At the same time, the aim to shift discussion from “does gender medicine harm or help” to “is the Cass Review good or bad” is clearly intended to get everyone to stop looking at the first question, which remains the important one.
So even if it were possible to prove Dr. Cass to be a mad hobo in the pay of Big Intersex Abortion, gender medicine is still either harmful or helpful. The evidence is piling up so fast that it is super harmful that advocates of it would really rather we discussed “Cass, hobo or no?” instead.
"Gender medicine" isn't special -- elective cosmetic surgery is always harmful, and medical doctors who have taken the Hippocratic Oath have no business being involved in any way.
Getting insurance companies to pay for "cisgender-affirming" breast implants as "medical necessities" is the obvious end that they are pursuing. These profit-seeking monsters must be separated from the field of medicine.
The approach of the believers in "gender-affirming care" to the Cass Review is very reminiscent of the “debunking” of the 2023 Cochrane Review's findings regarding the effectiveness of masks to slow respiratory virus infections, and it shouldn’t surprise anyone who has followed NEJM’s publication record on mask mandates during the pandemic. Ideology > science all the way, on both topics.
I'm not going to relitigate this in detail here since the masking battle has largely been won (and much of it has thankfully slipped my mind), but this is exactly the point: the editor-in-chief of the Cochrane Review intervened for political reasons, against the will of the review's authors, publishing a "revised" statement with softened language, which was misrepresented as a "revision" of the review's conclusions by mask advocates. Yes, it's true that its conclusion was that there is still uncertainty, and future studies might show an effect, but at some point, after the most rigorous studies have failed to show benefit, you just have to admit that the effect size is going to be minuscule if not non-existent.
My point was that the response strategy on the part of people in favor of the intervention has been similar to the response to the Cass Review: Attack the review's authors, their methods and standards, argue that proper RCTs would be impossible or unethical, even question the value of RCTs overall, dismiss the review's conclusions as merely indicating the need for future research and not at all reflective of the fact that the intervention in question may simply not be effective. All because there is a strong political motivation to justify it.
The science on community masking is "inconclusive" in the sense that it's hard to prove a definitive negative on complex interventions like this. Normally, however, interventions with negative results like the ones we have on community masking are deemed to be ineffective, and don't continue to be recommended pending definitive proof that they don't work. Masking has been treated differently for purely political reasons.
"The effect of citing these claims here is to get weak arguments from sources which are not peer-reviewed and not published in any reputable journal, platformed without serious scrutiny by the NEJM."
Exactly.
Several previous essays have done the same-- the Yale reports are quoted in lots of places, including other papers by those authors.
While we can understand the , empathy-driven , need to believe in “ gender identity/ fluidity “ ideology ( what else can we call it?) from social scientists and their disciples, how can we understand so many key medical scientists and their institutions’ collusion? Superficially it just looks like misplaced compassion ( specifically in relation to obligatory medical intervention in minors) but there has to be darker, more pernicious, forces which been willing to fight so much harder to have gained such dominance. The longer the beast remained unchallenged, the stronger it became, to our shame.
Nothing to do with compassion. If it were, this medicalization of the issue would be the LAST resort, not the first. This is nothing but pure ideology. The ideology being nothing short of an assault on 'cognitive liberty'. IOW, the trans 'issue' is a proxy for distorting and perverting reality, sanity, psychology health, and Society itself. The sooner this is realized, the sooner this can quashed, and forever shifted into the bin.
Great article, but I would disagree on one point: that so-called 'gender-affirming care' has nothing to do with abortion access. Planned Parenthood is heavily invested in the provision of both, with a legacy of advocating for the sterilisation of mentally ill people.
Thank you. I didn't know anything about it (and that was perhaps for the better).
What I would like to see, though, is a piece on the new trial on puberty blockers that was (if I understand correctly) sponsored by the Cass review itself, and the ethical implications of it.
> That the authors interpret girls receiving hormone therapy for hirsutism as “gender-affirming” is highly revealing. It is a concession that girls should be hair-free, as that is indicative of a feminine gender, and thus by removing hair hormonally, this act becomes gender-affirming.
The authors clearly indicate that hormone therapy for hirsutism is *sometimes* sought by cisgender girls, as an example of the obsessively focused lens by those who oppose GAC. Management of body hair *can* be gender-affirming depending on how the particular patient views their gender. Many women don't care about body hair, but many do. For many women, not shaving their armpits or legs is gender-affirming; for others, shaving and other hair removal is gender-affirming. There is no indication in the excerpt you quoted, whether explicitly or in subtext, that the authors believe that cisgender girls *should* be hair-free. I am frankly bewildered as to how you even parsed such a conclusion out of that excerpt.
Thanks for your commentary and analysis. Unfortunately even prior to publishing this piece of trash the NEJM had already lost their heartbreaker great majority of the credibility it once enjoyed as a trusted non partisan authoritative source. It seems increasingly difficult for any legacy media to retain objectivity.
> an unattainable level is treated as exemplary when it could never be met in the first place
But more than half of studies met the required moderate/high standard, so none of this is true. There is no "unattainable standard", there is a clearly attainable one, because studies attained it. If no studies met the moderate/high standard you might have a point, but they did, so you don't.
Randomised control trials not being proposed for puberty blockers has nothing to do with ethics. Gender clinics never had a problem with being unethical or carrying out shoddy 'research'.
It's because the clinics refuse to accept the premise that children with transgender ideation might be fine without puberty blockers, as the whole edifice of the transition industry would crumble.
Therefore these clinics are diametrically opposed to any trial including a control group. And the drugs are so powerful that double-blinding is impossible, which provides a convenient excuse for not having a control group.
"The scale grades non-randomized studies in relation to the more desirable randomized studies."
Why do you keep saying this? It's not true. Based on the NOS, two of the studies were rated as high quality and neither of them were RCTs. How could they be rated high quality if they were rated in relation to RCTs?
I think you may be confusing the NOS with the standards of Evidence-Based Medicine in general, the latter of which treats RCTs as the gold standard of evidence. But the NOS is a lower bar that doesn't compare anything to RCTs.
Excellent, thorough, and VERY patient.
At the same time, the aim to shift discussion from “does gender medicine harm or help” to “is the Cass Review good or bad” is clearly intended to get everyone to stop looking at the first question, which remains the important one.
So even if it were possible to prove Dr. Cass to be a mad hobo in the pay of Big Intersex Abortion, gender medicine is still either harmful or helpful. The evidence is piling up so fast that it is super harmful that advocates of it would really rather we discussed “Cass, hobo or no?” instead.
"Gender medicine" isn't special -- elective cosmetic surgery is always harmful, and medical doctors who have taken the Hippocratic Oath have no business being involved in any way.
Getting insurance companies to pay for "cisgender-affirming" breast implants as "medical necessities" is the obvious end that they are pursuing. These profit-seeking monsters must be separated from the field of medicine.
The approach of the believers in "gender-affirming care" to the Cass Review is very reminiscent of the “debunking” of the 2023 Cochrane Review's findings regarding the effectiveness of masks to slow respiratory virus infections, and it shouldn’t surprise anyone who has followed NEJM’s publication record on mask mandates during the pandemic. Ideology > science all the way, on both topics.
yes. because everything to do with treating illness and providing medical care is wrong.
It's all connected man.
First 5G towers, and now trans people can have their bodies the way they want.
The Cochrane Review's revised statement makes clear that the question of whether masks help reduce the spread of infectious diseases like COVID and the flu remains a question. There just weren't sufficient studies out there to lead them to a conclusive opinion. https://www.cochrane.org/CD006207/ARI_do-physical-measures-such-hand-washing-or-wearing-masks-stop-or-slow-down-spread-respiratory-viruses
I'm not going to relitigate this in detail here since the masking battle has largely been won (and much of it has thankfully slipped my mind), but this is exactly the point: the editor-in-chief of the Cochrane Review intervened for political reasons, against the will of the review's authors, publishing a "revised" statement with softened language, which was misrepresented as a "revision" of the review's conclusions by mask advocates. Yes, it's true that its conclusion was that there is still uncertainty, and future studies might show an effect, but at some point, after the most rigorous studies have failed to show benefit, you just have to admit that the effect size is going to be minuscule if not non-existent.
My point was that the response strategy on the part of people in favor of the intervention has been similar to the response to the Cass Review: Attack the review's authors, their methods and standards, argue that proper RCTs would be impossible or unethical, even question the value of RCTs overall, dismiss the review's conclusions as merely indicating the need for future research and not at all reflective of the fact that the intervention in question may simply not be effective. All because there is a strong political motivation to justify it.
Do you think it's possible that the science is, actually, inconclusive?
The science on community masking is "inconclusive" in the sense that it's hard to prove a definitive negative on complex interventions like this. Normally, however, interventions with negative results like the ones we have on community masking are deemed to be ineffective, and don't continue to be recommended pending definitive proof that they don't work. Masking has been treated differently for purely political reasons.
"The effect of citing these claims here is to get weak arguments from sources which are not peer-reviewed and not published in any reputable journal, platformed without serious scrutiny by the NEJM."
Exactly.
Several previous essays have done the same-- the Yale reports are quoted in lots of places, including other papers by those authors.
While we can understand the , empathy-driven , need to believe in “ gender identity/ fluidity “ ideology ( what else can we call it?) from social scientists and their disciples, how can we understand so many key medical scientists and their institutions’ collusion? Superficially it just looks like misplaced compassion ( specifically in relation to obligatory medical intervention in minors) but there has to be darker, more pernicious, forces which been willing to fight so much harder to have gained such dominance. The longer the beast remained unchallenged, the stronger it became, to our shame.
Nothing to do with compassion. If it were, this medicalization of the issue would be the LAST resort, not the first. This is nothing but pure ideology. The ideology being nothing short of an assault on 'cognitive liberty'. IOW, the trans 'issue' is a proxy for distorting and perverting reality, sanity, psychology health, and Society itself. The sooner this is realized, the sooner this can quashed, and forever shifted into the bin.
or trans people exist, and it makes your uncomfortable and you want it to be a conspiracy.
Literally no one denies that people calling themselves trans exist. We hear them continuously.
Nice try Jaden....but no.
Great article, but I would disagree on one point: that so-called 'gender-affirming care' has nothing to do with abortion access. Planned Parenthood is heavily invested in the provision of both, with a legacy of advocating for the sterilisation of mentally ill people.
https://genspect.substack.com/p/planned-parenthood-junk-science-and
Thank you. I didn't know anything about it (and that was perhaps for the better).
What I would like to see, though, is a piece on the new trial on puberty blockers that was (if I understand correctly) sponsored by the Cass review itself, and the ethical implications of it.
Please see my article on this very topic, comments welcome. https://genspect.substack.com/p/an-ethical-design-for-the-uks-puberty
Welcome to substack where everyone thinks trans people are a psyop.
This is a complete misread on your part:
> That the authors interpret girls receiving hormone therapy for hirsutism as “gender-affirming” is highly revealing. It is a concession that girls should be hair-free, as that is indicative of a feminine gender, and thus by removing hair hormonally, this act becomes gender-affirming.
The authors clearly indicate that hormone therapy for hirsutism is *sometimes* sought by cisgender girls, as an example of the obsessively focused lens by those who oppose GAC. Management of body hair *can* be gender-affirming depending on how the particular patient views their gender. Many women don't care about body hair, but many do. For many women, not shaving their armpits or legs is gender-affirming; for others, shaving and other hair removal is gender-affirming. There is no indication in the excerpt you quoted, whether explicitly or in subtext, that the authors believe that cisgender girls *should* be hair-free. I am frankly bewildered as to how you even parsed such a conclusion out of that excerpt.
Thanks for your commentary and analysis. Unfortunately even prior to publishing this piece of trash the NEJM had already lost their heartbreaker great majority of the credibility it once enjoyed as a trusted non partisan authoritative source. It seems increasingly difficult for any legacy media to retain objectivity.
> an unattainable level is treated as exemplary when it could never be met in the first place
But more than half of studies met the required moderate/high standard, so none of this is true. There is no "unattainable standard", there is a clearly attainable one, because studies attained it. If no studies met the moderate/high standard you might have a point, but they did, so you don't.
I don't think you understand what "unattainable" means.
NOS "was developed to assess the quality of nonrandomised studies"
https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
You're just trolling now so bye.
Randomised control trials not being proposed for puberty blockers has nothing to do with ethics. Gender clinics never had a problem with being unethical or carrying out shoddy 'research'.
It's because the clinics refuse to accept the premise that children with transgender ideation might be fine without puberty blockers, as the whole edifice of the transition industry would crumble.
Therefore these clinics are diametrically opposed to any trial including a control group. And the drugs are so powerful that double-blinding is impossible, which provides a convenient excuse for not having a control group.
"transition industry". that's so cynical.
Have you ever considered that trans people exist, and we like having our bodies a certain way?
have you considered that helping people be well (ie, food shelter and other needs) often involves corporate entities?
"The Newcastle-Ottawa Scale references RCTs as the standard"
This is absolutely false. The Newcastle-Ottawa Scale is overtly designed to assess the quality of NON-randomized studies.
https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
"The scale grades non-randomized studies in relation to the more desirable randomized studies."
Why do you keep saying this? It's not true. Based on the NOS, two of the studies were rated as high quality and neither of them were RCTs. How could they be rated high quality if they were rated in relation to RCTs?
I think you may be confusing the NOS with the standards of Evidence-Based Medicine in general, the latter of which treats RCTs as the gold standard of evidence. But the NOS is a lower bar that doesn't compare anything to RCTs.