Hillary Cass at Scottish parliamet - live

@Sloejelly
No.
What you do is push 100% of patients through treatment A that has a 95% sucess rate. You check to see if it's working for each patient. For 95% it will work.
For the remaining 5% you then explore other options. Try and figure out why option A doesn't work for them. What's different?

50/50 A B is strawmanning. Making up something ridiculous and then holding it up as ridiculous. Absurdity is not a rational argument.

Having watched the committee session I’m pensive: the MSPs in this committee seemed to largely have a good grasp of what Cass was saying in her report and largely seemed non-hostile to Cass herself. Should we anticipate future statements or voting behaviour to reflect this new understanding they’ve reached post-Cass Review? Or is that too much to hope for?

For x condition there are two treatment options, only one can be followed:

• Treatment A - 95% complete cure rate, no adverse effects, no ongoing treatment necessary
• Treatment B - anecdote suggests possible benefit to 0.00001%, serious adverse effects, lifetime dependency on medication, requires ongoing surgeries, and high risk of suicide following treatment.

Dear ethics committee, we intend to run a trial comparing these treatments. Half the children will get treatment A and half will get treatment B….

If you want to have a crack a defining transgender, have at it. I have no such desire because I don't believe it, but i still need to be able to use language to describe who I'm referring to.

Do you though?

Nobody can define 'transgender' or 'gender' or 'gender whatever' and those that have, basically include all women who own a chainsaw or a drill, or guys who like to do the washing.

It is all bobbins. The whole rotten lot of it.

That's the point. Once you use the term you are moving them from 'normal human who likes a range of things or people' to 'potential human for therapeutic or medical intervention'.

I think Cass erred on the side of diplomacy when she said puberty blockers should only be assessed as part of a rigorous research trial because I highly suspect Cass knows damn well that such a trial would never get past any proper ethics committee because of the harm that would result, not to mention the very real problem as OldCrone points out of there being no clear indication as to what is being treated.

She knew if she said “not now, not ever” it would be a stick to beat her report with. Saying what she said doesn’t mean there’s a valid option of doing just that.

There were many reports of people claiming benefit from their lobotomy. It doesn’t matter how many that was or what the percentage was. It was clear you could not identify which patients would.

There is no such thing as a trans child. It’s not possible to be born in the wrong body. Even if adults think their lives are better because of PBs, they are saying that while existing with the harm they have inflicted.

@Sloejelly and @AlisonDonut
It feels to me very much like because no gender borg can debate why they think all the current gender woowoo is great, that for you I'm going to have to do as an outlet. I don't support gender ideology, or whats being done to kids.

example
OK lets start with this... You take all the kids who self report as transgender

Can we define 'transgender' first?

What is it?

I am not advocating for transgenderism. When I use the words "self report as transgender" I'm trying to convey that kids believe something about gender trumping sex. It's a big pile of all sorts of muddled gobbledygook. The kids identifies as some element(s) of that muddled pile. My language is "self reports" as having some element of the shitshow. Clearly I'm not validating it when I say "self reports as". If I said ( regluarly ) "transgender kids" then you'd have a point, but I don't. If you have a better phrase to describe those kids then I'm all ears.

If you want to have a crack a defining transgender, have at it. I have no such desire because I don't believe it, but i still need to be able to use language to describe who I'm referring to.

And we come back to what is meant by ‘useful’?

If a kid turns up at a UK doctor who is using PBs bought from outside UK, the data on that kid's experience should be used to increase medical knowledge,

In what way do you think their biased anecdotes would contribute to “proper evidence based research following the scientific method”?

If you are promoting giving puberty blockers to children as part of a trial then you are advocating harm to children.

80% is the lower end, other studies found over 95% or cases resolved after puberty.

We already know from existing research that the most effective treatment - 80% effective - is going through puberty.

You cannot ethically try a high-adverse-effect treatment that helps (but doesn't cure) 0.00...01% before the no-side-effect treatment that cures 80%. And you can't use a puberty blocker after puberty.

So unless and until you can identify the 80% - ideally also the 0.00....01% - there is no clinical place for PBs.

Until then, we absolutely should be doing retrospective case series on the people who have already taken them, but there is no reason for new trials. It would be like testing a vaccine for ingrowing toenails that only works on people who've had both feet cut off.

By the time we have a way to identify the 80%, we could have extensive data from the retrospective work to assess the need for and ethics of any future prospective trials.

I seem to remember that the interim Cass report said something along the lines of "no more puberty blockers for kids, unless it's done within the scope of an approved and tightly controlled research study". This seemed like a positive step at the time. You may argue that even this constitutes harm.

I would say that this constitutes harm. What is the benefit to the children in this study? They are being harmed. Unethical experimentation on children should never be given approval. Even if the children think they've consented and their parents have also consented.

Up to now we've hypothetically dealt with 99.9xxxx9%, but there's always going to be one or two edge cases. And in those cases competent medical professionals may be forced to consider other options. It's possible PBs might be on the list.
I'm not a doctor, but Cass is. I trust Cass on this.
If we say PBs can never be the answer under any circumstances then in my opinion we fall into the same trap as the trans rights activists. Pre supposing that we are right, and being closed to any possibility we dislike.

But first, as I said, we need a definition of gender dysphoria. What is it? What is the illness that is being treated?

And we need a description of what a positive outcome would look like. What are doctors trying to achieve by treating children with these drugs? What is the benefit of treating them as children rather than as adults when they can make mature decisions with a full understanding of all the implications of treatment?

I don't think it's presupposing anything to say that a child with no sexual experience cannot make an informed decision to have their sexual function permanently impaired. It's not presupposing anything to say that a child cannot consent to being sterilised.

No no I'm not.
I think you are fundamentally misunderstanding what I'm saying. I think you are injecting some meaning of your own into what you think I am saying, and arguing with that.

What I am saying ( again ) is that I am in favour of proper evidence based research following the scientific method. I want the medical profession to increase their knowledge on this issue to be able to help these kids with more appropriate treatment than kumbyya gender woowoo.
I have to be prepared that it is possible that the research may involve things I disagree with.
I seem to remember that the interim Cass report said something along the lines of "no more puberty blockers for kids, unless it's done within the scope of an approved and tightly controlled research study". This seemed like a positive step at the time. You may argue that even this constitutes harm.

Young trans reporting kids still currently have access to PBs from external to the UK providers e.g. Gender GP. I think this is very wrong and should be illegal asap. But I think doctors should use all sources of information to increase their knowledge. If a kid turns up at a UK doctor who is using PBs bought from outside UK, the data on that kid's experience should be used to increase medical knowledge, and it should also be used by politicians as a reason to outlaw the practive and shut places like Gender GP down.
Is that kid being harmed by the PBs yes, is the data from their use useful, yes.

OK lets start with this... You take all the kids who self report as transgender

Can we define 'transgender' first?

What is it?

lechiffre55 you posted a link to the TGN1412 phase 1 trial, can you be sure that there are no children with ‘gender dysphoria’ who could benefit from that drug? That there isn’t 0.0xxxx1% of cases, edge cases, that could benefit? Perhaps doctors should have this drug as an option? Would we be falling ‘into the same trap as TRAs’ to presuppose that it won’t help?

But you are advocating for harm.

But first we need a definition of the condition or disease that the treatment is designed to treat. And also a clear description of what a good outcome would look like. What would be considered to be a successful result?

This.

Because many of these children, who have been showing up to gender clinics, would be absolutely convinced they have actually been 'born in the wrong body'. Just because they don't follow social stereotypes.

Activists have convinced doctors to treat children with harmful drugs over a made up condition.

And yes, what is a successful result?

Living a permanent lie would not appear to be the best way to treat a severe mental health issue.

And in terms of puberty blockers, surely they arrest mental maturation, as well. I'm constantly struck by the children who have been on them who appear to be walking around in a permanent state of adolescence.

Jazz Jennings, Jackie Green, all those transmen in the Stella O'Malley documentary. They all come across as self-absorbed teens.

It can't be considered successful if you have arrested the physical and mental development of children to the point where they have no idea that they're wandering around totally undeveloped.

There's a reason people compare it to lobotomies.

Removing the capacity for mature, developed thought, because of a mental health issue?

I don't think they are a good idea.
I'm not going to harm any kids, it's not my decision to make. It's the doctors like Cass who get to make that decision. Maybe the doctors agrees with you and that's the end of it. I'm not a doctor and I don't get to decide.

OK lets start with this.
You take all the kids who self report as transgender, and you do what any sane person would do, and what the Cass report advises, and you get some psycologists to talk to the young person and find out what mental issues the young person is dealing with. You examine all sorts of things like sexual orientation, family life and cicumstances, possible physical and sexual abuse, any trauma, is one or more parents Munchausen by proxying etc.... And you help the young person with all that. The hollistic appraoch recommended by Cass.
And then you keep up the mental health care, and you monitor and track it. As the person grows older you keep up the care. For some people this might be enough. Some people might require more long term support than others. Some people might require lifelong mental health support.
Lets say for well over 99% and a few more 9s past the decimal point this gives the best outcome. Lets say for the vast majority going through puberty and or coming out as same sex attracted resolves their major issues. For others a change in circumstances e.g. removal of abuser proves to be the solution. And so on and so on. You could categorise patients into ever smaller groups by problem/solution. And some will require not just one solution but several, and belong to several problem/solution groups.
All of this so far would be great research for how to help trans identifying kids. Especially if follow up data was gathered for as long as possible.

Up to now we've hypothetically dealt with 99.9xxxx9%, but there's always going to be one or two edge cases. And in those cases competent medical professionals may be forced to consider other options. It's possible PBs might be on the list.
I'm not a doctor, but Cass is. I trust Cass on this.
If we say PBs can never be the answer under any circumstances then in my opinion we fall into the same trap as the trans rights activists. Pre supposing that we are right, and being closed to any possibility we dislike.

Thanks for outlining this Alison. You're research for your 'puberty blockers how did we get here?' thread is really paying off!

And if that future research shows PBs are never a good idea, I'm utterly fine with that, and if it shows under very exceptional circumstances they can provide the least worst outcome, then I have to be fine with that too.

How many children are you prepared to harm before you agree that they are never a good idea?

Sorry, again to discuss the thing that for some reason people don't want to be discussed, they have seemingly been doing this since at least 1998, off label, with no follow-ups, so for a quarter of a century.

I am unsure what 'future research' could be useful here.

They are treating 'gender disphoria, distress, incongruity' whatever the latest iteration of the 'problem' is.

With drugs that are not safe.

On kids.

My point being that at the end of the day the acid test is when humans actually take the new drug. Everything up until then counts but humans taking it and observing the results is still important.

But first we need a definition of the condition or disease that the treatment is designed to treat. And also a clear description of what a good outcome would look like. What would be considered to be a successful result?

I don't believe anyone has yet come up with a definition of gender dysphoria in children which indicates that interfering with their normal development into adults is an appropriate treatment.

What is considered a good outcome of this treatment? The best that can be hoped for is that the child will become an adult who convincingly resembles a member of of the opposite sex. This adult will not have normal sexual function and will be infertile. They will be constantly on their guard about being outed as their actual sex.

It seems to be assumed that despite this, as an adult this person's mental health will be better than it would have been had they been allowed to grow up to be a an adult with their sexual and reproductive functions intact, and who isn't constantly aware that they are living a lie. This seems unlikely.

And that's before we start to consider the physical health implications of treating children with these drugs, such as the impact on bone health.