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.

Interesting to see how this may impact the upcoming review into adult care for gender issues.

Sadly, Ben Goldacre doesn’t seem to have the courage. I’m disappointed—used to think he was great.

But good news that the BMA isn’t totally captured. Its genderist statements over the past few years have been quite bizarre. Or is it just because the BMJ has editorial independence from the BMA? and the BMA hierarchy is still captured?

Quite.

There’s also an ethical issue that never seems to be considered. Changing gender can have a harmful impact on other people. Facilitating men’s ability to access women’s single-sex spaces and services is harmful to women and children. If you wanted a drug that (say) prevented hair loss but made you violent, surely that would be restricted?

And why is WPATH treated like a professional body when it’s actually just an activist group?

They did a very good job of identifying as a professional body and convincing people that that was what they were.

The BMA does own BMJ Publishing, but the BMJ has complete editorial independence. Sanity in the pages of the latter does not indicate a sudden outbreak of sense in the former.

I’ve just finished reading the article and two things stand out to me:

1. the number of organisations and individuals in important positions who refused to give any comment. They just ignored the journalist. This is antithetical to promoting and maintaining public trust and confidence and frustrates accountability.

2. the number of medical researchers who basically said it’s fine for adults to be prescribed things that cause physical harm and iatrogenic diseases as long as it keeps these adults happy and as long as we inform them that the medically unnecessary treatments are bad for them. I mean, with this attitude why do organisations like WHO and NHS bother with public health campaigns warning of dangers like smoking, HIV, and illegal narcotics if certain members of these bodies promote this attitude that some people should be able to do whatever they want to damage their health?!

Special circumstances carved out once again, on the basis of ideology rather than medical evidence, for people who want to take cross sex hormones and have medically unnecessary (sometimes dangerous) operations. If medics and researchers are going to be this resistant to evidence based medicine they may as well bring back blood letting or diagnosis via Galen’s theory of four humours 🤷‍♀️

the number of medical researchers who basically said it’s fine for adults to be prescribed things that cause physical harm and iatrogenic diseases as long as it keeps these adults happy and as long as we inform them that the medically unnecessary treatments are bad for them

A standard that's not applied to any other type of medical care. If you want unnecessary opioids, or antipsychotics, or your leg cut off, any doctor providing that on a 'well I warned them, but they really wanted it' basis would be struck off

A standard that's not applied to any other type of medical care. If you want unnecessary opioids, or antipsychotics, or your leg cut off, any doctor providing that on a 'well I warned them, but they really wanted it' basis would be struck off

It's rare but surgeons have performed elective amputations for Body integrity identity disorder.

edition.cnn.com/2020/05/07/health/body-integrity-dysphoria-wellness/index.html

Nadeau N. Successful treatment of body integrity dysphoria with amputation: A case report. Clin Case Rep. 2024 Mar 27;12(4):e8720. doi: 10.1002/ccr3.8720. PMID: 38550725; PMCID: PMC10966911.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10966911/

There's an article that's frequently cited on FWR about the Jewell Shuping who persuaded a psychologist to blind them. US, so I'm uncertain about clinical gradings of psychologists there.

It's rare but surgeons have performed elective amputations for Body integrity identity disorder.

It has happened, but generally after a couple of instances the country where it happened goes 'What the fuck?!' and bans it. There was an article not that long ago about leg removal surgeries and how they have floated around the world as successive countries closed the loophole left by thinking nobody would be that mad. At the time of publishing about the only remaining option was one semi-underground group somewhere in South East Asia that would pretend you had a terrible thrombosis or other injury and amputation was essential.

And, of course, a significant difference with BIID is that nobody pretends it isn't an extreme mental health disorder. The patient in that finger amputation case report had to try multiple psychological and psychopharmaceutical options before the surgeon would go near him.

A bit of an aside but I heard the other day that the Eunuch Maker bods were appealing against the length of their sentences on the grounds that nothing they did was against anyone's will and the participants were happy with the results.

They could feasibly get WPATH to defend them.

It's the logical conclusion of the idea that anything is ok as long as it's consenting adults.

Seems like every challenging conversation out in the big boards, is deleted as soon as someone finds reality too challenging. Guessing we won’t see that username again either.

Re WPATH, Spotted on Twitter....

I do believe though that a gp in Scotland started getting carried away with this idea that it could help, and was firmly dealt with.

THIS is something that needs to be addressed more across all spheres

It was a Scottish surgeon, not a GP, who was convinced that this could help, and he did carry out a few amputations. He was only stopped because he was doing the amputations in an NHS hospital (although these were private patients who paid for the surgery).

http://news.bbc.co.uk/1/hi/scotland/625680.stm

I suspect the court will knock that argument down, in which case it may be useful precedent. There was a case many years back where some blokes were nailing one another’s bits down in BDSM play and the court said you could not consent to this. https://en.m.wikipedia.org/wiki/R_v_Brown

I suspect the court will knock that argument down, in which case it may be useful precedent.

It may indeed. If this happens, it brings us closer to the position where doctors will be held to account for removing body parts as "treatment" for distress that is related to mental health.

@smallchange
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.

I just cannot understand why the NHS has paid for these cosmetic procedures given the decisions they normally make.
Have wondered if it would be possible for someone to take them to court for offering say, hair removal, to males but not females. Blatant sex discrimination.

I'm concerned that any judgements that essentially agree that people can consent to serious harm would have much wider ramifications. There's the 'rough sex' defence, men still try to use it I believe. Then there's the Assisted Dying, I'm worried we might end up like Canada. I still can't wrap my head around that what these guys did was criminal but a Doctor or surgeon doing exactly the same thing is perfectly fine.

Any argument about consent would need to balance the harms and benefits of the treatment.

The problem gender treatment faces is that there isn't a defined illness that results in harm if not treated; it hasn't been proven that the discomfort a person feels is in any way linked to a gendered spirit, and as such what are the interventions actually treating?

Informed consent would be impossible as the entire thing is based on the professional hunch of a small number of psychologists, but I do think it's a bit different to the rough sex consent issue.

People who need operations consent to surgery being conducted on their bodies, but that is where it is considered medically necessary. I suppose there are also cosmetic operations (face lifts, boob jobs) and these are not medically necessary in general, but as a society we allow people to consent to it and surgeons to carry it out. As with many things, the lines need to be carefully drawn I suppose.