Hillary Cass at Scottish parliamet - live

[ArabellaScott]

This started at 9am.

https://www.scottishparliament.tv/meeting/health-social-care-and-sport-committee-may-7-2024

However I am all for science based research. Observation, results, follow ups for the lifetime of the patient. Collating all results for all patients, accumulating as much raw data as possible.
A new cancer drug has to be tried out on people, the covid vaccines didn't have enough time for the usual years long medical trials, so there was an element of leap of faith in us all taking that.

But this is not a disease like covid or cancer. What is the illness that these hormonal treatments are supposed to cure? What is gender dysphoria? Is it a mental illness? Why is stopping the normal development of a child's body into that of an adult being used as a treatment for a mental condition which in most cases resolves itself by the time the child reaches adulthood?

What is the ultimate aim of the treatment? Why are problems to do with the mind or the child’s perception of their place in society being treated with irreversible medication with serious negative side effects? In what ways do they think that making someone's body resemble that of the opposite sex will improve their social functioning? How does sterilising children help them to have improved functioning as adults?

If this is to be a scientific study, surely the first thing they need to do is to define the exact nature of the illness that they are trying to cure.

You know when threads on this board veer offtopic it ends up being hard to find them, or to decide which to read.
This discussion about the PB trials is really interesting but it's not Cass at the Scottish parliament any more.

Puberty itself can cause, and change, and 'solve' dysphoria.

So even leaving aside the serious side effects and the potential for sterilisation, the blocking of puberty can in some cases be preventing the very process that would be the solution.

Excellent questions, @OldCrone Very thought provoking. Thank you.

I don't have the expertise to judge your suggestion as a researcher, but I don't see any reason to give children a treatment which will harm them physically, which will probably harm their mental health and which is still a gamble in terms of how much they will look like the opposite sex when they grow up. That's the problem for me - we would definitely harm the child whose gender distress persisted, by giving them an essentially palliative "treatment". We can't get around that fact. The only justification for puberty blockers is to delay, in the short term, precocious puberty. I believe cross-sex hormones are needed occasionally in cases of some DSDs, but for health, not for gender presentation or gender distress.

So sorry, shall I get my posts deleted for you?

Cass was discussing PB for children, of course this thread will discuss that.

Not just some cases, the vast majority of cases.

I feel that's a bit unfair in that of course :
A ) Obviously you're not going to test something that you know is harmful.
B ) Obviously you'd want to do as much theory, lab tests, tissue teats, animal testing etc... first. Human testing comes last. There's almost certainly years of work done before any drug gets anywhere near a human.
Or at least you'd hope so. Truth seems stranger than fiction on this point. Famous example. https://www.bbc.co.uk/news/magazine-35766627

My point being that at the end of the day the acid test is when humans actually take the new drug. Everything up until then counts but humans taking it and observing the results is still important.

A ) Obviously you're not going to test something that you know is harmful.

Yet that is exactly what is being proposed here with puberty blockers.

@AlisonDonut
What has been done so far by the positive affirmation model crowd does not count as science. It's political and religious dogma. It is middle ages thinking.
To even describe it as experimenting on kids, is to vastly over value and give credit that is not due. Experiments follow the scientific method of observation and repeatability. It does not come close to meeting that bar. It is medical interference and mutilation based on political and quasi-religious beliefs by an empty headed virtue signalling social cast for likes and social credit.
This is "experimenting" only in the sense of word of Nazi and Japanese "doctors" torturing people in wartime.

I am not defending it, and I think it's the biggest medical scandal up there in scale with things like Thalidomide and Purdue Pharma OxyContin. Probably worse because it affects so many young people with serious mental health issues and involves surgery that has lifelong negative consequences. People should be going to prison for the rest of their lives for the damage they have done to young people.

That useful idiots in positions of power have for political and religion like reasons done so much harm to so many young people within the medical, scientific, and political spheres of life, does not mean that proper research cannot or should not be done on the subject going forwards. It is our duty to understand what has happened, why it happened, and the consequences of it. It's also our duty to make sure that the kids who have suffered so much already get the best care going forwards, and that the same thing does not happen to future upcoming generations of kids.

What has been done already cannot be classed as medical research or science because it abandoned the principals of the scientific method for "be kind" and feelings over facts. It is all tainted. The best that can come out of it, is understanding how the idiots managed to cause so much harm in an otherwise rational society that should never have let the harm happen.

I don't know what future research on this subject would show. But I am in favour of evidence based research. That idiots have fucked things up so much already does not mean we should not do the research, it just means the idiots should be purged from the process, and protocols put in place to keep them as far away from the process as possible. Jail would be good.

And if that future research shows PBs are never a good idea, I'm utterly fine with that, and if it shows under very exceptional circumstances they can provide the least worst outcome, then I have to be fine with that too.

My point being that at the end of the day the acid test is when humans actually take the new drug. Everything up until then counts but humans taking it and observing the results is still important.

But first we need a definition of the condition or disease that the treatment is designed to treat. And also a clear description of what a good outcome would look like. What would be considered to be a successful result?

I don't believe anyone has yet come up with a definition of gender dysphoria in children which indicates that interfering with their normal development into adults is an appropriate treatment.

What is considered a good outcome of this treatment? The best that can be hoped for is that the child will become an adult who convincingly resembles a member of of the opposite sex. This adult will not have normal sexual function and will be infertile. They will be constantly on their guard about being outed as their actual sex.

It seems to be assumed that despite this, as an adult this person's mental health will be better than it would have been had they been allowed to grow up to be a an adult with their sexual and reproductive functions intact, and who isn't constantly aware that they are living a lie. This seems unlikely.

And that's before we start to consider the physical health implications of treating children with these drugs, such as the impact on bone health.

Sorry, again to discuss the thing that for some reason people don't want to be discussed, they have seemingly been doing this since at least 1998, off label, with no follow-ups, so for a quarter of a century.

I am unsure what 'future research' could be useful here.

They are treating 'gender disphoria, distress, incongruity' whatever the latest iteration of the 'problem' is.

With drugs that are not safe.

On kids.

And if that future research shows PBs are never a good idea, I'm utterly fine with that, and if it shows under very exceptional circumstances they can provide the least worst outcome, then I have to be fine with that too.

How many children are you prepared to harm before you agree that they are never a good idea?

Thanks for outlining this Alison. You're research for your 'puberty blockers how did we get here?' thread is really paying off!

OK lets start with this.
You take all the kids who self report as transgender, and you do what any sane person would do, and what the Cass report advises, and you get some psycologists to talk to the young person and find out what mental issues the young person is dealing with. You examine all sorts of things like sexual orientation, family life and cicumstances, possible physical and sexual abuse, any trauma, is one or more parents Munchausen by proxying etc.... And you help the young person with all that. The hollistic appraoch recommended by Cass.
And then you keep up the mental health care, and you monitor and track it. As the person grows older you keep up the care. For some people this might be enough. Some people might require more long term support than others. Some people might require lifelong mental health support.
Lets say for well over 99% and a few more 9s past the decimal point this gives the best outcome. Lets say for the vast majority going through puberty and or coming out as same sex attracted resolves their major issues. For others a change in circumstances e.g. removal of abuser proves to be the solution. And so on and so on. You could categorise patients into ever smaller groups by problem/solution. And some will require not just one solution but several, and belong to several problem/solution groups.
All of this so far would be great research for how to help trans identifying kids. Especially if follow up data was gathered for as long as possible.

Up to now we've hypothetically dealt with 99.9xxxx9%, but there's always going to be one or two edge cases. And in those cases competent medical professionals may be forced to consider other options. It's possible PBs might be on the list.
I'm not a doctor, but Cass is. I trust Cass on this.
If we say PBs can never be the answer under any circumstances then in my opinion we fall into the same trap as the trans rights activists. Pre supposing that we are right, and being closed to any possibility we dislike.

I don't think they are a good idea.
I'm not going to harm any kids, it's not my decision to make. It's the doctors like Cass who get to make that decision. Maybe the doctors agrees with you and that's the end of it. I'm not a doctor and I don't get to decide.

But first we need a definition of the condition or disease that the treatment is designed to treat. And also a clear description of what a good outcome would look like. What would be considered to be a successful result?

This.

Because many of these children, who have been showing up to gender clinics, would be absolutely convinced they have actually been 'born in the wrong body'. Just because they don't follow social stereotypes.

Activists have convinced doctors to treat children with harmful drugs over a made up condition.

And yes, what is a successful result?

Living a permanent lie would not appear to be the best way to treat a severe mental health issue.

And in terms of puberty blockers, surely they arrest mental maturation, as well. I'm constantly struck by the children who have been on them who appear to be walking around in a permanent state of adolescence.

Jazz Jennings, Jackie Green, all those transmen in the Stella O'Malley documentary. They all come across as self-absorbed teens.

It can't be considered successful if you have arrested the physical and mental development of children to the point where they have no idea that they're wandering around totally undeveloped.

There's a reason people compare it to lobotomies.

Removing the capacity for mature, developed thought, because of a mental health issue?

But you are advocating for harm.

lechiffre55 you posted a link to the TGN1412 phase 1 trial, can you be sure that there are no children with ‘gender dysphoria’ who could benefit from that drug? That there isn’t 0.0xxxx1% of cases, edge cases, that could benefit? Perhaps doctors should have this drug as an option? Would we be falling ‘into the same trap as TRAs’ to presuppose that it won’t help?

OK lets start with this... You take all the kids who self report as transgender

Can we define 'transgender' first?

What is it?

No no I'm not.
I think you are fundamentally misunderstanding what I'm saying. I think you are injecting some meaning of your own into what you think I am saying, and arguing with that.

What I am saying ( again ) is that I am in favour of proper evidence based research following the scientific method. I want the medical profession to increase their knowledge on this issue to be able to help these kids with more appropriate treatment than kumbyya gender woowoo.
I have to be prepared that it is possible that the research may involve things I disagree with.
I seem to remember that the interim Cass report said something along the lines of "no more puberty blockers for kids, unless it's done within the scope of an approved and tightly controlled research study". This seemed like a positive step at the time. You may argue that even this constitutes harm.

Young trans reporting kids still currently have access to PBs from external to the UK providers e.g. Gender GP. I think this is very wrong and should be illegal asap. But I think doctors should use all sources of information to increase their knowledge. If a kid turns up at a UK doctor who is using PBs bought from outside UK, the data on that kid's experience should be used to increase medical knowledge, and it should also be used by politicians as a reason to outlaw the practive and shut places like Gender GP down.
Is that kid being harmed by the PBs yes, is the data from their use useful, yes.

Up to now we've hypothetically dealt with 99.9xxxx9%, but there's always going to be one or two edge cases. And in those cases competent medical professionals may be forced to consider other options. It's possible PBs might be on the list.
I'm not a doctor, but Cass is. I trust Cass on this.
If we say PBs can never be the answer under any circumstances then in my opinion we fall into the same trap as the trans rights activists. Pre supposing that we are right, and being closed to any possibility we dislike.

But first, as I said, we need a definition of gender dysphoria. What is it? What is the illness that is being treated?

And we need a description of what a positive outcome would look like. What are doctors trying to achieve by treating children with these drugs? What is the benefit of treating them as children rather than as adults when they can make mature decisions with a full understanding of all the implications of treatment?

I don't think it's presupposing anything to say that a child with no sexual experience cannot make an informed decision to have their sexual function permanently impaired. It's not presupposing anything to say that a child cannot consent to being sterilised.

I seem to remember that the interim Cass report said something along the lines of "no more puberty blockers for kids, unless it's done within the scope of an approved and tightly controlled research study". This seemed like a positive step at the time. You may argue that even this constitutes harm.

I would say that this constitutes harm. What is the benefit to the children in this study? They are being harmed. Unethical experimentation on children should never be given approval. Even if the children think they've consented and their parents have also consented.

We already know from existing research that the most effective treatment - 80% effective - is going through puberty.

You cannot ethically try a high-adverse-effect treatment that helps (but doesn't cure) 0.00...01% before the no-side-effect treatment that cures 80%. And you can't use a puberty blocker after puberty.

So unless and until you can identify the 80% - ideally also the 0.00....01% - there is no clinical place for PBs.

Until then, we absolutely should be doing retrospective case series on the people who have already taken them, but there is no reason for new trials. It would be like testing a vaccine for ingrowing toenails that only works on people who've had both feet cut off.

By the time we have a way to identify the 80%, we could have extensive data from the retrospective work to assess the need for and ethics of any future prospective trials.