World Professional Association for Transgender Health (WPATH) Files

carveone

Jaysus that was long. What am I like!

AllForIt

https://www.boards.ie/discussion/comment/122104242#Comment_122104242

We're used to that round here, at least you didn't give us any homework.

plodder

https://www.boards.ie/discussion/comment/122103451#Comment_122103451

The public healthcare system would grind to a halt in the morning if the equivalent of the Cass Review were applied

What you are doing here is one of two things: either calling into question the entire evidence base for public healthcare, or else casting doubt on systematic reviews such as what Cass has done.

So, which is it?

One eyed Jack

https://www.boards.ie/discussion/comment/122105059#Comment_122105059

What I will do is not allow you to present what I said out of context. This should answer your question:

The public healthcare system would grind to a halt in the morning if the equivalent of the Cass Review were applied to all areas in medicine:

Conclusion

Using rigorous methods for judging quality of evidence, more than 9 in 10 healthcare interventions studied within Cochrane Reviews do not have high-quality evidence to support their effectiveness and safety. This problem can be remedied by high-quality studies in priority areas. These studies should measure harms as rigorously as benefits. Practitioners and the public should be aware that most frequently used interventions are not supported by high-quality evidence… 

https://www.sciencedirect.com/science/article/abs/pii/S0895435622001007

Bold emphasis my own.

Ten of Swords

@faircitywok threadbanned

plodder

https://www.boards.ie/discussion/comment/122105223#Comment_122105223

Your assertion isn't supported by the conclusion you quoted. All the conclusion is saying is that more research is needed to provide more high quality evidence*. But, you are implying that if the studies were done, it would find the treatments to be ineffective "The public healthcare system would grind to a halt". The paragraph you quoted isn't pre-supposing what the outcome would be at all.

That's a kind of appeal to ignorance - basically arguing that the healthcare system would collapse due to the (alleged) absence of evidence of the effectiveness and safety of interventions.

"*" Though this point is debatable, since new drugs/treatments have to undergo randomised clinical trials which do provide high quality evidence of efficacy and safety at least.

volchitsa

https://www.boards.ie/discussion/comment/122111553#Comment_122111553

There’s another equally fundamental problem with Jack’s conclusion: contrary to the misrepresentation of the Cass report by TRAs, the “90% not high quality” did not mean that 90% were rejected by Cass. The BBC “More or less” broadcast looked into that claim and found it was simply untrue.

High and moderate quality studies - about 58%, from memory - were included in the Cass report, so that’s what you’d need to compare it with. Only the very lowest quality studies (a significant number all the same) were rejected.

So about 42% of the transgender studies were of too poor quality to be included. Not 90+%.
Is there any information about that level of inclusion for the Cochrane reviews?

Here’s the link if anyone wants to check for themselves: https://www.bbc.co.uk/sounds/play/w3ct5tpy

concerned_tenant

https://www.boards.ie/discussion/comment/122115626#Comment_122115626

What I have established from the most vocal critics of the Cass Report is that they have absolutely no understanding how rigorous academic and clinical research / methodology is conducted.

It's actually embarrassing how they speak with the highest confidence about something which they have next to no knowledge or experience of — yet the feel that their proclamations, and that's exactly what they are, are somehow sufficient to dismiss the work of a world-renowned paediatrician and researcher in this area.

One eyed Jack

https://www.boards.ie/discussion/comment/122111553#Comment_122111553

I’m not implying that if the studies were done, that they would find the treatments to be ineffective. The conclusion is saying that of the studies that have been done, contained within in the Cochrane library, the evidence to support their effectiveness and safety in 90% of them is not high quality. That’s where the recommendation to address the issue of the lack of high quality evidence in the studies comes from:

Using rigorous methods for judging quality of evidence, more than 9 in 10 healthcare interventions studied within Cochrane Reviews do not have high-quality evidence to support their effectiveness and safety.

What I’m saying is that if the same rigorous evaluation as the Cass Review were carried out in all areas of medicine, the public health system would grind to a halt, because the evidence to support the effectiveness and safety of the treatments is not of high quality. That’s why the Cass Review recommended going back to square one as it were - in order to establish a high quality evidence base for any treatment of children presenting with gender dysphoria in clinical settings.

That’s why Cass is of the opinion that young people have been let down - because they have, because up to now clinicians appear to have gone with the idea of “this works because we can see it works”, and without the follow-up data from the adult clinics (y’know, what I earlier suggested were akin to “dog ate my homework” excuses for not providing the data), that leaves no room for manoeuvring like trying to keep the clinics open and carrying on as before while also waiting for the long-term outcomes of clinical trials! The waiting list would only become increasingly unsustainable. As it is, the idea of holistic regional centres is one of the recommendations the NHS appears to be pursuing, but as noted by Cass - the NHS has a job on its hands to gain young people’s trust and confidence. I’d say the NHS has an even bigger challenge, and that is to gain the trust and confidence of young people’s parents.

That’s why I’m more concerned with the review by the Mental Health Commission of CAMHS than I am with one individual and a newspaper article that amounts to nothing more than a pity party for her. Because if the HSE takes the same route as the NHS, it will likely be CAMHS who will be providing holistic support services in Ireland at a national level.

https://www.boards.ie/discussion/comment/122115626#Comment_122115626

The problem you point out isn’t anything to do with any conclusion I’ve made. I’m not responsible for, and have no wish to be associated with anyone misrepresenting the Cass Review for their own ends.

Is there any information about that level of inclusion for the Cochrane reviews?

There is, in the reviews themselves, a whole library of them:

https://www.cochranelibrary.com

volchitsa

https://www.boards.ie/discussion/comment/122115825#Comment_122115825

That doesn’t answer my question: you made a claim which is easily shown to have been based on an apples/oranges comparison.

IF you can provide more comparable data, then by all means post it up. Telling someone else to wade through pages and pages of info searching for better data than you provided is a bit much.

Podge_irl

https://www.boards.ie/discussion/comment/122115825#Comment_122115825

What I’m saying is that if the same rigorous evaluation as the Cass Review were carried out in all areas of medicine, the public health system would grind to a halt, because the evidence to support the effectiveness and safety of the treatments is not of high quality.

What on earth are you basing this wildly outlandish claim on?

concerned_tenant

https://www.boards.ie/discussion/comment/122116497#Comment_122116497

The worst part of what you quoted is that even if that contention were true, it still wouldn't invalidate the Cass Report's findings.

But I don't believe that the contention made was sincere. But it has nonetheless garnered the response intended.

One eyed Jack

https://www.boards.ie/discussion/comment/122116483#Comment_122116483

It does answer your question. How else would you suggest the level of information included in the reviews could be compared or determined without actually reviewing the reviews that are being referred to? I don’t suggest you do anything, I was just providing an answer to the question you posed.

https://www.boards.ie/discussion/comment/122116497#Comment_122116497

Wildly outlandish? That’s definitely a matter of perspective, but anyways, I’m basing it on research like this:

https://www.sciencedirect.com/science/article/abs/pii/S0895435622001007

And this:

https://www.nature.com/articles/s41416-022-02038-4

It would cause considerable consternation if the public healthcare system had to restrict services while they awaited the long-term outcomes of clinical trials which were instituted with the intent of improving healthcare services provided to the public by the national healthcare services provider.

One eyed Jack

https://www.boards.ie/discussion/comment/122116562#Comment_122116562

It’s not intended to invalidate the findings of the Cass Review? It was in response to the suggestion that  the reality is that the majority of posters here are actually looking to improve healthcare for trans people from the current incredibly low standard to the standard that is deemed acceptable in all other aspects of healthcare.

The standard of healthcare deemed acceptable in all other aspects of healthcare is equally low, is the point that I was making. It’s what’s causing people to seek out alternatives, and that’s definitely not a good thing:

https://amp.theguardian.com/society/article/2024/may/03/cross-sex-hormones-available-online-11-pounds-a-month-young-people-gender-identity

volchitsa

https://www.boards.ie/discussion/comment/122116565#Comment_122116565

It's an outlandish claim because the link you provided does not in the least suggest that "if the same rigorous evaluation as the Cass Review were carried out in all areas of medicine, the public health system would grind to a halt, because the evidence to support the effectiveness and safety of the treatments is not of high quality."

I see that the link discussing that study about the Cochrane reviews also gives another reason why the claim above is untrue: it's because the vast majority of the studies based on poor evidence are in fact alternative medicine, and that of studies into pharmacological/drug treatments, 78% are of high quality.

https://edzardernst.com/2022/06/most-healthcare-interventions-tested-in-cochrane-reviews-are-not-supported-by-high-quality-evidence/

So in fact the overall average is brought down by attempts to provide scientific studies supporting various alternative medicines, which, unsurprisinglhy, are of poor quality. As are those supporting so-called transgender healthcare.

One eyed Jack

https://www.boards.ie/discussion/comment/122116877#Comment_122116877

I think you may find the tables in the review more useful than a blog which is more interested in taking a dump on homeopathic nonsense and claims of its efficacy in the treatment of cancer (that’s not the least bit interesting):

https://boris.unibe.ch/169432/1/1-s2.0-S0895435622001007-main.pdf

If I were solely interested in promoting pharmacological interventions in the treatment of gender dysphoria, I too might want to take a dump on the recommendations in the Cass Review. But I don’t, and I don’t think you should be using that blog as a source for much either tbh; bog roll maybe, and even then only in a pinch.

concerned_tenant

It's worth noting the abject silence that has evolved since the Cass Report was released.

More and more people have come to accept the report's findings, even those who previously held unjust sceptical views (based on misinformation released online). They don't claim public support for the report for fear of a legitimate backlash, so they remain silent and forget they were ever involved in the movement at all.

Apart from some anti-scientific cranks on social media, everybody else has accepted the report's findings.

There isn't some widespread debate within scientific and medical circles, and that — in the end — is what matters.

volchitsa

https://www.boards.ie/discussion/comment/122117046#Comment_122117046

I took a single piece of information from it. If that’s incorrect, please don’t hesitate to correct it. With a link of course.

Otherwise I’m going to continue to assume that over 3/4 of the drug-based studies were of high quality and that it was mainly the homeopathic studies (0% of good quality) and similar that brought that average right down.

plodder

https://www.boards.ie/discussion/comment/122117765#Comment_122117765

I did a search on the Cochrane Library for reviews with COVID in the title. 98 results came back and here is a sample of three interesting ones together:

The first and the third reviews found little evidence to support the interventions. The second had very high quality evidence in favour. None of the three are all that surprising. But what does it signify that two out of the three had little evidence to support the intervention? Nothing at all is the answer. Even if I checked the conclusion of all 98 reviews what general conclusion could I draw from that about interventions for Covid 19? Nothing at all. Each review is standalone and trying to aggregate them tells us nothing. Same as OEJ's statistic about 9 in 10 of all Cochrane reviews showing little evidence to support the intervention. It tells us nothing. Maybe most of the 90% were like the Ivermectin and Chloroquine quack cures for Covid. Who knows, and why would anyone care? It's an obvious misuse of statistics

One eyed Jack

https://www.boards.ie/discussion/comment/122117765#Comment_122117765

I took a single piece of information from it.

Yeah that was kinda the problem, which is why I provided a link to the review in its entirety for your review. Having already provided you with a link to the entire review, and you’re now telling me you will continue to assume what you had assumed already, I’m thinking more power to you, work away sure 👍

One eyed Jack

https://www.boards.ie/discussion/comment/122118216#Comment_122118216

Same as OEJ's statistic about 9 in 10 of all Cochrane reviews showing little evidence to support the intervention.

That’s not MY statistic, nor is it even representative of the statistic you’re attempting to attribute to me:

https://boris.unibe.ch/169432/1/1-s2.0-S0895435622001007-main.pdf

plodder

You're the one quoting it to support the theory that the healthcare system would collapse if Cochrane reviews were applied across the board. That's your assertion - nobody else's.

One eyed Jack

https://www.boards.ie/discussion/comment/122118370#Comment_122118370

It is, and it would be great if you didn’t continuously misrepresent what I was suggesting, but I can’t see that happening any time soon either, not least when you’ve done the same as volchista has done and in spite of being provided with the source, you figure that hand-picking three studies out of thousands, proves that I’m misrepresenting statistics.

That’s why I provided you with the methodology, so you could review it for yourself. They didn’t just limit themselves to cancer, they have a whole A to Z of conditions, listed alphabetically, and their corresponding interventions, and three tables worth of observations about the quality of the studies, assessing the quality of evidence of the intervention effects to the quality of evidence of the intervention harms, similar to the way the Cass Review reviewed the quality of the evidence related to hormone treatments, and the quality of the evidence of harm.

One of the limitations in the review I provided is that they acknowledge the GRADE standard could be too demanding, it was one of the reasons I suggested the Cass Review review wasn’t demanding enough - they would have had to exclude far more studies that wouldn’t have met much more stringent standards. Personally, I don’t see that as a limitation, I expect high standards in medicine.

If however, the recommendations of the Cass Review, which remember there was plenty of cries of victory and vindication when the interim report was published and the Tavistock closed, were to be instituted on the basis of the lack of high quality evidence and they had to go back to square one in order to establish a high quality evidence base for all treatments, I don’t see how it’s possible that they could continue to operate without significant disruption which would mean services would grind to a halt.

It’s fairly basic stuff - going back to square one in order to establish a high quality evidence base from scratch. That way medicine improves, and we don’t have to rely on anecdotal evidence of either good or bad outcomes that people are seeing with their own eyes or experiencing, when the highest quality evidence for any intervention exists independently of anyone’s biased views. That would cost horseloads of public funds though, far beyond the budget of many public health services providers.

plodder

https://www.boards.ie/discussion/comment/122118563#Comment_122118563

I'm not misrepresenting you. You've made a fairly outlandish claim, and it's up to you to provide evidence in support of it, much more than links to studies that at first glance seem to be saying something similar (but really aren't). Myself and another poster have raised a reasonable question that you haven't addressed at all - namely that you can't read anything into the numbers of studies in Cochrane reviews and simply tot up whether they support the given claim or not, and then read anything into that figure. The onus is on you (the person making the outlandish claim) to refute that. You haven't done this. So, this is my last post on the question. Have a nice day!

One eyed Jack

https://www.boards.ie/discussion/comment/122118994#Comment_122118994

Myself and another poster have raised a reasonable question that you haven't addressed at all - namely that you can't read anything into the numbers of studies in Cochrane reviews and simply tot up whether they support the given claim or not, and then read anything into that figure.

That’s not what I’ve done, it’s what volchista has done based upon the assessment of one set of studies in relation to cancer treatments (that’s where the 78% came from), which has no bearing on the quality of evidence for all the rest of the A to Z of conditions and treatments - they were all assessed separately and pharmacological interventions in the treatment of cancer has no bearing on pharmacological interventions in the treatment of cystic fibrosis for example.

All you’ve actually managed to demonstrate is that evidence, regardless of whether it is of high or low quality, never mattered to you in the first place; the only way it could matter is if it supports your already held beliefs, and that’s why it was “astonishing” that a single individual’s anecdotes in relation to the proposed legislation to ban conversion therapy carried more weight than the Mental Health Commission review of the services provided by CAHMS that concluded they couldn’t currently provide parents with an assurance that their children have access to a safe, evidence-based mental health service.

You did the same with the newspaper article published in the Irish Times that claimed that Catholic schools could be forced to teach children something they absolutely could not, because of the protection afforded to religion in the Irish Constitution. Even when I provided you with evidence that they were involved in the consultation process about the curriculum, you still deferred to suggesting the article was correct.

I don’t particularly care one way or another whatever you believe, I’ve always maintained I was more interested in policies than politics, and to that end it’s clear where Government priorities in England are at - it’s certainly not in improving the public healthcare system in the interests of the public. They’re infinitely more interested in making life difficult as possible for the 1% of the population, which has the actual effect of making life that much more difficult for everyone. Their latest proposed effort is an example of how they mean to continue (until at least they’re fcuked out of Government at the next election):

https://www.theguardian.com/uk-news/article/2024/may/06/gender-specific-toilets-to-be-required-in-non-residential-buildings-in-england

Large bottle small glass

2016 I had a bone spur on my hand, which only caused issue during 12h plus bike rides and 8h plus labtop days. As both were circa 1/month consultant said best not to proceed with operation. Either way he showed me the data on success with similar operations and his own internal data. Combining data and my personal circumstances I decided against procedure.

2016 anxiety was higher than I like so I sat down with a psychologist and went through the data on CBT and it's success rates.

2019 discovered I had an umbilical hernia and again sat down with surgeon went through available public data and his own experience before making a decision.

1985- present day I have had stitches for wounds perhaps 30-40 times, fractures on fingers, nose etc. I never had a doubt nor did parents as to likely efficacy of any treatment given.

In 2014 my wife had cancer and 2021 needed a new hip. On both occasions she and I were able to interview surgeon/oncologist as to best treatments and reasons for making given decision.

2021-2022 we had oodles of data in terms of whether to take a vaccine or not.

2018-present I have had data driven discussion with cardiologist as to whether I should take BP medication or not. Ditto with cholesterol medication.

I have a mother who is 90 in September who has needed guidance with major and varied medical decisions for last 20 years. Most of the time decision was based on good data.

To equate my typical experience with the abysmal "care" for trans youth is a couple of steps below disingenuous.

One eyed Jack

https://www.boards.ie/discussion/comment/122119688#Comment_122119688

To equate my typical experience with the abysmal "care" for trans youth is a couple of steps below disingenuous.

It certainly would be, if anyone had attempted to do that, not least because they have no prior knowledge of yours or your family’s medical history, but because the only way a reasonable comparison could be made between individuals experience of healthcare is if they were both transgender, and not. You would likely have had a very different experience if you were transgender, but none of what you’ve described above is predicated upon your identity. A person who is transgender would likely receive the same treatment for the same conditions, for the same reasons, and they too would have the same rights as a patient as you do to exercise informed consent, as you did.

No, I would suggest taking a much broader view than your own individual experience and that of your family members, though being careful not to come out with statements like you did earlier declaring that we’re letting down our children, at which point I suggested you speak for yourself. I think you’d be very much in the minority of parents who feel they have let down their children, and other people’s children are not yours or my responsibility. There wasn’t so much as a peep out of you when I pointed out that children’s mental health services in this country are sub-standard, and that’s at a national level, no need to compare it to your individual experience at all.

The HSE generally speaking just isn’t capable of providing high standards of quality service, and that doesn’t need to be measured subjectively, it’s far easier to measure objectively. Take for example their performance in relation to providing high quality standards of care for children experiencing chronic eating disorders. I only remember it vividly because volchista mentioned at the time that there was no attention around anorexia in young girls (about two weeks ago), and later that week there was a Prime Time special on that very issue:

https://www.rte.ie/news/primetime/2024/0425/1445753-no-plan-for-20-promised-eating-disorder-beds-to-open/#:~:text=By%20Prime%20Time,with%20Responsibility%20for%20Mental%20Health.

Although things have improved in the last 20 years, like when the heel prick test became standard practice for newborns, it caught diagnoses of CF in girls much earlier than previously detected. There were a couple of reasons for that gender disparity:

http://archive.imj.ie/ViewArticleDetails.aspx?ArticleID=2497

https://www.nature.com/articles/s41431-020-0661-5

Treatments have come a long, long way in that time, but there is still much more needs to be accomplished in other areas of healthcare before I would agree with you that the standard of healthcare available to children who are not transgender is any better than the standard of healthcare available to children who are transgender, because in and of itself - being transgender does not require any medical or clinical intervention.

volchitsa

https://www.boards.ie/discussion/comment/122119343#Comment_122119343

it’s what volchista has done 

LOL

No I didn't.

And it's VolchiTSa.

cdeb

The British Secretary for State for Education, Gillian Keegan, has spoken about proposed updates to sex ed in British schools, one of which is that gender identity and gender spectrum is not to be taught at any age. Referencing the Cass Report, she says "Teachers are there to teach children facts, not push the agendas of campaign groups" and that parents must be clear on what their children are being taught, saying it is "completely unacceptable" for curriculum providers to be seeking to hide material from parents. (How on earth did this start happening?!)

The summary is that teaching in this area should be done "on a factual basis, at an appropriate age, and not based on contested ideology" (Quotes from the speech to Parliament here)

And like - duh. How any of this needs reiterating is amazing. But at least it seems the tide is still turning in this regard.

concerned_tenant

https://www.boards.ie/discussion/comment/122152551#Comment_122152551

It's fantastic news; and another blow against this extreme ideology.

My concern is that many activists, particularly on social media, now openly talk about the need to "be suffragettes" i.e. implying the need to use disturbance, which may include the justification of violence. We also saw the widespread support of Sarah Jane Baker, who was arrested after saying to widespread applause that, "if you see a TERF, punch them in the f***ing face". Baker was subsequently referred to by activists as a political prisoner.

We already saw that Cass herself was advised not to use public transport due to these risks of violence.

I strongly suspect, though I hope I'm wrong, that a tiny minority of extremist activists will resort to some kind of violence the more that the government rolls back on their activist agenda.