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The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.

Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

“Soccer is a collective game, a team game, and everyone has to play the part which has been assigned to them, which means they have to understand it spatially, positionally and intelligently and make it effective.”

Then there is the structure of your network. There is by now a vast body of research on how differently people behave depending on the structure of the social networks. People with vast numbers of acquaintances have more job opportunities than people with fewer but deeper friendships

This influence happens through at least three avenues. First there is contagion. People absorb memes, ideas and behaviors from each other the way they catch a cold.

soccer is like a 90-minute anxiety dream — one of those frustrating dreams when you’re trying to get somewhere but something is always in the way. This is yet another way soccer is like life.

Let me simplify it with a classic observation: Each close friend you have brings out a version of yourself that you could not bring out on your own. When your close friend dies, you are not only losing the friend, you are losing the version of your personality that he or she elicited.

Once we acknowledge that, in life, we are playing soccer, not baseball, a few things become clear. First, awareness of the landscape of reality is the highest form of wisdom. It’s not raw computational power that matters most; it’s having a sensitive attunement to the widest environment,

Second, predictive models will be less useful. Baseball is wonderful for sabermetricians. In each at bat there is a limited range of possible outcomes. Activities like soccer are not as easily renderable statistically, because the relevant spatial structures are harder to quantify

Finally, there is the power of the extended mind. There is also a developed body of research on how much our very consciousness is shaped by the people around us.

Is life more like baseball, or is it more like soccer?

the number of advanced-placement classes that local students feel compelled to take and the number of hospitalizations for depression rise in tandem.

They reflect a status consciousness that bedevils Americans at all income levels, and they underscore an economic trepidation that is sadly widespread and is seemingly intensified by the gaping divide between the haves and have-nots.

According to a 2013 survey by the C.D.C., 17 percent of American high school students had considered suicide in the previous year. Eight percent said they’d attempted it.

“There’s something about childhood itself in Palo Alto and in communities like Palo Alto that undermines the mental health and wellness of our children,

It reflects on the shortfalls of some modern parenting, which, in her view, can be not only overprotective but overbearing, micromanaging the lives of children, pointing them toward specific mile markers of achievement and denying them any time to flail or room to fail. They wind up simultaneously frazzled and fragile

“The suicides are tragic, but they are at the pointy head of the pyramid, the tippy top,” she said. “Beneath them is a larger number of kids who are really struggling and beneath them is an even larger number of kids who feel an amount of stress and pressure that they shouldn’t be made to and that’s untenable.”

while many Palo Alto parents are “wealthy and secure beyond imagining,” they’re consumed by fear of losing that perch or failing to bequeath it to their kids. “Maintaining and advancing insidiously high educational standards in our children is a way to soothe this anxiety,” he said

He recommended lightening children’s schedules, limiting the number of times that they take the SAT, lessening the message that it’s Stanford or bust.

“I will never be neutral on this issue,” he wrote. “The ‘Koala Dad’ is the far better parent than the ‘Tiger Mom.’ ”

“Want the best for your child, not for your child to be the best.”

Just as the loss of a species decreases the richness of an ecosystem, the addition of new animals could achieve the opposite effect.

National Geographic Society hosted a larger conference to debate the scientific and ethical questions raised by the prospect of “de-extinction.

“De-extinction went from concept to potential reality right before our eyes,

less scientific, if more persuasive, argument was advanced by the ethicist Hank Greely and the law professor Jacob Sherkow, both of Stanford. De-extinction should be pursued, they argued in a paper published in Science, because it would be really

“This may be the biggest attraction and possibly the biggest benefit of de-extinction. It would surely be very cool to see a living woolly mammoth.”

They will replace chunks of band-tailed-pigeon DNA with synthesized chunks of passenger-pigeon DNA, until the cell’s genome matches their working passenger-pigeon genome.

Scientists predict that changes made by human beings to the composition of the atmosphere could kill off a quarter of the planet’s mammal species, a fifth of its reptiles and a sixth of its birds by 2050

This cloning method, called somatic cell nuclear transfer, can be used only on species for which we have cellular material.

There is a shortcut. The genome of a closely related species will have a high proportion of identical DNA, so it can serve as a blueprint, or “scaffold.”

By comparing the fragments of passenger-pigeon DNA with the genomes of similar species, researchers can assemble an approximation of an actual passenger-pigeon genome.

As with any translation, there may be errors of grammar, clumsy phrases and perhaps a few missing passages, but the book will be legible. It should, at least, tell a good story.

the genome will have to be inscribed into a living cell.

“We’ve framed it in terms of conservation,”

MAGE (Multiplex Automated Genome Engineering). MAGE is nicknamed the “evolution machine” because it can introduce the equivalent of millions of years of genetic mutations within minutes

Developmental and behavioral biologists would take over, just in time to answer some difficult questions. Chicks imitate their parents’ behavior. How do you raise a passenger pigeon without parents of its own species? And how do you train band-tailed pigeons to nurture the strange spawn that emerge from their eggs; chicks that, to them, might seem monstrous: an avian Rosemary’s Baby?

For endangered species with tiny populations, scientists would introduce genetic diversity to offset inbreeding.

They will try to alter the birds’ diets, migration habits and environment. The behavior of each subsequent generation will more closely resemble that of their genetic cousins.

For species threatened by contagion, an effort would be made to fortify their DNA with genes that make them disease-resistant

The scientific term for this type of genetic intervention is “facilitated adaptation.”

This optimistic, soft-focus fantasy of de-extinction, while thrilling to Ben Novak, is disturbing to many conservation biologists, who consider it a threat to their entire discipline and even to the environmental movement.

The first question posed by conservationists addresses the logic of bringing back an animal whose native habitat has disappeared. Why go through all the trouble just to have the animal go extinct all over again?

There is also anxiety about disease

“If you recreate a species genetically and release it, and that genotype is based on a bird from a 100-year-old environment, you probably will increase risk.”

“There’s always this fear that somehow, if we do it, we’re going to accidentally make something horrible, because only nature can really do it right. But nature is totally random. Nature makes monsters. Nature makes threats. Many of the things that are most threatening to us are a product of nature. Revive & Restore is not going to tip the balance in any way.”

De-extinction also poses a rhetorical threat to conservation biologists. The specter of extinction has been the conservation movement’s most powerful argument. What if extinction begins to be seen as a temporary inconvenience?

De-extinction suggests that we can technofix our way out of environmental issues generally, and that’s very, very bad.

How will we decide which species to resurrect?

Philip Seddon recently published a 10-point checklist to determine the suitability of any species for revival, taking into account causes of its extinction, possible threats it might face upon resurrection and man’s ability to destroy the species “in the event of unacceptable ecological or socioeconomic impacts.”

But the most visceral argument against de-extinction is animal cruelty.

“Is it fair to do this to these animals?” Shapiro asked. “Is ‘because we feel guilty’ a good-enough reason?” Stewart Brand made a utilitarian counterargument: “We’re going to go through some suffering, because you try a lot of times, and you get ones that don’t take. On the other hand, if you can bring bucardos back, then how many would get to live that would not have gotten to live?”

In “How to Permit Your Mammoth,” published in The Stanford Environmental Law Journal, Norman F. Carlin asks whether revived species should be protected by the Endangered Species Act or regulated as a genetically modified organism.

He concludes that revived species, “as products of human ingenuity,” should be eligible for patenting.

The term “de-extinction” is misleading. Passenger pigeons will not rise from the grave

Our understanding of the passenger pigeon’s behavior derives entirely from historical accounts.

There is no authoritative definition of “species.” The most widely accepted definition describes a group of organisms that can procreate with one another and produce fertile offspring, but there are many exceptions.

Theseus’ ship, therefore, “became a standing example among the philosophers . . . one side holding that the ship remained the same, and the other contending that it was not the same.”

What is coming will go well beyond the resurrection of extinct species. For millenniums, we have customized our environment, our vegetables and our animals, through breeding, fertilization and pollination. Synthetic biology offers far more sophisticated tools. The creation of novel organisms, like new animals, plants and bacteria, will transform human medicine, agriculture, energy production and much else.

How do we reconcile our enjoyment of social media even as we understand that the corporations who control them aren’t always acting in our best interests?

hat was because the underlying economic conditions hadn’t been changed or “disrupted,” to use a favorite Silicon Valley phrase. Google has to serve its shareholders, just like NBCUniversal does. As a result, many of the unappealing aspects of the legacy-media model have simply carried over into a digital age — namely, commercialism, consolidation, and centralization. In fact, the new system is even more dependent on advertising dollars than the one that preceded it, and digital advertising is far more invasive and ubiquitous

the popular narrative — new communications technologies would topple the establishment and empower regular people — didn’t accurately capture reality. Something more complex and predictable was happening. The old-media dinosaurs weren’t dying out, but were adapting to the online environment; meanwhile the new tech titans were coming increasingly to resemble their predecessors

I use lots of products that are created by companies whose business practices I object to and that don’t act in my best interests, or the best interests of workers or the environment — we all do, since that’s part of living under capitalism. That said, I refuse to invest so much in any platform that I can’t quit without remorse

these services aren’t free even if we don’t pay money for them; we pay with our personal data, with our privacy. This feeds into the larger surveillance debate, since government snooping piggybacks on corporate data collection. As I argue in the book, there are also negative cultural consequences (e.g., when advertisers are paying the tab we get more of the kind of culture marketers like to associate themselves with and less of the stuff they don’t) and worrying social costs. For example, the White House and the Federal Trade Commission have both recently warned that the era of “big data” opens new avenues of discrimination and may erode hard-won consumer protections.

I’m resistant to the tendency to place this responsibility solely on the shoulders of users. Gadgets and platforms are designed to be addictive, with every element from color schemes to headlines carefully tested to maximize clickability and engagement. The recent news that Facebook tweaked its algorithms for a week in 2012, showing hundreds of thousands of users only “happy” or “sad” posts in order to study emotional contagion — in other words, to manipulate people’s mental states — is further evidence that these platforms are not neutral. In the end, Facebook wants us to feel the emotion of wanting to visit Facebook frequently

social inequalities that exist in the real world remain meaningful online. What are the particular dangers of discrimination on the Internet?

That it’s invisible or at least harder to track and prove. We haven’t figured out how to deal with the unique ways prejudice plays out over digital channels, and that’s partly because some folks can’t accept the fact that discrimination persists online. (After all, there is no sign on the door that reads Minorities Not Allowed.)

just because the Internet is open doesn’t mean it’s equal; offline hierarchies carry over to the online world and are even amplified there. For the past year or so, there has been a lively discussion taking place about the disproportionate and often outrageous sexual harassment women face simply for entering virtual space and asserting themselves there — research verifies that female Internet users are dramatically more likely to be threatened or stalked than their male counterparts — and yet there is very little agreement about what, if anything, can be done to address the problem.

What steps can we take to encourage better representation of independent and non-commercial media? We need to fund it, first and foremost. As individuals this means paying for the stuff we believe in and want to see thrive. But I don’t think enlightened consumption can get us where we need to go on its own. I’m skeptical of the idea that we can shop our way to a better world. The dominance of commercial media is a social and political problem that demands a collective solution, so I make an argument for state funding and propose a reconceptualization of public media. More generally, I’m struck by the fact that we use these civic-minded metaphors, calling Google Books a “library” or Twitter a “town square” — or even calling social media “social” — but real public options are off the table, at least in the United States. We hand the digital commons over to private corporations at our peril.

6. You advocate for greater government regulation of the Internet. Why is this important?

I’m for regulating specific things, like Internet access, which is what the fight for net neutrality is ultimately about. We also need stronger privacy protections and restrictions on data gathering, retention, and use, which won’t happen without a fight.

I challenge the techno-libertarian insistence that the government has no productive role to play and that it needs to keep its hands off the Internet for fear that it will be “broken.” The Internet and personal computing as we know them wouldn’t exist without state investment and innovation, so let’s be real.

there’s a pervasive and ill-advised faith that technology will promote competition if left to its own devices (“competition is a click away,” tech executives like to say), but that’s not true for a variety of reasons. The paradox of our current media landscape is this: our devices and consumption patterns are ever more personalized, yet we’re simultaneously connected to this immense, opaque, centralized infrastructure. We’re all dependent on a handful of firms that are effectively monopolies — from Time Warner and Comcast on up to Google and Facebook — and we’re seeing increased vertical integration, with companies acting as both distributors and creators of content. Amazon aspires to be the bookstore, the bookshelf, and the book. Google isn’t just a search engine, a popular browser, and an operating system; it also invests in original content

So it’s not that the Internet needs to be regulated but that these big tech corporations need to be subject to governmental oversight. After all, they are reaching farther and farther into our intimate lives. They’re watching us. Someone should be watching them.

Honest philosophers know they cannot complain about casting their philosophical pearls before drowsy swine, because they, too, have fallen asleep over the works of philosophers greater than themselves.

Not only is sleep a reminder of our ultimate helplessness, or even of how circumscribed a place thought sometimes plays in our lives, there is also the fear of contagion, as if talking about sleep might induce it – just as this reference to yawning will get at least 50% of you yawning in the next 15 minutes. (It’s a fact, honest!)

Since all animals sleep, we assume it has a biological purpose. The trouble is, we don’t know what that purpose is. There are many theories – energy conservation, growth promotion, immobilisation during hours of darkness when it might be dangerous to be out and about, consolidation of memories – but they are all open to serious objections.

Dreams, of course, have figured more significantly in philosophy. Being a mode of consciousness – prompting Aristotle to say that “the soul makes assertions in sleep” (On Dreams 458b) – dreams seem one step up from the mere putting out of zzzs.

they place a philosophically interesting question mark against our confidence in the nature of the world we appear to share with others.

Naturally, dreams preoccupied him as much as the daily resurrection of the self. He suggested that dreams might be an attempt to make sense of the body’s passage from sleep to wakefulness.

nothing is more sleep-inducing than the egocentric tales of someone else’s solipsistic dreams. We long to hear that magic phrase “And then I woke up.”

If men vastly outnumber women as mass shooters, those perpetrators are often a model for the next male shooters who "see themselves in them," Peterson said, a phenomenon she noted is particularly true in young, white men.

"Many school shooters study Columbine, for example; other university shooters study the Virginia Tech shooting. And they really are kind of using those previous shootings as a blueprint for their own."

But at the same time, as a psychologist, I've been worried about all the risk factors that we know of for mass shootings that have been exacerbated in the pandemic. So, trauma, experiencing a mental health crisis, suicidality, time online and access to firearms have all increased.

. We can kind of work our way backwards and say, these are individuals who are in crisis, who have very easy access to firearms. And are there simple things we can do like universal background checks or safe storage that prevent that ease of access?

But we can also go further back and talk about things like, how do we make sure everybody's trained in crisis intervention and suicide prevention? How do we build trauma-informed schools, and go even further back?

I would say, in particular, the media coverage seems to have shifted. I'm not seeing as much of the perpetrator in the news cycle. I'm not seeing the perpetrator's name and face everywhere, which we know is what contributes to the social contagion.

we find information or misinformation “22 times more memorable in narrative form.”

It’s a contagion, and thanks to social media, or “participatory propaganda,” highly viral

The Fox News counternarrative model is as simple as it is cunning. The segment producer’s job is to get the answers to two questions: What is the most emotionally engaging story we have right now

The next question is, how do we construct a counternarrative that includes as many existing other believable meta-narratives as possible

The hunt for the killer narrative starts with the “Morning Memo” to the producers. It shares the interpretation from the vice president of news of the highest-trending articles on Foxnews.com and Drudge

The next move is to get a few Fox News contributor regulars — elected officials and paid pundits — not just to deliver the new counternarrative but also to wrap it inside an existing or new meta-narrative.

What do the ratings tell the producers are the most engaging meta-narratives for the over 80 million Fox News viewers on all digital platforms?

Conspiracy theories.

Why do people love conspiracy stories? It’s human behavior

The emotional payoff from being on the inside of a conspiracy is a self-esteem jolt that makes you feel smarter than your tribal foe and keeps your eyeballs glued to screens

Every successful Fox News segment producer has the conspiracy script down cold. These segments work best when the “proof” of a conspiracy against a tribal leader — in this case the Republican president — makes the viewer feel under attack as well

it helps when a proposed conservative thought leader mixes in the meta-narrative to the effect that “we are victimized again by the condescending Beltway elites.”

Believing in conspiracy theories is a psychological construct for people to take back some semblance of control in their lives. It inflates their sense of importance. It makes them feel they have access to “special knowledge” that the rest of the world is “too blind,” “too dumb” or “too corrupt” to understand.

Removing a mask requires special attention to avoid hand contamination, and it could also breed a false sense of security.

in some parts of Asia everyone now wears a mask by default - it is seen as safer and more considerate.

In mainland China, Hong Kong, Japan, Thailand and Taiwan, the broad assumption is that anyone could be a carrier of the virus, even healthy people. So in the spirit of solidarity, you need to protect others from yourself.

In East Asia, many people are used to wearing masks when they are sick or when it's hayfever season, because it's considered impolite to be sneezing or coughing openly.

The 2003 Sars virus outbreak, which affected several countries in the region, also drove home the importance of wearing masks, particularly in Hong Kong, where many died as a result of the virus.So one key difference between these societies and Western ones, is that they have experienced contagion before - and the memories are still fresh and painful.

Some argue that ubiquitous mask wearing, as a very visual reminder of the dangers of the virus, could actually act as a "behavioural nudge" to you and others for overall better personal hygiene.

But there are downsides of course. Some places such as Japan, Indonesia and Thailand are facing shortages at the moment, and South Korea has had to ration out masks.

There is the fear that people may end up re-using masks - which is unhygienic - use masks sold on the black market, or wear homemade masks, which could be of inferior quality and essentially useless.

People who do not wear masks in these places have also been stigmatised, to the point that they are shunned and blocked from shops and buildings.

In countries where mask wearing is not the norm, such as the West, those who do wear masks have been shunned or even attacked. It hasn't helped that many of these mask wearers are Asians.

Every year, 1.5 million young children die of preventable infectious diseases such as diarrhea because of poor sanitation, according to UNICEF. One out of every three humans on our planet -- some 2.2 billion people -- lack access to safe drinking water, and six out of 10 lack access to proper sanitation, meaning toilets or safely managed sewage systems. Residents of the Kibera slum in Nairobi, Kenya, can share one pit latrine with over 100 people. In Dharavi, Asia's largest urban slum located in Mumbai, India, 80% of its seven million residents have no running water, the National Observer has noted. What hope do they have of washing their hands frequently?

More than two million Americans live without running water, indoor plumbing or wastewater treatment, according to the nonprofits Dig Deep and the US Water Alliance. A report by Food & Water Watch found that, in 2016, 15 million Americans had their water shut off due to an inability to pay water bills -- one out of every 20 households across the country. The US neither provides a constitutional right to water nor recognizes the UN Human Right to Water and Sanitation.

The truth is that in every country, water infrastructure -- where it is present -- is deteriorating.

But investing in clean water infrastructure saves lives, and we must seize this moment to ramp up investment in safe water and sanitation. Spending on water is not just the right thing to do; it's also the smart thing to do.

According to the UN, every $1 invested in safe drinking water in urban areas yields more than $3 in saved medical costs and added productivity, on average. For every $1 invested in basic sanitation, society makes $2.50 back. The return is higher in rural areas, with $7 gained or saved for every $1 invested in clean drinking water.

Without clean water and proper sanitation, we will not be able to combat the spread of the new coronavirus. Like Covid-19, water scarcity is a global problem that needs collective action. Never has there been a more urgent time to address the world's water crisis.

some activities, including dangerous ones, provide negative feedback only rarely. When I am in a rush, I often cross the street at a red light. I understand intellectually that this is stupid, but I’ve never once seen evidence of my stupidity.

Exposure to COVID-19 works the same way. Every time you engage in a risky activity—like meeting up with your friends indoors—the world is likely to send you a signal that you made the right choice. I saw my pal and didn’t get sick. Clearly, I shouldn’t have worried so much about socializing!

Let’s assume, for example, that going to a large indoor gathering gives you a one in 20 chance of contracting COVID-19—a significant risk. Most likely, you’ll get away with it the first time. You’ll then infer that taking part in such gatherings is pretty safe, and will do so again. Eventually, you are highly likely to fall sick.

2. Individually Rational, Collectively DisastrousWe tend to think behavior that is justifiable on the individual level is also justifiable on the collective level, and vice versa. If eating the occasional sugary treat is fine for me it’s fine for all of us. And if smoking indoors is bad for me, it’s bad for all of us.

The dynamics of contagion in a pandemic do not work like that

if everyone who isn’t at especially high risk held similar dinner parties, some percentage of these events would lead to additional infections. And because each newly infected person might spread the virus to others, everyone’s decision to hold a one-off dinner party would quickly lead to a significant spike in transmissions.

The dynamic here is reminiscent of classic collective-action problems. If you go to one dinner, you’ll likely be fine. But if everyone goes to one dinner, the virus will spread with such speed that your own chances of contracting COVID-19 will also rise precipitously.

3. Dangers Are Hard to Recognize and Avoid

Many of the dangers we face in life are easy to spot—and we have, over many millennia, developed biological instincts and social conventions to avoid them

When we deal with an unaccustomed danger, such as a new airborne virus, we can’t rely on any of these protective mechanisms.

The virus is invisible. This makes it hard to spot or anticipate. We don’t see little viral particles floating through the air

In time, we can overcome these biases (at least to some extent).

Social disapprobation can help

We all should do what we can to identify the biases from which we suffer—and try to stop them from influencing our behavior.

Months later, I compounded my accidental ‘like’ crime by following Magdalen Berns on Twitter. Magdalen was an immensely brave young feminist and lesbian who was dying of an aggressive brain tumour

Magdalen was a great believer in the importance of biological sex, and didn’t believe lesbians should be called bigots for not dating trans women with penises, dots were joined in the heads of twitter trans activists, and the level of social media abuse increased.

‘TERF’ is an acronym coined by trans activists, which stands for Trans-Exclusionary Radical Feminist. In practice, a huge and diverse cross-section of women are currently being called TERFs and the vast majority have never been radical feminists

why am I doing this? Why speak up? Why not quietly do my research and keep my head down?

I’ve got five reasons for being worried about the new trans activism, and deciding I need to speak up.

Firstly, I have a charitable trust that focuses on alleviating social deprivation in Scotland, with a particular emphasis on women and children. Among other things, my trust supports projects for female prisoners and for survivors of domestic and sexual abuse. I also fund medical research into MS, a disease that behaves very differently in men and women

I’ve wondered whether, if I’d been born 30 years later, I too might have tried to transition. The allure of escaping womanhood would have been huge.

The second reason is that I’m an ex-teacher and the founder of a children’s charity, which gives me an interest in both education and safeguarding

The third is that, as a much-banned author, I’m interested in freedom of speech and have publicly defended i

The fourth is where things start to get truly personal. I’m concerned about the huge explosion in young women wishing to transition and also about the increasing numbers who seem to be detransitioning (returning to their original sex), because they regret taking steps that have, in some cases, altered their bodies irrevocably, and taken away their fertility

ten years ago, the majority of people wanting to transition to the opposite sex were male. That ratio has now reversed. The UK has experienced a 4400% increase in girls being referred for transitioning treatment. Autistic girls are hugely overrepresented in their numbers.

American physician and researcher Lisa Littman set out to explore it. In an interview, she said: ‘Parents online were describing a very unusual pattern of transgender-identification where multiple friends and even entire friend groups became transgender-identified at the same time. I would have been remiss had I not considered social contagion and peer influences as potential factors.’

her career took a similar hit to that suffered by Maya Forstater. Lisa Littman had dared challenge one of the central tenets of trans activism, which is that a person’s gender identity is innate, like sexual orientation. Nobody, the activists insisted, could ever be persuaded into being trans.

The argument of many current trans activists is that if you don’t let a gender dysphoric teenager transition, they will kill themselves.

the new trans activism is having (or is likely to have, if all its demands are met) a significant impact on many of the causes I support, because it’s pushing to erode the legal definition of sex and replace it with gender.

As I didn’t have a realistic possibility of becoming a man back in the 1980s, it had to be books and music that got me through both my mental health issues and the sexualised scrutiny and judgement that sets so many girls to war against their bodies in their teens

I want to be very clear here: I know transition will be a solution for some gender dysphoric people, although I’m also aware through extensive research that studies have consistently shown that between 60-90% of gender dysphoric teens will grow out of their dysphoria

The current explosion of trans activism is urging a removal of almost all the robust systems through which candidates for sex reassignment were once required to pass. A man who intends to have no surgery and take no hormones may now secure himself a Gender Recognition Certificate and be a woman in the sight of the law.

We’re living through the most misogynistic period I’ve experienced. Back in the 80s, I imagined that my future daughters, should I have any, would have it far better than I ever did, but between the backlash against feminism and a porn-saturated online culture, I believe things have got significantly worse for girls.

From the leader of the free world’s long history of sexual assault accusations and his proud boast of ‘grabbing them by the pussy’, to the incel (‘involuntarily celibate’) movement that rages against women who won’t give them sex, to the trans activists who declare that TERFs need punching and re-educating, men across the political spectrum seem to agree: women are asking for trouble.

I’ve read all the arguments about femaleness not residing in the sexed body, and the assertions that biological women don’t have common experiences, and I find them, too, deeply misogynistic and regressive

It’s also clear that one of the objectives of denying the importance of sex is to erode what some seem to see as the cruelly segregationist idea of women having their own biological realities or – just as threatening – unifying realities that make them a cohesive political class.

It isn’t enough for women to be trans allies. Women must accept and admit that there is no material difference between trans women and themselves.

‘woman’ is not a costume. ‘Woman’ is not an idea in a man’s head. ‘Woman’ is not a pink brain, a liking for Jimmy Choos or any of the other sexist ideas now somehow touted as progressive. Moreover, the ‘inclusive’ language that calls female people ‘menstruators’ and ‘people with vulvas’ strikes many women as dehumanising and demeaning.

I’ve been in the public eye now for over twenty years and have never talked publicly about being a domestic abuse and sexual assault survivor. This isn’t because I’m ashamed those things happened to me, but because they’re traumatic to revisit and remember.

the scars left by violence and sexual assault don’t disappear, no matter how loved you are, and no matter how much money you’ve made. My perennial jumpiness is a family joke – and even I know it’s funny – but I pray my daughters never have the same reasons I do for hating sudden loud noises, or finding people behind me when I haven’t heard them approaching.

I believe the majority of trans-identified people not only pose zero threat to others, but are vulnerable for all the reasons I’ve outlined. Trans people need and deserve protection

So I want trans women to be safe. At the same time, I do not want to make natal girls and women less safe. When you throw open the doors of bathrooms and changing rooms to any man who believes or feels he’s a woman – and, as I’ve said, gender confirmation certificates may now be granted without any need for surgery or hormones – then you open the door to any and all men who wish to come inside. That is the simple truth.

On Saturday morning, I read that the Scottish government is proceeding with its controversial gender recognition plans, which will in effect mean that all a man needs to ‘become a woman’ is to say he’s one. To use a very contemporary word, I was ‘triggered’

I forgot the first rule of Twitter – never, ever expect a nuanced conversation – and reacted to what I felt was degrading language about women. I spoke up about the importance of sex and have been paying the price ever since. I was transphobic, I was a cunt, a bitch, a TERF, I deserved cancelling, punching and death. You are Voldemort said one person, clearly feeling this was the only language I’d understand.

Huge numbers of women are justifiably terrified by the trans activists; I know this because so many have got in touch with me to tell their stories. They’re afraid of doxxing, of losing their jobs or their livelihoods, and of violence.

But endlessly unpleasant as its constant targeting of me has been, I refuse to bow down to a movement that I believe is doing demonstrable harm in seeking to erode ‘woman’ as a political and biological class and offering cover to predators like few before it

I stand alongside the brave women and men, gay, straight and trans, who’re standing up for freedom of speech and thought, and for the rights and safety of some of the most vulnerable in our society: young gay kids, fragile teenagers, and women who’re reliant on and wish to retain their single sex spaces

The supreme irony is that the attempt to silence women with the word ‘TERF’ may have pushed more young women towards radical feminism than the movement’s seen in decades.

All I’m asking – all I want – is for similar empathy, similar understanding, to be extended to the many millions of women whose sole crime is wanting their concerns to be heard without receiving threats and abuse.