BMJ's editor on evidence void and overtreatment of gender dysphoria

[mirax]

This isnt a very substantive article but it suggests what was once unthinkable - that the much touted gender affirming care was not properly evidenced - and counsels caution.
"“Much of this clinical practice is supported by guidance from medical societies and associations, but closer inspection…finds that the strength of clinical recommendations is not in line with the strength of the evidence.”

They are backing away slowly in anticipation of the Cass Review.
www.bmj.com/content/380/bmj.p553

The risk of overtreatment of gender dysphoria is real.

Wow.
Feels significant.

Interesting article and sounds positive, particularly in highlighting the risk over over treatment as above. My only slight concern is the following (emphasis added by me):

. Taking this route is essential: an evidence void not only exposes people to overtreatment but can also be used to deny people the care that they seek, such as through the draconian laws now being introduced in some US states (doi:10.1136/bmj.p533).

This links through to an article about a number of states that it says have brought in laws which are similar to Sweden and Finland.

Other factors need to be weighed up, such as how invasive is the intervention you are recommending.

I would suggest reporting parents as a safeguarding risk for not going along with the ideology was an overly invasive intervention.

Trans side appeals to authority:

"All these medical organisations agree with me"

Because you pressured them into it, in the first place?

I keep saying this but I can’t get over how little data collection, audit or research was carried out by GIDS over the decades. From the world-renowned Tavistock, the UK’s flagship (only) gender dysphoria service, and it seems that their only evidence was that of charities with an almost evangelical agenda.

So shocking. The only conclusion I can reach is that maybe MH services aren’t bound by the same obligations of any other clinical service to audit and research, to ensure best practice based on actual evidence.

What shocks me most is how many medical workers were complicit in this. They come from multiple disciplines - drs, nurses, pharmacists, psychologists etc - each with their own codes of practice and standards, including training of and an expectation for evidence based care (especially in the NHS to ensure good use of public funding), and yet still there was enough complacency, enough just mindlessly going along with it, that we end up here. Absolutely systemic failings of course, but also individual professional failings from every person involved in my opinion.

Absolutely agree. Shockingly unprofessional.

I came across a YouTube link that helped me understand the NHS mental health stance better.

It's an interview with a religious woman, she wrote a book which has the religious slant.

I noted that like David Starkey in his (I think it was on) Triggernometry interview they both pinpoint the same beginning point in time.

Although not substantive, I think that the fact that it's the BMJ gives it a gravitas that is very useful. The Tavistock is the world's largest paediatric gender clinic and for too long it's been assumed they know what they're doing and thus have been copied the world over. It needs serious professional pushback to reverse the course of events. Articles like this will help.

And let’s not forget that the director of the service throughout all the turmoil has been Polly Carmichael, who is STILL director. Perhaps she deployed her (evidently very effective) tactic of bursting into tears if/when it was suggested she stand down?

(“You’ve made Polly cry”, from Time to Think by Hannah Barnes.)

Polly has made many cry and many will cry for generations over what she did, that is not a legacy of improving the nation's mental health.

Just finished Barnes' book, and need to digest it a bit. But one thing that she refers to (though not a lot) is the vicious treatment anyone expressing reservations received, and how external 'patient advocate' groups had outsized influence on the very top level of the GID.

I believe that the equivalent of narcissistic rage I see reservations receive on Twitter must be almost unbearable when it is done in real world spaces. Why things were allowed to get as bad as they were really deserves a good explanation. Galileo's Middle Finger already described the hounding and canceling of people who disagreed, however politely, so the problem must have been known.

Yes, @nepeta - awful enough online, where however neutral and considerate you try to be you manage to somehow offend one or both sides, it has a “chilling”, silencing effect. But to experience it in person, for someone who CHOSE to go and work in the prestigious exciting GIDS centre, to be accused of “transphobia”…? Well, if those principled, concerned clinicians can be called transphobic then so can the rest of the world.

Perhaps the BMJ team can have a word with the editors at Nature, who have a really poor record with gender-woo.

The ones who don't agree are forced out.
No share token, I'm afraid but...

www.telegraph.co.uk/news/2019/12/12/childrens-transgender-clinic-hit-35-resignations-three-years/

John Launer's piece was temperate and carefully worded.

Over my years at the Tavistock I got to know several colleagues who worked in that unit. I heard how the numbers of young people they saw rose exponentially, in line with social awareness of gender dysphoria and public acceptance of it. They often dealt with hostility from patients, families, and pressure groups who believed that the service should offer treatment more readily. Internally, they faced criticism by some clinicians who believed in a more cautious approach involving a much longer assessment.2 I knew and respected people who held passionate positions on both sides of this question.

www.bmj.com/content/380/bmj.p477

I wonder if Kamran Abassi (author of OP's linked piece) has been persuaded over time to start reflecting on the evidence base by reading Cass, McCartney, Bewley, Meads, and Rogers.

It's the endocrinologists I'm most shocked at. GIDS staff are largely psychotherapists, social workers etc, not medical professionals. They make referrals to endocrinologists who you would hope would have a deeper understanding of the effects of blockers and hormones on young bodies. Polly Carmichael is coming in for a lot of stick but I think those who administer the drugs need examining.

MavisMcMinty, I wish the Tavistock was the UK’s only gender clinic, as it is being closed down, but unfortunately here in Scotland the Sandyford clinic is sailing on regardless. When confronted with the Cass enquiry, the SNP unbelievably dismissed it as “only applying to England”.

I totally agree!
Who were the endocrinologists?
Was it at UCLH?
I'm astonished that nobody seems to be investigating this side of things

The endocrinology team at UCLH have come up in the various court cases and tribunals - been doing a sort of ‘We we’re just following orders’ Nuremberg-type defence.

You can sort of see their point.

The endocrinologist didn’t make the diagnosis and the diagnosis is not an endocrinological disorder anyway.

All they can do is monitor for side effects (eg periodic bone density scans). They can’t monitor the effectiveness of the ‘treatment’ because the diagnosis (gender Dysphoria) isn’t in their wheel house.

The main dude at UCLH, Professor Gary Butler is deffo on board the Gender train though:

www.researchgate.net/profile/Gary-Butler-4

One small point in their favour is that at least UCLH were monitoring bone density - GenderGP will happily prescribe the same GNRHa drugs to kids online with no face fo face appointments at all, let alone periodic bone scans.

I happen to know that at least one of the senior editors of Nature has a transgender child and froths about "TERFs".

The latest Blocked and Reported podcast has an interview with Hannah Barnes talking mostly about the Tavistock clinic. It might be worth a listen. It was episode 155.

Is there anyway you can listen without having to subscribe? They want my money.

This is free:

m.youtube.com/watch?v=wFle2YoQwWg

That’s a song by someone called Gillian Welsh!