There is an interesting constitutional challenge brewing in Tennessee where 3,000 physicians and health care professionals are suing the Biden Administration over the mandate for doctors to perform gender transition procedures. One of the first changes ordered by the Biden Administration was redefine the discrimination laws to include the denial of such gender transition procedures. The case could force courts to address a direct conflict between anti-discrimination laws and religious values–a medical version of cases like Masterpiece Cake shop.. The Defendants include the U.S. Department of Health and Human Services and the Office for Civil Rights of the HHS, including Xavier Becerra, the secretary of the HHS, and Robinsue Frohboese, acting director and principal deputy of the Office for Civil Rights of the HHS.
Section 1557 of the Patient Protection and Affordable Care Act provide that an individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination on the grounds prohibited under Title VI of the Civil Rights Act of 1964. One of the earliest acts of President Biden to sign an executive order upon entering office that required Section 1557 and Title IX be interpreted to include gender identity as a protected trait.
Title IX also prohibits discrimination on the basis of race, color, national origin, sex (including sexual orientation and gender identity), age or disability in covered health programs or activities.
These medical experts challenge the government’s authority to effectively order them to perform gender transition procedures, prescribe hormones or puberty blockers. Additionally, they claim the Biden Administration is forcing them conform their speech to gender identity, rather than biological sex, regardless of their medical judgment or conscientious objections.
Notably, the first claim in the Complaint below is brought under the Administrative Procedures Act (APA) which has proven repeatedly successful in challenges to the unilateral actions of the Biden Administration.
The second claim is brought under both the First and Fifth Amendments in raising claims of free speech and free association:
“Plaintiffs oppose the gender identity mandate’s requirements of, and restrictions on, their speech including: having to offer and refer for gender interventions; the use of pronouns; medical screening questions; medical coding and record keeping; referrals; policies governing speech and information at their medical practices; assurances of compliance with Section 1557; and mandatory notices of compliance with Section 1557.”
The third claim is under the Religious Freedom Restoration Act (RFRA) which prohibits the federal government from substantially burdening a person’s exercise of religion, unless the government demonstrates that the burden is the least restrictive means of furthering a compelling government interest. 42 U.S.C. § 2000bb-1(a): “The gender identity mandate substantially burdens the Religious Plaintiffs’ exercise of religion by requiring them to engage in the objectionable practices in violation of their beliefs.”
The fourth claim is based on the First and Fifth Amendments in the alleged denial of freedom of religion. Notably, this claim reveals a division among plaintiffs, which the Complaint addresses by creating a subset of claims:
“All Plaintiffs bring this Free Exercise Clause claim except the nonreligious members of ACPeds. CMA asserts the claim on behalf of its members, and ACPeds brings it on behalf of its religious members. Dr. Dassow brings the claim on behalf of herself. Collectively, these are referred to as the Religious Plaintiffs.”
The fifth and final claim is based on federalism that the order on gender identity exceeds Congress’s Article I enumerated powers and transgresses on the reserved powers of the State under the federal constitution’s structural principles of federalism and the Tenth Amendment.
Some of these claims like the federalism challenge will be difficult to maintain since the government maintains national medical rules tied to federal programs. However, this is a major challenge that could force a ruling on whether physicians retain the right to decline procedures or practices based on religious objections.
Here is the complaint: American College of Pediatricians v. Becerra
That this is even happening is insanity. I’m not opposed to whatever someone wants to do with their own body assuming they’re an adult and take responsibility for it themselves. But putting the onus on doctors to play the game, which is all it is, “gender neutral” words and such, just all a silly game. We already have the English language and we already have words for the two genders. Of which there are only two. Anything else is make believe.
We’re placating to mental illness, and calling it healthy. After all don’t we have just a few other national and global problems to deal with right now? Like keeping the lights on, wars, mass poverty, the economy, etc. Aren’t these a little bit more important than whether or not little Johnny doesn’t like having a wee-wee and wants mommy to cut it off?
Sex is for the bedroom (and wherever else that’s private and two consenting adults decide to fool around at). Its not for the schoolhouse, the workplace or the polling center. Why is that a difficult concept to grasp? Why is everything with the democrats these days about how they feel about their genitalia? Doesn’t anyone have to go to work anymore? Doesn’t anyone care about real things any more?
The older I get, regardless of my self commitment not to, I find myself turning more and more into a picture of Clint Eastwood sitting on his front lawn in “El Camino” and saying, “git the hell off my lawn kid”.
I feel like a stranger, in my own country. And I don’t recognize hardly anyone, any more.
The left in this country has got the population believing up is down and down is up. I really believe most of the people in this country don’t know the difference between right and wrong.
You’re almost right, but you left out the right too. Its a two way street, and the problem isn’t on one side or the other. The problem is the street.
I don’t know who you are, but do not post my work videos on here. Just because my account is public, doesn’t mean you get to post my work videos on a political blog. I’m not ashamed of my work or who or what I am, but I won’t have anonymous trolls hiding behind their hidden identities trying to “dox” my work and drag my job into this political blog. . Remove this video or I will. And if this keeps up, then I guess I’ll just have to deactivate my wordpress account and leave this blog and stop posting. Sad but I should have known the sort I was dealing with.. Remove this and don’t do it again.
Chris, I’m a different anonymous commenter, and you can email Turley (his address is listed here: https://www.law.gwu.edu/jonathan-turley ) asking that he have the moderator here, Darren Smith, remove the comment. The person who posted it cannot remove it, but you’re right that that person shouldn’t be trying to dox you; that’s explicitly against JT’s few rules. Just tell him the page and timestamp, or click on the timestamp to get a URL for that specific comment. When the comment is deleted, it will also remove all replies.
Thanks, I just deleted the video. Didn’t like doing that but it wasn’t a really important one, just a vlog. My work videos are public and of course free for anyone to watch but naturally most of my followers on Youtube and Instagram are other tree cllimbers and cutters and people and companies associated with the work and has absolutely zero to do with anything spoken of in here so no reason to post one in here other than trying to dox my job. I knew it was possible but was trusting on the erudite nature of the blog and most of the commenters to display some basic civility that doesn’t go beyond a few neener neeners and name calling. I should have known better but thanks for letting me know, whoever you are. Next time I’ll try that first.
And btw, I don’t know what “conclusion” you’re talking about but I said nothing about social media bringing us closer one way or the other, and nor would I have implied that we should not be out in public “mano on mano”, as I myself am every day, … the irony of you writing that misdirected statement spoken from behind the name anonymous” notwithstanding.
If someone wants to deride my character, they’ll have to do better than some clown without even enough balls to use his own name behind his little baby name calling. Cheap, tired insults from a little man too afraid to even use his own name behind his infantile words, don’t mean a damn thing.
America today has gone off the deep end, the state arguing about enforcement of ethics burdening individual rights of others holding differing ethics. Tyranny prevails.
Below are the issues that are scheduled for the Supreme Court 2021-2022 in a condensed format. Seems like a non-confrontational schedule especially since we have a Border in Crisis, legitimacy of voting questions, Executive and Legislative Branches exercising unconstitutional directives, Bureaucracies issuing mandates without authority, States and Cities usurping Federal authority and private enterprises denying constitution rights. Do we now have Tyrannical governance and a feckless Supreme Court? Is (WOKE?) in a true runaway motion, that its dominance has overtaken momentum, and is now harder to stop? If we applied Newton’s law of motion we still may be able to reduce the impact of WOKE, take corrective action from the known impacts it’s had on our morals, decency, and our constitutional rights, reestablishing reasonability to discourse and behavior.
As David Held wrote in “Models of Democracy” “In order for democracy to be effective or meaningful as ‘rule by the people’, there must be constitutional limits on government and constitutional guarantees of the civil and political rights of the citizens. This will ensure, or at least encourage, freedom of expression, opinion, and publication, and the free, frequent and informed elections which are necessary for democracy to be other than a formal title.”
Felon in possession of gun and 4th amendment/
Supplemental Security Income 5th amendment/
Unconstitutional conviction and imprisonment 4th amendment/
Death penalty/
Foreign or international tribunal/
Abortion, State, 14 amendment/
State, federal habeas relief/
Constitutional right to confront witnesses/
Right to carry 2nd amendment/
Free Speech 1st amendment/
State secrets clandestine activities/
Federal Arbitration courts/
Abortion/
Petition of habeas relief/
Copyright infringement/
State secrets privilege/
Municipal code restrictions constitutionality/
Jurisdiction of federal courts immigration/
Public education funding religion/
Conspiracy to commit crime Hobbs Act/
Federal disability laws/
This kind of gender hysteria was resisted in Canada by Jordan Peterson six years ago. https://www.youtube.com/watch?v=SiijS_9hPkM. Many said that government coercion can’t happen here. Here we are. We will make you perform abortions. We will make you change a persons sex. We will make you do experimental surgery on Jews. We will make you give syphilis to the Tuskegee Airmen. You will do these things wether you like it or not because they are for the betterment of mankind. The penalty for non compliance will be harsh. Resistance is futile.
“We will make you give syphilis to the Tuskegee Airmen.”
Thanks for putting your ignorance on display.
Yeah. The last person who made that correlation was Dementia Joe.
Yes, Biden made the same mistake. I’d have thought that Thinkitthrough would have learned from Biden’s mistake, but no.
While the they did not give it to them the Tuskegee University did not treat 400 Afro Americans to study the effects syphilis. 100 died. Nome were informed what the study was.
It did not involve the Tuskegee Airmen.
“One of the first changes ordered by the Biden Administration was [to] redefine the discrimination laws to include the denial of such gender transition procedures.”
– Professor Turley
______________
Anti-discrimination laws are irrefutably unconstitutional. The fact that discrimination is fully and immutably constitutional was established by the American Founders and Framers who passed the Naturalization Acts of 1790, 1795, 1798 and 1802 (four iterations), wherein citizens must have been “…free white person(s)….” Additionally the Founders established discriminatory vote criteria as male, European, 21 with 50 lbs. Sterling/50 acres. Discrimination was constitutional in 1789 and it is constitutional in 2021. Discrimination is not to be insidiously conflated with bodily injury, abduction or property damage. It is related that the right to “claim and exercise dominion” over private property rests solely with the owners. The right to private property is absolute or the right to private property does not exist, nor does America.
“[Private property is] that dominion which one man claims and exercises over the external things of the world, in exclusion of every other individual.”
– James Madison
______________
discriminate verb
dis·crim·i·nate | \ di-ˈskri-mə-ˌnāt
\
discriminated; discriminating
Definition of discriminate
transitive verb
1a : to mark or perceive the distinguishing or peculiar features of
Depth perception may be defined as the ability to appreciate or discriminate the third dimension …— H. G. Armstrong
b : distinguish, differentiate
discriminate hundreds of colors
_________________________
Congress has no power to regulate anything other than money, commerce and land and naval Forces. Americans enjoy the freedoms of speech, thought, religion, belief, press, dissemination, assembly, segregation, choice, and every other conceivable natural and God-given right, freedom, privilege and immunity, per the 9th Amendment. Americans most certainly enjoy the freedom of discrimination. If Americans cannot discriminate, Americans cannot be free and they then exist under dictatorship. That one does not like the outcomes of freedom, does not nullify those freedoms, indeed it makes the indivdual a direct and mortal enemy of the Constitution and America. Americans are free to “pursue happiness” and free enterprise. Government is severely limited and restricted by the Constitution.
The judicial branch and Supreme Court must have supported the Constitution and immediately struck down mandates for doctors to perform gender transition procedures. The judicial branch has no authority to legislate or modify legislation. The judicial branch must declare all acts contrary to the “manifest tenor” of the Constitution void. The preponderance of the judicial branch, with emphasis on the Supreme Court, must be impeached and convicted for abuse and usurpation of power, and dereliction and subversion of the Constitution.
_______________________________________________________________________________________________
“…courts…must…declare all acts contrary to the manifest tenor of the Constitution void.”
“…men…do…what their powers do not authorize, [and] what they forbid.”
“[A] limited Constitution … can be preserved in practice no other way than through the medium of courts of justice, whose duty it must be to declare all acts contrary to the manifest tenor of the Constitution void. Without this, all the reservations of particular rights or privileges would amount to nothing … To deny this would be to affirm … that men acting by virtue of powers may do not only what their powers do not authorize, but what they forbid.”
– Alexander Hamilton
I am borrowing a link provided by Estovir. The leftist keep telling us to follow the science accept when the science doesn’t agree with their political propaganda. https://link.springer.com/article/10.1007%2Fs12020-020-02197-5. Thank you for the science Estovir.
Two viewpoints here. Doctors should be able to perform gender reassignment surgery should they so choose. Not on minors.
And I am a conservative. But this Texas decision is absolutely an end run around Roe.
This will absolutely increase the calls for ” packing” the SC. Which I am fervently against.
It will also distract from the Afghanistan evacuation debacle that our country has just witnessed.
This will absolutely increase the calls for ” packing” the SC. Which I am fervently against.
This court is doing what the Roe court should have done. Leave it to state legislatures. I don’t care how you frame abortion, but in no way does abortion require a judicial hand.
Forced mutualism of adults and children for political purpose. Joseph Mengela ain’t got nothin on Biden. These 3000 doctors will not be forced to become the protégés of the most notorious experimental doctor in history. Finally there are some heroes amongst us who will put their lives on the line to stop the madness. Not all is lost. Stay resolute.
Could you imagine Dr. Mengela practicing medicine in this country today?
Gender transmission..truly insane. Pandering to the Progressives. I hate to be blunt but all these bad choices that unhappy people are making will be blatantly obvious in a decade. Is sex change the answer to profound neurosis?
“I wanna be a girl…I cant handle reality as it is…or something. Oh, and I’m 14 years old.”
Whoops, transition not trasmission.
Good luck to the doctors.
Is this part of the CDC?
https://townhall.com/columnists/betsymccaughey/2021/09/01/cdcs-mission-confusion-n2595110
I thought anti-discrimination laws were a good idea at one time. But now that people who should know better are using them as tools for tyranny I think we would be better off eliminating almost all of them. They are causing more harm than good.
They are indeed inviting disastrous consequences in those individuals who seek such transitions.
Prescribing hormones longterm is a matter best left to trained specialists like Endocrinologists. Men who suffer with low testosterone due to aging, for example, are hard pressed to get their physician to prescribe longterm testosterone via injection, the most efficacious treatment plan as is used in hypogonadal young men due to genetics. Aging men with low levels of testosterone are lucky to receive a prescription for daily gel testosterone which is less efficacious, burdensome and has poor compliance with patients. Oral “pills” testosterone is injurious to the liver and is no longer used. Thus it is instructive that elderly men with low testosterone have to fight physician bias and an onslaught of negative media hype about testosterone even if trans patients seem to merit it without question.
As it is, people who undergo trans treatment are no better when it comes to mental health outcomes and reduction of suicidal behaviors after undergoing transition, as compared to prior to undergoing the transition. See the recently published findings of the Amsterdam Cohort of Gender Dysphoria study. This is a very complex patient and not to be casually treated by a regular physician never mind by force. If an individual is wishing to undergo the transition process, a smart patient will want a trained & experienced specialist physician. Forcing any and all physicians to treat these individuals is unwise for all parties. Alas, this is about politics and not science, as if one needs to make that distinction.
See
Patel, H., Arruarana, V., Yao, L. et al. Effects of hormones and hormone therapy on breast tissue in transgender patients: a concise review. Endocrine 68, 6–15 (2020). https://doi.org/10.1007/s12020-020-02197-5
Young, good people do not need laws to be good. Good people pass laws to prevent bad people from doing bad things. Unfortunately, eventually bad people gain power and use the laws good people passed to do bad things.
S. Meyer — Beautifully put.
And the state of Texas is also being sued for its unconstitutional abortion ban.
But Turley, who has repeatedly touted how Trump’s appointees to the court really weren’t so conservative is silent about the fact that SCOTUS hasn’t stayed implementation of the law — a law that allows citizens to sue someone who merely has an **intention** of helping someone obtain an abortion after embryonic heart cells start to beat, who talks with someone about where they can obtain an abortion after just a few weeks of pregnancy, and more. The Republicans who passed this law included thought crime.
@Anon 11:51: And how does that relate to the present discussion? Railing about “embryonic heart cells” in this conversation simply makes you appear idiotic.
It’s almost as if you don’t even realize that transitioned people, by definition, will never need an abortion because they can never procreate. Frankly, I’m fine with that outcome. There used to be an adage that said “stupid people shouldn’t reproduce” (I’ve also heard it referring to ugly people as well). If you want to hack off, or add to, you genitalia please go right ahead. Indeed, I would encourage you to do so. The gene pool Shirley could use a big shot of chlorine right about now.
I consider it related in that it’s another major health-related suit that raises significant legal issues, and it’s also related to several previous columns that Turley wrote saying things like “As we await important and likely divided decisions on issues like abortion, Chief Justice John Roberts and his colleagues seem to be sending a message that the Court is not so rigidly ideological as Democratic members and activists suggest.” This law is clearly unconstitutional under Roe and Casey. SCOTUS should have stayed the law, but it hasn’t.
But if you consider it totally off topic, OK, people often post off-topic comments here. No one is forcing anyone to respond.
@Anon 1:06: I agree that “no one is forcing anyone to respond.” Is there some one forcing you to read Mr. Turley’s blog? Perhaps you could better utilize your time by creating one of your own. You would then have absolute control over its content and stance.
“how does that relate to the present discussion? “
Anon likes to kill things.
Kill babies, Kill speech, Kill Americans left behind, etc. Amazing how the capital letters add up to KKK.
Allan S. Meyer, aka Anonymous the Stupid, the author of the 6:26 PM comment, likes to lie and denigrate.
Gee, thanks. I would like some praise as well.
nice attempt at deflection
Abstention, prevention, adoption, and compassion. And Pro-Choice, the nominally “secular” religion, not limited to the the wicked solution, a handmade tale that denies women and men’s dignity and agency, and reduces human life to a negotiable asset. There is no mystery in sex and conception.
Can they abort the child. cannibalize her profitable parts, sequester her carbon pollutants, and have her, too?
Anon- “And the state of Texas is also being sued for its unconstitutional abortion ban.”
***
I am beginning to think there isn’t a Constitution. Lately judges and politicians just make it up as they go along.
There is the general principle of non-discrimination. There should be no government policy forbidding a group from getting prescribed medical care and/or medication.
There is the general principle of age-of-consent regarding sex. Given the non-reversible nature of some hormone therapy and surely some surgery, the child should not be allowed the choice until age-of-consent. Until then parent/guardian controls. There should be no government policy forbidding anyone from getting prescribed medical care and/or medication. Only a doctor should be allowed to diagnose gender dysphoria and its treatments.
@Old.George: All three of your points are exactly correct. I would only add that the general principle of freedom should forbid any attempts by the government (at any level) to A) require any medical provider to prescribe any medical care/medication and/or perform any procedure or treatment, B) override any licensed medical provider’s opinion regarding the medical necessity of any care/medication/treatment/procedure, and C) insert itself between a medical provider and a patient, except when there is a demonstrable civil or moral imperative to do so.
Reassigning penises or vaginas does not meet the criteria in C, as it would use the compulsory power of the State to inflict one individual’s decision upon another needlessly: The individual is free to find another provider that does not have the same reservations about the decision. Even if the first provider is the only one in the immediate area, that does not preclude her/his right to be free from molestation by the State. Anyone disagreeing should honestly consider: What if the party or ideology you oppose were to be in power and wanted to force *you* to do something. Would you really want the State to have the power to do so? I certainly do not want a government that has any more power than I would like “the other side” to have.
The government forces us to do a variety of things. If you’re male, you have to register with the Selective Service. If you drive a car, you have to be licensed and carry insurance. You have to let police into your home if they present a valid search warrant. …
You think it should be legal for a doctor to choose not to inform a patient that s/he has a treatable illness, precisely what happened in the horrendous Tuskegee syphillis experiment: https://en.wikipedia.org/wiki/Tuskegee_Syphilis_Study
Forcing people to carry out transgender conversion therapy, including: surgical and medical corruption, and indoctrination (e.g. conflation of sex and gender) is a violation of civil and human rights. Not quite the wicked solution (i.e. planned parent/hood), but unconscionable nonetheless.
@Anon 12:41: Thanks for you response. Selective Service and failure to carry insurance are reversible: If I didn’t initially do them in a timely manner, I can do them at some future point (although there may well be penalties and fines). Driving is a privilege, and securing a license is the means by which I am allowed to do so. Also, we agree that those items and actions are required: but the State does not physically compel your compliance. Similarly, the State does not *force* you to stop at red lights, yield to pedestrians, or obey speed limits. If I fail to do them the State may impose penalties or fines, may give me a warning, or may not even catch my noncompliance. Search warrants are not authorized without the demonstration of a compelling State interest.
Forcing a doctor to perform a procedure or prescribe a medication that has long-term or permanent effects is wholly different from any such examples. Certainly, altering genitalia will affect the patient. But the provider is also affected as well. Some providers may not consider altering a patient’s genitalia as terribly significant. Others, however, see it as an affront to their sense of morality (as the plaintiffs ostensibly do). Therefore, the patient’s decision to have the procedure does not offer the State any reason to compel the doctor to violate his own morals: pick a different doctor.
No, I do not think the Tuskegee experiment was legal. It wasn’t ethical, and it certainly was not moral. However, forcing a doctor to DO something is, again, wholly different from withholding information (essentially, NOT doing something). Lastly, if a doctor does not believe transgenderism to be moral, it is highly unlikely they will conversely think it to be medically treatable. They may believe it to be a psychological issue, but do not view hormones and irreversible surgeries to be viable treatment options. Would you have the State be authorized to override their medical opinion rather than refer the patient elsewhere?
“Driving is a privilege, and securing a license is the means by which I am allowed to do so.”
Being a doctor is also privilege for which people are licensed.
“the State does not physically compel your compliance.”
They sometimes physically compel compliance with search warrants: people who resist a warrant can be arrested and removed.
My point was not that these other situations are analogous. I was simply addressing your more general question — “What if the party or ideology you oppose were to be in power and wanted to force *you* to do something. Would you really want the State to have the power to do so?” — and noting that the state already has the power to force us to do things, and it uses that power already.
“If I fail to do them the State may impose penalties or fines, may give me a warning, or may not even catch my noncompliance.”
The same is true here. The suit itself says “doctors now face an untenable choice: either act against their medical judgment and deeply held convictions by performing controversial and often medically dangerous gender-transition interventions, or succumb to huge financial penalties, lose participation in Medicaid and other federal funding, and, as a practical matter, lose the ability to practice medicine in virtually any setting.” They face penalties, including fines.
You said “the general principle of freedom should forbid any attempts by the government (at any level) to A) require any medical provider to prescribe any medical care/medication.” The Tuskegee doctors chose not to prescribe penicillin for syphilis. They didn’t just withhold information. They refused care they knew could help their patients.
“Would you have the State be authorized to override their medical opinion rather than refer the patient elsewhere?”
But I don’t have the impression that the doctors who object are referring these patients to other local providers covered by their insurance. If I’m wrong about that, please correct me. I don’t think it should fall to the state to make the referral.
Anon– The Tuskegee study was not horrendous.
At the time participants were drawn largely from a poor community with no insurance or adequate health care. They inevitably were not going to be treated for syphilis with or without the study.
Their ordinary ground state was no treatment for anything.
Even if they could have been treated the available medicine, Salvarsan, was based on arsenic and known to have side effects like nausea, vomiting and deafness. There was a question whether treatment or non-treatment with the medicine was better.
Participants were given fairly extensive medical care for everything except treatment with Salvarsan for syphilis. Also they were provided transportation and meals. They rationally concluded they were significantly better off in the program than left on their own with the disease.
The ethical breach occurred years into the program when antibiotics for treating the disease became available and the participants should have been given the opportunity to take it but weren’t. However, by that time for many the disease had either resolved on its own or done its major damage. It was wrong, but the consequences may not have been as usually hyped.
For the participants, entering the program was a rational decision and had I been similarly placed I would have enrolled as well.
Far more terrible were the plutonium experiments done on American citizens without their knowledge or consent. See ‘The Plutonium Files’.
Another government crime involved the Hanford plutonium plant in Hanford, Washington. Secretly and at night and in violation of law they released plumes of radioactivity into the atmosphere to drift northeast across Washington and the Idaho Panhandle to drift down on unsuspecting Americans. Since it has been revealed that population has been dubbed ‘Downwinders’ and been monitored.
The Tuskegee participants gave informed consent to participate in the study. The plutonium subjects and the Downwinders didn’t even know what their government was doing to them.
“The Tuskegee study was not horrendous.”
You’re disgusting.
They did not inform the men that they had syphilis, they did not treat them, they lied to the men telling them that they were being treated when they were instead given placebos, … Not only did over 100 men die from syphilis or its complications, but dozens of their wives were infected, and 19 children were then born with congenital syphilis. It’s an astounding ethical violation.
“The Tuskegee participants gave informed consent to participate in the study.”
You’re either ignorant or lying or both.
If researchers are going to lie to participants, but they fail to say in the consent form that they may lie to participants, the potential participants literally cannot give informed consent. Apparently you do not understand what it means for consent to be informed.
Anon– I thought you would be telling me I was disgusting, I was watching for it in fact, looking forward to it.
Here is some information on the Tuskegee study: https://www.tuskegee.edu/about-us/centers-of-excellence/bioethics-center/about-the-usphs-syphilis-study
“The men were offered what most Negroes could only dream of in terms of medical care and survivors insurance. They were enticed and enrolled in the study with incentives including: medical exams, rides to and from the clinics, meals on examination days, free treatment for minor ailments and guarantees that provisions would be made after their deaths in terms of burial stipends paid to their survivors.”
“There were no proven treatments for syphilis when the study began. When penicillin became the standard treatment for the disease in 1947 the medicine was withheld as a part of the treatment for both the experimental group and control group.”
Read more about it and you will find that the participants were informed of the disease being studied in terms they used themselves for the disease, not scientific terms. If you learn more about informed consent you will discover that the legal standard is for the patient to be informed in terms he can understand, not just words the doctor understands.
There was a famous case (BANG v. CHARLES T. MILLER HOSPITAL) I think in which a patient was told he needed a transurethral resection. He asked if that would take care of his problem and the doctor said correctly that it would. The procedure was performed and the patient later learned that a consequence of the procedure was sterilization. He sued. Here it is: https://casetext.com/case/bang-v-charles-t-miller-hospital. The informed consent obtained in the Tuskegee study was adequate for the times and better than that afforded to Mr. Bang.
You are getting a little bit like Natacha–are you Natacha?–with the ready accusations of lying and bad faith and abusive remarks.
I notice that you had nothing to say about the greater abuses in the Plutonium Cases. Is that because mostly only whites were victims?
“the ready accusations of lying and bad faith and abusive remarks.”
If you don’t like it, then stop doing it yourself. What you regularly dish out may sometimes be returned to you.
“If you learn more about informed consent you will discover that the legal standard is for the patient to be informed in terms he can understand, not just words the doctor understands.”
And if YOU learn more about informed consent, you will discover that among other things, the legal and ethical standards require that the person be informed of the purpose of the study and of potential risks along with the potential benefits, and they require that the researchers minimize the risks to the participants. Perhaps you want to pretend that there was no way to explain those things to the participants in terms they could understand, that if they’d been told “we may lie to you,” they wouldn’t have understood. If so, I wouldn’t be surprised, as you sometimes go to great lengths to excuse immoral acts.
Your own link states “the men were never told about or offered the research procedure called informed consent.” Apparently you disagree with that part of your chosen reference. Don’t like that quote? Here’s a quote form the CDC FAQ on the U.S. Public Health Service Syphilis Study at Tuskegee: “There is no evidence that researchers obtained informed consent from participants.”
The failure to obtain informed consent and to subsequently provide information and treatment was so egregious that it resulted in significant reforms in the requirements and review processes nationwide for research involving human subjects.
You as do as many others do and look at the Tuskegee study through the lens of modern concepts of informed consent, some of which were formed after the Tuskegee Study but most from court cases. I have referred you to Canterbury before.
As for “person be informed of the purpose of the study and of potential risks along with the potential benefits” consider the risks and benefits.
No non-toxic and reliable treatment was available when the study began.
The population selected had high rates of syphilis [they still do] and essentially no medical care. If they elected not to join the study they had NOTHING. No syphilis treatment no medical care for other matters no death benefit.
If they joined the study they still got what they already had–no syphilis treatment–but they did get the other benefits I mentioned above, including some health care that they did not already have.
There was no upside to not joining the study. There was no downside to joining the study. I would have done knowing everything about it that I know even now. I bet you would have done too.
As for your CDC FAQ on informed consent, stuff it. They have likely joined the chorus of people who are for racial justice schemes trying to turn this study into a Nuremberg crime. It isn’t. Not even close. The CDC has blown its credibility
Other things I have read indicate that the participants were given information consistent with the standards of the time. The local term for syphilis was ‘bad blood’ and they were told that was being studied.
Still none of this hand wringing from you for the many people who were experimented on with plutonium without their knowledge much less their consent. But they weren’t black so there is no profit in making an issue of them. In fact, you are rather disgusting and racist.
You’re the one who said “If you learn more about informed consent …,” but now complain about what “informed consent” means.
“As for “person be informed of the purpose of the study and of potential risks along with the potential benefits” consider the risks and benefits.”
Work on your reading skills. They were not INFORMED of the purpose and potential risks, and therefore could not give INFORMED consent, because INFORMED consent requires that the researchers INFORM prospective participants of the PURPOSE and possible RISKS along with informing them of the possible benefits. You totally ignore their silence about the purpose. You seem to deny that there were any risks. You’ve clearly never written a consent form or carried out research involving human subjects. The law is quite explicit that you MUST inform prospective participants of possible deceit with few exceptions, which are listed, as being deceived is a risk. You ignore the risk that a cure would be developed and the researchers would fail to inform them. You ignore the risk to their sexual partners (in many cases, their wives). You ignore the risks to their children.
“There was no upside to not joining the study. There was no downside to joining the study.”
Bullshit. And your opinion about that is also irrelevant to whether they gave INFORMED consent. They didn’t. But apparently you cannot admit that.
“I would have done knowing everything about it that I know even now.”
Then you’re an even bigger fool than I’d previously concluded.
“As for your CDC FAQ on informed consent, stuff it.”
You ignore that your own chosen reference agrees that the participants didn’t give informed consent. Stuff your denial.
“Still none of this hand wringing from you for the many people who were experimented on with plutonium without their knowledge much less their consent.”
That was repugnant TOO. But you’re too sick to find both of them immoral.
You’re the one who said “If you learn more about informed consent …,” but now complain about what “informed consent” means.
“As for “person be informed of the purpose of the study and of potential risks along with the potential benefits” consider the risks and benefits.”
Work on your reading skills. They were not INFORMED of the purpose and potential risks, and therefore could not give INFORMED consent, because INFORMED consent requires that the researchers INFORM prospective participants of the PURPOSE and possible RISKS along with informing them of the possible benefits. You totally ignore their silence about the purpose. You seem to deny that there were any risks. You’ve clearly never written a consent form or carried out research involving human subjects. The law is quite explicit that you MUST inform prospective participants of possible deceit with few exceptions, which are listed, as being deceived is a risk. You ignore the risk that a cure would be developed and the researchers would fail to inform them. You ignore the risk to their sexual partners (in many cases, their wives). You ignore the risks to their children.
“There was no upside to not joining the study. There was no downside to joining the study.”
Bull. And your opinion about that is also irrelevant to whether they gave INFORMED consent. They didn’t. But apparently you cannot admit that.
“I would have done knowing everything about it that I know even now.”
Then you’re an even bigger fool than I’d previously concluded.
“As for your CDC FAQ on informed consent, stuff it.”
You ignore that your own chosen reference agrees that the participants didn’t give informed consent. Stuff your denial.
“Still none of this hand wringing from you for the many people who were experimented on with plutonium without their knowledge much less their consent.”
That was repugnant TOO. But you’re too sick to find both of them immoral.
Pretty much all of your rant comes down to informed consent. They did not get ‘informed consent’ according to modern standards because, as I have said, it did not exist then. They were informed of the benefits of joining the program. That’s why they signed up.
As for the consequences I can’t distinguish between not being treated in the program and not being treated out of the program. Except in the program you get other benefits.
By the standards of the time they were treated well up to the time antibiotics became available and it is questionable how much those would have done in late stage.
You, and others, are trying to shoehorn modern standards into the past to cry about some sort of racist crime. It wasn’t.
How does this differ from modern double blind studies in which some are treated and others are not?
You still haven’t seen shown any concern for the people actually poisoned with Plutonium by the government.
There is more than a touch of racism in how you select your victims to cry about.
You are only virtue signaling.
Anon– “That was repugnant TOO. But you’re too sick to find both of them immoral.”
***
The Tuskegee folk agreed to join a study that improved their lives with meals, transportation, medical care and death benefits. There was no safe treatment for syphilis then.
Those who did not join the study also didn’t get treatment but no benefits either.
None was injected with experimental drugs or given experimental treatments. They were given lunch.
By contrast the Plutonium victims had no idea they were part of any study. Even pregnant women were give Plutonium without any warning. That’s Nazi level abuse.
If you can’t see the difference between that and Tuskegee you are too far gone to think rationally.
Anon– “You ignore the risk to their sexual partners (in many cases, their wives). You ignore the risks to their children.”
***
You are trying to be stupid.
There was no proven treatment for syphilis.
So calculate the risks to others if the study had not existed.
It was exactly the same.
No treatment outside the study is the same as no treatment inside the study.
The consequences are identical.
You just want to be outraged.
“You, and others, are trying to shoehorn modern standards into the past …”
You think “thou shalt not lie” is a modern standard?
“How does this differ from modern double blind studies in which some are treated and others are not?”
Why are you so unskilled at looking up the answers to your questions? Tell me your search terms, and I’ll help you get better at looking up the answers to your questions.
As for all of your lies about me, those are on you, not me.
Anon– “As for all of your lies about me, those are on you, not me.”
***
You still haven’t said what the difference is between not being treated outside the study and not being treated in the study. The risks and consequences are identical.
Do you need to search for some Fact Sheet to understand it? You make me wonder what your diagnosis was. Do you have a search term for it?
Okay. You really are Natacha-. You have spittle but no rational response. Enough said.
“You still haven’t said what the difference is between not being treated outside the study and not being treated in the study. ”
Do you deludedly believe that the onus is on me to address your ignorant false dichotomy?
You could start by informing yourself about what an ethical and knowledgeable doctor did in the 1930s when he diagnosed a patient with syphilis and then inform yourself what an ethical and knowledgeable doctor did in the 1940s for a patient previously diagnosed with syphilis. You could inform yourself, but you apparently choose not to. If you’re too lazy to educate yourself, that’s your problem, not mine.
“The risks and consequences are identical.”
Perhaps you believe that because you start with a false assumption that an ethical and knowledgeable doctor did nothing. Again: if you’re too lazy to educate yourself, that’s your problem, not mine.
S. Meyer is right. You really are stupid.
You want me to consider what a capable doctor could have done with syphilis in the Thirties and Forties and apply it to the Tuskegee situation.
First, there was NO safe remedy for curing the disease.
Second, that population had no health care. They got some for joining the study.
I notice you like to say ‘false dichotomy’ a lot as if you were making a profound point.
You aren’t.
It is No Healthcare vs. No Healthcare.
There is NO dichotomy at all, much less a false one.
Strange that after all of this you are still incapable of seeing it.
That’s where virtue signalling gets you…rage and looking stupid.
As I said, Young, you start with a false assumption that an ethical and knowledgeable doctor did nothing, or in your words, the only options were “No Healthcare vs. No Healthcare.”
S. Meyer accuses others of stupidity because he is not interested in having a sincere discussion and because he loves denigrating those he disagrees with. It is a form of self-defense for him, as it is for you.
“S. Meyer accuses others of stupidity because he is not interested in having a sincere discussion and because he loves denigrating those he disagrees with. It is a form of self-defense for him, as it is for you.”
Anonymous the Stupid, that is not true. When I lack the needed knowledge about something, I say so. Yet, you jump in saying how I should have that knowledge when all you have done is take a superficial look at the question. That is pure Stupidity, and I am correct to say it is.
I don’t need to act defensively because I know what I am talking about. You don’t. That has been proven over and over again, and that is why your icon is anonymous. That is your defense mechanism. I call you Anonymous the Stupid to separate you from the others since the word, Stupid, fits.
Anon– “As I said, Young, you start with a false assumption that an ethical and knowledgeable doctor did nothing, or in your words, the only options were “No Healthcare vs. No Healthcare.”
***
Even if an ethical and knowledgeable doctor could have done something it makes no difference in the Tuskegee study.
THEY COULDN’T AFFORD DOCTORS! Without the study they had NO healthcare to speak of.
They had NO healthcare without the study.
You keep throwing in “well ifs” when there were no well ifs…
If the study had never existed the same people with syphilis would have gone untreated because:
1. There was no effective treatment; and
2. They had minimal to no healthcare in the community.
You keep arguing outside the facts of the situation…hypotheticals.
Confine yourself to actual facts and you won’t get so confused.
Like many social justice freaks you desperately want this to be worse than it is.
“You keep arguing outside the facts of the situation…hypotheticals.”
Duh. That’s what we’re discussing: a hypothetical within the realm of possibility in which they were treated differently.
Again, Young, you’re assuming that they could not be provided with ethical and knowledgeable medical care. Of course they could have been (e.g., in a study that looked the effects of providing ethical and knowledgeable treatment to the poor), even though they weren’t. You claim that there was no effective treatment at the time, even though neosalvarsan was widely used and fairly effective, though the side-effects were worse than penicillin. Doctors could have told them that they were infected with syphilis (not any of the other diseases that were also sometimes called “bad blood”), explained the disease to them, presented neosalvarsan as an option, explained the potential side-effects, and allowed the men to make an informed choice. They could have educated the men about the progression of the disease, the risk to partners and children, …
But you are apparently incapable of even imagining an ethical and knowledgeable medical professional doing these things. If “rage and looking stupid” describes someone here, it certainly doesn’t describe me.
Anon,
Well, if all they had to do was go to the local ethical doctor for a diagnosis and get salvarsan for treatment despite its known risks, why didn’t they do it before the study was begun?
Hmmm?
Nobody was stopping them.
Other people in other communities did it.
I do so want you to answer that question.
The study was important because it followed the disease as it normally progressed in the community without white people coming in like zookeepers to take care of stock that couldn’t take care of itself as you apparently see it.
You have the zookeeper’s approach to the black community. They are never responsible for themselves. You want the white saviour to take over.
You are a true racist.
You can sit in your mom’s basement, smoke dope, and have pipe dreams about all sorts of solutions except for one that actually deals with real world facts.
If you are too stupid or too spaced to acknowledge the facts there is no hope for you and that’s your problem, not mine or S. Meyer’s.
Young,
“Maybe behavioral reform”
Essentially turning people into Pavlov’s dogs?
That doesn’t set well.
“I do so want you to answer that question.”
I’m unsurprised that you want to spew insults and get an answer to a loaded question.
I want you to be sincere and civil.
We don’t always get what we want.
Anon- “I’m unsurprised that you want to spew insults and get an answer to a loaded question.”
***
The question wasn’t loaded, but the answer might be for you. You clearly want to avoid it.
Why didn’t the Tuskegee people get ‘ethical’ treatment before the Tuskegee study began? Nobody was stopping them.
I think you know why but you haven’t the moral courage to answer. You want to be the white saviour.
” You want to be the white saviour.”
More likely, Anonymous the Stupid wants to be the white slave master.
Anon,
Here’s another thought for you to ponder. How well would you do as a white saviour in that community?
One has already shown up with loads of antibiotics and Medicaid.
Guess what? Syphilis rates are still sky high amongst the same population.
Maybe behavioral reform is more necessary than medicine. Modern, free medical care apparently isn’t working.
Anon, Another thing to ponder. In Michigan blacks account for more than 56% of all syphilis cases.
https://www.mdch.state.mi.us/osr/std/STDbyRace.asp
Why don’t you go there and do your white saviour thing; it’s not too late. You attack the Tuskegee researchers for not doing more when there were no medicines available. Now you have antibiotics. Go show all of us how its done rather than only sit around posting on Turley.
By the way, the same high percentages are shown for blacks with other sexually transmitted diseases.
Must be whitey’s fault.
The Tuskegee experiments were awful and disgusting. And they went on until 1972. There is NO DEFENSE!!!
Nonsense– Read the material I linked above and then tell me what you find disgusting about them. The one ethical flaw was failing to inform or provide antibiotics when they became available. Prior to that the people in the Tuskegee program were far better off than those that weren’t.
https://www.tuskegee.edu/about-us/centers-of-excellence/bioethics-center/about-the-usphs-syphilis-study
You have adopted the screecher approach: “It’s awful! It’s awful!” Without having a clue what you are talking about.
But, convince me. Read the report from the university and then tell us what was awful apart from what I mentioned.
Was it awful to give them health care they didn’t have?
Was it awful to feed them?
Was it awful to transport them to the clinics?
Was it awful to offer them a death benefit?
They wouldn’t have any of that without joining the study.
But, you screamed. Show us what you are screaming about.
Education in this country is in the pits.
Paul, one of the frequent complaints about the study was that “dozens of men had died and their wives, children and untold number of others had been infected.”
But what would the outcome have been if the Tuskegee Study had not taken place?
SAME THING. THERE WAS NO TREATMENT AVAILABLE.
The other complaint touches on the number who died. The study lasted 40 years. Even without syphilis a significant number would have died in that time. More without the study probably because those not in the study did not get the extra medical treatment for other problems that the participants did.
Again, the sole ethical problem at the time was not providing antibiotics late in the study by which time most of the harm from an untreatable disease had already occurred.
As for the disease itself, when I first read about it a decade or so ago one of the questions posed was what are the Tuskegee conditions now? Surprisingly, even with the advent of antibiotics the rate of syphilis in the community was about the same as back then. There is a significant behavioral problem there.
You are all for government taking power from the individual and using force.
Essentially this immunized those involved from penalty. You are in agreement with authorizing the federal government to do whatever you want at the time despite the fact you know little about what you talk about.
Blame yourself for Tuskegee.
Anon- “You are all for government taking power from the individual and using force.”
***
Was that aimed at me? With so many anonymouses running around it is hard to tell who is arguing with whom.
But, if at me, it is a stupid statement. No force was used in the Tuskegee study and the participants agreed to take part after being informed.
Nobody was immunized from penalty. There was no penalty. The standards of the time were followed. No laws were broken.
Blame myself for Tuskegee? Thanks. I think it was a good study up to the point that antibiotics became available and weren’t offered. But I have to wonder whether if a newly created drug for Disease A is being tested in an expensive double-blind study and another drug known to be effective becomes available to treat Disease A will the study be interrupted and everyone given the new drug? Probably not even in these days.
People are paid to participate in studies even if they get a placebo, but they are not patients in an ordinary physician/patient relationship. They are subjects in a study and the laws and conventions are different.
Frankly, I suspect that if the Tuskegee subjects had been white nobody would care. Nobody seems to care about the victims of the Plutonium experiments which were far more egregious and would have gotten doctors hanged at Nuremberg.
Anon- “You are all for government taking power from the individual and using force.”
“Was that aimed at me? “
—–
NO! It was aimed at Anonymous the Stupid. Everything you said was correct. He likes government intervention, so he should blame himself for whatever he doesn’t like about Tuskegee. What you said is true.
It was a study started when no treatment existed. What bothers me is when the participants are provided immunity from suit or other action. That immunity, whether needed or not, was from the government, not the private sector. The concerns occurred later in the study. Most doctors that see the eyes of the patient try to be ethical. My problem is only that the researchers were given the right to keep their eyes shut. Whether or not ethical violations occurred is something I don’t know.
The government is the worst violator of ethics because the government uses force and has guns.
“Whether or not ethical violations occurred is something I don’t know.”
Then you are ignorant, S. Meyer the Stupid, and there is ample reading about the ethical violations should you wish to inform yourself.
Anonymous the Stupid, I don’t use headlines and emotions to make a decision. I use fact. That means I have to know what I am talking about something you don’t seem to understand.
Yes, like you I have read about the experiment, but unlike you I didn’t form an opinion based on political correctness or politics. I need much more data than sites like Wikipedia and I need to know the progression of the disease in each patient at the time along with the standard of care and their access to treatment. You are too shallow to ever think before opening your mouth and barfing.
S. Meyer– I agree completely. If you take off the PC glasses and ask what really was done in the Tuskegee study it actually looks pretty good for the first ten years or so. By the standards of the time it seems about right.
Were any other race involved it would have been ignored and forgotten long ago.
When a drug was developed expressly to protect black people from a disease that struck them in particular there was a furor. The beneficial drug was racist because it implied blacks were different in some respects.
We are all different and each ethnic group, race, has some vulnerability that can be addressed with tailored treatment. But were I in the business of looking for cures for diseases I think I would skip blacks altogether. No matter what it seems you get nothing but opprobrium. Not worth it. I am sure Zulu medical researchers will fill the gap.
Leftists use all different standards to conclude that their opponents are wrong but never use those standards on themselves. I don’t blame Anonymous the Stupid for that because he doesn’t recognize what standards are. He is ignorant. Thus he can blame slavery on America when it was practiced for millennia while forgetting that slavery still exists in Africa and elsewhere. America had a civil war over slavery, and the blood spilled was tremendous. Yet Anonymous the Stupid continues with his Stupidity.
“You are all for government taking power from the individual and using force.”
I’m not, and you shouldn’t pretend to read my mind. I was pointing out to Hickdead that the government does force us to do some things, whether via fines or the threat of criminal charges or, on occasion, physical force from LE or medical treatment approved by a court for those who are hospitalized against their will.
“you know little about what you talk about”
Look in the mirror. You can’t even follow a conversation.
Babble. But, have you read the Canterbury case yet?
“you shouldn’t pretend to read my mind.”
No one has to read your mind, Anonymous the Stupid. All one has to do is read what you have written. Once that is done the ultimate understanding is that you are an idiot and you don’t know it. You are shallow, so you lie or deceive rather than provide information of value.
More Babble. Have you read “The Plutonium Files”?
OK, it’s soap-box time: “There should be no government policy forbidding a group from getting prescribed medical care”
Except for the Covid stricken unvaxxed who should be refused ICU space as well as health insurance coverage for the $17,500 hospital bill.
My own heart is failing, I had an operation scheduled, then cancelled and the ICUs are filled with absolute morons.
Uh, yeah sure. I guess. Here’s another helpful contribution, while you’ve got your box out already: https://ycharts.com/indicators/world_tea_price
Acromion: “Except for the Covid stricken unvaxxed who should be refused ICU space as well as health insurance coverage for the $17,500 hospital bill.”
***
Interesting thought. Should we also refuse space to those who suffer severe side effects from the vaccine, and there are more and more of them lately?
Should we refuse care to the vaccinated who develop autoimmune diseases and vascular problems from the vaccine which is one possibility within the realm of medical concern?
Savage little thing, aren’t you?
Having a dong sewed on is not a right or a privilege. It’s like smoking or vaping
There would seem to be an awakening from wokeness when it encounters reality. In a free (and rational) society I have the absolute right to think, feel, and believe whatever I wish. However, I do not have any right whatsoever to tell you that you *must* accept it as fact. Likewise, you can want to be whatever gender you can invent. However, your rights do not govern my ability to address you by whatever genitalia you lack or wish you had.(or wish you didn’t have, as the case may be). I will respect your right to reject my religion only as far as you allow me to reject calling a penis-person a vagina-person, and vice versa. Perhaps if you politely asked me to refer to you as a vagina person, I might comply as a matter of decorum. When you demand it, however, I will just as vehemently decline and will very likely intentionally refer to you as a penis-person.
Lastly, you have utterly no right to coerce my into telling my children (or anyone else for that matter) that your choices and preferences are right, correct, proper, or based in reality: Just as you have the same protection regarding my religion.
Re: “[T]he mandate for doctors to perform gender transition procedures.”
“I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on, when they lie on an operating table under my hands? [. . .] Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it – and still less safe, if he is the sort who doesn’t.” (Dr. Hendricks in _Atlas Shrugged_, on why he quit medicine)
It is sad that physicians have to resort to religious claims (which may be perfectly honest and I am not implying otherwise) to avoid being commandeered by the government to do things they believe to be contrary to their patients’ medical interest.
Until 1940, the idea of a peacetime draft was anathema, and even then was acceptable only because much of the world was already at war and the well-grounded fear that the war would eventually find us.
Commanding people to do things is the essence of being drafted, and we now accept that this is perfectly OK unless someone has a religious scruple, and even then the burden is on them.
We are truly no longer “the land of the free.”
Lefties not only want freedom for themselves – a righteous goal, but they want the ability to compel others with differing beliefs – a despicable goal.
Lefties are indulging their inner Fascist.
Oh, i think at this point they are indulging their outward fascist. Sadly, if this can’t be resolved through legal means such as fair and free voting, it’ll be resolved through other means.
I am waiting for the Democrats on the left to raise their voices against government intrusion into their civil liberties.
Who wouldn’t want to have these complex and cosmetic procedures done by a doctor who doesn’t want to do them?
You are assuming that these individuals indulge in rational thinking. They don’t. They just want what they want like any other spoiled brat.