UK Politics: Not even a Penny for a new Prime Minister

[Rippounet]

3 hours ago, Heartofice said:

Sure. I'm sure you know better than the authors of the Cass review,

Edit: Hilary Cass being the chair, who are the other authors?
And lol, Dr Cass wrote a report that -among many other things- cautions against the widespread use of puberty blockers and hormones in kids.
It's really not the world-changing event that you're making this to be. I mean, seeing you gloat, I seriously thought we were talking about trans-identity generally speaking, and that the report offered a transformative review of the scientific literature.

So I shouldn't have (not an area of interest), but I checked it out. The report starts with these words:

Quote

This Review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people’s rights to healthcare. It is about what the healthcare approach should be, and how best to help the growing number of children and young people who are looking for support from the NHS in relation to their gender identity.

Ok, good. Glancing at the recommendations, you can find ones like this:

Quote

In the case of puberty blockers, NHS England has set out that these will only be available under a research protocol.

Sounds great. Establishing a scientific framework, doing more research, encouraging trans kids to wait until adulthood to take important decisions while providing care and support...
Again, for a while there, I thought you were talking about transition therapy for all trans individuals, but this is about kids.
And the heart of the matter seems to be:

On puberty blockers:

Quote

All the studies were small uncontrolled observational studies, and all the results were of low certainty. Many did not report statistical significance.
3.7 The studies that reported impact on gender dysphoria, mental health, body image and psychosocial impact were of very low certainty and suggested little change from baseline to follow-up. The studies that reported bone density outcomes were similarly unreliable so no safety outcomes could be confirmed.

And on gender-affirming hormones:

Quote

Results from five uncontrolled, observational studies suggested that, in children and adolescents with gender dysphoria,
gender-affirming hormones are likely to improve symptoms of gender dysphoria, and may also improve depression, anxiety, quality of life, suicidality and psychosocial functioning. The impact of treatment on body image was unclear.

So more research is needed. Ok, I personally wouldn't have opposed that 6 days or 6 years ago.

The rest of the report leaves me slightly uneasy though. First a part on "Developmental considerations
for children and adolescents" that presents interesting generalities and then an intriguing "Growing up in the 2000s" that basically suggests trans-identity is something "societal," and that the internet and porn are now widespread problems...

I mean, sure. But at some point the review leans heavily into suggestions that trans-identity is, basically, anything else than trans-identity.
Sentences like this: "Changes in beliefs about gender identity in Generation Z have led to much more flexible thinking about how gender is expressed, and a move away from gender stereotypes. Young people within Generation Z, as well as younger Millennials, are much more open to experiment with gender expression than previous generations."
And on page 121 there's mention of a "transgender narrative."
This gives me the impression that the review was written by one's conservative grandma, looking at the entire question as a fad. Which is kind of a problem because one wonders how serious the review of the literature was... Cass attacks at least 9+5 studies, but I feel she doesn't consider the simple possibility that a new generation can be better educated about a specific condition. And it's kind of weird that she would suggest gender dysphoria is often undiagnosed autism when autism is much better diagnosed today thanks to awareness having been raised about it.

Anyway, have to go. This was an interesting report, but I wouldn't make too much out of it.

Edited April 15 by Rippounet

[DanteGabriel]

5 hours ago, Heartofice said:

 

One of the big conclusions of the Cass Review is that we have seen a period where ideology has taken over science in medicine. We have to get away from being scared of being challenged by uncomfortable facts. We need to be able to look at the causes of what is going on without feeling afraid. 

 

Come now. Ideology taking over science in medicine is nothing new. You're just alarmed because you feel it's "woke" ideology. Just like the age-old practice of social ostracism and "cancellation" suddenly became a major problem because it started to affect people with views you sympathized with.

[DMC]

43 minutes ago, TrackerNeil said:

I accept that. I hope you can accept, in turn, that those who take the report seriously may be just as earnest, and may have approached the review with an equally open mind.

Yeah the issue isn’t so much the Cass review but the weaponization of its findings.  As Ripp alluded to, if you actually read the report, its recommendations are far less conclusive and determinative than being suggested here. For instance, on social transitioning:

Quote

76. The systematic review showed no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence. However, those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway.

77. Although it is not possible to know from these studies whether earlier social transition was causative in this outcome, lessons from studies of children with differences in sexual development (DSD) show that a complex interplay between prenatal androgen levels, external genitalia, sex of rearing and sociocultural environment all play a part in eventual gender identity.

78. Therefore, sex of rearing seems to have some influence on eventual gender outcome, and it is possible that social transition in childhood may change the trajectory of gender identity development for children with early gender incongruence. 

79. The clinician should help families to recognise normal developmental variation in gender role behaviour and expression. Avoiding premature decisions and considering partial rather than full transitioning can be a way of ensuring flexibility and keeping options open until the developmental trajectory becomes clearer. (31-32)

Immediately thereafter, on medical pathways:

Quote

85. The University of York also carried out a systematic review of outcomes of masculinising/ feminising hormones. Overall, the authors concluded that “There is a lack of high-quality research assessing the outcomes of hormone interventions in adolescents with gender dysphoria/incongruence, and few studies that undertake long-term follow-up. No conclusions can be drawn about the effect on gender dysphoria, body satisfaction, psychosocial health, cognitive development, or fertility. Uncertainty remains about the outcomes for height/growth, cardiometabolic and bone health. There is suggestive evidence from mainly pre-post studies that hormone treatment may improve psychological health, although robust research with long-term follow-up is needed”.

[…]

88. A problem, that has become increasingly apparent as the Review has progressed is that research on psychosocial interventions and longer-term outcomes for those who do not access endocrine pathways is as weak as research on endocrine treatment. This leaves a major gap in our knowledge about how best to support and help the growing population of young people with gender-related distress in the context of complex presentations. (33)

In other words, a lot of the findings in the report are resolvedly .

Which is very far from what’s being argued here - because there’s plainly an underlying political motive.  Instead, the thrust of the report emphasizes caution and developing a research protocol for the future - something that is eminently reasonable for most, I’d imagine.

[TrackerNeil]

22 minutes ago, DMC said:

Which is very far from what’s being argued here - because there’s plainly an underlying political motive.

I usually try to assume that people actually believe what they say they believe, and not that they have political motives, but YMMV.

Edited April 15 by TrackerNeil

[DMC]

1 minute ago, TrackerNeil said:

I usually try to assume that people actually believe what they say they believe, and not that they have political motives, but YMMV.

Having political motives does not mean people don’t actually believe what they say they believe.  It..just means it’s motivated by their political beliefs.  It’s very strange to think otherwise.

[TrackerNeil]

1 minute ago, DMC said:

Having political motives does not mean people don’t actually believe what they say they believe.  It..just means it’s motivated by their political beliefs.  It’s very strange to think otherwise.

So that would mean that those who oppose the Cass Review are also motivated by their political beliefs?

[DMC]

Just now, TrackerNeil said:

So that would mean that those who oppose the Cass Review are also motivated by their political beliefs?

Sure!  It’s a very political document.  Hard not to.

[TrackerNeil]

3 minutes ago, DMC said:

Sure!  It’s a very political document.  Hard not to.

Great! So, given that both sides are politically motivated, perhaps we should all allow some humility into this conversation; after all, we can all be wrong, particuarly when our political beliefs are invoked.

[DMC]

1 minute ago, TrackerNeil said:

perhaps we should all allow some humility into this conversation;

Yup.  Perhaps we should not accuse people that are trying to grasp this report and interpret its findings as best they can with premeditated insults and instant hostility.  That, ya know, was my point.

[Heartofice]

2 hours ago, karaddin said:

You linked a thread which aims to summarize the study on cross sex hormone treatment of minors when we'd been talking about puberty blockers which doesn't exactly smack of good faith HoI, but I decided to click through and find the thread summarizing the PB findings from your own source for you

I linked to a thread based on a response Ripp made about 'calling bullshit' on the methodology of the review, saying he had seen a really good bit of evidence that goes against the review. This is a pretty common response to the review that I've seen, that good quality evidence has been disregarded, but this is easily debunked. If you want to go find details about puberty suppression then I can easily link to that too.

The rest of your post I'm struggling to read because of copy pasting formatting. 

Cass agrees that the supposed purpose of PB is to buy time for children to help make up their mind:
 

Quote

However, no changes in gender dysphoria or body satisfaction were demonstrated. There was insufficient/inconsistent evidence about the effects of puberty suppression on psychological or psychosocial wellbeing, cognitive development, cardio-metabolic risk or fertility.
83.
Moreover, given that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinising/ feminising hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.

So not only was there little evidence that there were positive benefits, but there is concern it merely acts as an affirmation pathway. Again the big point here is that these are treatments that were being given to children with little scientific backing. Yet we were told for years they were perfectly safe, that there was years of solid data around them, you yourself parroted this claim numerous times on this board. This now turns out to not be the case. That is the disinformation I was referring to. 

So yes, you are right, the main conclusion is that more research should be done before resuming use of these treatments. I think that is fair.
What I think is being missed is what was actually happening in the past, that these treatments had claims made about them which were not backed up by evidence, that children were put on those treatments when they didn't even meet the very specific criteria of the original Dutch study that promoted the use of PB (checking for mental trauma, sexual abuse, history of gender confusion etc), that there was not enough work put into understanding more about the children's history or contributory conditions for fear of being accused of denying their identity. 
 

2 hours ago, karaddin said:

When I've already conceded that some detransitioners exist, providing the one single detransitioner you know of hardly strengthens your point. I suspect that if we were balancing "trans kids not receiving treatment" vs "cis kids incorrectly receiving treatment" your honest answer would be "all trans kids should be denied treatment if we can't guarantee a single cis kid won't receive incorrect treatment". 

You said nothing had demonstrated confirmed harm. I think Keira Bell would say she has been harmed wouldn't you? She isn't alone either.

And no, I think that children should be given the appropriate treatment. There may be a number of children for whom PB may be the right treatment, I suspect it would be very small number, but I'm not ruling it out. The right checks and balances and investigation into what is going on with a child should be going on first however, there should be no rushing through to PB. I also don't think young children are emotionally capable of making that choice, so these things will have to happen later on.

1 hour ago, karaddin said:

we functionally don't share a common frame of reference when reading the review.

I think this is pretty accurate, we are definitely coming at this from a very different basic framework as to what is happening, which is why we will never agree. 

[Heartofice]

1 hour ago, Rippounet said:

The rest of the report leaves me slightly uneasy though. First a part on "Developmental considerations
for children and adolescents" that presents interesting generalities and then an intriguing "Growing up in the 2000s" that basically suggests trans-identity is something "societal," and that the internet and porn are now widespread problems...

I mean, sure. But at some point the review leans heavily into suggestions that trans-identity is, basically, anything else than trans-identity.

Well this goes into a wider question as to what you think the other answer to that question is. I don't expect you to answer here because we probably won't agree, but as I just said above, I think there are so very different basic framework differences which I think create a lot of problems. 

[Rippounet]

Back from lunch, I'll add a few things:

2 hours ago, BigFatCoward said:

I don't disagree with your central premise, but people will do a whole lot to avoid being criticised, one area that most moderate people are almost terrified of speaking out is on trans issues. 

[...]

The biggest issue with the current report is I can't find anywhere where it shows - Are more people getting treatment who shouldn't, or would more people who should be getting treatment be failed if any recommendations were brought in. 

That's the problem: we don't really know. And it might be almost impossible to know this with certainty.

But seen from the outside, this is my two cents. There was, in fact, a fuckup in the UK, and puberty blockers were too easily prescribed, without the necessary precautions/investigations. The section of the Cass report on diagnosis makes it rather clear that gender dysphoria became a "default diagnosis" for kids/teens with mental health issues. This eventually led to a lawsuit (Bell v. Tavistock), that led to the Cass report iself, which, preditably and logically, recommends that more precautions be taken, with a conservative tone overall, that can/could potentially be used/weaponised against trans-identity.
 

2 hours ago, karaddin said:

The Cass review, from those summaries, has utilized fundamentally incorrect metrics for assessing the existing research on puberty blockers and this has been the case in every snippet of it I have seen. The purpose of puberty blockers is not to resolve the gender dysphoria, it is to prevent biological changes that will worsen it and cause undesired changes that will last for life. It's not expected to accomplish a positive outcome, its to prevent a negative one. So a review that looks as these studies and says "there's lack of a clear positive outcome here" has missed the point of them.

That's funny, 'cause that thought had occurred to me while perusing the report.

To be fair, the report says on page 185:

Quote

This demonstrates how difficult it is to separate out and understand the impact of the various elements of care; for example, the extent to which psychopharmacological treatments improve mental health, and how much of the improvements is a result of gender-affirming treatment.

 

44 minutes ago, TrackerNeil said:

So that would mean that those who oppose the Cass Review are also motivated by their political beliefs?

There's not much to "oppose" though. Though the report has a conservative tone and accuses Gids of screwing up, it's still very nuanced and takes a lot of precautions to be uncontroversial.

Edited April 15 by Rippounet

[Heartofice]

1 minute ago, Rippounet said:

But seen from the outside, this is my two cents. There was, in fact, a fuckup in the UK, and puberty blockers were too easily prescribed, without the necessary precautions/investigations. The section of the Cass report on diagnosis makes it rather clear that gender dysphoria became a "default diagnosis" for troubled kids/teens. This eventually led to a lawsuit (Bell v. Tavistock), that led to the Cass report iself, which, preditably and logically, recommends that more precautions be taken, with a conservative tone overall, that can/could potentially be used/weaponised against trans-identity.

Yes you are getting it, apart from the last sentence, which is just your interpretation. I would suggest it's using realistic evidence based language, which has been absent from the last few years on the topic.

You are also missing the why, of how this happened, which is to understand how GIDS managed to misdiagnose and over prescribe treatments.

4 minutes ago, Rippounet said:

There's not much to "oppose" though. Though the report has a conservative tone and accuses Gids of screwing up, it's still very nuanced and takes a lot of precautions to be uncontroversial.

And yet there are quite a few people who are sticking their head in the sands and opposing the report as some sort of anti trans propaganda. Luckily even the groups who have been the main advocates for many of the unscientific rhetoric of the past few years like Stonewall and Mermaids have basically had to backtrack. It's only now I've become of the term 'Reverse Ferret' which it turns out is not a sexual position. 

[Rippounet]

40 minutes ago, Heartofice said:

Well this goes into a wider question as to what you think the other answer to that question is.

Do we agree that the question is "why is there an increase in the number of people being treated for gender dysphoria" ?

Because the funny thing is that the progressive answer (more people are being diagnosed because the awareness about this condition has increased) and the conservative answer (more people are being erroneously diagnosed because the condition's sociological/political implications make it fashionable) are not mutually exclusive.

Edited April 15 by Rippounet

[TrackerNeil]

12 minutes ago, Rippounet said:

There's not much to "oppose" though. Though the report has a conservative tone and accuses Gids of screwing up, it's still very nuanced and takes a lot of precautions to be uncontroversial.

In my half-century on this planet, I have come to realize that any position, no matter how carefully or thoughtfully stated, can (and will) be opposed by some. I used to think differently, but...well, a half-century. 

Edited April 15 by TrackerNeil

[Matrim Fox Cauthon]

1 hour ago, TrackerNeil said:

So that would mean that those who oppose the Cass Review are also motivated by their political beliefs?

This point is something of a truism that, IMHO, attempts to depict both sides as being equivalent by simple virtue of being motivated by their political beliefs. Like, for example, Christian fundamentalists opposing gay marriage were politically motivated but it seems a bit disingenuous to then point out that gays were also politically motivated in obtaining legal marriage rights.

Likewise, pointing out that both those opposing and supporting the Cass Review are motivated by their political beliefs doesn't really give us a sense of what those political beliefs are or the validity thereof. As others in this thread have pointed out, some of that political motivation by those weaponizing its findings involves an anti-trans ideology, ranging from those suspicious of trans-identities to those who are downright hostile to it. 

[DMC]

I’d also point out that the medical community generally has zero problem prescribing drugs in which we have no idea concerning the long term effects to children on a host of other issues.  This is pretty much how my entire generation grew up.

Should there be concern about over-diagnoses?  Absolutely.  But there also shouldn’t be fear-mongering related to the general practitioner as long as they are acting in concert with all the requisite mechanisms for protection.

[Heartofice]

47 minutes ago, Matrim Fox Cauthon said:

As others in this thread have pointed out, some of that political motivation by those weaponizing its findings involves an anti-trans ideology, ranging from those suspicious of trans-identities to those who are downright hostile to it. 

Maybe by some, but there is also a trend of just mischaracterising people's beliefs, especially when a lot of what people were objecting to was around protecting children. The other point to consider is that many of the things that Cass is criticising are due to ideological beliefs being placed ahead of scientific rigour. 

[Mr. Chatywin et al.]

Just consider opioids or something as simple as being prescribed a pill for ADHD (often times when it shouldn't be). Mistakes were obviously made in several instances, but the visceral reaction to medication for potential trans individuals is more hostile and tends to come from those without it actually impacting them in any way. 

[Mr. Chatywin et al.]

4 minutes ago, Heartofice said:

especially when a lot of what people were objecting to was around protecting children. 

Sure it is...