Hilary Cass sent a document to every single MP and Peer, justifying and defending the puberty blockers trial

[SingleSexSpacesInSchools]

https://x.com/JamesEsses/status/2075512549248745744?s=20

There are ten images on X, sorry can't add them all here, or upload a file with it all in.

Then it’s an observation that people who medically transitioned as children still have mental health problems. This is what they found in Finland.

Fishing exercise? It’s perfectly normal to conduct audits of patient populations. It’s the sort of research junior doctors do to complement their training on a regular basis.

“How many people getting a knee replacement are on a GLP 1 agonist?”

”What percentage of people attending our clinic for diabetes also see a vascular surgeon for leg ulcers?”

“What is the rate of renal impairment in people we give this particular drug to?”

It’s not difficult at all.

Therefore, the absence of mental health deterioration during pubertal suppression is viewed as a benefit.

I’m trying to get my head around this one. How do you clearly determine the benefit of the absence of something? How can variable x be proven by its absence?

Child A with gender/body dysmorphia feels happier at not going through puberty. They get told ‘don’t worry’ we’ll pause those stressful changes. At the end of 1 to 2 years, they’re told so now you have to go through those changes that you were distressed about… and their mental health at this point either does or does not deteriorate. Fingers crossed that counselling means their mental health doesn’t deteriorate at having to go through delayed puberty. But this is a big ask.

Child B with gender/body dysmorphia doesn’t want to go through puberty but is told ‘tough’ they have to go through puberty but they will get counselling to support them through the changes. And their mental health either does or does not deteriorate as they go through puberty.

That conclusively proves what about PBs? Anyone else figure this one out? It’s making my head hurt trying to understand how an absence proves anything.

Why is anyone interested in it? Lots of people seem remarkably insistent that it's a bad thing without their interest being questioned? Are people not allowed to have a different opinion without their motives being interrogated?

Then it’s an observation that people who medically transitioned as children still have mental health problems. This is what they found in Finland.

Did you notice the complete dataset that they used to establish this, the actual measure that they used (not 'still have mental health problems'), and the caution with which they couched their findings? And you think that the scrappy crappy data collected by the Tavistock could provide anything similarly statistically significant?

I think you are way overly optimistic about data collection in the adult gender service records. I can't imagine that they were routinely collecting bone density information on their patients.

Agreed. But surely the opportunity is to recruit and review those people now?

What I don't understand about the Pathways study is the short term nature of it. A couple of years is not what needs to be understood here. It's about effects over a much longer term.

But that’s useful in itself. Because it can be said “at the time of assessment, X% had a significant mental health condition. This is above/below/comparable to the known population data. It is not clear if this is better, worse or the same as pre-PBs due to poor record keeping pre-treatment.”

That tells its own story anyway doesn’t it? It’s not useless data.

Then add “X% of females required regular gynaecological attendance to manage testosterone-related problems.”

”There have been Y number of liver cancer cases, which is above/below/comparable to population rates.”

It’s useful data.

And THAT indicates a problem in itself doesn’t it.

“Our linkage study shows that despite bone density issues being a recognised complication of this treatment, barely any patients were being actively monitored for this and had data recorded on their bone health. We recommend urgent implementation of bone density assessments, monitoring and treatment in this population.”

A fishing exercise?! 😂

No. I would like everyone whose data is being examined to be informed and given an opportunity to opt out.

There is a scientific exemption in GDPR that supports this approach. It's ethical if used meaningfully. The ethical purpose here is to reduce the number of people who need to be experimented upon in order to have an evidence base. We should be looking at every possibility from the data of those who have already been experimented upon before conducting more physical intervention experiments.

Personally, I think the cognitive decline is the one that nobody dares explore because that's the massive can of worms here.

Occam's razor:

• if I remove a part of someone's brain for the good of their mental health, it is highly likely that they will be brain damaged for life and any mental health benefit therefore rendered less meaningful (lobotomies)
• if I stop the development of someone's brain for the good of their mental health, it is highly likely that they will be brain damaged for life and any mental health benefit therefore rendered less meaningful (PBs)

No wonder the NHS no longer says on its gender dysphoria pages that the impact on the developing teenage brain is unknown. If they make it too obvious that it was experimental, just like lobotomies, they will get sued by a lot of people in the future. There are lots of things that piss my off in this whole mess - the removal of those words is in my top 3. It was those words that made me say no to my daughter's request for PBs and look into everything with more depth. If she had asked for them now, all I would have is information telling me we're in good hands and they'll help work out if she needs them or not. Good hands my arse.

God, no that isn't.

If you go fishing in any set of data you are going to find things that are above or below average for the general population. That's just obvious.

Yes of course people are allowed to have different opinions.The motive for raising concerns is pretty straightforward, to prevent further harm to children.

I admit that I too was curious about your views because on this thread your comments sound as though they’re the kinds that a medical researcher would make to defend the trial on clinical grounds. It might be that you’re in favour of the trial in the belief that it will provide the hard evidence to permanently stop use of PBs, but personally I don’t share that belief.

A fishing exercise?! 😂

That's what's it's called when you do that! https://en.wiktionary.org/wiki/fishing_expedition

So it’s NOT useful to know if children treated at the Tavistock who are now adults have mental health condition rates triple that of the general population? Or 10 times the rate of certain cancers? Or who have had a thrombo-embolic event prior to 30?

Really? You’re just being silly now. Of course it’s useful.

You can almost guarantee that if the data was available and showed them to be happy, healthy and doing tremendously well then gender clinicians would be shouting it from the rooftops.

They also have not, as many PPs have said, identified their actual, falsifiable hypotheses. If you cannot say what gender identity is, or name precisely what improvement looks like - is it learning to live with their sexed body? Is it becoming more and more eager to surgically alter their sexed body? If it’s anything to do with improvement or maintenance of mental health, why PBs and not SSRIs? - then you do not actually have a rigorous study. Even the most loosey goosey survey study needs to have clear and falsifiable hypotheses - this study does not.

@noblegiraffe , as you think this trial should go ahead, can you answer these questions?

This ⬆️

That's exactly the kind of thing I mean by extracting what can be seen already from existing data. Each data point contributes to a story through correlation.

Could it be that Cass found herself between a rock and a hard place? Ske knew what had gone at the Tavistock was unacceptable and that there had been no proper follow up or monitoring of the children that passed through its doors, and yet she also knows that many people have fully signed up to this business and have been 'transed', including many children ( the awful example of the child transed at age 2, who now won't leave the house).She also knows that these people are now accessing puberty blockers illegally and in an unregulated way, including for their children.

This recent mail out to MPs could well be her feeling deeply panicked/compromised. She is now under-playing or even denying the known potential harms caused by puberty blockers because her professional judgement is on the line. She has seen many in both houses express extreme doubt and worry about the ethics of such a trial and she feels she needs to defend her decision. She knows that her neck, and her judgement, is now on the line.

I was laughing at the idea that you think looking at data points from 9000 people to examine patterns (as per PPs' examples) is simply a fishing exercise.

The term itself is perfectly viable but if you think that I'm advocating a spurious look at data to prove my own hypothesis (e.g. the cognitive impact issue) then I don't think you've understood a single thing I said in this thread.

What baffles me is that you believe that a fresh set of data will yield different results. As a starter for 10, how would you remove the impact of cross-sex hormones on long term outcomes if any of the 226 children go on to take these?

If there are 9000 data points which sit equally around a national average (i.e. there are just as many with good as bad mental health, when compared with the general population) that tells a story.

If there are more with positive or more with negative, that tells a story.

If only 3000 of the records make any reference to mental health at all, the same applies (but this time in a reduced data set).

In a data set that size, every viable data point should be examined. The hypotheses need to be written first. Some won't be viable to test against the data set but many will.

Edited to add: mental health is just one category. All potential outcomes should have hypotheses written and tested, including bone density, cognitive/executive function and so on. We don't know what's viable or not in the data set because nobody wants to look....

The person I was responding to when I used the term fishing exercise was proposing doing exactly that.

I'm not proposing a 'fresh set of data to yield different results', I'm proposing a complete, comprehensive and accurately recorded set of data that will yield statistically valid results.

At the moment we have a pile of crap data full of holes, missing extremely important data points and people think that if they go rummaging around in it long enough they'll find something that will convince people to stop giving these drugs to kids. They won't. The completely valid objections to whatever is found are already written before they start.

As a starter for 10, how would you remove the impact of cross-sex hormones on long term outcomes

You have to look at short term outcomes before you can look at long term outcomes.

The person I was responding to when I used the term fishing exercise was proposing doing exactly that.

If you believe conducting a standard clinical audit of data a “fishing exercise” that’s on you. Most people recognise it’s what happens in medical research constantly.

This potential linkage study would be looking for specific data.

If there are more with positive or more with negative, that tells a story.

No it doesn't. If you don't know whether your cohort suffered childhood trauma or not (which is higher among gender confused children but wasn't recorded by the Tavistock) then if you have a higher number of mental health problems in the adult cohort how can you attach any meaning or story to it?

You were throwing out a whole bunch of things and hoping something will stick.

Fishing exercise.

As a starter for 10, how would you remove the impact of cross-sex hormones on long term outcomes

You have to look at short term outcomes before you can look at long term outcomes.

OK. Then what? We'll have a 2 year data set in isolation that tells us whether children have been harmed or not by being on the PBs.

Do we need some of them to agree to resume puberty or does it matter if they all go on to have cross-sex hormones? If it doesn't matter, how will the effect of PBs alone be isolated from the effect of cross-sex hormones?

What valuable information does the short term data tell us once we have our outcome from it, given the concerns raised all relate to long term outcomes?

If we end up knowing that brain development and bone density both decline but mental health seems to remain stable over 2 years (because the impact on mental health is likely to be over a much longer period, considering participants will likely feel positive that they are being treated), what then?

“bunch of things”.

The “things” we need to know about.

Mental health status.
Recognised physical side effects: fertility, bone health, sexual function, impact on pelvic floor of testosterone, cardiovascular risks.

It’s not a list of random “things”. Just because the “things” we currently have no long term data on, but need long term data on is extensive doesn’t mean we can’t or shouldn’t look.

It demonstrates the opposite: the list of potential negative impacts of a proposed prospective study is so extensive we need to consider why it’s appropriate to do it before knowing anything else.

One question really isn't an interrogation.
I'd thought from another thread where you were trying to persuade the OP not to write to schools about the new KCSIE guidance plus vague memories of previous threads that you'd said were a teacher. I tend to remember educators on here as we so often share the same views about safeguarding children, ethics and the capture of the unions etc by trans extremism.

I was just curious. No worries.