusionary radical feminist,” a term of abuse that, of late, has been adopted as a sort of ironic badge of honour by gender-critical feminists.) It seems as if some type of British exceptionalism is asserting itself in resistance to the trans Zeitgeist that permeates many other Western countries.

“TERFs” outside the UK might wonder if it’s possible to clone JK Rowling, the gender-critical Harry Potter writer who’s followed the Tavistock saga closely, presciently declaring two years ago that “it feels as though we’re on the brink of a medical scandal.” Her 3,600-word open letter, written a month before that, serves as a plain English explainer for those puzzled about gender ideology, sex-based rights, the fury of trans-rights activists, and the alarming surge in teenage girls seeking a chemical and surgical escape route out of the female category. (In writing it, Rowling quoted from a January 2020 Quillette article in which former Tavistock psychoanalyst Marcus Evans explained why he’d resigned and turned whistleblower. He also picked apart the irresponsible “transition or suicide” narrative that activists—and even patients—sometimes cite as a tactic to push aside legitimate concerns.) Rowling may be a one-off, but all countries have at least some influential voices of concern that are able to reach large audiences with the message that medicalisation of children is not something to be celebrated. And those voices should be amplified.

In any event, the sobering fact is that many of the obstacles to common sense complained of elsewhere in the world also had to be negotiated in the UK, as illustrated by British politician Kemi Badenoch’s recent candid account of dealing with public-service groupthink on gender.

When I became equalities minister in early 2020,” she wrote in The Times last month, “the [Tavistock] NHS clinic for young people was presented to me by government officials as a positive medical provision to support children. I was assured that there was ‘nothing to see here’; if anything, the Tavistock was getting unfair press. This was despite whistleblowers like Dr. David Bell already raising concerns about practices at the clinic.
I insisted on meeting campaigners on both sides of the debate: not just [the trans-rights lobby group] Stonewall UK but, to the horror of some officials, the LGB Alliance [which opposes gender ideology as homophobic]. I met clinicians and, most importantly, I asked to meet young people who had used the Tavistock’s services.
One such young person was Keira Bell. To my surprise, I was advised strongly and repeatedly by civil servants in the department that it would be ‘inappropriate’ to speak to her. I overruled the advice.

Badenoch also noted the threats and smears directed at sceptical journalists as well as women in the “gender critical” movement:

The reason it took this long for the Tavistock clinic to be shut down is that activists succeeded in creating an environment in which critics and journalists felt unable to interrogate the dogma that youngsters should be able to medically transition in the way overseen by Tavistock. The treatment of these women showed the heavy price to pay and many people including MPs on all sides of the house simply didn’t want to get involved.

For all its progress, Britain has a formidable task ahead in ensuring that a more mainstream therapeutic culture both displaces the influence of gender ideology, and grapples with the full complexity of distressed children and adolescents. The fall of the Tavistock clinic, if clearly explained without gender-identity jargon, will make sense to the vast majority of Brits. But there is as yet little public understanding of the broader institutional and ideological forces that put so many minors on the path to unnecessary medicalisation.

“Closing the Tavistock is a first step, but schools are frequently acting as a pipeline to the clinics,” a spokesman for a gender-critical parents’ organisation, the Bayswater Support Group, told The Times. These parents have learned that while doctors are the ones who actually prescribe puberty blockers, any strategy for avoiding unnecessary medicaliation must look at the broader information environment that faces children before they show up at a clinic’s doors:  

We want the [U.K.] Department for Education to issue clear guidance to schools, and for Ofsted [the Office for Standards in Education] to enforce rules. Many of our [trans-identifying] children came across gender identity theory in schools, which then played an active role in socially transitioning them without parental knowledge or clinical oversight. When parents question these policies, schools have denied they exist, told us we can’t view educational resources, and in some cases reported us to social services for failing to affirm our children as the opposite sex.

This is a sleeper issue in many affluent countries, where youth gender clinics have gone from novelty to claimed essential service in the space of just a few years, with scant official oversight or public awareness. Britain’s path to remedying this situation, however incomplete the process may be, offers a precedent that responsible politicians, journalists, clinicians, and parents in other nations should monitor carefully.


This is a companion discussion topic for the original entry at https://quillette.com/2022/08/05/closing-the-tavistock-is-an-important-step/
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Excellent things are happening in the UK. Thank goodness for Hillary Cass, who told the truth. Thank goodness for JK Rowling, who was dumped on, spat on, cancelled, but nevertheless she persisted.

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As the UK has a centralized public health system, such decisions have immediate positive effects. In the UK, there will be far fewer butcheries of confused children going forward.

In the US, our dysfunctional and incoherent health care system will be far more difficult to turn around. Some states (CA, NY, OR) are making it easier for children to medically butcher themselves, without parental consent or in some cases even parental knowledge. Other states, like FL, are making even the discussion of gender idiocy in schools off-limits.

This butchery of children will be part of the Nov discussion. Hopefully those pushing medical butchery will be unsuccessful.

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Good article.

I am really looking forward to the ensuing 1,784 comments in the Quillette Circle endlessly belaboring the trivialities of an issue that is clearly a manifestation of teen angst and solipsism to the exclusion of other, more pressing topics facing our shared celestial globe.

Let the games begin…

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That makes two of us …

Gender ideology maybe a convenient scapegoat but the the plain simple fact was an inefficient health system overloaded & poorly managed. Interestingly the results of the review have had a positive reception from trans charities in the UK contradicting the fast track to medicalisation sensationalist narrative.

Perhaps because many of these countries already had more cautious efficient holistic health services.The UK’s problems aren’t necessarily a reflection of other countries.

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Maybe not an issue to you, but to a parent of a child captured by this trannie insanity, it is not a trivial matter.

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Even I am starting to feel that enough is enough. How many times do we have to go over the same ground? Let’s just applaud those who have achieved this shutdown and hope for more.

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This is probably a painful new reality for the small numbers of trans kids who experienced their gender dysphoria during the more historically normal period of ages 4.5 and 7 and then began to experience far more acute gender dysphoria with the onset of puberty. In therapeutic terms, these are usually the 20% or so of children whose symptoms persist into adult and for whom puberty won’t reverse their gender dysphoria. For these rare few, the world must seem an incredibly unfair place since the Tavistock was shuttered.

Many trans people have had to deal with the incredibly hurtful admonition that they are mentally ill. For activists, it must have seemed as though they were saving children by pushing back against such tropes- and given that the ability to pass is a decisive factor in reducing adult trans suicide rate it must have felt as though they were saving the next generation from some of the difficulties they had to face in their daily lives. But what they failed to account for or wouldn’t accept was the survivorship bias- for every one trans person whose gender dysphoria persisted into adulthood their were four kids who grew out of it and for the most part went onto to live perfectly lives as gays or lesbians with the dreadful livelong risk of trans suicide forever removed.

And the argument that many of the kids in the eleven or so studies which looked at trans desistence during puberty were simply gender nonconforming simply doesn’t hold water- because whilst it may to an extent be true, the simple fact is that when clinical standards have been relaxed, with none of the stringent elimination protocols which were present historically, this is far more likely to have been true in the past decade than it was before.

Around 35% of kids referred to the Tavistock were autistic, and whilst it may be true that there is a correlation between autism and trans, with one study showing a prevalence of 6.5%, this incredibly high figure is truly alarming, and a key indicator of systemic ideological capture. This is not to say that the staff at the Tavistock haven’t done an amazing job, most have struggled to deliver proper therapeutic services against a mounting workload which denied the possibility of more extensive clinical work. We should single out particular praise for those courageous enough to speak out, as well as the more numerous individuals with the integrity to resign rather than participate in a system in which they had fundamentally lost faith.

But we’ve seen this before. It only takes a relatively small number of individuals to ideologically capture an institution, barely more than a handful, especially if one of them makes it into the leadership class. Entire countries have fallen into darkness as the result of a few hundred ideologically committed individuals. Powerful CEOs of large companies have admitted to fearing their H.R. Managers- especially salient given that the ‘Get Woke, Go Broke’ phenomenon is becoming increasingly prevalent and, given the recent Sir Lanka debacle, the ESG bubble is likely to burst at some point over the next few months.

Albert Maysles once said Tyranny is the deliberate removal of nuance, and this is one of those issues where political and cultural polarisation of the debate has robbed the discussion of all fine distinctions and individual cases of truly horrific suffering. But if truth is the first casualty of war- and make no mistake this is a cultural war- the second casualty must surely be kindness and the ability to treat people as individuals rather than singularly uniform members of an arbitrary group.

With trans kids, whole societies have failed and continue to fail, regardless of which side they happen to fall on the cultural side of the debate. A fair, just and kind system would see trans kids given dozens or possible even hundreds of individual hours of therapeutic care before they ever made the fateful decision to make a lifechanging and largely irreversible decision- and, although the exceptions of those referred for early transition would likely be rare- they would still exist, especially if it became clear to their clinician that their probable course was taking a decidedly dark turn.

But in a system captured by ideology there is no alternative to shuttering the Tavistock. Quite depressingly, it’s a numbers game- should we attempt to intervene in the rare few at the horrible and harmful expense of the many? When one of the original architects of the Dutch Protocols is sounding the alarm bells, arguing that other countries are ‘blindly accepting’ their research, without doing the hard therapeutic work of separating the few from the many, and proclaiming that their urgently needs to be research into the massive increase of girls wanting to transition, then the West really needs to hit pause to prevent an unfolding humanitarian catastrophe.

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It is an astonishing and sobering thing. But it seems so very easy. Hitler had to work hard and long to overthrow democracy in Germany. Why is it so easy now?

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One of the obsessions I shared with Jordan Peterson, especially in my teens and twenties, was how could have the Nazi perversion succeeded in overwhelming everything just and noble? They were at the time perhaps the most culturally advanced nation on the face of the planet. He looked to the internal solutions, to conscience and psychology. I looked at the external, what societal forces were in play?

Goebbels and the role of propaganda cannot be understated, nor can the role of how it quickly filtered down to the level of social enforcement and feedback. Most people either follow the mob or are cowed by them. In my youth I wondered just how much a role media was playing in propagandising us- making us take for granted truths that simply weren’t so.

But with the rise of social media the ability to propagandise has reached even greater heights so the extent to which it is possible to pathologise an entire society has only amplified. By comparison, the media tools the Nazis had to work with were quite mild, even if they were used to devastating effect.

As usual, my essays are to be found on my Substack, which is free to view and comment:

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I mostly agree with your post, but this part I strongly disagree with. While there may be a physical rather than mental pathology at work, that does not distract from the fact that this is a malady which strongly looks like a mental illness. Describing it as thus may be “incredibly hurtful” but it is not an “admonition”.

However the speed at which so many hustle away from the idea that it may be a mental illness actually does cause real harm. It doubles down on the idea that a “mental illness” is something shameful to have. And that idea is a real harm that society needs to leave behind. My two cents.

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Great post, as usual.

Perhaps it’s better to say mental condition. Plus, anxiety and depression may often have environmental causes but they have real physiological effects on the brain, as demonstrated by the wealth of data which shows that SSRIs have a positive effect- although I do think there is tendency towards overdiagnosis and they should mostly be prescribed as a temporary plaster to get people through particularly hard periods. My doctor was really pissed that I stopped taking mine after the effects from the ‘memory shrapnel’ of my car accident became apparent ten years later- his quibble was that I should have really gone down to half a pill for a while and then stopped.

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What’s the evidence that this psychotic delusion is not a mental illness?

If I (male) believed that I was Napoleon, and wanted to have a surgical operation to reduce my height, mental illness would be the diagnosis. If I believed that was Josephine, your suggestion is that I get breast implants?

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Now there we have a practical suggestion. With LITERALLY thousands of children falling prey to this delusion, this is not possible period. In addition, the professional therapist class has been captured by the trannie activists. Finding a therapist who will not “affirm” the trannie delusion is extremely difficult.

What is clear, to anyone who is looking at the situation, is that this is a social contagion. Social hysteria is a common thing, and with the internet, the spread of social hysteria is very fast. From 2000 to now, the numbers of trannies have increased not by a few %, but by 4000-6000%. In 2000, maybe there were 20 at some of these clinics. Now there are, literally, thousands and thousands.

The reason that the social contagion of this phenomena is so prevalent is that the trannie delusion is the ultimate teen-parent argument winner for the teen. “If you don’t agree that I am the wrong sex, I will kill myself”. For most parents, this is an argument that cannot be ignored. The attention paid to trannies, due to idiocy like “oh, trannies are just misunderstood”, is a huge winner for the trannie as well. In a world of millions of white normal kids, becoming a trannie is a very attractive way to go from being in the oppressive class (white male esp) to being one of the “marginalized”.

We need to stop being respectful of trannies. They are pathetic losers and they are deluded.

Now there the two of us can agree with the suggestion that

Unfortunately you then appear to ignore that advice completely. Use of the terms delusion, trannie, social hysteria and contagion, and ultimately,

This begs the question, are we part of the solution, or part of the problem?

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What’s your point? I guess you think you are shaming me or some other such nonsense.

And, yes, there should be far less respect given these deluded psychopaths. By the current approach of affirmation, children (as young as 13) are led to the path of surgical mutilation, sterilization. The affirmation of society leads them to this terrible situation.

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Nope, mental illness. Sugar coating things has been standard practice for a lifetime, but it turns out that all that it does is give you cavities. Believing that your soul is female when your body is male is as delusional as believing that you are Napoleon. Worse – modern Napoleon’s don’t want their genitals mutilated and are not going to end up as medicalized cripples for the rest of their lives.

Hey! I hope that idea circulates you could get some takers I bet.

I once read a marvelous essay that suggested that sane folks official quarantine words that have become contaminated. ‘Affirm’ should now be on the list. The first word on the list, according to the essay, was ‘gay’.

What we have is a sorta combination of the Salem witch trials with Beetlemania and the Satanic Panic. But the Beetles never had a thoughpolice running around trying to destroy the lives of fans of the Dave Clark Five, nor did they advocate genital mutilation. Yes, we had adolescent girls rolling around on the ground, but it was mostly in sexual rapture, nobody was pointed out as a witch and nobody got hung. Ah, for the good old days.

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This is not about you, and I could not give a fig about specifically shaming or humiliating you. At this point in my life your specific relevance to me is close to zero.

What I am concerned about is the approach you represent. This vilification of folks that clearly have a serious mental health problem is not a good starting point. One needs to approach this with just a tad more understanding and compassion. Perhaps you mean to make a distinction between the children themselves and the perpetrators of these atrocities. If so, step one would be to clarify this distinction.
If you cannot make the distinction, stay away from the problem, you could be creating more harm than good.

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