Puberty Suppressing Hormones, House of Commons, Wes Streeting taking a firm and intelligent stand

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Wes Streeting is doing a good job of calmly holding his own in Parliament on this issue of puberty blockers being banned pending a trial.

Some MPs have been standing up and speaking about ‘trans kids’ and suicide and so on, and how young people currently taking puberty blockers will source drugs from other sources as they will be left so desperate. Certain MPs have shown no inkling of the wider issues concerning gender dysphoria among troubled young people.

WS read out report saying that suicide figures of trans people were skewed, and reporting of it dangerous.

Others have seemed to be more aware. Sir John Hayes has brought up those who were vilified for whistleblowing such as Kathleen Stock, the lives ruined by the Tavistock and how it could have happened? WS has just paid tribute to Hannah Barnes. Women’s concerns.

“I am very disappointed in behalf of our trans children….” Vikki Slade. She says there is no information on suicides for those on a gender waiting list. WS says all child deaths are monitored and reviewed.

Jim Allister asking about parental consent and age for the puberty blocker trial. WS ethical concerns are being taken very seriously.

“A breach of young people’s human rights” Carla Denyer (Green).

Robin Swann County Antrim asking about closing access to puberty blockers through loopholes.

Anyway, it is worth hearing WS. It seems to be the first time someone from Labour, who is allowed to speak, has seemed to have a depth of understanding about gender issues. He also speaks lucidly and with nuance.

I don’t know if he is just very clever, but in the end slippery, or actually someone who will make a difference for the better but was impressed.

Protest outside Streeting's office
I hope the parents of the Trans Kids Deserve Better had the good sense to keep them away from this. If a violent sex offender who is out on license is involving themselves with your children's project then it's time to stop and reflect on what you're allowing/encouraging and the connections and relationships being formed within this group of activists.

I knew it would be SJB.

but no, the parents will not reconsider. Tarnish by association (however nebulous/imaginary) is only for the terven.

I think the key thing is that gender medicine is practiced in the same way as other areas of medicine. This wasn't happening at the Tavi prior to the Cass Review and Kiera Bell's case.

There is a belief/suggestion that PBs improve outcomes for some gender dysphoric children. There are case studies that show this. Therefore, in line with other areas of medicine, a trial has been proposed.

If we want treatment to be evidence based and not ideologically based, standard protocols should be applied to gender medicine. This involves proposed trials being subject to the same ethical approval processes ;and corresponding safeguards) that all trials have to pass.

If the government try and prevent gender medicine being practiced in line with all other areas of medicine, they are on dodgy ground. The could legitimately take issue with ethical approval processes etc. but this would need to be across the board (eg for all paediatric studies) not just one branch of medicine)

If this was another branch of medicine, though, do you think the trial would get past an ethics committee?

There is a belief/suggestion that PBs improve outcomes for some gender dysphoric children. There are case studies that show this. Therefore, in line with other areas of medicine, a trial has been proposed.

A trial has already been carried out by GIDS, starting in 2011. Why not start with analysing the results from that trial rather than risk harming any more children?

Thankfully his desire to do a good job is taking precedent. He's definitely at the stage of waking up to the cognitive dissonance.......but is not fully there yet.

I have read the Wes Streeting quotes but not yet listened to him speaking. This is my impression too.
When he stops using the phrase "trans children" it'll be an indication that he's likely arrived at a fully sensible approach to this. As David Bell explains so clearly, using this phrase is wrong because it forecloses on the outcome of any exploration of why the child might be distressed. It's a potential destination following exploration, not a start point that's followed by a demand for puberty blockers to allow (what will now be a biased) exploration.

A trial has already been carried out by GIDS, starting in 2011. Why not start with analysing the results from that trial rather than risk harming any more children?

Hear hear. And putting pressure on (or simply asking) the US government for the results of the Johanna Olsen-Kennedy trial that it funded for the last 9 years would also be good. This needs international collaboration because it's an international problem. Enough children have already been experimented upon around the world. Let's get the results out there for all to use.

PB trial about to be discussed on Woman's Hour, with Deb Cohen (former Newsnight reporter)

Deb Cohen very good on this. Nuala out of her depth. Deb setting out the ethical considerations that still have to be thrashed out.

It's finished now. Well worth a listen
https://www.bbc.co.uk/programmes/m00261fg

Deb Cohen also talked about the reaction to the original Tavistock reports she did with Hannah Barnes - she was banned from Twitter, monstered online, called a transphobe etc etc

Not sure if this has already been linked - recent article by Deborah Cohen
https://www.bbc.co.uk/news/articles/clyd2qe5kkjo

Thank you @BoreOfWhabylon

I shall look forward to listening to that. I hope Nuala and others at the BBC are starting to feel a growing sense of confusion followed by shame that they might have dismissed this medical scandal as nothing more than a culture war.

Not yet available -taking a long time…

It always takes ages for WH to be available for some reason.

@Shortshrift, I have a recent and relatively long history of being on a REC. The same criteria is applied to all studies, but there is still a level of subjectivity involved when it comes to high risk studies and, ultimately deciding if the ends justify the means.

Successful applications require the applicant to demonstrate consideration of all potential risks. If any potential risks are overlooked or minimised, the application is likely to receive a 'provisional opinion' whereby the applicant is asked to resubmit having done further work.

Ultimately, the committee assess whether the potential benefits of the research justify the risks. High- risk studies do receive permission when the potential benefits are clear and where the study presents the only means of generating the new knowledge/ evidence needed.

I have seen on this and other threads posters suggesting the purpose of PBs is cosmetic. I don't think this will be a factor that is included in the REC submission. I expect it will focus on exploring the evidence of improving mental health outcomes in the short term - and long term if it's a longitudinal study (which it should my imho).

I expect the mitigating measures they will put in place will involve limiting the length of exposure and conducting regular monitoring. I imagine they will also put significant screening processes in place (inclusion and exclusion criteria). I expect this will cause uproar as many seem to be expecting access to be similar to before but on the condition of signing up to a study. I also expect people to start jumping up and down about the Equality Act in relation to the exclusion criteria. However, I can't see ethical approval being granted without careful consideration as to who should or shouldn't be included in the trial. Again, this is a balancing act!

Pleased this made WH.

And pleased it's Deb Cohen leading on it

Are there any other medications, apart from psycho-actives, that are used to treat mental health - but which have possible, and profound, long term physical impacts? Any negative effect of puberty blockers on the developing brain and body would not be seen in the immediate short-term; so how could a meaningful trial be short term and/or time controlled?

Are there any other medications, apart from psycho-actives, that are used to treat mental health - but which have possible, and profound, long term physical impacts?

Not sure. But partial lobotomies spring to mind.

Puberty blockers are almost a chemically induced partial lobotomy because they prevent the "pruning" phase of brain development from happening in adolescence.

Actually, that doesn't quite make sense as a partial lobotomy will remove parts of the brain.

The pruning phase of development is a natural removal of connections that is essential for the change from childhood to adulthood.

So it's not the same thing but it logically has a similar net effect. It's the natural functioning (the essential pruning) that has been "lobotomised". In both cases, the brain is no longer able to work as it would have done otherwise.

"Are there any other medications, apart from psycho-actives, that are used to treat mental health - but which have possible, and profound, long term physical impacts? Any negative effect of puberty blockers on the developing brain and body would not be seen in the immediate short-term; so how can trials be short term and/or time controlled?"

I'm not sure the 'other medications used to treat mental health' comparator will come into play with REC, they will look at the research protocol on its own merit.

Drugs trials are different to longitudinal studies and I expect there will be at least 2 related studies taking place.

I think a Stage 4 drugs trial will be conducted to explore efficacy in the short/ medium term. Stage 1-3 trials have already been conducted for PBs with child populations, so only a Stage 4 trial is needed to explore off label use.

I expect a longitudinal study will also be conducted to explore long term outcomes and side effects. This research is likely to last decades.

Yes, the type of medication seems unique for this condition.

Medication for mental conditions are normally designed to cure or alleviate the mental symptoms or, if there is a physical cause, to heal or cure the physical illness which is causing mental distress.

I don't think there are any other conditions where the treatment for a mental health condition is to make the physical body less healthy, or to cut off healthy body parts.

Vikki Slade mentioned near the start is Lib Dems

So would there be a risk of legal action if those on the trial develop bone/brain abnormalities further down the line?

I think a Stage 4 drugs trial will be conducted to explore efficacy in the short/ medium term. Stage 1-3 trials have already been conducted for PBs with child populations, so only a Stage 4 trial is needed to explore off label use.

I'm not familiar with the jargon used here, but fortunately there's lots of information on the Web about clinical trials and what is involved in the different stages. Here, for example.

Why do you say Stage 1-3 trials have already been conducted?

From my link:
If a drug can show an improvement over the standard treatment in a phase 3 clinical trial and is safe to use, it is likely to be approved by regulatory authorities so that it may become the new standard treatment for patients with that disease.

I think we are a long way from halting puberty in healthy children being shown to be safe and the most effective treatment for this mental condition.

Phase 4 appears to come into play after the drug has been approved for use.

There will be an information sheet that outlines the risks of participating in the study. This will include any known/anticipated potential side effects.

I think the risk of litigation relating to side effects is limited if potential risks are clearly explained in the information sheet and they have been deemed by the REC to be reasonable when considered against the potential benefits.

I am very interested in their inclusion criteria. The easiest way to get through the REC would be to only include those who are experience very high levels of distress and for whom current quality of life is dire (e.g not going to school, rarely leaving the house, not eating, self harming etc.). It will be difficult to justify the potential risks for populations who are functioning relatively well on a daily basis.

"Phase 4 appears to come into play after the drug has been approved for use"

When an approved drug is being trialled for purposes that differ to those they are licensed for, the first 3 stages don't need to be repeated. PBs have been approved for use in children with precocious puberty. The proposal is to now trial them for use with children with gender distress.