BMJ investigative report into evidence base for medical advice.

[pantsforteaagain]

This is a commissioned investigative article in a major medical journal and a really clear-eyed look at the (lack of) evidence for transition interventions, plus who is recommending them.
BMJ article

Interesting. And it says a proposed Cochrane review into puberty blockers won’t be happening (yet).

There is an article today in the Times about a much higher stroke and heart attack rate amongst those taking transgender hormones.

'Garofalo ...told a podcast interviewer in May 2022 that the evidence base remained “a challenge . . . it is a discipline where the evidence base is now being assembled” and that “it’s truly lagging behind [clinical practice], I think, in some ways....“There is universal support for gender affirming care from every mainstream US based medical society that I can think of: the AMA, the APA, the AAP. I mean, these organisations never agree with one another.” Garofalo declined an interview and did not respond to The BMJ’s requests for comment.'

Yes mate, it is weird. Yes, it is an anomaly. Could be spotted from space. And yet you are 'safely' treating kids without wondering why in the 30 years of this 'treatment' there are no long term studies? Come the fuck on.

Contrast the lack of evidence with clinical guidelines for other conditions. They all need gold standard robust evidence to get funding.

I noticed that the lead researcher for that study was a third year resident. I was puzzled by why it wasn’t a more senior clinician. I can only conclude no one senior wants to touch this subject, or they do but someone else in the team has agreed to front it. Either way, it’s not a ringing endorsement of the profession when the findings are so important.

Well done BMJ, it's keeping me optimistic that some academic journals are still able to publish content like this, when others like Nature are completely captured bybthe ideology.

“A spokesperson for Cochrane told The BMJ that its editors have to consider whether a review “would add value to the existing evidence base,” highlighting the work of the UK’s National Institute for Health and Care Excellence, which looked at puberty blockers and hormones for adolescents in 2021. “That review found the evidence to be inconclusive, and there have been no significant primary studies published since.”

That’s exactly what I questioned in the thread here a few days ago. I couldn’t understand why they would be effectively replicating NICE when there was nothing new to add.

Half way through, and gosh, it's pretty damning.

Far too much to quote but it basically says they're all lying about the evidence base to the general public and patients.

They're passing off opinion as evidence base.

Thank you for posting this OP. I look forward to reading it.

The magnitude of opinion consensus with lack of actual evidence is scary.

There is a flurry of health care focused action today it seems. I am off to read this and to watch the sex matters webinar from last night.

The study into the cardiovascular negative side effects of cross sex hormones seemed to contain a dismissive element of ‘the benefits outweigh the negatives’. That was mentioned in the Times article today

www.thetimes.co.uk/article/7de59308-b3b8-11ed-bc64-f71663a88018?shareToken=87b09de880a9c7d1b51942a8bff45e32

All this activity is going to start to unpick the myths, the falsehoods and the perpetuation of what has underpinned some very harmful ideological driven negligence.

Just toying these two thread's together as they're very much around the same thing.

That opinion and myth is being presented as evidence based.

Psychiatrist challenges trans myths www.mumsnet.com/Talk/womens_rights/4749879-psychiatrist-challenges-trans-myths

I saw that thread Warrior, I felt that I needed more from Dr Levine.

isn’t that ridiculous of me though, he is there saying ‘this is untrue’ but I want to see the working behind his thinking when I know most of it is untrue (I did wonder about number 3 though about sexual orientation…)

What a world we live in!

Why is the US still so captured? I’ve basically frozen all my US liberal friends on SM because it’s getting hard to hold my tongue on this matter and I don’t want to lose friends.

I can't see the article you mention, so I'm not sure if this is relevant, but in scientific papers it's usual for the senior people to be listed at the end of a group of authors, not the start. So the more junior person who actually does the grunt work comes first and the person who directs the lab comes last. When taking note of who authored a paper you look at the last names on the list as much as - or even more so - than the first. The last names tell you whose lab or labs the work comes from.
Again, I haven't seen the author list so I apologise if this is irrelevant in this case.

The first name -the junior- is still considered the lead author btw.

I thought that the endocrine society was interesting and how they decided what was important to evidence in order to support gender irming care. They basically gave greater importance to whether the treatment was successful in aligning the body with the opposite sex and whether the treatment improved the psychological health of the patient, and gave lower importance to whether the treatment caused harm.

This is where ideological perspectives are really important and the lack of long term studies. Giving importance to how effectively you can change the body only makes sense if you think that being innately transgender is a thing and that the best way to reconcile the mismatch is to change your body to match your mind. It would also seem evident to me that, at least at first, if you give a patient what they want they will have/will report improved mental health (at least in the short term). By not giving equal importance to the harms caused by the treatment and giving importance to the idea of being transgender (in preference to other options of being gender non-conforming, being pissed off with gendered expectations or simply trying to find a solution to psychological problems) you are potentially depriving people of the option of avoiding those harms, whilst still being at least reconciled with their body and having a positive effect on mental health.

I feel like I've read a published article by him or including this recently?

It’s this article:

The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed

https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2150346

Scott Hadland, chief of adolescent medicine at Massachusetts General Hospital and Harvard Medical School, dismissed the “handful of cruel protesters” outside the AAP meeting in a tweet that morning. He wrote, “Inside 10 000 pediatricians stand in solidarity for trans & gender diverse kids & their families to receive evidence-based, lifesaving, individualized care.”

This is some of the problem - this guy is a “chief of adolescent medicine” at Harvard, so one would assume he’d know what he was talking about. And then the rest of the article demonstrates that he doesn’t - at least not in terms of the evidence base on which he’s relying to decide the standards of care he applies to teenagers with ‘ROGD.’

IANAD, but when even WPATH has to admit that the GRADE assessments of the studies it’s used are “low,” then you’d think a consultant of his seniority would be wary about accepting their recommendations.

But maybe the hundreds of thousands (plus) he earns each year from the procedures he performs help him to block out what that “handful of cruel protestors” are trying to tell him.

Very well put @PaleBlueMoonlight

This is the most glacial scandal unfolding I've ever seen.

It really is.

They're completely deliberately ignoring the writing in the wall.

It's scary.

Good this is in the BMJ. More evidence of a move away from WPATH to refer to.

Thanks Not