To nominate the principle authors of the CASS review for this..

[NameChangeCass]

“Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.”

https://www.bmj.com/content/327/7429/1459.short?fbclid=IwAR0hTt57o-yFS61aJE-IGCpKSPaDs--rdrPlbiby_wBCF1czpAWDaCcAEcM_aem_ATiWMtvZxiSzw8pj9CX271gyDByuMHTOKwQskBcCXx9aZOj1IPusHJ_z79olcRiFlhE

lol thanks for “mansplaining” the methodology of systematic reviews to me.

Ive personally conducted many, but thank you very much.

There’s no point in lying on the internet when it’s apparent to everyone that you haven’t got a clue what you’re talking about. 🤣🤣🤣

Your blurry screenshot does not come from that paper.

Shark jumped.

Okay, I've found the paper, can't find that table. And on page 182 of Cass it says

15.19 The studies had many methodological problems including the selective inclusion of patients, lack of representativeness of the population, and in many of the studies there were no comparison groups. Where there was a comparison group, most studies did not control for key differences between groups

Nothing about "double blinds" there...

(Indeed, there's basically nothing on "blinds" in Cass itself, apart from in an explanation of terms).

It's almost as if OP is just making stuff up.

From the BMJ (think part of it was screenshotted below):

One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret. The methodological quality of research matters because a drug efficacy study in humans with an inappropriate or no control group is a potential breach of research ethics. Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions. Yet this inconclusive and unacceptable evidence base was used to inform influential clinical guidelines, such as those of the World Professional Association for Transgender Health (WPATH), which themselves were cascaded into the development of subsequent guidelines internationally (doi:10.1136/bmj.q794).7
The Cass review attempted to work with the Gender Identity Development Service (GIDS) and the NHS adult gender services to “fill some of the gaps in follow-up data for the approximately 9000 young people who have been through GIDS to develop a stronger evidence base.” However, despite encouragement from NHS England, “the necessary cooperation was not forthcoming.” Professionals withholding data from a national inquiry seems hard to imagine, but it is what happened.
A spiralling interventionist approach, in the context of an evidence void, amounted to overmedicalising care for vulnerable young people. A too narrow focus on gender dysphoria, says Cass, neglected other presenting features and failed to provide a holistic model of care. Gender care became superspecialised when a more general, multidisciplinary approach was required. In a broader sense, this failure is indicative of a societal failure in child and adolescent health (doi:10.1136/bmj.q802 doi:10.1136/bmj-2022-073448).89 The review’s recommendations, which include confining prescription of puberty blockers and hormonal treatments to a research setting (doi:10.1136/bmj.q660), now place the NHS firmly in line with emerging practice internationally, such as in Scandinavia (doi:10.1136/bmj.p553).1011

www.bmj.com/content/385/bmj.q837

Apologies I am on my phone. It’s from here:

https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf

NameChangeCass · Today 10:01

The CASS review has made recommendations that puberty blockers (and other medical treatments for trans children) should no longer be routinely be available on the NHS on the grounds that there isn’t enough evidence on their efficacy. In reaching this conclusion they chose to discard evidence from around 100 studies on the grounds that these studies weren’t double blinded , randomised control trials.

They omitted 98 trials, because they were poorly designed and recorded and were effectively useless and / or misleading. Every stage of the report was reviewed in a two stage process. All statistical analysis was checked and approved by two independent experts.

It's not wise to listen to heavily invested non scientists and non statisticians and their emotive rants.

They omitted 98 trials, because they were poorly designed and recorded and were effectively useless and / or misleading

thank you. Most of this thread has been spent with people trying to dispute this.

They omitted 98 trials, because they were poorly designed and recorded and were effectively useless and / or misleading

thank you. Most of this thread has been spent with people trying to dispute this.

Again, if you genuinely want a good faith engagement here, point to at least one specific study, by name, that you personally think has been wrongly excluded.

thank you. Most of this thread has been spent with people trying to dispute this.

I don't agree with you and I'm actually wrong, having read some the links...

The fact that you can't refer to a specific study which you think supports your case for puberty blockers speaks volumes.

Explain social benefits?
There should be a cost v benefit analysis but I don’t think social benefits are a factor!

First do no harm.

Erm… you know that this comment does not support your position, don’t you?

I am actually quite angry about this thread.

Not least because the level of methodological understanding being employed is ‘haha. Why don’t they do RCTs about parachutes if RCTs are so good?’. Seriously, people HAVE died jumping from things without parachutes. They have died from parachute failure. None of that is funny.

You don’t do RCTs where you KNOW that one of the options will kill people. Despite TRAs using the spectre of suicide in deeply dangerous and problematic ways across any sphere they are active in, there is no comparison here.

Indeed, one of the reasons the evidence base in gender medicine is so poor is because so many of the interventions are unethically risky to conduct RCTs for.

The relevant comparison is advocates for parachuteless free-falling insisting an evidence base of extremely poor quality attitudinal surveys proves that you don’t need parachutes - indeed that insisting that people use parachutes is free-fall-phobic.

I don't want the thread to be deleted because it's such a great example of the logic and rhetoric of transactivism.

I fear that it will inevitably be deleted because the start point of ‘haha. Why don’t the authors of the Cass review kill themselves?’ (which is exactly what the OP intended to imply) is outright nasty.

And every subsequent post shows that our namechanging agent provocateur is not operating in good faith in any way.

Yes - both of those things are absolutely characteristic of so much online transactivism. But it’s hard to see how @MNHQ can really justify leaving it up.

oh please stop with the ridiculous pearl clutching about the parachute trial joke.

I was quoting a humorous and well known joke from a satirical article published in the BMJ. ( The excellent joke being very pertinent in the context of the Cass review).

If the readership of the BMJ can cope, I’m sure the robust ladies who frequent mumsnet Aibu can manage…

You don’t do RCTs where you KNOW that one of the options will kill people.

This. It's just fatuous.

As is characteristic of your approach here:

1. misogynistic insults to discredit ✅
2. decontextualised claims ✅
3. missing the point on purpose ✅
4. gaslighty ‘it’s a joke’ ✅

And so on.

But it’s not relevant. Because that bmj article is not arguing that medical and surgical interventions with life long implications should be carried out on children on the basis of poor quality evidence. That article has NOTHING to do with that.

You did start a thread basically saying ‘why don’t the authors of this report I don’t like kill themselves’. Which speaks volumes about you.

What 😂. I’m not “gasslighting” it’s a joke. It’s literally a joke. Or are you suggesting that the BMJ article is serious?

Other countries seem to be taking on board the results of the Cass review. Just the OP and other TRAs seem to be struggling to read the room.

www.telegraph.co.uk/world-news/2024/04/13/belgium-netherlands-puberty-blocker-restrictions/

These are the footnotes:

Contributors GCSS had the original idea. JPP tried to talk him out of it. JPP did the first literature search but GCSS lost it. GCSS drafted the manuscript but JPP deleted all the best jokes. GCSS is the guarantor, and JPP says it serves him right.

It's the wishing it on individuals part that's not acceptable. It ceases to be a joke.

That BMJ article was a joke. Yes.

My comment is not about that article at all. It’s about your thread.

But you know that. Because you are disingenuous right down to the bone.

From the article:

We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

Thats literally part of the joke. The part that makes it funny.
No one is wishing anything on anyone . it’s. A. Joke.