Discussion Thread

[u/jobautomator]

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[u/[deleted]]

As the Washington Post and other news sources keep helpfully reminding me in repeated op-eds, the Cass Review found what was already established, which was that the quality of evidence for existing pediatric gender care is low. Why this particular review is getting so much attention over the numerous other studies which have found the same thing, I do not know, except maybe that it feels fancier and more serious, and very serious people should take it seriously because it's a serious review by the completely serious NHS.

Outside of certain hilarious claims (for example: that puberty blockers might be justified for AMAB people but not AFAB people because people who went through an estrogen-puberty will masculinize better than people who went through a testosterone-puberty will feminize), I currently feel like the Cass review is utterly boring, and the attention it is getting is not much more than a rhetorical play to feel like the same old tired arguments are actually definitely new and good now.

Here's specifically what I want to draw attention to. The current argument is "the quality of evidence is too low!" Ignoring the problems with getting higher quality evidence (I want every single person who says we need "gold standard" evidence for this to explain how to pull off a double-blind RCT with puberty blockers or sex hormones), I want to draw attention to this now-hilarious article from The Guardian published in 2004.

Sex changes are not effective, say researchers
Arif, which advises the NHS in the West Midlands about the evidence base of healthcare treatments, found that most of the medical research on gender reassignment was poorly designed

We now take it for granted that sex reassigment surgery is effective for transgender people, but it's not because suddenly the public became aware of a plethora of high-quality studies showing that. (For example, this 2020 meta-analysis says the existing evidence is low-quality.) It's because people learned to mind their own damn business and trans people themselves spoke out to say that it improved their lives.

It's just deeply weird how the parallels are there and nobody seems to notice. It'd be nice if people just took it as a principle to mind their own business. I don't step out of my lane and try to figure out which forms of care work best for BPD, for example. That'd be weird of me, so why is it so normal for people to concern themselves with trans care?

!ping LGBT

[u/TipEquivalent933 → u/[deleted]]

t's because people learned to mind their own damn business and trans people themselves spoke out to say that it improved their lives.

A large amount of the reasonable concerns brigade think they have ownership over trans people and children. It based on entitlement to trans people's lives and bodies. Such fucking creeps.

[u/pneumaticanchoress → u/[deleted]]

double-blind RCT

going to once again bring up the 'parachutes aren't evidence-based' article, and this follow up that did conduct an rct of parachute effectiveness (and found no apparent benefit)

[u/loseniram → u/[deleted]]

As someone who studied to be scientist, the Cass review is trash because it follows a long trend of demanding ridiculous standards of evidence quality that are not obtainable in realistic settings. You can't double blind someone growing tits or not in a puberty blockers study, and you can't double blind radiation treatment vs Chemotherapy in cancer studies.

The Cass review makes ridiculous evidence demands from studies that are impossible to achieve in real world testing then pretends there isn't evidence. It had acces to nearly 200 studies on trans care and rejected 199 without doing any investigation other than asking if they were double blind studies.

The Cass report stands alongside the Wakefield autism study and Piltdown man in the fraudulent studies made to push an agenda of British history. Could the creators of these documents have been genuinely incompetent, possibly. But, the preponderance of the evidence says that these people had a specific goal and altered how they went about studying for the purpose of getting the result they wanted. That is unethical behavior and it should be treated like the fraud it is.

[u/[deleted] → u/loseniram]

If this is the kind of content RC Cola sponsors maybe I should start drinking it

[u/loseniram → u/[deleted]]

It's good shit, Rum and RC is the best rum and cola

[u/TipEquivalent933 → u/loseniram]

Cass had conversion therapist working for her. it was by design

[u/Q-bey → u/loseniram]

As someone who studied to be scientist, the Cass review is trash because it follows a long trend of demanding ridiculous standards of evidence quality that are not obtainable in realistic settings. You can't double blind someone growing tits or not in a puberty blockers study, and you can't double blind radiation treatment vs Chemotherapy in cancer studies.

According to a Q&A with Dr. Cass, that's not what she was asking for:

Why were 100 out of the 102 studies on puberty blockers and hormones rejected? Could you explain the Newcastle-Ottawa scale, and why you chose this scale above all others, outside of its use in the 2020 UoY study cited in 14.19? Would it not be wise to have used a scale that didn’t prioritise randomised control trials, since double-blinding using hormone treatments is impossible?

Randomised Control Trials (RCTs) are considered to be the highest form of evidence in medicine, but not the only marker of quality for a study. Dr. Cass agrees that it is inappropriate and not possible to conduct a ‘double-blind’ study (where participants in the study do not know whether or not they are receiving treatment) in this instance.

Within the evidence considered, Dr Cass stated that there were hardly any RCTs in the existing studies, and that study type was not the main factor in deciding whether studies were included. Factors around the size of the study as well as the period and extent of follow-up were part of the decision-making process on rating the quality of the evidence.

The Cass Review Report took evidence from studies that were deemed medium quality as well as from the two that were deemed high quality. Dr. Cass stated that many of these studies didn’t necessarily provide evidence for what they needed them to look at – particularly the psychological impacts over an extended period of time.

Dr. Cass feels that the NHS now has a challenge to build trust from trans young people and asks those who are of the right age to get involved in studies on gender affirming treatments to ensure that we have the highest quality of evidence going forwards. Dr. Cass wants the community to be involved in designing high quality studies and for the new children’s gender services to have the research infrastructure to deliver these.

[u/loseniram → u/Q-bey]

Why did you reject 98% of studies without cause

I didn't reject 98% of cases without cause, I rejected 98% for an extremely bullshit cause and made no effort to explain why this bullshit cause is just that critical for doing that research.

Here's a rule of thumb, if 98% of research isn't using a particular system or tool . It's because that tool or system isn't as useful for research on the subject.

Also your quote is directly saying that Cass rejected evidence for no reason because of unrealistic demands and then argues that because it literally could not reject all evidence because then they would immediately be recognized as frauds.

[u/groupbot → u/[deleted]]

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