WPATH & WHO - suppressing the evidence

[TimTamTime]

https://www.bmj.com/content/387/bmj.q2227

A pretty impartial look at more dodgy work by WPATH and the WHO - suppressing publication of their own commissioned reviews in case they compromise the defence of court cases.

Excellent and as a BMJ investigation no less. Thank you @TimTamTime

What a fantastic article. They are beginning to say the quiet bit out loud. That 'gender affirming care' is not medical treatment, and should be applied not on the basis of medical need and evidence of benefit, but rather according to the values and preferences of the individual.

To me this puts it firmly in the same category of Botox and lip filler, which we don't give to children and are not available on the NHS.

That's a very fine piece.

As an author and reviewer of reviews, IYSWIM, I'm horrified by the following (amidst many other issues).

Robinson emailed Chang about problems with WPATH just days after receiving a letter from several members of its executive committee outlining new “policy and procedures,” which instructed the Hopkins team to submit manuscripts to WPATH for an approval process that involved a vote by the SOC8 chair and co-chairs, as well as WPATH’s board. Only then would the Johns Hopkins researchers be given a “green light to be published.”
WPATH sent an update to Robinson and all SOC8 coauthors in October 2020 stating, “It is paramount that any publication based on the WPATH SOC8 data is thoroughly scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender healthcare in the broadest sense.”
The approval process was to be overseen by the organisation’s president elect at the time, Walter Bouman, a specialist in trans health at the University of Nottingham, UK. Gail Knudson, a physician at the University of British Columbia and former WPATH president, had also signed the letters to Robinson. Bouman and Knudson were appointed to WHO’s guideline development group for transgender health and remain members. Neither responded to The BMJ’s request for comment.

We've been here before with pharma refusing to allow publication or data release. It's no better when other organisations and sponsors use their powers to do this.

As usual - the toxic influence of medics making their personal fortunes is evident.
Great to see the BMA exposing the corruption in their midst. We'll only know this is being taken seriously when these people are being arrested and hauled before the courts for the damage they're doing - especially to vulnerable children and young people.

Very well written article. I like that they also referenced that the impact of allowing people to be treated as the opposite sex on other groups was not considered.

I haven't seen anywhere whether it was ever questioned why there was an assumption that transgender patients need medical treatment at all. I may have missed it of course.

So, the who/wpath review of the evidence will only allow evidence to come to light if it supports surgery and hormones for children? Jeez.

Dr Hannah Ryan of the Liverpool Resisters getting a mention there. Good job, Hannah!

This is brilliant. And long over due - finally the established medical community are taking notice and noting it's all a pile of dangerous bs.

This is what freedom of information laws were designed for

This is key imo:

“Best practice would be to publish,” Franco concurs. Even if the reviews were disseminated on preprint servers, says Heneghan, “there are no excuses in this modern era for not making your data or your particular systematic review available.”

Robinson at John Hopkins is blaming WPATH, but it sounds like they're saying they can't stop publication - is someone at JH putting the blocks on? I don't blame the individual researchers as it would be career suicide to go against your employer.

If so, it would be fascinating to see a map of all the financial and ideological conflicts of interest that make up this mess. This is not science, it's activism and politics.

Hannah Ryan is very succinct: “liberalised access to healthcare interventions that might in fact have harmful effects is not actually in support of anyone’s human rights.”

Where is Ben Goldacre when you need him. Any other branch of medicine and he would be all over this.

Actually can anyone more on twitter pose him the question of what he thinks of this?

It's been done hundreds of times. He clearly doesn't want to get involved because he sees absolutely no upside for him in doing so. Feet of clay unfortunately.

There are mentions on contracts with JH researchers - so
maybe they couldn't submit without WPATH approval within the terms of their contract? I agree it is extremely bad practice all round

WPATH says not: WPATH stood by its guidelines, commenting that “WPATH could not and did not prohibit the [Johns Hopkins] evidence based review team from publishing.

But of course they hold the purse strings over JH in terms of funding for future work so this may be disingenuous on their part.

I know Goldacre has been asked to wade in on the paucity of evidence. But this is different. This is the active withholding of data, the thing he has made his career campaigning against.

The article is suggesting clearly that WPATH tried to restrict any publication by John Hopkins to those papers they approved:

“In a separate exchange three years earlier with Christine Chang, a director at the US Agency for Healthcare Research and Quality, Robinson had referred to submitting “reports of reviews (dozens!)” to WPATH, but she added that “we have been having issues with this sponsor trying to restrict our ability to publish.”
Johns Hopkins is one of nine centres contracted with the Agency for Healthcare Research and Quality to conduct systematic reviews on a wide variety of topics, and the agency was considering having one done on treating gender dysphoria in children and adolescents. Exactly how many systematic review manuscripts Johns Hopkins drafted remains unknown, and neither Robinson nor anyone from the university responded to The BMJ’s email requests for comment.
Robinson emailed Chang about problems with WPATH just days after receiving a letter from several members of its executive committee outlining new “policy and procedures,” which instructed the Hopkins team to submit manuscripts to WPATH for an approval process that involved a vote by the SOC8 chair and co-chairs, as well as WPATH’s board. Only then would the Johns Hopkins researchers be given a “green light to be published.”
WPATH sent an update to Robinson and all SOC8 coauthors in October 2020 stating, “It is paramount that any publication based on the WPATH SOC8 data is thoroughly scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender healthcare in the broadest sense.”
The approval process was to be overseen by the organisation’s president elect at the time, Walter Bouman, a specialist in trans health at the University of Nottingham…”

https://www.mumsnet.com/talk/am_i_being_unreasonable/5200216-to-think-refusing-to-publish-the-findings-of-a-child-medical-study-because-you-dont-like-the-results-is-a-crime-nytimes-found-a-long-term-high-quality-study-of-puberty-blockers-has-been-blocked

So, does this mean the hair removal, various surgeries and drugs funded by the NHS can stop?

I notice MNHQ have deleted this thread. Did they tell you why?

Well technically it's the BMA but I am assuming the BMJ is acting relatively independently on this? Uncomfortable for the BMA review of Cass?

“Gordon Guyatt, distinguished professor in the Department of Health Research Methods, Evidence, and Impact at McMaster University in Ontario, isn’t bothered by this. “I think most people would say that adults thinking of transitioning should be allowed to make the decision, and the medical care to help them transition should be made available to them,” he says. While there may be only low quality evidence of benefit, adds Guyatt, “it seems to me a very value and preference sensitive decision.”
Juan Franco, a family physician and editor of BMJ Evidence-Based Medicine, agrees, as long as “the guideline clearly clarifies that patients have an understanding that the evidence is uncertain, and safeguards are in place to follow up and monitor for adverse events.” “

Sorry, long quote. Interesting to me that these two seem to be saying - adults should be able to take what they like, as long as they know it might not be good for them. But there are some drugs that are actually illegal for adults to take, aren’t there? Is the difference that they are saying you can take anything a doctor prescribes as long as you know it may be bad for you?

Guyatt was one of the early proponents of "evidence based medicine" which advocates for three things to be taken into consideration when making decisions:

1. The best available evidence (acknowledging that "best available" might be poor quality or sparse)
2. Professional experience
3. Patient values and preferences

So if you can find a doctor who considers themselves qualified to treat you, then it's reasonable for that doctor to weigh the low level of evidence against your "keenness" for treatment. It's part of the responsibility of the doctor to use their experience and what they know of the evidence to make sure you're informed of the risks and unknowns of course.

Whether these treatments should be available via publicly funded health services is different, and bodies like NICE generally expect more demonstrated benefit as they're making decisions about how to advise the health service to spend a very finite pot of money. If you're paying yourself then Guyatt's comments are reasonable.

This is maybe a bit of an aside - but maybe not...

More and more I think, not only should such things not be paid for by the state - I don't think doctors should be allowed to do them.

Cosmetic surgery, body modification, and even assisted death - these things are not actually health care and are not compatible with the limits doctors must observe in their practice of medicine.

And I think that because doctors do these things, it creates a sense of legitimacy that doesn't come from the "treatment" in itself - it comes from the legitimacy and trust we give to the medical profession.

Maybe if people want boob jobs or butt lifts, there needs be be some other group of people trained to do those services, without all the social trust we extend to doctors. And - without the subsidized education!