Prof Guyatt presents an excellent overview of the ethical approach required to justify a medical intervention. This includes honesty demanded of the clinician in relation to the evidence supporting that intervention, the ‘the quality of evidence’.
The patient is then able to make an informed decision.
Given the ‘affirmative’ (aka ‘encouraging’) approach to hormonal and surgical management of gender dysphoria in children and young people, and the fact that the ‘quality of evidence’ supporting it is ‘low’/‘very low’ logic and ethics would suggest that clinicians should be discouraging patients from proceeding with any form of ‘transition’.
I was surprised to learn how recent the evidence-based movement is. To an outsider like an admission that whatever medicine had been doing, it might have had little to do with evidence.
The strict rules about evidence base are new but we have been following strict evidence based medicine for a long time in most other fields.
For example when a new drug is introduced into oncology practice it must usually demonstrate efficacy in a large randomised controlled double blind trial and efficacy means a signifcant improval in survival.
But the Affirmative Model for Transgender treatment has not had anything even approaching that, and causes major physical harm. Somehow they achieved approval for the use of GnRH Agonists which as far as I can see has no TGA approval for this indication.
It amazes me that it was ever allowed to proceed and captured support of eminent Colleges of Medicine and even Courts of Law.
Bernard I so wish you could get to the ears of Chris Minns and Perrotet and convince them not to get behind the Gay conversion therapy laws they both promissed to back, shortly after the elections in NSW. Politcians need to wake up to this and back parents fighting to protect their kids or young adults (because unfortunately the maturity doesnt suddently turn on once they reach 18)
most of the lobbying and negotiations are being conducted behind closed doors, hard to know who knows what but I believe many politicians are unaware of the situation and the details of treatments offered in clinics. All blinded by the societal shame of how homosexuals were 'treated' in the past, so keen to demonstrate their "trans friendly" attitude now. Given that the media are not covering this openly, no one knows unless they actively go searching for the information (what parents caught in it do). Once you know, and peaked, there is not way back. I am truly hoping Moira Deeming will have a chance to share her knowledge of the topic at federal level, maybe it will encourage some media (beyond the Australian) to cover this
Yes. A failure of media coverage is a big part of the problem. B
Prof Guyatt presents an excellent overview of the ethical approach required to justify a medical intervention. This includes honesty demanded of the clinician in relation to the evidence supporting that intervention, the ‘the quality of evidence’.
The patient is then able to make an informed decision.
Given the ‘affirmative’ (aka ‘encouraging’) approach to hormonal and surgical management of gender dysphoria in children and young people, and the fact that the ‘quality of evidence’ supporting it is ‘low’/‘very low’ logic and ethics would suggest that clinicians should be discouraging patients from proceeding with any form of ‘transition’.
I was surprised to learn how recent the evidence-based movement is. To an outsider like an admission that whatever medicine had been doing, it might have had little to do with evidence.
The strict rules about evidence base are new but we have been following strict evidence based medicine for a long time in most other fields.
For example when a new drug is introduced into oncology practice it must usually demonstrate efficacy in a large randomised controlled double blind trial and efficacy means a signifcant improval in survival.
But the Affirmative Model for Transgender treatment has not had anything even approaching that, and causes major physical harm. Somehow they achieved approval for the use of GnRH Agonists which as far as I can see has no TGA approval for this indication.
It amazes me that it was ever allowed to proceed and captured support of eminent Colleges of Medicine and even Courts of Law.
What were they all thinking??
And yet, Auspath response 2 days ago to the latest article recommending a cautious approch to Gender Dysphoria care published by the Westmead gender clinic team refers to it again as a golden standard. https://auspath.org.au/2023/03/01/auspath-response-to-elkadi-j-chudleigh-c-maguire-a-m-ambler-g-r-schers-kozlowska-k-developmental-pathway-choices-of-young-people-presenting-to-a-gender-service-with-gender-distre/
Bernard I so wish you could get to the ears of Chris Minns and Perrotet and convince them not to get behind the Gay conversion therapy laws they both promissed to back, shortly after the elections in NSW. Politcians need to wake up to this and back parents fighting to protect their kids or young adults (because unfortunately the maturity doesnt suddently turn on once they reach 18)
I have no idea whether or not Perrottet knows that his Health Minister & Health Department are expanding youth gender medicine.
most of the lobbying and negotiations are being conducted behind closed doors, hard to know who knows what but I believe many politicians are unaware of the situation and the details of treatments offered in clinics. All blinded by the societal shame of how homosexuals were 'treated' in the past, so keen to demonstrate their "trans friendly" attitude now. Given that the media are not covering this openly, no one knows unless they actively go searching for the information (what parents caught in it do). Once you know, and peaked, there is not way back. I am truly hoping Moira Deeming will have a chance to share her knowledge of the topic at federal level, maybe it will encourage some media (beyond the Australian) to cover this