Transwomen are not Women - Part 15

[angrysoba]

Yeah. From the automatically generated transcript, I notice this, and wonder why they don’t draw the most obvious parallel:

“The problem with EBM is that it focuses too narrowly on just the clinical evidence. And what our argument has been at science-based medicine, that you need to include all of the evidence, all of the scientific evidence, not just the clinical evidence.

You need to include the preclinical evidence, the animal study, plausibility, physics, right? Because what happened was homeopathy, acupuncture, Reiki, all of these things that had no prior plausibility or break the laws of physics were like, we love EBM. All we have to do is just roll the dice on clinical trials without any consideration of prior plausibility and basically use that to promote our, then cherry pick the positive results and use that to promote our nonsense.”

From The Skeptics' Guide to the Universe: The Skeptics Guide #995 - Aug 3 2024, 3 Aug 2024
https://podcasts.apple.com/jp/podca...the-universe/id128859062?l=en&i=1000664226838
This material may be protected by copyright.

Followed by this…

“There was one review in particular which I recommend, which I'll link to for part of the story, which came was, did come out of Yale, that I'm not biased because it's out of Yale, it just happened to come out of Yale, but involved a lot of, they said the author group has collectively 86 years of experience caring for more than 4,800 transgender youth, published 278 peer-reviewed studies, 168 of which are in the field of gender-affirming care. Most of the people involved in the CAS review do not have anywhere near that level of experience. They are mainly pediatricians without experience in transgender care.”

The most obvious parallel is that in reviews of, say, acupuncture, the ones that have authors with many years of practice of acupuncture are often least likely to be science-based.


Disappointing from Steven Novella.

 

[lionking]

I still haven't seen anything about the Cass review on 'Science-based Medicine'. However, the latest podcast edition of 'Skeptics's Guide to the Universe' just dropped, and included a segment on the Cass Review.

Amongst other guff, Dr. Steven Novella informs us that the most significant problem with the Cass review is it required studies to be double-blinded placebo control trials, and therefore disregarded lots of high quality evidence supporting gender-affirming care.

Yes, that's right. Novella just confirmed that he either has not bothered examining the methodology used for the review, or is lying. At least we know.

Link here. The start discussing the Cass review around 40 mins in. The double-blinding issue is not the only false statement, see how many you can spot.

Novella was very misleading in that podcast. He mentioned in passing that the Cass review focused on puberty blockers used on minors, but left the impression that Cass wanted to withdraw care from all people seeking transition. He did not even mention Tavistock and the culture and practices it espoused. He said, against expert advice, that puberty blockers were reversible. And he made no mention at all of minors who regretted transitioning.

Extremely disappointing from someone who I usually respect.

 

[Elaedith]

Yeah. From the automatically generated transcript, I notice this, and wonder why they don’t draw the most obvious parallel:



Followed by this…



The most obvious parallel is that in reviews of, say, acupuncture, the ones that have authors with many years of practice of acupuncture are often least likely to be science-based.


Disappointing from Steven Novella.

Obviously only those with many years of experience practicing homeopathy and a strong vested interest in defending homeopathy are qualified to conduct reviews of homeopathy and to comment on other people's reviews of homeopathy.

 

[Elaedith]

Novella was very misleading in that podcast. He mentioned in passing that the Cass review focused on puberty blockers used on minors, but left the impression that Cass wanted to withdraw care from all people seeking transition. He did not even mention Tavistock and the culture and practices it espoused. He said, against expert advice, that puberty blockers were reversible. And he made no mention at all of minors who regretted transitioning.

Extremely disappointing from someone who I usually respect.

Virtually everything he said about the review is objectively incorrect, misleading or unsupported. But the thing that stands out above all else is that he actually stated specifically that the reason American clinicians have not accepted the review is not because of vested interests or ideology, but because it uses flawed methodology, and the major flaw is that it used arbitrary and unrealistic criteria such as requiring placebo-controlled double-blind studies of puberty blockers.

This is objectively false. It is not a matter of opinion. The research commissioned for Cass used NOS, a rating scale for non-RCTs, that does not downgrade research for not being blinded. They even removed a criterion that the observer should be blinded to outcome (single blind), making it more generous to the body of research. The also set the criteria for low quality lower than is often done (a score <50%, whereas some reviews use <70%). They did everything to be as generous as possible to low-quality research, and yet even by this standard almost half the studies were low quality, including the ones that activists most heavily rely on to support their claims. This is the reason they are upset with the review. They already dug themselves in too deep by having activists do guest articles for SBM where these studies were cited as strong evidence and they lapped it up uncritically.

I'm sure somebody has pointed out by now that this claim is objectively false. If they don't correct it, they are showing they are willing to knowingly peddle misinformation if it suits their agenda. There is no reason anyone should trust them.

 

[Elaedith]

Novella was very misleading in that podcast. He mentioned in passing that the Cass review focused on puberty blockers used on minors, but left the impression that Cass wanted to withdraw care from all people seeking transition. He did not even mention Tavistock and the culture and practices it espoused. He said, against expert advice, that puberty blockers were reversible. And he made no mention at all of minors who regretted transitioning.

Extremely disappointing from someone who I usually respect.

Also this gem "The big focus of the review was hormones for delaying puberty, but also included cross-sex hormones and gender affirming surgeries, you know, either breast reduction surgery, mastectomy, or vaginoplasty, or whatever, right? So, you know, basically genital surgery."

The review did not evaluate surgeries because they are not performed in the UK on those under 18.

He also stated at the outset that the standard of care recommended by Cass is basically consistent with Endocrine Society and WPATH guidelines. One of the systematic reviews commissioned for Cass evaluated international clinical guidelines using a standard assessment instrument and concluded that both these guidelines were not evidence-based, lacked transparency, and were not recommended for use.

I don't think he actually read the review at all. He is basing everything on uncritical acceptance of misinformation from hit pieces like the so-called 'Yale critique'.

 

[lionking]

Also this gem "The big focus of the review was hormones for delaying puberty, but also included cross-sex hormones and gender affirming surgeries, you know, either breast reduction surgery, mastectomy, or vaginoplasty, or whatever, right? So, you know, basically genital surgery."

The review did not evaluate surgeries because they are not performed in the UK on those under 18.

He also stated at the outset that the standard of care recommended by Cass is basically consistent with Endocrine Society and WPATH guidelines. One of the systematic reviews commissioned for Cass evaluated international clinical guidelines using a standard assessment instrument and concluded that both these guidelines were not evidence-based, lacked transparency, and were not recommended for use.

I don't think he actually read the review at all. He is basing everything on uncritical acceptance of misinformation from hit pieces like the so-called 'Yale critique'.

I expected the response from Novella. He has previously proclaimed that self stated gender identity is all that matters, and that’s a valid belief to have. But when young people in particular are harmed, he should step back.

 

[d4m10n]

SBM & co. continue to openly beclown themselves by arguing to forgone conclusions instead of following the evidence wherever it leads.

 

[Ziggurat]

The most obvious parallel is that in reviews of, say, acupuncture, the ones that have authors with many years of practice of acupuncture are often least likely to be science-based.

That sort of argument from experience can sometimes be valid. For example, the field of exercise science is kinda garbage (for a variety of reasons), and long-time strength coaches can learn a lot and know a lot from experience that the exercise science academics seem not to have figured out with clinical studies. But 1) there are also some coaches with years of experience who have convinced themselves of ******** nonsense anyways, and 2) for those who are paying attention, there's actually a pretty objective measure of your success, namely how strong your trainee got. If they can lift more, they are stronger. Placebo doesn't have to play much of a role when the feedback you pay attention to can be so easily and objectively measured.

But placebo can have a HUGE impact on something like gender affirming treatment. It can totally swamp any real effects, and it's impossible to avoid on the measures of interest. Couple that with patient dropout if they're unsatisfied, plus effects that play out over very long time scales, and it's incredibly easy for practitioners to get a very, very distorted picture of the efficacy of their treatments. So yeah, I wouldn't trust the "experience" of "gender affirming" treatment providers in the slightest. I bet lobotomy practitioners thought they were getting great results.

 

[smartcooky]

I expected the response from Novella. He has previously proclaimed that self stated gender identity is all that matters, and that’s a valid belief to have. But when young people in particular are harmed, he should step back.

IMO, what these idiot doctors don't get is that trialing puberty blockers is not like trialing aspirin to see if it helps with headaches. This is not some harmless experiment that they can just stop, and everything will go back to how it was before.

Puberty blockers have a huge, life-long, physiological impact on those who take them long term. The effects are irreversible, and they are using them on children - i.e. those who are desperate and the MOST vulnerable to unquestioningly doing anything that doctors tell them to do. The victims of these quacks are not mentally or emotionally developed enough to make such important decisions about themselves.

I predict that we are going to see a surge of mental problems in the future with those who have already become victims of trans ideology-captured quacks like Novella. Their lives will be in ruins because those quacks were looking for a quick chemical fix instead of treating gender dysphoria for what it is, a mental illness.

 

[Samson]

IMO, what these idiot doctors don't get is that trialing puberty blockers is not like trialing aspirin to see if it helps with headaches. This is not some harmless experiment that they can just stop, and everything will go back to how it was before.

Puberty blockers have a huge, life-long, physiological impact on those who take them long term. The effects are irreversible, and they are using them on children - i.e. those who are desperate and the MOST vulnerable to unquestioningly doing anything that doctors tell them to do. The victims of these quacks are not mentally or emotionally developed enough to make such important decisions about themselves.

I predict that we are going to see a surge of mental problems in the future with those who have already become victims of trans ideology-captured quacks like Novella. Their lives will be in ruins because those quacks were looking for a quick chemical fix instead of treating gender dysphoria for what it is, a mental illness.

Everything you say is correct.

 

[lionking]

IMO, what these idiot doctors don't get is that trialing puberty blockers is not like trialing aspirin to see if it helps with headaches. This is not some harmless experiment that they can just stop, and everything will go back to how it was before.

Puberty blockers have a huge, life-long, physiological impact on those who take them long term. The effects are irreversible, and they are using them on children - i.e. those who are desperate and the MOST vulnerable to unquestioningly doing anything that doctors tell them to do. The victims of these quacks are not mentally or emotionally developed enough to make such important decisions about themselves.

I predict that we are going to see a surge of mental problems in the future with those who have already become victims of trans ideology-captured quacks like Novella. Their lives will be in ruins because those quacks were looking for a quick chemical fix instead of treating gender dysphoria for what it is, a mental illness.

I don’t know what you know of Novella, but he certainly isn’t a quack. The Science Based Medicine podcast has done a lot to rid medicine of quackery.

 

[smartcooky]

I don’t know what you know of Novella, but he certainly isn’t a quack. The Science Based Medicine podcast has done a lot to rid medicine of quackery.

Well he's acting like a quack on this issue. Perhaps he has blinders on!

Frankly, I don't see how he can reconcile "science based medicine" with his agreement that a biological male can declare himself to be a woman and he becomes a woman by fiat, and expect the world to take him seriously?

 

[theprestige]

I don’t know what you know of Novella, but he certainly isn’t a quack. The Science Based Medicine podcast has done a lot to rid medicine of quackery.

A lot of ostensibly critical thinkers have been ideologically captured by a particular brand of sociopolitical woo.

 

[d4m10n]

A lot of ostensibly critical thinkers have been ideologically captured by a particular brand of sociopolitical woo.

Indeed; the test of critical thinking is whether you continue to take that approach when it might have negative social consequences. It is safe to say SBM has failed that test on both sex and gender.

The thing is that a bimodal distribution is not a vague notion, but a well defined type of statistical distribution that can be well characterised. That characterisation is lacking in Novella’s account, and instead gives a number of handwaving arguments in its favour (which we shall look at below). Novella does not cite any biology literature that explains how sex is bimodal but instead points to a diagram taken from the web site of a real-estate and crypto “entrepreneur”, Cade Hildreth. And indeed, Novella’s arguments appear to very much parallel the muddled discusion on Hildreth’s website. Hildreth also offers many more “scientific” insights into the health benefits of protein powders, vitamin and mineral supplements, and also claims to be the founder of the “world’s largest stem cell industry news site”. Novella’s web site also has a keen interest in these subjects like stem cell clinics, although on all matters bar the nature of sex, Novella’s and Hildreth’s views diverge somewhat.

But saying a measurement follows a bimodal distribution is a very precise claim. A bimodal distribution is a probability distribution of some measurement of a population that has two “modes” or most common values.

The claim sex is bimodal suggests we can make a measurement on an individual and use that to plot them along a distribution. The most basic question you can ask about a bimodal distribution is “what is the measurement you are taking that leads to this bimodal distribution”? We are not told this in Novella’s blog. At least, not one that defines “sex”. If you are going to claim “sex is bimodal” you need to say what measurement characterises sex. No-one ever has.

https://www.quackometer.net/blog/2022/07/the-muddling-of-the-american-mind-part-i.html

 

[Elaedith]

Indeed; the test of critical thinking is whether you continue to take that approach when it might have negative social consequences. It is safe to say SBM has failed that test on both sex and gender.



https://www.quackometer.net/blog/2022/07/the-muddling-of-the-american-mind-part-i.html

"The claim sex is bimodal suggests we can make a measurement on an individual and use that to plot them along a distribution."

To nit-pick, a categorical variable can have a mode since the mode is a frequency count. However, the accompanying graphs showing overlapping continuous distributions make it clear they are not thinking about sex as a categorical variable.

 

[Safe-Keeper]

IMO, what these idiot doctors don't get is that trialing puberty blockers is not like trialing aspirin to see if it helps with headaches. This is not some harmless experiment that they can just stop, and everything will go back to how it was before.

Puberty blockers have a huge, life-long, physiological impact on those who take them long term. The effects are irreversible, and they are using them on children - i.e. those who are desperate and the MOST vulnerable to unquestioningly doing anything that doctors tell them to do. The victims of these quacks are not mentally or emotionally developed enough to make such important decisions about themselves.

I predict that we are going to see a surge of mental problems in the future with those who have already become victims of trans ideology-captured quacks like Novella. Their lives will be in ruins because those quacks were looking for a quick chemical fix instead of treating gender dysphoria for what it is, a mental illness.

I was about to write a response, but I stopped at 'idiot'. If you have that little respect for those who disagree with you I don't know if there's any point. Your ignorance doesn't help either.

 

[Samson]

I was about to write a response, but I stopped at 'idiot'. If you have that little respect for those who disagree with you I don't know if there's any point. Your ignorance doesn't help either.

Keep describing your position on preventing children from forming normal human relationships.

 

[Elaedith]

I was about to write a response, but I stopped at 'idiot'. If you have that little respect for those who disagree with you I don't know if there's any point. Your ignorance doesn't help either.

So why don't you address somebody else and tell us what you disagree with on this issue.

 

[theprestige]

I was about to write a response, but I stopped at 'idiot'. If you have that little respect for those who disagree with you I don't know if there's any point. Your ignorance doesn't help either.

And thus the world is deprived of a rational argument for trialing puberty blockers on prepubescent children, because you didn't like someone's tone.

 

[d4m10n]

To nit-pick, a categorical variable can have a mode since the mode is a frequency count. However, the accompanying graphs showing overlapping continuous distributions make it clear they are not thinking about sex as a categorical variable.

Moreover, the whole point of the argument from bimodality (on this topic) is to refute the idea of sex as categorical. Solid nitpick, though.