It's a shame that two SRs, which sound like they would be near publication, may never get released. Even if the materials are handed over to SEGM, I don't think they could publish them in a manner consistent with what SRs are intended to prevent.
You can tell that the concern isn't actually about SEGM, because if the SRs had reached a different conclusion, if they had discerned that there was strong evidence for youth gender affirming care, the source of the funding would be no issue. It's only because the SRs come to the "wrong" conclusion that this partnership is being dissolved.
It looks like SEGM did everything right here, in contrast with WPATH. They had a question about the efficacy of care, they found independent researchers to synthesize the research, and then backed off. If only all "hate groups" were so well behaved.
I tried to be slightly vague about this in the article because there's a lot of uncertainty and folks who don't want to be IDed, but the sense I got is that it is more likely than not that they *will* be published, though not a guarantee.
What a mess. Dr. Guyatt is undermining a lifetime’s work by taking this position. Valuing autonomy over the other values would give a blessing to any patient wanting any quack medicine, including hazelwood necklaces and ivermectine for COVID. What is the use of EBM if it cannot help discard unproven treatments? And by "discard", I don’t mean "ban", but allow professionals to vigorously challenge widespread, unproven, and potentially dangerous treatments.
The only silver lining: the more SPLC and other organizations will push bats*** crazy stuff, the more they will discredit themselves, and youth gender medicine as well.
That study took place in Bangladesh. The ultimate takeaway with Ivermectin is that it did reduce duration of illness, but it was only in regions in which parasites are common. Because Ivermectin is a medication used for parasite-type-stuff (worm infections), it was treating the COVID patients comorbid worm infections, which made the patients much healthier and therefore able to recover from COVID sooner than those not treated with Ivermectin (and who also had a worm infection). So there was a real effect, but only because it is treating another issue that is happening simultaneously, so the effect is only seen in those regions of the world. It does not actually act on COVID.
Thanks -- I'd sort of forgotten the link to the worm issue and I'd only skimmed that article. But ICYMI, Scott Alexander at Astral Codex Ten had an exhaustive & exhausting summary of the topic:
Though not terribly impressed with him since he once included some transwomen in the women cohort of one of his surveys; was "indefinitely suspended" for taking him to task:
But I had been alluding to a different study that, if I remember correctly, had given some evidence of its use at higher dosage levels as an antiviral:
"Ivermectin is a specific inhibitor of importin α/β-mediated nuclear import able to inhibit replication of HIV-1 and dengue virus":
It seems to me it's well past time to deem the SPLC a hate group. I'm not joking. In their case, it is quite aggressive and gravely destructive to society. And it legitimately endangers its targets.
I think "making up lies to defame your enemy" is something the Klan would be pretty comfortable doing.
I think he is afraid to lose funding for GD treatments, so of course suddenly he is willing to provide care for a patient with low quality evidence.... weird, huh? It's a good thing he is in Canada were the Liberals are in power. He would get defunded in a heartbeat by the Trump administration!
"The high respect for autonomy becomes particularly important when the certainty of the evidence is low or very low."
Isn't that ass-backward? Shouldn't a medical professional actively discourage a patient from acting on very low-certainty information? Especially if there may be risks, even if we have low or very low certainty regarding both risks and benefits.
Particularly when the “certainty of evidence is low” only for the benefits of the treatment! The first order effects are not uncertain at all - puberty blockers are extremely good at blocking puberty. Mastectomy is nearly 100% effective in removing breast.
Would an evidence based doctor prescribe puberty blockers for precocious puberty if there was “low or very low” evidence that the patient was likely to successfully complete puberty at a later time, and be healthier than if they had continued their precocious puberty? Would that doctor recommend mastectomy to a cancer patient if there was “low or very low” evidence that the surgery would eliminate or at least substantially reduce their cancer? Would the patient’s stated desire based on something they read on the internet or heard from a friend be enough to override the lack of evidence in these cases?
Of course not. But if the condition is gender identity, suddenly “evidence based” turns immediately to “vibes based” lest the SPLC say mean things about you. Cowardly.
If it is low/very low it means you don't know how likely it is to help, so use your judgement/values.
But as you are saying, the missing piece is what else is going on. Whether it is likely to be beneficial in one way is not the whole thing one considers.
It's Benefits, Risks, Alternatives and doing Nothing.
The problem is that the risks are significant (health and psychological ones), the alternatives are less risky, and "doing Nothing" is not understood--it's not like diabetes where if you don't provide insulin, if you "do nothing," you know the person will die. They might in fact just grow out of their gender dysphoria, or have it resolve when they better understand themselves, their distress, get in a different place in their lives, etc.
If you just look at whether something might be beneficial in one way and it might be, and you totally ignore the risks, alternatives and doing nothing, I don't know what you call that.
I’ve been browsing this Substack for some time and teetering on whether to add another subscription to my list, and this article tipped the scale. Excellent work. If I remember correctly Dr Guyatt has made attempts to run politically for the NDP. When science and politics dance the politics often leads
"t is profoundly misguided to cast health care based on low-certainty evidence as bad care or as care driven by ideology, and low-certainty evidence as bad science. Many of the interventions we offer are based on low-certainty evidence, and enlightened individuals often legitimately and wisely choose such interventions. Thus, forbidding delivery of gender-affirming care and limiting medical management options on the basis of low certainty evidence is a clear violation of the principles of evidence-based shared decision-making and is unconscionable. The appropriate use of our work is in ensuring patients receive needed care and in helping TGD patients and their clinicians in decision-making."
Jesse if I'm not mistaken this is academic language for GOBSAT, right?
And also thank you for showing how far from its mission that the SPLC has strayed. I was a pretty faithful contributor when they actually fought real hate groups but now they have NO legitimacy about this issue. I just give a small contribution to the SEGM, hope they do good work! You don't need a weatherman to tell which way the wind blows, and you don't need an activist group to know the haters!
I can't believe that the SPLC doesn't know how DAFs work. One of the huge benefits of a DAF is that it allows donations to be laundered so that they are effectively anonymous - the gift comes from a faceless charitable giving organization and not the actual donor recommending the gift from their DAF. Sort of shocking they wouldn't know that "Fidelity Charitable Investments" is a collection of DAFs and not one ideologically motivated donor.
Great deep dive and I’m interested to read the interview in part 2. It always strikes me - and this is not exclusive to this area of medicine or science - that the scientific/medical self-policing idea is woefully misbegotten. If there was a time where self-regulation was sufficient (and I don’t think there was, really), the principles folks espoused were much more closely held than they are now. It’s a bummer.
"Oh no! Not my favorite next day delivery! This seems well outside of Jesse's wheelhouse, but I'm glad he gets to cover something other than- well, nevermind."
Speaking as a Canuck (not the Vancouver ones, though they too have their moments ...), as a Canadian ..., I'm rather "disconcerted" that an erstwhile reputable Canadian University should be bending the knee to transgender dogma. From their screed and my comment thereon in the LGBVoices Substack:
McMaster: "Members and allies of 2SLGBTQIA+ communities have raised concerns about recent systematic reviews related to gender-affirming care. These concerns center on the funding source, and specifically on the potential for the research to be misused to harm trans youth and to deny gender-affirming care."
Of course the intent is to "deny gender-affirming care", at least that is the more or less inescapable conclusion of that research. Though any reasonable analysis of the facts of the matter would justify the conclusion that such "gender-affirming care" is based on an absolutely monstrous premise: because some dysphoric and autistic children exhibit some behavioural and psychological traits more typical of the sex other than theirs, they should therefore have their genitalia mangled into some ersatz and Frankensteinian replicas typical of that other sex – “transmogrifing” and castrating them, and turning them into sexless eunuchs.
In the face of that "premise", what's really kind of astounding -- and a salient part of a medical scandal of the first water -- is that any research at all is required.
Even if the evidence were low or very low that they are a hate group, denying my ability to call them craven grifting hate-filled shit heels would be a violation of my autonomy.
I imagine them as a sort of tinkerbell flying around with a wand and saying in a falsetto, "you're a hate group, and you're a hate group, an you're a hate group, too" as the wand is waved and pixie dust comes out and stings the targets. Power corrupts.
What they are accusing others of doing, they are doing, so it's 100% fair. No laws have to be broken, but they have certainly attacked, maligned, or vilified entire categories of people for reasons of their identity (which would include their versions of "TERF," "conservative," etc.). If they want to change the meaning of "hate group" then they must endure having a mirror held up to their faces.
I can’t really blame Guyatt et al for succumbing to severe social pressure, but it is very disappointing.
On the other hand, SPLC’s behaviour is shockingly irresponsible and malicious.They are quickly destroying a reputation painstakingly established over decades.
Mr. Singal, thank you for this detailed, fair minded report. Unfortunately everything you said made me trust Academic reasearch results even less than I already did. Oh well, at least we still have Physics, for now.
It's a shame that two SRs, which sound like they would be near publication, may never get released. Even if the materials are handed over to SEGM, I don't think they could publish them in a manner consistent with what SRs are intended to prevent.
You can tell that the concern isn't actually about SEGM, because if the SRs had reached a different conclusion, if they had discerned that there was strong evidence for youth gender affirming care, the source of the funding would be no issue. It's only because the SRs come to the "wrong" conclusion that this partnership is being dissolved.
It looks like SEGM did everything right here, in contrast with WPATH. They had a question about the efficacy of care, they found independent researchers to synthesize the research, and then backed off. If only all "hate groups" were so well behaved.
I tried to be slightly vague about this in the article because there's a lot of uncertainty and folks who don't want to be IDed, but the sense I got is that it is more likely than not that they *will* be published, though not a guarantee.
What a mess. Dr. Guyatt is undermining a lifetime’s work by taking this position. Valuing autonomy over the other values would give a blessing to any patient wanting any quack medicine, including hazelwood necklaces and ivermectine for COVID. What is the use of EBM if it cannot help discard unproven treatments? And by "discard", I don’t mean "ban", but allow professionals to vigorously challenge widespread, unproven, and potentially dangerous treatments.
The only silver lining: the more SPLC and other organizations will push bats*** crazy stuff, the more they will discredit themselves, and youth gender medicine as well.
Yes I think they used to be pretty good but they are pushing crazy stuff and yet are entitled to call others haters.
> "... ivermectin for COVID ..."
Apparently has some beneficial effe to as an anti-viral, though the dosage levels may be "contraindicated":
"A five-day course of ivermectin for the treatment of COVID-19 may reduce the duration of illness"
https://pmc.ncbi.nlm.nih.gov/articles/PMC7709596/
That study took place in Bangladesh. The ultimate takeaway with Ivermectin is that it did reduce duration of illness, but it was only in regions in which parasites are common. Because Ivermectin is a medication used for parasite-type-stuff (worm infections), it was treating the COVID patients comorbid worm infections, which made the patients much healthier and therefore able to recover from COVID sooner than those not treated with Ivermectin (and who also had a worm infection). So there was a real effect, but only because it is treating another issue that is happening simultaneously, so the effect is only seen in those regions of the world. It does not actually act on COVID.
Thanks -- I'd sort of forgotten the link to the worm issue and I'd only skimmed that article. But ICYMI, Scott Alexander at Astral Codex Ten had an exhaustive & exhausting summary of the topic:
https://www.astralcodexten.com/p/ivermectin-much-more-than-you-wanted
Though not terribly impressed with him since he once included some transwomen in the women cohort of one of his surveys; was "indefinitely suspended" for taking him to task:
https://www.astralcodexten.com/p/x-fact-check-does-gender-integration/comment/49625356
https://www.astralcodexten.com/p/x-fact-check-does-gender-integration/comment/49666376
But I had been alluding to a different study that, if I remember correctly, had given some evidence of its use at higher dosage levels as an antiviral:
"Ivermectin is a specific inhibitor of importin α/β-mediated nuclear import able to inhibit replication of HIV-1 and dengue virus":
https://pmc.ncbi.nlm.nih.gov/articles/PMC3327999/
That one doesn't say anything about its use with Covid, though I seem to recollect having seen one that did that was along the same line.
It seems to me it's well past time to deem the SPLC a hate group. I'm not joking. In their case, it is quite aggressive and gravely destructive to society. And it legitimately endangers its targets.
I think "making up lies to defame your enemy" is something the Klan would be pretty comfortable doing.
As an alumna of McMaster I'm going to have to write an email to the president...
Good, that will make them put a "addressing misinformation some of our alumni have" post on their home page.
Please do! I wish I’d gone there so I could do the same!
Interesting that Guyatt forwarded you emails so you could find a "smoking gun" about SEGM that wasn't there.
Perhaps he was so flustered he didn't read the emails carefully? Whatever the reason, it doesn't reflect well on his capacity as a careful researcher.
I think he is afraid to lose funding for GD treatments, so of course suddenly he is willing to provide care for a patient with low quality evidence.... weird, huh? It's a good thing he is in Canada were the Liberals are in power. He would get defunded in a heartbeat by the Trump administration!
Whatever the motivation, reading Part II he appears craven and avoids straight answers to clear questions.
"The high respect for autonomy becomes particularly important when the certainty of the evidence is low or very low."
Isn't that ass-backward? Shouldn't a medical professional actively discourage a patient from acting on very low-certainty information? Especially if there may be risks, even if we have low or very low certainty regarding both risks and benefits.
Particularly when the “certainty of evidence is low” only for the benefits of the treatment! The first order effects are not uncertain at all - puberty blockers are extremely good at blocking puberty. Mastectomy is nearly 100% effective in removing breast.
Would an evidence based doctor prescribe puberty blockers for precocious puberty if there was “low or very low” evidence that the patient was likely to successfully complete puberty at a later time, and be healthier than if they had continued their precocious puberty? Would that doctor recommend mastectomy to a cancer patient if there was “low or very low” evidence that the surgery would eliminate or at least substantially reduce their cancer? Would the patient’s stated desire based on something they read on the internet or heard from a friend be enough to override the lack of evidence in these cases?
Of course not. But if the condition is gender identity, suddenly “evidence based” turns immediately to “vibes based” lest the SPLC say mean things about you. Cowardly.
If it is low/very low it means you don't know how likely it is to help, so use your judgement/values.
But as you are saying, the missing piece is what else is going on. Whether it is likely to be beneficial in one way is not the whole thing one considers.
It's Benefits, Risks, Alternatives and doing Nothing.
The problem is that the risks are significant (health and psychological ones), the alternatives are less risky, and "doing Nothing" is not understood--it's not like diabetes where if you don't provide insulin, if you "do nothing," you know the person will die. They might in fact just grow out of their gender dysphoria, or have it resolve when they better understand themselves, their distress, get in a different place in their lives, etc.
If you just look at whether something might be beneficial in one way and it might be, and you totally ignore the risks, alternatives and doing nothing, I don't know what you call that.
A "mistake."
yes...................
Has that real horse’s head on the bed feel about it, doesn’t it?
🙂 Something of a death-bed conversion?
I’ve been browsing this Substack for some time and teetering on whether to add another subscription to my list, and this article tipped the scale. Excellent work. If I remember correctly Dr Guyatt has made attempts to run politically for the NDP. When science and politics dance the politics often leads
"t is profoundly misguided to cast health care based on low-certainty evidence as bad care or as care driven by ideology, and low-certainty evidence as bad science. Many of the interventions we offer are based on low-certainty evidence, and enlightened individuals often legitimately and wisely choose such interventions. Thus, forbidding delivery of gender-affirming care and limiting medical management options on the basis of low certainty evidence is a clear violation of the principles of evidence-based shared decision-making and is unconscionable. The appropriate use of our work is in ensuring patients receive needed care and in helping TGD patients and their clinicians in decision-making."
Jesse if I'm not mistaken this is academic language for GOBSAT, right?
And also thank you for showing how far from its mission that the SPLC has strayed. I was a pretty faithful contributor when they actually fought real hate groups but now they have NO legitimacy about this issue. I just give a small contribution to the SEGM, hope they do good work! You don't need a weatherman to tell which way the wind blows, and you don't need an activist group to know the haters!
I can't believe that the SPLC doesn't know how DAFs work. One of the huge benefits of a DAF is that it allows donations to be laundered so that they are effectively anonymous - the gift comes from a faceless charitable giving organization and not the actual donor recommending the gift from their DAF. Sort of shocking they wouldn't know that "Fidelity Charitable Investments" is a collection of DAFs and not one ideologically motivated donor.
The big reason I like to use DAF is so that I don't end up punished by being spammed to death for the sin of donating to charity.
Great deep dive and I’m interested to read the interview in part 2. It always strikes me - and this is not exclusive to this area of medicine or science - that the scientific/medical self-policing idea is woefully misbegotten. If there was a time where self-regulation was sufficient (and I don’t think there was, really), the principles folks espoused were much more closely held than they are now. It’s a bummer.
Not gonna lie. I immediately clicked when I read the headline because I thought this was about the industrial supplier.
Me too!
"Oh no! Not my favorite next day delivery! This seems well outside of Jesse's wheelhouse, but I'm glad he gets to cover something other than- well, nevermind."
Ah yes, I remember the brouhaha over the First Lady's jacket that read "I REALLY DON'T CARR DO U?"
Speaking as a Canuck (not the Vancouver ones, though they too have their moments ...), as a Canadian ..., I'm rather "disconcerted" that an erstwhile reputable Canadian University should be bending the knee to transgender dogma. From their screed and my comment thereon in the LGBVoices Substack:
McMaster: "Members and allies of 2SLGBTQIA+ communities have raised concerns about recent systematic reviews related to gender-affirming care. These concerns center on the funding source, and specifically on the potential for the research to be misused to harm trans youth and to deny gender-affirming care."
https://hei.healthsci.mcmaster.ca/systematic-reviews-related-to-gender-affirming-care/
Of course the intent is to "deny gender-affirming care", at least that is the more or less inescapable conclusion of that research. Though any reasonable analysis of the facts of the matter would justify the conclusion that such "gender-affirming care" is based on an absolutely monstrous premise: because some dysphoric and autistic children exhibit some behavioural and psychological traits more typical of the sex other than theirs, they should therefore have their genitalia mangled into some ersatz and Frankensteinian replicas typical of that other sex – “transmogrifing” and castrating them, and turning them into sexless eunuchs.
In the face of that "premise", what's really kind of astounding -- and a salient part of a medical scandal of the first water -- is that any research at all is required.
https://lgbausa.substack.com/p/gender-id-koed-by-world-boxing-dreaded/comment/149172956
Afterca careful review of the evidence, I have concluded that the SPLC is a hate group. BOOM. TAKE THAT. Now it is completely delegitimized.
Even if the evidence were low or very low that they are a hate group, denying my ability to call them craven grifting hate-filled shit heels would be a violation of my autonomy.
I said the same thing! We need to start a campaign. I wish I had money for a billboard.
I imagine them as a sort of tinkerbell flying around with a wand and saying in a falsetto, "you're a hate group, and you're a hate group, an you're a hate group, too" as the wand is waved and pixie dust comes out and stings the targets. Power corrupts.
What they are accusing others of doing, they are doing, so it's 100% fair. No laws have to be broken, but they have certainly attacked, maligned, or vilified entire categories of people for reasons of their identity (which would include their versions of "TERF," "conservative," etc.). If they want to change the meaning of "hate group" then they must endure having a mirror held up to their faces.
I would gladly contribute to a SEGM crowdfund to pay for a defamation lawsuit against the SPLC. No: *gleefully*.
This couldn't possibly work in America, not for a fuzzy accusation such as that of being a "hate group".
I can’t really blame Guyatt et al for succumbing to severe social pressure, but it is very disappointing.
On the other hand, SPLC’s behaviour is shockingly irresponsible and malicious.They are quickly destroying a reputation painstakingly established over decades.
Mr. Singal, thank you for this detailed, fair minded report. Unfortunately everything you said made me trust Academic reasearch results even less than I already did. Oh well, at least we still have Physics, for now.