The NYTimes had a long article today about Jamie Reed and the clinic she worked for that is a must read.....This is an archive copy so anyone should be able to open it.
And this twitter thread leads to an article listing number of procedures regarding "gender affirming care" surgeries, etc. Regarding the report, take special note of the number and type of hospital/clinic included....I think there is very likely and undercount.
My conviction is that the end-end point of the ‘affirmative model/debacle’ will be a shameful awakening and realisation that ‘we were wrong’. Of course the irreparable damage done will remain.
It will not be the first time that lessons learned will have been ignored by the zealots ‘who know’.
I cite a recent example:
In 1998 The Australian Medical Association (AMA) marketed the Intravaginal Sling Tunneller device as an “Australian medical design breakthrough” to treat incontinence and prolapse in women, a condition that can follow pregnancy. The device did not undergo a trial to confirm safety and efficacy and resulted in a litany of dreadful irreversable complications including: dyspareunia, intractable pain, incontinence, infection, systemic autoimmune conditions, organ perforation and invasion of the vaginal wall.
The device was withdrawn by the TGA in 2018.
Thousands of women globally were irreversibly damaged with legal payouts to the tune of US$8 billion.
“I can only answer that in good faith we thought it was a good idea”
Alabama AG Steve Marshall is a shrewd lawyer. Appellants bet their entire case on WPATH's standards and invited this outcome. He works well with other Republican AGs. Add Jamie Reed's testimony and you have probably the biggest courtroom threat to pediatric "affirmation" on the planet, right now.
Great point. Judges love to avoid having to decide on hugely complex and controversial issues though. In Missouri, unlike with other cases, it's a county judge deciding this based on state law. I would guess we'll see a pretty narrow ruling on the preliminary question of whether to allow the law to go in effect while the case is decided.
I'm torn between wanting to see them get sued into oblivion and being afraid that it'll make them double down like WPATH with the last-minute removal of age minimums in SOC 8.
Doctors are held.accountable for every other procedure. That's why they have insurance and that's why there are malpractice and negligence suits. Same here. If they are negligent they should be sued.
Doctors are human beings who also make mistakes. Some are biased, incompetent, ideologues or malicious. They should be treated just like everybody else is. You harm another person, you pay. Preferably in jail.
Same applies for professional associations and for individuals or bodies who encourage or require doctors to fail their most fundamental duty to do no harm.
I'd certainly want authorities to go after the groomers. 2 or 3 high-profile cases in a few countries should shut most of them down.
As the themes emerge and evolve, i like to keep emphasizing them. Just for one, the development of patient-centered medicine. Aimed to correct paternalistic medicine, it has gone too far and become retail consumer driven.
“As a matter of principle, it is wrong to use satisfaction and regret as the benchmark for judging whether pediatric sex trait modification (PSTM) is a medically necessary and ethical practice. If medicine is to retain its authoritative role in human affairs, patient satisfaction alone cannot determine when interventions are medically necessary. Self-reported satisfaction is how we judge cosmetic procedures, not medically necessary ones. The role of the doctor is to heal, not please.“
Outcome assessment is a very important part of the story. Looking at subjective vs. objective measures is controversial because of the justified criticism of "objectivity" in academia. And yet there has to be a balance. Enter: Multiple measures designs. "A lack of clear consensus on the most important clinical outcome, combined with the need to examine clinical effectiveness on related outcomes spanning disparate domains, encourage the use of multiple outcomes" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071542/
Just from the abstract it's hard to tell. I'm sure the scales are unpersuasive since it's clear that people have widely divergent ideas about gender identity. I can't imagine how you establish content/construct validity. The authors say it's part of the "more research is needed" pile. OK, fine.
Yes, I’ve seen criticism of gender dysphoria studies because of use of many different types of outcome measures across studies, making it diffIcult to assess the literature.
Did you see the WPATH statement about medical necessity? S16-S17.
"Medical necessity is a term common to health care coverage and insurance policies globally. A common definition of medical necessity as used by insurers or insurance companies is “Health care services that a physician and/or health care professional, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (a) in accordance with generally accepted standards of medical practice; (b) clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s illness, injury, or disease; and (c) not primarily for the convenience of the patient, physician, or other health care provider, and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.”
Below they elaborate:
"Generally, “accepted standards of medical practice” means standards that are based on credible
scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, designated Medical Specialty Societies and/or legitimate Medical Colleges’ recommendations, and the views of physicians and/ or HCPs practicing in relevant clinical areas."
I'm not sure if there are generally accepted standards of medical practice in this field right now, given all the disagreement about treatment?!
After a near fatal self-inflicted wound to their credibility via an attempted overthrow of the US government in 2021 , the GOP has been miraculously saved in the nick of time by actors so convinced of the superiority of their "other ways of knowing" that they have been willing to sacrifice children on the altar of their moral superiority to prove their point. The pagan god Molech would be pleased.
The problem is capture of these organisations by activists. The WPATH is of course wholly Activist. It is clear in its recruiting guidelines that anyone on its SOC8 Revision committee has to have “expertise due to accomplishments in trans health advocacy and a history of work in the community, or a member of a family that includes a transgender child, sibling, partner, parent, etc.” And be a member or associate member of WPATH. In other words they have to be a believer in everything that WPATH espouses.
The American Academy of Pediatrics, the Endocrine Society and the A(American)MA presumably delegated their decision making to subcommittees like the RACP and the Australian AMA have done and these have been populated by Doctors having an interest in the subject. And these doctors tend again to be activists.
They then give their recommendations and the boards of the organisations rubber stamp them with no say from the greater membership.
So in fact the guidelines are not endorsed by the membership of these organisations but usually only by a tiny group within them. And by only including practitioners of Transgender medicine there is no independent review.
So surprise , surprise. They keep on endorsing their own Guidelines.
The only way for the affirmative model to be properly reviewed is by someone completely outside transgender medicine who can look at the data dispassionately and without fear or favour.
This is what was done in the UK and in Europe with resultant constraints on doctors treating these patients.
Members of the group Do No Harm had a stall with detransitioner Chloe Cole at the recent Endocrine Society conference in Chicago. They found European endocrinologists very open in discussing the risks of gender medicine & were surprised that America had not restricted the practice. American attendees were also concerned about the risks but felt this was not something they could express publicly. I guess Australia’s position (& the position in NZ & Canada) is closer to America than Europe.
The NYTimes had a long article today about Jamie Reed and the clinic she worked for that is a must read.....This is an archive copy so anyone should be able to open it.
https://web.archive.org/web/20230824005800/https://www.nytimes.com/2023/08/23/health/transgender-youth-st-louis-jamie-reed.html
And this twitter thread leads to an article listing number of procedures regarding "gender affirming care" surgeries, etc. Regarding the report, take special note of the number and type of hospital/clinic included....I think there is very likely and undercount.
https://twitter.com/benryanwriter/status/1694363996613161247
My conviction is that the end-end point of the ‘affirmative model/debacle’ will be a shameful awakening and realisation that ‘we were wrong’. Of course the irreparable damage done will remain.
It will not be the first time that lessons learned will have been ignored by the zealots ‘who know’.
I cite a recent example:
In 1998 The Australian Medical Association (AMA) marketed the Intravaginal Sling Tunneller device as an “Australian medical design breakthrough” to treat incontinence and prolapse in women, a condition that can follow pregnancy. The device did not undergo a trial to confirm safety and efficacy and resulted in a litany of dreadful irreversable complications including: dyspareunia, intractable pain, incontinence, infection, systemic autoimmune conditions, organ perforation and invasion of the vaginal wall.
The device was withdrawn by the TGA in 2018.
Thousands of women globally were irreversibly damaged with legal payouts to the tune of US$8 billion.
“I can only answer that in good faith we thought it was a good idea”
Dr Michael Gannon (then President of the AMA)
Alabama AG Steve Marshall is a shrewd lawyer. Appellants bet their entire case on WPATH's standards and invited this outcome. He works well with other Republican AGs. Add Jamie Reed's testimony and you have probably the biggest courtroom threat to pediatric "affirmation" on the planet, right now.
Great point. Judges love to avoid having to decide on hugely complex and controversial issues though. In Missouri, unlike with other cases, it's a county judge deciding this based on state law. I would guess we'll see a pretty narrow ruling on the preliminary question of whether to allow the law to go in effect while the case is decided.
I'm torn between wanting to see them get sued into oblivion and being afraid that it'll make them double down like WPATH with the last-minute removal of age minimums in SOC 8.
It’s difficult to see how they extricate themselves from this mess, but I guess government & courts *might* help pressure them to course correct.
Doctors are held.accountable for every other procedure. That's why they have insurance and that's why there are malpractice and negligence suits. Same here. If they are negligent they should be sued.
Doctors are human beings who also make mistakes. Some are biased, incompetent, ideologues or malicious. They should be treated just like everybody else is. You harm another person, you pay. Preferably in jail.
Same applies for professional associations and for individuals or bodies who encourage or require doctors to fail their most fundamental duty to do no harm.
I'd certainly want authorities to go after the groomers. 2 or 3 high-profile cases in a few countries should shut most of them down.
As the themes emerge and evolve, i like to keep emphasizing them. Just for one, the development of patient-centered medicine. Aimed to correct paternalistic medicine, it has gone too far and become retail consumer driven.
Seen this article by Leor Sapir?
“As a matter of principle, it is wrong to use satisfaction and regret as the benchmark for judging whether pediatric sex trait modification (PSTM) is a medically necessary and ethical practice. If medicine is to retain its authoritative role in human affairs, patient satisfaction alone cannot determine when interventions are medically necessary. Self-reported satisfaction is how we judge cosmetic procedures, not medically necessary ones. The role of the doctor is to heal, not please.“
https://www.city-journal.org/article/a-slow-trek-back-to-truth
Outcome assessment is a very important part of the story. Looking at subjective vs. objective measures is controversial because of the justified criticism of "objectivity" in academia. And yet there has to be a balance. Enter: Multiple measures designs. "A lack of clear consensus on the most important clinical outcome, combined with the need to examine clinical effectiveness on related outcomes spanning disparate domains, encourage the use of multiple outcomes" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071542/
What do you think of this?
https://psycnet.apa.org/record/2021-60556-001
Just from the abstract it's hard to tell. I'm sure the scales are unpersuasive since it's clear that people have widely divergent ideas about gender identity. I can't imagine how you establish content/construct validity. The authors say it's part of the "more research is needed" pile. OK, fine.
Yes, I’ve seen criticism of gender dysphoria studies because of use of many different types of outcome measures across studies, making it diffIcult to assess the literature.
Not a moment too soon.
Did you see the WPATH statement about medical necessity? S16-S17.
"Medical necessity is a term common to health care coverage and insurance policies globally. A common definition of medical necessity as used by insurers or insurance companies is “Health care services that a physician and/or health care professional, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (a) in accordance with generally accepted standards of medical practice; (b) clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s illness, injury, or disease; and (c) not primarily for the convenience of the patient, physician, or other health care provider, and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.”
Below they elaborate:
"Generally, “accepted standards of medical practice” means standards that are based on credible
scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, designated Medical Specialty Societies and/or legitimate Medical Colleges’ recommendations, and the views of physicians and/ or HCPs practicing in relevant clinical areas."
I'm not sure if there are generally accepted standards of medical practice in this field right now, given all the disagreement about treatment?!
After a near fatal self-inflicted wound to their credibility via an attempted overthrow of the US government in 2021 , the GOP has been miraculously saved in the nick of time by actors so convinced of the superiority of their "other ways of knowing" that they have been willing to sacrifice children on the altar of their moral superiority to prove their point. The pagan god Molech would be pleased.
Democrats are experts at snatching defeat from the jaws of victory.
The problem is capture of these organisations by activists. The WPATH is of course wholly Activist. It is clear in its recruiting guidelines that anyone on its SOC8 Revision committee has to have “expertise due to accomplishments in trans health advocacy and a history of work in the community, or a member of a family that includes a transgender child, sibling, partner, parent, etc.” And be a member or associate member of WPATH. In other words they have to be a believer in everything that WPATH espouses.
The American Academy of Pediatrics, the Endocrine Society and the A(American)MA presumably delegated their decision making to subcommittees like the RACP and the Australian AMA have done and these have been populated by Doctors having an interest in the subject. And these doctors tend again to be activists.
They then give their recommendations and the boards of the organisations rubber stamp them with no say from the greater membership.
So in fact the guidelines are not endorsed by the membership of these organisations but usually only by a tiny group within them. And by only including practitioners of Transgender medicine there is no independent review.
So surprise , surprise. They keep on endorsing their own Guidelines.
The only way for the affirmative model to be properly reviewed is by someone completely outside transgender medicine who can look at the data dispassionately and without fear or favour.
This is what was done in the UK and in Europe with resultant constraints on doctors treating these patients.
Members of the group Do No Harm had a stall with detransitioner Chloe Cole at the recent Endocrine Society conference in Chicago. They found European endocrinologists very open in discussing the risks of gender medicine & were surprised that America had not restricted the practice. American attendees were also concerned about the risks but felt this was not something they could express publicly. I guess Australia’s position (& the position in NZ & Canada) is closer to America than Europe.