'Biological sex is vital in healthcare' - BMJ rapid response

[ArabellaScott]

www.bmj.com/content/373/bmj.n1261/rr-2?fbclid=IwAR3NciluHjxL7bN5GBNdKU1RIFzxcUQF09uVTW8XN4eLPduHk7OWbFjZTw8

'The truth of the sex binary is anchored in the mechanism that brings every human into existence.[1] Humans have two different types of gametes, two types of reproductive systems, two discrete reproductive roles: two sexes. As a result, we have given these two sexes different names: female and male. These will exist whether or not the clinician writes them down, or asks a transgender patient “what is your sex?” The fact that 0.02% of babies[2] have differences in sex development that cause the usually easy identification of sex to become a more complex affair, does not invalidate sex as one of the most clinically useful categorisations in medicine. To suggest that it does, and therefore sex should not be recorded, is absurd'

• written in response to this article:

www.bmj.com/content/373/bmj.n1261

'Rethinking sex-assigned-at-birth questions' - Unhelpful, potentially harmful, and should be abandoned

Brilliant! Sums up the matter nicely. Let sanity prevail.

I liked the ending, too:

'Healthcare cannot collectively discard words for the two biological sexes. Awareness of the importance of clinical research into sex differences in medicine, especially for the female sex[9], has just been highlighted by the pandemic. How would such work be done if the sexes cannot be named?

Clear language on sex is vital in medicine, science, and public health education.

It is surprising these words should need to be typed in a Rapid Response to the BMJ'

It is surprising these words should need to be typed in a Rapid Response to the BMJ

Quite.

Has a grown-up arrived at the BMJ?

The Rapid Response is a letter, I think. Not editorial.

@ArabellaScott

The Rapid Response is a letter, I think. Not editorial.

Unless it's published in the mainstream journal as a "letter" it is not a letter, IYSWIM, it remains an online response.

All too sadly, the Rapid Responses on some particularly contentious topics have been known for some time as the Rabid Responses - and the authors of them used to pass them off as 'published letters' so there's a very careful distinction. (I'd like to think that this response would be included in a future edition as a letter but we might need to wait and see. It can sometimes take months for a letter to be accepted.)

Ah, I see, thanks Embarrassing. Not my area, at all!

Oh, I see, there are more responses!

www.bmj.com/content/373/bmj.n1261/rapid-responses

In regard to pregnancy, many cisgender and transgender people have the ability to become pregnant, and some do not have that ability due to surgery or other reasons. Thus, pregnancy risk cannot be determined by knowing sex assigned at birth.

You can rule out possible pregnancy in 50% of the population by knowing their sex.

'Why are you peddling this nonsense?' asks a responder of the BMJ. Well, indeed.

Its embarrassing isn't it. That uts eveb a discussion in a medical journal.

Illness and disease do not discriminate. Nor do they care about identities.

It is indeed a crazy article for the BMJ to have published, nice to see such forthright responses

Our medical organisations need a bit of a re-think. They especially need to refocus this mass of attention onto women who have suffered from a lack of research and now need to be put front an centre in order to catch up.

Women are just a little bit cross

Thank heavens. But yes, who would have thought the time would come when we seriously needed to remind medics that there are biological differences between the sexes

Lol. This is where the ideology gets pushed too far.

Looks like the author of that Rapid Response has already published a peer reviewed paper on the ethics of removing sex from the medical record. It's open access too

www.tandfonline.com/doi/full/10.1080/20502877.2020.1720429

Gobsmacking that the British Medical Journal is advocating doctors not keeping a record of patients' sex (or what they call sex assigned at birth, fgs). They appear to be advocating, instead of asking women if they may be pregnant (before some relevant medical care), asking everybody whether they may be pregnant. Can you imagine the (further) disrepute the profession will be brought into if doctors ask bearded men whether they think they might be pregnant! And rather than having a record of someone's sex, if they need to know someone's sex, apparently doctors are supposed to ask each patient whether they have a certain sexual organ. The full article isn't visible, so that's based on the comments. Like this one:

Dear Editor

The authors identify several different reasons that information on patients’ sex is collected, recorded and used in healthcare:

Identification
Inpatient care (e.g. which wards to house people in)
Policy enforcement
Preventative care
Differential diagnosis in acute settings
Knowing what pronouns to use

They note that because of changes over a lifetime (such as hysterectomy and orchidectomy) and intersex conditions (which they wrongly state as meaning that 2% of people have bodies that do not fit sexual classification[1] ), the data field of sex (male or female) offers incomplete or obsolete information to answer specific questions about an individual such as would this person need a cervical smear test?

They say that using data on sex “as a proxy for more specific questions about anatomy and hormone levels” has the potential to harm patients.

Therefore they reach the astounding conclusion that sex of patients should not be recorded.

It should immediately be obvious that not having a field in which to record patient sex would do much greater harm. To take the cervical smear test example, while not every female patient will need one, no males do. Targeting all patients for testing is a wasteful, pointless exercise, while only asking “people with a cervix” to attend for screening will lead to many patients who do not have detailed knowledge of their own anatomy being missed. This can be repeated for any number of other medical risks and conditions. Are the risks from COVID different for males and females? The authors say this is not a question worth asking, and all the data which might answer it should be thrown away.

Instead it states that a question about “gender identity” should be used.

However gender identity solves none of the weaknesses they identify for the sex question - for example knowing that someone identifies as non-binary does not tell you whether they might need prostate or cervical screening, whether they might be at risk of getting or being pregnant, or whether they would be alarming to other patients if put in a shared bay of an inpatient ward. It does not even tell you what pronouns to use for them.

It is a principle of data management that each field should be used for one piece of data only, and they shouldn’t be confused or mixed together. It is clear and obvious that data on sex should be collected and recorded for every patient.

Recognising and respecting transgender people’s identity and privacy (where possible) is not in conflict with this, but this identity should not be confused with their sex, nor should other people’s sex be regarded as a gender identity, as this opens up the data to corruption.

As to the question of what pronouns to use for people, most people are comfortable with the grammatical pronouns associated with their sex, for those who are not, an additional note can be made in a separate data field (and honorific such as Ms, Mrs and Mr which also give an indication need not be tied to a person’s sex). Knowing that someone prefers to be referred to as he/him, she/her, they/them, she/they, he/they zie/zer tells you precisely that. It contains no reliable information of clinical or epidemiological relevance. To replace the reliable recording of sex with this social nicety in healthcare is dangerous and unjustified.

[1] Leonard Sax (2002) How common is lntersex? A response to Anne Fausto‐Sterling, The Journal of Sex Research, 39:3, 174-178, DOI: 10.1080/00224490209552139

Doctors are supposed to be the brightest and the best. It turns out that however bright you are, you can be corrupted by a faith-based ideology. And quickly, too.

According to the authors of the original article, "pregnancy risk cannot be determined by knowing sex assigned at birth."

Such an assessment of risk by sex may very well be beyond the abilities of the authors. They would not be the first people to believe that something is impossible because they can't do it. I strongly suspect that there are plenty of competent statisticians who would be able to calculate meaningfully accurate pregnancy risk for each sex, by taking into account facts such as (a) only female people can be pregnant, and (b) the proportion of the female adult population who do actually have been pregnant (I've seen a figure of 75%), and (c) male people can never become pregnant. Other data, including the current worldwide sex ratio of 1.02 adult males to every 1 child-bearing-age female, may also be useful in the risk calculations.

I offer my own free starter statistic to save other people some time and effort: the risk of male people becoming pregnant is 0.000000000000000000 +/- 0.000000000000000000 %.

(I have actually calculated the risk to 50,000 decimal places but all of them contain the digit 0, so I decided to limit the display of this risk to 18 decimal places to avoid straining internet connection bandwidth).

Meanwhile, attempting to determine pregnancy risk by knowing gender identity is a useless absurdity:
Do male people with no gender identity have a higher or lower risk of pregnancy than male people with a so-called "cis" gender identity, and how does their pregnancy risk compare to male people with a trans gender identity?

That's the great mystery and the thing I just can't get my head around: all these clever people, with all their PhDs, turning out to be so fundamentally stupid and unreliable. And all those MPs who've presumably had to work hard within their parties to get where they are, who don't seem to have enough basic common sense to spot blatant lies or ask probing questions.

A chum applied for a post with the NHS recently and this cropped up on the Equalities Monitoring form that was not noticeably separated from the application form. She sent it to me to ask what the terms meant as there wasn't an accompanying glossary.

Whilst I am rather incredulous at this letter the fact it has been published doesn’t mean all doctors hold such views.

@Gassylady

Whilst I am rather incredulous at this letter the fact it has been published doesn’t mean all doctors hold such views.

No but I don’t think the BMJ should have published it if they want to be taken seriously as a respected medical journal.

I always found the term “assigned at birth”,in relation to male or female, really odd. Makes it sound like the midwife did eenie meenie Minnie mo to choose whether to tell the parents they have a boy or girl.

“ Dear Editor,
I remain utterly confused at your decision to publish this article and your kamikaze-like approach to your reputation.
It is an indisputable fact that there are two sexes, two reproductive roles; male and female. This understanding is crucial in order to practice medicine.
I expect to next see in the Astronomical Journal that the world is in fact flat.”
Guffaw.