Category: medicine and health

Doctors Without Borders Accused of violating its own policy of political neutrality to impugn Israel, and my cessation of donations

July 21, 2024 • 9:40 am

A while back I was a big fan of Doctors without Borders (or “MSF”, for “Médecins Sans Frontières”).  It was put in my will to get a big bequest, and when I auctioned of a copy of Why Evolution is True, autographed by many famous scientists and nonbelievers, and illustrated and illuminated by Kelly Houle, every penny of the $10,000+ we got on eBay went to MSF.

Then I heard that the organization was anti-Israel (this was well before October 7 of last year). Checking up on the Internet, I found some confirmation of that claim, including several reports that MSF refused to cooperate with Israeli medical teams working in the same location. This, from the article below, may be what I remember (Rossin is named as “secretary general of MSF in the 1970s”)

Rossin recalled his experience in 2010 on a mission to Uganda when an MSF Holland contingent refused to interact with a fellow Israeli medical NGO team dispatched to help. Rossin remembered it as an episode of “one-way empathy,” where prejudice had poisoned the MSF team’s ability to cooperate with Israel in their shared goal of helping civilians.

(See also here, though MSF denies all these allegations.)

I subsequently wrote MSF asking them if they ever used Israeli doctors in their relief efforts.  I got no reply, even though in the letter I told them I was a donor. Their ignoring me after the dosh I’d given them was, well, uncharitable.

Now I can’t really criticize MSF’s humanitarian efforts: they’ve done a great deal of wonderful medical work during crises all over the world.  No, here I’m pointing out an article in Canada’s National Post that documents a pervasive anti-Israel—a former MSF secretary calls it “antisemitic”—attitude on the part of the organization, an attitude reflected in its refusal to criticize Hamas for the terrorist’s group own blocking or hijacking medical aid and turning Gaza hospitals into terror centers.  In the piece below, quite a few former directors and employees of MSF, not to mention donors, weigh in criticizing the organization on this account.

My own decision, based on what I’ve read over the years, is to stop donating to MSF, and I’ve taken them out of my will, replacing them with other humanitarian organizations (and that is a fair amount of dosh!).  Read the article below for yourself (click on the headline) and decide if you want to support them.  The article is free, and you can also find it archived here.

I’ll simply give a number of quotes from the article. According to its charter, MSF is supposed to be politically neutral and impartial, but former executives, donors, and employees say that when it comes to Israel, that’s not the case.

Former leaders and a major Canadian donor of Doctors Without Borders are distancing themselves from the venerable aid organization after its employees celebrated the October 7 atrocities, gave aid to the Hamas-run Ministry of Health, ran a one-sided social media feed and internally circulated articles accusing Israel of creating Palestinian “death worlds.”

“To be frank, I was very, very, surprised because it’s not the MSF I knew,” Alain Destexhe, the secretary general of the organization, popularly known by its French acronym MSF, from 1991 to 1995, told National Post.

Destexhe said MSF’s messaging throughout the Israel-Hamas war is markedly different than past conflicts.

“We used to make statements, you know, in Bosnia and Rwanda, but not taking sides like this,” he said. “We always took into account the political context, but not to take sides from one group to another. In the Gaza War, I really got the feeling that MSF was totally biased.”

From a donor:

Destexhe wasn’t the only MSF loyalist to have an October 7 wake-up call. One major Canadian Jewish donor told the Post he urged his mother to support the group despite pushback from family members cautioning him against MSF’s reputation of being institutionally biased against Israel.

“I think most people know that they have a history of not being the friendliest towards Israel,” the philanthropist, who spoke on the condition of anonymity, told the Post.

He said he reassured his mother, following conversations with MSF Canada’s leadership, that the organization was duty-bound to be apolitical and strictly adhere to its mission of providing aid and observation. However, the inconsistencies between their initial promise and their treatment of Israel reached a boiling point in November 2023 when the patron confronted MSF Canada’s executives.

“I will be honest,” the donor told then-executive director Joe Belliveau in an email shared with the Post, “the more I review MSF public communications (Instagram, specifically), the evidence is overwhelming that the MSF stance has a pronounced bias. There is still not one single mention of the 200+ civilian hostages; not one mention of Hamas’ indiscriminate rocket fire into civilian centers, both of which are war crimes and violations of the Geneva conventions,” he wrote in late November.

. . . and a former MSF executive:

The donor’s November 2023 email rattled Byron Sonberg, who’d proudly served as MSF Canada’s treasurer for two years. He’d begun to sense the organization straying from its principle of impartiality, especially after he was copied on the donor’s email chain expressing growing frustration with the group. But the final straw came in mid-February 2024 when he, and hundreds of MSF global leaders, were forwarded an article: “Israeli necropolitics and the pursuit of health justice in Palestine.” [JAC: I found some of that article here; just read the “summary box”]

It was shared by Ruby Gill, president of MSF Canada’s board of directors, to provide “more insight” into the ongoing conflict. It argued that “framing Palestinian violence on October 7 as provocation and Israeli violence as response is ahistoric and indicates indifference to the everyday violence experienced by Palestinians.”

In other words, Israel “had it coming” on October 7. And the article was apparently sent out by MSF!  More:

Hamas receives a single passing reference in the piece, while Israel is cited nearly eighty times to bolster the claim that the Jewish State’s military response is unjustifiable. It accuses Israel of creating “death worlds” for Palestinians. The ideas expressed in the article, and the silence of MSF’s leadership, disturbed Sonberg, a self-described political moderate.

This concentration on Israel and complete neglect of Hamas is distressing in light of the fact that Hamas repeatedly impedes medical efforts in Gaza, including highjacking medical supplies, turning hospitals into terror bases, and even shooting Gazan civilians.

From another former MSM executive:

Richard Rossin, who served as secretary general of MSF in the 1970s and later co-founded Médecins du Monde (Doctors of the World), said that he perceived a tone shift within the organization several decades ago.

“I think it was perceptible around the beginning of the ‘80s,” Rossin told the Post by phone from his home in southern Israel. Antisemitism within MSF “began under the cover of anti-Zionism.”

See the quote from Rossin in the opening paragraphs.

One of the most distressing parts of this narrative is that MSF blamed Israel for the attack on the al-Ahli Hospital on October 17 of last year, an “attack” that did not involved Israel at all, but came from a misfired rocket from Palestinian Islamic Jihad that landed in the hospital’s parking lot, with the casualties greatly exaggerated by Hamas. MSF never retracted its accusation, which has been abandoned by everyone familiar with the evidence, including the Associated Press (no fan of Israel), which summarizes the evidence. (there’s also a telling conversation between two Hamas operatives saying the rocket was “from us).

By comparison, after the al-Ahli Hospital blast on Oct. 17, 2023, MSF rushed to blame Israel.

“We are horrified by the recent Israeli bombing of Ahli Arab Hospital in #Gaza City, which was treating patients and hosting displaced Gazans. Hundreds of people have reportedly been killed. This is a massacre. It is absolutely unacceptable,” MSF International wrote on X on the day of the explosion.

Although the blast was the result of a misfired rocket from Gaza, likely launched by a Palestinian group, MSF never corrected the record. The post, as well as several Instagram posts published by major chapters — including Spain, Canada, Brazil, and France – remain active. No apology or correction has been issued.

To a scientist, refusal to retract an accusation like this is shameful. But that’s MSF. Here’s their tweet, still up on X, but with “context corrections”:

More:

After Hamas invaded and killed over a thousand people, MSF did not release a single post addressing the worst killing of Jews since the Holocaust and it has not called for the return of kidnapped Israelis. Five days after the terrorist attack, the group issued a statement drawing a moral equivalence between Hamas and Israel. [JAC note: I think the link is meant to go to the MSF “X” feed, not to just one post.)

“We are horrified by the brutal mass killing of civilians perpetrated by Hamas, and by the massive attacks on #Gaza now being pursued by Israel,” MSF International wrote on Oct. 12. The remainder of the thread denounced Israel for “indiscriminate violence and the collective punishment of Gaza.” Two days later, the group called on Israel to “show humanity.”

The tone set by MSF International trickled down to its chapters across the globe.

By Oct. 17, MSF Canada wrote, “unconditional humanity needs to be restored in Gaza,” calling Israel’s response “unimaginable” and “inhumane.” The statement made no reference to Hamas or their invasion, which ignited hostilities.Before October 7, several nations facing humanitarian issues were highlighted in MSF Canada’s social feeds – including Malawi, Venezuela, Sudan, Haiti and Burkina Faso – but its coverage following the Hamas attack veered near-exclusively to covering Israel. At one point, in early November 2023, MSF Canada’s Instagram account was blanketed with six red-bolded calls for an immediate ceasefire, something not previously done as part of its advocacy for Sudan or Ukraine.

No calls on Hamas to “show humanity,” not just towards Israel but to civilian Gazans?

Despite the fact that the Gaza Ministry of Health, run by Hamas, is known to exaggerate death tolls, which have been revised strongly downward by even the UN, MSF continued to use them. Another comment from MSF’s former secretary-general:

MSF’s relationship with the Hamas-run Ministry of Health was another major reason why Destexhe lost faith. Their failure to admit “health facilities (are) being used by Hamas and by soldiers,” he told the Post, left him “really sad, and then I became angry.”

More:

MSF International’s Instagram page was comparatively muted in February 2022 following the Russian invasion of Ukraine, calling the situation “extremely worrying.” Within a month, the organization’s focus had quickly shifted to Libyan refugees, midwives in South Sudan, and social workers in the Palestinian Territories.

The messaging inequality was studied by Gerald Steinberg, founder and leader of NGO Monitor, a watchdog organization based in Jerusalem, who combed through MSF’s X feed. He found over a hundred tweets between the Hamas invasion and late November, “not one (solely) mentions Israeli victims.” There were five instances when Israelis were mentioned, but always alongside Palestinians.

Steinberg has grown accustomed to this discrepancy. “MSF is both a humanitarian and advocacy organization, and on Israel and the Palestinians, the partisan dimension is dominant and destructive,” Steinberg told the Post by email. He recalled the group showing similar favouritism during an earlier flare-up in 2009.

Finally, there are further claims in the article that a sizable percentage (a third) of MSF staffers celebrated the October 7 massacre, that some MSF employees have been linked to terror groups, and that MSF had donated to Gaza’s Ministry of Health but refused to respond when asked how MSF ensured that medical supplies weren’t getting hijacked by Hamas.

And a final comment by another former secretary general of MSF:

Rossin, a former secretary general who predated Destexhe, remains pessimistic that MSF can take a more balanced approach to Israel and Gaza moving forward.

“It cannot be fixed,” he said, exasperated. “How can you fix antisemitism, which is not an opinion but a mental disease?”

Although I long ago decided to give no more money to MSF, but divert it to organizations that have a “more balanced approach”, readers may wish to have a look at this article.  I was angered by MSF’s failure to even respond to my email about Israel, despite Kelly Houle and I having given them a substantial lump of money. (I haven’t asked Kelly for her opinion on this article.)

If you’re looking for reputable organizations that do good humanitarian health work without constantly impugning Israel and making unretracted false claims, I’d suggest you do what I did: go to Peter Singer’s list of reputable charities called The Life You Can Save. It shows a number of charities (not all involved with health), all of which have been vetted by Singer’s uncompromising criteria of providing the most assistance for the least money. The second time Kelly and I did an eBay auction of an autographed and illustrated book, my Faith Versus Fact, we deep-sixed MSF and gave all the money to Helen Keller International, a charity that prevents blindness and death in children by giving them inexpensive vitamin A supplements. The charity provides a lot of bang for the buck.

And you can bet that in my rewritten will, the part that goes for children’s health and poverty (the other parts go for wildlife conservation and purchasing lands for reserves) isn’t directed to MSF, but to Singer’s charities.

Repost with evidence: Health New Zealand “encourages” its employees to say Māori prayers daily

July 18, 2024 • 9:30 am

NOTE:  I put this post up the other day, but then got a very irate email from a Kiwi saying that no, I was WRONG: Health New Zealand, he asserted, never sent around any notice to employees encouraging them to say spiritual prayers (karakia) during the day: a Māori custom.  I objected to this as a mixing of religion and government (governmental health efforts), as well as a partial sacralization of indigenous practices. Because of the correspondent’s objection, and because I had no original evidence for such a notice being sent out—just a reader’s assertion—I pulled the post. I also informed a NZ outlet, which had asked to republish my post, to hold off until they could get evidence that such a notice about karakia was indeed circulated.

The organization in NZ has now procured such evidence, so I’m reposting what I took down, but have added the notice (with a link) verifying the government’s urging employees to pray.  And to the person who told me in very strong terms that no such notice existed, well, this is a family site and I won’t tell him what to do—but you can guess.

My post, now with the notice and a link to it:

This item, from the Breaking Views website in New Zealand, is one of the rare cases of a Kiwi speaking up against forcible adherence to Māori customs on the job—in this case, saying Māori prayers. First, “Health New Zealand,” the organization in question, is a government agency that, according to its own description:

. . . . will manage all health services, including hospital and specialist services, and primary and community care. Hospital and specialist services will be planned nationally and delivered more consistently across the country. Primary and community services will be commissioned through four regional divisions, each of which will network with a range of district offices (Population Health and Wellbeing Networks) who will develop and implement locality plans to improve the health and wellbeing of communities.

And the author of this short plaint, A. E. Thompson, is described as “a working, tax-paying New Zealander who speaks up about threats to our hard-fought rights, liberties, egalitarian values, rational thinking and fair treatment by the state.”  He or she is also courageous! (It’s not clear whether Thompson is employed by Health New Zealand; if so, that won’t be for long!)

The beef is that the government sent out a notice to Health New Zealand’s staff encouraging them to say Māori prayers daily.  From the site:

I was made aware that Health New Zealand recently sent an email to its staff as follows:

“We encourage everyone to incorporate karakia daily. To help support you with this we have created some pre-recorded videos to learn karakia. Our resource is designed to give you some options that will enable you to learn and develop your confidence and skills. Note over time we will be adding more recordings for you to choose from.”

The word ‘karakia’ surely must be a Maorified way of saying ‘prayer’, but it seems very difficult and may be impossible to determine whether the term was used before Europeans arrived or if there were other terms that iwi used for their incantations, chants and verbal offerings of respect to their various spiritual entities. Regardless, karakia almost always involve references to supernatural forces whether they be Christian (in practice, they usually end with ‘amine’), pagan or spiritualist. They often involve communication intended for (usually unspecified) long-dead ancestors.

Massey University assistant lecturer Te Rā Moriarty was quoted as saying: “Karakia allow us to continue an ancestral practice of acknowledging orally the divine forces that we, as Māori, understand as the sources of our natural environment. We call these forces atua. So, it is a way to connect through the words of our tūpuna to the world that we live.”

Here’s the notice that the NZ news site that was going to publish my post eventually found. And yes, it is real, and came with a note:

NAME REDACTED tells me she has been advised that an email was sent to employees and invited them to view the message in their browser.

Click the notice to see the announcement—on a Health New Zealand website. The “you can read more” link doesn’t work for me; it apparently requires credentials to access. But the notice says exactly what my informant claimed.  Yes, the New Zealand government is urging some of its employees to pray daily.

In the Māori dictionary, “karakia” is defined this way:

(noun) incantation, ritual chant, chant, intoned incantation, charm, spell – a set form of words to state or make effective a ritual activity. Karakia are recited rapidly using traditional language, symbols and structures. Traditionally correct delivery of the karakia was essential: mispronunciation, hesitation or omissions courted disaster. . . . .

So what we have is a government agency “encouraging” its staff to chant to supernatural powers in hope of connecting to one’s ancestors (tūpuna). This encouragement, of course, violates the separation of church and state, and is an unwarranted sop to the indigenous people. (New Zealand, of course, doesn’t have a First Amendment.)  It’s one more sign of how the sacralization of the oppressed is spreading in New Zealand.  Of course these prayers have no effect, and encouraging the descendants of “colonists” to say them is to force one’s beliefs on others who may not share them.

Thompson has a few words about this:

We can choose not to attend places where the religious practices feel offensive or intolerant to us, and the hosts in those places can exercise similar choice about visiting our spaces.

However, when we are employed and rely upon that employment for our survival, we don’t have the choice to avoid our place of employment. Being employed in a state service under a secular government, workers should have choice over whether they participate even passively in practices involving claimed spiritual entities or supernatural beliefs. Expecting employees to participate denies their right to choose to follow their own religion or philosophical belief and not other people’s, a characteristic of totalitarian rule.

This is especially true in New Zealand, where refusal to sacralize the presumed “oppressed” is sometimes punished severely, with threats of losing one’s job. Thompson’s piece continues:

Sure, the email to health staff only used the word “encourage” but really, when your employer issues an email saying that, you know it will be expected and that ignoring or opposing it will be held against you and may cost you your job.

Pressuring state employees and even private company employees to participate in karakia sets a dangerous precedent in eroding separation between state and religion. As we speak, Muslim immigrants in Europe are deliberately imposing their religious practices on non-Muslim populations by having their distorting loudspeakers call dozens or hundreds of faithful to prostrate themselves in prayer on public footpaths and roadways (even though nearby mosques are plentiful). The practice reflects their belief that Islam is so important that everyone either needs to convert to it or be discriminated against or killed.

As usual, I was sent this with the assumption that the sender would remain anonymous. Thompson, however, clearly has some guts, for even if he/she doesn’t work for Health New Zealand, it’s a huge risk to publish something like this anywhere.

WPATH and the U.S. government try to interfere with research on gender care

June 30, 2024 • 10:30 am

Below are three articles, the first one in The Economist, the second in the NYT, and the latest from Colin Wright’s Substack site, showing that both the U.S. government and WPATH (World Professional Association for Transgender Health: the most influential organization dealing with doctors and therapists who provide care for gender dysphoric and trans people) have been pressuring scientists to get rid of minimum age limits for “affirmative care”. (WPATH, by the way, though purporting to be a “World Professional Association”, is influential only in North America, having almost no bearing on transgender care in other countries.)

As you know, “affirmative care” is that form of care for gender-dysphoric adolescents that guides and pressures them to become trans people, affirming (rather than exploring) their feelings that they’re in the wrong bodies. Beyond cursory “rah rah” therapy, the program then gives adolescents puberty blockers that supposedly pause their development to give them time to decide, and then urges hormonal treatment and—sometimes—top or bottom surgery.  It’s the “affirmative” part—the idea that the child’s views and desires must be catered to—that bothers many of us.  Involved in this are three issues:

1.)  Are adolescents to be trusted with making decisions about medical care that can affect their lives in a major way, decisions that involve taking hormones and having surgery that can sterilize them and (in the case of bottom surgery) lead to severe complications?  Shouldn’t there be a minimum age limit for making such decisions?  According to the NYT article below, the Biden administration had issued draft guidelines, but these were never enacted. (To my mind, these guidelines seem way too young. 17 for genital surgeries and 14 for hormone treatments?)

The draft guidelines, released in late 2021, recommended lowering the age minimums to 14 for hormonal treatments, 15 for mastectomies, 16 for breast augmentation or facial surgeries, and 17 for genital surgeries or hysterectomies.

Now, it appears, many people want NO age minimums, and that includes the U.S. government.

2.)  The long-term effects of puberty blockers on adolescents are not known very well. In some European countries the use of such blockers as regular therapy is banned, and blockers are employed only in clinical trials.

3.)  The bulk of cases of gender dysphoria resolve themselves on their own, without dysphoric people needing hormones or surgery before puberty, and many on hormone therapy stop that therapy, which may not (as gender advocates say) be completely irreversible. Many of these children resolve as homosexuals, which involves neither medicine nor surgery.  As Pamela Paul of the NYT noted, with links:

Studies show that around eight in 10 cases of childhood gender dysphoria resolve themselves by puberty and 30 percent of people on hormone therapy discontinue its use within four years, though the effects, including infertility, are often irreversible.

Europeans are taking a more watchful approach to these questions, but somehow in the U.S. many gender activists want no minimum age limit for affirmative care (including the use of blockers when kids are quite young), only perfunctory therapy for gender-dysphoric adolescents (perhaps only a single session), and make decisive (and erroneous) pronouncements that puberty blockers are not only perfectly safe, having no long-term effects, but are also completely reversible.

This first report, from the Economist (click to read) shows that WPATH tried to impede the work of scientists and researchers working on reviews of transgender issues, reviews meant to inform WPATH’s own guidelines for transitioning. In other words, WPATH wanted researchers to come up with only those results that the organization wanted, results that buttressed affirmative therapy.

Both this article and the NYT article resulted from discovery documents and emails released in a court case challenging Alabama’s ban on transgender medical care for minors.

Here are some experts showing how WPATH resisted systematic analysis of relevant data. (WPATH adamantly denied the results of the NHS’s Cass Review in England, which put considerable brakes on affirmative care in the UK).

Court documents recently released as part of the discovery process in a case involving youth gender medicine in Alabama reveal that WPATH’s claim was built on shaky foundations. The documents show that the organisation’s leaders interfered with the production of systematic reviews that it had commissioned from the Johns Hopkins University Evidence-Based Practice Centre (EPC) in 2018.

From early on in the contract negotiations, WPATH expressed a desire to control the results of the Hopkins team’s work. In December 2017, for example, Donna Kelly, an executive director at wpath, told Karen Robinson, the EPC’s director, that the WPATH board felt the EPC researchers “cannot publish their findings independently”. A couple of weeks later, Ms Kelly emphasised that, “the [WPATH] board wants it to be clear that the data cannot be used without WPATH approval”.

There was then a negotiation stipulating that WPATH didn’t have to approve the data, but could offer review and feedback to the researchers without “meddling” in publication:

Eventually WPATH relented, and in May 2018 Ms Robinson signed a contract granting WPATH power to review and offer feedback on her team’s work, but not to meddle in any substantive way. After WPATH leaders saw two manuscripts submitted for review in July 2020, however, the parties’ disagreements flared up again. In August the WPATH executive committee wrote to Ms Robinson that WPATH had “many concerns” about these papers, and that it was implementing a new policy in which WPATH would have authority to influence the EPC team’s output—including the power to nip papers in the bud on the basis of their conclusions.

But only one review was ever published, about the effects of hormone therapy on transgender people, and, six years later, there are no more articles published, despite the fact that the EPC group has enough data for SIX more reviews.  Something fishy is going on, but what it is we don’t know. (Bolding below is mine.)

No one at WPATH or Johns Hopkins has responded to multiple inquiries, so there are still gaps in this timeline. But an email in October 2020 from WPATH figures, including its incoming president at the time, Walter Bouman, to the working group on guidelines, made clear what sort of science WPATH did (and did not) want published. Research must be “thoroughly scrutinised and reviewed to ensure that publication does not negatively affect the provision of transgender health care in the broadest sense,” it stated. Mr Bouman and one other coauthor of that email have been named to a World Health Organisation advisory board tasked with developing best practices for transgender medicine.

Since WPATH is all out for affirmative care, and demonizes those who call for caution (e.g., the Cass Review), the bit in bold above looks like arrant interference by WPATH with the scientific process.  One could lump WPATH’s behavior in this case along with attempts by other ideologues to make reality comport with ideology—what I call the “reverse appeal to nature”, or “What we consider good and moral must be seen in nature.”

But what seems even worse, at least to American liberals, is that officials in the Biden Administration, including the trans woman who is the assistant secretary for Health and Human Services, have tried to get WPATH to drop all its guidelines for age minimums.  And the pressure worked! WPATH has no more age guidelines.

Click below to read the NYT piece, or find it archived here


Some excerpts (I’ve added a link to Levine):

Health officials in the Biden administration pressed an international group of medical experts to remove age limits for adolescent surgeries from guidelines for care of transgender minors, according to newly unsealed court documents.

Age minimums, officials feared, could fuel growing political opposition to such treatments. [JAC: That apparently means that age limits indicate that there are issues involved with decisions to undergo such treatments. But this is not a political issue!]

Email excerpts from members of the World Professional Association for Transgender Health recount how staff for Adm. Rachel Levine, assistant secretary for health at the Department of Health and Human Services and herself a transgender woman, urged them to drop the proposed limits from the group’s guidelines and apparently succeeded.

Now WPATH, an organization to which many American doctors and therapists adhere, has no age guidelines at all.  If an eight-year-old girl says she feels like she’s in a boy’s body, then affirmative care could begin immediately, and hormones administered soon thereafter. And surgery at any age!

Now I’m not sure about the ethics of a trans woman in the government —or any person, be they cis or trans—pressuring a professional organization to drop age limits for “adolescent surgeries”, but it doesn’t sound kosher.  No bureaucrat should be applying any pressure. for this is an issue best left to doctors and medical ethicists. Yet the pressure from Levine and her office was constant:

The email excerpts released this week shed light on possible reasons for those guideline changes, and highlight Admiral Levine’s role as a top point person on transgender issues in the Biden administration. The excerpts are legal filings in a federal lawsuit challenging Alabama’s ban on gender-affirming care.

One excerpt from an unnamed member of the WPATH guideline development group recalled a conversation with Sarah Boateng, then serving as Admiral Levine’s chief of staff: “She is confident, based on the rhetoric she is hearing in D.C., and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out.”

Another email stated that Admiral Levine “was very concerned that having ages (mainly for surgery) will affect access to care for trans youth and maybe adults, too. Apparently the situation in the U.S.A. is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them.”

There are a lot more emails that I haven’t read, but here’s one more bit showing that even within WPATH there was dissent about removing age limits:

In other emails released this week, some WPATH members voiced their disagreement with the proposed changes. “If our concern is with legislation (which I don’t think it should be — we should be basing this on science and expert consensus if we’re being ethical) wouldn’t including the ages be helpful?” one member wrote. “I need someone to explain to me how taking out the ages will help in the fight against the conservative anti-trans agenda.”

The international expert group ultimately removed the age minimums in its eighth edition of the standards of care, released in September 2022. The guidelines reflected the first update in a decade and were the first version of the standards to include a dedicated chapter on medical treatment of transgender adolescents.

The fact is that we know very little about the long-term effects of various medical interventions on the health and mental well-being of gender-dysphoric adolescents. And with WPATH and the government trying to impose their own dictates on what the results should be, gender care in America looks dire.  Like any other branch of medicine and therapy, it should be informed by science, not ideology, and ideologues should not be dictating how the scientific results should turn out. Yet WPATH continues to make statements without evidence, preferring anecdotes:

The final WPATH guidelines state that distress about breast development in particular has been associated in transgender teenagers with higher rates of depression, anxiety and distress.

“While the long-term effects of gender-affirming treatments initiated in adolescence are not fully known, the potential negative health consequences of delaying treatment should also be considered,” the guidelines state.

“Gender-affirming surgery is valued highly by those who need these services — lifesaving in many cases,” Dr. Bowers said.

I’m pretty sure the “lifesaving part”, as epitomized in the advice given parents of gender-dysphoric children, “Do you want a live son or a dead daughter?”  Gender dysphoria is often accompanied by depression and other mental issues, and there’s no evidence I know of that gender-dysphoria alone causes suicide in the absence of affirmative care.

UPDATE: I’d missed this article from Reality’s Last Stand, but it’s highly relevant. Click below to read it:

 

An excerpt, noting that apparently the NYT had even more damning emails but didn’t publish them (bolding below is the author’s):

Last night, I had drinks with a friend I hadn’t seen in a long time, determined not to talk about The Issue. But a few minutes before I arrived, I found out that The New York Times had decided not to publish a part of a story about the World Professional Association for Transgender Health—an advocacy group that creates “standards of care” for trans medicine, which American medical groups avow to adhere to (they don’t) and claim are evidence-based (they aren’t).

That part of the story would have discussed recently unsealed WPATH documents, subpoenaed by the state of Alabama, as part of a lawsuit, Boe v. Marshall. Alabama parents, medical providers, and a Birmingham pastor named Paul Eknes-Tucker sued the state because of its ban on “gender-affirming care” for minors—and the criminalization of those who practice it.

. . .The emails show that Hopkins did conduct a systematic review, and that—like all the other SRs—it found diddly squat in terms of evidence supporting the efficacy of hormones and surgeries. But WPATH prevented Johns Hopkins from publishing these reviews because they didn’t come to WPATH’s preferred conclusions. WPATH hid this very important information from the entire world, then published standards of care saying an evidence review was impossible. And a government agency knew this!

We are talking about kids and the most invasive possible interventions here. We are talking about venerable academic institutions and government agencies and censorship and secrets.

. . . Turns out, there’s a whole heckuva lot more of these damning emails. The New York Times had access to them but chose not to cover them. A source told me this is because no one from Johns Hopkins would comment on the record. The documents will be available via the LGBT Courage Coalition tomorrow (I will add a link and start a thread when it’s up), but I had a chance to preview them. If you have not yet had what GIDS whistleblower Anna Hutchinson called her “holy fuck!” moment, now’s the time.

After discussing the concessions the Johns Hopkins researchers made to WPATH, apparently deep-sixing six review papers, author Davis says this:

Can you believe the John Hopkins folks agreed to this? This is not science. WPATH is not credible. And this is why we in America are the outliers: we’re not basing guidelines on systematic reviews, or reality. We’re basing them on an activist group’s political agenda, and even the HHS knows there’s no good evidence. In fact, AHRQ was asked to review guidelines for treating gender dysphoric youth back in 2020, because, the request said:

There is a lack of current evidence-based guidance for care of children and adolescents who identify as transgender, particularly regarding the benefits and harms of pubertal suppression, medical affirmation with hormone therapy, and surgical affirmation. While these are some existing guidelines and standards of care,2, 5-6 most are derived from expert opinion or have not been updated recently so a comprehensive evidence review is currently not available.

What did AHRQ decide, after communicating with the Hopkins researchers?

The EPC Program will not develop a new systematic review because we found protocols for two systematic reviews that addresses portions of the nomination, and an insufficient number of primary studies exist to address the remainder of the nomination.

Basically, they said someone was already doing it, and there wasn’t enough evidence to sort through. But the someone already doing it had already agreed to put science aside and only discuss benefits, not harms.

In future years the suppression of scientific research on gender medicine in America will be seen as a scandal. And besides unforeseen damage to people’s lives, we can expect a spate of lawsuits.

Both WPATH and the Biden Administration bear the blame for the latest series of missteps.  In its efforts to placate the progressive Left (something I didn’t predict when Biden was elected), the Biden Administration has badly mishandled issues of sex and gender.

h/t: Rosemary

Readers’ wildlife photos

June 24, 2024 • 8:15 am

I am still running low on photos, though I have a handful of contributions, and would greatly appreciate any readers sending in their good photos. Thanks!

Today we have a text-and-photo natural history and medical lesson from Athayde Tonhasca Júnior; his narrative is indented and you can enlarge the photos by clicking on them.

Suspicions and proofs

From a hundred rabbits you can’t make a horse, a hundred suspicions don’t make a proof (Fyodor Dostoyevsky)

Few people contributed more with entries to medical dictionaries than renowned German physician, anatomist and pathologist Friedrich Gustav Jacob Henle (1809-1885): Henle’s fissure, Henle’s layer, Henle’s ligament and Henle’s tubules are some of the several terms named after him. But there’s more from the good doctor: in a 1840 paper quirkily titled Von den Miasmen und Contagien (On Miasmas and Contagions), Henle championed the theory that microscopic organisms caused diseases, which was questioned by his peers. Later, Henle proposed the necessary steps to prove the theory, such as detecting the suspected agent in every case of the disease and establishing its absence in healthy people. These ideas were refined by Henle’s most famous student, Robert Koch (1843-1910), a future Nobel laureate, and are known today as the Henle-Koch postulates – although often, and unfairly, called just Koch postulates. These guidelines hold that the suspected microorganism must be present in every host affected by the disease but absent in healthy organisms; the microorganism must be isolated from a contaminated host and grown in a culture; the cultured microorganism should cause the disease when inoculated into a healthy organism; and the microorganism must be isolated again from the inoculated organism and identified as being identical to the original agent.

Dr Henle helped debunk the belief that diseases were caused by miasma, or bad air. Image in the public domain, Wikimedia Commons.

The original Henle-Koch postulates are no longer universally applicable because we learned quite a lot since they were formulated: for example, many pathogenic organisms are regularly found in healthy hosts, and the rules are not valid for viruses, which had not yet been discovered. Nonetheless, the postulates gave a rigorous scientific foundation to the emerging field of medical microbiology. By establishing a reliable causal relationship between microorganisms and infectious diseases, doctors could explore options for prevention and treatment.

Drs Friedrich Henle and Robert Koch were entitled to be proud of their work, but they probably would have been surprised to learn that their postulates are also relevant in the field of pollination ecology.

Pollination is the fundamental mechanism of plant reproduction. Since plants can’t go out on a date, they need an agent to transfer pollen for them. For nearly 90% of all wild flowering plants, this work is done by animals, mainly insects. And considering that more than 75% of the world’s most important crops benefit in some degree from animal pollination, identifying pollinating agents is enormously important for the economy and humanity’s well-being.

The apparently obvious way of recognizing pollinators is by checking out which creatures visit flowers. However, it has long been known that an insect or any other animal landing on a flower does not necessarily contribute to its pollination. Some visitors are nectar thieves: they take the flower’s nectar without touching stigmas or anthers. Others are nectar robbers: they get it through holes in the flower made by themselves or by previous visitors. Visitors in search of pollen may also contribute zilch to pollination if they eat pollen on the spot and take away few or no pollen grains. Sometimes they are too good at gathering it, carrying the entire loot back to their nests, leaving nothing for plant reproduction. In some cases, these pollination cheats can constitute the bulk of flower visitations. To complicate matters, visitors can be cheats and pollinators at the same time, or under different circumstances.

The sixteen-spot ladybird (Tytthaspis sedecimpunctata) is a keen flower visitor but an abysmal pollinator because it gobbles down pollen to its heart’s content © Gilles San Martin, Wikimedia Commons.

Pollination will happen only when pollen grains from the anthers (male parts of the plant) make their way to a stigma (female part). Evidence for this crucial event can be obtained by a sequence of conditions analogous to the Henle-Koch postulates. It must be demonstrated that pollen is transferred from anthers to the vector (the suspected pollinator), transported by the vector, and  deposited on a receptive stigma by the vector (Cox & Knox, 1988).

The process of cross-pollination © Ali Niaz, Wikimedia Commons.

These steps seem straightforward, but they are in fact not easy to prove. King et al. (2013) had a go at it with observations from two Scottish sites and a deciduous forest in Costa Rica. They kept an eye on recently opened flowers from 13 species, waiting for the first visitor to alight on a bloom. Once that happened, the stigma from that flower was taken to a laboratory, where pollen grains were recovered, identified and counted. By carrying out repeated observations, the authors obtained estimates of single-visit deposition (SVD), which measures a visitor’s ability to take pollen from a given plant and deposit it in another plant where it can lead to fertilization. By estimating SVD values of the main flower visitors, the authors discovered that about 40% of them were not effective pollinators.

In southeast England, bramble (Rubus fruticosus agg.) flowers are frequently visited during daytime by flies, bumble bees (Bombus spp.) and the European honey bee (Apis mellifera). But an analyses of SVD revealed that most pollination is done at night by moths (Anderson et al., 2023). In a similar vein, Ballantyne et al. (2015) evaluated potential pollinators of heather (Erica tetralix, E. cinerea and Calluna vulgaris) and gorse (Ulex europaeus and U. minor) in Hyde Heath, England. By combining the frequency of flower visitation with SVD values, it was possible to establish who was pollinating what. Hoverflies were frequent visitors, but they deposited few pollen grains. The European honey bee, another regular visitor, was an efficient pollinator of common heather (C. vulgaris), but not as good as bumble bees for the other plants. In fact, SVD data for 76 plants from 30 families in Kenya, Israel and UK have confirmed the frequently reported observation that the European honey bee, despite often being the most abundant flower visitor, is a less effective pollinator than are solitary bees and bumble bees (Willmer et al., 2017).

Networks illustrating a combination of frequency of flower visitation and mean SVD for the main pollinators of heather and gorse. 1: Bombus terrestris/lucorum; 2: B. pascuorum; 3: B. lapidarius; 4: B. jonellus; 5: B. hortorum; 6: A. mellifera; 7: Halictidae; 8: other solitary bees © Ballantyne et al., 2015.

If you suspect that estimating SVD is hard work, you are right. There are alternatives, such as percentage of flowers that develop into fruit, fruit weight, fruit production, and so on. But these methods are equally laborious and not as precise as SVD. A great number of studies have used visitors’ features such as their abundance, hairiness and size, their pollen load, the number of stigmas touched, and the frequency and duration of flower visits. These are indicators of visitors’ potential, but not proof of effectiveness. For example, pollen attached to a visitor’s body may be lost on the way, or end up on incompatible or unreceptive stigmas. We need evidence of pollen deposition that may lead to fertilisation.

A marmalade fly (Episyrphus balteatus) on a grey-haired rockrose (Cistus creticus) flower. Pollination in action? Possibly, but the presence of pollen grains alone does not guarantee it © Aka, Wikimedia Commons.

Conservation organisations, academics, the press and social media have reiterated—often exaggeratedly—the imperiled state of pollination services. These concerns heighten the importance of safeguarding pollinators’ abundance and welfare, and the quality and extent of their habitats. Pollinators are in the spotlight, which opens opportunities for public involvement, new projects, funding – and to bandwagon jumping. A range of flower visitors have been claimed to be pollinators based solely on the fact that they are flower visitors. Even a tree frog was recently reported in the press as a new member of the pollinators club because one specimen was observed with pollen attached to its back. Could it be a pollinator? Possibly, but not likely:  a frog or any animal may accidentally fertilise a flower, but that does not make them reliable, consistent pollinating vectors. Like any other scientific endeavour, progress in our understanding of pollination ecology and processes requires data resulting from hard work. Just listing creatures that fancy a pretty flower won’t do.

Flower-loving Pepé Le Pew is not likely to contribute to pollination © Prayitno, Wikimedia Commons.

Readers’ wildlife photos

May 29, 2024 • 8:15 am

Today the wildlife is H. sapiens medicalensis: portraits of medical workers taken by reader Christopher Moss in the hospital where he works as a doctor.  To show how intrepid he is, he took one of these when he himself was hospitalized for a bone marrow transplant. (Normally he’s a doctor there.)

Christopher’s captions are indented, and you can enlarge the photos by clicking on them.

These are all portraits taken on film, with a variety of cameras. Many are taken on a weekend morning after rounds at the hospital, when I used to torment the nurses and fellow docs by taking a camera into the hospital. I see there are notices all over the place now declaring photography forbidden except with permission of the micro-managing administrators, so there can be no more such photos.

Emily. Pentax 645N, 75mm/f2.8, Tri-X @400, HC-110, Nikon 9000 scan:

Holly. Nikon F6, 85mm/f1.4, Ilford XP2 @200, Rodinal 1:100 semi-stand:

Treva. Rolleiflex 2.8GX, Rolleinar 1, HP5+ @400, TMax Dev, Imacon 848 scan:

Terry-Lynn. Rolleiflex 2.8GX, HP5+, TMax developer, Imacon 848 scan:

Khaled. Nikon F6, Nikkor 85mm/f1.4, XP2 @ ISO200, Rodinal stand, Imacon 848 scan:

Dan. Nikon F6, Nikkor 85mm/f1.4, XP2 @ ISO200, Rodinal stand, Imacon 848 scan:

Elaine and Chelsie. Nikon F6, Nikkor 85mm/f1.4 AFD, TMax 400 at 400ISO, TMax developer, Imacon 848 scan

Brenda. Leica M7, Summarit 75, TMax400, Rodinal stand, Imacon 848 scan.

Lockdown lunacy. I was not allowed to shave because of a bleeding tendency! Nikon F6, 50/1.4, XP2 @200, HC-110, Nikon 9000 scan:
Post-BMT and hairless! Nikon F6, XP2 Super, Diafine, Nikon 9000 scan.

Thomas. Hasselblad 503cx, Sonnar 250mm/f5.5, TMax 100, Diafine, Nikon 9000 scan:

Hasselblad selfie. Hasselblad 500c/m, Distagon 50/4, XP2 Super pushed to 3200, HC-110, Hasselblad X1 scan.

Guest post: The new Cass Review

April 18, 2024 • 9:15 am

The final version of the Cass Review (formally the “Independent Review of Gender Identity Services for Children and Young People”) was issued on April 10. Here’s a brief summary by the CBC, noting that doctors and others have griped about it:

A long-anticipated — and contentious — national review of gender-affirming care for youth in England was released last week, resulting in headlines across the U.K. saying that gender medicine is “built on shaky foundations.”

The Cass Review, chaired by pediatrician Hilary Cass, was commissioned by England’s National Health Service (NHS) in 2020.

Even before the final report was published, the review has led to significant changes for youth gender medicine in England, where the debate over transgender care has become increasingly heated, with complaints of both long waiting lists and medical treatments being too readily available to youth.

Last month, the Cass Review findings led to a ban on the prescription of puberty-suppressing hormones except for youth enrolled in clinical research.

That’s a move away from the standard of care supported by many international medical bodies, including the Canadian Pediatric Society (CPS), the American Academy of Pediatrics and World Professional Association for Transgender Health. Though several European countries including Sweden have also restricted access to puberty blockers and other medical treatments for youth.

The report cites a systematic review of evidence, commissioned as part of the Cass Review, which found “a lack of high-quality research” that puberty blockers can help young people with gender dysphoria.

While experts in the field say more studies should be done, Canadian doctors who spoke to CBC News disagree with the finding that there isn’t enough evidence puberty blockers can help.

I had no time to read the long report, and didn’t think that just regurgitating a summary for the readers was sufficient. But reader Jez told me he was going through it, and I asked him if he wouldn’t mind writing his take for this site. He kindly agreed, and so, without further ado. . . .

First, though, Jez notes

“The Cass Review’s final report (and its other publications) are available here.

 

THE CASS REVIEW: A READER’S TAKE

by Jez Grove

Since around 2014, the number of children and young people presenting at gender clinics in the Western world has surged and the patient profile has switched dramatically from predominantly pre-pubertal males to teenage females. Both changes are unexplained. The treatment offered to these patients has also significantly shifted: a psychosocial and psychotherapeutic approach has given way to many being offered medical treatment with puberty blockers (gonadotropin-releasing hormone analogues, GnRH) and cross-sex hormones.

In September 2020, Dr Hilary Cass, a retired consultant paediatrician and former President of the Royal College of Paediatrics and Child Health, was appointed to undertake a full review into how NHS England* “should most appropriately assess, diagnose and care for children and young people who present with gender incongruence and gender identity issues [and] to make recommendations on how to improve services […] and ensure that the best model/s for safe and effective services are commissioned”. [Cass Review Final Report, henceforeth “CRFR”, Appendix 1: Terms of Reference]

The Cass Review’s Interim Report (2022) highlighted that a lack of evidence on the medium- and long-term outcomes of the treatments that children and young people were receiving was limiting the advice that the Review could give. In response, it commissioned an independent research programme to provide “the best available collation of published evidence, as well as qualitative and quantitative research to fill knowledge gaps” and set up a Clinical Expert Group to help it interpret the findings. [CRFR, p. 25]

The Interim Review also warned that social transitioning (changing, name, appearance and pronouns, etc.):

. . . .“may not be thought of as an intervention or treatment, because it is not something that happens within health services. However, it is important to view it as an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning. There are different views on the benefits versus the harms of early social transition. Whatever position one takes, it is important to acknowledge that it is not a neutral act, and better information is needed about outcomes”. [Cass Review Interim Report, henceforth”CRIR”; pp 62-63]

The findings of the Interim Report led to the closure of the Gender Identity Development Service (GIDS) last month.

Last week, the Cass Review published its Final Report. Dr Cass begins it with an apparent effort to placate her critics; her opening sentences read:

“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”. [CRFR, Foreword from the Chair, p. 12]

However, she is not blind to the problems that have developed in this area of healthcare:

“It often takes many years before strongly positive research findings are incorporated into practice. There are many reasons for this. One is that doctors can be cautious in implementing new findings, particularly when their own clinical experience is telling them the current approach they have used over many years is the right one for their patients. Quite the reverse happened in the field of gender care for children. Based on a single Dutch study, which suggested that puberty blockers may improve psychological wellbeing for a narrowly defined group of children with gender incongruence, the practice spread at pace to other countries. This was closely followed by a greater readiness to start masculinising/feminising hormones in mid-teens, and the extension of this approach to a wider group of adolescents who would not have met the inclusion criteria for the original Dutch study. Some practitioners abandoned normal clinical approaches to holistic assessment, which has meant that this group of young people have been exceptionalised compared to other young people with similarly complex presentations. They deserve very much better”. [CRFR, Foreword from the Chair, pp. 13-14]

The problems with the evidence base that sparked the Review persist, with Cass writing that the independent research programme she had commissioned

. . . .“has shown that there continues to be a lack of high-quality evidence in this area and disappointingly […], attempts to improve the evidence base have been thwarted by a lack of cooperation from the adult gender services.  The Review has therefore had to base its recommendations on the currently available evidence, supplemented by its own extensive programme of engagement”. [CRFR, p. 20]

The failure of the UK’s adult gender services to cooperate is perhaps the most shocking revelation in the report. As Cass notes,

“When clinicians talk to patients about what interventions may be best for them, they usually refer to the longer-term benefits and risks of different options, based on outcome data from other people who have been through a similar care pathway. This information is not currently available for interventions in children and young people with gender incongruence or gender dysphoria, so young people and their families have to make decisions without an adequate picture of the potential impacts and outcomes”. [CRFR, p. 33]

A quantitative data linkage study was intended to

. . . “use existing data held by the NHS, including data from GIDS, hospital wards, outpatient clinics, emergency departments and NHS adult GDCs, to track the journeys of all young people (approximately 9,000) referred to the GIDS service through the system to provide a population-level evidence base of the different pathways people take and the outcomes. This type of research is usual practice in the NHS when looking to improve health services and care received.  However, this has not been the case for gender-questioning children and young people and the hope was that this data linkage would go some way to redress this imbalance”. [Cass Review Final Report, p. 190]

Despite its “not particularly unusual” methodology, it took more than a year for the study to receive ethics approval from the Health Research Authority (HRA); Cass considers the “robust scrutiny and consideration [to be] entirely appropriate given the sensitivity of the subject matter”. [Ibid.] The independent research team “undertook stakeholder engagement and developed the patient notifications and communications resources to explain the research and provide information about how to opt-out of the study should an individual choose to do so. […] In January 2024, the Review received a letter from NHS England stating that, despite efforts to encourage the participation of the NHS gender clinics, the necessary co-operation had not been forthcoming”. [Ibid.] Appendix 4 of the Review sets out the details and history of the “thwarted” study.

The proposed linkage study had been complicated by the fact that, uniquely, GIDS patients are issued new National Health Service (NHS) numbers when registering their new gender identity. Cass notes:

“From a research perspective, the issuing of new NHS numbers makes it more difficult to identify the long-term outcomes for a patient population for whom the evidence base is weak”. [CRFR, p. 229]

The UK government had to bring forward a special legislative instrument to facilitate linking the patients’ new and old NHS records; NHS England had vowed to pursue the thwarted research before the special instrument’s powers expire in 2027.

There are other serious unintended consequences of allowing young patients to change their NHS numbers. Cass writes,

“Safeguarding professionals have described a range of situations where this has put children/young people at risk. These include young people attending hospital after self-harm not being identifiable as a child already on a child protection order; records of previous trauma and/or physical ill health being lost; people who do not have parental responsibility changing a child’s name and gender; children being re-registered as the opposite gender in infancy; children on the child protection register being untraceable after moving to a new area”. [CRFR, p. 229]

While Cass has been unable to use a stronger evidence base, she has provided a valuable service in bringing together an independent and thorough assessment of the existing research in areas related to the assessment, diagnosis, and treatment of gender-confused children and young people and suggested a way forward.

The Review gives:

  • An overview of the patient profile, including mental health and neurodiversity, adverse childhood experiences, theories about the rise in referrals and the change in case mix, and the weak evidence with regard to suicidality.
  • An important appraisal and synthesis of the available international guidelines. Cass notes,

“For many of the guidelines it was difficult to detect what evidence had been reviewed and how this informed development of the recommendations. For example, most of the guidelines described insufficient evidence about the risks and benefits of medical treatment in adolescents, particularly in relation to long-term outcomes. Despite this, many then went on to cite this same evidence to recommend medical treatments.

Alternatively, they referred to other guidelines that recommend medical treatments as their basis for making the same recommendations. Early versions of two international guidelines, the Endocrine Society 2009 and World Professional Association for Transgender Healthcare (WPATH) 7 guidelines influenced nearly all the other guidelines. These two guidelines are also closely interlinked, with WPATH adopting Endocrine Society recommendations, and acting as a co-sponsor and providing input to drafts of the Endocrine Society guideline. WPATH 8 cited many of the other national and regional guidelines to support some of its recommendations, despite these guidelines having been considerably influenced by WPATH 7. The links between the various guidelines are demonstrated in the graphics in the guideline appraisal paper (Hewitt et al., Guidelines 1: Appraisal).

The circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.” [Cass Review Final Report, p. 130]

  • An overview of the existing clinical approach and clinical management and recommendations to improve them.
  • Recommendations for a new service model for NHS England, including follow-through services for 17-25 years-olds to ensure continuity at “a potentially vulnerable stage in their journey” and “allow clinical and research follow-up data to be collected”. [CRFR, p. 225] She also stresses the needs for detransitioners to be supported and warns of the dangers of private healthcare providers outside the NHS not following its policies.
  • Finally, she cautions that, while innovation in healthcare is important, there must be a “proportionate level of monitoring, oversight, and regulation that does not stifle progress, but prevents creep of unproven approaches into clinical practice. Innovation must draw from and contribute to the evidence base”. [Cass Review Final Report, p. 231]

To critics who say the Cass Review tells us nothing new, surely the onus is on them to justify continuing to provide children and young people with “gender-affirming care”, care for which we already knew there is no reliable evidence on the medium-and long-term outcomes.

______________________

* Health is devolved in the UK; Scotland, Wales, and Northern Ireland (and indeed all other  healthcare services) are free to ignore the Cass Review’s findings, but may be unwise to do so.

Dawkins and Sokal on the dumb ideological ploy maintaining that human sex is “assigned at birth”

April 9, 2024 • 12:30 pm

What a pair! The renowned biologist and the hoax-exposer/mathematician, teamed up to attack the medical profession’s new and woke tendency to deny the existence of biological sex as a reality. (Yes, all animals have exactly two sexes, which are not made up by society.) This eloquent op-ed is in the Boston Globe, and you can click below to read it for free, or find it archived here (h/t Mark, Barry).

It’s the “sex assigned at birth” meme, which any fool knows was made up to pretend that biological sex doesn’t really exist in nature, but is merely a “social construct”. This is the same risible meme taken apart by Alex Byrne and Carole Hooven in a recent NYT op-ed. As Alan and Richard note below, the distortion of reality was made for ideological reasons—by gender activists who want to see biological sex as a spectrum, and that is based on the the insupportable view that if you distort biology, transgender or transsexual people will not be “erased”. But, as I’ve said ad infinitum, you don’t need to distort biology to justify treating such people with civility and respect, and to confer on them the same moral value as everyone else has.

The excerpt from the above speaks for itself, but has a lot of useful links to show how well the termites have dined.

The American Medical Association says that the word “sex” — as in male or female — is problematic and outdated; we should all now use the “more precise” phrase “sex assigned at birth.” The American Psychological Association concurs: Terms like “birth sex” and “natal sex” are “disparaging” and misleadingly “imply that sex is an immutable characteristic.” The American Academy of Pediatrics is on board too: “sex,” it declares, is “an assignment that is made at birth.” And now the Centers for Disease Control and Prevention urge us to say “assigned male/female at birth” or “designated male/female at birth” instead of “biologically male/female” or “genetically male/female.”

After discussing the biological definition of sex, which, as you know well by now involves differences in developmental systems that produce gametes of different size and mobility, Sokal and Dawkins give a sharp rap on the knuckles of the medical establishment. I’ve put the last two paragraphs in bold; the penultimate one shows the trend and motivation, while the last one shows the damage.

Much is speciously made of the fact that a very few humans are born with chromosomal patterns other than XX and XY. The most common, Klinefelter syndrome with XXY chromosomes, occurs in about 0.1 percent of live births; these individuals are anatomically male, though often infertile. Some extremely rare conditions, such as de la Chapelle syndrome (0.003 percent) and Swyer syndrome (0.0005 percent), arguably fall outside the standard male/female classification. Even so, the sexual divide is an exceedingly clear binary, as binary as any distinction you can find in biology.

So where does this leave the medical associations’ claims about “sex assigned at birth”?

A baby’s name is assigned at birth; no one doubts that. But a baby’s sex is not “assigned”; it is determined at conception and is then observed at birth, first by examination of the external genital organs and then, in cases of doubt, by chromosomal analysis. Of course, any observation can be erroneous, and in rare cases the sex reported on the birth certificate is inaccurate and needs to be subsequently corrected. But the fallibility of observation does not change the fact that what is being observed — a person’s sex — is an objective biological reality, just like their blood group or fingerprint pattern, not something that is “assigned.” The medical associations’ pronouncements are social constructionism gone amok.

. . .For decades, feminists have protested against the neglect of sex as a variable in medical diagnosis and treatment, and the tacit assumption that women’s bodies react similarly to men’s bodies. Two years ago, the prestigious medical journal The Lancet finally acknowledged this criticism, but the editors apparently could not bring themselves to use the word “women.” Instead the journal’s cover proclaimed: “Historically, the anatomy and physiology of bodies with vaginas have been neglected.” But now even this double-edged concession may be lost, as the denial of biological sex threatens to undermine the training of future doctors.

The medical establishment’s newfound reluctance to speak honestly about biological reality most likely stems from a laudable desire to defend the human rights of transgender people. But while the goal is praiseworthy, the chosen method is misguided. Protecting transgender people from discrimination and harassment does not require pretending that sex is merely “assigned.”

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It is never justified to distort the facts in the service of a social or political cause, no matter how just. If the cause is truly just, then it can be defended in full acceptance of the facts about the real world.

And when an organization that proclaims itself scientific distorts the scientific facts in the service of a social cause, it undermines not only its own credibility but that of science generally. How can the public be expected to trust the medical establishment’s declarations on other controversial issues, such as vaccines — issues on which the medical consensus is indeed correct — when it has so visibly and blatantly misstated the facts about something so simple as sex?

 

Read also Byrne and Hooven; click below (or read it archived here):

Finally, the infamous Lancet cover: