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    Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine

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    Dr. Hilary Cass published a landmark report that led to restrictions on youth gender care in Britain. U.S. health groups said it did not change their support of the care.After 30 years as one of England’s top pediatricians, Dr. Hilary Cass was hoping to begin her retirement by learning to play the saxophone.Instead, she took on a project that would throw her into an international fire: reviewing England’s treatment guidelines for the rapidly rising number of children with gender distress, known as dysphoria.At the time, in 2020, England’s sole youth gender clinic was in disarray. The waiting list had swelled, leaving many young patients waiting years for an appointment. Staff members who said they felt pressure to approve children for puberty-blocking drugs had filed whistle-blower complaints that had spilled into public view. And a former patient had sued the clinic, claiming that she had transitioned as a teenager “after a series of superficial conversations with social workers.”The National Health Service asked Dr. Cass, who had never treated children with gender dysphoria but had served as the president of the Royal College of Pediatrics and Child Health, to independently evaluate how the agency should proceed.Over the next four years, Dr. Cass commissioned systematic reviews of scientific studies on youth gender treatments and international guidelines of care. She also met with young patients and their families, transgender adults, people who had detransitioned, advocacy groups and clinicians.Her final report, published last month, concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.” On her recommendation, the N.H.S. will no longer prescribe puberty blockers outside of clinical trials. Dr. Cass also recommended that testosterone and estrogen, which allow young people to develop the physical characteristics of the opposite sex, be prescribed with “extreme caution.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Widening Racial Disparities Underlie Rise in Child Deaths in the U.S.

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      New research finds that the death rate among Black youths soared by 37 percent, and among Native American youths by 22 percent, between 2014 and 2020, compared with less than 5 percent for white youths.The NewsThanks to advancements in medicine and insurance, mortality rates for children in the United States had been shrinking for decades. But last year, researchers uncovered a worrisome reversal: The child death rate was rising.Now, they have taken their analysis a step further. A new study, published Saturday in The Journal of the American Medical Association, revealed growing disparities in child death rates across racial and ethnic groups. Black and Native American youths ages 1 to 19 died at significantly higher rates than white youths — predominantly from injuries such as car accidents, homicides and suicides.Dr. Coleen Cunningham, chair of pediatrics at the University of California, Irvine, and the pediatrician in chief at Children’s Hospital of Orange County, who was not involved in the study, said the detailed analysis of the disparities documented “a sad and growing American tragedy.”“Almost all are preventable,” she said, “if we make it a priority.”Flowers for Karon Blake, 13, who was shot and killed in Washington, D.C., in January 2023. Gun-related deaths were two to four times higher among Black and Native American youth than among white youth.Carolyn Kaster/Associated PressSome Context: A frightening trend examined more closely.Researchers at Virginia Commonwealth University and Children’s Hospital of Richmond had previously revealed that mortality rates among children and adolescents had risen by 18 percent between 2019 and 2021. Deaths related to injuries had grown so dramatically that they eclipsed all public health gains.The group, seeking to drill deeper into the worrying trend, obtained death certificate data from the Centers for Disease Control and Prevention’s public WONDER database and stratified it by race, ethnicity and cause for children ages 1 to 19. They found that Black and American Indian/Alaska Native children were not only dying at significantly higher rates than white children but that the disparities — which had been improving until 2013 — were widening.The data also revealed that while the mortality rates for children overall took a turn for the worse around 2020, the rates for Black, Native American and Hispanic children had begun increasing much earlier, around 2014.Between 2014 and 2020, the death rates for Black children and teenagers rose by about 37 percent, and for Native American youths by about by about 22 percent — compared with less than 5 percent for white youths.“We knew we would find disparities, but certainly not this large,” said Dr. Steven Woolf, a professor of family medicine at the V.C.U. School of Medicine, who worked on the research. “We were shocked.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Millions of Girls in Africa Will Miss HPV Shots After Merck Production Problem

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      The company has told countries that it can supply only 18.8 million of the 29.6 million doses it was contracted to deliver this year.Nearly 1.5 million teenage girls in some of the world’s poorest countries will miss the chance to be protected from cervical cancer because the drugmaker Merck has said it will not be able to deliver millions of promised doses of the HPV vaccine this year.Merck has notified Gavi, the international organization that helps low- and middle-income countries deliver lifesaving immunizations, and UNICEF, which procures the vaccines, that it will deliver only 18.8 million of the 29.6 million doses it was contracted to deliver in 2024, Gavi said.That means that more than 10 million girls will not receive their expected HPV shots this year — and 1.5 million of them most likely will never get them because they will be too old to qualify for the vaccine in subsequent years.Patrick Ryan, a spokesman for Merck, said the company “experienced a manufacturing disruption” that required it to hold and reinspect many doses by hand. He declined to give further details about the cause of the delay.“We are acting with urgency and rigor to deploy additional personnel and resources to resolve this matter as soon as possible,” he said.Mr. Ryan said that Merck would deliver the delayed doses in 2025. He also said the company would ship 30 million doses of the vaccine to Gavi-supported countries this year. However, about a third of these are doses that were supposed to have been sent in 2023, leaving Gavi with the 10.7 million dose shortfall.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Who Needs Paper? Many Students Embrace the All-Digital SAT.

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      Several test takers across the country found themselves in favor of the new format of the college admissions exam — even with some technical glitches.The Scantron bubbles were gone. So were the page-long passages and the pressure to speed-read them. No. 2 pencils? Optional, and only for taking notes.On Saturday, students in America took the newest version of the SAT, which was shorter, faster — and most notably, all online. Some exams were briefly mired by technical glitches, but even so, many test takers had positive views about the new format. They were especially relieved with the brevity of the exam — which dropped from three hours to a little over two hours — as well as the ability to set their own pace as they worked through the questions. “It’s here to stay,” said Harvey Joiner, 17, a junior at Maynard H. Jackson High School in Atlanta, referring to the digital format. “Computers are what we’re more comfortable with.”Given on paper for 98 years, the SAT was updated to reflect the experience of a generation raised in an era of higher anxiety, challenged attention spans and remote learning. The change comes as the College Board, which administers the test, and proponents of standardizing testing say that the exams still have a place in determining college acceptance and aptitude.Disrupted by the pandemic and rocked by concerns that the tests favor high-income students, the SAT has had a shaky few years, with many colleges removing standardized tests as a requirement for admission. Some selective universities, including Brown, Yale, Dartmouth and M.I.T., have since reinstated the test, but at most schools, it has remained optional. We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Texas Judge Blocks Paxton’s Request for Transgender Minors’ Records

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      An L.G.B.T.Q. organization had sued after the state’s attorney general asked for documents on children receiving gender-affirming care.A judge on Friday temporarily blocked the Texas attorney general from forcing an L.G.B.T.Q. organization to turn over documents on transgender minors and the gender-affirming care they may be receiving.In Texas, medical care for gender transition is prohibited for minors under a law passed last year. As part of an investigation into violations of the ban, the office of Attorney General Ken Paxton demanded early last month that the nonprofit PFLAG National, which supports families in accessing gender-affirming care for children, provide information on minors in the state who may have received such treatments. But on Friday, Judge Maria Cantú Hexsel of Travis County District Court issued an injunction against Mr. Paxton, just days after PFLAG sued to block the request, saying turning over the documents would cause “irreparable injury, loss or damage” to the group. The judge added that such an ask would infringe on the group’s constitutional rights and that its members would be subject to “gross invasions” of privacy.In a statement, PFLAG’s lawyers, including the American Civil Liberties Union, said they were “grateful that the court saw the harm the attorney general’s office’s intrusive demands posed.”Mr. Paxton’s office did not immediately respond to requests for comment on Friday’s order. But he has previously argued that the information from PFLAG is “highly relevant” to his investigation into medical providers who he says are trying to work around the ban on gender-affirming care for minors. “Any organization seeking to violate this law, commit fraud or weaponize science and medicine against children will be held accountable,” he said in a statement. The judge scheduled a hearing for March 25 to give the attorney general a chance to argue against the injunction. We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      A.I. Is Making the Sexual Exploitation of Girls Even Worse

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      On Tuesday, Kat Tenbarge and Liz Kreutz of NBC News reported that several middle schoolers in Beverly Hills, Calif., were caught making and distributing fake naked photos of their peers: “School officials at Beverly Vista Middle School were made aware of the ‘A.I.-generated nude photos’ of students last week, the district superintendent said in a letter to parents. The superintendent told NBC News the photos included students’ faces superimposed onto nude bodies.”I had heard about this kind of thing happening to high school girls, which is horrible enough. But the idea of such young children being dehumanized by their classmates, humiliated and sexualized in one of the places they’re supposed to feel safe, and knowing those images could be indelible and worldwide, turned my stomach.I’m not a technophobe and have, in the past, been somewhat skeptical about the outsize negative impact of social media on teen girls. And while I still think the subject is complicated, and that the research doesn’t always conclude that there are unfavorable mental health effects of social media use on all groups of young people, the increasing reach of artificial intelligence adds a new wrinkle that has the potential to cause all sorts of damage. The possibilities are especially frightening when the technology is used by teens and tweens, groups with notoriously iffy judgment about the permanence of their actions.I have to admit that my gut reaction to the Beverly Hills story was rage — I wanted the book thrown at the kids who made those fakes. But I wanted to hear from someone with more experience talking to teens and thinking deeply about the adolescent relationship with privacy and technology. So I called Devorah Heitner, the author of “Growing Up in Public: Coming of Age in a Digital World,” to help me step back a bit from my punitive fury.Heitner pointed out that although artificial intelligence adds a new dimension, kids have been passing around digital sexual images without consent for years. According to a 2018 meta-analysis from JAMA Pediatrics, among children in the 12 to 17 age range, “The prevalence of forwarding a sext without consent was 12.0 percent,” and “and the prevalence of having a sext forwarded without consent was 8.4 percent.”In her book, Heitner offers an example in which an eighth-grade girl sends a topless photo to her boyfriend, who circulates it to his friends without her permission. After they broke up, but without her knowledge, “her picture kept circulating, passing from classmate to classmate throughout their middle school,” and then “one afternoon, she opened her school email to find a video with her image with sound effects from a porn video playing with it.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      What We Know About the Death of Nex Benedict in Oklahoma

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      Nex Benedict, a 16-year-old student, died one day after an altercation with classmates in a school bathroom in Oklahoma, renewing scrutiny over the state’s strict gender policies.The death of a 16-year-old nonbinary student after an altercation in a high school girls’ bathroom in Oklahoma has drawn national attention and outrage from gay and transgender rights groups that say the student had been bullied because of their gender identity.Nex Benedict, who often used the pronouns they and them and told relatives that they did not see themselves as strictly male or female, died in early February, one day after the altercation with three girls at Owasso High School. Details over what happened and what exactly caused Nex’s death were unclear, but in a police interview video released Feb. 24, Nex said they had “blacked out” while being beaten on the bathroom floor.The police said the case was still under investigation.Nex’s death and the circumstances around it have put school officials and law enforcement under scrutiny. There has been an outpouring of grief across the country, particularly from the L.G.B.T.Q. community, and a renewed focus on the proliferation of policies that restrict gay and transgender rights.Here’s what we know so far:What happened leading up to Nex’s death?The altercation took place on Feb. 7. The Owasso Police Department said in a statement on Feb. 20 that no police report had been made about the fight until after Nex was taken to a hospital by relatives later the same day.At that point, a school resource officer went to the hospital, the police said. Nex was discharged and went home but was rushed back to the hospital by medics the next day, and died there, the police said.On Feb. 24, the police released a video of Nex’s interview at the hospital on the day of the altercation, which provided the fullest account yet of what happened.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Kansas City Parade Shooting and Gun Violence: Young Victims, Young Suspects

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      In the Super Bowl parade shooting, many of the wounded were children, and the two people charged so far in connection with the gunfire are also under 18.After the shooting in Kansas City this week at a parade to celebrate the Super Bowl victory of the hometown Chiefs, children who had been struck by gunfire flooded into Children’s Mercy Hospital, less than a mile from Union Station, where the shooting occurred.“Fear,” the hospital’s chief nursing officer, Stephanie Meyer, told reporters. “The one word I would use to describe what we saw and how they felt when they came to us was fear.”On the other side of the guns were young people, too, according to the authorities who said on Friday that two teenagers detained in the aftermath of the shooting had been charged with “gun-related” offenses and with resisting arrest.What had seemed like an attack on the parade itself turned out to be a far more common act of American violence: a dispute that ended in gunfire, and in this case, left one person dead and 22 people injured, about half of them younger than 16.The shooting on Wednesday sent thousands of fans fleeing from around the stage that was the center of the Super Bowl celebration.Christopher Smith for The New York TimesThe shooting was news around the world because of when and where it unfolded. But in many respects, the circumstances were all too familiar in a country where guns and gun violence are pervasiveGun Homicides in the United States by Age GroupThe gun homicide rate for children of middle and high school age is rising.

      Source: Centers for Disease Control and PreventionBy Robert GebeloffWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      A Midwestern Republican Stands Up for Trans Rights

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      As 2023 slouches to an ignominious end, some news came Friday that gave me an unexpected jolt of hope. I have spent much of the year watching with horror and trying to document an unrelenting legal assault on queer and trans people. Around 20 states have passed laws restricting access to gender-affirming care for trans and nonbinary people, and several have barred transgender and nonbinary people from using bathrooms that align with their gender identity.So it was shocking — in a good way, for once — to hear these words from Ohio’s Republican governor, Mike DeWine, as he vetoed a bill that would have banned puberty blockers and hormones and gender-affirming surgeries for trans and nonbinary minors in Ohio and blocked transgender girls and women from participating in sports as their chosen gender:“Were House Bill 68 to become law, Ohio would be saying that the state, that the government, knows better what is medically best for a child than the two people who love that child the most — the parents,” DeWine said in prepared remarks. “Parents are making decisions about the most precious thing in their life, their child, and none of us, none of us, should underestimate the gravity and the difficulty of those decisions.”DeWine, by situating his opposition to the bill on the chosen battlefield of far-right activists — parents’ rights — was tapping into an idiom that is at once deeply familiar to me and yet has almost entirely disappeared from our national political discourse: that of a mainstream, Midwestern Republican. It is a voice I know well because it is one I heard all my life from my Midwestern Republican grandparents.I did not agree with all of their beliefs, especially as I got older. But I understood where they were coming from. My grandfather, a belly gunner in the Pacific Theater in World War II, believed a strong military was essential to American security. My grandmother was a nurse, and she believed that science, medicine and innovation made America stronger. They made sure their children and grandchildren went to college — education was a crucial element of their philosophy of self-reliance. And above all, they believed the government should be small and stay out of people’s lives as much as humanly possible. This last belief, in individual freedom and individual responsibility, was the bedrock of their politics.And so I am not surprised that defeats keep coming for anti-transgender activists. At the ballot box, hard-right candidates in swing states have tried to persuade voters with lurid messaging about children being subjected to grisly surgeries and pumped full of unnecessary medications. But in race after race, the tactic has failed.Legally, the verdict has been more mixed, which is unsurprising given how politically polarized the judiciary has become. This week a federal judge in Idaho issued a preliminary ruling that a ban on transgender care for minors could not be enforced because it violated the children’s 14th Amendment rights and that “parents should have the right to make the most fundamental decisions about how to care for their children.” The state is expected to appeal the decision.In June, a federal court blocked an Arkansas ban on gender-affirming care for minors. “The evidence showed that the prohibited medical care improves the mental health and well-being of patients,” the ruling said, “and that, by prohibiting it, the state undermined the interests it claims to be advancing” of protecting children and safeguarding medical ethics. In 2021, Asa Hutchinson, then the governor, had vetoed the ban for reasons similar to DeWine, but the Arkansas Legislature overrode his veto. (The Ohio Legislature also has a supermajority of Republicans and may decide to override DeWine’s veto.)In other states, like Texas and Missouri, courts have permitted bans to go into effect, forcing families to make very difficult decisions about whether to travel to receive care or move to a different state altogether. The issue seems destined to reach the Supreme Court soon. The A.C.L.U. has asked the Supreme Court to hear its challenge to the care ban in Tennessee on behalf of a 15-year-old transgender girl. Given how swiftly and decisively the court moved to gut abortion rights, it seems quite possible that the conservative supermajority could choose to severely restrict access to transgender health care for children or even adults.But maybe not. After all, the overturning of Roe has deeply unsettled the country, unleashing a backlash that has delivered unexpected victories to Democrats and abortion-rights advocates. Ohio voters just chose by a wide margin to enshrine the right to end a pregnancy in the state Constitution.This is why I think DeWine’s veto speaks to a much bigger truth: Americans simply do not want the government making decisions about families’ private medical care. Polling on abortion finds a wide array of views on the morality of ending a pregnancy at various points up to viability, but one thing is crystal clear: Large majorities of Americans believe that the decision to have an abortion is none of the government’s business.Rapidly changing norms around gender have many people’s heads spinning, and I understand how unsettling that can be. Gender is one of the most basic building blocks of identity, and even though gender variations of many kinds have been with us for millenniums, the way these changes are being lived out feel, to some people, like a huge disruption to their way of life. Even among people who think of themselves as liberal or progressive, there has been a sense that gender-affirming care has become too easily accessible, and that impressionable children are making life-changing decisions based on social media trends.It has become a throwaway line in some media coverage of transgender care in the United States that even liberal European countries are restricting care for transgender children. But this is a misleading notion. No democracy in Europe has banned, let alone criminalized, care, as many states have done in the United States. What has happened is that under increasing pressure from the right, politicians in some countries have begun to limit access to certain kinds of treatments for children through their socialized health systems, in which the government pays for care and has always placed limits on what types are available. In those systems, budgetary considerations have always determined how many people will be able to get access to treatments.But private care remains legal and mostly accessible to those who can afford it.Republicans are passing draconian laws in the states where they have total control, laws that could potentially lead to parents being charged with child abuse for supporting their transgender children or threaten doctors who treat transgender children with felony convictions. These statutes have no analog in free Europe, but they have strong echoes of laws in Russia, which is increasingly criminalizing every aspect of queer life. These extreme policies have no place in any democratic society.Which brings me back to my Midwestern Republican grandparents, Goldwater and Reagan partisans to their core. My grandfather died long before Donald Trump ran for president, and 2016 was the first presidential election in which my grandmother did not vote for the Republican candidate. But she did not vote for Hillary Clinton, choosing another candidate she declined to name to me. Like a lot of Republicans, she really didn’t like Clinton, and one of the big reasons was her lifelong opposition to government health care. She didn’t want government bureaucrats coming between her and her doctors, she told me.I think many, many Americans agree with that sentiment. Transgender people are no different. They don’t want government bureaucrats in their private business.“I’ve been saying for years that trans people are a priority for enemies and an afterthought to our friends,” Gillian Branstetter, a strategist who works on transgender issues at the A.C.L.U., told me. “I’ve made it my job to try and help people understand that transgender rights are human rights, not just because transgender people are human people, but because the rights we’re fighting for are grounded in really core democratic principles, like individualism and self-determination.”Those are core American values, but 2024 is an election year, and even though transphobia has proved to be a loser at the ballot box, many Republicans are sure to beat that drum anyway. Mike DeWine has me hoping that some Republicans will remember what was once a core principle of their party, and embrace the simple plain-spoken truth of my heartland forebears: Keep the government out of my life, and let me be free to live as I choose.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow the New York Times Opinion section on Facebook, Instagram, TikTok, X and Threads. More