New mental health analysis of Tavistock pb trial

[WarriorN]

Bbc report by Hannah Barnes

It doesn't mention their sex though

It appears to be more around the way the data was interpreted and as only 44 children is a very small sample size.

Children on puberty blockers saw mental health change - new analysis www.bbc.co.uk/news/health-66842352

Paper (not yet peer reviewed)

www.medrxiv.org/content/10.1101/2023.05.30.23290763v3

I think you've misunderstood me - publishing no-result data is important, it's publicising it in the media and suggesting there is a result even where there doesn't seem to be is what I'm unsure of.

Ah, yes - I'd mostly agree with you there.

There's still a place for 'X doesnt work' reports in the mainstream media if it's a reasonably clear result; less so for this type of thing. And the findings and significance need to be clearly explained, which this won't be.

Agreed. Given how fraught some of the discourse can be in both directions about transgender medicine and given the vagueness of this result, I'm inclined to be wary

This is hugely important. The original paper with the original data was published a matter of days after the Bell vs Tavistock judgment, when the authors told the judge during the hearing it wasn’t ready yet. Then, even though the original data showed no improvement in psychological functioning, there were media organisations that claimed it showed patients were happier.

This data and its analysis represents all that is wrong with puberty blocking children: poor initial study format, no controls, poor outcomes, poor conclusions, and media spin on the outcomes. It’s an exemplar of every single paper purporting to show benefits of medically altering the bodies of children.

So the fact the data has been reanalysed to offer greater scrutiny is refreshing, and hopefully going to be also applied to every other paper. It happens with other papers but such analysis is either ignored, refused (Michael Biggs had an online comment removed analysing Jack Turban’s bullshit) or don’t reach wider attention because it’s published in a quiet space, like a lesser known journal.

This paper and its reporting on the BBC is sunlight.

Publishing null findings is good science. Publishing small-n studies with no control group then allowing people to draw inferences not supported by the data, not so much.

Keeping this in the public eye is a good thing, and reporting truthfully is a good thing.

The BBC summary of the paper's results and interpretation was very clear and pretty balanced. It explained the gaps and limitations and it mentioned the small sample and lack of controls and what they imply. I'd expect no less from Hannah Barnes - she wrote "Time to Think".

Though we can't stop other people "drawing inferences" to suit themselves.

That's not what this paper is, though.

Thanks for the clarification @MumOfYoungTransAdult and @NotBadConsidering.
Having read so many dodgy "research papers" on pbs I sometimes get them mixed up. I'm still trying to find any that stand up to rigorous scrutiny but haven't found any yet, so if anyone knows of any I'd love to read them.

So, ultimately, we are still treating children with medications based on fuck all evidence that the benefits outweigh the risks, yes?

I'm scunnered by this.

Eventually there will be some but don't hold your breath!

At the moment it's important to just recognise how little reliable data has been gathered about the effects of transition overall and especially childhood transition, and from a practical point of view to accept that gender clinicians really have been making "strong recommendations based on weak evidence" (Dr Julia Walker)

From a research point of view it's normal for there to be discussion and disagreement about how to interpret research findings. It's the attempts to cover up and silence disagreement that are most worrying.

It's not an area where definitive answers are easy to get. But if I was funding studies I would put much more emphasis on physical health outcomes which up to now seem quite neglected.

Yes, exactly. And scunnered is the word! Along with feart.

I assumed it was "bbc balance."

I think Barnes finds it very hard to get things passed through.

I appreciate what this paper is trying to achieve, but as PP has said the source quality of the data is not great, and I'm really not sure how helpful publicising this is given that the results, even if they were obtained through rigourous controlled testing, appear fairly inconclusive with a roughly 1/3 breakdown between improvement, no change, and deterioration. Its all rather odd.

I can't help wondering if they can't start the 'nhs trials' without designing the trial properly which means working out how the data will be collected and reported?

It is all a bit weird. I’m not sure how you distinguish statistically between “some people got better, some people got worse, some experienced no effect” and “puberty blockers had no effect” with a sample size of 44.

But since the original study authors welcomed it, I’m willing to accept there may be something useful about this re-analysis. I don’t see how it can possibly merit a BBC headline though! I’m guessing it’s a sign that the TRAs at the BBC are absolutely desperate, because at face value I don’t think this is particularly good news for them. But they are so desperate to promote the idea that “trans kids” are a real thing that any evidence that some kids might be helped by puberty blockers is apparently headline news.

I thought the BBC article was careful, factual, adequate. I think they have simply caught up with the idea that they have a particular duty on this issue to engage in careful, comprehensive fact-based reporting. And perhaps they feel that the publicity that may have been given to the earlier analysis requires them to air this corrective re-analysis, despite the smallness of the study, the provisional nature of its findings, the clear need for further research, about all of which the article is very clear.
The very fact that this makes the article seem somewhat inconsequential shows that they are trying to subtract the journalistic hype that has tainted earlier reporting.

I can't help wondering if they can't start the 'nhs trials' without designing the trial properly which means working out how the data will be collected and reported?

I hope so! Design it properly from the start, and no monkey business.

And perhaps they feel that the publicity that may have been given to the earlier analysis requires them to air this corrective re-analysis,

I'm not sure there was a lot of publicity given to the earlier analysis? It's linked below and it's difficult to see how you could spin it into something attention-grabbing. But I agree with you the article is quite factual, it's just very much "in the weeds" and it's odd reading because of that.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243894#sec020

From the discussion section of the original analysis: However, some conclusions can be drawn. It is unlikely that the reported adverse events such as headaches do not relate directly to GnRHa treatment. Equally, given that there were no changes in psychological function and differences in point estimates were minimal for nearly all outcomes, it is unlikely that the treatment resulted in psychological harm.

OH! OK, I actually get why this is news now. Presumably the "no psychological harm" part of the conclusion was previously reported. That's now been undermined by the re-analysis. I see the piece was written by Hannah Barnes. I suspect it might read as inconsequential because it was very heavily edited.

Yes that's spot on. Sorry I realise I didn't point that out in the OP

Thanks OP. This was very interesting to read.

On Newsnight right now

Interested to see that they abre now trying to sort out data differently. Acknowledging that there are children at both ends of the mental ill heath spectrum. The mean is not as relevant or important as the individuals response. PBs to be banned unless part of a clinical trial. This is still abusing some children obviously. David Freedman very vocal about his concerns. There was no breakdown as to sex.

Hannah Barnes just had a piece on Newsnight (Tues 19th Sept) interviewing a health statistician who explains how the conclusion of no overall effect can be drawn from this data.

Well worth a watch.

The lack of control means that you cannot draw any conclusion about effect or lack of it from the data. We do not know what the mental health outcomes would have been if these children were not given the medication - they may well all have shown a significant improvement beyond that experienced by even the ‘improved’ children. At most the statistician could say the mental health at followup was not significantly different from that at baseline.

On the point of reporting being reasonably balanced:

It is a criminal offence to promote drugs for children and any information in any articles must be accurate to comply with this. (And there has been more than one article by a TRA in MSM where this has been ignored)