Hillary Cass at Scottish parliamet - live

I think it's possible that PBs might be the right intervention for some.
My biggest problem with the positive affirmation model for trans identifying kids is that it's a one size fits all model. It deliberatly throws away individiual circumstances in favour of a one size fits all ( OSFA ) model of care.
I strongly reject the OSFA approach because of the many possible negative life long consequences that are not acknowledged or discussed for kids with the most incredibly complex and challenging lives.
To say that PBs could never give someone a better quality of life, even after all the negatives are taken into consideration is also a OSFA approach, and for that reason I have to reject it. For something as complex as the lives of the kids self reporting that they are trans there cannot possibly be a single OSFA solution. It has to come down to the indivdual's circumstances.
I think the number of cases where PBs were the best option would be utterly miniscule compared to what TRAs demand, but it has to remain a possibility specifically to avoid the OSFA trap.

Found it here https://www.thepublicdiscourse.com/2019/11/58371/

“In this study, the NNT appears to be a staggering 49, meaning the beneficial effect of surgery is so small that a clinic may have to perform 49 gender-affirming surgeries before they could expect to prevent one additional person from seeking subsequent mental health assistance”

Discussion is about this study https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010080.

This article doesn’t go into the number needed to harm which is the number of individuals who must be treated so that one of them presents an adverse reaction accountable to the treatment. For gender medicine, which is usually done on physically healthy bodies, must be astronomical when you look at all of the side effects.

https://en.wikipedia.org/wiki/Number_needed_to_harm

As I said, my 'minimum of 7' was being exceedingly generous on several points. Closer to 50ish certainly seems well within the bounds of the possible.

I’m disappointed if she actually said that hormones are the right treatment for some. I would have thought the jury was still out on that as well. Given there have been no recent attempts to explore more modern/recent mental health interventions and the long term evidence base is also poor for this group, I’d much prefer if she had been circumspect in this too.

As for “trans” representation, WPATH, PBs and affirmation are the perfect example of why it is essential that patients are not involved in deciding the medical direction here, beyond the same level of patient input as there might be for diabetes treatment or whatever.

I can't help wondering whether they're seeing an opportunity to adopt a more balanced position now that they're not dancing to the Green position.

What kind of person do you have to be to think that it's ok to harm 49 others to improve your own life?

That's grim.

Wings over Scotland reckons Cass's words had a big impact:

The Scottish Government's lethally reckless and misguided ban on "conversion practices" was dealt a fatal blow today.
https://wingsoverscotland.com/a-watery-grave/

I can’t find it now, but I think the number needed to treat was close to 50. So 49 people would have a negative effect before the one person had a positive outcome

Isn't one of the reasons for studies of gender incongruent children to identify who might benefit from puberty blockers or cross sex hormones? Wouldn't they try to figure out which children are likely to persist in identifying as a different gender?

E.g., if you found that all autistic boys who wanted to be a girl before age 4 persisted and none of the neurotypical boys who developed gender incongruence after age 7 did, could you start trials of PBs or other interventions (e.g., social transition vs counseling only vs wait list) for those autistic boys who had consistently wanted to be a girl before age 4, since you know that they are very likely to continue to want to be a girl? You might try various supportive services for neurotypical boys who developed gender incongruence after age 7 but you wouldn't allow them to participate in PB studies or other studies with harmful side effects.

I assumed that was one reason they wanted better data about who persisted in their gender dysphoria/incongruence. Once you know that, you can narrow down reasonable treatment or testing options.

or stand in front of signs saying "decapitate TERFS"
empty headed fools

Thanks for all the info in the thread @ArabellaScott especially the summaries of what was said.

Yes. ANy more than giving any other random intervention might help a particular problem.

The big elephant I see in all this is - what do they think the problems these kids are having are really about? What is the cause? We know they aren't actually "trans" whatever that is supposed to mean. They are kids who are confused and distressed.

They can't, or won't talk about that, so it's not possible to say, giving hormones to kids is never likely to resolve the issues they are having, and is a bad idea.

As I said, it's a question of where the line is drawn.

Of course politicians get to express political opinions at work. That's their job. By speaking and voting.

Affiliations? That's trickier. RSPB? Stonewall? Sanofi-Aventis? Millwall? Rangers?

As is expressing opinions by means other than speaking or voting. For example in the House of Commons a slogan T-shirt would be banned (don't know the Holyrood rules on those). So it's not actually a simple question. Do you allow lanyards but not T-shirts? Both? Neither? For some causes but not others? What about placards or flags?

I don't know what the right answer is, but I do know it's not as straightforward as it first appears.

It's not unlike saying every teenage boy should be castrated because some of them will go on to get testicular cancer. You would be absolutely right is saying that this approach would save some lives (so in that respect there's arguably a stronger case for castrating every teenage boy).

But you also can't harm lots of other children in the process of helping a tiny number
If we make some very generous assumptions, the number needed to treat¹ (back of an envelope calculation) seems to be at least 7.The number needed to harm is 1. That is, every single person who receives the treatment is harmed² by it - even if some also receive a benefit that might (in some cases) outweigh the harm.So unless and until there's some way of narrowing down who might be the 1 in 7, there's no way ethics panels should be even considering this sort of treatment. ¹ A research measure that says how many people on average would need to receive the treatment for 1 to benefit. It's a hypothetical measure that assumes the treatment has no harmful side effects, and it's particularly difficult to calculate for something like transition. So it's of limited usefulness, but gives us some sort of number to compare with the NNH.² Not just 'side effects', which we know are common and serious, but judged against normal pubertal development the actual intended effect is a harm.

Couldn’t agree with you more. This goes for anyone working in the public sector.

Is that another politician stepping away from trans extremist beliefs?

“On matters of such sensitivity about the wellbeing of children and young people we should listen to clinicians.”

And thank you for the thread Arabella.