Cont: Transwomen are not women - part XI

[LondonJohn]

I was asking London John. He is under the impression they did nothing wrong.

That's a straw man misrepresentation of my opinion, by the way. Unsurprisingly.

 

[LondonJohn]

The Tavistock centre will be closed with the roll out of a new service model which will address the issues identified the first stage of the Cass enquiry, ie

* The service is overstretched

* There is no way for any other mental health problems the patient's have to be treated once they start with GIDS.

This matches some of the issues Barnes outlines.

It has also recommended a rigorous data keeping protocol for the new centres.

The interim report doesn't mention it but the new model could help with the centralised power issues Barnes identifies.

For all the other things, we will have to wait for the completion of the enquiry.

Exactly. And lionking could have found this information out trivially easily if he had a sincere interest in learning the objective truth of this matter.

 

[LondonJohn]

There may be cases where incompetence has occurred, I'm waiting for more information.

The Cass Interim report and Barnes' book emphasise the skill hard work and commitment to the well being of the patients exhibited by most of the staff.

Of course bad practice happens throughout medicine unfortunately. Our youngest suffered deafness for six months because our pediatrician wouldn't refer him to an ENT as we wished.and an audiology clinic tested normal hearing when he could not have had more than 5% of the sound penetrating.

The brother of a friend of mine at school nearly was disabled for life when his knee pain was diagnosed as psychosomatic.

There is a distinction between the problems at Tavistock, cause by organisational dysfunction and the general running down of the NHS and the status of treatment for.gender dysphoria generally.

That is, of course, the intended bait and switch intended by bringing up Tavistock in a discussion about the status of treatment for GD.

By the way, the Barnes book is actually quite good. From the comments I think that a few of those accusing me of not reading it have probably not read the whole thing themselves but just referred to parts reproduced in blogs here and there.

Oh I'm sure Cass will have found examples of incompetence - just as, for example, there are examples of incompetence to be found in (say) an adult renal surgery unit. And likewise, there will undoubtedly be examples of interventions which turned out to be detrimental to the patient.

But this is an unfortunately-inevitable consequence of the immense difficulty clinicians have faced in trying to tailor optimised clinical pathways for minors presenting with gender dysphoria, especially given the current paucity of long-term outcome data. Fortunately, of course, the recent significant increase in patient numbers will, over the next few years, feed through into a significant growth in the evidence base when it comes to gauging longer-term outcomes against clinical interventions (or non-interventions, as the case may be).

The point I was making is that - despite the vociferous protestations to the contrary by many anti-transgender-identity commentators - the (inevitable) discovery of instances of incompetence, mistakes and detrimental outcomes does not, in and of itself, mean or imply that the Tavistock was institutionally unfit for purpose (cue "mutilating kids", "sterilising kids" hysteria...). The official review will - and indeed is intended to - highlight areas for improvement in an extremely difficult, and largely uncharted, area of clinical practice.

 

[LondonJohn]

Jesse Singal just unlocked a good critique of this study.

Maybe It’s A Bad Idea To Give A Bunch Of Kids Double Mastectomies Without Checking Whether It Helps Them

Among other things, the study didn't use any validated measures of mental health and used a non-validated scale of chest dysphoria which essentially just measures whether patients are unhappy about having breasts before surgery and less unhappy about having breasts once they no longer have them.

How does one "check whether (offering mastectomies to young adult natal females with gender dysphoria) will help them"?

Is a crystal ball involved, perhaps.....?

 

[d4m10n]

“…validated measures of quality of life, depression, anxiety, or functioning.”

Sent from my Emperor Vectre using Tapatalk

 

[lionking]

How does one "check whether (offering mastectomies to young adult natal females with gender dysphoria) will help them"?

Is a crystal ball involved, perhaps.....?

Your disregard for minors damaged by Tavistock is unsurprising.

Like it or not Cass uncovered disgraceful practices (the chief amongst them was unquestioned affirmation, followed by lack of real follow up) and their demise has been unlamented by all but a few ideologues. They have gone from one of the “adults in the room” fawned over by TRAs, to one of the most disgraced and mistrusted medical bodies in the UK.

Not unfit for purpose? You must be joking.

 

[d4m10n]

(cue "mutilating kids", "sterilising kids" hysteria...)

"Mutilating" is a strong and emotionally charged term—and a bit of a judgement call—but whether children are indeed sterilised when put on the GnRHa → CSH → SRS treatment pathway is merely a question of fact. Care to venture a guess?

 

[LondonJohn]

Your disregard for minors damaged by Tavistock is unsurprising.

Like it or not Cass uncovered disgraceful practices (the chief amongst them was unquestioned affirmation, followed by lack of real follow up) and their demise has been unlamented by all but a few ideologues. They have gone from one of the “adults in the room” fawned over by TRAs, to one of the most disgraced and mistrusted medical bodies in the UK.

Not unfit for purpose? You must be joking.

I'd venture to suggest that your anti-transgender animus might be rather clouding your understanding of this matter. There was never "unquestioned affirmation"; the underlying reason behind lack of appropriate follow-up was that the centre was overwhelmed with new cases, far and away more than it was ever designed to handle.

As for your hyperbolic nonsense that "(The Tavistock) have gone from one of the “adults in the room” fawned over by TRAs, to one of the most disgraced and mistrusted medical bodies in the UK", well..... it's not worthy of consideration really.

As I said, it's pretty clear that - even when you've been presented with the explicitly clear reasons why the Tavistock is closing - you still prefer to follow your own agenda based on your own misunderstanding about why it's closing. And frankly, I don't care what you mistakenly believe, because the truth is very different.

 

[LondonJohn]

"Mutilating" is a strong and emotionally charged term—and a bit of a judgement call—but whether children are indeed sterilised when put on the GnRHa → CSH → SRS treatment pathway is merely a question of fact. Care to venture a guess?

Yes, I know. But you (and most anti-transgender-identity commentators) are still mistakenly treating this as a black-and-white issue, and mistakenly arguing that, in effect, it's at best fundamentally clinically wrong and detrimental to offer/carry out this form of treatment for minors with gender dysphoria (and at worst, it's positively evil....).

The truth, however, is (as so often) way, way more nuanced. For some minors presenting with gender dysphoria, this - after a lot of consultation and psychotherapy, and after an extremely in-depth communication of the outcomes of such treatment - will prove to be a clinically therapeutic medical intervention.

Most of the minors who've passed through the care of the Tavistock over the past several years have received treatment/therapy which has resulted in positive outcomes and happier people. Yes, there have been mistakes; and yes, a lot of the clinical intervention is (at present) based primarily upon the best efforts of the clinicians rather than with reference to an evidence base - because there simply isn't a statistically-reliable evidence base to use until sufficient minors have been treated in the various different ways.

And if a rational person stops to think about it, the argument that treatment of minors with gender dysphoria should primarily be evidence-based.... is entirely self-defeating in a vicious circle. Because the logical work-through of that argument is that - in the absence of a proper evidence base - no treatments should be given to minors with gender dysphoria. Which, in turn, means that there will never be a proper evidence base. Which in turn means that no treatments should be given to minors with gender dysphoria. Et cetera.

 

[LondonJohn]

“…validated measures of quality of life, depression, anxiety, or functioning.”

Sent from my Emperor Vectre using Tapatalk

But how can a clinician "know" if mastectomies will help natal female minors with gender dysphoria..... until/unless the mastectomies are actually performed?

Yes, it would then (ie after surgery) be possible (and very desirable) to gauge whether this surgical intervention had been therapeutic and beneficial to that patient.

But one would have to actually carry out the surgery in order to be able to make that assessment, you see. Nobody can reliably know in advance of the surgery whether or not the surgery is going to turn out to be therapeutic and quality-of-life-enhancing.

Of course, as the evidence base grows in this area - an evidence base which, by definition, will include significant numbers of minors who've undergone this surgery, and an assessment of the clinical outcomes of those patients - it should become easier to make better-informed clinical assessments pre-surgery as to whether the surgery is likely to be the right treatment for any given patient. But we're not at that point yet. And we'll only get to that point once sufficient patients have undergone the procedure in order for their outcomes to be assessed.


(By the way, I always belly-laugh at your highly amusing "Sent from my...." valedictions. They're a really funny distraction from the turgidly serious discussion of the thread. Keep 'em coming!!)

 

[Elaedith]

But how can a clinician "know" if mastectomies will help natal female minors with gender dysphoria..... until/unless the mastectomies are actually performed?

Yes, it would then (ie after surgery) be possible (and very desirable) to gauge whether this surgical intervention had been therapeutic and beneficial to that patient.

It is not possible unless one uses the types of procedures and measures that allow this inference, and they are not being used.

You would know this if you had any understanding anything about how interventions are evaluated, or bothered to read critical analyses by people who do understand this.

 

[LondonJohn]

It is not possible unless one uses the types of procedures and measures that allow this inference, and they are not being used.

You would know this if you had any understanding anything about how interventions are evaluated, or bothered to read critical analyses by people who do understand this.

I told you: I'm completely stupid unfortunately. And I certainly don't possess the sorts of psychic powers you're discussing.

See, if a person presents with a broken hip, there's a very large evidence base of differing surgical interventions and their likely outcomes and risks, split out by factors such as age, gender, bone density, lifestyle, cardiovascular strength, and so on. So an orthopaedic surgeon can have a pretty high degree of confidence as to which intervention is likely to result in the optimal outcome for that particular patient.

But as you know, I'm of very little brain, so I'll be happy to defer to the official review and the official reasons why the Tavistock is closing. I wish I had the mental capacity to understand why you know better than the experts.

 

[Elaedith]

I told you: I'm completely stupid unfortunately.

My condolences.

And I certainly don't possess the sorts of psychic powers you're discussing.

No psychic powers needed, as you would know if you bothered reading the analysis.

See, if a person presents with a broken hip, there's a very large evidence base of differing surgical interventions and their likely outcomes and risks, split out by factors such as age, gender, bone density, lifestyle, cardiovascular strength, and so on. So an orthopaedic surgeon can have a pretty high degree of confidence as to which intervention is likely to result in the optimal outcome for that particular patient.

The size of the database is irrelevant if the research is of poor quality. A larger database of improperly-conducted research and invalid measures will not improve ability to secure optimal outcomes. In fact, it will impede it by obscuring the facts.

But as you know, I'm of very little brain, so I'll be happy to defer to the official review and the official reasons why the Tavistock is closing. I wish I had the mental capacity to understand why you know better than the experts.

There is no evidence from anything you have posted that you understand why the Tavistock is closing, or that you understand the views of experts, or that you are able to distinguish genuine experts from quacks, or sound research from pseudoscience.

 

[d4m10n]

And we'll only get to that point once sufficient patients have undergone the procedure in order for their outcomes to be assessed.

Quite a few patients have undergone gender-affirming top surgery in the US, UK, & EU. The problem is that they aren't being tracked in terms of “validated measures of quality of life, depression, anxiety, or functioning” before and after these interventions.

Sent from my Declasse Mamba using Tapatalk

 

[lionking]

As for your hyperbolic nonsense that "(The Tavistock) have gone from one of the “adults in the room” fawned over by TRAs, to one of the most disgraced and mistrusted medical bodies in the UK", well..... it's not worthy of consideration really.

Of course you will say this, although I doubt you mean it. I’d rather take the sworn testimony of David Bell, accepted by the high court. The Tavistock was acting without regard to the welfare of its patients by not taking the steps a decent medical service should.

Bell’s report anticipated the concerns of the high court and he feels vindicated by its judgment. “It was jaw-dropping,” he says. “Because it was very strong.” As he read it, he was struck by details that have not been widely reported, particularly those involving a lack of data, a problem he had raised himself (GIDS was unable to produce for the court any data relating to outcomes and effects, whether desirable or adverse, in children who had been prescribed puberty blockers; nor could it provide details of the number and ages of children who had been given them).

Do you seriously think that Tavistock’s excuse (“we were busy”) should hold any water at all?

https://www.theguardian.com/society...leblower-david-bell-transgender-children-gids

 

[Elaedith]

But how can a clinician "know" if mastectomies will help natal female minors with gender dysphoria..... until/unless the mastectomies are actually performed?

Nobody is saying they can know unless the mastectomies are performed. That's something you made up out of whole cloth.

Yes, it would then (ie after surgery) be possible (and very desirable) to gauge whether this surgical intervention had been therapeutic and beneficial to that patient.

It's a shame they aren't doing that then, isn't it? Even more worrying when they pretend that they are, and when news reports make false statements claiming they have found this.

But one would have to actually carry out the surgery in order to be able to make that assessment, you see. Nobody can reliably know in advance of the surgery whether or not the surgery is going to turn out to be therapeutic and quality-of-life-enhancing.

Nobody is saying they can know in advance. That's something you made up.

Of course, as the evidence base grows in this area - an evidence base which, by definition, will include significant numbers of minors who've undergone this surgery, and an assessment of the clinical outcomes of those patients - it should become easier to make better-informed clinical assessments pre-surgery as to whether the surgery is likely to be the right treatment for any given patient.

No evidence base will grow that allows this if they do not conduct properly controlled, systematic, long-term studies using valid designs and measures.

But we're not at that point yet. And we'll only get to that point once sufficient patients have undergone the procedure in order for their outcomes to be assessed.

We will only get to that point if there is any valid research on outcomes conducted. Otherwise number of patients is irrelevant.

 

[LondonJohn]

Good to see that the process is now well under way to kick Moira Deeming, an anti-transgender-identity campaigner, out of the Liberal party in the parliament of the Australian state of Victoria. Deeming played an active role in the debacle of a "meeting" a few days ago on the steps of the Melbourne parliament building, which was an anti-transgender-identity protest under the Trojan-Horse misdirection guise of "Let(ting) Women Speak" (though fortunately virtually all of the Australian media, together with every state parliament across the country, easily saw through the disguise).

There's no place in progressive governments or parliaments for anyone who is an active denialist of transgender identity.

https://www.theage.com.au/national/...esutto-s-motion-revealed-20230321-p5ctvl.html

 

[lionking]

By the way LondonJohn, you say that you are not a TRA, yet you have adopted their language. Being critical of irreversible medical and surgical treatment of minors with gender dysphoria without due diligence and informed consent is not transphobia. Nor is being critical transwomen in woman’s prisons and competing in women’s sport (two things you are at least equivocal about). Using the words “transphobe” and “anti-transgender animus” to describe those critical of Tavistock is incorrect. Not that I expect you to change.

 

[d4m10n]

There's no place in progressive governments or parliaments for anyone who is an active denialist of transgender identity.

Can we safely assume Moira Deeming openly denies that some people identify as the opposite of their natal sex and/or assigned gender? Or is this an inference on your part?

Sent from my Canis Kamacho using Tapatalk

 

[Elaedith]

Good to see that the process is now well under way to kick Moira Deeming, an anti-transgender-identity campaigner, out of the Liberal party in the parliament of the Australian state of Victoria. Deeming played an active role in the debacle of a "meeting" a few days ago on the steps of the Melbourne parliament building, which was an anti-transgender-identity protest under the Trojan-Horse misdirection guise of "Let(ting) Women Speak" (though fortunately virtually all of the Australian media, together with every state parliament across the country, easily saw through the disguise).

There's no place in progressive governments or parliaments for anyone who is an active denialist of transgender identity.

https://www.theage.com.au/national/...esutto-s-motion-revealed-20230321-p5ctvl.html

In that case, I assume you will stop pretending that 'progressive governments all agree with it' constitutes evidence of the validity of gender identity ideology, since you have just admitted that politicians are not allowed to disagree with it.

I mean, you wouldn't want to be somebody who applauds dissenters being punished, and simultaneously claims that the scarcity of dissenters proves you are right, would you?

That is what Kathleen Stock aptly defined as a totalitarian mindset.