NEW: Grounds in support of intervention in the Bell v Tavistock JR appeal published

Pathologising the normal process of puberty for commercial gain.

Whoopie.

So he self confesses to 'salivating' at the thought of being able to administer drugs to children who he knows cant consent.

OP wrote:
"I think many of us have been wondering just how medical practices for dealing with gender identity issues in children have changed so rapidly over the past decade or so. Who is pushing earlier and earlier use of puberty blockers, cross-sex hormones, and surgery in children, without controlled clinical trials (and apparently ignoring the evidence that does exist that many children will desist if allowed to go through their natural puberty)?

One Norman Spack appears to have played a major role. Spack is a pediatric endocrinologist who founded the Gender Management Service (GeMS) at Boston Children's Hospital in 2007. It bills itself as "the first major program in the United States to focus on transgender children and adolescents."

The Daily Mail called Spack "evangelist-in-chief for early medical intervention" and "the guiding light of Mermaids and a friend of both Susie Green and Dr Webberley."
www.dailymail.co.uk/news/article-3973036/Jackie-Green-heart-controversy-children-young-nine-given-drugs-change-sex.html

from that article:
He wants children who identify as transgender to routinely be given hormone-blocking drugs around the onset of puberty, and then move to high doses of hormones to change their sex, after which they can consider surgery.

The Spack philosophy is that age limits are arbitrary and often cruel. ‘Why wait?’ is his mantra. He says he has put ‘about 200 children’ onto hormone blockers, and claims 100 per cent have gone on to take cross-sex hormones because ‘no one changes their mind’.

Here is a Q & A with the doctor published in 2008:
archive.boston.com/bostonglobe/ideas/articles/2008/03/30/qa_with_norman_spack/?page=full

Some bits that stood out to me (Spack in italics, my own comments in brackets):

All I know is that when I see preadolescents, they have been dressing in the underwear of the other sex for years. These kids are almost certainly transgendered. [As we know, the clothes make the man/woman/boy/girl.]

The puberty-blocking drugs work best at the beginning of the pubital process, typically age 10 to 12 for a girl and 12 to 14 for a boy. Stopping puberty is, in itself, a diagnostic test. If a girl starts to experience breast budding and feels like cutting herself, then she's probably transgendered. If she feels immediate relief on the [puberty-blocking] drugs, that confirms the diagnosis. [Gee there are no possible other reasons girls in our society might feel distress at body changes during puberty, huh?]

You have to explain to the patients that if they go ahead, they may not be able to have children. When you're talking to a 12-year-old, that's a heavy-duty conversation. Does a kid that age really think about fertility? But if you don't start treatment, they will always have trouble fitting in. And my patients always remind me that what's most important to them is their identity. [So he understands that his patients are incapable of truly informed consent to sterilization...]"

And from the article linked by OldCrone:

"The puberty-blocking protocol gained legitimacy in 2009, when it was endorsed by the Endocrine Society, the leading association of hormone experts, on the recommendation of a task force including Dr. Spack."

Apols if this was already posted. A thread from Maya about the co-opting of the RCOG and their statement about Gillick.

twitter.com/MForstater/status/1354594516624437248

Incidentally, my impression is that people in the US are much more likely to talk proprietorially about ‘my endocrinologist’, ‘my OBGYN’, ‘my dermatologist’ as people who promote wellness.

In the U.K., you usually only see a specialist if referred by a GP because something is wrong.

The culture seems very different.

However, even if you follow that line of thinking, you still have to start with a diagnosis.

There is a huge difference between that and an American lobby group for the pharmaceutical industry who wants to promote drugs that evidence suggest has no benefit to children who can’t consent to them.

It shows that this is not about child welfare but about pushing for a particular position no matter what the cost to children who have to live with the consequences.

I think Siablue there was a lot of evidence from around the world but in KB's case, they were very high in their professions which is why they were giving evidence. Whether these interveners are at that level, I don't know

I've just started reading this book from 2009 that may be of interest to others. It has a lot of parallels to the way the US is approaching gender identity. It available for £3.99 on Kindle.

Cohen, Susan. Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry's Quest to Manipulate Height

Normal at Any Cost describes more than fifty years of medical attempts to modify height in children. The broader purpose is to illustrate how the future might play out as medicine offers more and more opportunities to change inherited traits. Because over the last five decades, as physicians discovered ways to treat pathological conditions that make some people extremely tall or short, they also intervened in the lives of young patients who were normal and healthy, just far from average. Along the way, doctors made miracles and caused tragedies. They found themselves facing ethical dilemmas that reach far beyond the issue of how much height matters. They engaged in a running debate about what is normal; whether their prescriptions alleviate suffering or reinforce social prejudice; and how far they should go to accommodate the wishes of children, or the aspirations of parents. In a way, this small group of doctors has been on the front line of the future, along with the families of the tallest and shortest kids.

We tell this story decade by decade. It begins with girls whose mothers worried they would grow too tall to be happy, and who dutifully took massive doses of estrogen to stunt their heights. It describes how the pituitary gland, a pea-size organ that sits at the base of the brain and produces growth hormone, fascinated scientists who competed to harvest cadavers for the stuff that might make short kids grow. The book narrates the early days of treating children for dwarfism, until a strange disease seen in the elderly and among cannibals in a Papua New Guinea jungle struck down a young man in California. It follows scientists who raced to synthesize human growth hormone using the new technology of genetic engineering and in the process launched an entire industry, then details how that industry sometimes stepped over the lines of legality as it turned short stature into a market. The later decades include detective stories of a sort, as adults given treatments as children found one another, and as researchers tried to track down what became of these children. The final chapters show how, as ways to manipulate height expand, the government agencies that protect patients, the nonprofit organizations that speak for them, and the physicians who treat them have all been influenced by the pharmaceutical companies that sell to them. In the end, short stature is a multibillion-dollar business that is still growing like a weed.

The most notable thing that is missing from this is Mermaids. Have they decided to ditch Mermaids. I noticed that the description of Gendered Intelligence is that it is a trans run organisation.

The endocrine society thing is very sinister. Why are an American lobby group promoting drugs intervening in a British court case about whether children can consent to treatment?

merrymouse I have the horrible feeling that in America there are attempts to make gender dysphoria an endocrine disorder. So instead of saying that someone has such severe dysphoria that they need to take cross-sex hormones, it's presented as "This person is a boy (because they say they are). But they have girl hormones. This is an endocrinology problem."

I'll see if I can find some evidence for this assertion - it might have been in California or Canada?

My impression was that the main reason for the High Court's judgment was lack of evidence to enable them to make a different judgement.

These interventions seem very much along the lines of "Do you know who we are?", but there doesn't seem to be much suggestion that they are going to provide the missing data.

Agreed. Which places specific emphasis on the quality of the consents discussion at the Tavi end, but unfortunately there seems to have been huge problems there if the level of careful recording of patient consents is anything to go by.

So an endocrinologist can diagnose hyperthyroidism, but how can they make a diagnose that depends on a psychiatric assessment? The document actually says that endocrinologists diagnose diseases related to the glands. However, I don’t think it has ever been suggested that there was anything wrong with KB’s glands.

There seems to be a misuse of the word ‘referral’ in the grounds for intervention. A GP refers - they pass the case on to somebody else, but presumably in this case an endocrinologist should work as part of a team and is only responsible for a discrete part of treatment.

I am confused about where an endocrinologist would fit into the diagnostic process in the U.K.

I understand that they would prescribe and monitor, but to diagnose, wouldn’t they need to demonstrate a hormone disorder?

Salivating.

Ugh.

www.nytimes.com/2015/06/17/nyregion/transgender-minors-gender-reassignment-surgery.html

One of the first and biggest hormone programs for young teenagers in the United States is led by a Harvard-affiliated pediatric endocrinologist, Dr. Norman Spack, at Boston Children’s Hospital.

Dr. Spack recalled being at a meeting in Europe about 15 years ago, when he learned that the Dutch were using puberty blockers in transgender early adolescents.

“I was salivating,” he recalled. “I said we had to do this.”

is this org the same endocrine society whose guidelines were developed by Norman Spack et al?

I have no idea. I have never heard of Spack I'm afraid. Do I dare ask?

So they would be over turning that ruling in order to get this through on this argument.

I expect the American endocrine organisation want to intervene because they think that if keira's team won again, waves will slowly ripple out through the world.

I think that's exactly the case. I imagine there are a few ambulance chasers in the US sniffing the air and turning a predatory gaze towards some of the ES's members.

I expect the American endocrine organisation want to intervene because they think that if keira's team won again, waves will slowly ripple out through the world. It won't effect them directly, but they must think that if the court of appeal in London are on record saying "children cannot consent to this, this is experimental medicine with a dodgy evidence base" it will not be good for business in the long run.

Is this org the same endocrine society whose guidelines were developed by Norman Spack et al?
I'm actually amazed that Stonewall want to continue their involvement. They are the only ones in this who could still back away from the 'trans kids' agenda relatively unscathed.

That grounds for intervention by is wonderful- really cheered me up.

It's like they haven't even read the reasons the initial appeal was denied. They bang on about how their staffs (lived) experience is that kids are gillick competent and transition really helps them but:

a) the first court already had that 'evidence' and it wasn't nearly enough to outweigh the known and potential harms or the difficulty in any child assessing such long term risks.

b) the appeal court already strongly implied that the appeal was likely to fail on that basis, when it allowed the appeal

c) the case for PBs being efficacious got a lots worse the day after the verdict when GIDs finally released their data showing no evidence of MH benefits.

I think those activists do indeed think that they own the Tavi, and that the clinicians there should be doing what they're told with no questions. Much like the activists who have taken ownership of WPATH.

It will be better in the long run if they get to put their case, and absolutely all the evidence is put before the court.

And I'm absolutely willing to be convinced. If there is a case to be made and evidence to be assessed that hasn't yet been shared then yes, very important that this is put forward in full daylight.

But I'm still confused as to how when I thought no new evidence can be put forward, and as to why when the Tavistock were the experts and it was between the court and them why activists seem to feel its between them and the court. That's something I'd like to understand more off, because the Tavistock went to court as the experts, submitting the evidence they had and the policy and practice and case studies that they had and wished to use to justify their position and practice. What activists have to do with that is debatable unless you're looking at concerns raised by CQC and whistleblowers.

Unless this is a case of a technicality of law that somehow three (two very senior) judges got wrong - which again will be fascinating to see proven and explained. Or that it's felt that it is better to let all this be said, since in the refusal to intervene and refusal to grant an appeal it was made plain that the emotion, personal accounts and anecdotal evidence was not relevant to the case.

Signal box I agree. Justice being seen to be done. It will be better in the long run if they get to put their case, and absolutely all the evidence is put before the court.

I wonder how this will all affect the cass review? Will she have to wait and see what the court of appeal say?

I expect the American endocrine organisation want to intervene because they think that if keira's team won again, waves will slowly ripple out through the world. It won't effect them directly, but they must think that if the court of appeal in London are on record saying "children cannot consent to this, this is experimental medicine with a dodgy evidence base" it will not be good for business in the long run. The tanker has started to turn and they are trying to nip it in the bud. (3 metaphors for the price of one!)