Continuation Trans women are not women (IX)

[mumblethrax]

Originally Posted by theprestige

Seems like the null hypothesis and the Hippocratic Oath prevail, then: No puberty blockers for prepubescent children suspected of having gender dysphoria.

I'm not sure what you think the null hypothesis is, and the Hippocratic oath isn't a thing.

[mumblethrax]

Originally Posted by Louden Wilde

Indeed (re: the highlighted). The pdf that mumblethrax linked to also noted that the drugs have been used as puberty blockers for ~30 years. This sounds like a long time, but that means the kids it was used on are only in their mid 40s. You'd like a broad health assessment of those initial cohorts, at the very least.

When it comes to the question of whether or not puberty blockers stunt growth, can we safely assume that people in their 40s have stopped growing?

[Ziggurat]

Originally Posted by mumblethrax

I'm not sure what you think the null hypothesis is

In this instance, the null hypothesis would be that puberty blockers don't help children with gender dysphoria.

Quote:

and the Hippocratic oath isn't a thing.

The concept of doing no harm very much is, which was the obvious point.

[d4m10n]

Originally Posted by Ziggurat

In this instance, the null hypothesis would be that puberty blockers don't help children with gender dysphoria.

I don't think "help children with gender dysphoria" can be reduced to a single hypothesis test, since there are several questions which need to be answered.

Do puberty blockers help alleviate dysphoria in the short term, compared to similarly situated control subjects without the treatment?

Do puberty blockers help alleviate dysphoria in the long term, when compared against CSH undertaken after puberty instead of before?

What are the long-term health effects of blockers for patients who skip the process of endogenous puberty?

If I've learned anything from the Cass Review so far, it's that the evidence base isn't remotely in place to answer these questions yet.

[Emily's Cat]

Originally Posted by mumblethrax

Incredibly dishonest. Here's the chain of that conversation for you again:



As you can see, you claimed that their use as puberty blockers was off-label, and that they were approved only for use in treating cancer. I claimed that they were approved as puberty blockers (and not for "their use for gender dysphoria").


I haven't done that at all. You don't seem to be able to keep the conversation straight.

The approved primary indication is for cancer - that's what it "says on the tin". There is an approved secondary indication for precocious puberty.

They are NOT approved for use as puberty blockers in normal adolescents who do not have precocious puberty!

Seriously, if you have to get down into teensy semantic quibbles and bait-and-switching of terms, you should reconsider your argument.

[Emily's Cat]

Originally Posted by Louden Wilde

Indeed (re: the highlighted). The pdf that mumblethrax linked to also noted that the drugs have been used as puberty blockers for ~30 years. This sounds like a long time, but that means the kids it was used on are only in their mid 40s. You'd like a broad health assessment of those initial cohorts, at the very least.

As an analogy, I used to point that (when teaching advanced classes) that we still don't whether people conceived IVF will have normal lifespans (the first being born in 1978), but we know they often exhibit epigenetic alterations

It's also conflating use to halt an inappropriate precocious puberty and use to interrupt a perfectly normal puberty.

FFS, it's nearly as bad as claiming that sumatriptan has been used to treat 'headaches' for 20 years and using that to support it being used for tension headaches. It's blatant motte and bailey, reliant on conflating the medical condition of precocious puberty with transgender.

[theprestige]

Originally Posted by mumblethrax

I'm not sure what you think the null hypothesis is, and the Hippocratic oath isn't a thing.

I'm confident you understand both my meaning and my point.

[Elaedith]

Since we are on this issue, I remember there was some interesting information in Benjamin Boyce's interview with endocrinologist Dr Will Malone in 2019. Like all of Boyce's interviews it's very long. The part I found most interesting was the description of how the affirmation-only approach with promotion of medical transition was simply declared by fiat to be the only acceptable approach by organisations like the endocrine society, AAP and APA, despite lack of data and with suppression of debate. This bit starts around 28.40.

Another interesting issue explained in the interview is that the affirmation-only psychotheraputic approach used in the US is not consistent with the Dutch protocol (where the medical approach with puberty blockers originated). Although the Dutch protocol did use medical transition, it was accompanied by a neutral rather than affirmative theraputic approach to avoid consolidating cross-sex identity where it would otherwise have resolved. This is explained around 20.00.

The interview also covered what we have been discussing surrounding puberty blockers in the earlier part. Everything Malone said about this is consistent with the Cass review.

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I AGREE

[mumblethrax]

Originally Posted by Ziggurat

In this instance, the null hypothesis would be that puberty blockers don't help children with gender dysphoria.

That strikes me as too vague to be useful. You'll probably want to look for a specific effect.

Quote:

The concept of doing no harm very much is, which was the obvious point.

I mean, it's a concept, sure. It's unclear how it has any practical value here.

Originally Posted by d4m10n

If I've learned anything from the Cass Review so far, it's that the evidence base isn't remotely in place to answer these questions yet.

That seems to be pretty close to the state of things. Weak evidence for a benefit, weak evidence for adverse effects.

Originally Posted by Emily's Cat

The approved primary indication is for cancer - that's what it "says on the tin". There is an approved secondary indication for precocious puberty.

If there's an approved secondary indication, then it also says that on the tin. That's what approval is. It means (among other things) that they can advertise it for that purpose. Which they do.

Quote:

They are NOT approved for use as puberty blockers in normal adolescents who do not have precocious puberty!

I didn't claim they were.

Quote:

Seriously, if you have to get down into teensy semantic quibbles and bait-and-switching of terms, you should reconsider your argument.

Again, this is incredibly dishonest. You denied that they were approved for use as puberty blockers at all. Now you want to weasel your way out of that and somehow that's my fault. You might be fooling somebody, but it isn't me.

Quote:

It's also conflating use to halt an inappropriate precocious puberty and use to interrupt a perfectly normal puberty.

At no point did this occur.

Quote:

FFS, it's nearly as bad as claiming that sumatriptan has been used to treat 'headaches' for 20 years and using that to support it being used for tension headaches. It's blatant motte and bailey, reliant on conflating the medical condition of precocious puberty with transgender.

This is just foolish. The claim is about safety, rather than efficacy, so it would be more like saying that aspirin has been used safely for years and so it's probably safe for prevention of pre-eclampsia, too. And "blatant motte-and-bailey"? It's not even a motte.

[Ziggurat]

Originally Posted by mumblethrax

I mean, it's a concept, sure. It's unclear how it has any practical value here.

If you don’t understand how the concept of not making things worse applies here, I really don’t know what to say to you.

[mumblethrax]

Originally Posted by Ziggurat

If you don’t understand how the concept of not making things worse applies here, I really don’t know what to say to you.

I don't see how not making things worse is preferable to not letting things get worse, which is why I don't particularly think "do no harm" is a useful principle in modern medical ethics. Or any kind of ethics, really.

[Ziggurat]

Originally Posted by mumblethrax

I don't see how not making things worse is preferable to not letting things get worse, which is why I don't particularly think "do no harm" is a useful principle in modern medical ethics. Or any kind of ethics, really.

First, because if you make things worse, that doesn’t preclude them continuing to get worse on their own as well. Second, because you might be wrong about them getting worse on their own. Third, if you can’t make things better, then maybe you don’t even understand the problem.

[mumblethrax]

Originally Posted by Ziggurat

First, because if you make things worse, that doesn’t preclude them continuing to get worse on their own as well.

It also does not preclude them getting better due to "making things worse", so this is not a reason to prefer "do no harm" to "allow no harm".

Quote:

Second, because you might be wrong about them getting worse on their own.

You also might be right about them getting worse on their own, so this is not a reason to prefer "do no harm" to "allow no harm".

Quote:

Third, if you can’t make things better, then maybe you don’t even understand the problem.

And this does not even address the question. If you can't make things better, there's no reason for intervention at all.

[Ziggurat]

Originally Posted by mumblethrax

If you can't make things better, there's no reason for intervention at all.

No ****. That's exactly the point of "first, do no harm".

[mumblethrax]

Originally Posted by Ziggurat

No ****. That's exactly the point of "first, do no harm".

If the only situation where "first, do no harm" gives you any ethical guidance is the one where no physician who doesn't have to wear a football helmet indoors needs ethical guidance, then it's entirely useless.

[Darat]

Originally Posted by Ziggurat

No ****. That's exactly the point of "first, do no harm".

It's a bit of a sidebar but the "do no harm" is not really used in modern medical ethics - you are looking at "non-maleficence". A quick think explains why the "do no harm" is not used in considering medical ethics, for example even a blood test causes undeniable harm to a patient (an injury) using "do no harm" as a rule would bring modern medicine to a standstill.

Your wider point is of course still correct, "puberty blockers" have been used unethically by some medical practitioners when treating pre-pubescent children given the lack of research.

This is one of those tricky areas in medical ethics when the only valid research possible is going to involve real people undergoing treatment with these drugs. Personally I don't think we know enough yet about how to treat trans children outside of physical medicine to start research on delaying or supressing puberty via chemical or physical means.

[Rolfe]

One huge problem identified at the Tavistock was the lack of record-keeping and follow-up. At an earlier stage these treatments were justified on the grounds of research, but there was no control group and no proper protocol. No systematic data-gathering operation was mounted, and no systematic protocol of follow-up examinations. Instead, at some point the treatments were simply held to be a success and they carried right on.

So research opportunities that might have answered a lot of questions were lost. Nobody was looking at desistance or detransition rates or even regret. There was a huge attrition rate among the original participants, and nobody tried to follow these patients up to find out why. It was simply assumed that the patients who continued to attend were typical of the entire cohort. However, many detransitioners who have come forward have said that they didn't go near their original provider once they realised the whole thing was a horrific mistake, for various reasons.

The attitude even among medical professionals seems to have been, we know this is the best way to treat paediatric gender dysphoria and that's what we're going to do. Anyone who treats a child in a different way (as would be necessary for a control group on the watchful waiting pathway) is a child abuser, and anyone who questions our actions is a bigoted transphobe.

[mumblethrax]

Originally Posted by Darat

It's a bit of a sidebar but the "do no harm" is not really used in modern medical ethics - you are looking at "non-maleficence". A quick think explains why the "do no harm" is not used in considering medical ethics, for example even a blood test causes undeniable harm to a patient (an injury) using "do no harm" as a rule would bring modern medicine to a standstill.

And in particular, there is no compelling reason to prioritize non-maleficence over its counterpart, beneficence. A much better general gloss would be something like "provide treatment that you have reason to believe is likely to produce benefits that outweigh its risks, while respecting the autonomy of your patient. And if you live in a civilized country, something about distributive justice".

[shuttlt]

Originally Posted by Rolfe

One huge problem identified at the Tavistock was the lack of record-keeping and follow-up. At an earlier stage these treatments were justified on the grounds of research, but there was no control group and no proper protocol. No systematic data-gathering operation was mounted, and no systematic protocol of follow-up examinations. Instead, at some point the treatments were simply held to be a success and they carried right on.

So research opportunities that might have answered a lot of questions were lost. Nobody was looking at desistance or detransition rates or even regret. There was a huge attrition rate among the original participants, and nobody tried to follow these patients up to find out why. It was simply assumed that the patients who continued to attend were typical of the entire cohort. However, many detransitioners who have come forward have said that they didn't go near their original provider once they realised the whole thing was a horrific mistake, for various reasons.

The attitude even among medical professionals seems to have been, we know this is the best way to treat paediatric gender dysphoria and that's what we're going to do. Anyone who treats a child in a different way (as would be necessary for a control group on the watchful waiting pathway) is a child abuser, and anyone who questions our actions is a bigoted transphobe.

I used to have some connection to psychotherapists at the Tavistock who came into psychotherapy in the 70s. They were heavily connected to the Oxford New Left and Cultural Studies. I remember in the 90s having conversations with a couple of them about the challenge of testing psychoanalytic theories. Effectively the majority view was remarkably similar to the kind of opinions expressed by homeopaths and chiropractors on this forum... the treatments were so personalised and dependent on the relationship between therapist and patient, that they couldn't be tested. My impression is that much of what the Tavistock is built on is actively opposed to the idea of evidence based medicine. Many of the same people were connected to similar debates on the New Left about the privileging of theory.

[theprestige]

Originally Posted by mumblethrax

It also does not preclude them getting better due to "making things worse", so this is not a reason to prefer "do no harm" to "allow no harm".

You don't have an argument that it makes things better, though.

Quote:

And this does not even address the question. If you can't make things better, there's no reason for intervention at all.

I knew my confidence was not misplaced.

[Rolfe]

Originally Posted by shuttlt

I used to have some connection to psychotherapists at the Tavistock who came into psychotherapy in the 70s. They were heavily connected to the Oxford New Left and Cultural Studies. I remember in the 90s having conversations with a couple of them about the challenge of testing psychoanalytic theories. Effectively the majority view was remarkably similar to the kind of opinions expressed by homeopaths and chiropractors on this forum... the treatments were so personalised and dependent on the relationship between therapist and patient, that they couldn't be tested. My impression is that much of what the Tavistock is built on is actively opposed to the idea of evidence based medicine. Many of the same people were connected to similar debates on the New Left about the privileging of theory.

That is interesting. Before all this my only reference point for the Tavistock was a short scene in my favourite TV show of all time, "A Very Peculiar Practice" (1986-88). In this scene the senior GP partner Jock, who was drunk, was accusing the young and idealistic Stephen of being "one of these Tavi chaps", obviously having no good opinion at all of the pie-in-the-sky trendy leftie mindset of the Tavistock practitioners.

[d4m10n]

Originally Posted by Rolfe

That is interesting. Before all this my only reference point for the Tavistock was a short scene in my favourite TV show of all time, "A Very Peculiar Practice" (1986-88). In this scene the senior GP partner Jock, who was drunk, was accusing the young and idealistic Stephen of being "one of these Tavi chaps", obviously having no good opinion at all of the pie-in-the-sky trendy leftie mindset of the Tavistock practitioners.

Well it only took three decades for the NHS to start turning the ship around by clarifying the need for an adequate evidence base.

[mumblethrax]

Originally Posted by theprestige

You don't have an argument that it makes things better, though.

I mean, I do.

But what I'm objecting to is idea that this should be an adversarial affair, where we do not impartially look over the evidence but accept every account of an adverse effect, no matter how implausible or unevidenced, and then wait for someone else to come along to catalog any potential benefits, no matter how implausible or unevidenced. This is obviously not the way to proceed.

[shuttlt]

Originally Posted by Rolfe

That is interesting. Before all this my only reference point for the Tavistock was a short scene in my favourite TV show of all time, "A Very Peculiar Practice" (1986-88). In this scene the senior GP partner Jock, who was drunk, was accusing the young and idealistic Stephen of being "one of these Tavi chaps", obviously having no good opinion at all of the pie-in-the-sky trendy leftie mindset of the Tavistock practitioners.

It started out in the interwar period. You've got different periods of intellectual development that mirrors the Left in the UK. You've got an early period where it is quite aristocratic. People connected to Freud, the treatment of survivors of WW1. You might want to check into Bion an his daughter Parthenope, just to get an idea of the kind of people in the early Tavistock.

You then have Freud coming over and dying in Hampstead. All that got absorbed by the NHS. In the 60s/70s things shift over to the New Left. In the 2000s things then shifted to a new generation. I think it maybe became more managerial. Gender dysphoria became the big growth area for them.

[theprestige]

Originally Posted by mumblethrax

I mean, I do.

But what I'm objecting to is idea that this should be an adversarial affair, where we do not impartially look over the evidence but accept every account of an adverse effect, no matter how implausible or unevidenced, and then wait for someone else to come along to catalog any potential benefits, no matter how implausible or unevidenced. This is obviously not the way to proceed.

The thread runs along libertarian lines. Nothing stops you from doing exactly what you propose, if you believe the thread needs more of that and less of the other thing.

Honestly I was a lot less polarized at the beginning of this discussion. I kinda figured that transwomen were women pretty much across the board. I had some misgivings about certain areas of sex segregation, and I looked forward to seeing the more informed and invested trans-inclusionists address those concerns with the best reasoning and science they could muster.

Instead, though, their response has only deepened my concerns, and led me to the conclusion that there is very little science and reasoning at all, behind the trans-inclusionist view of those concerns.

If you don't like the adversarial mode, stop being adversarial. If you think we should take a more balanced approach, and you have a more balanced approach in mind, lead the way. If you have science that says prescribing puberty blockers to prepubescent children diagnosed with gender dysphoria does more good than harm, cite it.

As far as I know, there is no good science that says that it's helpful to diagnose prepubescent children with gender dysphoria, that it's better to intervene than to let normal puberty progress, and that the long-term benefits of such treatment outweigh the long-term detriments. So for me it's less a matter of being "adversarial" and more a matter of thinking there's only one really rational way to look at it. If you have another rational way to look at it, that would greatly lessen my "adversarial" position on the subject.

[d4m10n]

UKites please tell me why #OwenJonesIsATerf is trending on my favorite microblogging platform.

[Elaedith]

Originally Posted by d4m10n

UKites please tell me why #OwenJonesIsATerf is trending on my favorite microblogging platform.

Do you know who Owen Jones is?

[d4m10n]

Originally Posted by Elaedith

Do you know who Owen Jones is?

I thought he was just another across-the-pond journo until just now.

[Elaedith]

Originally Posted by d4m10n

I thought he was just another across-the-pond journo until just now.

He is the Wokiest of the Woke with a capital W, morally grandstanding 'speech has consequences' bully, questioning the narrative is literal violence, JK Rowling is evil etc. I would probably agree with his opinions on many social issues, but he has gone way down the authoritarian Critical Social Justice cult path.

Then he said something that wasn't quite ideologically pure. I think it started when Helen Joyce said that we should try to reduce the number of people medically transitioning, and was immediately accused of advocating eugenics (which a lot of people seem to be conflating with genocide - somebody who was advocating eugenics would surely encourage medical transition because it sterilizes people).

OJ said something about not over-reacting and mentioned detransitioners, and then got a massive pile-on accusing him of being a Nazi and literally condoning eugenics/genocide etc. Then he complained about being frustrated at false claims being accepted as truth on social media, with a total lack of irony or self-reflection.

Some of us find it amusing. These people will always end up turning on each other.

ETA. I think he did actually condemn Helen Joyce, just not strongly enough. He said it was 'chilling' but denied that it was advocating genocide or something. Big mistake. Always use words like 'genocide' 'fascist' etc to be safe.

That's just my rough understanding. I haven't bothered looking up exactly what he said. Everyone will eventually fail to be ideologically pure enough no matter how safe they think they are.

[Ziggurat]

Originally Posted by Elaedith

OJ said something

I can't avoid associating this abbreviation with someone else.

Quote:

Some of us find it amusing. These people will always end up turning on each other.

"Like Saturn, the Revolution devours its children" - Jacques Mallet du Pan

[SuburbanTurkey]

Originally Posted by Ziggurat

I can't avoid associating this abbreviation with someone else.



"Like Saturn, the Revolution devours its children" - Jacques Mallet du Pan

I think comparing twitter squabbling to a revolution would be sin serious enough for the French to feed you into a guillotine.

Getting into tedious debates and working yourself into a furor is why Twitter exists. Gonna have to play the "touch grass" card on this one. Twitter slapfights aren't real life*

*Unless you're Graham Linehan and decide to piss away your whole personal life over it. I guess if you try hard enough, you can make it real.

[Ziggurat]

Originally Posted by SuburbanTurkey

Getting into tedious debates and working yourself into a furor is why Twitter exists. Gonna have to play the "touch grass" card on this one. Twitter slapfights aren't real life*

You say that like this dynamic is confined to Twitter. It isn't. And for some reason (well, probably because they're largely immature narcissists), journalists in particular seem to treat Twitter as if it was real, so there can in fact be significant real-world consequences for journalists to what happens on Twitter. Maybe there shouldn't be, but there often are.

[theprestige]

Originally Posted by SuburbanTurkey

I think comparing twitter squabbling to a revolution would be sin serious enough for the French to feed you into a guillotine.

Getting into tedious debates and working yourself into a furor is why Twitter exists. Gonna have to play the "touch grass" card on this one. Twitter slapfights aren't real life*

*Unless you're Graham Linehan and decide to piss away your whole personal life over it. I guess if you try hard enough, you can make it real.

The revolution and its failure modes are fractal.

[SuburbanTurkey]

Originally Posted by Ziggurat

You say that like this dynamic is confined to Twitter. It isn't. And for some reason (well, probably because they're largely immature narcissists), journalists in particular seem to treat Twitter as if it was real, so there can in fact be significant real-world consequences for journalists to what happens on Twitter. Maybe there shouldn't be, but there often are.

Well, is this one such time?

We can all cite twitter weirdos aggravated about this or that topic until the cows come home. My point is that pointing to a bunch of weirdos slapfighting on twitter is not very instructive.

Perhaps this twitter spat is a reflection of something happening in the broader world, perhaps not. Seems like something that ought to be demonstrated before going any further.

[Elaedith]

Originally Posted by d4m10n

I thought he was just another across-the-pond journo until just now.

Here's a sample thread about it. Apparently he was 'tone policing trans people for saying Joyce was calling for genocide'.

[Meadmaker]

Originally Posted by theprestige

The revolution and its failure modes are fractal.

(Ignore my sig for this one. I just thought the saying was great.)

[mumblethrax]

Originally Posted by theprestige

If you don't like the adversarial mode, stop being adversarial.

I haven't been, at least not in the sense I mean. I have not played the part of the "trans activist", and I don't intend to.

Quote:

As far as I know, there is no good science that says that it's helpful to diagnose prepubescent children with gender dysphoria

Why would you expect a diagnosis to be helpful?

Quote:

that it's better to intervene than to let normal puberty progress, and that the long-term benefits of such treatment outweigh the long-term detriments. So for me it's less a matter of being "adversarial" and more a matter of thinking there's only one really rational way to look at it. If you have another rational way to look at it, that would greatly lessen my "adversarial" position on the subject.

Here's a recent overview of the evidence commissioned by Florida's AHCA:

https://ahca.myflorida.com/letkidsbe...tachment_C.pdf

Here's a relatively recent longitudinal study that looks at the mental health consequences of puberty blockers and gender-affirming hormones:

https://jamanetwork.com/journals/jam...rticle/2789423

[Elaedith]

Originally Posted by mumblethrax

Here's a relatively recent longitudinal study that looks at the mental health consequences of puberty blockers and gender-affirming hormones:

https://jamanetwork.com/journals/jam...rticle/2789423

Funnily enough, that is one I was meaning to use as an example of a study in this area that misrepresents findings - only I am still working though it and the critiques.

Anyway, here is Jesse Singal's take:
Researchers Found Puberty Blockers And Hormones Didn’t Improve Trans Kids’ Mental Health At Their Clinic. Then They Published A Study Claiming The Opposite.

[d4m10n]

Originally Posted by Ziggurat

...journalists in particular seem to treat Twitter as if it was real, so there can in fact be significant real-world consequences for journalists to what happens on Twitter. Maybe there shouldn't be, but there often are.

Dave Weigel has joined the chat.

[mumblethrax]

Originally Posted by Elaedith

Funnily enough, that is one I was meaning to use as an example of a study in this area that misrepresents findings - only I am still working though it and the critiques.

Haven't finished Singal's take, but yeah, I agree they're misrepresenting their findings.