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Cass Report

They did offer me grow-taller-hormones somehow, in grade school, in maybe 1987? Someone sent me home with a pamphlet and everything. Because very short. But somehow despite the social contagion of how awesome it is to be tall and how terrible to be short (besides the typical stuff we had a much maligned four foot five teacher) I was like uhhhh no, no thank you.
 
Might well have saved you from CJD apart from anything else.
Oof! Yeah I remember not being particularly put off by the hormones being cadaver-derived, but of course I wouldn't even have thought about prion disease.
 
It seems like a good subject for an episode of The Studies Show, and indeed, they have just brought one out on the Cass Report.

Unfortunately all but the first 10 minutes is behind a paywall which they do for their more controversial hot button episodes.

https://www.thestudiesshowpod.com/p/paid-only-episode-7-youth-gender
Just to mention, this episode of 'The Studies Show' on the Cass review has now been removed from paywall so you can listen for free.
 
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Just to mention, this episode of 'The Studies Show' on the Cass review has now been removed from paywall so you can listen for free.
Is this generally a trusted source or is it some RFK/Oprah nonsense? Because everything they are claiming on this podcast goes 100% against what all the skeptic organizations, Skeptics Guide to the Universe, all the atheist orgs and pretty much what all the reason based community youtubes (except reason.com of course) are claiming
 
Is this generally a trusted source or is it some RFK/Oprah nonsense? Because everything they are claiming on this podcast goes 100% against what all the skeptic organizations, Skeptics Guide to the Universe, all the atheist orgs and pretty much what all the reason based community youtubes (except reason.com of course) are claiming
Do you mean on this issue specifically in or general? Because on this issue, most atheist/skeptic organisations and in particular anything associated with Novella and Gorski (including SGU and Science Based Medicine have all gone down the rabbit hole (see thread on the SGU misrepresentation of the Cass Review). There is also a large divide between the US and the UK (and many other countries which are rolling back medical transition for minors). The Studies Show is UK based I believe.
 
Is this generally a trusted source or is it some RFK/Oprah nonsense? Because everything they are claiming on this podcast goes 100% against what all the skeptic organizations, Skeptics Guide to the Universe, all the atheist orgs and pretty much what all the reason based community youtubes (except reason.com of course) are claiming

What are the skeptic organizations claiming?

It should be easy enough to sort out which are the correct claims and which ones are the false ones.

As for whether this is a trusted source, I tend to think so. The hosts are Stuart Ritchie and Tom Chivers who are science writers themselves and take something of a Ben Goldacre-style approach to science (with the exception, it seems of the placebo effect where they are more critical of Goldacre's position). As far as RFK Jr is concerned they are very much against his stances on, well... pretty much everything. I expect they would not appreciate the comparison with Oprah either.
 
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What are the skeptic organizations claiming?

It should be easy enough to sort out which are the correct claims and which ones are the false ones.
Used to be anyway. I invite you to bring this up with Matt Dillahunty, if we run low on fireworks this New Years Eve, that owuld be a perfect substitute
 
The role of the skeptic is not to poll the leading skeptic orgs for consensus.

The claims being made by people like Cass (and her critics) are testable, so put them to the test.


Reading now! I've never ever ever seen quackometer be anywhere near this balanced...kind of blown away here
 
Speaking of balance on skeptic blogs, I find it curious that SBM has barely touched this issue since Cass (final version) dropped.

SBM's go-to guest blogger on this topic appears to have jumped ship. I suspect it is now impossible to cover this topic since they would either have to repeat lies that can very easily shown to be objectively false in comments, or admit that statements Novella and Gorski already made publicly on social media and the SGU podcast are false.
 
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SBM's go-to guest blogger on this topic appears to have jumped ship. I suspect it is now impossible to cover this topic since they would either have to repeat lies that can very easily shown to be objectively false in comments, or admit that statements Novella and Gorski already made publicly on social media and the SGU podcast are false.
Don’t know who that is, but the webpage you linked to is dated Feb 2024 which is before the date that the Cass Report came out.
 
SBM's go-to guest blogger on this topic appears to have jumped ship. I suspect it is now impossible to cover this topic since they would either have to repeat lies that can very easily shown to be objectively false in comments, or admit that statements Novella and Gorski already made publicly on social media and the SGU podcast are false.
Well, for proper skeptics, admitting you're wrong shouldn't be a problem.
 
Don’t know who that is, but the webpage you linked to is dated Feb 2024 which is before the date that the Cass Report came out.
AJ Eckert is the guest blogger who managed a gender-affirming clinic and wrote the previous SBM pieces on gender-affirming care for minors, attacking critics as transphobic and frequently linking to papers that failed to support the claims made (e.g. a claim that puberty blockers do not affect brain development was supported by a link to a paper discussing the need to conduct long-term studies on whether puberty blockers have negative effects on brain development).
I wasn't suggesting that Eckert's departure from Anchor gender clinic is related to the Cass review but it might be related to SBM going quiet on this topic. I don't know if Eckert is still working in the gender care field at a different clinic since nothing I can find online seems to be updated including the SBM bio.
 
Yeah, I saw that too. I began reading it before realizing how long it was (something like 8000 words) which also reference a number of other papers both pro- and con- the Cass Review and some in-between, such as Gideon Meyorowitz-Katz (who I tend to think of as a pretty good science writer and who did much of the work to unmask the massive fraud in some of the ivermectin studies). In this case, however, Singal is pointing to some of Gideon M-K's critiques of the Cass Review critics.
 
AJ Eckert is the guest blogger who managed a gender-affirming clinic and wrote the previous SBM pieces on gender-affirming care for minors, attacking critics as transphobic and frequently linking to papers that failed to support the claims made (e.g. a claim that puberty blockers do not affect brain development was supported by a link to a paper discussing the need to conduct long-term studies on whether puberty blockers have negative effects on brain development).
I wasn't suggesting that Eckert's departure from Anchor gender clinic is related to the Cass review but it might be related to SBM going quiet on this topic. I don't know if Eckert is still working in the gender care field at a different clinic since nothing I can find online seems to be updated including the SBM bio.
Ah, I see. So has SBM actually addressed it at all since it came out? I know Steven Novella has in a way that suggests he hadn't really looked at it properly and which Gideon M-K (mentioned above) and the Studies Show (also mentioned above) and Jesse Singal (mentioned above) could have corrected him on such as his assertion that the Cass Review just invented an ad hoc exclusion/inclusion criteria, which is not true. Gideon M-K writes about the scale used (but points out that it did change from the one it pre-registered which GM-K pulls them up on saying there should be a clearly given rationale for it even though it is unlikely to have changed the outcome)...

I don't know if his series has been covered here, but as I said, I think he's usually quite good on these sorts of things and does offer some criticisms of the review...

 
Ah, I see. So has SBM actually addressed it at all since it came out? I know Steven Novella has in a way that suggests he hadn't really looked at it properly and which Gideon M-K (mentioned above) and the Studies Show (also mentioned above) and Jesse Singal (mentioned above) could have corrected him on such as his assertion that the Cass Review just invented an ad hoc exclusion/inclusion criteria, which is not true. Gideon M-K writes about the scale used (but points out that it did change from the one it pre-registered which GM-K pulls them up on saying there should be a clearly given rationale for it even though it is unlikely to have changed the outcome)...

I don't know if his series has been covered here, but as I said, I think he's usually quite good on these sorts of things and does offer some criticisms of the review...

I think it's a valid criticism of the Cass Review that they did not explain the change from using MMAT stated in their pre-registration to using NOS for some of the systematic evixence reviews. There are sometimes valid reasons to change protocol from pre-reg but it should be explained clearly. In this case, they used NOS for the studies of hormone treatments. All the studies in these reviews involved non-RCT quantitative designs, for which NOS is designed. They used MMAT for the review on psychosocial transition which included qualitative, quantitative and mixed-method designs. MMAT is specifically for systematic reviews that contain both qualitative and quantitative and/or mixed methods studies, so in both cases the appraisal tool seems appropriate for the type of studies evaluated within each review. I don't think there is anything sinister about deciding to use NOS for the quantitative-only reviews; they probably just decided that there was no reason to use a tool intended for reviews with diverse study designs for reviews that had only quantitative studies. They may have intended originally to include all treatments in one review (which would then involve diverse designs) which would explain why they originally proposed only MMAT.
I have seen activists claim that the switch was due to MMAT recommending against excluding low quality studies (implying this was part of a sinister plot to brand all studies with positive results as low quality and exclude them). However, I have not been able find anything to support this and several papers discussing the MMAT list excluding low quality studies as an accepted use of the tool.
 
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Ah, I see. So has SBM actually addressed it at all since it came out? I know Steven Novella has in a way that suggests he hadn't really looked at it properly and which Gideon M-K (mentioned above) and the Studies Show (also mentioned above) and Jesse Singal (mentioned above) could have corrected him on such as his assertion that the Cass Review just invented an ad hoc exclusion/inclusion criteria, which is not true. Gideon M-K writes about the scale used (but points out that it did change from the one it pre-registered which GM-K pulls them up on saying there should be a clearly given rationale for it even though it is unlikely to have changed the outcome)...

I don't know if his series has been covered here, but as I said, I think he's usually quite good on these sorts of things and does offer some criticisms of the review...

Novella repeated misinformation about it on the SGU podcast where there is no opportunity to respond directly (it appears any emails about it were ignored). It hasn't been addressed directly on SBM where it is possible for anyone to post comments. I know Gorski has also repeated misinformation on social media and he blocks anyone who points out errors.
 
I think it's a valid criticism of the Cass Review that they did not explain the change from using MMAT stated in their pre-registration to using NOS for some of the systematic evixence reviews. There are sometimes valid reasons to change protocol from pre-reg but it should be explained clearly. In this case, they used NOS for the studies of hormone treatments. All the studies in these reviews involved non-RCT quantitative designs, for which NOS is designed. They used MMAT for the review on psychosocial transition which included both qualitative, quantitative and mixed-method designs. MMAT is specifically for systematic reviews that contain both qualitative and quantitative and/or mixed methods studies, so in both cases the appraisal tool seems appropriate for the type of studies evaluated within each review. I don't think there is anything sinister about deciding to use NOS for the quantitative-only reviews; they probably just decided that there was no reason to use a tool intended for reviews with diverse study designs for reviews that had only quantitative studies. They may have intended originally to include all treatments in one review (which would then involve diverse designs) which would explain why the originally proposed only MMAT.
I have seen activists claim that the switch was due to MMAT recommending against excluding low quality studies (implying this was part of a sinister plot to brand all studies with positive results as low quality and exclude them). However, I have not been able find anything to support this and several papers discussing the MMAT list excluding low quality studies as an accepted use of the tool.
Yeah Gideon M-K himself does not see anything sinister in it either, and seems to think as you do, only that it would have been better off being explained...
At some point, the reviewers switched to the Newcastle-Ottawa Scale for rating the literature included in their reviews. In the reviews, there is no reason given for this that I can see, which is certainly not best practice. There’s a belief going around online that the reason that the reviewers switched the scales is because the MMAT recommends against excluding low quality work, while the NOS has no such recommendation.

As someone who does systematic reviews professionally, this argument makes no sense to me. All rating for bias is to some extent subjective. While both the MMAT and NOS attempt to create some measure of objective ranking for research, they are both ultimately up to the judgement of the reviewers who are using the tools. Changing your rating scale isn’t going to magically change the conclusions of a systematic review, especially when the review uses a narrative (i.e. subjective) synthesis method anyway.

In addition, as I noted above, including low quality studies in these reviews probably wouldn’t change much, because the low quality of the papers reduces their usefulness anyway. I very much doubt that anyone cared enough about the rating scale to switch it for nefarious reasons - the most likely explanation is that they didn’t find many qualitative studies in their searches.
 
Novella repeated misinformation about it on the SGU podcast where there is no opportunity to respond directly (it appears any emails about it were ignored). It hasn't been addressed directly on SBM where it is possible for anyone to post comments. I know Gorski has also repeated misinformation on social media and he blocks anyone who points out errors.

This is a shame since Novella has also been giving talks (such as at CSI-Con) where he says the important thing for skeptics to do is to share disagreements but has, as you say, appeared to avoid them except in venues where there cannot be a meaningful dialogue.

Then again, maybe he will respond on his blog, Neurologica...

 
Then again, maybe he will respond on his blog, Neurologica...

Novella writes:
Coyne’s position is that we should categorize biological sex by gametes and gametes only. Why? He only said during his talk that this is how it is done, so an appeal to tradition, I guess. He seems to be engaged in a bit of circular logic – biological sex is binary because of gametes, and we use gametes to define biological sex because they are essentially binary (with rare exceptions).
I really don't get the sense Novella spent much time interrogating where Coyne is coming from here. The gamete binary exists in nature because of selection pressures which took place aeons ago, sexual dimorphism is layered atop of it. The argument for going back to gametes isn't about tradition, it's about why we are observing a binary in the first place. All the variables which measurably differ between male and female placental mammals go back to adaptations around the gamete binary which preexists class Mammalia in general and human tradition in particular.

Novella also writes:
Most people who identify as trans knew their gender identity from a very young age, and their identity is remarkably persistent over their lives.
This right here is sort of a "tell me you didn't read the Cass Report without telling me" moment; Cass takes pains to point out that a large and increasing fraction of patients at Tavistock no longer fit this description, since they present with gender issues for the first time around adolescence rather than at a "very young age" as in the original Dutch study.
 
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A petition has been started calling for 'An Independent Evaluation of the Cass Review on Child Gender Services'. It states that 'We believe that trans healthcare should be based on unbiased research that is peer reviewed.' I wonder if they are aware that all the systematic evidence reviews conducted for the Cass Research programme by the University of York were peer reviewed before publication? It would be funny if they reach 10,000 signatures and get a government response pointing this out.
The petition did reach over 10,000 and the government has responded.
 
A new systematic review and meta-analysis from Canada supports the findings of Cass and other independent reviews regarding low certainty of evidence for puberty blockers. This used GRADE for evaluating evidence quality and modified ROBINS-I to assess risk of bias in comparative observational and before-after studies. It is also the first to use meta-analysis rather than narrative review. There is another one on hormone treatments that I haven't look at yet.
 

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