Apology for the Priesthood Ban / "March of Dimes Syndrome" / "Mission Creep" / "Spencer's Law"

[Calm]

6 minutes ago, smac97 said:

Feel free to post them, and I'll give them due consideration.

Thanks,

-Smac

I am not the one claiming I post statements based on someone being a percipient witness.  I will generally choose to post research that supports my thesis.

You do make the claim, so why aren’t you looking for them?

Edited October 11, 2024 by Calm

[Calm]

My bad…misread.  I blame 3 hours sleep.  Have had good sleep lately, so this level of sleep deprivation actually is a bit of a rush, feel a little too good, lol, and I get careless.

Edited October 11, 2024 by Calm

[smac97]

22 minutes ago, Calm said:

I am not the one claiming I post statements based on someone being a percipient witness.  I will generally choose to post research that supports my thesis.

Same here.  Statements by percipient witnesses fits the bill.  

22 minutes ago, Calm said:

You do make the claim, so why aren’t you looking for them?

"{T}hem" being percipient witness statements that have something to say that does not support my position?  Do you have this expectation across the board?  Or just with me?

Again, feel free to post them, and I'll give them due consideration.

Thanks,

-Smac

Edited October 11, 2024 by smac97

[Calm]

18 minutes ago, smac97 said:

Same here.

Then the fact someone is a percipient witness is not the primary reason you choose them as a reference.  It may be equal in value to you as being supportive of your argument, but it is not more important if you are choosing to only post or search out those who support your premises.

I am not asking you to consider them, I am questioning your use of “primarily”.  
 

Quote

am quoting this article primarily because she is a percipient witness

 

Edited October 11, 2024 by Calm

[Analytics]

1 hour ago, smac97 said:

Fifth, are you disputing the contents of Jamie Reed's article on ideological grounds?  Because her statements contravene or weaken your ideological support for medical treatments involving electively removing healthy body parts of children and electively sterilizing children?

My “ideological support for medical treatments involving electively removing healthy body parts of children and electively sterilizing children”?

Objection. Lacks foundation.

I’m not disputing anything in particular in the report (although I am noting that an investigative reporter researched the details of her claims and found that several of them misleading and at least one objectively false). For example, Jamie Reed said:

Quote

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

The Times reporter found this patient, and here is the rest of the story:

Quote

Ms. Reed’s affidavit describes a patient whose liver was damaged after taking bicalutamide, a drug that blocks testosterone. It makes a specific claim about what a parent had written to the child’s doctors: “The parent said they were not the type to sue, but ‘this could be a huge P.R. problem for you.’”

The parent, Heidi, a data scientist in the St. Louis area who requested anonymity because of privacy concerns, said she was stunned to read this “twisted” description of her teenage daughter’s case.

Heidi’s daughter indeed had liver damage, a rare side effect of bicalutamide. But she had been taking the drug for a year, records show, and had a complicated medical history. She was immunocompromised, and experienced liver problems only after getting Covid and taking another drug with possible liver side effects.

In a message to doctors that was shared with The Times, Heidi actually wrote, “In our world, it’s like a P.R. nightmare” — referring to tensions in her family about the gender treatments. The message did not mention anything about suing the clinic. To the contrary, it said: “We don’t regret any decision.”

Ms. Reed said that she learned about the case from Ms. Hamon, who helped compile examples for the affidavit, and that she regretted citing the case when she had not seen the medical record herself.

“My daughter’s situation was exploited,” Heidi said, noting that the hospital told her that her records would be shared with the state.

Can you see the problem with relying on a one-sided propaganda piece?

For my part, I am disputing is Jammie’s methodology. She kept a Red Flag book, where she looked for anecdotes that supported her ideological position. Over the course of about 3 years, she collected 76 anecdotes where things apparently didn’t go well. Presuming she is representing these cases accurately, that is tragic. However, this methodology ignores the other (hundreds of?) cases where things may have gone better, and makes these myopic, one-sided anecdotes appear representative when they might not be.

What are your thoughts on the NYT article I quoted?

 

[Tacenda]

19 minutes ago, Analytics said:

My “ideological support for medical treatments involving electively removing healthy body parts of children and electively sterilizing children”?

Objection. Lacks foundation.

I’m not disputing anything in particular in the report (although I am noting that an investigative reporter researched the details of her claims and found that several of them misleading and at least one objectively false). For example, Jamie Reed said:

The Times reporter found this patient, and here is the rest of the story:

Can you see the problem with relying on a one-sided propaganda piece?

For my part, I am disputing is Jammie’s methodology. She kept a Red Flag book, where she looked for anecdotes that supported her ideological position. Over the course of about 3 years, she collected 76 anecdotes where things apparently didn’t go well. Presuming she is representing these cases accurately, that is tragic. However, this methodology ignores the other (hundreds of?) cases where things may have gone better, and makes these myopic, one-sided anecdotes appear representative when they might not be.

What are your thoughts on the NYT article I quoted?

 

This happened with my sister who was extremely angry because she'd watched/heard something about the state of Michigan being able to perform these surgeries on children, because of the running elect for VP of the US made it happen. I fact checked and that is false, so she's believing some media out there saying this will happen with a new law or policy. 

Here's the thing the running candidate did in actuality. https://www.snopes.com/fact-check/walz-gender-reassignment-surgery-children/

[smac97]

32 minutes ago, Analytics said:

My “ideological support for medical treatments involving electively removing healthy body parts of children and electively sterilizing children”?

Objection. Lacks foundation.

Well, I apologize.  I misapprehended your ideological position on this issue.  What is it?  Do you ideologically support or oppose so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children?

32 minutes ago, Analytics said:

Can you see the problem with relying on a one-sided propaganda piece?

I have not relied exclusively on Reed's article.  I have also reviewed quite a bit of stuff about the Tavistock Clinic and various other developments in Europe and the United States.

As for characterizing an article written by a "queer woman" married to a "transman" as "a one-sided propaganda piece," I think that's overwrought.  I think she comes across as authentically concerned for the welfare of children.

32 minutes ago, Analytics said:

What are your thoughts on the NYT article I quoted?

"The reality was more complex than what was portrayed by either side of the political battle, according to interviews with dozens of patients, parents, former employees and local health providers, as well as more than 300 pages of documents shared by Ms. Reed.  Some of Ms. Reed’s claims could not be confirmed, and at least one included factual inaccuracies. But others were corroborated, offering a rare glimpse into one of the 100 or so clinics in the United States that have been at the center of an intensifying fight over transgender rights."

Her article is one piece of a larger discussion.

Thanks,

-Smac

Edited October 11, 2024 by smac97

[smac97]

1 hour ago, Calm said:

Then the fact someone is a percipient witness is not the primary reason you choose them as a reference.  

Yes, it is.  This is why I said: "I am quoting this article primarily because she is a percipient witness."

1 hour ago, Calm said:

It may be equal in value to you as being supportive of your argument, but it is not more important if you are choosing to only post or search out those who support your premises.

I am not asking you to consider them, I am questioning your use of “primarily”.  

I am the world's leading authority on what I think.  I guess you'll just have to trust me when I say that I quoted Reed's article "primarily because she is a percipient witness."

Thanks,

-Smac

[SeekingUnderstanding]

16 minutes ago, smac97 said:

Do you ideologically support or oppose so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children?

This black and white thinking is where you and yours get into trouble. A medical procedure can be overused and misused. That doesn’t mean it never has a place. The answer to overuse is to reduce usage to cases where the outcomes support it. The answer to misuse is to better communicate the proper use. I personally think that mental health drugs are vastly overused, especially in children. But I would never think to ban them. I do think more cautious use would be advisable. It doesn’t have to be an either or. 

[Analytics]

19 minutes ago, smac97 said:

Well, I apologize.  I misapprehended your ideological position on this issue.  What is it?  Do you ideologically support or oppose so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children?

I am agnostic on what medical treatments other people receive--that is between them and their doctors. Furthermore, whether or not an intervention is advisable needs to be considered on a case by case basis.

Since we aren’t talking about a particular case, I find your question somewhere on the spectrum between ideological and nonsensical.

19 minutes ago, smac97 said:

As for characterizing an article written by a "queer woman" married to a "transman" as "a one-sided propaganda piece," I think that's overwrought.  I think she comes across as authentically concerned for the welfare of children.

A few other points you seem to be ignoring:

• The psychologists and physicians at the clinic she is attacking also seem to be authentically concerned for the welfare of children
• In general, their qualifications to assess the successes and failures of their past medical interventions, and the benefits and risks of potential medical interventions, are superior to that of this one caseworker, and you seem to be deliberately ignoring their qualifications and their perspectives.

19 minutes ago, smac97 said:

"The reality was more complex than what was portrayed by either side..."

And that complexity is what you seem to be ignoring. You seem to boil the issue down to whether you want to be one of the good guys who cares about the wellbeing of children and oppose chopping off healthy body parts, or whether you are one of the ideologically driven people who don’t care about the wellbeing of children and are in favor of chopping off healthy body parts.

[smac97]

Again, my bullet list of primary concerns regarding so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

A May 2023 article by Leor Sapir : The Responsibility to Inform

Quote

Last February, Jamie Reed went public in a sworn affidavit and in The Free Press with allegations that the Washington University Transgender Center (WUTC), where she was a case worker for over four years, was rushing minors into harmful medicalization. Since then, media outlets, including the St. Louis Post-Dispatch, the Missouri Independent, New York, and NBC have published articles that attempt to push back against Reed’s claims.

The common theme of these articles is that some parents dispute Reed’s account and are satisfied with the care their children received at the clinic. The unstated premise is that if Reed’s allegations were true, we’d expect to see many families coming forward to corroborate her reports of medical harm and few to dispute them. Since the journalists find more families in support of the clinic than against it, the reasoning goes, Reed’s allegations should be viewed with suspicion, if not dismissed.

Last week, MSNBC’s Chris Hayes tweeted that, against a single account by a mother who agreed with Reed’s claims, “there have now been *dozens* and *dozens* of interviews conducted that in no way bear out the original allegations. If what the ‘whistleblower’ was saying were true, I feel like we’d have a lot more than a single mom backing it up at this point?”

Hmm.  Hayes' Tweet includes a link to this NBC article: Raising a trans kid in Missouri has become a 'dystopian nightmare' for families

It's worth a read.

Back to the Sapir article:

Quote

Hayes is wrong, and he should know better. Determining whether a clinic was operating in a harmful way is not simply a matter of tallying up the number of happy versus unhappy patients or families. Journalists who want to help the public understand both what actually happened at the clinic and the broader significance for medical care and medical ethics should be more scrupulous in their reporting on this ongoing story.

 

First, even if one accepts Hayes’ framing, it is unsurprising that more families who believe they had positive experiences have come forward compared with families having negative experiences. Anyone remotely familiar with the realities of pediatric gender medicine will instantly recognize the selection-bias problem at work here. It is almost definitionally true that dissatisfied families experience serious strains on the relations within the family unit and want to keep those strains private. Frequently in these scenarios, a child will express a strong desire for medicalization and at least one of the parents will be skeptical that puberty blockers or cross-sex hormones are the best therapeutic option. It is not uncommon for the decision over medicalization to drive a wedge between parents, or between parents and other family members.

Yes, this seems to be a common problem.

Quote

For parents in these circumstances to go public with their story can worsen familial tensions and make an already difficult situation harder still. The story of Caroline, the mother mentioned by Chris Hayes, whose encounter with the St. Louis clinic was reported on in The Free Press, is a case in point. Caroline agreed with Jamie Reed that “when parents disagreed about their child’s treatment, the center would make things difficult for the objecting parent, especially in the case of divorce.” Caroline’s estranged husband was on board with puberty blockers for his child, while Caroline was not. After Caroline went public, her “non-binary” child took to Twitter to dispute her account of things (but ended up corroborating some of the most important parts of the mother’s story). This was a family feud unfolding before the drama-hungry eyes of (at last count) 26.7 million strangers.

Yeesh.

Quote

A new book coming out by the organization Parents for Inconvenient Truths about Trans, which features essays by parents who have endured the relentless indoctrination in schools and the “gender affirming” medical gauntlet, illustrates the problem in grim detail.

The second link is to an article posted on a website for "Parents with Inconvenient Truths About Trans."  

Quote

Many of the parents feared being accused of harboring “transphobic” attitudes and being indifferent to their kids’ suicidal tendencies. One parent I spoke with whose child attended the St. Louis clinic and who wants to remain anonymous told me that talking to the press would almost certainly result in the already-estranged child cutting parental contact off entirely. Faced with the fact that total estrangement would make it even more difficult to prevent unneccessary medicalization, the parent has decided to remain silent—at least for now. I imagine that this parent is not alone.

A desire for privacy.

Fear of being publicly labeled a bigot/transphobe for voicing concerns about this topic.

Not wanting to publicly air intra-family disputes.

All sorts of reasons for people concerned about "trans" treatment might be - like the above parent - "decid{ing} to remain silent."

Quote

Meantime, parents on board with medical transition are likely to be on better terms with their kids and thus lack the deterrent against going public.

So sampling errors may be in play in the NBC piece cited by Hayes.

Quote

It turns out that when a kid really wants something and her parents give it to her, she feels less estranged from them. Moreover, pro-medicalization parents are likely to be actively engaged in the promotion and defense of “gender affirming care,” not just anonymous clients.  These parents often operate within “gender affirming” parent networks and support groups, which they can tap into in order to recruit others to convey a coordinated message of support for gender clinics.

Compromised assessments of the best interests of the child. 

Ideological/sociopolitical influences/pressures on medical care. 

I think these merit discussion.

Quote

That is what happened in the case of the St. Louis clinic. The same day that Reed’s story came out in The Free Press, TransParent, an organization for parents dedicated to “gender-affirming care,” sent out a letter to its subscribers. The letter, which was leaked to me, contained the following request: “We are looking for parents who would be willing to sit on a panel to discuss their experiences, write letters in support of the center, or otherwise tell their story in order to combat this article which we believe to be largely inaccurate. We are potentially working on a town hall to be covered by media outlets. If you have any contacts with the media, please let us know. We need people to show up for this urgent fight.” The letter went on to say that “we are trying to coordinate as fast as possible to get other views heard” but clarified that these “other views” should include only “positive words about your experience with the Gender Center.” In his investigative reporting on the hyper-partisan media coverage of Reed and WUTC, Jesse Singal found that Kim Hutton, one of the parents interviewed by Colleen Schrappen for her piece in the St. Louis Post-Dispatch, is a cofounder of TransParent and played a role in the establishment of WUTC—facts Schrappen failed to disclose to her readers.

Hmm.

Quote

This brings us to the second and more crucial point: short-term patient or parental satisfaction is not the metric we should use to judge pediatric gender medicine.

Longitudinal studies essentially absent. 

Quote

Medicine is not consumerism. Doctors may not dole out untested and risky drugs to vulnerable patients and declare “caveat emptor.” Medical professionals have an affirmative duty to “first, do no harm.” Sometimes fulfilling this duty means overriding the desires of patients—for instance, the desire of addicts for powerful painkillers. Just as minors seeking pediatric gender services are more likely to believe that they “need” these surgeries to solve their problems, drug addicts who seek out doctors known to operate OxyContin pill mills may believe that opioids can solve theirs. In both cases, the patient’s subjective belief about what will work for him should not be the decisive factor in determining the course treatment. Nor should the patient’s satisfaction after getting the desired “treatment” be viewed as evidence of sound medical practice.

Compromised assessments of the best interests of the child. 

Quote

While subjective satisfaction is not unimportant, medicine runs a risk of doing harm by investing too much in patients’ self-reported feelings. This is one of the lessons of the opioid epidemic. The medical community’s adoption of pain as the fifth vital sign and deference to patients’ self-assessed pain levels paved the way for Purdue Pharma, maker of OxyContin, to create a new market on the backs of vulnerable Americans.

In the case of “gender affirming care,” it is important to distinguish between whether a teenager is satisfied with the treatment she received and whether her mental health actually improved as measured through validated mental-health tests. Researchers in this field often use metrics of dubious clinical value such as the Chest Dysphoria Measure, which measures a patient’s satisfaction with how her chest looks after getting a double-mastectomy. One recent study measured CDM in teenagers and young adults three months after “top surgery.” The day after the study appeared, CBS News ran an article with the headline: “Top Surgery Drastically Improves Quality of Life for Young Transgender People, Study Finds.” It should be obvious that asking teenage girls how they feel about their chests three months after getting a double mastectomy tells us very little about whether these procedures guarantee them “quality of life” in the long term.

Due to the health risks and uncertainties of puberty blockers, cross-sex hormones, and surgeries, the debate over pediatric gender medicine’s clinical value should prioritize long-term over short-term mental-health outcomes. A teenage girl distressed over the changes to her body due to puberty may report feeling better in the months after receiving puberty blockers or cross-sex hormones—but will she feel this was the right decision when she’s in her thirties and realizes that she cannot have biological children of her own? And what will that do to her mental health? How will a future of sexual dysfunction and trouble with relationships affect the psychological and emotional wellbeing of a boy who began medical transition at age 11? How will the known and anticipated side-effects from “gender affirming” hormones and surgeries, which include not just infertility but a number of agonizing physical consequences such as chronic and debilitating pain due to lack of bone mineralization, affect quality of life down the road?

Longitudinal studies essentially absent. 

Compromised assessments of the best interests of the child. 

Quote

But even if we grant that subjective satisfaction equates to mental health and that short-term satisfaction matters most, the very real possibility exists that placebo/nocebo effects can account for mental health “improvement.” Due to what is known as the “Hawthorne effect,” teenagers may show short-term improvement in mental health simply because they feel they are being listened to and taken seriously. “A patient who is part of a study, receiving special attention, and with motivated clinicians, who are invested in the benefits of the treatment under study,” explains Alison Clayton in an essential article on this subject, “is likely to have higher expectations of therapeutic benefits.” This is crucial because “[e]xpectation of outcome is a principal mechanism of the placebo effect and anything that increases patients’ expectations is potentially capable of boosting placebo effects.”

The same is true in reverse: in a social climate in which politicians, the media, civil rights groups, medical associations, and social media influencers tell young people in distress over their bodies that “gender” is the source of their problem, that drugs and surgeries alone will provide them with “gender euphoria” and “trans joy,” and that being deprived of these interventions is tantamount to a death sentence, a pernicious nocebo effect can take root in which patients experience real psychological distress at being denied something they have come to believe they desperately need.

A full investigation of WUTC is underway, and until the findings of that investigation are released and carefully scrutinized, it is irresponsible either to dismiss Reed’s allegations out of hand or to treat them as settled facts.

I agree with this last statement.

Quote

Still, we have good reasons to believe the allegations are credible. Reed made them in a sworn affidavit and handed over evidence to Missouri authorities. (The fact that she has not been willing to share the same evidence with reporters like Schrappen of the St. Louis Post-Dispatch, who has consistently tried to discredit Reed, does not mean that the evidence doesn’t exist.) Further, Reed’s allegations bear striking resemblance to what Hannah Barnes found had happened at the Tavistock clinic in the U.K.

The Tavistock Clinic deserves a lot of attention.

Quote

and physician Hilary Cass said in her report to the National Health Service last year.

So does the Cass Report.

Quote

Cass mentioned the existence of “an affirmative model” that “originated in the USA” as partly responsible for making the Tavistock clinic unsafe. Finally, in its own internal investigation, in which it (unsurprisingly) found no evidence of wrongdoing, the WUTC tacitly acknowledged some of Reed’s claims, including, for instance, the lack of a written informed-consent process.

Informed consent.

Wow.  Wow.

Quote

Journalists should treat Reed’s allegations as an opportunity to educate themselves and their readers not simply about what to think about “gender affirming care” but more importantly about how to think about this controversial medical practice. Journalists have a duty to provide context and frame issues in ways that help citizens form sound judgments on matters of public interest.

Yep.

Thanks,

-Smac

Edited October 11, 2024 by smac97

[smac97]

From September 2023: The pullback from youth gender transition has begun

Quote

First comes the pushback, then the pullback. 

Yesterday, the Washington University Transgender Center at St. Louis Children’s Hospital announced that doctors there will no longer prescribe puberty blockers or cross-sex hormones to children and adolescents. This decision follows months of controversy and comes in the wake of a new law that just went into effect in Missouri, which limits hormonal and surgical interventions for gender transition to patients over the age of 18.

Under a “grandfather clause” in the new law, the Transgender Center could have continued to prescribe puberty blockers and cross-sex hormones to current patients. However, it decided to back away from these interventions altogether:

 

We are disheartened to have to take this step. However, Missouri’s newly enacted law regarding transgender care has created a new legal claim for patients who received these medications as minors. This legal claim creates unsustainable liability for health-care professionals and makes it untenable for us to continue to provide comprehensive transgender care for minor patients without subjecting the university and our providers to an unacceptable level of liability.

 

- Washington University Transgender Center

The Center first came under intense scrutiny earlier this year, when former case manager Jamie Reed blew the whistle on what she had come to see as dangerous practices within the clinic. 

Hmm.

"{T}he Transgender Center could have continued to prescribe puberty blockers and cross-sex hormones to current patients. However, it decided to back away from these interventions altogether."

This seems to vindicate at least a substantial portion of Reed's concerns.

Quote

The Transgender Center rejected Reed’s assessment and conducted their own internal investigation — an investigation in which they never bothered to speak to Reed — before declaring her allegations “unsubstantiated”. 

But the case for youth gender transition has been unravelling this year, under pressure from state officials and legislators and increased scrutiny from the media. At the end of August, St. Louis Circuit Court Judge Steven Ohmer allowed Missouri’s ban on hormonal and surgical interventions for youth to go into effect, writing that the evidence for youth transition “raises more questions than answers”. 

Hence the “unsustainable liability” Washington University cited in its decision to pull back from this area of healthcare. That’s because Missouri’s new law also extended the period of time former patients have to sue for damages to 15 years. Perhaps, when the Washington University investigated themselves, they found more merit to Reed’s allegations than they were willing to acknowledge publicly. They fear being made to pay for it. 

Medical scandals tend to end quietly: the “chemical lobotomy” phased out the lobotomy-lobotomy. The Satanic Panic choked not on its own absurdities but in courtrooms and insurance offices. Public reckonings are few and far between. “Unsustainable liability” may be the beginning of the end for youth gender transition. 

We'll see, I suppose.

I suspect the lawsuits about this will be legion.  I suspect a lot of issues in my list of bullet points will be heavily litigated (centering on "Informed Consent" about the other bulleted items not being sufficiently disclosed/addressed) :

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

Thanks,

-Smac

Edited October 11, 2024 by smac97

[smac97]

Another article: Opposing Children’s Transgender Medical Interventions Isn’t ‘Anti-Trans’ — It’s Pro-Child Wellbeing

Quote

An appellate judge in Montana blocked the state’s law preventing minors from undergoing transgender medical interventions, marking the latest salvo in a national battle over whether children should be allowed to medically “change” their gender.

Often, this issue is presented as being about trans-ideology and ensuring people who identify as transgender are treated equally under the law. Consider the following examples from the Montana case alone:

• In his ruling, Judge Jason Marks concludes, “The legislative record is replete with animus toward transgender persons, mischaracterizations of the treatments proscribed by SB 99 and statements from individual legislators suggesting personal, moral or religious disapproval of gender transition” (p. 34).
• The American Civil Liberties Union (ACLU) described Montana’s law as “hateful” in a press release praising the ruling.
• The New York Times’ latest round-up of state gender policies described “supporters of transgender rights” in its subtitle as people trying to “convince judges that transition care for minors was safe” and included a break-out section of new gender rulings entitled, “The Anti-Trans Push in America.”

The underlying message is clear — if you oppose letting children undergo medical gender “transitions,” you must hate people who identify as transgender and want to take their legal rights.

This is an effective, if disingenuous, strategy to discount critics’ perspectives as hateful. It’s easy to dismiss the arguments of “bad” people without testing their merit.

Ideological/sociopolitical influences/pressures on medical care. 

Quote

In reality, the debate over so-called gender-affirming care for children has little to do with trans-rights and ideology, and everything to do with child welfare. Critics do not have to be hateful, opposed to the transgender social agenda, or even religious, to understand evidence that opposite-sex hormones, puberty blockers and transgender surgeries are physically and mentally damaging for kids.

I think this is a solid point.

Quote

Supporters of children medically “changing” genders typically argue puberty-blockers and opposite-sex hormones don’t harm minors’ physical and mental development. The often cite studies showing the mental health of gender-confused children improves after they start medically “transitioning” to their chosen gender.

But these findings don’t track long-term outcomes of opposite-sex hormones and puberty blockers. An oft-cited 2022 study found 315 gender-confused American children were less anxious and depressed than their peers after taking opposite-sex hormones — but scientists drew their conclusions after only two years.

Longitudinal studies essentially absent. 

Quote

Investigations of Western European transgender clinics and testimony from whistle blowers like clinic worker Jamie Reed also suggest facilities prescribing transgender medical interventions aren’t keeping track of the amount of patients who “detransition” back to their biological gender after taking hormones and puberty blockers or getting surgery.

Some of these detransitioners are now vocal critics of allowing children to medically “change” their gender.

I think we need to listen to these folks, particularly in the absence of long-term longitudinal data.

Quote

Additionally, early research, like a seminal six-year study from the Netherlands in 2011, doesn’t apply to the new demographic of gender-confused children. As early as 2015, researchers from Finland raised concerns the number of gender-confused children was increasing and most new patients were girls with pre-existing mental health problems, as opposed to the 2011 study’s sample of mostly boys.

Comorbidities.

Quote

Concerns about insufficient research are often ignored because, as Marks wrote in his Montana ruling, “the medical community overwhelmingly agrees that (cross-sex hormones, puberty blockers and transgender surgeries) are the accepted care for treating gender dysphoria in minors” (p.38-39).

The truth is more complex. American medical associations started supporting transgender medical interventions for children after Western Europe implemented them. But now, these trailblazing countries — Finland, Sweden, France, Norway and the U.K. — are rapidly rolling back their support of such “treatments.”

Ideological/sociopolitical influences/pressures on medical care. 

Compromised assessments of the best interests of the child. 

Quote

Finland revised their medical guidelines to exclude puberty blockers from the “first line of care” for gender-confused children in 2020. Sweden’s National Board of Health and Welfare followed suit two years later, saying hormones and puberty blockers should only be used in exceptional cases. The National Academy of Medicine in France strongly cautioned against transgender medical interventions the same year, citing concerns about their physical and mental side-effects:

“Although, in France, the use of hormone blockers or hormones of the opposite sex is possible with parental authorization at any age, the greatest reserve is required in their use, given the side effects such as impact on growth, bone fragility, risk of sterility, emotional and intellectual consequences and, for girls, symptoms reminiscent of menopause.

“As for surgical treatments … their irreversible nature must be emphasized.”

Informed consent.

Irreversibility.

Quote

The Academy’s release also noted differences between what they call “’structural’ gender dysphoria” and “gender dysphoria” that goes away after a child grows up, writing, “The risk of over-diagnosis is real as shown by the increasing number of transgender young adults wishing to detransition.”

Norway and the U.K made similar findings in their 2023 investigations, concluding transgender medical interventions and their effects on processes like growth, bone density and cognitive development were under-researched.

Both investigations found doctors were lax and inconsistent in how they prescribed interventions like cross-sex hormones. The U.K. review found staff at the country’s premier transgender “treatment” program felt pressured to put children on puberty blockers and cross-sex hormones in an “unquestioning affirmative approach.” They further concluded gender-confused children presenting with multiple mental illnesses were often only given hormones for gender-confusion with their other illnesses left untreated.

The U.K.’s investigation once-prestigious Tavistock clinic to close.

Ideological/sociopolitical influences/pressures on medical care. 

Compromised assessments of the best interests of the child. 

Thanks,

-Smac

[smac97]

An August 2023 article responding to the Times article cited earlier by @Analytics: A Slow Trek Back to Truth?

Some excerpts:

Quote

Ghorayshi and the Times deserve credit for a well-researched article. Ghorayshi does a good job allowing different sides in the controversy to be heard. Her discussion of the medical research, though not the focus of her article, is refreshingly honest and accurate. Considering the pressure exerted on the Times and its reporters by transgender advocacy organizations like GLAAD to toe the ideological line, it takes courage to write a piece as rigorous and as thoughtful as this one.

Ideological/sociopolitical influences/pressures on medical care. 

Quote

And yet, the article has problems. Two in particular stand out. The first concerns the question of satisfaction and regret, and the second involves the role of mental-health interventions in pediatric gender medicine.

If the reader comes away from the Times piece feeling ambivalent about the St. Louis clinic, that is because Ghorayshi contrasts Reed’s allegations of wrongdoing with stories of families who say they are satisfied with the treatment their children received there. “It’s clear the St. Louis clinic benefited many adolescents,” says Ghorayshi.

But is it?

As a matter of principle, it is wrong to use satisfaction and regret as the benchmark for judging whether pediatric sex trait modification (PSTM) is a medically necessary and ethical practice. If medicine is to retain its authoritative role in human affairs, patient satisfaction alone cannot determine when interventions are medically necessary. Self-reported satisfaction is how we judge cosmetic procedures, not medically necessary ones. The role of the doctor is to heal, not please. Pleasing, though not unimportant, is secondary and subordinate to healing. Bitter pills are coated with sugar to make pleasing to patients, but it doesn’t follow that sugar is good for you or that doctors should encourage patients to eat it to their heart’s desire. Failure to distinguish the pleasant from the good can result in serious iatrogenic harm. More broadly, it can corrupt medicine and reduce it to mere consumerism.

"Self-reported satisfaction is how we judge cosmetic procedures, not medically necessary ones. The role of the doctor is to heal, not please."

This is an important point.

Quote

Ghorayshi is right to take interest in the satisfaction of patients and families who attended the St. Louis clinic. But to leave it at that and to imply that patient satisfaction is a valid counterargument to Reed’s allegations is to miss the far deeper and more significant ethical issues involved. Worse, it’s to take a side in that ethical debate without presenting the competing arguments in a serious way.

"{T}he far deeper and more significant ethical issues involved."

Yep.  We need to be discussing these, and not letting ideologues stifling such discussion via accusations of bigotry.

Quote

I’ve written in the past about the vital importance of providing readers with context about the satisfaction/regret question, especially when it comes to how we think about the St. Louis clinic. If journalists contribute to the public’s (misguided) belief that short-term satisfaction of distressed teenagers with drugs and surgeries is ultimately what matters, they should at least mention that the validity of this framing is itself a key part, if not the heart, of the scientific and medical debate over PSTM {"pediatric sex trait modification"}.

Research in gender medicine has found no necessary relationship between subjective satisfaction and more objective measurements of mental health and psychosocial functioning. One of the first follow-up papers on gender medicine published by Dutch clinicians in 1988, right around the time they began experimenting with hormonal interventions in adolescents, reflected on the question of subjective versus objective measurements of improvement. The paper acknowledged “a trend” in existing research on adult transsexuals at the time: “the subjective well-being of the transsexuals has increased, whereas an ‘improvement’ in their actual life situation is not always observed.”

A 2020 study by Finnish gender clinicians in the Nordic Journal of Psychiatry did look at more objective outcome measures. To assess whether hormonal interventions are beneficial, the authors used “proxies for adolescent development” including “age-appropriate living arrangements, peer relationships, school/work participation, romantic involvement, competence in managing everyday matters and need for psychiatric treatment.” The researchers found that patients “who did well in terms of psychiatric symptoms and functioning before cross-sex hormones mainly did well during real-life. Those who had psychiatric treatment needs or problems in school, peer relationships and managing everyday matters outside of home continued to have problems during real-life.” Thus, “Medical gender reassignment is not enough to improve functioning and relieve psychiatric comorbidities among adolescents with gender dysphoria.” Presumably, most of the patients were satisfied with their treatment.

"Research in gender medicine has found no necessary relationship between subjective satisfaction and more objective measurements of mental health and psychosocial functioning."

I think this merits some attention.

Quote

The pivot in PSTM research from objective to subjective metrics may reflect an exasperation of the field with trying to find good, causal evidence of improvement in mental health and psychosocial functioning. It may also reflect the true but rarely acknowledged purpose of sex-trait modification, which is to achieve “embodiment goals,” i.e., desired cosmetic outcomes.

Let’s assume, however, that satisfaction/regret is the appropriate benchmark for evaluating the ethics of PSTM. What does the empirical literature tell us about satisfaction and regret from hormonal or surgical interventions? “The number of people who detransition or discontinue gender treatments is not precisely known,” Ghorayshi observes. “Small studies with differing definitions and methodologies have found rates ranging from 2 to 30 percent.”

Ghorayshi is correct. Given the poor quality of research in this field, we do not currently know the true rates of satisfaction and regret among adults who transitioned as adults. Still less do we know about regret and satisfaction in those who transitioned as adolescents. Another problem with relying on satisfaction—especially when, as is often the case in this field of research, follow-up happens mere months after procedures—is that it may be confounded by placebo and Hawthorne effects. (The latter term refers to “the phenomenon where clinical trial patients’ improvements may occur because they are being observed and given special attention.”)  Rigorous long-term data, which is more important than short-term data when it comes to adolescent decisions, will take at least another decade to collect and analyze.

"Given the poor quality of research in this field, we do not currently know the true rates of satisfaction and regret among adults who transitioned as adults. Still less do we know about regret and satisfaction in those who transitioned as adolescents."

"Rigorous long-term data, which is more important than short-term data when it comes to adolescent decisions, will take at least another decade to collect and analyze."

Longitudinal studies essentially absent.

Quote

Also missing from the Times piece is any serious treatment of the question of harms. Ghorayshi implies that detransitioners were harmed, but in her sworn affidavit Reed documents several instances of harm suffered by patients receiving gender-transitioning care that go unmentioned in the Times piece. These include a teenage girl who experienced bleeding vaginal lacerations following testosterone injections (a known side-effect) and another girl whose clitoris got so large from taking the androgenizing hormone that it painfully chafed against her underwear when she walked.

After conducting an internal investigation, in which it never bothered to interview Reed, Washington University reported that it did not find evidence of any “adverse physical reactions” among those treated at the gender clinic. Not a single case.

Huh.

Quote

Considering how hard this is to believe, it would have been appropriate for Ghorayshi to probe deeper into this matter. Medical treatment decisions by their very nature require balancing benefits against harms. At a time when Americans need to hear the truth about what is known and not yet sufficiently studied about the side effects of these powerful drugs, Ghorayshi’s piece comes across as somewhat sanitized. Ghorayshi mentions 18 patients and families who say that they had “overwhelmingly positive” experiences at the St. Louis clinic, one patient—Alex—who discontinued testosterone after “realiz[ing] she was nonbinary,” and a file compiled by Reed and her coworker that documented 16 instances of detransition. What do these numbers tell us? The answer: close to nothing. The St. Louis clinic apparently had 613 patients who were medicalized during the relevant timeframe (Ghorayshi mentions 598, a number she takes from Washington University’s internal investigation, but Reed’s documents show otherwise). Since we don’t know the fate of the other patients, it’s impossible to draw any conclusions about the overall rates of regret or satisfaction. But again, whether most patients at the St. Louis clinic are satisfied or not is no rebuttal to Reed’s allegations. Using subjective satisfaction as the sole metric is reasonable for cosmetic procedures, but not for “medically necessary” ones.

"Using subjective satisfaction as the sole metric is reasonable for cosmetic procedures, but not for 'medically necessary' ones."

This seems like a pretty massive blow to what seems like the primary justification for pediatric sex trait modification ("PSTM").

Quote

This brings us to the second problem in the article. “The turmoil in St. Louis,” Ghorayshi writes, “underscores one of the most challenging questions in gender care for young people today: How much psychological screening should adolescents receive before they begin gender treatments?”

The key word here is “before.”

Informed consent.

Compromised assessments of the best interests of the child. 

Ideological/sociopolitical influences/pressures on medical care. 

Quote

Ghorayshi’s question seems to suggest that the debate between Europe and the U.S. is over how much mental-health screening and counseling to offer adolescents before putting them on a medical track. In truth, the European countries have adopted an approach that emphasizes, for most gender dysphoric adolescents, mental health support instead of hormones.

Though she notes the divergence in medical policy in Europe versus the U.S., Ghorayshi doesn’t fully explain the nature of this divergence and understates its extent. True, Europe hasn’t banned hormonal interventions altogether. But if the restrictions now in place in Finland, Sweden, and Denmark (the situation in the U.K. is more complicated) were implemented in U.S. clinics, the majority of American teenagers now being put on the medical track would receive only mental-health support. In Denmark, for instance, the rate of intake-to-medicalization at the country’s centralized gender clinic was 65 percent in 2018. After restrictions were imposed, the rate fell to 6 percent in 2022.

"{T}he rate of intake-to-medicalization at the country’s centralized gender clinic was 65 percent in 2018. After restrictions were imposed, the rate fell to 6 percent in 2022."

This, to me, is pretty stunning.

Quote

Ghorayshi mentions a Washington Post op-ed from 2021 by two psychologists, Laura Edwards-Leeper and Erica Anderson, who support the early medical-intervention model albeit with guardrails. According to Ghorayshi, Edwards-Leeper and Anderson “warned that American gender clinics were prescribing hormones to some children who needed mental health support first” (my emphasis). But what Edwards-Leeper and Anderson actually argue in their op-ed is that comprehensive mental-health assessment is needed to figure out whether medicalization is appropriate—a subtle but crucial difference. Such assessment is necessary for differential diagnosis and avoidance of unnecessary and potentially harmful medicalization.

Thus, it’s not just that patients referred to the St. Louis clinic were not receiving “mental health support first.” If judged by Scandinavian standards, which are far more in line with the principles of evidence-based medicine, many or most patients at the St. Louis clinics were likely being given drugs they should not have been prescribed at all. While some may believe that current restrictions in Europe are about “trying everything again from scratch,” an equally plausible explanation is that this is the first step in a bigger retrenchment that will result in firm age restrictions. Time will tell.

"If judged by Scandinavian standards, which are far more in line with the principles of evidence-based medicine, many or most patients at the St. Louis clinics were likely being given drugs they should not have been prescribed at all."

Wow.

Quote

Ghorayshi calls Republican laws “draconian,” but the truth is that these laws reflect a view of the underlying medical research and a policy stance much closer to those of European health authorities than those held by Democrats and U.S. medical associations. Condemning Republican laws while implying that the European changes are consistent with evidence-based medicine is, to put it mildly, puzzling.

Ideological/sociopolitical influences/pressures on medical care. 

Quote

Related to this is an impression Ghorayshi gives that a root cause (or even the root cause) of dysfunction at the St. Louis clinic was the sharp surge in the number of teenagers, many with serious psychological problems. The subtitle of the article itself says that the clinic “was overwhelmed by new patients and struggled to provide them with mental health care.” The article’s first sentence describes a clinic “buckling under an unrelenting surge in demand.” Ghorayshi later mentions the U.K.’s Tavistock clinic, where long wait times created pressures on clinicians to “affirm” and refer for hormonal treatments rather than do careful mental-health assessments.

But long wait times were only one of the problems identified by physician Hilary Cass in her investigation of the U.K. Gender Identity Development Service (GIDS). The other, and arguably more important problem, was the existence of “an affirmative approach” that “originated in the USA.” GIDS clinicians, Cass wrote, “feel under pressure to adopt an unquestioning affirmative approach [that is] at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.” Ghorayshi mentions this pressure on the clinicians but makes it seem as though it were somehow caused by the growing waitlists.

Ideological/sociopolitical influences/pressures on medical care. 

Quote

While Ghorayshi acknowledges the “affirming” model as part of the problem, she does not grapple with the true nature of that problem: the infiltration into medicine of a novel set of ideas, including that children have an innate and infallibly knowable “gender identity” and that “a child’s sense of reality” is the “navigational beacon to orient treatment around.” Ghorayshi’s use of terms like “transgender children” and “8-year-old transgender daughter,” though probably intended as a show of respect, implies that kids can know that they have a permanent transgender identity. Current research does not support this belief. Common sense and millennia of experience contradict it. The U.S. Endocrine Society itself says: “With current knowledge, we cannot predict the psychosexual outcome for any specific child.”

It is odd that in the short section of Ghorayshi’s article where she directly discusses the affirmative approach, the patients’ stories she tells all have happy endings. Indeed, she writes: “It’s clear the St. Louis clinic benefited many adolescents.” European health authorities have said the opposite: the current affirmative approach is a major cause of unsafe practices.

Moreover, the surface similarities between the St. Louis clinic and the Tavistock clinic obscure the more significant differences. As Hannah Barnes discusses in her book on Tavistock, GIDS was founded on a strong ethos of psychotherapy rather than medicalization. The story of Tavistock’s collapse is largely one of institutional mission creep: the founding ethos of 1989 was gradually replaced with a new understanding of the role of mental-health clinicians as rubber-stampers for experimental drugs.

In contrast, U.S. pediatric gender clinics were founded well after the Dutch started their experiment with puberty blockers and, it can reasonably be argued, for the purpose of offering these drugs. Endocrinologist Norman Spack, the founder of the first clinic in Boston, would later recall “salivating” at the prospect of using puberty blockers for children entering adolescence. In contrast with the Tavistock clinic, which referred patients to nearby hospitals for endocrine consultations, American gender clinics regularly employ endocrinologists like St. Louis’s Christopher Lewis, who, Ghorayshi notes, has prescribed hormones to patients after only a single visit. As the old saying goes, if you’re a hammer, every problem is a nail.

Given these important differences in the founding purpose, personnel composition, and sense of mission in American versus English clinics, it makes little sense to imply that the rush to medicalize at St. Louis was due to inadequate staffing of mental-health professionals. The surge in referrals may have been an aggravating factor, but it is not the root cause. The true root cause is the new ideology of gender and the mountain of subpar research that has been created to justify early intervention.

"The story of Tavistock’s collapse is largely one of institutional mission creep: the founding ethos of 1989 was gradually replaced with a new understanding of the role of mental-health clinicians as rubber-stampers for experimental drugs."

"Mission creep."  This thread, originally about "March of Dimes Syndrome" relative the Priesthood Ban, has now morphed into a discussion about "March of Dimes Syndrome" (aka "mission creep") relative to "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children.

Quote

Ghorayshi and the Times deserve much credit for a report that is more thorough and balanced than many that we’ve seen from the newspaper of record in recent years on this issue. They are operating in a political environment in which even mere skepticism of PSTM is seen by some as complicity in “genocide.” They are challenging the received wisdom of their own political tribe, which is never easy.

On the other hand, the Times itself has promoted the narrative that PSTM is “medically necessary” and “life-saving,” and that criticism of it reeks of ignorance and bigotry. The trek back to impartiality and devotion to truth-telling will be long and arduous, but it begins with articles like Ghorayshi’s on Reed and the St. Louis clinic.

Massive ideological/sociopolitical influences/pressures on medical care. 

Thanks,

-Smac

[Calm]

1 hour ago, smac97 said:

I guess you'll just have to trust me when I say that I quoted Reed's article "primarily because she is a percipient witness."

Okay, but it doesn’t make sense to me you aren’t quoting articles supportive of the opposite view that also have percipient witnesses.  I was thinking believing you, like most people, choose articles etc to support their claims was better than thinking you did a poor job of researching for percipient witnesses.

[Calm]

51 minutes ago, Analytics said:

• The psychologists and physicians at the clinic she is attacking also seem to be authentically concerned for the welfare of children
• In general, their qualifications to assess the successes and failures of their past medical interventions, and the benefits and risks of potential medical interventions, are superior to that of this one caseworker, and you seem to be deliberately ignoring their qualifications and their perspectives.

Would they not also be percipient witnesses?

[bluebell]

4 hours ago, Calm said:

The skin is the largest organ of the body.  

Good thing he didn't mention cutting off healthy organs.

 

3 hours ago, smac97 said:

Yes.  I was speaking specifically of so-called "gender-affirming" medical procedures.  I even specified the ones I was referencing: penectomies and mastectomies.

I think the side bar is something of a red herring.

Removal of a skin tag may technically fall within an overly-broad use of "elective removal of healthy body parts," but I wasn't referring to that, either.

Thanks,

-Smac

I'm assuming (maybe wrongly) that Cal views you as requiring precision in the word choices of others, and so she's holding you to the same standard.  But I could be way off on her motivations.

[smac97]

41 minutes ago, Analytics said:

I am agnostic on what medical treatments other people receive--that is between them and their doctors.

Oh.

41 minutes ago, Analytics said:

A few other points you seem to be ignoring:

• The psychologists and physicians at the clinic she is attacking also seem to be authentically concerned for the welfare of children

Compromised assessments of the best interests of the child. 

Massive ideological/sociopolitical influences/pressures on medical care. 

I think these risks need to be addressed.  And I've pointed to them many times.

41 minutes ago, Analytics said:

And that complexity is what you seem to be ignoring.

Not so.  I have spoken on this topic many times over the years, and have cited various sources as the basis for my position, and I have provided a litany of issues that pertain directly to the complexities involved in so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

I have cited numerous references addressing these issues.

41 minutes ago, Analytics said:

You seem to boil the issue down to whether you want to be one of the good guys who cares about the wellbeing of children and oppose chopping off healthy body parts, or whether you are one of the ideologically driven people who don’t care about the wellbeing of children and are in favor of chopping off healthy body parts.

First, I have gone out of my way to select evocative-but-not-inflammatory terms.  I don't think I have used words like "mutilation," and instead proposed "chopping off healthy body parts," and later settled on "electively removing healthy body parts of children and electively sterilizing children" (and, in the last few minutes, "PSTM" ("pediatric sex trait modification")).

Second, the above bullet lists outline eleven fairly discrete concerns I have about PSTM, and I have posted and commented on a substantial number of references addressing these issues at substantial length.  So I respectfully reject your characterization above.

Third, two of the concerns I have raised are:

• Compromised assessments of the best interests of the child. 
• Massive ideological/sociopolitical influences/pressures on medical care. 

I think there are plenty of otherwise good and decent people who fit within these parameters.  For example, parents who support PSTM out of a reactionary fear to the commonly-cited alternative - their child committing suicide - may very well be said to be compromised in their assessments "about the wellbeing of children."  Perhaps some doctors as well.

I think ideological/sociopolitical influences/pressures are also very heavily in play.  Again, I have cited a number of articles and references which indicate this is a real concern.

Thanks,

-Smac

[Calm]

4 minutes ago, bluebell said:

I'm assuming (maybe wrongly) that Cal views you as requiring precision in the word choices of others, and so she's holding you to the same standard.  But I could be way off on her motivations.

Yep and a little more…

Smac is coming cross to me as inflating the idea of objectivity in his own approach while inflating the appearance of emotionality in others’ approaches.

Edited October 11, 2024 by Calm

[smac97]

1 hour ago, SeekingUnderstanding said:

Quote

Do you ideologically support or oppose so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children?

This black and white thinking is where you and yours get into trouble.

And alternative "it all depends"-style thinking is where you and yours get into trouble.

I am speaking about a general, though not necessarily absolute, proposition regarding so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children.

1 hour ago, SeekingUnderstanding said:

A medical procedure can be overused and misused.  That doesn’t mean it never has a place.

Broadly speaking, I agree.

What are your thoughts on "Conversion Therapy"?  Do you take a similar "it can be overused and misuses, but that doesn't mean it never has a place" tack?  Or are you take a more "black and white thinking" approach to it?

1 hour ago, SeekingUnderstanding said:

The answer to overuse is to reduce usage to cases where the outcomes support it. The answer to misuse is to better communicate the proper use. I personally think that mental health drugs are vastly overused, especially in children. But I would never think to ban them. I do think more cautious use would be advisable.

I think the following issues need to be extensively addressed, and until then PSTM needs to be severely pared back or stopped altogether:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

1 hour ago, SeekingUnderstanding said:

It doesn’t have to be an either or. 

Well, maybe it does.  Informed consent alone may end up being an insuperable bar to PSTM.  

Thanks,

-Smac

[smac97]

8 minutes ago, bluebell said:

Quote

Yes.  I was speaking specifically of so-called "gender-affirming" medical procedures.  I even specified the ones I was referencing: penectomies and mastectomies.

I think the side bar is something of a red herring.

Removal of a skin tag may technically fall within an overly-broad use of "elective removal of healthy body parts," but I wasn't referring to that, either.

I'm assuming (maybe wrongly) that Cal views you as requiring precision in the word choices of others, and so she's holding you to the same standard. 

I took her comments as more of a "gotcha."  My comments have clearly been about so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children (or, if you prefer, "PSTM").

I was not speaking about circumcision.  At all.

Thanks,

-Smac

[SeekingUnderstanding]

6 minutes ago, smac97 said:

Well, maybe it does.  Informed consent alone may end up being an insuperable bar to PSTM.  

How so? Minor's can't consent to anything legally speaking? I didn't consent to my circumcision. I didn't consent to my religious upbringing which I view as causing me irreparable harm. Minor's can't consent to any number of things. It seems awfully suspicious to me that this is where the line must be drawn. Especially so, since you oppose all gender affirming care from a theological standpoint.

[Calm]

17 minutes ago, smac97 said:

I took her comments as more of a "gotcha." 

I don’t do “gotchas” as I have stated before.  If something sounds like one, it is because I want to know the reasoning behind it as it seems inconsistent with other things someone says.  I am interested in these discussions mostly to examine how people reason and that isn’t always clear from what they say, especially when as stated there appears to be a conflict.  I believe nuances in thinking are very often revealed when apparent conflicts are resolved with more information, either by revealing there is no actual conflict or by showing the conflict is valid but was unrecognized and once recognized can be corrected for a more accurate position…or a combo of the two since things can be complex and both somewhat correct but incomplete and somewhat in conflict.

Edited October 11, 2024 by Calm

[SeekingUnderstanding]

14 minutes ago, smac97 said:

What are your thoughts on "Conversion Therapy"?  Do you take a similar "it can be overused and misuses, but that doesn't mean it never has a place" tack?  Or are you take a more "black and white thinking" approach to it?

Conversion therapy was accepted practice for decades. Decades.

See here:

https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-whether-conversion-therapy-can-alter-sexual-orientation-without-causing-harm/

If Gender Affirming Care had similarly bad outcomes in all cases, "However, after reviewing the research, we concluded that there is no credible evidence that sexual orientation can be changed through therapeutic intervention. Most accounts of such change are akin to instances of “faith healing.” There is also powerful evidence that trying to change a person’s sexual orientation can be extremely harmful. Taken together, the overwhelming consensus among psychologists and psychiatrists who have studied conversion therapy or treated patients who are struggling with their sexual orientation is that therapeutic intervention cannot change sexual orientation, a position echoed by all major professional organizations in the field, including the American Psychological Association whose substantial 2009 report is available here. " then I would support bans. 

However, I know from personal people that I am acquainted with, that gender affirming care, including sex change operations can have an enormously positive impact on their emotional and physical health and well-being. To the extent that any undue pressure exists one way or another exists, it should be promptly addressed and mitigated. To the extent that there is a lack of knowledge and understanding of the risks (something that is problematic across all medical fields) this should be improved. But ban? The only people that support outright bans as far as I can tell are religiously motivated ideologues. 

[SeekingUnderstanding]

7 minutes ago, Calm said:

I don’t do “gotchas” as I have stated before.

It baffles me, that SMAC can be as active as he is here and think this. You have never as long as I've been on this board done a "gotcha." You are as faithful as they come in the church. At the same time, you expect honesty, careful speaking, citing of sources, not overstating anything, and most of all you seek understanding FROM ALL SIDES. I'd lend you my moniker since it no longer really fits my persona here, but alas, I can't.