Susie Green

[SlowlyShrinking]

Is the implication that she supports this? I suppose I shouldn’t be surprised, but fucking hell!!

Females wanting breast implants on the NHS unless for cancer need psychological assessments in Fife and some fail because they overplay how depressed they'd be if their breasts weren't bigger and appear body dysmorphic. It seems odd to allow males breast implants without a psychological assessment

What are the ethics committees doing these days?
The people who keep a close watch on genetic research used to be quite vocal in areas of significant medical development.
They seem strangely silent.

IME they're coming up with more pointless barriers that don't actually have anything to do with ethics.
My institution seems to base their ethics on potential negative social media impact to the university. Often it feels like this is all they're concerned about . Though no one will now dare to put anything trans related to our dept ethics committee after someone was 'managed out' for innocently commenting on the legality of a TW taking funding intended for females.

(Not medical and will out myself if I'm too specific but very relevant to trans presence and behaviour online. There are years of research to be had out of this if things ever calm down.)

As a general rule, the more serious or risky the interevntion, the more detailed the process of informed consent needs to be, and although doesn’t necessarily have to be written, it will usually be considered good practice.
In order to give informed consent, a patient must be able to believe, understand and retain the information they are told and then use that to make and communicate a decision.

A while ago, I read a piece by a neurosurgeon who specialises in particularly difficult surgeries. He said that if his patient and their companions aren't shaken or actually crying by the time he's finished explaining the risks of certain procedures to them then he assumes he hasn't been clear enough.

That sounds brutal but he was obviously completely committed to the idea that people should fully understand the surgery that was being recommended and the various outcomes or they couldn't begin to provide informed consent.

What's shocked me the most was when I learned fairly recently that one side-effect of puberty blockers was probably preventing the natural maturation of the brain.

Presumably, that's something that could be evidenced by MRIs or fMRIs? Providing, of course, that adults who were given puberty blockers as children would consent; and, anyway, would it be ethical if it was likely that the scans would show their brains were irrevocably impaired?

It's such a minefield. There's too much history of medical science being used for purposes other than the wellbeing of patients. I'd guess that most people think that's in the past, but ideology has reared its ugly head yet again.

Thank you for your fantastic insights, Red

Great posts Red. You've really opened my eyes to the whole wider issue around ethics and lobbying in medicine.

I stepped down from a role I occupied within an LGBT organisation in part because an event was held raising money for Mermaids and I find that organisation's objectives deeply, deeply worrying.

I saw this tweet earlier and was aghast at it, even by the standards of the stuff I have previously seen from this source. It really is concerning -- surely no reasonable person could think what this message says about other surgeries is accurate, or what it seems to imply about surgery for those still legally children is in any way a good idea.

red I love reading your posts they always break it down for me that helps my processing

If we can stay measured on this, I believe it makes it more difficult for this thread to be challenged.

Emotion, when it comes to talking about medical ethics, can be very unhelpful. Its a tool to manipulate feelings, but ethics and research are purely about rational and logic. Emotion has a habit of getting in the way of establishing best practice.

Red Thank you, I always appreciate your informed, reasoned and compassionate posts.

This point especially is really important.

detailed 4thWaveNow article :
'Should Mermaids be permitted to influence UK public policy on ‘trans kids’?'
Posted on October 21, 2017
by Artemisia
(extract)
"Mrs Green has promoted Mermaids energetically. As CEO, and before that, Chair, she has been regularly quoted and interviewed in the media. In recent years she has been an invited speaker at various forums and conferences. Convenors have included the Westminster Social Policy Forum and the Royal College of Paediatrics and Child Health.

In 2015, Mrs Green was selected to give evidence in person to the inquiry into Transgender Equality conducted by the Women and Equalities Committee of the House of Commons. Mermaids also submitted a written statement. Later in this post I shall have more to say about that.

In a previous post I discussed an episode in which local authority social workers handed over to Mermaids the effective management of a child welfare case. This did not end well. Ultimately the High Court ordered that the child be removed from his mother. The charity was excluded from further contact.

Mermaids also offers training to professionals:

social workers
teachers
health workers
With this in view, it is reasonable to enquire into Mrs Green’s qualifications for the kinds of activity she and her organisation undertake. Under ‘Education’ on her LinkedIn page there is only one institution listed: ‘prince2 academy’.

PRINCE2 is an acronym for PRojects IN Controlled Environment and as its name suggests, it is a project management system. The PRINCE2 Academy appears to be a set of courses delivering online training in the PRINCE2 method. It is not clear if Mrs Green is a registered PRINCE2 practitioner or whether she has simply taken the foundation course. But that is not particularly important.

Project delivery is about process. Training, advocacy, an advisory role with respect to public policy: these are primarily about content. Delivery of accurate information is key, accompanied with well-informed insight, perceptive analysis.

Let’s look at how Mermaids measures up.

Mermaids submitted erroneous evidence to the Women and Equalities Committee

The following passage is taken from the written evidence submitted by Mermaids to the Transgender Equality Inquiry conducted by the Women and Equalities Committee in 2015.

Mermaids frequently quote the Equality Act, primarily to schools unwilling to accommodate trans children. Antithetically, a young person of 16 wanted their name changing at school but their parents did not consent to this. Although the Equality and Human Rights Committee found the schools refusal to comply was discriminatory, they could not proceed with action against the school as the young person was under 18.

[Recommendation]: Lower or remove the age the Commission could pursue a young person’s complaint without parental consent.

This passage was quoted in the Committee’s report, which duly recommended:

The Equality and Human Rights Commission must be able to investigate complaints of discrimination raised by children and adolescents without the requirement to have their parents’ consent. [See pp. 27, 74, 81]

Following which the Government Equalities Office looked into the matter. Here is the Government response:

No such restriction exists on the Equality and Human Rights Commission’s (EHRC’s) power to investigate complaints of discrimination, and we are not aware of any legal basis for the statement in Mermaids’ written evidence to the Committee that “a young person of 16 wanted their name changing at school but their parents did not consent to this. Although the Equality and Human Rights Committee [sic] found the schools [sic] refusal to comply was discriminatory, they could not proceed with action against the school as the young person was under 18.” The Committee may wish to note that, in order to comply with the Data Protection Act 1998, the Equality Advisory and Support Service may pass an individual’s details to the EHRC only with the explicit consent of the individual. The case referred to in Mermaids’ written evidence was not referred to the EHRC. EHRC staff have met with Mermaids recently to clarify how the referrals process operates. [p. 13]

Rather snarky, it seems to me, but civil servants don’t like having their time wasted.

So: for whatever reason, Mermaids included a claim without foundation in its submission to the Transgender Equality Inquiry. The Committee trusted the organisation to know what it was talking about — and found itself with egg on its face.

Does Mermaids understand how much this matters?

It matters because public policy should be founded on sound evidence — on facts. No one who peddles made-up claims should be advising government committees. Nor should they be involved in training professional people with direct responsibility for children, sick people or families in crisis." (continues)

4thwavenow.com/2017/10/21/should-mermaids-be-permitted-to-influence-uk-public-policy-on-trans-kids/

As far as I'm aware, Mermaids still receives funding from the Department for Education, which is the government department which leads on child safeguarding.

It may be worth getting in touch with the DfE to register some of these concerns. All the information below is in the public domain, of course, at www.gov.uk, but in case it helps:

At ministerial level, the Secretary of State is the Rt Hon Damian Hinds MP and the relevant junior minister is Nadhim Zahawi MP, Parliamentary Under Secretary of State for Children and Families. Mr Zahawi has child protection and safeguarding in schools within his responsibilities.

Or people who want to do so could contact appropriate senior officials. The Permanent Secretary is Jonathan Slater and the Director General for Social Care, Mobility & Disadvantage is Indra Morris. She has responsibility for children's social care policy.

Although the general DfE contact address is in Manchester, all the people mentioned above can be reached at the main London office in Sanctuary Buildings, Great Smith Street, London SW1P 3BT.

There need to be some serious questions asked.

1. What due diligence have government and state agencies done on the people they are taking advice from and building policing on that advice from?
2. What funding flow is there? I’ve just seen above that DoE provides funding to mermaids? That’s fairly shocking
3. Minutes of all ethics committee meetings dealing with this to be made public. Full disclosure on each member’s affiliations etc. Full disclosure on objections made and how/by who they were overruled.
4. Full investigation into the groups lobbying for alteration of DSM and ICD classifications, and changes in standard of care. Their funding streams. The pressures exerted.
5. Open discussion on the ramifications of transing children. Public discussion on the harms of blockers, surgery.
6. Open discussion of the parties pressing for reduced age of consent. Both in the context of irreversible physical damage to children and in the danger of opening loopholes for paedophilia.

Current thread re Children in Need's funding of Mermaids (also MESMAC, Gendered Intelligence, Allsorts...):

www.mumsnet.com/Talk/womens_rights/3415611-Children-in-Need-funds-group-who-promote-sterilising-children

There was important discussion on the thread discussing the Victoria Derbyshire show which promoted Susie Green, Mermaids charity and their ideology:

www.mumsnet.com/Talk/womens_rights/3294478-Victoria-Derbyshire-show-today-transgender-children-buying-time-by-delaying-puberty

Don't see this thread lasting...

Wait until they get back from Argentina and resume policing Mumsnet...

They'll get busy reporting all the posts and trawling through individuals posting histories to get them banned in good time.

It's when they leave their bias confirmation bubble at WPATH and realise the rest of the world isn't cheering them on that they'll get back to their dirty tricks.

I'm so disappointed in Marci Bowers. I used to have a lot of respect for them because of the FGM reversal stuff. But I am not really surprised.

They'll get busy reporting all the posts and trawling through individuals posting histories to get them banned in good time.

Someone did that to me...

It's a thing people try and do.
I tihnk HQ have cottoned onto it now though.

Please keep using your voices to fight for children. It’s so important. I truly believe this will be a scandal of the likes we’ve never seen.

After scanning some of the tweets on the WPATH hashtag it looks like my country has guzzled the kookaid. Probably (hopefully) not as far gone as Canada.

Ok this new iPhone update is driving me bonkers. Predictive text is really random. Better sign off the night before I get another strike.

There need to be some serious questions asked.

I want to see Bowl's questions answered and those of Kathleen Stock.

I also want to know why this committees are similar ones aren't using "procedural justice" and explicit methods for considering and weighting evidence and ethics to consider materials and justify their decisions and make them available for challenge and revision: NICE does.

If anyone wants to go after this thread, they should be aware of what that action in itself demostrates.

Bias confirmation is a problem with medicine - which is precisely why you do research and encourage research to limit it as much as possible. Establishing the strengths and weaknesses of studies and where there are ommisions and gaps in our knowledge which require further study and poor methodolgy are crucial parts of trying to eliminate confirmation bias.

This is why we have an established hierachy of the quality of evidence, which is as follows:

Expert Advice and Opinion
Case Reports
Cross Sectional Studies
Case Controlled
Cohort Studies
Randomised Controlled Trials with Confidence in the Results
Systematic Review and Meta Analysis.

Trans Health Research, hasn't got much past the first couple of levels.

Anyone care to comment on why you might face is resistance to research?

Could it be because it takes power away from self appointed experts who don't have a medical / research background?

To such people patients are nothing more than political footballs. Props to maintain power and influence of those self appointed experts. They are not being put first.

Should we not be concerned that we have an entire area of healthcare which is not being led by people who come from a research background, who work to actively remove confirmation bias?

This is precisely why we should make the distinction and be aware of the difference of lobby groups and how pose a threat to the institutions frameworks designed to put patients first. It is incredibly concerning how many MPs are not aware of the difference and how they accept the motivations of lobby groups at face value, rather than considering whether they really are centring patients.

The 'why is it happening now?' question has to be asked in this context too. We have a government with many MPs who have a vested interest in destroying the NHS. So undermining its influence and power is helpful to that. Especially if they have finanical interests in private health care. MPs who believe in the value of the NHS should be particularly wary of lobby groups for this reason. What precident does giving huge amounts of unchecked power to lobby groups create?

It is most definitely not a problem restricted to trans health, I should add at this point.

I'll stress again - to whose benefit is it, to resist the normal structure of research?

Is it patients?

We know that patients are not necessarily always put first. Thats why these systems have been built up in the first place.

We know the stuff about big pharma and how suppressing or not publishing research can be done deliberately and how companies are not necessarily obliged to publish what they know internally - because profit is put ahead of patients.

We know how PR is used to try create awareness in healthcare, but there are big ethical questions about how you go about doing this. Is it creating a culture of the 'worried well', who are being prioritised over people who are chronically ill. We know how celebrities are used to promote a fashionable cause, because its good for their image or career. But what about the people who have a condition who doesn't have a big PR machine to promote their interests? The ones who don't attract a celebrity to lobby for additional funding? Is the emotional pitch, merely affecting where funds are directed due to political power, rather than on the basis of patient need? Surely those on the left in particular should be concerned about patient equality throughout the NHS and be aware of how lobbying makes certain groups of patients vulnerable to financial decisions within the NHS?

Once again, in this context, you have to start asking big questions about why would you want to take a group of people who are taking medicine or planning to have surgery away from the supervision of healthcare frameworks? Why would you want to remove the power of HCPs and place it in the hands of managers who are at the mercy of political pressure? Who then are churning out policies - for financial reasons - which, in some cases, go completely against NICE recommendations.

Is it about patients or political power?

KEEP ASKING THE QUESTION:
Is it for the benefit of those patients?

Are they the only ones benefitting? If there are others around who are benefitting, in what ways are they benefitting? Its an important question that should ALWAYS be used to centre on the needs of the patient.

You have to ask very serious questions of groups or individuals who actively work to resist research, because thats all about maintaining ignorance or a current confirmation bias.

It should be absoluetely challenged.

So as I say, attempting to go after this thread in itself should raise great big huge red flags. These questions are not controversial. They are fundamental to the well being of patients and patients being put before all other considerations in a fair manner which doesn't harm others.

There are ways in which we can improve handling and the senstivity of HCPs and a lack of resources can cause additional problems. You don't get around this by bypassing the system. You fund the system adquately. You can't cut corners on health, as much as we've tried to in this country. It has this perserve affect of coming back to bite you on the bum in a big way. Politicians in this country, do not seem to have grasped this concept.

And finally I've recommended Margaret McCartney's 'The Patient Paradox: Why sexed-up medicine is bad for your health' on MN many times. It is quite simply THE best book you can read, to give you an over view of the many, many ways in which outside pressures affect healthcare, and aren't necessarily in the best interests of patients.

At the moment, the position health care for trans people finds itself in, is one which is particularly precarious.

Amazing post red - agree wholeheartedly.

Agreed

Yup. There's a lot of power swilling about in a tub which certain people, professionals and private individuals, are currently enjoying a swim in. The reluctance for proper oversight and the deliberate damaging of all kinds of safeguarding mechanisms looks very like an attempt to stay swimming around in the tub as long as possible.

There's a lot of power swilling about in a tub which certain people, professionals and private individuals, are currently enjoying a swim in. The reluctance for proper oversight and the deliberate damaging of all kinds of safeguarding mechanisms looks very like an attempt to stay swimming around in the tub as long as possible.

Agreed.