It is quite possible that the recent Pelvic Mesh disaster that resulted in litigation payouts in the range of 8 billion dollars globally will not be a one-off in recent history.

The vaginal mesh implant was introduced in the late 1990’s as a treatment for pelvic organ prolapse in women, a not-uncommon complication following childbirth. No randomised controlled clinical trial had been undertaken prior to the introduction of the device.

It is estimated that globally some 3 to 4 million were surgically implanted.

It took a few years prior for the realisation that serious complications associated with the implant were occurring, these included: chronic pain, dyspareunia, vaginal migration of the device, incontinence and systemic auto-immune conditions.

The of lawsuits commenced around 10 or 15 years after the introduction of the device and rapidly escalated reaching some $1,000,000,000, one thousand million dollars in payouts and an awful lot of damaged women.

The message from this global disaster must surely be that untrialled invasive therapies must not be used in otherwise healthy individuals.

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Dr Predny's conclusion quoted above that: “A major Australian [medical indemnity insurer] withdrawing cover in this way sends a message to all clinicians that gender-affirming care is an inherently high-litigation-risk area of medicine, even though there is no evidence to support this notion,” and her fear that “(i)t will discourage doctors not already working in this area from building their skill base and providing gender-affirming care” (forgetting to mention the likely exodus of doctors already working in the area!) made me laugh.

The people in insurance companies whose analysis is drawn on to make such decisions are actuaries, not ideologues. My brother is one. They are stone cold, hard-headed, bloodless, objective arbiters of economic risk. It can take up to 10 years to become a fully qualified actuary. The assignments and exams in my brother's course consistently offered only one grade of pass—and multiple grades of fail.

To suggest that such hardworking, left-brained, emotionless, freakishly mathematical professionals might be prone to act rashly or prejudicially, without looking at the evidence, is utterly preposterous.

How long will gender doctors continue to live in delusional activist fairyland? Are they, like other narcissistic medicos at the dark heart of some of the world's worst scandals, still dreaming of a Nobel Prize? Do they really need to be thrashed in court before they realise that reality cannot be pushed aside forever?

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