I Emailed My Doctor 133 Times: The Crisis In the British Healthcare System

he checked off his equipment hello my name is Abigail over the last few years I have emailed Britain's National healthcare provider 133 times trying to get a doctor's appointment this video is about what that was like why big institutions fall apart and why they're so difficult to change as research I've spoken to some of the nhs's most senior administrators so over the course of this rational analysis I'll be revealing some exclusive Insider information the video is sponsored by nebula but after I've paid back the owner of this laptop I'll be donating most of that money

to charity so you can sit back and relax as I bring you a calm dispassionate exploration of the big questions at the heart of Britain's National Health Service [Music] welcome back [Music] [Music] here's how things are supposed to work British citizens of all ages have a right to free health care on the National Health Service or NHS I was born in the NHS and both my parents were doctors my dad used to say when I was a kid that he treated everyone from all walks of life from literal Aristocrats to prisoners from the local jail

because the point of the service is that it's there for everyone since its Creation in 1948 the NHS has become the symbol of the country that a lot of British people are very proud of like the royal family or William Shakespeare or beans on toast the NHS is split into several Regional bodies called trusts like there's a Cambridge trust and an Oxford trust and an East London trust and a West London trust and so on the trusts get money from the government which they spend on Health Care Services like Staffing equipment and supplies and they

give that to patients for free in this way the NHS is funded mainly by the taxpayer but even if you don't make enough money to pay taxes you can still use it because again the point of the service is that it's there forever everyone which it definitely definitely is as well as the right to use the NHS we also have the right to begin treatment within 18 weeks of referral and that right to free medical treatment within 18 weeks includes free medical transition for transgender people of all ages if you didn't already know that includes

me I'm a trans woman and we'll be using the nhs's treatment of me as our case study for today which will reveal some more General things about how the service is run and the challenges that it's facing in the 21st century if you want to medically transition in England then you can start by going to your local family doctor in Britain we call this person a general practitioner or GP your GPA will send you to a gender identity Clinic where you'll be assessed by Specialists to see if you fit the criteria for gender dysphoria a

diagnosis that is definitely real and which definitely makes a lot of sense if you are diagnosed with dysphoria then they'll let you use other bits of the NHS for example if you want surgery they'll send you to a surgeon if you want hormones they'll tell your GP to prescribe hormones for you which your GP definitely will once you're in the medical system you can also change the legal sex that is recorded on your birth certificate and your passport in England you cannot change either of those things without first obtaining a doctor's permission but it all

starts with a friendly visit to your local NHS doc who will be only too happy to provide you with world-class Medical Care from the finest system in the world several years ago I went to my GP told her I'm trans and asked to be referred to a gender identity Clinic the first thing she did was refuse not exactly after a great start I won't name her or any of the real people I'll be referring to today instead I'll call her lieutenant scheisskoff [Music] scheisskopf told me to come back in a month and said that if

I was still trans then she would refer me GPS in England aren't routinely trained in trans medicine hence the separate clinics so the idea that you're supposed to wait a month before you can go she made that up on the spot she also tried to send me to Mental Health Services which wasn't what I was there for she only had one job send me to the gender Clinic but for some reason she wouldn't do it I am not the only patient who fell at the first hurdle this is a 2013 NHS report titled monitoring and

promoting trans Health across the Northwest the authors investigated the needs of trans patients across Northwest England and how GPS were meeting those needs or rather they tried to but they couldn't because GPS overwhelmingly refused to cooperate with the researchers only half of the practices they investigated even replied and that was just the beginning it was extremely difficult to get Beyond reception staff to speak to practice managers for example the research was told many times that the practice manager was not in but would be later only to be told later that they were on leave or

did not work in the afternoons very few practice managers understood what was meant by transgender people and were unwilling to engage in this research some practice managers receptionists and GPS were spoken to express particularly negative attitudes towards trans people this study clearly demonstrates that most GP practices are not sufficiently prepared or knowledgeable to appropriately address the needs of this patient group 2013 was almost a decade ago but more recent data and my own experience confirms this is still a problem this 2015 NHS report which solicited feedback from patients and staff also highlighted uncooperative GPS as

a major problem this 2016 article in the British medical journal says the same thing in 2021 the non-profit Trans actual ran a survey which included questions about Healthcare 14 of trans respondents said that their GPS like mine simply refused to help them that's more than one in ten as my friend Alice is fond of saying the NHS is a wonderful Institution unfortunately it is run by the British but I didn't have any other choice so I went away for a month as ordered and 30 days later surprise surprise I was still transgender so I went

back to Lieutenant scheisskoff a second time and this time she said she would refer me six months went by I remind you that we have the right to be treated within 18 weeks so at this point I've already waited double that and I'm not even in the door but after six months I still hadn't even gotten so much as a letter from the clinic saying I was in the system so I went back to scheisskopf a third time and this time she said oh the letters still here I must have forgotten to send it dismissed

captain I said dismiss Captain get the hell out of my office the last time I took from this was that my doctor was either so incompetent she couldn't work a post box or more likely she didn't want to give me Medical Care neither of which is great to be honest honestly you think you're on good terms with someone and then you come out as trans and suddenly they don't want anything to do with you anymore in a lot of ways the NHS is just like my dad I just like to clarify that that was a

joke I have a normal and happy relationship with my father who is a very supportive and loving man at this point I moved to a different area of the country and signed up with a new GP and I went along and I asked to be sent to the gender clinic but this time I printed out the NHS rules on treating trans patients and highlighted the relevant sections so when he said I'm sorry I can't send you to the clinic I pulled them out and I said actually doctor you not only can you are required to

after a great deal of persuasion he did in fact agree to follow the rules and he referred me to the clinic I made sure to get a signed and dated copy of that referral Under the Clock officially started I waited 18 weeks I waited 18 more weeks and then I waited 18 more there are currently seven gender clinics for adults operating in England none of them are seeing patients within the required 18-week limit and waiting lists are extremely long how long you ask well at a time of recording the largest clinic in London has 11

407 patients on its waiting list last month they offered first appointments 250. that means that if you were referred today you will be waiting for 19 years and that's not 19 years for health care either that's 19 years for a first appointment of which you may have several with months or even years between them you might be wondering wow only 50 maybe they had a really slow month last month maybe that's throwing the numbers off nope 50 is pretty typical that's actually better than it used to be when I was referred it was 26 years

the long waiting times contribute to high levels of distress among trans patients it also impacts our access to civil rights like marriage death and privacy because remember in England if you want to change the sex marker on your birth certificate or passport you need a doctor's permission if you haven't changed the marker on your passport for instance because you're on a year's Long waiting list to get permission then every time you apply to rent a flat or get a job you'll have to show them your passport and they'll instantly know your trans employers and landlords

are not allowed to discriminate ha ha ha ha ha ha long waiting times are an especially acute problem when it comes to trans children if you know that you're trans at a young age and you're forced to go through the wrong puberty it can be very distressing and it can cause dare I say it irreversible damage or not really damage but it has permanent effects for instance I went through a testosterone puberty as an adolescent and as a result I'm taller than the average English woman also I can do this with my voice whenever I

want to [Music] I mean I think those things are positives about me because I really like being tall and also it's useful as an actress to have two voices and a perfect impersonation of Matt Berry on tap and there are other effects that are negative and also permanent so it's especially important that trans children get prompt treatment if you're 13 and trans and there's a years-long wait to get care then by the time you're seen it could be too late and your life is not over if that happens to you but it will shape the

rest of your time on Earth and that's what a lot of this comes down to waiting for somebody else's permission to live the rest of your life faced with these waiting lists a lot of trans people do one of three things option one is Private health care obviously that's very expensive so it tends to be the more privileged usually white trans people who get to do that and even if you can't afford it that's money that you can't spend on a holiday or a house or a wedding or it means you go into a lot

of debt option two is self-medication that means buying hormones off the internet or sharing them with a friend I found a 2016 article in the Lancet which records that 40 of adult patients who get an appointment at the London Clinic are already self-medicating when they arrive if that rate holds constant Across the Nation that would mean there are tens of thousands of people doing it although because it's underground who knows anecdotally every British trans person I know except for two I think is either self-medicating or has at some point if you're a trans woman like

me then self-medicating in England is legal you need a testosterone blocker and estrogen and you can order both of those from a foreign country without a prescription on the internet and have them sent here if you have them it's also legal to share them with a friend who needs them however if you're a trans man then things are a little trickier because you're going to need testosterone and it's illegal to sell or share that the government doesn't want trans guys getting too yoked Richie sunax a short King he doesn't want to be intimidated by all

these trans dudes walking around getting buff but obviously taking pills that you bought on the internet can be very medically risky GPS are supposed to help people who do though again some simply refuse there is a large and growing network of people in the trans underground to help each other out although mindful as I am of YouTube's Community guidelines I can't tell you how to self-medicate and please note I'm also explicitly not saying that I recommend it I'm just saying it is a fact that a lot of people do probably because they find that option

more palatable than option three option three is that you die when people do die on the waiting lists every year at trans Pride there are more names read out of the people who aren't here anymore there was a recent death in the community of a woman who'd waited more than a thousand days on the waiting list I've had parents of trans children email me about the kids that they've lost I'm gonna be honest with you writing this episode of philosophy tube has been a struggle because the show is about being compassionate and seeing all sides

but as a human being I have a strong preference for my own Survival and a strong emotional reaction when I see other people needlessly suffering what I'm saying is this episode might get a little bit more personal than usual because now I need to tell you about what I did next having waited much much longer than the legal maximum waiting time I decided to start sending some emails I found out which trust runs the gender Clinic I'd been referred to and I wrote to someone on their board of directors a man I'll be referring to

as major discovery major Discovery is the trust's head of compliance it's his job to make sure that they're following all the rules he's not a doctor and actually that's worth bearing in mind the NHS is not administered by doctors it's administered by administrators I wrote to Major Discovery every week for several months and eventually he wrote back dear Abigail as you've noted in your email we are unable to offer a first appointment with the 18-week time frame that operates for most NHS Services although this 18 week recommendation does in principle apply to our service we

and all the other gender Services nationally are unable to meet this target currently due to very high demand here I can bring in one of our big philosophers for today Sarah Ahmed and her book complaint which is all about how making complaints to institutions reveals the way they really work in his letter to me major decoverly was using a very interesting technique from management and business philosophy a technique called lying the 18-week time limit is not a recommendation or a Target that applies in principle it's actually a right I pointed this out politely of course

and his next move seemed a little better if you would like to discuss any aspect of your complaint further please do let me know and I will arrange for you to speak to a senior member of the gender identity Clinic that sounded like progress talking to the guy who runs the clinic yeah if anyone can get me an appointment he surely can so we arranged a meeting he picked the time and place I waited for over an hour and he never turned up I honestly cannot stress enough to you how absolutely [ __ ] [

__ ] all these people are at scheduling they miss emails they forget to press send when they write their replies multiple times we've arranged meetings they chose the time and place and then they just never turned up trying to reach them is like attempting The Impossible all these little mistakes get made but they're always mistakes that benefit the institution never the person complaining and for this reason Sarah Ahmed coins the term strategic inefficiency the harder it is to complain the fewer complaints they have to deal with the more they can just carry on doing what

they're doing she also says that making a complaint becomes a kind of unpaid job because in order to complain about a system you have to spend a lot of time learning about how it's supposed to work I don't think I can adequately explain to you just how maddening it is to go through all that organizational hell and then when you finally get into the meeting they don't know the rules that they're supposed to be following so often in this process I have wanted to say to these people why am I doing your job just dozens

and dozens and dozens of emails hundreds of hours spent doing this in my free time just to get an appointment with a doctor and so that I can turn it into educational content for all of you fine people patreon Dot com slash philosophytube I am no longer asking sign the [ __ ] up exhaustion can become a management technique so much of the work of complaint is work we would not have to do with institutions were as committed to creating open accessible and inclusive environments as they claim to be eventually I managed to reschedule that

meeting and I came face to face with a man who actually runs a gender identity Clinic I'll call him major major he's not a doctor but he sat there and he nodded and listened sympathetically as I explained I'd been waiting for longer than the legal maximum waiting time and I'd like my appointment now please he told me the exact same thing major to coverly had they aren't working within the 18-week time limit and they aren't going to I I don't understand exactly what it is that you think I can do you're a major major major

major you can just sign things sign what the form what form after several weeks of back and forth it dawned on me that major Discovery had arranged this meeting not to actually solve the problem but to try and get rid of me Ahmed says institutions handle complaints using non-performative speech in philosophy performative speech is when you say something and by saying it you also do it like when you say I promise you're speaking but you're also doing the act of promising or if you're at a straight wedding and the officiant says I Now Pronounce You

man and wife they're saying it and they're doing it on the flip side non-performative speech is when you say something and by saying it you prevent it from being done like we are listening to feedback we take your concerns very seriously non-performative speech is how an institution can appear to be doing something about a problem whilst actually very deliberately doing nothing major major supplied a top-tier example when he said that whilst the waiting times are bad we are working hard to improve the quality of weight I said that's like telling me you're going to keep

kicking me in the face but you're working hard to put on softer shoes I pointed out that by failing to treat patients within the required time some of whom died the clinic was doing a great deal of harm to trans people and at this point major major got upset he said I'm a black gay man I'm a trans Ally I have trans friends I'm on your side here which was very interesting because we'd been talking about the failures of the clinic but he substituted to the clinic for himself as a person he took my complaints

about the failures of the system as an attack on his character and in so doing he made the conversation about his feelings rather than the failures that he's responsible for and how he's going to fix them this is also a management technique that Ahmed and others have identified The Scholar Manta akapadi talks about her experiences trying to criticize University departments for institutional racism and she found that when she raised this problem the white women in charge of the University departments often cried because they thought they were being called racist their hurt feelings then become the

problem and the real problem the institutional racism never got addressed open your eyes Clevenger it doesn't make a damn bit of difference who wins the war to someone who's dead congratulations I can't think of another attitude that could be dependent upon to give greater Comfort to the enemy the enemy is anybody who's gonna get you killed no matter which side he's on having established pretty thoroughly the major major was a dead end I went back to Major discovery and this time he said that if I was still unsatisfied with how my complaint had been resolved

because it hadn't been resolved I was free to make a complaint to the Parliamentary and Health Service Ombudsman which I guess in this example would be like the military police they're an independent body who was supposed to investigate the NHS when things go wrong so I made a formal complaint to them and they told me that they would assign an investigator within eight weeks 16 weeks later they did a man I'll be referring to as chaplain Chapman Chapman Chapman was honestly the only person I spoke to in this whole journey who was the least bit

sympathetic he asked me how my experiences had made me feel about major Discovery and major major and I quoted Moby Dick to him which we both found very funny Chaplin insanity is contagious everybody's crazy except for us you and I have to be careful we may be the only same people in the entire world however after several more months of waiting for him to investigate he told me his superiors had ordered him to drop the case I apologize for this negative outcome one thing I was surprised to hear from chaplain Chapman though was that there

were other cases that he was also being ordered to drop it honestly hadn't occurred to me before that anyone else might have taken it as far as I had Ahmed talks about how official complaints procedures can be individualizing which kind of just means lonely the NHS has no way for a group of people to complain together about the same problem you have to do it alone and bear the cost on your time and your emotions alone too which is another way of discouraging you from trying I guess if somebody really wanted to they could put

together a kind of collective complaint like they could get together with some friends and go down to NHS England's offices maybe with some signs and placards and a microphone so I did together with a bunch of activists from a group called transgender action block I attended a protest outside NHS England's offices there were hundreds of us who'd all just been denied Healthcare some of whom had been left in pain between surgeries some of some of whom had lost friends and relatives but it still didn't get me an appointment NHS England never even publicly acknowledged that

protest took place I cried on the phone to chaplain Chapman I asked is there anyone else I can possibly appeal to besides God and he said I'm not aware of their being a higher authority but he was wrong there is a higher authority there is and after a few more months of emailing I found him the man behind the man the man who gives the orders colonel caccott colonel Cathcart is the head of NHS England's specialized commissioning he tells the trusts how they have to handle medical transition he can't act on his own but everyone

I spoke to told me he's the guy and when I emailed the CEO of the NHS herself she also passed me back down to him I'm Colonel Cathcart and as of now I'm in charge of you sorry ass bunch of homosexuals by the way a lot of these people's emails aren't publicly listed and it was kind of fun to go hunting for them I managed to get in touch with the CEO of the NHS by getting her old workplace email off LinkedIn emailing that and getting an automatic out of office reply saying hey I'm leaving

this job now to go and run the NHS if you need me here's my new email address and I was like yes I'm in I told Colonel Cathcart I had been waiting for much much longer than the legal maximum waiting time and I would like to have my appointment now pretty please he told me to take it up with major major in major to coverly and I said Colonel you're not going to believe it but uh they've already sent me to you and then he told me that the reason for the delays was because GPS

are uncooperative the very problem I'd encountered at the start he told me that everyone wants to change the system and make it faster but they can't because GPS won't let them the GPS are scared he told me and one of cathcart's flunkies sent me this this document is from 2019 it was published by the Royal College of GPS it's titled the role of the GP in caring for gender questioning and transgender patients they really need a more exciting naming system in it the Royal College acknowledges that GPS get no training in trans Healthcare and that

trans patients sometimes have bad experiences so they recommend more resources in the system and more training and that's basically it there's nothing in here to support cathcart's claim that GPS are the ones standing in the way of changing the system in fact it seems to me that when you actually read this document they acknowledge several reasons why the system should change it's even weirder too that he sent me this given that it makes a bunch of recommendations from 2019 and none of them have actually happened so why send me this as if it explains or

solves anything but then I remembered some more Philosophy from Sarah Ahmed she talks about how documents become tools of institutional performance they don't really exist in order to be read they exist to give the institution a good image an example might be anti-bullying policies your workplace probably has one and our match talks about how when she encountered bullying in her workplace she reported it to management and they sent her a copy of the policy even as they defended the bullies documents create fantasy images of the organizations they apparently describe the document says we are diverse

as if saying it makes it so many practitioners and academics have expressed concerns that writing documents or having good policies becomes a substitute for Action as one of my interviewees puts it you end up doing the document rather than doing the doing furthermore the orientation toward writing good documents can block action insofar as the document then gets taken up as evidence that we have done it colonel Kafka was just doing the same thing major to coverly had trying to get rid of me except instead of using a meeting he was using a piece of paper

but since he tried to shift the blame to the Royal College of GPS you know what I did next you know I had to do it to him I emailed her a college of GPS and after doing that every week for several months then let me speak to one of our top guys a guy I'll call major Danby I actually asked major Danby upright is it true what Colonel Cathcart said Is it true that GPS are the reason behind all of this and he said oh no no medical association's fault so I emailed them too

I'm not giving up this is my white whale that's right [ __ ] I was assigned hater at Birth they told me it was Colonel cathcart's fault at this point I was feeling very calm very normal Joker makeup was bursting out of my Paws I was turning into a giant insect falling down an infinitely repeating staircase things of this nature I couldn't understand it we have the right to be seen within 18 weeks I'd waited at this point over a year just what the heck is going wrong with the NHS [Music] now I bet that

some of you are sitting there thinking that sucks but what do you expect the NHS is in crisis and you are absolutely right to show you just how right you are I'd like to take a moment now to calmly impartially explore exactly why the NHS is in crisis it is true that the situation is pretty dire for everyone right now there are over 7 million people in England on some kind of waiting list for NHS care the majority of maternity units in England no longer meet safety standards there are parts of England where you'll wait

for several hours just to get an ambulance and public satisfaction with the NHS is at a 25 year low there are Regional inequalities too the healthcare that you get in Newcastle where I'm from might be of a very different standard to the healthcare you get in Sunderland just one city over and that sucks because as much as it pains me to say it the people of Sunderland do deserve to live obviously on the condition that they renounce their football team things are certainly a mess but on the other hand being impartial I'm sure the health

secretary has a plan to fix it whoever that is this week depending on who you ask there are different explanations for all this Mass according to the government things were pretty okay but then covert came along and it's true that covered did not help the pandemic swallowed up a lot of the nhs's capacity still is and a lot of Frontline healthcare workers burned out or had to be re-tasked or just died according to people who don't like brexit brexit caused a staff shortage and it's true that that probably didn't help either because a lot of

NHS staff were from the EU emphasis on were now that we've left it is easier for them to go elsewhere because European citizens have freedom of movement if you're a doctor in France and you want to work abroad you could fill out a whole bunch of forms and pay a bunch of money to go to England or you could you could go to the Netherlands for free where you've got more rights and the pay is better and also they have double decker trains in the Netherlands which is really cool we're having to recruit more medical

staff from outside the EU now to make up for the brexit shortfall which is happening but it does take a little bit of time however we should also bear in mind that this snowball has been rolling for a while for the last decade and change there's been a lot of cuts to public services and when you slash budgets not as much stuff can be done things run understaffed overworked underpaid people burn out new people are hard to find anecdotally almost every doctor I know is planning to move to New Zealand there was already a staffing

crisis in the NHS before brexit or covid and the capacity was already falling too remember earlier I said there are seven million people in England on some kind of NHS waiting list well before the pandemic that number was already four and a half million so I think the ship had a few holes in before we even hit the iceberg Captain the NHS has also been massively impacted by cuts to local government because in England local government handles Social care for example let's say that you're an older person and you have a knee replacement in an

NHS hospital after a few days you're well enough to go home but you need a social worker to go and get groceries for you or to just pop in and check on you every now and again whilst you continue recovering well the bad news is there aren't enough social workers there aren't even enough people to process your application for a social worker because budget cuts you're not sick enough to stay in hospital but you're not really well enough to go home on your own so you just kind of sit there like a lemon there are

a lot of people sitting around in hospital beds who don't need to be there but who can't be discharged because they've got nowhere they can go and that means that new people can't come in these cuts are also very difficult to row back on one way that a trust can make up a shortfall in its budget is by selling its assets off to private developers and once a piece of the Health Service is owned by an American private Equity Firm or a Chinese Investment Group they ain't going to want to give it back if a

job like nursing for instance just doesn't pay enough for people to live on then that creates massive recruitment problems that are very difficult to get around on the other hand being impartial I'm sure that after over a decade of all these cuts the British economy is in great shape with all this ambient crisis going on isn't it understandable that things are bad for Trans patients I mean wouldn't it be unfair to criticize the NHS even ungrateful wouldn't it play right into the hands of the people who want to privatize it that's definitely an argument that

some people make and I'm being calm and rational and impartial so I'm not gonna say no but I am very strongly going to say yes and my GP didn't refuse to help me because they didn't have the money it would have cost her nothing to actually do her job the 2013 and 2015 investigations into trans Healthcare didn't find problems of budget they found problems of bigotry also in 2015 the women under quality select committee issued a report on the state of trans Healthcare which again identified Prejudice as a major obstacle and we aren't the only

minority that gets hit by it unfortunately remember earlier I said that the majority of maternity units in England don't meet safety standards well black women are four times as likely to die in childbirth than white women oh and if you're trans and a person of color that's a double whammy pretty much all of these reports also say that getting trans Healthcare is even more difficult if you aren't White although they never say it in those terms they're always like this report identifies inconsistencies in the treatment of transgender patients of colors needs are not always consistently

being met by the Health Service and it's like guys if you just call it racism think how much money you'd save on printering I'm not saying that everyone who works in the NHS is a frothing bigot I'm just saying it is a fact that the NHS admits not all the problems are caused by a lack of funding and with that in mind I'd like to take a closer look now at how the trans Healthcare System is actually designed let's say for the sake of argument that you are a transgender woman and you want to get

an orchidectomy that's an operation to remove your testicles in the USA they say orchiectomy but here we say orchidectomy because the whole point is that you keep the d a trans woman in England who wants that operation has to first get an appointment at the gender Clinic then be diagnosed with gender dysphoria then be on hormone replacement therapy for a certain amount of time and then she needs two separate psychiatric assessments in contrast a cisgender man that is a man who is not transgender who has chronic scrotal pain and wants the same operation can be

sent straight to a surgeon from his GP it's not like it's a difficult procedure either it's just like getting a tonsils out except they do it at the other end and the same is true across the board a cisgender woman with chronic uterine bleeding who wants a hysterectomy that's a removal of the womb can be referred to a surgeon from her GP transgender man who wants the same operation from the same surgeon has to go through all those extra steps a cisgender woman who wants to take estrogen for menopause can get it from her GP

in fact pretty soon she'll be able to buy it from a pharmacy a trans woman who wants the same medicine has to go to the gender clinic and be diagnosed with dysphoria first this is the one that really gets me if a cisgender man is worried about going bald he can get testosterone blockers from his GP but we can't this isn't how other countries do it the president of the world's Professional Association of transgender Health called the British system outdated and inefficient in 2021 in Canada parts of the USA and Argentina you can start medical

transition a lot easier by just going to a GP that's a space GP not AGP this system is very unpopular with patients too speaking only for myself I find it a little bit irritating that I have to go to a separate clinic to get the same medicine as everyone else I mean even if I could go on the same day and there was no waiting list why do I have to more on that later speaking not just for myself in 2018 the NHS ran a consultation in which they asked patients what we wanted to change

about the system in 2015 the women in equality select committee also asked both reports clearly record patients desires for an informed consent system one in which we don't need to get a doctor's permission to transition but we can just get our health care the same way everyone else does in 2013 that GP report that I mentioned earlier also recommended an informed consent system surprise surprise systems like that are associated with higher patient satisfaction and it would save the NHS a huge amount of money running these separate clinics has massive costs for Staffing and training and

computers if they just gave us Healthcare the same way CIS people get the way other countries do the way we've been asking for years it would genuinely save the NHS a lot of cash despite this Defenders of the British system say that it makes sure only Specialists control who transitions this supposedly prevents harm to patients in particular the harm of someone transitioning and then regretting it yes the system can be very difficult but it has a benevolent goal and if you're very clever you'll already have spotted what's wrong with that argument cast your minds back

to the very first thing that happened to me in my quest to get Healthcare my GP who had no training in trans medicine refused to send me to the gender clinic and there was nothing I could do it's supposed to be that only Specialists control who transitions but in reality everyone in this system from the Specialists to the GPS to the receptionist who answers the phone everyone has the power to deny patients Medical Care by simply refusing to do their jobs as sociologist Ruth Pierce points out in her book understanding trans Health in this system

everyone controls who transitions except the patient who's doing it the system also doesn't prevent harm as we've seen it causes a great deal of harm denying patients Medical Care some of whom die as a result and many others are forced to take risks like self-medication but regret is a much more interesting consideration for all sorts of reasons we don't have time to get into today medical regret is actually a fascinating field and one that's very difficult to do studies on because like what are the units of regret wistfulness per kilogram perhaps the data we have

suggests that transition regret is actually very rare I found a meta-analysis of 27 studies that looked at just under 8 000 trans patients in several countries who'd had some form of surgery and which found a regret rate of about one percent the other way of phrasing that would be to say that gender confirming surgery appears to have a satisfaction rate of about 99 according to that meta-analysis which is remarkably High especially when we compare it to other surgeries and that's the kicker because do you know what kind of surgery actually has quite High regret rates

knee replacements but there's no need for a psych evaluation before you get one of them another example nose jobs no psych evaluations there surgeon just says okay tell me what you want Cyrano de Bergerac or Lord Voldemort if you're not gonna block CIS people getting Medical Care on the grounds that they might regret it it's pretty paternalistic to only do it for us the argument from regret is supposed to justify having this two-track system but actually it assumes the very thing it's supposed to be arguing for namely that transmedicine and CIS medicine should be separate

that trans regret and CIS regret should never be compared designing the system to avoid hypothetical regret also assumes that there is a conflict of interest between trans people and people who regret transitioning but actually we could be on the same side there are a small number of people who do de-transition I found one study from Britain that looked at over 3 000 trans patients and found that 13 of them about 0.4 percent de-transitioned and interestingly most of those de-transitioned temporarily and re-transitioned later the study could only find three people who stopped permanently although there might

be more because if you just stop taking your hormones and going to the clinic then you're not going to turn up in the data but regardless even if it is only three people they still matter they still need health care too and having to go around the houses to try and get it the same way we do is presumably just as much of a pain in their ass and this is the really maddening thing the real jokification juice if the NHS just gave us an informed consent Healthcare System it would save them a whole lot

of money and time and produce better Healthcare outcomes for everyone who uses it that's why I personally cannot accept the argument that we should just suck it up because the NHS is in crisis and if you take nothing else from today's video then please let it be this the deadly waiting times for Trans Healthcare in Britain are not caused by underfunding excessive demand or a lack of staff and when the NHS says that I'm really sorry but they're just not telling the truth these problems are caused by bad system design and once I understood that

I was ready for what came next because Colonel Cathcart sat me down and he said okay you clearly understand the system and all of its problems so what do you propose [Music] this is not the first time that the NHS has dropped the ball and looking at previous mistakes might help us to learn something so with that in mind I'd like to talk for a moment about the natural births Scandal Sometimes the best way to deliver a baby is by doing what's called a cesarean section so if the baby's the wrong way around or if

there's any number of problems rather than push it out through the vagina the doctor can cut open the womb and lift it out and when it's done properly the procedure is very safe and normal I actually know people who've been born by C-section and it's completely fine but starting in the 1980s the NHS the Royal College of midwives and the Royal College of Obstetricians and gynecologists somehow got it in their heads that C-sections are very bad and you should only ever do natural birth and there was never really any evidence for this in fact this

story is a great example of the ways in which the top levels of medical organizations can sometimes latch on to things that aren't really supported by the medical evidence more on that later unfortunately it had disastrous consequences the Shrewsbury and Telford trust tried to reduce their number of C-sections to zero with the result that between 2000 and 2019 hundreds of babies were left stillborn or with permanent brain damage fractured skulls and other complications from Forced delivery at least 12 mothers died in childbirth and had they gotten C-sections they'd still be alive their families spent years

campaigning to try and get this investigated there were inquiries and reviews which the trust fought every step of the way but eventually the truth came out the Royal College of midwives has now officially apologized and accepted that its position on C-sections was not based on the medical evidence the president of the Royal College of Obstetricians has also formally apologized and the Shrewsbury and Telford trust has paid out more than 58 million pounds in Damages and Counting the reason I tell this story is because it shows that no matter how bad things get it is possible

to address it we can't bring back the people who died or undo the suffering but the NHS can and does face up to its mistakes and if they can do it for the natural birth scandal then they can do it for us one thing that would be good then would be if there was some kind of inquiry or truth commission set up to look at the issues we've raised today somewhere where the people who were denied health care and the families of the ones who died had a chance to tell their story something a bit

more formal than lady and silly costumes makes a video essay it would be nice too if that inquiry featured a majority of trans people on its governing body there have been NHS reports into this sort of thing before but they tend to be oh CIS people have investigated themselves and concluded they did nothing wrong the report from that inquiry would then give us a nice place to start talking about material changes like apologies resignations changing the system memorials damages public executions that sort of thing it would be cool if gp's got some training in transmedicine

the rcgp recommended that years ago so it'd be great if they actually got around to it there's lots of people who benefit from that sort of thing actually people who have endometriosis all who go through menopause have a really hard time getting GPS to listen to them so if doctors actually knew a little bit more about the communities are meant to be helping as well as you know tackling Prejudice in the workforce that sort of thing would be really helpful too decriminalizing testosterone might also help a lot of people do have to resort to self-medication

when the NHS fails them so a harm reduction approach would probably do a lot of good there that's not something the NHS could do on their own it would require political pressure to bring about my dad suggested that I write to my mp about all this so at time of recording I have sent my mp 19 emails 12 phone calls and one handwritten letter all of which she has completely ignored I got a campaign leaflet through my letterbox the other day being like hey remember to vote for me at the next election and I was

like babes you should book yourself an orchidectomy because you've got some [ __ ] balls external pressure could also be brought through the courts whenever I talk about this subject Americans always tell me you should launch a class action lawsuit which sounds great but sadly it doesn't really exist in England the NHS is currently being sued by four trans people though that's why Chaplin Chapman was ordered to drop my case his superiors say he can't do anything that might affect the outcome at time of recording the case is scheduled to be heard any day now

and it could have major ramifications at the end of the day though the big solution is the one that's been staring the NHS in the face for years the one we've been asking for for years the one that other countries already do an informed consent system I actually said this to Colonel Cathcart directly I said hey why not just close the gender clinics get rid of the waiting list entirely let us get our health care the same way everyone else does I mean we don't we don't need a doctor's permission to change our bodies right

that's that's bodily autonomy 101 so I mean everyone agrees the system is bad so you're going to change the system aren't you and Colonel Cathcart said yes I agree things do need to change that's why I have a plan a plan to change the system in 2020 NHS England commissioned a new pilot scheme called transplus here in London it's a sexual health clinic and a gender identity Clinic rolled into one and this is Colonel cathcart's baby he told me so himself he wants this to be the future of trans Healthcare in England there are more

clinics like it on the way patients and activists have been campaigning for years to get something done and it's possible that this might represent a slight Improvement at some point in the future but when cathcot told me this I wept because this plan doesn't change the system at all we still have to get permission from a doctor to get the same Healthcare that everyone else can GPS still have way too much power it's still out of step with what other countries are doing it's still a massive unnecessary expensive layer to the system patients still have

no control over what happens to us and this is the bit that really gets me he wants us to just forget about all the horrible things that have happened Sarah Ahmed talks about how institutions have their own relationships to time what philosophers call temporality when you make a complaint you look back at the harm that was done but in all my conversations with NHS senior officers they only want to look forwards they don't want to look back are the warnings they were given are the promises they made but the harm that was done especially they

don't want to look back at the people who died as a result of their decisions or the people who were permanently negatively impacted it's nice that they want to open more clinics at some point but what about the people who need health care now what about the people who are dead even if we only look at the ones who survived tens of thousands of people were kept waiting and suffering needlessly for years they knew about it and did nothing they're still suffering this is still happening people's lives are being destroyed by this system and they

[ __ ] matter there's nothing in cathcot's plan about actually fixing any of it not even an apology Ahmed says the burden of forgiveness often falls on the person making the complaint we're expected to look forward like the institution does and accept that we'll never get Justice I actually asked Colonel Cathcart Point Blank who's looking into these cases when are you awarding damages when's the public apology coming who is going to resign over these failures colonel and he hasn't said anything time of recording and if we actually do look back we'll find that this plan

is not what patients wanted remember we said we wanted an informed consent system several times they've been publishing reports and investigations and consultations into it for almost a decade multiple times we told them what we wanted and this is not that however this plan shakes out it represents NHS England and Colonel Cathcart in particular I'm afraid continuing to override the expressed wishes of the people they are meant to be helping when kafkart told me his plan I went back to Major Danby a second time and I said major based on everything I've seen it seems

to me that decisions about the Healthcare of patients are being made not based on the medical evidence but based on interdepartmental politics and institutional inertia and he said yes you're absolutely correct so I mean at least someone finally admitted it as I said this has been a very difficult episode for me because philosophytube is about compassion and reason but it's hard to maintain those things in the face of a brutal and irrational system in truth I I hate what this experience has done to me it has wasted my goodness and it has made me angry

and bitter and I don't like being that way the angry easy explanation is that the system is bad because the people in charge are bad and that it won't change because of them and I don't want to think that way about my fellow human beings I I don't think my old philosophy teacher Mr Baker would want me to think that way either I know that people try their best and so there must be another explanation why are institutions so inflexible why are they so difficult to change is it because ultimately people are nasty and selfish

or is there a deeper reason and that's actually why this topic is so fascinating to study because this sort of thing's happening all over we've known that climate change is a problem for ages we know what we have to do to stop it but we keep doing things that we know won't work we know about the threats from rising inequality and increasing extremism we talk and we talk and we talk and we don't do anything why not well after a lot of research I think I've found an answer Stafford beer was a management cyberneticist which

is a very cool job title and probably explained by the fact that he invented it basically he thought a lot about computers and he tried to apply what he knew to institutions the job of any institution he says is to take inputs and give consistent outputs so for example imagine you've got a very simple system with one employee and their job is to push one button whenever a customer asks them to in this case the input is the customer asking and the output is the button push the system has two states that it can be

in either he presses the button or he doesn't so we say that it has a variety of two if you have 10 employees and they each have one button now the system has a variety of 1024 that's the number of possible combinations of button pressed or not if you have a hundred employees now the system has a variety of two to the 100 and if you have a system as big as the NHS with employees who have jobs way more complicated than pushing one button and inputs a lot more varied than please push the button

you can see how things get pretty complicated pretty fast faced with all this variety How can any institution possibly deliver consistent outputs in an Ideal World an institution would have enough variety to cope with any possible input so for example in the ultimate clothing store there is one shop assistant for every customer and there are infinite different sizes of every single possible item of clothing you could ever want and I still can't find a crop top I enjoy wearing obviously that's not practically possible though especially when the institution is running on a limited budget so

beer says every institution has systems in place to keep variety down we've already seen several during my Voyage Through the NHS GPS with very narrow mindsets complaints procedures that are restrictive and individualizing documents that exist to be read but never followed non-performative statements that are used to brush people off these are all ways that the NHS tries to keep variety down and keep on ticking to produce consistent outputs even when that means consistently bad ones the drive to reduce variety beer says is like gravity or entropy he actually calls it a natural law and says

that institutions do this even when the people working in them don't want them to and even if it makes things less efficient and more expensive this is why big institutions are so inflexible and why change happens so slowly inch by Angry Inch beer was especially interested in when this drive causes an institution to collapse he says we shouldn't really think of them like this as a fixed hierarchy that's really only useful if you're trying to find someone to blame instead he says try thinking of an institution like a wave on a beach a wave is

a system water molecules move in a circle and as they get closer to the shore the ones on the bottom are slowed down by friction with the seabed and so the circle becomes elliptical until it becomes so elliptical that the water molecules on the top collapse and the wave breaks this happens because the system of the wave is internally unstable and there's nothing anyone can do about it it's just physics so too Bia says institutions have the drive to reduce variety and if that drive contradicts what people actually need from it then eventually it will

fail bearing all that in mind in my opinion this system is failing and will continue to fail despite cathcart's plan because the drive to reduce variety contradicts what patients actually need if we had an informed consent system which would be like allowing patients to push the buttons ourselves that would be better but it would massively increase the system's variety it would require it to give a new kind of output which it instinctively resists and there's one big example of this that I'd like to look at in the final section of today's video that I think

explains a lot of the problems that we see here this is the spicy bit this is the bit where probably a few people are going to get a little bit upset at me but I would like to talk now about the concept of gender dysphoria [Music] here's the real [ __ ] we are firmly in the territory of my opinion here not everyone agrees with what I'm about to argue if I'd stayed in Academia this is probably what I'd have written my PhD on as we've seen by now medical transition in England and let's not

forget a lot of legal transition as well hinges on first being diagnosed with gender dysphoria which is supposedly the feeling of discomfort that arises when there is a disconnect between the sex you were assigned at Birth and the gender you are and I think that this concept as it is used in the NHS system is a complete Croc of [ __ ] the philosopher Gilbert Ryle tells a story about a guy who goes to Oxford and asks to see the university and they show him the colleges and the libraries and the quads and at the

end of the day he says yes but where's the University you haven't shown me that and he's made a mistake what philosophers call a category error he thinks the university is its own building but it's not it's just the sum of all those ordinary buildings A lot of people talk about dysphoria as if it was its own extra feeling and I think that that too is a category error I don't think it is an extra feeling I think it's just the sum of and CIS people also feel all those feelings maybe not about the same

things or to the same intensity but they do feel them if a cisgender woman goes through menopause and thinks oh my my body feels bloated it doesn't feel like my own I'm anxious and depressed is that not gender dysphoria if a CIS man is skinny and can't grow a beard and looks at his peers and thinks oh I I should be manlier is that not gender dysphoria if a sister and the woman has hair on her face and thinks oh I've got a mustache I look like a man I want to get laser hair removal

to get rid of it is that not dysphoria I think the only plausible answer here is yes but when CIS people feel those feelings it doesn't have its own clinical label and they don't have to be diagnosed with it to get treatment remember if a CIS woman goes through menopause she can get estrogen from her GP if a trans woman wants it we have to go to the gender clinic and be diagnosed with gender dysphoria when we feel those feelings it's treated differently and you might be saying well when CIS people feel those things that's

body dysmorphia not gender dysphoria it is a different thing but that's what I'm asking why is it different to which the only answer is well because you're trans and that's exactly my point functionally in the English clinical system gender dysphoria just means the thing that trans people have and in that case you might as well just call it mad disease and it's not just the concept itself that raises my eyebrows the history of it is also questionable being trans used to be considered a mental illness transsexuality as it was then called was added to the

diagnostic statistical Manual of mental disorders in 1980 and there was immediately a campaign to remove it so in 2013 the American Psychiatric association got together and said we gotta update this and they assembled a committee there were 12 doctors on that committee as far as I can find all of them were CIS side note one of them was Ray Blanchard a name that all the trans people in the audience will know because banchard has since been disgraced and his um theories about us have been thrown out by the medical community and thoroughly debunked including by

other YouTubers more talented than me this was the committee that pretty much invented the modern concept of gender dysphoria as it is used today this team of 12 looked at the history of diagnosing trans people looked for patterns in the medical literature and came up with their new diagnosis dysphoria unfortunately there was a major problem with the data that they relied on a problem which also makes the diagnosis extremely difficult to actually use how do you diagnose someone with gender dysphoria or transsexuality or mad disease or whatever we're calling it this decade when you get

to the gender Clinic what does the specialist actually do well they ask you questions of course this person who has the power to decide what the rest of your life will look like asks you questions to make sure that your answers fit the ones they have in their textbook and can you guess what the problem is we lie or not even necessarily lie but just we tell them what they want to hear there's a documented history of trans people doing this since at least the 1950s and we're still doing it a 2015 study found that

about 30 percent of trans-respondents admitted to lying or withholding information during their NHS gender assessments because of course we do if you wait several years for that appointment and you finally get in the room with a person who has your life in their hands a person who is almost certainly CIS and they ask you so when did you know of course you're going to say oh ever since I was a child yeah I wore my mother's dress I called myself Wendy like all I want is to be a 1950s housewife and marry a man of

course you're gonna say that I'm not saying you should lie to your doctor I'm saying it's a fact that it happens it's always been a problem and it's always going to be a problem as long as we have to pass a behavioral assessment to get health care to put it in cybernetic terms we ourselves reduce the variety of inputs to the system because unless we give the right inputs we don't get to live it's a running joke in the British trans community that the assessments for gender dysphoria are ridiculous but to be honest the questions

they ask can also be very humiliating how do you masturbate how often what do you think about when you masturbate what do you wear when you masturbate who do you have sex with how often what positions tell me about your childhood were you abused as a child what toys did you play with were you abused as a child which other children did you choose to play with were you abused as a child what was your first sexual experience when did you start having sex tell me again specifically in detail how do you masturbate on and

on and on it's humiliating enough as an adult to be interrogated like that by a stranger I can't imagine what it's like if you're a trans child and it's not like you can say hang on a minute where's your evidence that any of this is medically relevant because they have the power to deny you health care and if you're the committee in 2013 going through the reports from those assessments trying to find the patterns you've got no way of knowing how accurate that data is which raises serious questions about the reliability of their conclusions there's

no way of knowing whether gender dysphoria is a real diagnostic pattern or just a collective invention I remind you that getting trans Healthcare in England and a lot of legal transition to requires you to go through that interrogation first that's the real reason the waiting list is so long there are very few Specialists who conduct these assessments apparently it's hard to recruit people to do the job of asking strangers how they jack off but even if there were a million of them even if the asking strangers have a jack off sector became the biggest employer

in the country I just don't think it's a valuable clinical diagnosis I don't think it even makes sense and it's also a little bit insulting that I have to do that but a CIS person doesn't I'm like The Emperor's New Clothes with this man gender dysphoria there's nothing there now we're bullied and insulted and harassed and shoved around all day long by insane people and we do our duty mission after mission 35 40 then we're told it's not good enough with all that said why not just ditch the concept of dysphoria if it's grounded in

philosophical error based on unreliable data incentivizes patients to lie creates a deadly bottleneck in the system and adds this whole extra expensive layer we don't need why not just get rid of it we could still use the word if somebody says how are you Abby and what I want to say is I feel bad about my body and the way that it is perceived by myself and others in a way that relates to my gender because there is a gap between what I want and what I have then it's probably just faster to say dysphoria

or honestly most of the time it's faceted just making noise like that there have been calls for years internationally to ditch the clinical use of dysphoria and just give trans people Healthcare without that extra step of a diagnosis there are some practical hurdles to be sure the diagnostic requirement is very baked into the NHS and British law in 1999 there was a landmark legal case a trust in Lancashire announced they weren't going to fund transition anymore on the grounds that it was merely cosmetic and they were sued by three trans patients who said actually it

was necessary to alleviate their gender identity disorder as it was called at the time the patients one which meant that we have a right to free transition but it also codified the idea that we need to be diagnosed with something first the NHS tries to cure illness rather than maximize Health those are not necessarily the same thing so gender dysphoria provides an illness that they can respond to practical hurdles can be overcome though it would take some work to change the system sure but it's not impossible we could have a system that gives us free

healthcare and doesn't rely on diagnosing us with mad disease other countries already do again and this is the question I kept coming back to with Colonel Cathcart why not change the system I have a theory about what's really going on here and to explain it I want to draw on some philosophy of disability in her book the capacity contract philosopher Stacy Clifford simplicon Compares two different ways of thinking about what it means to have a disability one is the so-called medical model you have a disability if you have a medical problem and the other is

the social model you have a disability if for example you use a wheelchair and your building doesn't have a ramp the problem isn't your body the problem is that the building wasn't designed by you simplicon says that the medical model can be very appealing to able-bodied people because it soothes our anxiety I don't want to think about the fact that Society is unfair or that the systems I'm part of exclude people I definitely don't want to think about the fact that I could acquire a disability and then I'd be the one who was excluded so

the medical model allows me to imagine that there is a very distinct line between them and me a line that is located in their bodies where the problem is and that also presents an obvious solution get them out of here I think that gender dysphoria does a similar thing because here's the real secret of the universe if you want to change sex it's possible for all of human history we've had this divide between men and women but if you want to cross that divide if you want to transcend it entirely and be neither it's possible

in particular hold in one hand all of masculinity 4. Leonidas Beowulf James Bond Andrew Tate Jordan Peterson all of them and in the other hold just two milligrams of estrogen a day and tell me which one is more powerful we live in a culture that valorizes men treats them as the default but when you're a trans woman you can take all of that and just and you can be happier for it in a male-dominated gender hierarchy where it is assumed that men are better than women and that masculinity is superior to femininity there is no

greater threat than the existence of trans women who despite being born male and inheriting male privilege choose to be female instead by embracing our own femaleness and femininity we in a sense cast a Shadow of Doubt over the supposed supremacy of maleness and masculinity I think that some CIS people are made a little bit anxious by that I think they like to imagine that male and female are naturally occurring stable categories and that we are just the exceptions that prove the rule I think they like to imagine that there is a clear Line Between Us

and Them and the concept of gender dysphoria draws that line it locates the problem within our bodies and also creates a class of Specialists who can Patrol that line and decide who gets across hell there are some trans people who like that line being there there are some not naming names who say I'm a real transsexual I've been diagnosed with the mental illness that is gender dysphoria not like all these tenderqueer non-binary teenagers with their green hair and their Lucy and Yak dungarees and I'm like babes you've been diagnosed with bologna suffered beer famously said

that the purpose of a system is what it does and what he meant was there's no point claiming A System's job is to do something it consistently fails to do it functions how it functions it gives the outputs it gives with that Outlook I don't think anyone can really claim that the nhs's current system exists to help trans patients it might occasionally do that as a side effect but in my opinion it's real function its main output is control NHS gender clinics exist as part of a larger system that is gender itself and they reduce

variety within that system parades aren't designed to teach us anything they're designed to humiliate us they're designed to make us suffer the indignity of doing something entirely pointless so that sadistic Scheid scarf can demonstrate he has power over us the more pointless the activity the greater our humiliation and the more power he feels and we can sit here and pretend all we want that there must be some more noble war effort type purpose that was walking around in [ __ ] rectangles but there isn't one we do parades so scheitzgov can feel like a tough

guy that's what parades are for in my opinion the concept of gender dysphoria pathologizes transness so people can avoid the endearing truth that there is no line and that really we aren't so different and so that some of them can avoid asking themselves the big question given that human beings can change sex do you want to [Music] I should have known that the ending of my story would be as absurd as all the rest of it one day I got a phone call and they said come in on Tuesday I don't know whether Colonel cathcock

did something or whether someone ahead of me on the waiting list died they just said it's on Tuesday and I thought I would be happy or excited but to tell the truth I was angry with them and with myself I was angry because why did I why did I get that phone call and then someone else didn't It Is by luck and a hell of a lot of privilege that I am here to tell this story and the arbitrariness of that system compounds the survivor's guilt for a hell of a lot of people by the

time they finally get an appointment they've either already self-medicated or they've gone private so there's hardly any point in even getting one it seems that the only way to get trans Healthcare in Britain is not to need trans Healthcare and there is actually a specific name for that kind of logical trap it's called catch 22. there's some catch that catch 22. it's the best there is I hope that sharing my story does some good I'm going to tell you the real on YouTube Everything has to be clickable and shareable and homogeneous it's very difficult to

get a message out when you make something like this which is a little bit different but when we try it can be wonderful I recently wrote a stage play called the prince which was on here in London with me in it and we won an off West End award the highest award we were eligible for we won it I've gone from making YouTube videos in my bedroom to award-winning playwright because it turns out when we're actually allowed to tell our own stories for a change they're pretty good the play was filmed and the filmed version

is going on a streaming service called nebula if you'd like to see it there's a link in the description curiositystream.com philosophytube the way it works is you click on that link you sign up to curiositystream and you get nebula included as well the whole bundle costs like 15 a year which is ridiculously cheap for what it is and you also get everything on curiositystream included and there's loads of good stuff on there like David Attenborough has a documentary about bioluminescence that I came across randomly on curiosity stream it's really good it's about animals that give

out light that's what I'm trying to be I'm going to donate most of the money that nebula gave me to the charity gendered intelligence they're run by trans people and they help educate the public about what we need that's all from me for today thank you for watching and best of luck fly [Music] [Music] glory glory to God is everybody happy by the sergeant looking up I'll give a deeply answered yes and then they stood him up he jumped into the icy plastic static line of hook and he ain't gonna jump no more [Music] glory

glory to God he ain't gonna jump no more zones he counted long he counted loud he waited for the shock he felt the wind he felt the cold he felt the awful drum the silk from his reserve Spilled Out and wrapped around his legs [Music] [Music] he ain't gonna jump no more so so your eyes are swung around his neck the nectar's practice long suspension lines were tied and not so wrong to skinny bones [Music] Zoom one day she lived and loved and love kept running through his mind it's all about the girl back home

the one he left behind it's all about America [Music] to die [Music] seems to me that you spend a lot of energy railing against things that you can't control and who says I can't control them