Atul Gawande's New Yorker article comparing the medical systems of El Paso and McAllen, Tex., has been a definitional piece in the health reform conversation. President Obama has repeatedly invoked it. Senators have talked about it. The media have embraced it. I spoke to Gawande this afternoon about the fallout from his article, the problem of revenue-driven medicine, and whether a public plan would make a difference. He called from Jordan, where he's helping the World Health Organization implement better surgical protocols to reduce post-operation deaths. That made me feel very lazy in comparison. A lightly edited transcript of our discussion follows.
You've gotten some pushback on your article about McAllen, Texas. Today, in fact, some doctors from the area held a press conference rebutting your claims, and you published a blog post re-rebutting theirs. What have you found to be the most convincing counterarguments against your piece?
The three lines of criticism were ones I anticipated or even talked about. The idea that these people in McAllen are unhealthier. The idea that it's all malpractice. The one point I didn't get into was the snowbirds [retirees from colder areas who winter in Texas], but they're not in the spending calculations anyway because Medicare counts them in their home area.
The criticisms I'd been hearing and seeing but that hadn't been going away was pointing out that McAllen is the poorest county in the country. They'd say you couldn't compare it to Mayo. But I didn't. El Paso, which I did compare it to, was the sixth poorest in the United States. They're very closely similar in poverty, in immigration, in physician supply, in rates of disease, and so forth.
That brings up another point. Putting aside the difference between El Paso and McAllen, both are going to have higher costs because their people are poorer. This gets to the whole question of social determinants of health: the fact that you're sicker if you have less income, or education. Do we give that enough attention?
I think the really interesting thing is that even beyond the baseline amount of poorer health associated with lower incomes, there's this whole body of powerful literature showing that levels of inequality are even more highly correlated with poor health. So a place like Texas has poverty, yes, but also huge inequity of income. States with similar poverty but less inequity of income have much better health profiles. I've actually had this on my list to write about. I don't completely understand what it is about inequality that drives that. For instance, there's something protective about rural areas, where there's less inequality, so if you take rural areas and urban areas with similar levels of poverty, the rural areas will be healthier. And people say these areas are more socially cohesive and that's what does it. But how does that make cancer rates lower?
One thing that really struck me about your piece was that you focused much more on the question of care providers than insurance providers. The political conversation tends to do the opposite. Want to talk a bit about that distinction?
I had a hard time connecting the dots. My vantage point on the world is the operating room where I see my patients. And trying to think about whether a public option would change anything didn't connect. I order more than $50,000 worth of health care in a day. Would a public or private option change that?
People say that the most expensive piece of medical equipment is the doctor's pen. It's not that we make all the money. It's that we order all the money. We're hoping that Medicare versus Aetna will be more effective at making me do my operations differently? I don't get that. Neither one has been very effective thus far.
Do you think much that we're hearing in the political conversation is responsive to the issues you pointed out?
Part of the difficulty is that it's very hard. But you can learn from good hospitals. They do peer review, for instance, and that changes what doctors do in their offices. They blunt the financial incentives in various ways that we haven't studied at all. It's kind of ridiculous that there haven't been very many people putting feet on the ground and studying what the positive deviants are doing. There are hundreds of examples out there. They're not just the Mayo Clinic and not just Grand Junction. Go to Portland, Oregon; Temple, Texas; Pensacola, Florida. These are places that are doing something differently.
But getting there requires a change in local medical cultures and rebuilding local medical systems. All medicine is local just as all politics is local. But let's create a cadre of researchers who go into these communities and figure out what's going on and spread the word.
The Washington debate -- there are smart reasons to think about including a public option in the mix, but we have not been thinking hard enough about how we control costs and make a better system. I think it's achievable in about 10 to15 years, and maybe even faster. I can tell you three things that will transform McAllen overnight. But CBO doesn't score them.
So what are the three?
First, they spend more than $3,500 per Medicare beneficiary on home visits. El Paso is around $800. McAllen is spending more than half what many communities spend on their entire health care expenditures. The doctors there have to disinvest from these home health agencies and come to agreement on when those visits are worth using.
At the end of life, McAllen spends $22 per person on hospice but more than $3,000 on ambulance rides. In a place like Portland it will be more than $400 on hospice and around $500 on ambulances. Increasing use of hospice, offering that as an option and working as a community on how to manage end of life, would be a smart move.
Work on basic cardiac prevention like getting people statin drugs. Most studies have shown you'll lower the cardiovascular disease rate by 25 percent and lower the number of procedures ordered. This was done in by Kaiser of Northern California, and they became the first community I've ever heard of where heart disease stopped being the leading cause of death.
If you took those three things and worked on them for a year, you could go from $15,000 per person per year to less than $10,000.
You brought up medical cultures. And those are hard to change. It's hard to legislate norms. But how do they develop it? How does one city end up with a culture with totally different incentives than another?
It's not just about incentives. The interesting thing to me is not that McAllen is different from elsewhere. it's that El Paso is different than McAllen. They have the incentives to go in that direction! My hypothesis is that communities have local anchor institutions that foster values and norms that make the medical system successful. My sense is that in McAllen it was about a few institutions striking out in different ways that set the norm for what others did.
in the early 90s, McAllen was the same cost as El Paso. Three years later, they jumped into the top 10 or 20 and never really left. The first thing to really leap in price was home health care and it happened, it seems, because a few home health agencies came on the scene and began offering doctors something serious for their involvement: extra salaries as medical directors who don't really do much. McAllen is also on the leading edge of for-profit innovations. They were early with a specialty hearts center, for instance, and cardiovascular operation rates began climbing. Then you had physician-owned imaging centers and physician-owned surgery centers and everything began going up a lot.
What I've observed -- and we really need some real data behind in it -- but in those places with organized systems of care, with lower cost and higher quality, they've had to find some way to blunt the incentives of quantity over quality, or, more bluntly, revenues over patients' needs. Some of them have done it by moving doctors to salaries, like Mayo or Kaiser. But others, like Grand Junction, don't salary. They have fee-for-service. But they have medical groups that make sure that people who see more Medicaid or uninsured patients aren't penalized, and they remove a physician's privilege to practice at the hospital if they don't participate in a strong peer review system. And there are, to be sure, salary hospitals where you see very poor quality of care and people leave at three. But if you are in a fee for service system you have to have a structure around it that helps physicians resist the incentives of revenue-driven medicine.
It may not be conscious, but it's not subtle! It's things like whether you decide to take phone calls from patients and instead bring them to your office because you're paid for office visits but not phone calls. When you have a referral whether you worry about losing the referral business if you don't do what the referrer expected you to do. Most of us really do work hard to avoid that conflict. The vast majority of doctors really do try to take the money out of their minds. But to provide the best possible care requires using resources in a way that keeps you viable but improves the quality of care.
An example is electronic medical records system. They've been proven to reduce errors and enhance communication and improve care, but they don't pay. You lose revenue getting that system into place. In another system of incentives, your incentive is to figure out how to get that system going with your colleagues and make that possible. I think I said somewhere towards the end of the piece that to reduce waste and improve quality means organizing ourselves in ways that would sacrifice revenues. And that makes it hard.
You were around in 1994 working for Rep. Jim Cooper, and then in the White House. Do you see any important similarities between now and then? Any important differences?
The big question is what has really changed since 1992 that means anything for reform? Two things that matter on the political side and then a couple on the medical side. The big things on the political side is that we've stretched the economy and our budget much thinner with the damage from health care costs. The sense that both people in business and citizens have is that we're really in danger here. That's not something people felt as palpably in 1993. I think that sense of danger has concentrated attention.
On the medical side, there is a much greater sense of dissatisfaction in our work lives. We're working incredibly hard to make the system work for our patients. But it doesn't work very well for them or us. Some of that is the march of science. The increase in coordination and complexity makes it impossible to do this stuff out of your office. We're not in a system that's well equipped to make this a satisfying way to spend your time.
But at the same time, we are in this moment when we're reinventing medicine. Because of my experience with the World Health Organization, I'm in a lot of countries. And they're experiencing much the same thing. The underlying force here is not the politics but the science. We have 13,000 diagnoses for people. 13,000 ways the human body can fail. We can treat a lot of it. But it's not like penicillin. It's complex stuff. Pathology labs and dozens of medications and treatments. Our health system was built for a 20th century science. I can keep giving you numbers if you want.
Okay. There are also more than 6,000 drugs and 4,000 types of operations and procedures. That's what a hospital has to be able to manage and a doctor's office has to manage. Our system in my hometown struggles with how to manage that. We're trying to reform a system to be prepared for the 21st century of medicine and we'll be struggling for answers for awhile.
That sounds like more than a single human can handle. Does that mean we're going towards more electronic medicine. Will it be your doctor feeding your symptoms into Google?
I think the extreme complexity of medicine has become more than an individual clinician can handle. But not more than teams of clinicians can handle. And part of what's such a marvel about a place like a Mayo or places like it is that they've been able to get teams of doctors work with nurses and nutritionists to work together. I'm sitting here in Jordan showing nurses and surgeons and anesthesiologists from Yemen and Pakistan how to take a 90-second check before an operation to make sure they have the antibiotics and the blood and they've all agreed on what the operation is. We don't know how to do that culturally in surgery. We're doing dress rehearsals on how to talk to each other. It's hilarious. But when we do it, we not only lower costs, we lower the death rate 40 percent and the complication rate 30 percent. And that's why I think the answers will be there.
Photo credit: Harvard School of Public Health.
Next: Should Democrats Fight for the Public Plan?
Great interview. I'm sending Dr. Gawande's key three things to most of my co-workers.
Dr. Gawande continues to have great insight on the issues of the day. Key here is not only the three things, but the fact that the CBO does not score them. In other words, CBO does not assume any change in the mix of utilization. I think that is a major flaw in their methodology and makes their numbers conservative. I think that we look back ten years from now and we will find reform did not cost what the CBO said it would....it will have cost less.
For someone who travels a lot, he doesn't comment much on how European models are able to control costs and have as good or better outcomes. It's as if he is only looking to pockets of success in the US to build on. Curious.
JEIrvine ought to read Dr. Gawande's seminal piece in a New Yorker issue of January or February 2009 (Sorry, date of issue not available to me right now). Dr. Gawande deals in extenso with several European models as well as the Taiwanese one.
There are literally mountains of academic papers, hundreds of good books and excessive documented deliberations on US Health Care reform.
However, the Guwande article in THE NEW YORKER and follow up interviews like this will have the most potent impact on long onverdue US health care reform.
Why? Excellent writing and impeccable timing.
"We're hoping that Medicare versus Aetna will be more effective at making me do my operations differently? I don't get that. Neither one has been very effective thus far."
Medicare and Aetna don't control costs for very similar reasons: both have been afraid of, and unable to surmount, pressure from providers when they seek to control medical costs in any serious way.
The protection of provider revenue and net income becomes framed as protection of the patient from attempts to deny care or deny choice, or as preventing the poor physician from earning a living. This pushback from providers gets taken by the public at face value. Never mind that according to Forbes, 9 out of the top 10 jobs in America are physician specialties and that physicians overall earn more than $200,000 a year on average (over $170,000 in primary care and over $250,000 in specialties).
The smartest thing reformers could do right now is to set the stage in terms of incentives and organizational structures for the "market" to control costs down the road. A frontal assault on provider revenue will not get very far. Creating accountable organizations, rewarding outcomes, removing or transforming fee for service, etc., should be foremost on the agenda for controlling costs.
If we achieve that, we will bend the cost trend in the least painful, least intrusive and most reliable manner. A public payer's importance pales in comparison to changing the incentives.
Another thought: if government gets serious about controlling costs with the health plans it runs (Medicare, Medicaid and the new public payer) with a combination of fee cuts, restrictions on allowable procedures and utilization management techniques ("bean counters" telling doctors what to do)...how long will it be before doctors vilify the government plans just as they have successfully vilified private plans in the public eye? Republicans will take those complaints to the bank, literally and figuratively.
I don't mean to put this all on doctors, but Gawande is absolutely right that they (and other providers of care) are the key. I hope this interview becomes just as much required reading at the White House as his New Yorker article.
As Dr Gawande says, he knows about medicine, but not about insurance. I still maintain that although he is right, the big problems are in the practice of medicine, he doesn't know how to get physicians to change. He is very good at pointing out the problems, but not so hot at giving solutions. Look what happened in McAllen. They fought back. They didn't change. They fought back.
Meanwhile there is $500 Billion each year wasted in the high overhead and compliance costs of private insurance and high drug prices. We know how to claw back that money. Give Medicare to everybody (HR676) and outlaw "marketing" of prescription drugs including Drug Reps and payments to physicians.
Then once we have everyone covered and not dying from lack of insurance, we can start to look for the $1.2 TRILLION of savings we would have if we were as efficient as France or any other wealthy country.
Consumers spending their own money holds costs down in every other sector of the economy: Consumers obsess about prices; providers fight to earn their business. Trying to duplicate this process through a government board of experts is pointless.
staticvars - You wanna apply that principal to fire departments? If we had private firedepartments we paid directly, we could save a bundle.
BTW they tried that in colonial Philly...briefly.
"JEIrvine ought to read Dr. Gawande's seminal piece in a New Yorker issue of January or February 2009... Dr. Gawande deals in extenso with several European models as well as the Taiwanese one."
Thanks. I read it when it came out. But even though he mentions them, his models for change in the US seem to still be based on US case studies - positive outliers within a broken system, rather than looking to change the framework itself .
So you think doctors make too much? Start cutting their pay more. Then fewer people will go into medicine *or* the quality of people going into medicine will decline.
No, they don't make too much money for the work they do. Look how much training it takes.
So now more of our 'best and brightest' will go to law school. Great, just what we need, more lawyers.
Gawande's "Cost Conundrum" could be to health reform what Sinclair's "The Jungle" was to food safety. It explains current trends in the commercialization of medicine better than virtually any journalistic work I've seen.
Sadly, it appears that its author is now more inclined to "stay above the fray" than to try to articulate and lobby for the regulatory infrastructure necessary for the cultural change he so eloquently advocates.
staticvars -- neither you nor Messrs. Friedman or Stossel realize that even if you do away with the insurers, the decision-maker is still spending someone else's money when it comes to healthcare. That is, the doctor is spending the patient's money.
I'll use the example of my cousin who just had a foot surgery to remove a bone spur. She didn't wake up one morning and say "My foot hurts, I'm going to go buy a surgery." She woke up one morning and said, "My foot hurts and I need an expert to tell me why, and what to do about it." If her doctor had said it needed "watchful waiting" she would have done that. If he had suggested massage therapy, she would have done that. He said "surgery," so she did that.
Like 99 percent of all patients, she neither second-guessed nor overruled her doctor, even though it was her money to spend (she has an HSA).
If you really think that eliminating third-party pay would contain costs, you're nurturing an illusion of control you simply don't have. Regardless of who pays the bill -- an individual or an insurer -- no one would willingly choose a medical alternative that was more intensive/more invasive/longer recovery. We do it because someone with an MD or DO after their name says so.
Control the providers and you control the costs. It is really that simple. And it is really that hard.
atlmom1234: "So you think doctors make too much? Start cutting their pay more. Then fewer people will go into medicine *or* the quality of people going into medicine will decline."
Keep battling that strawman and you might win.
Kinda interesting. 50 years ago doctors owned hospitals. You got sick, you went to the hospital. After Medicare got started, people began to notice the conflict of interest. They made it illegal for doctors to own hospitals, which were reorganized as nonprofits (yes, they were always nominally nonprofits, but this made them more nonprofit).
Now hospitals started to get concerned about the length of hospital stay. The turnaround and fallout in the 80s was quite dramatic. Today the trend is to grease the skid and shoot you out the door, to a nursing home or your own home for recovery.
The cost of home care will usually be dramatically less than nursing home care, but it seems obvious you can't let the doctors collect fees as board members for businesses they refer patients to.
It's not the physician pay that's the problem. It's the distribution. U.S. specialists earn about what European specialists earn with respect to what other people make in their respective countries. However, there are two US specialists for every one generalist which is the reverse of the European ratio. That results in very expensive, somewhat disjointed medical care. Studies have shown that increased primary care decreases costs and increases quality. At the Mayo, specialists are not incented to perform primary care functions. In the community, they are -- because there are so many of them that they can't support themselves without it. At the Mayo there is also cultural pressure on the generalists to take on the appropriate level of care. In the community, the cultural pressures push the generalists to kick care up to the specialty level.
A German or a Brit with a couple of minor medical problems will usually see a generalist for care. Here in the US that's less likely. If, for instance, you have several minor medical problems, say maybe mild asthma, hypertension, and hypothyroidism, you may see a specialist for each. However, the pulmonologist may be happy to treat your asthma, but won't touch your thyroid disease and the cardiologist will adjust your blood pressure but refuse to renew your asthma inhaler. Many people perceive this specialty care as "higher quality". So for this example, if you want the "best quality" care you may wind up seeing three specialists each charging 50% more than a generalist and paying a total of 450% compared to generalist care. It's not that the incomes are out of line with Europe, it's that the use of care is distorted. Interestingly, European health care systems are attempting to curtail rising costs by restricting (inappropriate!) access to specialty care.
European vs. U.S. physician income. Note that French docs are the beneficiaries of an enormous tax break and effectively make a lot more money than is reflected in this report.
I am a private practice OBGYN doctor in a large group in the Texas Medical Center in Houston. I have been involved in the management of our business for the last 17 years. The medical business is like any other business over this time, margins are getting thinner and operating expenses are going up. The ability to offer compassionate expert care to your patients relies on your ability to remain a viable business. The push for physician investment in the facilities or ancillary piece was driven by the declining reimbursement in the medical services piece. Dr. Gawande does not recognize or fails to mention the hidden subsidies of the salaried doctors that he refers to. We have a great example in one of our Nation's premier medical schools in Houston of the medical services piece not being able to support the salaried physicians without the facilities piece or the ancillary piece that is owned by the hospital. Where do you think the profits from the Mayo Clinic Surgery Centers and Imaging Centers go? They support the salaries of the medical staff. To compare apples to apples, you have to correct for the NIH grants, the endowed chairs, the not-for-profit subsidy, the profit margins of each of the cost centers in the integrated medical systems, etc.. Take away all opportunities to capture lost revenues by a medical group, put all of the doctors on salaries within integrated systems, let their salaries be subsidized by the same profit centers that are currently subsidizing them both privately and publicly, and you will have wiped out private practice medicine. Private practice medicine is what is at risk of being lost here. If you are a good doctor, you take good care of me, you have nice office staff who handles my needs to my satisfaction, then I will keep coming to you and tell my friends to come to you. Let me assure you, that is a more difficult job description to fill everyday than being a salaried employee. Watch out what you wish for!
"It's kind of ridiculous that there haven't been very many people putting feet on the ground and studying what the positive deviants are doing. There are hundreds of examples out there. They're not just the Mayo Clinic and not just Grand Junction. . . These are places that are doing something differently."
AGREED! How about a study of Santa Cruz County, in northern California (Ezra's old stomping grounds)? We spend 10% less than less per Medicare beneficiary than the national average -- yet we have the HIGHEST HOSPITAL WAGE INEEX IN THE COUNTRY, due to our high cost of living. Clearly Santa Cruz is doing something right. Any ideas?
A great interview--so glad you did this.
It was so important to give Gawande a chance to repond to the misinformation that those who oppose reform put out there after his piece came out in New Yorker and gained so much public atention.
1. Academic medicine(the Mayo) is not private practice medicine. They operate in very different ways and have little comparisons. He is wrong to make the connection.
2. Taking extreme cases(McAllen) is fine to more dramatically point out the problems in a system. Using them as guiding principles is dangerous.
3. European healthcare does not have better outcomes period. What is never talked about when numbers for their system are thrown out is the benchmarks they are measuring from. Take infant moratlity..in Europe its "better"..well on closer inspection, the viability age in Europe is 28 weeks. Many infants born below 1 pound or 28 weeks are not provided care and left to expire after they are born. They are considered still births. Here vability is 24 weeks and much of the care is mandated by the government i.e even if a parent does not want intervention, the state mandates physicians to provide it to protect children. This makes a major difference in outcome, cost and complication rates. Another example, breast cancer survival rates in the UK are at or below 40%, ours are 30-40% higher...why? Because we have cutting edge drugs that all are able to obtain and we do cutting edge surgery. The list goes on.
4. To those who think Europeans are not paying for healthcare, check out there taxation rates..the countries that offer more tax more..there is no free lunch.
5. To those that think doctors are making too much money. Please factor in physicians are working 60-90hrs/week, 48 weeks/yr...do this math with your numbers and then see if you think the financial rewards are incredible. Also factor in a delay in earnings after college of anywhere from 8-12 years, medical school loan burden on average $150-200K, and malpractice premiums from $50-250K/yr before you hang a shingle, buy a car, buy a home or pay for the start of the rest of your business...in Europe and elsewhere this does not exist..
6. Be careful what you wish for, there is no free lunch..if you look to the North, Canadians are demanding a different healthcare system because low and behold the one they have is not working for them...read about Natasha Richardson's case as an example of Canadian trauma care.


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HomeGigsKASABIAN announce a massive hometown show at Leicester's Victoria Park for June 20th
KASABIAN announce a massive hometown show at Leicester's Victoria Park for June 20th
October 21, 2019 XS Noize Gigs, News
What promises to be one of the highlights of 2020, Kasabian has announced a massive hometown show at Leicester's Victoria Park for June 20th, six years on from their triumphant first show at the venue. It's their first outdoor UK show since their massive Isle of Wight headline set and their first UK show since a raucous Brixton Academy set in 2018. Tickets go on general sale on Friday 25 October at 9 am at LiveNation.co.uk
Currently working on new music, the UK's best and biggest rock band, are eager to return to Leicester next summer. Kasabian main man Serge Pizzorno recently released his critically acclaimed trippy solo record under the moniker The S.L.P. Newly revitalized, he is looking forward to making studio magic once again with Kasabian: singer Tom Meighan, bassist Chris Edwards, drummer Ian Matthews and guitarist Tim Carter.
Kasabian have five UK #1 albums to their name and have sold over 5.5 million albums worldwide. They've won a Brit, seven NME awards, four Q Awards and have headlined Glastonbury Festival, as well as V Festival, T in the Park, Reading and Leeds Festival and numerous festivals worldwide.
Serge said:'We're absolutely buzzing to be able to put on Solstice II in our home town of Leicester. Anyone who came last time would know how special it was and to get the opportunity to do it again is beyond a dream'.
www.kasabian.co.uk
U.K Show Date: 20 June 2020 Leicester, U.K. Victoria park
Tickets for Kasabian's 2020 U.K. Show go on sale to the general public on Friday 25 October 2019 at 9 am at LiveNation.co.uk
Chris Edwards
Ian Matthews
Serge Pizzorno
Tim Carter
ALBUM REVIEW: Brix & The Extricated – Super Blood Wolf Moon
WIN: Tickets to see OF MONSTERS AND MEN @ the Ulster Hall Belfast Thursday 24th October
KASABIAN return with 15 must-see intimate shows kicking off October 13th at the 02 Academy
May 28, 2021 XS Noize Gigs, News
Kasabian makes a most welcome return to touring with 15 must-see intimate shows kicking off October 13th at the 02 Academy, Glasgow, including a hometown show at Leicester's De Montfort Hall October 27th and climaxing […]
THE PALE announce UK LIVE RETURN ahead of 30th anniversary celebrations
February 21, 2020 Conor Kinahan News, Gigs, New Music
As Dublin band The Pale set about marking 30 years in the business in 2020, and the recent release of thirteenth album Merciful Hour they head back to the UK for a handful of dates […]
December 16, 2022 XS Noize Gigs, New Music, News

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Phrases - Objects, Part 51
Great Wall of China, Mutianyu Section,
Photo by Robin Zebrowski, CC BY License
Earth Fluent >> Chinese >> Phrases - Objects, Part 51
Learn how to say "I'm looking for something like this.", "One like this?", "I want to find something like that.", or "How about one like that?" in Chinese!
How About One Like That?
一个像这样呢?
How About One Like That? in Chinese
I'm Looking For Something Like This.
我正在寻找这样的东西。
I'm Looking For Something Like This. in Chinese
I Want To Find Something Like That.
我想找到这样的东西。
I Want To Find Something Like That. in Chinese
One Like This?
这样的人?
One Like This? in Chinese
► 一个像这样呢?
► 我正在寻找这样的东西。
► 我想找到这样的东西。
► 这样的人?
Words Covered : I'm Looking For Something Like This., One Like This?, I Want To Find Something Like That., How About One Like That?.
Words Covered : I'm Looking For Something Like This., One Like This?, I Want To Find Something Like That., How About One Like That?, Do You Need Another Key?, I Need Another Key., My Car Doesn't Work., Why Isn't This Working?.
Words Covered : I'm Looking For Something Like This., One Like This?, I Want To Find Something Like That., How About One Like That?, Do You Need Another Key?, I Need Another Key., My Car Doesn't Work., Why Isn't This Working?, When Will It Arrive?, It Will Arrive Shortly., How Do I Use This?, Use This By Pressing Here..
Words Covered : I'm Looking For Something Like This., One Like This?, I Want To Find Something Like That., How About One Like That?, Do You Need Another Key?, I Need Another Key., My Car Doesn't Work., Why Isn't This Working?, When Will It Arrive?, It Will Arrive Shortly., How Do I Use This?, Use This By Pressing Here., I Have Many Things To Buy., Are You Looking To Buy Many Things?, Is It Ready?, When Will It Be Ready?.
Words Covered : I'm Looking For Something Like This., One Like This?, I Want To Find Something Like That., How About One Like That?, Do You Need Another Key?, I Need Another Key., My Car Doesn't Work., Why Isn't This Working?, When Will It Arrive?, It Will Arrive Shortly., How Do I Use This?, Use This By Pressing Here., I Have Many Things To Buy., Are You Looking To Buy Many Things?, Is It Ready?, When Will It Be Ready?, Please Bring Me My Jacket., Where Is Your Jacket?, Which Is Best?, The Red And Black One Is The Best..
Words Covered : I'm Looking For Something Like This., One Like This?, I Want To Find Something Like That., How About One Like That?, Do You Need Another Key?, I Need Another Key., My Car Doesn't Work., Why Isn't This Working?, When Will It Arrive?, It Will Arrive Shortly., How Do I Use This?, Use This By Pressing Here., I Have Many Things To Buy., Are You Looking To Buy Many Things?, Is It Ready?, When Will It Be Ready?, Please Bring Me My Jacket., Where Is Your Jacket?, Which Is Best?, The Red And Black One Is The Best., I Like Your Car., I Love Your Motorcycle., Your Car Is Amazing., Your Motorcycle Is In Need Of Repair..
Words Covered : I'm Looking For Something Like This., One Like This?, I Want To Find Something Like That., How About One Like That?, Do You Need Another Key?, I Need Another Key., My Car Doesn't Work., Why Isn't This Working?, When Will It Arrive?, It Will Arrive Shortly., How Do I Use This?, Use This By Pressing Here., I Have Many Things To Buy., Are You Looking To Buy Many Things?, Is It Ready?, When Will It Be Ready?, Please Bring Me My Jacket., Where Is Your Jacket?, Which Is Best?, The Red And Black One Is The Best., I Like Your Car., I Love Your Motorcycle., Your Car Is Amazing., Your Motorcycle Is In Need Of Repair., Can You Please Put This In The Car For Me?, I Will Put It In The Car., Where Did You Put It?, I Put It In The Car., What's In It?, I Don't Know What's In It., Which One Do You Want?, I'll Take This One., Give Me The Pen., I Will Give You A Pen., What Are You Wearing?, What Should I Wear?, Can You Fix This?, I Can Fix That For You., Where Are My Glasses?, Your Glasses Are On The Book Shelf., Can You Carry This For Me?, I Will Carry This For You., Did You Break That?, I Didn't Break It On Purpose..
Words Covered : I'm Looking For Something Like This., One Like This?, I Want To Find Something Like That., How About One Like That?, Do You Need Another Key?, I Need Another Key., My Car Doesn't Work., Why Isn't This Working?, When Will It Arrive?, It Will Arrive Shortly., How Do I Use This?, Use This By Pressing Here., I Have Many Things To Buy., Are You Looking To Buy Many Things?, Is It Ready?, When Will It Be Ready?, Please Bring Me My Jacket., Where Is Your Jacket?, Which Is Best?, The Red And Black One Is The Best., I Like Your Car., I Love Your Motorcycle., Your Car Is Amazing., Your Motorcycle Is In Need Of Repair., Can You Please Put This In The Car For Me?, I Will Put It In The Car., Where Did You Put It?, I Put It In The Car., What's In It?, I Don't Know What's In It., Which One Do You Want?, I'll Take This One., Give Me The Pen., I Will Give You A Pen., What Are You Wearing?, What Should I Wear?, Can You Fix This?, I Can Fix That For You., Where Are My Glasses?, Your Glasses Are On The Book Shelf., Can You Carry This For Me?, I Will Carry This For You., Did You Break That?, I Didn't Break It On Purpose., Can You Open The Door?, I Will Open The Door For You., Is It Okay If I Open This Window?, I'm Going To Open A Window., Can You Pick Up Your Clothes?, I Will Pick Up My Clothes., When Will You Clean Your Room?, I'm Cleaning My Room Right Now., Can You Count This For Me?, I Will Count It For You., Do You Have A Clean Cup?, I Don't Have A Cup., Can You Start The Car?, I'm Starting The Car., 这本书有多大?, This Book Looks Old., Is This Your Garden?, This Garden Is Mine., Is That Her Garden?, That Is Our Garden., The Car Is Still Broken., When Will The Car Be Fixed?, Is The Car Fixed?, The Car Is Now Fixed., Is This Ours?, These Flowers Are Ours., Is The Tv Working?, The Tv Is Broken., Is The Room A Mess?, The Room Is A Little Bit Messy., What Is Its Color?, The Color Is Red., What Do You Think Of These Shoes?, These Shoes Are Beautiful., Where Is My Shirt?, You Left Your Shirt On The Chair., He's Very Annoying., She's Very Famous., He's Boring., She's Funny..
Font Wars (Typing Game that Requires Chinese Keyboard)
Phrases - Objects, Part 41 - Learn how to say "Can you carry this for me?", "I will carry this for you.", "Did you break that?", or "I didn't break it on purpose." in Chinese!
Phrases - Objects, Part 42 - Learn how to say "Can you fix this?", "I can fix that for you.", "Where are my glasses?", or "Your glasses are on the book shelf." in Chinese!
Phrases - Objects, Part 43 - Learn how to say "Give me the pen.", "I will give you a pen.", "What are you wearing?", or "What should I wear?" in Chinese!
Phrases - Objects, Part 44 - Learn how to say "What's in it?", "I don't know what's in it.", "Which one do you want?", or "I'll take this one." in Chinese!
Phrases - Objects, Part 45 - Learn how to say "Can you please put this in the car for me?", "I will put it in the car.", "Where did you put it?", or "I put it in the car." in Chinese!
Phrases - Objects, Part 46 - Learn how to say "I like your car.", "I love your motorcycle.", "Your car is amazing.", or "Your motorcycle is in need of repair." in Chinese!
Phrases - Objects, Part 47 - Learn how to say "Please bring me my jacket.", "Where is your jacket?", "Which is best?", or "The red and black one is the best." in Chinese!
Phrases - Objects, Part 48 - Learn how to say "I have many things to buy.", "Are you looking to buy many things?", "Is it ready?", or "When will it be ready?" in Chinese!
Phrases - Objects, Part 49 - Learn how to say "When will it arrive?", "It will arrive shortly.", "How do I use this?", or "Use this by pressing here." in Chinese!
Phrases - Objects, Part 50 - Learn how to say "Do you need another key?", "I need another key.", "My car doesn't work.", or "Why isn't this working?" in Chinese!
Phrases - Objects, Part 51 - Learn how to say "I'm looking for something like this.", "One like this?", "I want to find something like that.", or "How about one like that?" in Chinese!
Phrases - Objects, Part 52 - Learn how to say "Can you open the door?", "I will open the door for you.", "Is it okay if I open this window?", or "I'm going to open a window." in Chinese!
Phrases - Objects, Part 53 - Learn how to say "Can you pick up your clothes?", "I will pick up my clothes.", "When will you clean your room?", or "I'm cleaning my room right now." in Chinese!
Phrases - Objects, Part 54 - Learn how to say "Can you count this for me?", "I will count it for you.", "Do you have a clean cup?", or "I don't have a cup." in Chinese!
Phrases - Objects, Part 55 - Learn how to say "Can you start the car?", "I'm starting the car.", "How old is this book?", or "This book looks old." in Chinese!
Phrases - Objects, Part 56 - Learn how to say "Is this your garden?", "This garden is mine.", "Is that her garden?", or "That is our garden." in Chinese!
Phrases - Objects, Part 57 - Learn how to say "The car is still broken.", "When will the car be fixed?", "Is the car fixed?", or "The car is now fixed." in Chinese!
Phrases - Objects, Part 58 - Learn how to say "Is this ours?", "These flowers are ours.", "Is the TV working?", or "The TV is broken." in Chinese!
Phrases - Objects, Part 59 - Learn how to say "Is the room a mess?", "The room is a little bit messy.", "What is its color?", or "The color is red." in Chinese!
Phrases - Objects, Part 60 - Learn how to say "What do you think of these shoes?", "These shoes are beautiful.", "Where is my shirt?", or "You left your shirt on the chair." in Chinese!
Phrases - People, Part 1 - Learn how to say "He's very annoying.", "She's very famous.", "He's boring.", or "She's funny." in Chinese!
October 25, 2017 18:51:17 :
Phrases - Objects, Part 51 -- Added to http://www.EarthFluent.com.


text:
Q: Dynamic change of script source not working I have two files. An HTML file:
<!DOCTYPE html>
<html>
    <head>
        <script type="text/javascript">
function update_layout()
{
    var new_source = document.createElement('script')
    new_source.src = 'script_code.js'
    new_source.type = 'text/javascript'
    document.getElementsByTagName('head')[0].appendChild(new_source)
}
function do_layout()
{
    alert(Lay_Table['nam'])
}
        </script>
    </head>
    <body>
        <input type="button" value="Update" onclick="update_layout();do_layout();"/>
    </body>
</html>

and an JavaScript file named "script_code.js":
Lay_Table = {}
Lay_Table['nam'] = 'US 104 Key'

When I click on the "Update" button I get an error instead of an alert containing the text "US 104 Key".
I have looked at very similar questions on Stack Overflow but cannot find out what is wrong. Have I made a mistake, or is this method no longer allowed due to security reasons? I am using Google Chrome.

A: The script takes a bit of time to get inserted into the document and run - it doesn't happen immediately, so the Lay_Table is not defined in time when do_layout runs. Consider adding a load listener to the inserted tag (and avoid inline handlers, they have way too many problems to be worth using nowadays, such as a demented scope chain and quote escaping issues):
window.addEventListener('DOMContentLoaded', () => {
  document.querySelector('input').addEventListener('click', update_layout);
});
function update_layout()
{
    var new_source = document.createElement('script')
    new_source.src = 'script_code.js'
    new_source.addEventListener('load', do_layout);
    document.head.appendChild(new_source)
}

redpajama_set_name: RedPajamaStackExchange


Fresno authorities arrested Efrain Martinez, 44, of Parlier, after he attempted to evade police by rolling his car into the San Joaquin River and stealing a canoe.
On Tuesday, a 44-year-old California man led authorities on a chase that traversed both land and sea, crossed multiple cities, one orchard, a summer camp and the San Joaquin River. It ended in the jaws of a K-9 officer.
The chase began with an alleged home burglary in Del Rey, Calif., according to a statement from authorities. The victims identified Efrain Martinez, a man they knew, as the suspect. The victims alerted deputies with the Fresno County Sheriff's Department that Martinez was driving around the area.
Deputies attempted to conduct a traffic stop on Martinez, but the Parlier man refused to pull over. Some motorists reported he was holding a gun.
Authorities said Martinez then took off down Highway 99 and drove into downtown Fresno, where several deputies attempted to stop him with their patrol cars. They fired a round of bean bags from a shotgun in an attempt to break Martinez's window, and shot a pepper-spray projectile into his vehicle.
"However, Martinez was unfazed," the sheriff's department said in the statement.
Martinez escaped by ramming into several civilian vehicles, authorities said, and headed north on Highway 99, exiting in Madero County and driving through an orchard off Road 39. He continued onto a bluff of the San Joaquin River, and because the dirt on the edge is soft, Martinez's vehicle rolled down the embankment and into the river.
The journey became water-bound at this point, as Martinez ejected himself from the vehicle and swam across the river toward Scout Island, where authorities said about 100 elementary school-age students were attending day camp. The camp was placed on lockdown, under the assumption Martinez carried a weapon.
When a California Highway Patrol helicopter, H40, arrived to assist deputies, Martinez was spotted in the water, attempting to take a canoe downstream. The pilot of a second helicopter, the EAGLE One, hovered over Martinez and created a current, to prevent him from climbing into the canoe.
With his last ounce of energy, authorities said Martinez swam to shore and ran into the bushes, where a Fresno K-9 officer found him and bit him, enabling deputies to conduct an arrest, one-and-a-half hours after the pursuit began.
Martinez was transported to the hospital for treatment of the bites and booked into Fresno County Jail on felony counts of burglary, evading police, resisting arrest and harming a K-9 officer. Bail is set at $75,000.


text:
Q: AppleScripts Help...Close all Open Windows in Evernote I want to set up automation to close all open windows in Evernote every time the number of open windows exceeds 10.

*

*Application: Evernote

*Test: Windows Open > 10

*Action: Close all Open Windows
EverNote does have a "Close All Note Windows" command.


text:
Lienardia peristernioides é uma espécie de gastrópode do gênero Lienardia, pertencente a família Clathurellidae.

Ligações externas

Lienardia
Gastrópodes descritos em 1913

redpajama_set_name: RedPajamaWikipedia


I've worked at Accenture for 24 years and am now Managing Director for Accenture Strategy in the Middle East, Africa, Russia and Turkey. I'm from a generation that helped pave the path for women in the workplace. Based on my experiences, I'd like to share advice with women on how to succeed and rise through the ranks in a company like Accenture.
As women, especially during the early stages of our careers, we need to be very vocal, very confident and very clear about what it is that we're trying to achieve. These are the qualities that lend themselves to success within our organizational environments. In some cultures, it is typical for men to be trained to speak up much earlier in life, while women are trained—at school and in society—to take on a support role and remain in the background. But in our careers, we need to strike that balance. It's important to sometimes adopt a supportive role, but we also have to speak up for ourselves—otherwise, we can be overlooked.
It is especially important to speak up for ourselves when we are up for a new role within a firm. In my experience, I have found that if there are two male candidates applying for the same position, they will be proactive in positioning themselves very early in the process by asserting: "This is my job. I want this job, and these are my conditions." Women need to do the same and not feel held back by any obstacles—least of all our gender or how we may have been conditioned to behave. Sometimes it's not easy, especially if you happen to be one of few female employees within a firm. First, we need to overcome the "trained barriers" in our minds and demand to be treated as equals, be heard on the same level and be accepted based on our skills and experience, regardless of our gender.
This isn't currently the case everywhere. In Russia, for example, women tend be very well supported, stemming from Soviet times where individuals were meant to be equal. It's common, even in the Russian army, to find many women in working in engineering and other typically male-dominated professions. In fact, even today there seems to be 40% - 50% women in employment and more women in leadership positions. So, the positive examples are out there for other cultures to follow.
I have been fortunate to work for a company like Accenture, which creates an environment where people are encouraged to speak up and share opinions—regardless of their gender. What is most important is the ability to voice our opinions, be assertive about our ambitions and take control of our careers. It's about working in an environment that fosters a culture of breaking boundaries. It's about overcoming restrictions and shaping a practice or project—and, in turn, our own career path.
The most important piece of advice that I often give to aspiring women is to literally to stick up for yourself and define your own objectives. It's our culture within Accenture, and it is what many other companies encourage—whether you happen to be male or female.
Ready to forge your own career path with a company focused on equality and diversity? Search Accenture career opportunities today.


Please join the Mississippi Business Group on Health for a meeting on "The Value of Employer Health and Health Care Quality" on April 11th from 11:00 AM to 1:00 PM where participants will learn about current trends in employer health and local efforts to promote health care quality. Other topics such as value-based benefits, healthy workplace strategies, and specialty pharmacy will be discussed. The meeting will include a facilitated discussion on employer needs, provider-based initiatives, and healthy communities. Lunch will be provided and space is limited with MSBGH members being assured seats at the event.
The meeting will be held in the DeSoto Room at Baptist Memorial Hospital - DeSoto in Southaven, MS. Directions and Parking instructions will be sent in a confirmation email to those that register. This meeting is a collaboration with the Mississippi Business Group on Health and the Mississippi Affiliated Network.


Party hire Balwyn has a large warehouse stocked with the latest in party hire equipment. Our whole range is readily available via our quick and easy online enquiry form. Whether you're hosting a large event for 1000's of people or a small back yard event for family and friends, we can help. Party hire Balwyn has something for everyone, and we treat every job with as much importance. Choose your local party hire company to help make your next event go off without a hitch. Party hire Balwyn has the best in chair hire, table hire, marquee hire and slushy machine hire.
Slushy machine hire in Balwyn is available seven days a week. We have the latest Italian made machines in both twin bowl and single bowl packages. We offer a large selection of both adult syrups and children's syrups. Party hire Balwyn can provide frozen cocktail machine hire to anywhere within Balwyn and across Melbourne. A suitable table or bench is required for the hire. Once it is filled with your choice of syrups, the slushy machine will weigh approx. 65 Kilos. Party hire Balwyn has years of experience setting up slushy machines.
Throwing a party in Balwyn and need more tables? Trust party hire Balwyn to supply you with the best in table hire. We have a large number of table hire solutions available for your next event. Our trestle table is a thick plastic table with solid metal legs and a metal locking clip which locks in place to prevent the trestle table's legs from collapsing. Available in either 1.8 meters or 2.4 meters, and in either a solid wood or a thick plastic, party hire Balwyn has your table hire needs covered. If you're looking for banquet table hire within the greater Melbourne area, then allow party hire Balwyn to provide you with the best in banquet tables. Ideal for formal events, these tables offer a slightly more sophisticated look over our trestle table hire range.
When it comes to chair hire Balwyn, we have all the favourites such as tiffany chairs, wedding chair hire, plastic stackable chairs and folding gladiator chairs. We have been delivering and setting up our complete range of chair hire products to venues and homes all over Melbourne. With over 500 tiffany chairs and a variety of colours to choose from, tiffany chair hire is easy with party hire Balwyn. Perfect with our banquet tables, they look great at weddings and formals, in venues, garages and backyards. Tiffany chair hire is what we do best. Our chairs come in white and gold.


This entry was posted in cystic fibrosis and tagged cystic fibrosis, hernia surgery by unknowncystic. Bookmark the permalink.
I'm pleased you survived another visit to the hospital, being on a regular ward seems to have been not as traumatic as you thought it might be, as bad as things get there's always someone with a bigger pile of crap to deal with.
It was bad in a strange way. Psychological torture. Catheter insertion while awake. Bad. Staying without my hospital pack. Bad. RT. Bad. Not getting my regular meds. Bad. Nurses not flushing my IV. Bad. But you're right, it can always be worse.
Saw Wiggins won the race. That should make you happy.
I cannot imagine being in and out of a hospital as much as you have. I hope you're well and good now. My prayers are with you hoping that your scars don't turn into infections. Feel better soon!
Haha, good laucough from this one in the hernia series 'Please list all past hospitalizations and dates. (Are you kidding me? I'm at the hospital where all of them occurred. Look them up. What do people here use these computers for? Solitaire?)'.


My name is John Vandenberg, most just call me "Bubba". After a family business of pulling countless thousands of staples, I looked at what we had been doing and said, "there has got to be a better way". In the restaurant industry it is not a matter of whether or not your seating will need replaced. It's a matter of when. Great efforts and years of testing has led to the most innovative transition in replacement upholstery. Our proprietary system allows for a total conversion without damaging your existing seating. The great part is that when it's time for repairs, the new cover takes a mere 3 minutes to replace.
Our company is your best source for value driven, top-quality replacement services.
FASEAT brings over 5 decades of collective knowledge and experience that gives us a unique advantage in providing top quality replacement upholstery for restaurant seating, as well as our unique ordering system which is the first of its kind in the industry.
In the restaurant business, you'll eventually have torn or cracked booth covers/chairs that will need to be replaced.
FASEAT is a revolutionary seating system that allows you to quickly order, stock and replace your damaged restaurant seating in just minutes.
FASEAT® will take the guesswork out of getting your upholstered items replaced. At FASEAT®, we do more than just make quality booth and seat covers; we've created a complete Restaurant Management System with fast Online ordering, where you just simply click on your own specific product you need covers for and check out. Seriously, It's just that easy! Your covers are quickly shipped to your location and when they arrive, your just minutes away from turning your old torn, cracked booths or chairs into something that is, well....... good-as-new.
FASEAT® only uses quality vinyl to manufacture your new covers. Within minutes, you can have good-as-new gym equipment, restaurant seating and medical equipment using our custom made, no tools required, seat covers that will last longer.
We are the top in bottoms!
At Faseat, we offer all upholstery services including: spring repair, foam replacement, full remodels, upholstery supplies, materials and comprehensive consultations.


EDF Energy, Britain's largest nuclear power producer, stopped its 480-megawatt (MW) Hinkley Point B7 nuclear reactor on Wednesday evening to repair a hydraulic fluid leak, the company said. Hinkley Point B is one of four nuclear power stations in the area, the others being the adjacent Hinkley Point A together with Oldbury and Berkeley (being decommissioned) on the banks of the River Severn. A new Hinkley Point C nuclear power station is under consideration.
The reactor stopped so engineers could attend a hydraulic fluid leak on a valve and the unit is expected to restart on Saturday, EDF Energy said. "I can confirm the reactor went offline at around 2220 GMT last night," a spokeswoman said on Thursday morning.
The reactor at Hinkley Point B nuclear plant had previously restarted in the morning of February 9th, 2012, following a one week "planned maintenance period" on its unit 7 reactor.
These problems come just days before a transport study over the proposed Hinkley Point C development, the first planned to be built in the UK since the mid-1990s, will be open for debate at a council meeting next week. The report says EDF Energy's own assessment of a northern bypass for Bridgwater as an option was not adequate, despite the council asking for it to be considered from the outset of the project.
The study concludes that without the necessary technical work completed, it would not be possible to deliver the road in time to reduce the impact of the project within the current EDF Energy timescales set for Hinkley Point C. The study also found that a bypass would come at a high environmental as well as financial cost. EDF has been allowed to start preparatory work for the new power station despite planning permission for the facility not yet being granted.
SDC Leader, Duncan McGinty said: "It is regrettable that we have had to commission this work at the local tax payers' expense, which was the job EDF Energy should have done if it wants to route all its construction traffic through our town.
Sedgemoor District Council's council also cited "very real concerns" about paying to scrutinise EDF's nuclear power station plan. The council says it is adamant local taxpayers' money should not pay for officers to analyse the £10 billion Hinkley Point C plan. The money instead should come from EDF.
The exposed location of Hinkley Point meant that it was considered ideal for wind generation. However, a proposal to build 12 wind turbines close to the site of the nuclear power stations was turned down in October 2005. The reason given by the local council for the rejection was safety fears over what would happen were a turbine blade to detach and hit "something or somebody".


Running Time 1 hour and 30 minutes.
It's pretty clear that the number of ranches that still rope and drag calves to a fire in the manner of the Gret Basin tradition are diminishing in number. Those that do, carry on a tradition that is in danger of becoming very rare. I'd like to see stockmen who think you can't rope and drag to brand, and still maintain low stress stockmanship, watch Martin Black's Classic Rodea Style Ranch Roping. They would likely change their tune seeing Martin and his crew rope calves in a quiet manner, compared to the often stressful method associated with running calves through a calf table. Even if you don't have the opportunity to work cattle or rope from a rodea, the exceptional horsemanship and roping skills you'll see on this 90 minute DVD are an inspiration to horsemanship and low stress stockmanship.
There is also a three DVD set – 'From the Great Basin Tradition – Rodea Style Roping' from Martin Black which includes Classic Rodea Style Ranch Roping, as well as a DVD on Roping Fundamentals, and a third DVD which is 150 minutes worth of addressing common questions with detailed answers. This DVD set is likely your best value.


Have you ever heard about Shiatsu?
A traditional hands-on Japanese healing art, Shiatsu can help in a wide range of conditions from specific injuries to more general symptoms of poor health. Shiatsu is a deeply relaxing experience and regular sessions help to prevent the build-up of stress in our daily lives.
Barbara Olioso shared her experiences of Shiatsu with us.


text:
Stilettos, Sissy Boys, and the Limits of "Gender-Neutral" Parenting Advice
Filed By Paige Schilt | December 09, 2009 2:30 PM | comments
Follow @queerrocklove
Filed in: Living, The Movement, Transgender & Intersex
Tags: feminism, gender nonconformity, Karin A. Martin, Letty Cottin Pogrebin, parenting, queer, transgender
Last week, PBS Parents featured a blog titled "Gender Appropriate Toys." It begins promisingly enough with a critique of parents who enforce binary gender norms in their children's toys and activities. The author (Kristen of Supersisters) suggests that boys should be free to engage in nurturing and domestic activities as preparation for becoming well-rounded men. Next, she shifts into a discussion of childhood cross-dressing:
So why are we so concerned about our sons wearing our shoes? If wearing women's shoes as a small child causes any sort of issue when a boy gets older, nearly every man in the world would now be a cross-dresser.
As I read this, I tried not to get too hung up on what "any sort of issue" might cover or what she might mean by "cross-dresser." After all, the article was normalizing childhood cross-dressing. These are ideas that might be new to the readers of PBS Parents. Cut the lady some slack, I told myself.
Then I read the last line of the article.
And let's be honest. It's either stilettos now or stilettos later.
The assumptions embedded in that cautionary closing line are so familiar that the author needn't bother to unpack them. Because raising an adult cross-dresser (or a drag queen or a transsexual or a homo)--those would be self-evidently negative outcomes, right?
Sadly, this PBS Parents article is only the most recent example of parenting advice that champions gender-neutral parenting as a means to avoid raising gay or trans kids. In 2005, sociologist Karin A. Martin examined the legacy of second wave feminism's project of gender-neutral parenting. In "William Wants a Doll. Can He Have One? Feminists, Child Care Advisors, and Gender-Neutral Child Rearing," Martin finds a "stalled revolution." She argues that the movement's child rearing agenda has stalled, in part, because liberal feminist calls for gender-neutral parenting did not "fully eradicate heterosexism and homophobia from its writings about gender socialization."
Martin cites Ms. founder Letty Cottin Pogrebin's 1980 book Growing Up Free, which warned against the "erroneous" assumption that "homosexuality is one of the worst things that can happen to anyone," but then went on to re-stigmatize homosexuality with comments like these:
"Don't try to prevent homosexuality. It won't work and it may backfire."
"Don't make children feel they are the 'wrong' sex as this too can result in homosexuality."
"Don't use sex stereotypes as a vaccine against homosexuality. Trying to mold children to match stereotypes sometimes inspires just what parents meant to avoid."
As Martin notes, Pogrebin and her peers used the prevention of homosexuality as a kind of an advertising strategy for gender-neutral parenting: "these arguments stop just short of saying that gender-neutral child rearing is good for children because it prevents homosexuality."
Martin goes on to examine contemporary parenting advice from the late 90's and early 00's. She finds that, when it comes to childhood gender nonconformity, little has changed:
About 60 percent of the sources can be described as giving (at least) one of three types of advice. Two of these types have long been stereotypic responses to homosexuality" (1) Don't make it worse and (2) recode the behavior. The third response explicitly addresses the link between gender and sexuality: (3) Don't worry; it doesn't lead to homosexuality.
The assumption, once again, is that adult homosexuality is a self-evidently negative outcome, one that parents would naturally want to avoid.
In sorting through all of this, I find myself returning to Eve Sedgwick's famous, provocative essay, "How to Bring Your Kids Up Gay" from 1991:
There are many people in the worlds we inhabit...who have a strong interest in the dignified treatment of any gay people who happen already to exist. But the number of persons or institutions by whom the existence of gay people is treated as a precious desideratum, a needed condition of life, is small. The presiding asymmetry of value assignment between hetero and homo goes unchallenged everywhere: advice on how to help your kids turn out gay, not to mention your students, your parishioners, your therapy clients, or your military subordinates, is less ubiquitous than you might think. On the other hand, the scope of institutions whose programmatic undertaking is to prevent the development of gay people is unimaginably large.
Using Sedgwick's insight as a starting point, I pose this question to myself and other parents: if we believe that queer and gender-nonconforming people are a "precious desideratum," a gift to the world, an "outcome" to be cherished equally with other gender and sexuality outcomes, then how do we live that belief in our parenting?
Recently, I've sensed the need for a new paradigm to replace "gender-neutral" parenting, which is usually heteronormative (boys can play with dolls because they will become husbands and fathers) and sometimes (as I've shown above) homophobic and transphobic. In its place, I suggest "gendery" parenting.
Rather than conceiving of gender as a binary that can be cautiously "crossed," the gendery parenting paradigm would enjoin us to introduce our children to a wide variety of different gender identities and expressions. At our house, that means that our son, Waylon, spends time with his football coach grandpa and his urbane gay grandpa. Our chosen family includes a butch "tia" who probably irons her boxer shorts and an "uncle" who is a working-class straight guy. Waylon is comfortable hanging with the queens in the church choir and the sensitive skater dudes who teach at his school. Last Christmas, he asked Santa for a pair of black tights so he could dress like his high-femme auntie. This year he's been haranguing his FTM uncle to please, please sew him some more handmade stuffed animals. Whatever Waylon wants to do or be in the future, I'm confident that he knows there are many ways to live his gender and sexuality.
Rather than just begrudgingly allowing our children to play with "opposite gender" toys, the gendery parenting paradigm would encourage us to give children the language to think critically about gender binaries and gendered hierarchies. If we provide the tools, young children are quite capable of sussing out inequalities and analyzing gendered messages--as evidenced by a conversation I had with Waylon the other day:
Waylon: Mom, I think Power Rangers is kind of injustice to girls.
Me: Really, how so?
Waylon: Well, the girl Power Rangers always have to be pink or yellow, but the boy Power Rangers can be blue or red or green. It's not fair that they have more colors.
Me: Don't you think it's injustice to the boys too, since they never get to be pink?
Waylon: Well yeah, but the girl action figures are always really skinny too. They don't look like they could even fight very good. Why do they make them like that?
Finally, and most importantly, the gendery parenting paradigm would instill in children the belief that they will be loved and celebrated in all the complexity of their gender and sexual identities.
And that includes stilettos--now or later.
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Firebolt | December 9, 2009 2:48 PM
Great article! I especially loved the stories about Waylon. :)
Tobi Hill-Meyer | December 9, 2009 3:01 PM
Fascinating insight. Over the past six months or so I've been realizing that my parents fell into that trap to some degree as well. I was raised incredibly "gender neutral" but my parents bought into an idea espoused by some of the less-trans-friendly feminists that in a world without sexist oppression trans people would not exist, and they thought that as long as they offered me gender options then I could be as gender bending as I wanted and I wouldn't need to transition. Then when I did come out as trans, for a while they worried it was because they had not been gender neutral enough.
Alex Blaze | December 9, 2009 6:13 PM
Absolutely. I remember my mom saying something similar when I was a kid, that back when she was young allowing a boy like me to help in the kitchen would have been interpreted as trying to turn me gay, but she thought that was poppycock, that I wouldn't turn out gay either way. Well, I turned out plenty gay, but it's not because I helped my mom cook all those years. My pallet, though, probably is the result of being a young and encouraged foodie.
Jessi | December 9, 2009 6:49 PM
with the mode of thinking to which you refer, that perhaps is the reason why I am Trans. I helped my mom cook and clean, and in the evenings I helped dad with the yard,home repairs and mechanics on the car. little of both worlds which i still do today. this past summer shingled my house during the day and cooked dinner at night.
Rob Barton | December 9, 2009 9:40 PM
When I was five we moved and when we arrived my teddy bear and dolls were not there. They had been disposed of. My adoptive mother always kept my hair cut short though I always wanted it long. She hated that I looked so much like a girl when I was young.
My kids always played with whatever they wanted to without regard for gender appropriateness ideas. They have grown up around a wide variety of gender expressions and sexualities and have no hang ups about it.
I wouldn't call the approach gender neutral so much as I would call it gender aware and gender full. We never tried to make gender go away in the play and the toys but no gender identities were seen as negative.
Dana Rudolph | December 9, 2009 9:59 PM
Wonderful post, Paige. Thank you especially for proposing a term for your concept of gender-full parenting. It is hard to make change without the proper language.
Waymon is one insightful kid.
Paige Schilt | December 9, 2009 10:10 PM
Like lots of the commenters above, I am a product of the second wave feminist parenting project. As a child, I listened to Free to Be You and Me until the needle on my record player wore out. Just a few weeks ago, I played some of Free to Be for my Feminist Studies students (none of whom had ever heard it), and I almost started to cry when heard it. But all the same, even though it moves me, I don't play most of it for Waylon--because it's too heteronormative for these times and I'm afraid it will reify more myths than it dispels.
Rob, I think your term "gender-full" might be more catchy than my term: "gendery parenting." (Was it Eve Sedgwick who said "some people are more gendery than others"? Queer theory student of the day award to any one who remembers.)
Nerissa | December 9, 2009 11:26 PM
In animal studies exclusively gay animals are rarely found. OTOH bisexuality is common. With a more gender-full upbringing my guess is bisexuality would become the norm.
We're already seeing this with many young women most of whom were allowed to be much more traditionally masculine in behavior than women of earlier generations. Once boys are allowed to openly behave more traditionally feminine they'll also grow up to mostly be bisexual.
OTOH gender orientation does tend to be bimodal by nature so I doubt if nurture would make much difference other than trans inclined people would transition much, much earlier on average.
Finally my guess is cross-dressing for men would die on the vine if allowed openly. Most CDs like being special so-to-speak and if it was no big deal to dress fem they'd soon tire of it as do most women today.
battybattybats | December 10, 2009 11:30 AM
Most CDs are deeply closeted cause it's not accepted. 5% of the population or more are crossdressers.
No they won't dissapear. After coming to self acceptance many CDs say there is less of a rush and less of a pressure to crossdress... cause the fear is taken out as well as the self repression which previously would bottle up till they were ready to go crazy.
But they don't quit or go androgynous 24/7, they just find self acceptance and personal balance.
Most crossdressers in my experience, including myself and my girl/boyfriend (a FtM crossdresser) have a bi-gender gender identity. Something i think gendery parenting would enable to flourish rather than cause not to occur.
ginasf | December 9, 2009 11:46 PM
Nerissa,
I'm not a crossdresser so I can't speak from personal experience, but your theory about crossdressing for men disappearing if it were more accepted seems very much falling into the same kind of thinking Paige was writing about where "need for a specific kind of gender expression are mostly in reaction to social morays". It's also suggesting (as Julia Serrano wrote about in Whipping Girl) that femme presentations are somehow less natural or real than masculine ones. There might be some crossdressers who are excited by its surreptitious aspect but I suspect there are many more who would love to be out in the open (part of the reason some of the gender conferences have been so popular with that community). Most women might not dress "fem" because of the expense, time it involves, practical aspects and also how they are often made to feel negatively about their bodies by media. Which doesn't mean "most" women aren't excited by that kind of presentation in certain circumstances.
Nerissa | December 10, 2009 5:22 AM
The comment that the "need for a specific kind of gender expression [is] mostly in reaction to social morays" is correct. Imagine being stuck on an island with no-one around. Few people would wear heels, makeup or other feminine accoutrements. Femme presentations are less natural than male ones and I say this as a MTF TS who loves to dress femme.
All people role play if they wish to play traditional gender roles well and people in the female role have to work harder at it than men. Not only in the effort to get dressed but on hair and skin care, makeup, nails, weight control and more.
I do not see these things as problems. For example, it takes more effort to become a doctor than a street person yet most of us admire doctors more and most of us would rather be doctors than street people. Additionally people in the female role are as free as men to become out-of-shape and to make little effort in how they dress and otherwise present themselves.
As for the gender conferences I agree many men attend for the freedom of cross-dressing in safety. And yes, there would be a small number of men who would follow the typical female pattern of dressing femme for special occasions as do many gender benders in the gay community today if cross-dressing by men was more accepted.
Paige Schilt | December 10, 2009 10:09 AM
Hmm, I have several thoughts on this thread. My sister, the super smart sociologist Dr. Kristen Schilt, is always complaining about a certain kind of feminist argument that goes something like this: "if we could just get rid of gender, then trans people wouldn't have to exist." Yuck! Who would want that? Not me. I would like for gender to be less binary and hierarchical and ridden with inequalities, but that doesn't mean that I want it to go away. I'm deeply invested in loving gender nonconforming people and, in a certain way, loving gender.
That is to say, we need to remember the pleasures of gender as well as the pains.
And, as a lo-femme who's married to a genderqueer more on the FTM end of the spectrum, I have to dispute the idea that masculine gender expression takes less work or is more "natural." Just come over to our house on the night when my sweetie is getting dressed to perform--you'll see!
Tobi Hill-Meyer | December 10, 2009 2:43 PM
I think that greatly depends on what you define crossdressing as. If everyone was allowed to wear any gender clothing -- if clothing ceased to have a gender -- then what would crossdressing mean? We might cease to have a cultural understanding of "crossdressing" but as far as men wearing dresses and other femme acoutrements, I don't see it. There is no way that a social norm that says "men are allowed to wear dresses now" would result in less men wearing dresses. Take my hometown for examples. The inundation of hippie culture has resulted in men wearing dresses or skirts to public events much more often then other places. They don't think of it as "crossdressing" but they still do it.
As for the desert island example, would you wear men's dress shoes and cuff links? You're example points more to the infeasability of dressing up then it does of masculinity and femininity? Would it really be more natural to wear pants then a skirt? More natural to wear men's cut jean's then women's cut? A thick bulky watch rather than a thin one?
It's not just the point that femininity has natural aspects to it as well, but that masculinity can be unnatural too. While patriarchy has dictated that women should spend hours on grooming and beauty, not every woman does. Plenty of women can do femininity with minimal effort, while some men put hours into cultivating their masculine image.
Jamie | December 10, 2009 8:17 PM
I personally can't wait until the word "cross-dressing" is recognized to be as meaningless as it always has been. In my opinion there are two kinds of clothing: the kind I like and the kind I don't! Gender has nothing to do with it.
battybattybats | December 10, 2009 11:08 PM
Jamie that may be your experience but it sure aint mine.
I have to express my bi-gender identity somehow. Being able to use gender-associated clothing to match my needs on any given day is both useful and important to me. I agree it is the association that is the main reason clothing is gendered, a tiny amount is based on anatomy but the main of course is just association.
So some days I express myself with an androgyny and other days full femininity. Rare days a fair amount of masculinity. If clothing had no gender assiciation I'd need some other way to symbolise and express what i feel within, my bi-gender/genderqueer identity.
Even if we changed the term and removed the association of gender from clothes nevertheless crossdressers would still exist by another name and with whatever other ways of gender expression that existed.
I haven't heard much about the bi-gendered experience, thanks for sharing.
Lynn Miller | December 10, 2009 9:07 AM
I haven't raised children, so my comment may be wrong, but I wonder if genderless parenting isn't a bit like sweeping back a lake with a broom? Our culture is gendered and gender roles will be presented (and pushed) by the child's friends, teachers and just about everyone else. Its impossible to stop.
Making a child's life rich with a variety of gender role models seems a very good solution: gender-full parenting, not gender-less. Thank you, Paige, for writing this article. Waylon is lucky to have you, and Katy, as moms.
Sarah Jane | December 10, 2009 9:20 AM
As an older Lady who bloomed late, I think we have become so sensitive to letting or not letting children play with clothes and toys of the opposite sex. When we strongly tell boys that they can't wear stilettos--now, or girl clothes, we are giving those pieces of women's clothing some sort of mysterious, fantasy meaning; which only drives the child sexual attachments and feelings underground. Playing dress-up is very much different than taking a knife or other sharp instrument in one's hands to cut off the undesirable piece of flesh. Why is it so bad to teach a young boy, how to cook, how to clean, how to wash the family clothes properly. The more skill they learn growing up which de-mystify the tasks that girls do and the clothes they wear might just make that young man a more sensitive and caring father and husband who won't think women are objects to abuse and rape.
As parents we should be able to distinguish the difference between just 'dress-up' and behaviors which indicate a problem with gender identity.
"As parents we should be able to distinguish the difference between just 'dress-up' and behaviors which indicate a problem with gender identity."
What "problem" would that be, exactly? The main problem transgender and gender-variant children face comes from the harsh judgment and arbitrary gender rules of society.
So is it ok for a boy to play "dress up" in feminine clothing, but when it's time to dress "for real" he has to wear masculine clothing? I fail to see how that's any different from what the OP is critiquing.
Jamie's right theres a lot of problematic things you said just there.
Firstly while there is a sexual component in crossdressing for many crossdressers while they are struggling with self acceptance this is as far as I can tell merely the way the repression forces itself to the surface as its something that goes as they get self acceptance.
And there's plenty of anecdotal evidence that crossdressing can be herditary even though it's totally closeted with the father or grandfathers CDing only found after their death. While needing to be further explored this suggests it to be a result of a more common milder partial form of the phenomenon that causes transsexuals, just as Autism comes in a wide range of degrees.
As for rape your forgetting that men also rape men, women also rape women and women even rape men. You think that comes from some mystification of women? Surely thats just not feasible.
Bil Browning | December 10, 2009 9:49 AM
Cut the lady some slack, I told myself.
I'll admit, I thought that too until I read on. But I had to laugh at that little, tiny sentence because we were on the same brainwave there for a second. As I thought it, I read it.
Angela Brightfeather | December 10, 2009 10:12 AM
A very interesting discussion indeed.
This discussion borders on the outlines of about a thousand different ideas that I have experienced over the years about crossdressers, bisexuals and gender expression, along with interesting points of view about more modern nurturing of gender ideas and children.
I was born and raised in a time, a few months right after WWII, where gender expression in uniform was very important and gender expression on a tank assembly line was far less important. The aftermath of that was that genetic women were rushing back to anything femme and pretty and genetic males were heavy into companion activities like fishing and hunting. Genetic males who may have wanted to express themselves as femme or just pretty, had no place inside the ropes of that reparative time and only after many years and perhaps the hippie era, did anyone even think that much openly about gender expression, or bisexuality.
Raising children today is a whole lot different than in that time and to a great extent what we are doing today is trying to revise and repair the actions of the past, brought on by circumstances that necessitated gender verification, sexuality and indoctrination at an early age back then.
As someone who has participated and observed all these changes over that time period, I find that CD's today and their need to develop their female or male expression as the case may be, are only different in the fact that today there are many more things around to help them do that. More people who have have established a positive and personal dual identity. More people who are accepting and understanding of a person's need to express themselves as femme or butch. More means to buy those things that help them to be more passable and for the most part, CD's today are much more willing to explore their gender expression openly and in public. If there is one lament among my own peers, it is that we were born to soon.
The one thing that makes CD's very special in our society is that they emphatically point out forms of bigotry and inequality that were and still are based on sex and gender. The same kind of bigotry that was addressed, in part, by the feminist movement of the 70's and 80's. I think that is very important and I think that if ENDA passes, people are going to see a whole new industry pop up a few years after, catering to males who wish to express themselves in a more femminine way and more openly and a different concept of gender. I do not however think, that the need or enjoyment experienced by CD's will ever be diminished by it being more acceptable to cross gender express. It may be safer, but the desire to express themselves that way is just as much a thing of birth for them as is the need to change physicially is for any Transexual. A fact that is either lost, forgotten or reputed far to often by those who think that cross dressing is a choice and not a search for a person's balance in a duality based gender society.
The challenge of raising a gender diverse child today is not so much about the parenting, if the parents are willing to allow their child to explore openly and at any time as they mature. It is with the people and social structures that the child has to deal with on a daily basis and who say that their children are "to distracting to others in schools" or "are not normal" or "if they act like this now then they will grow up to be gay." We seem to be in a very pivotal period of time right now, when awareness, acceptance of gender diversity in our children and grandchildren, is at a point that makes things like hate crimes and ENDA more necessary to insure their future and success.
People may talk and ruminate all they want about raising children who are gender diverse in one way or the other. But the bottom line is that the most valuable gift that any parent can give a gender diverse child today, is not how they can dress or what toys they can play with today. It is how free will that child be to express themself openly and without fear tomorrow. Perhaps that might be another reason why GLBT people seem to be fighting many of the same battles and need to do it as one community.
Dana Rudolph | December 10, 2009 11:11 AM
I should point out, in the context of this discussion, the brand new book for middle-schoolers by David Walliams, The Boy in the Dress. (It came out last year in the UK, but it's new to the US.) Twelve-year-old Dennis isn't transgender or gay--he just likes fashion and wearing dresses. When his friend Lisa convinces him to wear one to school, complete with wig and makeup, he enjoys the experience, until he is found out and kicked off the soccer team right before the big game. Can he and Lisa right this wrong? The denouement stretches credibility a little, but one can't argue with the warm-hearted message of this fable about difference, acceptance, and gender expression. (And Quentin Blake, who illustrated Roald Dahl's works, did fun illustrations for this book as well.)
My only concern about the story is that I'm afraid some people will read it and not understand the difference between cross-dressing and being transgender. They might interpret the straight Dennis' cross-dressing as evidence that being trans simply means "dressing up" as the other gender. That's not at all the author's intent, but I worry that some will think it so, especially given the publication this year of 10,000 Dresses by Marcus Ewert, a picture book about a transgender child. The titles are similar, and in each, the protagonist has a female friend who encourages his or her love of dresses. One is about gender identity, though, and the other about gender expression.
I suppose it's a good thing that children's books are tackling both of these topics, though, right? They offer plenty of opportunities for us to educate.
ginasf | December 10, 2009 11:48 AM
Paige, thank both you and your sister Kristen. I have mistrust of the "if only... then this wouldn't need to exist" arguments as well. I don't believe in large degrees of birth gender determinism but neither do I do I put faith in any concept which states we're born as blank slates--no other species is. Yes, much of gender expression is culturally steered (and sometimes fiercely policed as with boy's clothes) but gender expression has a strong interaction with one's gender identity and gender attribute (how others experience you). We bring ourselves onto any 'desert islands' and would almost certainly create subtly gendered clothing wherever we go. Role playing is not just part of "traditional" gender roles, it existed just as absolutely in eras like the 60s when there were huge shifts in gender expression. We all wear uniforms, but often modified by our gender identities and filtered through how our need for gender expression interacts with our society. I strongly disagree one uniform is somehow more 'natural' than others. They're all organic, stylized and artificial to much the same degree.
I'm a parent (and have been a elementary school teacher) and am also a woman who is trans. I agree with the OP and Angela's statement about permitting children to express themselves fully and creatively and listening to the child as much as possible for guidance and clues. In my experience, many kids are heavily gendered in one direction or another (at very young ages), but many also pick and choose, especially around the ages of 4-5. I used to teach second grade, and that's an age where strong peer pressure starts to exert itself.
The vast majority of parenting (and even teaching) is through modeling--not lecturing or reasoning. A parent who is highly binary gender expressive telling their child to 'be themselves' is sending very mixed messages which, likely, won't be heard or processed. Such a high percentage of our subconscious behaviors are gendered there's no way we're going to filter it to somehow expose our children to a "more diverse parent" but if we respect our children's impulses with a minimum of judgement at least we allow them to explore. Most importantly, we have to really accept the outcome of who that child becomes, not try to make them into a matching set of luggage.
ss | December 10, 2009 12:41 PM
Thank you so much for your article and great analysis - I read the article last week and was so hurt/taken aback by the author's transphobia. I appreciate your willingness to speak up.
gregorybrown | December 10, 2009 12:53 PM
All of this is enlightening and mind-stretching for some of us who haven't spent much time nor effort thinking about the nuances. But I believe, sincerely and firmly, that NOBODY who values healthy feet should wear stilettoes at any point in life or on any identity continuum.
Dee Tate | December 10, 2009 4:53 PM
When it comes to expression through clothes and fashion society has to remember clothes and fashion change all the time.
At the beginning of our country men wore the wigs,make-up and carried what now is considered a purse.
Men did not abondon these things until women started to wear more of it more often.Thus changing what they considered to be masculine attire,wanting to differentiate themselves from women.
Clothing is fashion,many people like to dress to what is considered fashionable for the time and season.Younger generations of men nowadays will pierce both ears and wear mascara and other things expressing their individualism.
It doesn't mean they are questioning their sexual orientation or gender identity,their simply living their lives in their generational age.Understanding clothes don't make the person,knowledge and understanding of oneself does.
Society seems to live and depend upon it's visual perception more then it's reasoning and intellect.
I believe this is one of the factors why society has such a hard time accepting differences in humanity.It would rather judge and come to conclusions based on what it sees rather then stop to gain knowledge and understanding of that which it doesn't.
This made me smile so much. Thank you for posting it!
katy koonce | December 10, 2009 11:26 PM
WOW! way to go wifey! What a brilliant discussion. damn i married up! love you.
Sue Lefkowitz | December 16, 2009 8:45 AM
I grew up in the Fifties when this stuff wasn't even a known topic. If you were a "sissy", you either retreated into geekdom, or found a training program so you could become "a lean mean fighting machine". Although I am a post-op M/f who has lived and worked as a woman for over ten years, as a young boy I longed to be "The Creature" or "Dracula" so I could obliterate the relentless bullies. Not being a science person or am athlete, I discovered beatniks and spent my life as a gender rebel and probably ruined my chances of any promotions into management. I finally reached low level management after transition. There was zero guidance in the Fifties.


text:
Wednesday October 28 2020
Pirlo: 'Juve need work to reach Barca level'
Andrea Pirlo admits the plans Juventus had didn't quite come off and looked to the lack of experience. 'We need work until we can play Barcelona on level terms.'
The Bianconeri have now won only two games on the pitch this season, drawing three Serie A matches in a row and beaten 2-0 at home by Barcelona in the Champions League this evening.
Alvaro Morata was unfortunate to see three goals ruled offside, but Juve threatened precious little else, while Wojciech Szczesny performed heroics and Barca seemed intent on walking it into the net.
"We knew it'd be tough against a side that plays good football, that is accustomed to playing at this level, whereas we are a work in progress.
"Ultimately, it's a match that will be useful for us to grow and improve in future," the coach told Sky Sport Italia.
"I hope to have more players back soon, because I don't have many options and those I start end up having to play almost 90 minutes twice a week. That's not easy for them, especially when they are young and inexperienced.
"It's frustrating when you are down to 10 men, as you can't go to press them, otherwise it just ends up running on empty. That's what the lads didn't realise when we went down to 10."
Even before the Merih Demiral dismissal in the closing minutes, Juve barely ever threatened the Blaugrana.
"The plan had been to spread out the Barcelona defence a bit more, but we tended to be a bit too close together and playing all on the same lines."
Sky Sport Italia pundit Fabio Capello pointed out Federico Chiesa was generally ignored, as the ball kept going through Paulo Dybala, who was doubled up on the marking.
"It's true. We had tried to keep Chiesa wide, then pushed Rabiot into a more advanced area, with Cuadrado pushing up in the second half. The idea had been to pull Sergi Roberto out of position, as he struggles if he is out of position, but we were never really able to do that. The players ultimately make the decisions on the pitch.
"We need to be quicker in the way we move the ball to create one-on-one situations, but we didn't manage it tonight."
Does the Juventus midfield lack quality, especially compared to the team that they had with Pirlo as a player?
"Football clubs have eras, we had huge players with a lot of international experience. Now they are largely younger, so it'll take a while to get them up to that level.
"They tried to create something there, but we need to work and improve until we can play Barcelona on level terms."
Conte on Juve, Inter and financial crisis