You are currently browsing the category archive for the ‘Medicine’ category.
This excerpt from Leor Sapir’s article – The Deposition of Jack Turban – One of America’s leading gender clinicians proves that he doesn’t understand evidence-based medicine.
“Ramer asked Turban to explain the GRADE method (Grading of Recommendations Assessment, Development and Evaluations), a standardized EBM framework for evaluating quality. “GRADE generally involves looking at the research literature,” Turban explained. “And then there’s some subjectivity to it, but they provide you with general guidelines about how you would—like, great level of confidence in the research itself. Then there’s a—and then each of those get GRADE scores. I think it’s something like low, very low, high, very high. I could be wrong about the exact names of the categories.” Turban is indeed wrong: the categories are high, moderate, low, and very low. It’s surprising that someone involved in the debate over gender-medicine research for several years, and who understands that questions of GRADE and of quality are central, doesn’t know this by heart.
Ramer asked Turban what method, if any, he uses to assess quality in gender-medicine research. Turban explained that he reads the studies individually and does his own assessment of bias. GRADE is “subjective,” and this subjectivity, Turban said, is one reason that the U.K. systematic reviews rated studies that he commonly cites as “very low” quality. Turban’s thinking seems to be that, because GRADE is “subjective,” it is no better than a gender clinician sitting down with individual studies and deciding whether they are reliable.
I asked Guyatt to comment on Turban’s understanding of systematic reviews and GRADE. “Assessment of quality of evidence,” he told me, “is fundamental to a systematic review. In fact, we have more than once published that it is fundamental to EBM, and is clearly crucial to deciding the treatment recommendation, which is going to differ based on quality of evidence.” Guyatt said that “GRADE’s assessment of quality of the evidence is crucial to anybody’s assessment of quality of evidence. It provides a structured framework. To say that the subjective assessment of a clinician using no formal system is equivalent to the assessment of an expert clinical epidemiologist using a standardized system endorsed by over 110 organizations worldwide shows no respect for, or understanding of, science.”
At one point, Ramer pressed Turban to explain his views on psychotherapy as an alternative to drugs and surgeries. Systematic reviews have rated the studies Turban relies on for his support of puberty blockers and cross-sex hormones “very low” quality in part because these studies are confounded by psychotherapy. Because the kids who were given drugs and improved were also given psychotherapy and the studies lack a proper control group, it is not possible to know which of these interventions caused the improvement.
Turban seemed not to grasp the significance of this fact. If hormonal treatments can be said to cause improvement despite confounding psychotherapy, why can’t psychotherapy be said to cause improvement despite confounding drugs?
The exchange about confounding factors came up in the context of Ramer asking Turban about an article he wrote for Psychology Today. The article, aimed at a popular audience, purports to give an overview of the research that confirms the necessity of “gender-affirming care.” Last year, I published a detailed fact-check of the article, showing how Turban ignores confounding factors, among other problems. Four days later, Psychology Today made a series of corrections to Turban’s article. Some of these corrections were acknowledged in a note; others were done without any acknowledgement. In the deposition, Ramer asked Turban about my critique, to which Turban replied that he “left Psychology Today to do whatever edits they needed to do,” and that, when he later read the edits, he found them “generally reasonable.”
In sum, though Turban says that “there are no evidence-based psychotherapy protocols that effectively treat gender dysphoria itself,” the same studies he cites furnish just as much evidence for psychotherapy as they do for puberty blockers or cross-sex hormones—which is to say “very low” quality evidence.”
The quality of evidence that Gender Affirming Care works is “Very Low”. In other words those who argue for Gender Affirming Care are arguing from a base of low quality, probably confounded evidence that doesn’t say what they think it says. It just another example of how the pseudo-science of gender identity is propagated by believers – even medical doctors – over the principles of evidence based medicine. Make sure you go and read the full article, it is a wild ride.
The gender cult and associated gender religious members are pushing bullshit and now, finally, the stink is starting to seep out.
So here is thought, let’s not do medical practices that are unreliable and unable to justify the risks and uncertainties experienced by the patients (children).
“Systematic reviews represent the highest level of evidence analysis in evidence based medicine. The three European countries that did these reviews independently came to the same conclusion: Due to their severe methodological limitations, studies cited in support of hormonal interventions for adolescents are of “very low” certainty.
For health authorities in these countries, this meant that the studies were too unreliable to justify the risks and uncertainties of “gender affirming care.” Sweden, Finland, and England have since placed severe restrictions on access to hormones. Although these countries now allow hormones in a very carefully selected cohort of patients who fulfill the criteria of the Dutch protocol, they do so against the findings of their own systematic reviews.
That is because the systematic reviews found the Dutch study, on which the Dutch protocol is based, also provides “very low” certainty evidence. Finland’s Council for Choices in Healthcare recognizes medical transition for minors as “an experimental practice.”
The medical establishment in Ireland is being led away from evidence based medicine by the gender ideologues. Nothing good can come of it.
“This week another expert in his field offered a considered opinion and he has been studiously ignored. At various times in recent years, his expertise has attracted personal abuse. His credentials are unimpeachable but the problem is he is bearing inconvenient truths at a time when such truths are considered to be more trouble than they’re worth.
Professor Donal O’Shea is well known for his media contributions on obesity. He is the HSE’s national clinical lead on obesity but he also works as an endocrinologist in the National Gender Service within the executive. He has worked for over twenty-five years within the area of gender dysphoria. Last weekend he told the that he and his colleague, psychiatrist Paul Moran, are alarmed that the HSE is trying to set up an “activist led” gender service which will be “dangerous for patients”. The HSE is currently advertising for a clinical lead in the National Gender Service but bizarrely prior experience is not a prerequisite.”
Better to stop it before it takes root my Irish friends. The damage it has done to children here in Canada is an ongoing tragedy.
[…]
This is an entirely unremarkable state of affairs, considering how strong male sex-bias is in society, and that medicine has rather happily gone along with that. For more info on this much broader topic, I can recommend my book Born in the Right Body and Caroline Criado Perez’ Invisible Women, among a large body of work that addresses this issue.
In this overall sexist environment, we now have an ideology that essentially denies sex. Or rather, we have a proliferation of activists who claim that humans can change sex by changing their physical appearance. When these activists are confronted with reality – that sex is determined at fertilisation by the presence or absence of the Y chromosome (because both human males and females have an X but only males have a Y) and this cannot be changed using any known medical intervention – they declare genetic sex and sex chromosomes “irrelevant”.
I have seen my medical colleagues laugh this off for years. “Surely these people are just ignorant, they are talking nonsense (not exactly rare on the internet when medical issues are concerned!) and besides – who cares?”
While accurate, such laissez-faire attitude has gotten us to a point where activists who are denying basic human biology have now captured not just laws and policies but medical establishment itself, and any doctor who tries to debunk pseudoscientific “sex denialist” ideology will very quickly experience disproportionate interpersonal and institutional discrimination and violence.
I have seen doctors wade into these discussions in good faith, only to have activists report them to their governing bodies, which now have policies that conflate sex – being man, woman, boy, girl – with gender – emulating masculine or feminine stereotypes of appearance and behaviour. And god help anyone who doesn’t cower and apologise immediately.
The general public has observed this loss of sense and integrity within the medical profession for years now, which has been accompanied by the removal of the word “woman” from healthcare, loss of single-sex spaces (which are particularly important to women and girls due to the male violence I briefly discussed above) and deepening of the sex disparity in research which has plagued medicine since its inception.
We need to support our medical professionals when they speak up against the anti-reality/anti-science activists. Calling bullshit on their antics still carries far too high a price, that must change if we want to reestablish trust in our institutions and professional classes.
AAP announces they’ll do an evidence review
“The American Academy of Pediatricians (which also covers Canadian pediatricians) is starting to cave to pressure to evaluate their recommendations for gender-affirmation care. They announced this week that they would undertake a systematic review of evidence and update their guidance.
We see this as a ploy to buy some time as the AAP (hopefully) works out how they’re going to backpedal from the current policy they continue to promote. Three systematic evidence reviews have already been done in Europe and the Florida Medical Board has done a “review of reviews”. The findings from the AAP will not change.
Canadian research expert, Dr Gordon Guyatt of McMaster University was quoted in the New York Times yesterday saying the A.A.P.’s report will most likely find low-quality evidence for pediatric gender care. “The policies of the Europeans are much more aligned with the evidence than are the Americans’,” he said.”
All I can say is : ‘About Damn Time!’. Who would of thought that evidence based medicine should be based on evidence and proof of efficacy?
If you are violating one of the principles of human medicine – first do no harm – it may be wise to reconsider your position on ‘gender-affirming treatment’ regardless of how lucrative it is.
“Children are being harmed. Young people are being harmed.
In many ways, this story is not new. From snake oil to thalidomide, from lobotomies to opioids, medicine has a long history of fake cures and terrible practices. In his 2022 book The Skeptical Professional’s Guide to Rational Prescribing: The Impact of Scientific Fraud and Misconduct, Dr. Charles Dean writes that in modern times the challenges facing medicine include “untoward ties with drug companies, the power of the pharmaceutical industry to co-opt physicians and institutions, the failure of peer review, the use of fraudulent data, and the failure of institutions to monitor their investigators…other topics are also in need of review, including publication bias, spinning poor or questionable results into positive outcomes, omitting or changing the primary outcomes of studies after the data fail to deliver the expected results…” Certainly, many parents see all this in play in the unfolding gender medical scandal.
However, what is new is the Gordian knot of confused cultural ideas about gender and sex, along with a tangle of transgender activism, tribal politics, and medical lobbying that have ultimately allowed malpractice to continue. Those who can see some of the problems with the current protocol–otherwise ethical professionals–make calls for randomized trials, better research, and the restriction of these drugs and surgeries to “some” children. But they forget the most basic principle of medicine: primum non nocere: first do no harm. Decades of research have made clear that there is no good evidence that any of these medications or surgeries help anyone; there is good evidence that they harm. So what type of medical ethics is a clinician practicing when she begins the first stage of sterilizing a trans-identifying child, even a highly distressed one?
For those doctors, therapists, politicians, journalists, and educators who have grasped what’s going on, there is a tremendous urgency to raise awareness in order to change the current medical guidelines and stop the horrendous mistreatment of gender-diverse kids.”
bleatmop
Mystro
Dead Wild Roses 
Your opinions…