Healthcare

Why are the 99.6% required to opt in for gender on birth certificates?

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So Tasmania’s lower house has passed the motion to remove gender from birth certificates allowing people to choose what they identify with from age 16. Apart from the biological and genetic implications, one question is why must the majority opt in as opposed to the minority opting out? It can only be viewed as a form of constructed  re-education.

According to the ABS Census of 2016, only 0.4% identify as other than male or female. 10,000 out of 24 million. Therefore 99.6% are comfortable with traditional biologal gender.

What are the risks? At what point will legislation be tied to the use of puberty blockers? We can’t rule out some parents might try to encourage their young child to associate with the opposite gender?  It has already happened in the US. Parents will know that it is not hard to manipulate a 10yo. It is not to rule out completely that a child may truly identify as the opposite of biological gender but statistically it would be improbable to suggest it is a majority or all. So to dispense puberty blockers under false pretenses is a dangerous risk. Assuming a 10yo is of sound peace of mind to take such drugs, why not give them the ability to vote?! Effectively that is the decision making process being put forth. It is ludicrous.

Assume a child is coerced by guardians/parents (even if a small subset) into believing they are the opposite sex than biological gender and get government permission to take puberty blockers. We do not have enough empirical evidence to know if terminating these drugs will automatically lead to a natural resumption of puberty.

Scientific research has noted that side effects of puberty suppression hormones can lead to arrested bone growth, decreased bone accretion, can prevent full organization and maturation of the brain, cause sterility, coronary/cardiovascular disease, elevated blood pressure and lead to breast cancer. Hey, it is worth it for inclusion, right?

That’s a horrible set of risks to put on a child who might potentially grow out of gender dysphoria. That child’s life could be irrevocably ruined for the sake of ideology determined by those who shouldn’t be in a position to enforce such directives.

The Gender Identity Development Service in the United Kingdom saw a 2,000% increase in referrals over seven years—from 94 children in 2009/2010 to 1,986 in 2016/2017. Is this a case of creating a market to allow people to file for  gender dysphoria? Note this is not to cast aspersions on those who may properly suffer from the condition.

Hruz, Mayer, and McHugh wrote in a Supreme Court brief filed in the Gavin Grimm case that most-cited studies conclude most children with gender dysphoria come to embrace their birth sex but caution hormone therapy often solidifies a child’s gender dysphoria.

800 children in the UK aged as young as 10 are taking puberty blockers. Are we buying time or merely arresting development? The risks seem more like a concerted  push for institutionalized child abuse.

Ultimately who is the arbiter to determine between whether a child might be confused or properly gender dysphoric? Get it wrong and that life might be irreparably damaged. But hey, as long as it was done for the sake of progressive goals, such sacrifices are all in the name of diversity, no?

Tommy trouble

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It seems the UK Armed Forces are finding it difficult to recruit their own. So much so that they have lifted a 5-yr waiting period for Commonwealth citizens to join up. The National Audit Office states the armed forces are suffering the worst shortage of new recruits since 2010, being short 8,200 from desired levels. Therefore Aussies, Canadians, Indians and other Commonwealth citizens can sign up.

According to official Ministry of Defence (MOD) in the year leading to November 2017 1,759 of the 15,325 regular troops quit  because their time was up. Nearly half (7,439 ) quit early because of worsening conditions and falling morale. 3,325 were kicked out on disciplinary grounds and another 2,337 were medically discharged.

The MOD’s UK Regular Armed Forces Continuous Attitude Survey 2015 revealed,

-The number of personnel stating that they are dissatisfied with Service life has risen to 32%, up from 27% in 2014. Not a good start.

-There has been a fall in the number of personnel reporting that they are proud to be in their Service, from 81% in 2014 to 77% in 2015.

-25% “state that they plan to leave as soon as they can, or have put in notice to leave” (+9% on 2011).

-Satisfaction with pension benefits has dropped 18% since 2011

– Less than a third (27%) of Service personnel agree that the level of compensation is enough

-In 2015, job security was the top retention factor, followed by dental and healthcare provision, pension and opportunities for sport.

  • Individual morale 40% (-6% on 2011)
  • Unit morale 21% (-6% on 2011)
  • Service morale 14% (-4% on 2011)
  • Service life satisfaction 47% (-10% on 2011)
  • Job satisfaction 56% (-8% on 2011)

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Apart from the appalling trajectory of morale, it is clear that care once out of the military doesn’t fare much better.

While the MoD total budget will increase from GBP23bn to GBP50bn by 2020, data about how it is spent is highly opaque. More is learnt by some of the history surrounding the treatment of Tommies.

Support of  veterans has been so lacking that charities such as Help for Heroes has been active picking up the shortfall. It raises over GBP30 million per annum to support the 2,500 British veterans discharged for medical reasons every year to cope with civilian life.

Despite the American Psychiatric Association acknowledging PTSD in 1980, it took the UK another five years to officially recognize PTSD after the sharp increase in veterans suffering from mental health issues post the Falklands War of 1982. Of the 30,000 troops that were sent to fight, the UK armed forces allocated only one psychiatrist to the far away battlefield.

The problem was compounded in the 1990s with widespread closures of UK military hospitals as a cost cutting measure. Seven of the eight military hospitals had been shut or transferred to the NHS by 1999.

The UK Ministry of Defence (MOD) wrote in its recent report on those deployed in Iraq and Afghanistan about how low suicide rates were. It stated, “While rates of mental disorder are lower in the military (3.1%) than the general population (4.5%), the MOD routinely carries out research into those who have served on large scale combat operations, in order to more accurately assess the effects of deployment.” Note there is no data on veteran suicide in the UK.

The UK MOD’s ‘Defence People Mental Health and Wellbeing Strategy’ is supposedly in place to challenge the stigma surrounding mental health issues, to ensure that all who serve, and have served, can enjoy a state of positive physical and mental health. The MOD has committed £22 million a year on mental health with the establishment of two 24/7 helplines for serving personnel and veterans. How is it a charity funds 1.5x what the government does?

To put that in context, Australia spends 20x this amount every year just on veterans counseling services. America, albeit a larger veteran base, spends $9bn on mental health for its soldiers.

One wonders why the MOD doesn’t listen to the surveys and act. Then it wouldn’t have to go down the mercenary route.

How well do Americans know their Defense budget?

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The US spends more than the next 9 countries combined when it comes to defence. What is probably lost on many Americans is the spiraling cost of funding the veterans who served. The US is forecast in 2020 to spend almost as much on the Dept of Veterans Affairs (VA) as China does on military spending. The direct cost of wars in Iraq and Afghanistan has driven the indirect costs of treating those who served almost 5-fold since the war began. US politicians have passed increase after increase.  Have these increases been thought of in context of the trend? Or do annual increases just get signed off as a reflex action?

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If we put the VA budget next to the defence budget, the former has grown from 14.8% of the latter to around 29% between 2000 and 2020. The number of veterans receiving disability compensation has grown 2 million in 2000 to 4.3 million in 2016. A total of 7.2 million veterans are actively seeking services or payments from the VA, up from 5.5 million in 2000.

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Spending per veteran by priority group also reveals sharply higher costs. This is not an exhaustive list of priorities, but the main 7.

Priority 1

• Veterans with VA-rated service-connected disabilities 50% or more disabling
• Veterans determined by VA to be unemployable due to service-connected conditions.

Priority 2

• Veterans with VA-rated service-connected disabilities 30% or 40% disabling

Priority 3

• Veterans who are Former Prisoners of War (POWs)
• Veterans awarded a Purple Heart medal
• Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty
• Veterans with VA-rated service-connected disabilities 10% or 20% disabling
• Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation
• Veterans awarded the Medal Of Honor (MOH)

Priority 4

• Veterans who are receiving aid and attendance or housebound benefits from VA
• Veterans who have been determined by VA to be catastrophically disabled

Priority 5

• Non service-connected Veterans and non-compensable service-connected Veterans rated 0% disabled by VA with annual income below the VA’s and geographically (based on your resident zip code) adjusted income limits
• Veterans receiving VA pension benefits
• Veterans eligible for Medicaid programs

Priority 6

• Compensable 0% service-connected Veterans.
• Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.
• Project 112/SHAD participants.
• Veterans who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975.
• Veterans of the Persian Gulf War who served between August 2, 1990, and November 11, 1998.
• Veterans who served on active duty at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987.
• Currently enrolled Veterans and new enrollees who served in a theater of combat operations after November 11, 1998 and those who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for five years post discharge.

Priority 7

• Veterans with gross household income below the geographically-adjusted income limits for their resident location and who agree to pay copays.

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Countries have an obligation to look after the troops that sustain injury, physical, mental or otherwise. The question is whether politicians are cottoning on to the mounting relative increase in healing the veteran community to the spending on weapons of war?

There are 19.6 million veterans in the US. By 2045 this is expected to dip below 12 million. With 2.1 million serving active duty military personnel and reserves, the overall costs of healing may not come down anytime soon.

What it does say is that there is a massive need to work out how to reduce the costs to the VA without impeding improving healthcare and benefits for veterans.

Banned documentary – Let There Be Light, 1946

In compiling the book of letters from the battlefields of WWII by Lt. Norman Peterson, researching PTSD in that era has unearthed some interesting facts. A documentary made by John Huston in 1946, which chronicled the treatment of troops suffering from neuro-psychiatric conditions, was banned by the Army from release to the public until 1981. The excuse made was that it was necessary to protect the identity of the patients, despite Huston having received signed waivers. It would seem the top brass did not want to have the extent of the problem acknowledged by the broader public.

The first published book related to what we now know as PTSD was the Diagnostic and Statistical Manual of Mental Disorders of 1952. It listed the condition as “gross stress reaction.” It wasn’t until 1980 that PTSD was properly recognized as a psychological issue. After WWII, veterans were told to just tough it out.

WWII British Army veteran, Victor Gregg, wrote the following in The Telegraph newspaper article on 9th November 2015 with respect to PTSD like conditions.

“I remember one day during the Battle of Alamein when my friend Frankie Batt, a man I had enlisted with in 1937, was blown to pieces. I recall trying in vain to put the bits together, to somehow bring Frankie back to life. As I picked up what was left of him I could feel the hate burning inside me. For the next three or four weeks our section never brought in a single prisoner, in spite of the fact that the battle was nearly over and the enemy were surrendering in droves. So long as no officer was there to witness, we shot as many as we could until our anger died its own death…by the time I got home I had witnessed things that I had not thought possible, and my brain was filled with images of suffering that were to haunt me for the next forty years…When I was demobbed, people didn’t talk about what was going on in their minds. It just was not the done thing; you straightened your shoulders and got on with life. The men who did try to raise the subject were treated with scorn…It was only after many years that I realised how much heartache and misery my anger caused to those I loved. 

The Cambridge History of the First World War contains an article by Jay Winter, Professor of History at Yale University, where he suggested that shell shock in WWI comprised around 20% of all troops, not the 5% often reported. His contention was that the truth was deliberately suppressed otherwise sufferers would not have received a disability pension if not accompanied by physical wounds.

In 1993, MA Kidson, JC & BJ Holwill wrote in the Medical Journal of Australia a piece titled, ‘Post-traumatic stress disorder in Australian World War II veterans attending a psychiatric outpatient clinic’. Out of 108 veterans who participated in the study 45% were shown to carry symptoms of PTSD – as defined by DSM-III – 48 years after it had ended. The study claimed, The presence of PTSD was significantly associated with the taking of casualties (an indicator of severity of war stress as reported by the veterans themselves) and with combat stress as rated by their treating doctors.”

A 2007-08 study at the University Michigan looked at 78 WWII veterans being treated for depression and discovered that 38% of them had significant PTSD symptoms.

Dr. Helen Kales, principal investigator of the geriatric psychiatry section at the University of Michigan wrote,

World War II veterans come from a generation in which expressing psychological symptoms or distress was pretty stigmatized. So these cases may have gone untreated as the vets did not seek treatment and were able to somehow suppress their symptoms and function.

Reading into Traumatic Brain Injury (TBI) reveals even more concerns about the problems we face dealing with returning soldiers.

While PTSD does not necessarily require physical damage to occur, TBI, in the military, tends to occur when exposed to blast-related injuries such as artillery, improvised explosive devices (IED), land mines and rock-propelled grenades (RPG).

TBI can be the result of occurrences where an object (bullet, bomb fragments) causes the scalp/skull to break or fracture. Sometimes it is a closed injury where the outside force impacts the head but no objects manage to penetrate. Even in the case of closed injuries, the brain can experience such considerable force that it can result in torn tissues, bleeding and other physical damage which can be irreversible in severe cases.

TBI was better recognized in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) where 1.64 million served. 60% of blast injuries in those conflicts resulted in TBI. According to the US Veteran Affairs (VA), 59,000 (c.10%) Iraq and Afghanistan veterans who used the Veterans Health Administration (VHA) from 2009 to 2011 were diagnosed with TBI.

VA now records that 4.3mn receive disability benefits, up 2mn from 2000. The total budget for the VA in 2019 will total $198.6bn, up from $97.7bn in 2009. It was $43.6bn in 2000. The VA is asking for $212bn for 2020. The VA budget relative to the defense spending budget was 14% in 2000. It is now 30%. The cost of war is obscene. The cost of looking after veterans is hot on defence spending heels.

First responder assaults – the shocking stats

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We must question the sanity of the world we live in. First responders – police, fire and ambulance – are generally people trying to save the community from danger by putting themselves in harm’s way. Yet the incidence of assaults against them has grown to shocking levels around the world. These are not exhaustive stats (this will come in a more comprehensive piece) but this piece paints a picture of what is going on and why we shouldn’t be surprised at the growing incidences of PTSD suffered by first responders. Something must be done. The next journey for CM is to provide a solution.

By branch:

POLICE

The FBI noted in 2016 that 57,180 (c.10% of all) US police officers were assaulted while performing their duties. 28.9% were injured (enough to enforce time away from work). The largest percentage of victim officers (32.2%) were assaulted while responding to disturbance calls (domestic violence, family disputes, pub fights).

Assailants used hands, fists or feet in 78% of the incidents, firearms in 4.2% of incidents, and knives or other cutting instruments in 1.9% of the assaults. Other types of dangerous weapons were used in 16% of assaults. Assaults on police in the US are up 17% in the past two years. 

In NSW, Australia some 2,343 (13.3%) police officers out of 16,500 have been at the receiving end of assault in 2017. That’s 6 per day. With regard to official statistics, the NSW Police Force indicated that over a three year period from 2013 to 2015, an average of 2,236 police officers per year were assaulted during the course of their duties. Around 7% of officers actually end up physically injured. 

 AMBULANCE/EMS

In the US health care professionals experience the highest rate of workplace violence (WPV) compared to all other industries, with the majority of violent injuries committed by their patients according to the Bureau of Labor Statistics. Studies show EMS responders were three times higher than the national average for all other occupations to suffer WPV. In regards to occupational fatalities, the rate among paramedics is more than twice the national average for all occupations and is comparable to those of police and firefighters at 12.7 per 100,000 workers per year.

The rate of nonfatal injuries among US paramedics was 34.6 per 100 full-time workers per year — a rate more than 5x higher than the national average for all workers.  In regard to fatal injuries, a retrospective cohort study of nationally registered emergency medical technicians (EMTs) in the U.S. found that 8% of fatalities were due to assaults. 

Males have been reported as the most frequent perpetrators of violence however, a separate study found female patients of the mean age of 32.5 years +/- 8.1 years to be the most frequent perpetrators. 

In the NSW Ambulance Service, approximately 51% of assault incidents were attributed to mental illness, 22% to alcohol, 15% to drugs. Similarly, statistics provided by the NSW Bureau of Crime Statistics and Research (BOCSAR) concerning violence against Police from July 2006 to June 2016 suggest alcohol is a factor in many incidents.  Assaults on ambos in NSW are up 8-fold since 2001. Median lost hours for those EMS crew assaulted is around 8.6 weeks.

FIRE FIGHTERS

In what world do people shoot fireys? Here are 3 specific incidents in 2016 of attacks on fire fighters in the US. 

April 15, 2016: Firefighter fatally shot, second wounded in Prince George’s, Baltimore, Maryland

Jan. 22, 2016: Ark. firefighter shot, killed on EMS call, Pulaski County, Arkansas,

Jan. 20, 2016: Denver fire chief stabbed near station, Denver, Colorado,

Fire and Rescue NSW indicated its officers do not have the sort of violence prevention training of police and paramedics better able to protect their crew’s health and safety, including in respect of violent incidents. At the Parliamentary Committee’s hearing on 14 November 2016, Fire and Rescue NSW witnesses provided the following evidence:

Basically, when a crew arrives at an incident, you have a station officer and a station commander in charge of the crew and the…truck. That person undergoes promotional programs to get to that position. Part of that is understanding how the legislation is applied in reality from a practical point of view. Also, during that experience – we are talking probably eight to 10 years for that to occur …The promotional programs…cover the responsibilities of the officer and advise around the standard operational guidelines of when to withdraw and ask for police support and what is safe or not safe.

…If we look overseas for experiences and tried to align our experience to that, you would have to say that the civil unrest that is happening in the United States probably would not occur here to that degree. However, there is also an underlying issue in the United States where emergency service is seen as part of an arm of government and there is, hopefully, a small growing trend where emergency service ambushes are occurring…random shooters are calling emergency services to locations to make a point. We hope that never crosses to this country here, but we would always have an eye on what happens in other jurisdictions…because it is quite possible someone would pick that up as a possibility in this jurisdiction….”

PRISON GUARDS

The UK HMPS note that there were 7,159 assaults on staff in the year to March 2017 up 32%YoY. Serious assaults were up 25%YoY to 805 incidents. The National Tactical Response Group (NTRG) which is only called under extreme levels of prisoner violence  surged from 120 in 2010 to an annualized 630 by the end of 2016.  

THE PTSD IMPACT

This was the fascinating part of the research. It isn’t that the job isn’t hard enough already, it’s the lack of resources to support first responders when waiting for incidents. Lots of idle time to ponder.

US FEMA note stress has not only been categorized by exposure to traumatic incidents, but also the monotonous operational characteristics of EMS organizations, such as paperwork, lack of administrative support, low wages, long hours, irregular shifts, and cynical societal attitudes toward public safety officers.

Cumulative stress associated with the monotonous duties or low acuity calls has led to feelings of desensitization for patients, and their job as a whole. Concerns have also been raised regarding sleep quality and fatigue and the impact it has not only on the provider, but also job performance and patient  outcomes. Some research has posited that organizational stress often contributes more to the development of PTSD than traumatic events.

Also noteworthy is the notion that paramedics are often the source for a lot of criticisms by society for the decisions they make in determining life or death situations for patients and themselves. This can affect EMS providers in many ways and may contribute to the slow decline in provider morale.

Burnout (emotional exhaustion) is one of many organizational outcomes that may arise as a result of violence experienced by EMS responders. The question of whether or not violence would eventually lead to burnout was first raised in the early 1990s . Exposures to violence were noted as a reason many EMTs, especially volunteers, left the profession. In an early study from 1998, 7% of survey respondents within one urban fire department considered leaving EMS as a direct result of an abusive situation they encountered while on the job. Knowing how to emotionally cope following a tough incident can help to reduce anxiety and burnout.  

Mixed methods studies conducted in the U.S. and Sweden found that violent encounters altered the patient-provider relationship. Yet, some in the industry feel that exposures to violence do not cause stress or negatively impact providers. This lack of effect has been attributed to the internalization of the mentality that violence is a part of the job.  It has been posited that years of experience may be a protective factor that allows more experienced responders to experience less stress and anxiety after violent events. 

Evidence weighing the social and economic costs associated with increased violence and burnout is based mostly upon anecdotal evidence, with no assessments conducted on monetary value. Some suggest that, as violence increases, the need for police backup also increases, thereby increasing response time and delaying potentially critical care to a patient in need. 

Other concerns include altered operations for the private sector of EMS. Intent to leave the profession is also a concern. As more EMS responders leave the profession, numerous organizational and patient impacts have been hypothesized, including increased costs for training new EMTs and paramedics, greater numbers of inexperienced paramedics serving at any one point in time, and increased error rates committed by new and inexperienced paramedics. EMS responders also report seeking a job change away from their ambulance role. In some cases, responders stated they lost interest in fieldwork and tried to get off the road and into desk positions. 

What’s clear is that not enough is being done to help first responders cope with occupational hazards and handling the stress that comes from it. That is going to change very soon. Stay  posted!

While you’re at it, why not thank those first responders randomly in the street for the great work they do. It goes a long way! They need you just as much as you will need them when you’re in a bind!

Australia can learn from Ontario’s Doug Ford on energy policy

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Ontario Premier Doug Ford Jr’s Progressive Conservatives are pulling the plug on 758 renewables projects costing $790mn. The plan is to cut hydro rates by 12% which had been inflated by Wynne’s Liberals for 15 years to subsidize these green projects. Energy Minister Greg Rickford announced that none of the cancelled projects have reached “development milestones,” so believes it should be cheaper to scrap them now.

Three things stand out:

A senior Liberal spokesperson said, “Why would firms do business in Ontario if they see this kind of government meddling?

Well 12% lower electricity prices could be a start. The Liberals should look at how higher electricity prices in South Australia are driving businesses out of the state. The Independent Electricity System Operator said yesterday that “there are other means of meeting future energy supply and capacity needs at materially lower costs than long-term contracts that lock in the prices paid for these resources.

The German contractor needs better lawyers if this is a problem:

The CEO of wind turbine contractor WPD in Germany said in an open letter that it stands to lose up to $100mn on the cancellation of the White Pines project (which residents strongly opposed) for 9 wind turbines which commenced in 2009 yet is still not completed. A turbine a year? That’s a jobs creation scheme…stretch it out for as long as possible to fudge the employment numbers (at taxpayers expense). Did WPD just expect that Wynne would win another term hence not needing to lock down contract terms that covered risk of this sort. Where is the “based on clause 7, section 3 we will seek full compensation for your action.”? Why not mention that in the letter?

Fears of renewable job losses:

All this nonsense about green jobs creation is farcical. The Australian Bureau of Statistics (ABS) renewable employment figures which showed all states seeing declines. By state, South Australia has seen a 65% fall in green jobs since the peak in 2011/12. Victoria down 46%, Queensland down 49%, NSW down 32% & WA down 55%. The problem with green jobs is they are not sustainable.

Premier Doug Ford sacked Hydro One CEO Mayo Schmidt (whom he promised to fire at the June 7 election), a man he dubbed “the $6 million dollar man”without the expected $10.7 million severance payment (reduced to $400,000) and is replacing the company’s board of directors.

Let’s not forget Ford annihilated Liberal Kathy Wynne so badly her party can’t even serve in parliament. While liberals were complaining Ford won it for being a white heterosexual male they overlooked that most constituents which gave Liberals 15 years to show something were sick of being taken for mugs. High electricity prices were a major campaign issue.

An IPSOS poll taken before the poll showed that the Liberals polled “zero” for leading on any issues with respect to economy, energy costs, healthcare, taxes, education, minorities or any other issue…The Ontario Progressive Conservatives were polled as having the best policies for economy, energy and taxes. Just goes to show when you listen to the electorate and actually enact on promises they amazingly like it and can win office.

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Michelle Wolf is all class (yet again)

Michelle Wolf is all class yet again. It is amazing Netflix can even air such poor taste in programmes. She spends six minutes poking fun at abortion. Indeed it is Netflix’s  reputation at stake to air this crap. You might recall Wolf’s speech at the White House Correspondents dinner where her fingernails-down-a-chalkboard voice made off-coloured jokes surrounding abortion, Trump’s bedroom prowess, his daughter being as useful as an empty box of tampons and even portrayed WH Press Secretary Sarah Huckabee Sanders as a fat softball playing lesbian Uncle Tom for white women.

Even if one is pro abortion, it is hardly a topic which should be made the butt of jokes and flippant humour. Yes, comedy can cut across lines but there was zero content in this level of low base crass celebration. It is potty humour at best and vile at worst.

Watch the video on its merits and ask yourself did you laugh at any of her scripted attempt at humour? She lost a $4mn role to star in an Adam Sandler film after her White House stunt. Seems like doubling down is a thing for celebrities. Create shock value to make up for talent they don’t have. Was her comedy any good it would sell on its merit without having to resort to being face down in the gutter.

One thing is for certain, these events gift the mid terms to the GOP. Calling the Pro Life campaigners the equivalent of healthy ice cream or handsome testicles must have taken an age to think up. #WalkAway