Category: medicine and health

Israeli hospital saves Gazan child using a stem-cell transplant

February 29, 2024 • 11:00 am

It’s not widely known that Israeli hospitals will treat any Palestinian who’s sick or injured, given that a few conditions are met. First, the patient must not be a terrorist, though children of terrorists will be and have been treated so long as they’re accompanied by a relative (mother or grandparent) who is not suspected of terrorism.

Further, the patient must have a condition that is not treatable in a Palestinian hospital.  Finally, the patient must have permission from the Palestinian Authority (PA) to go to an Israeli hospital (the PA is supposed to cover the expenses but often doesn’t), and, if the patient is from Gaza, permission from the Gazan authorities.  Since the PA sometimes doesn’t pay up, often the treatment winds up being free, which means it’s paid for by Israel.

This has been going on forever, and yet it’s rarely publicized.  If Israel is an “apartheid state”—even with respect to Palestinians—this treatment wouldn’t be dispensed. It is, pure and simple, a case of humanitarianism and altruism.  And remember, this is not a one-off: it happens all the time.  It involves the Israelis helping people regarded as their antagonists, but they do it anyway, for they value life.  Remember that when you hear that the IDF is deliberately killing civilians for the sake of taking life.

How many people are treated in this way? The American Journal of Public Health answers this in a 2018 article:

Undoubtedly, the short- and long-term suffering of an ill Palestinian delayed at a checkpoint is always unfortunate, and occasionally even tragic. [JAC: delays for sick people passing through checkpoints into Israel sometimes occur to allow ambulances and the like to be checked for terrorists, bombs, or weapons, which have been found in ambulances and other vehicles.] However, despite ongoing terror threats, and even during unrest and wars, many Palestinians do pass daily into Israel for medical care. Israeli hospitals have long provided Palestinians with extensive medical services. For example, during the research period (in 2005 alone), approximately 123,000 Palestinians were treated at just one institution, Hadassah Hospital in Jerusalem, which included 15000 admissions as well as 32,000 visits to the emergency department.

In general, special entry permits are issued in humanitarian cases for ill people, their chaperones, and for Palestinian medical teams. For example, more recently, in 2016, 93,890 such authorizations were issued for patients (plus 100,722 for accompanying family) to be treated at hospitals throughout Israel. At the two West Jerusalem Hadassah hospitals alone, 15,743 patients, comprising more than one third of the total, came through checkpoints and were cared for there. Another 16% (6,577 patients) crossed into Israel and were treated in hospitals in East Jerusalem.

During the same year, 9,832 Palestinian children with birth defects and chronic diseases were treated in Israeli hospitals. During the first half of 2017, 46,132 such permits have been issued and a further 2,163 authorized Palestinian medical personnel to work or be trained in Israel or East Jerusalem (written personal communication, October 4, 2017, Ido D. Dechtman and Yuval Ran, Medical Corps, Tel Aviv, Israel Defense Forces). Another noteworthy example of Israeli compassion for the suffering of her Arab neighbors is the treatment of more than 4,000 victims of the Syrian Civil War in civilian hospitals at Israeli government expense.

Do people realize this? If they do, do they even care, or do they manage to write it off as some kind of “sickwashing”?  I find it a heartening example of humans at their finest.

So here’s the story of one Gazan child whose life was saved by a complex procedure in an Israeli hospital. This is a report from the Elder of Ziyon site.

Click to read; I’ve reproduced the whole short post below:

There’s an intro from the EoZ, and then the details from the Sheba Medical Center (further indented). Bolding comes from the EoZ’s post:

I received this from Sheba Medical Center:

Among Sheba’s values are “peace through health” – treating all patients from the region and Middle East and seeing healthcare as a path to peaceful coexistence.

At the outbreak of the war there were sixty-one Palestinian patients being treated at Sheba and housed on the campus with sixty-eight family members.

Sheba has continued to receive Palestinian patients from the West Bank throughout the war, as well as providing food, shelter and any needed treatments to the forty families from Gaza that were being treated at Sheba and cannot return at this point.

One story in particular is stunning.

W—–, who has asked that her identity and photo be obscured, came to Sheba from Gaza, with a toddler son S—- who has a serious and fatal immune system deficiency disorder. What was needed was a stem cell transplant, but he had no bone marrow match with his younger brother or other family members.

Sheba staff told W—- and her husband that if she had another baby, there was a possibility that child could be a match and a donor. They decided to try. She became pregnant and a test revealed that the fetus would indeed be a match for her sick son. So, Sheba put them up on the campus and treated her for the duration of her pregnancy and delivery.

The baby boy, G——, was born on Oct. 17.

While Sheba was receiving a flood of those injured and traumatized by the war, and with 200 doctors and nurses mobilized into the army, they proceeded with taking extraordinary steps to save the life of one Palestinian child.

The newborn’s cord blood was sufficient for the needed stem cell transplant. The procedure has been performed and the now-four-year-old son is expected to regain full health and live a normal life. When it is possible to do so, his family will return to Gaza with him and his new baby brother.

Hamas fired machine guns into cribs and then raped the mothers of the babies before murdering them, and Sheba is going to great lengths to save the life of a single toddler from Gaza.

You unfortunately will not read this story anywhere else. But our values will continue to define us, and we will continue to hold them high.

They are right – this story will not be published in the media. Stories of Israeli Jews being a light unto nations are not very popular right now for those who want to push the opposite message.

There is nothing inconsistent between this story from Sheba and what the IDF is doing in Gaza.  In both cases they are doing everything they can to save lives – both Israeli and Arab.

I wanted to reproduce this in the hopes of showing the humanitarian of Israelis, which in cases like this I consider both tear-inducing and reassuring. But it also shows what humans of any nationality are capable of if they can set aside fear and hatred of The Other.

New tendentious and possibly dangerous APA book on “gender-affirming care”

February 19, 2024 • 12:30 pm

From the Washington Monthly we hear of a brand-new book published by the prestigious American Psychiatric Association (APA), a book dealing with (and all gung ho for) “gender-affirming” care. You know what that is: it’s the care that goes to a child with gender dysphoria, taking him or her directly to a therapist or doctor who affirms the child’s feelings of being born in the “wrong” body, then to prescribing puberty blockers and other hormones, and, then if the patient wants it, to excision of body parts: operations on genitalia and removal of breasts, along with hormone treatment that eliminates a patient’s ability to have an orgasm.

Click below see the book on Amazon. It’s $58 and, as you see below it, the 18 ratings on Amazon so far aren’t very laudatory. But according to Amazon it came out only on January 7, and the gender activists haven’t yet weighed in. But they will after they read psychiatrist Sally Satel‘s critical take.

x

Why such poor reviews? Perhaps, as Sally notes in her description of the book in Washington Monthly, because it’s written by gender-affirming advocates and is woefully short on warnings about possible dangers of this kind of medical and psychiatric care. Nor does it appear to offer any alternative care that doesn’t wind up with hormone therapy.

Click to read:

Although the book is published by the APA, it doesn’t constitute “official APA guidance.” But here’s psychiatrist Sally Satel’s take (excerpts indented, bolding is mine):

Last fall, the APA’s publishing arm issued a textbook called Gender-Affirming Psychiatric Care. Described in accompanying promotional material as an “indispensable” resource, the book is written for mental health and primary care clinicians. The publisher, American Psychiatric Association Publishing, APPI, hails it as “the first textbook in the field to provide an affirming, intersectional, and evidence-informed approach to caring for transgender, non-binary, and/or gender-expansive (TNG) people.”

The “affirming, intersectional” textbook is not official APA guidance. Still, APA Publishing describes it as “rigorous” and “an expert view from fields that include psychiatry, psychology, social work, nursing, pharmacy, public health, law, business, community activism, and more. And because each of the 26 chapters features at least one TNG author, wisdom gleaned from lived experience bolsters the professional perspective provided throughout the book.” One would hope that “lived experience” might enhance the scholarship, but that is not the case here.

Affirming care for children with gender dysphoria, a condition that, according to the APA, refers to individuals who suffer from “a marked incongruence between one’s experienced/expressed gender and assigned gender [at birth],” is a major subject of the book. Unfortunately, though billed as a compendium of “best practices,” Gender-Affirming Psychiatric Care, instead of providing even-handed analyses of the controversies within a still-evolving topic of great clinical and social importance regarding the science of treating gender dysphoric youth, the volume approaches it as a settled matter when it is not.

The textbook’s treatment philosophy is that if a child or teen desires transitional steps, then the physicians should proceed, taking the patient’s request on its face. According to the authors, “Clinicians should … always allow patients autonomy in their care.” The authors further advocate for puberty blockers (chemicals that suppress the natural hormonal development and the appearance of secondary sexual traits) and then cross-sex hormones (estrogen or testosterone) to produce the physical characteristics aligned with the patient’s gender identity.

When it comes to gender-affirming surgery (which, for natal girls, can entail the removal of breasts, uterus, and ovaries, as well as penile construction; and for natal boys, involves the genital removal and the creation of a vaginal canal), patients first require a psychiatric evaluation before surgical consultation. In this evaluation, the authors say that “the [mental health] clinician should never place barriers to surgery, only identify those that exist and assist with overcoming them.” (Emphasis added.) While the final decision to operate ultimately lies with the surgeon, who is tasked with obtaining informed consent from the patient and guardian, a psychiatric greenlight is also necessary. Surely, there are times when a yellow or red light is appropriate. It’s telling that a book of 420 pages only mentions guardians once and in the context of saying that guardians and parents (who get five mentions) should not be part of decisions concerning their transitioning kids’ medical data. Parents are referenced only in the context of being unsupportive to their children’s desire to transition.

Satel has other beef. The book doesn’t cover the fate of youths who aren’t given this kind of care, many of whom become gay or no longer gender-dysphoric without affirmative treatments; the book doesn’t cover those who de-transition or reverse the process when it’s going on before medical treatment (“desisters”); the book doesn’t describe alternative treatments in which therapists don’t automatically buy into the patient’s wishes and narratives; and, most important, and, most important, the book doesn’t warn of the potential dangers of some of the medical treatments—dangers recognized by other Western countries.

First is the need for more objective care:

As a practicing psychiatrist, I would expect this volume to probe how to conduct productive interviews with all patients, especially children and young teens, who consider themselves candidates for a gender-affirming approach. After all, this is a book from the American Psychiatric Association’s publishing arm. As such, it should advise clinicians to examine, over many sessions, patients’ experiences and developmental struggles (such as emerging sexuality and identity formation), to learn about their home lives and social worlds, as well as to treat them for the frequent co-occurring issues, such as depression, anxiety, and posttraumatic stress disorder, which sometimes manifest as gender dysphoria in youth.

This would seem to be at the heart of any responsible psychiatric assessment of whether chemical intervention (which can be irreversible) and procedures as life-altering as “confirmation surgery” should be recommended. However, oddly, such foundational steps are ignored.

Here’s Satel on the lack of discussion of the dangers of affirmative therapy (again, we’re talking about young people who may not be mature enough to make such important decisions). To me, this almost verges on academic malpractice:

Finally, a reader gets no sense that gender-affirming care is the subject of vigorous international scientific debate. Remarkably, the textbook does not mention that in 2020, the United Kingdom’s National Health Service commissioned a comprehensive review of puberty blockers and cross-sex hormones and concluded that “the available evidence was not deemed strong enough to form the basis of a policy position” on their use.  Similarly, in 2022, Sweden’s National Board of Health and Welfare suspended hormone therapy for minors except in very rare cases and limited mastectomies to research settings. Likewise, the Norwegian Healthcare Investigation Board now defines all medical and surgical interventions for youth as “experimental treatment,” and the French National Academy of Medicine advises caution in pediatric gender transition.

Regardless of the authors’ personal views, a textbook that is advertised as “rigorous—and timely” as well as “informative” should, at the very least, acknowledge, and ideally explore, the tension between the European and American approaches and elucidate the concerns raised by European medical authorities.

Why the lacunae? As Satel notes, every chapter has at least one likely gender-activist author (“TNG”), and this has resulted in the sorry situation where the APA gives its imprimatur to treatment that might be dangerous or, at best, ineffective. Do note, however, that Satel also opposes state-imposed bans or limits on treatment for adults.

Gender activism is one thing, but when it comes with the imprimatur of the APA and without mention of either alternative therapies nor warnings about the dangers of medical care that have been recognized by other countries, that activism is irresponsible.

The worst thing one can say about this book is that it’s probably going to be highly recommended by ACLU lawyer Chase Strangio.

Pamela Paul’s NYT article on gender transitioning: more than an op-ed, and guaranteed to raise a ruckus

February 4, 2024 • 11:45 am

I mentioned this article this morning, but wanted to give a bit more detail because it’s important in two ways. First, it’s a good and objective assessment of gender transitioning in America, giving both the upsides and downsides. Second, it’s in the New York Times, which has, until recently, taken the “affirmative treatment” side of gender transitioning, staying away from the topics of harmful puberty blockers and those who reverse transitioning (“detransitioners”) or those who avoid medical transitioning after thinking about it (“desisters”). Recently, however, the paper has become more objective on transitioning (this started with Emily Bazelon’s 2022 article “The Battle Over Gender Therapy“, for which Bazelon got a lot of pushback from her colleagues). Pamela Paul’s article takes that even farther. It’s well worth reading. For more plaudits, read Eliza Mondegreen’s short UnHerd piece about Paul’s article, “The New York Times Gets Braver With Gender Coverage“. An except from Mondegreen:

This is a deeply moving piece that goes much further in its implications than anything the New York Times has run before. There are, however, also curiosities surrounding Pamela Paul’s piece, like the editorial decision to relegate her reporting to the opinion pages, and to run an apologia of sorts by Times opinion editor Kathleen Kingsbury, in which she suggests, in the mildest possible terms, that more conversation is a good thing for “humanity, nuance and empathy,” and that gender medicine is full of “complexities.”

If you read that apologia, by the editorial page editor, it’s pretty worthless, trying not to denigrate what Paul said but simply urging “more discussion.” Yes, of course, but all of us have said that all along. But more important, we need more research!

To read Paul’s piece, you can click below, or find it archived for free here if you’re not a subscriber.  This is definitely not an op-ed, however it’s labeled. At nearly 5,000 words, it qualifies at least as “news analysis”.

In short, Paul’s thesis is that America is dealing poorly with adolescents who wish to transition (nobody seems to have any issue with those over 25 who want to change gender), forcing them into an “affirmative treatment” program that affirms their “wrong body” feelings without question, gives them hormones to halt puberty, and then goes on to prescribe hormones that change your secondary sex characteristics, as well as surgery. Rarely do children with gender dysphoria get longer-term, objective care that explores their feelings rather than hustling them on to adopt another gender presentation.  Further, Paul makes three claims—all supported by evidence—that gender activists hate (this is my summary):

  1. There is indeed evidence for a form of “rapid onset gender dysphoria” (ROGD), in which children, without prior indication, suddenly claim they’re in the wrong body and want to change gender.  Gender activists have long claimed that ROGD is a fictional syndrome, one wrongly supported by Abigail Shrier in her readable but much-criticized (by gender activists) book Irreversible Damage: The Transgender Craze Seducing Our Daughters. This book is still causing controversy, but it seems that, in the main, Shrier’s claims were correct. ROGD does seem to be a real syndrome.
  2. It appears that ROGD may be promoted by social media and the urging of peers, who, perhaps having transitioned themselves, urge others to do so. Gender activists have long denied that social pressure plays a significant role in the transitioning of children and adolescents. Given social media and what I’ve read from those who have transitioned, I think social pressure is important.
  3. The majority (80%) of gender dysphoric children, if they don’t transition, resolve their identities by the time they reach puberty, often coming out as gay—a much less intrusive result. Further, about a third of people who take hormone therapy stop the procedure within four years, though by then permanent physiological damage, including infertility, might have been done.

Paul will undoubtedly be demonized for this, but I give her many encomiums. She’s a brave woman, who, like John McWhorter, isn’t afraid to tackle “antiwoke” topics in the NYT op-ed section. (Paul used to be the Sunday book-review editor.) She is a woman who is doing good, and I sugggest subscribi9ng to her columns if you take the NYT.

I’ll give a few quotes from Paul (indented) under each topic.

Improper treatment of gender dysphoria:

At 17, desperate to begin hormone therapy, Powell broke the news to her parents. They sent her to a gender specialist to make sure she was serious. In the fall of her senior year of high school, she started cross-sex hormones. She had a double mastectomy the summer before college, then went off as a transgender man named Grayson to Sarah Lawrence College, where she was paired with a male roommate on a men’s floor. At 5-foot-3, she felt she came across as a very effeminate gay man.

At no point during her medical or surgical transition, Powell says, did anyone ask her about the reasons behind her gender dysphoria or her depression. At no point was she asked about her sexual orientation. And at no point was she asked about any previous trauma, and so neither the therapists nor the doctors ever learned that she’d been sexually abused as a child.

“I wish there had been more open conversations,” Powell, now 23 and detransitioned, told me. “But I was told there is one cure and one thing to do if this is your problem, and this will help you.”

. . .In May 2017, Emerick began searching “gender” online and encountered trans advocacy websites. After realizing she could “pick the other side,” she told her mother, “I’m sick of being called a dyke and not a real girl.” If she were a man, she’d be free to pursue relationships with women.

That September, she and her mother met with a licensed professional counselor for the first of two 90-minute consultations. She told the counselor that she had wished to be a Boy Scout rather than a Girl Scout. She said she didn’t like being gay or a butch lesbian. She also told the counselor that she had suffered from anxiety, depression and suicidal ideation. The clinic recommended testosterone, which was prescribed by a nearby L.G.B.T.Q. health clinic. Shortly thereafter, she was also diagnosed with A.D.H.D. She developed panic attacks. At age 17, she was cleared for a double mastectomy.

“I’m thinking, ‘Oh my God, I’m having my breasts removed. I’m 17. I’m too young for this,’” she recalled. But she went ahead with the operation.

Gender activists and their drive for “affirmative care”:

Progressives often portray the heated debate over childhood transgender care as a clash between those who are trying to help growing numbers of children express what they believe their genders to be and conservative politicians who won’t let kids be themselves.

But right-wing demagogues are not the only ones who have inflamed this debate. Transgender activists have pushed their own ideological extremism, especially by pressing for a treatment orthodoxy that has faced increased scrutiny in recent years. Under that model of care, clinicians are expected to affirm a young person’s assertion of gender identity and even provide medical treatment before, or even without, exploring other possible sources of distress.

Many who think there needs to be a more cautious approach — including well-meaning liberal parents, doctors and people who have undergone gender transition and subsequently regretted their procedures — have been attacked as anti-trans and intimidated into silencing their concerns.

Activists’ resistance to objective care:

Laura Edwards-Leeper, the founding psychologist of the first pediatric gender clinic in the United States, said that when she started her practice in 2007, most of her patients had longstanding and deep-seated gender dysphoria. Transitioning clearly made sense for almost all of them, and any mental health issues they had were generally resolved through gender transition.

“But that is just not the case anymore,” she told me recently. While she doesn’t regret transitioning the earlier cohort of patients and opposes government bans on transgender medical care, she said, “As far as I can tell, there are no professional organizations who are stepping in to regulate what’s going on.”

Rapid onset gender dysphoria:

Most of her patients now, she said, have no history of childhood gender dysphoria. Others refer to this phenomenon, with some controversy, as rapid onset gender dysphoria, in which adolescents, particularly tween and teenage girls, express gender dysphoria despite never having done so when they were younger. Frequently, they have mental health issues unrelated to gender. While professional associations say there is a lack of quality research on rapid onset gender dysphoria, several researchers have documented the phenomenon, and many health care providers have seen evidence of it in their practices.

“The population has changed drastically,” said Edwards-Leeper, a former head of the Child and Adolescent Committee for the World Professional Association for Transgender Health, the organization responsible for setting gender transition guidelines for medical professionals.

For these young people, she told me, “you have to take time to really assess what’s going on and hear the timeline and get the parents’ perspective in order to create an individualized treatment plan. Many providers are completely missing that step.”

. . . . In a recent study in The Archives of Sexual Behavior, about 40 young detransitioners out of 78 surveyed said they had suffered from rapid onset gender dysphoria. Trans activists have fought hard to suppress any discussion of rapid onset gender dysphoria, despite evidence that the condition is real. In its guide for journalists, the activist organization GLAAD warns the media against using the term, as it is not “a formal condition or diagnosis.” Human Rights Campaign, another activist group, calls it “a right-wing theory.” A group of professional organizations put out a statement urging clinicians to eliminate the term from use.

Social pressure:

Many parents of kids who consider themselves trans say their children were introduced to transgender influencers on YouTube or TikTok, a phenomenon intensified for some by the isolation and online cocoon of Covid. Others say their kids learned these ideas in the classroom, as early as elementary school, often in child-friendly ways through curriculums supplied by trans rights organizations, with concepts like the gender unicorn or the Genderbread person.

The suicide trope (the tactic of warning parents that their kids will commit suicide if not allowed to transition, often expressed as “do you want a dead daughter or a live son?”, or vice versa):

After Kathleen’s 15-year-old son, whom she described as an obsessive child, abruptly told his parents he was trans, the doctor who was going to assess whether he had A.D.H.D. referred him instead to someone who specialized in both A.D.H.D. and gender. Kathleen, who asked to be identified only by her first name to protect her son’s privacy, assumed that the specialist would do some kind of evaluation or assessment. That was not the case.

The meeting was brief and began on a shocking note. “In front of my son, the therapist said, ‘Do you want a dead son or a live daughter?’” Kathleen recounted.

Parents are routinely warned that to pursue any path outside of agreeing with a child’s self-declared gender identity is to put a gender dysphoric youth at risk for suicide, which feels to many people like emotional blackmail. Proponents of the gender-affirming model have cited studies showing an association between that standard of care and a lower risk of suicide. But those studies were found to have methodological flaws or have been deemed not entirely conclusive. A survey of studies on the psychological effects of cross-sex hormones, published three years ago in The Journal of the Endocrine Society, the professional organization for hormone specialists, found it “could not draw any conclusions about death by suicide.” In a letter to The Wall Street Journal last year, 21 experts from nine countries said that survey was one reason they believed there was “no reliable evidence to suggest that hormonal transition is an effective suicide prevention measure.”

Leave our kids alone: All kids who have serious problems about their sexuality or gender deserve therapy. But they should get good, objective therapy, not “affirmative therapy”.

To the trans activist dictum that children know their gender best, it is important to add something all parents know from experience: Children change their minds all the time. One mother told me that after her teenage son desisted — pulled back from a trans identity before any irreversible medical procedures — he explained, “I was just rebelling. I look at it like a subculture, like being goth.”

“The job of children and adolescents is to experiment and explore where they fit into the world, and a big part of that exploration, especially during adolescence, is around their sense of identity,” Sasha Ayad, a licensed professional counselor based in Phoenix, told me. “Children at that age often present with a great deal of certainty and urgency about who they believe they are at the time and things they would like to do in order to enact that sense of identity.”

Ayad, a co-author of “When Kids Say They’re Trans: A Guide for Thoughtful Parents,” advises parents to be wary of the gender affirmation model. “We’ve always known that adolescents are particularly malleable in relationship to their peers and their social context and that exploration is often an attempt to navigate difficulties of that stage, such as puberty, coming to terms with the responsibilities and complications of young adulthood, romance and solidifying their sexual orientation,” she told me. For providing this kind of exploratory approach in her own practice with gender dysphoric youth, Ayad has had her license challenged twice, both times by adults who were not her patients. Both times, the charges were dismissed

And I find this statistic, which is stable, to be pretty telling:

. . . 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.

I could go on with Paul’s stories of “detransitioners” and “desisters,” but you can read the article yourself, especially since it’s archived. But for writing this story, and especially for calling attention to the problems of “affirmative therapy” and for telling stories of those who de-transition, Paul will be called a “transphobe”. She is not, nor are any of us who simply want gender-dysphoric kids to be treated properly.

And good for the NYT  for publishing this. Now we’ll know they’re really serious when they start questioning whether trans women should be competing against natal women in sports, or put in women’s prisons.

Intercessionary prayer fails again, this time with covid recovery

December 5, 2023 • 11:30 am

This is the third study I know of in which intercessory prayer (prayer by strangers for the afflicted) has failed to show results.  The first two papers, whose titles are below (click to read) showed that such prayer failed to help patients with heart disease.  I’ve discussed these before, and you can see for yourself that if God exists, listens to prayer, and sometimes responds, He clearly was not listening in these two experiments.

I give the conclusions of each of the first two studies below. Notice that the second study was funded in part by the John Templeton Foundation, which clearly hoped for a positive result!

First, a study from 22 years ago:

Conclusion: The study found no evidence of an effect of intercessory prayer on the primary outcome of mortality or on the secondary outcomes of hospitalization time, ICU time, and mechanical ventilation time.

Second, a study from 17 years ago:

Sadly, no gods with any power to respond to prayer did anything. Note as well that, in fact, intercessory prayer increased (nonsignificantly) the percentage of  bad outcomes (bolding is mine). Perhaps god doesn’t like intercessory prayer!

Results: In the 2 groups uncertain about receiving intercessory prayer, complications occurred in 52% (315/604) of patients who received intercessory prayer versus 51% (304/597) of those who did not (relative risk 1.02, 95% CI 0.92-1.15). Complications occurred in 59% (352/601) of patients certain of receiving intercessory prayer compared with the 52% (315/604) of those uncertain of receiving intercessory prayer (relative risk 1.14, 95% CI 1.02-1.28). Major events and 30-day mortality were similar across the 3 groups.

Conclusions: Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.

And look at the acknowledgements:

This study was supported by the John Templeton Foundation. The Baptist Memorial Health Care Corporation supported the Baptist Memorial Health Care Corporation site only.

And here’s the latest study, published in a weird journal, but one that is peer-reviewed: Heliyon. Here’s what Wikipedia says about it:

Heliyon is a monthly peer-reviewed mega journal covering research in all areas of science, the social sciences and humanities, and the arts. It was established in 2015 and is published by Cell Press. The journal is divided into numerous sections, each with its own editorial team.

Click the title to read, or you might find it more convenient to download the entire pdf here. The reference is at the bottom of the page.

The experiment was done in Brazil, and I don’t think I need to reprise the methods and results since the summary below gives all the essential information. I’ve highlighted the lack of positive results by bolding part of this summary:

Between September 2020 and December 2020, a total of 199 participants (out of 244 that were screened) were randomly assigned to either the Intervention group (n = 100) or the control group (n = 99, Fig. 1). Baseline characteristics, presented in Table 1, were well balanced between the two groups. The study population consisted of 34 % women, with a mean age of 61 years. Additionally, 44 % of participants had hypertension, and 6 % had obesity. At the end of the study, no significant difference in the primary outcome of mortality was observed between the intervention and control groups. Among the 99 subjects in the control group, there were 8 deaths, and the same number of deaths [8] occurred in the intervention group (HR 0.86, 95 % CI 0.32 to 2.31; p = 0.76). Similarly, there were no statistically significant differences in the secondary outcomes between the two groups. The need for ICU admission (p = 0.471), length of stay in the ICU (mean difference 􀀀 0.77, 95 % CI -4.13 to 3.20; p = 0.70), need for mechanical ventilation (p = 0.457), duration of mechanical ventilation (mean difference 3.89 days, 95 % CI -7.09 to 14.71; p = 0.54), and length of hospital stay (mean difference 1.96, 95 % CI -2.78 to 7.85; p = 0.45) were all similar between the two groups, as shown in Table 2. Due to the necessary change in participant identification during the study, we also evaluated the outcomes among participants who were identified by initials and received direct prayers (Table 3) and among participants who were identified by the number of the hospital beds (Table 4). Similarly, we did not observe any changes in the primary or secondary outcome. 

Other aspects of the study worth knowing about include the fact that subjects were admitted to intensive care or clinical inpatient facilities with a PCR-confirmed diagnosis of COVID-19. All patients were older than 18, and were used regardless of their religion or lack thereof. The study was double blind with a control group of patients; patients didn’t know whether they were being prayed for (half were; half were not) and the pray-ers didn’t know the names of the patients, who were identified and prayed for only by their initials and, later, by the number of their hospital bed (God presumably knows all this stuff).

The pray-ers were “Protestant religious leaders” who were able to pray daily for one of the patients. And the prayer devoted to each patient was INTENSIVE, as detailed below:

Each intercessor prayed from their own homes or workplaces, dedicating a total of 240 min per day, divided into three shifts of 80 min each (morning, afternoon, and night). The content of each prayer was not specifically assigned, but it was required to include the following topics: 1) preservation of the patient’s life, 2) avoidance of orotracheal intubation or mechanical ventilation for those not yet intubated, 3) shorter duration of intubation and mechanical ventilation for those already in that state, 4) reduced length of stay in the ICU, and 5) reduced total length of hospital stay.

Now that is what I call prayer. Nevertheless, there was no difference in the outcomes of the experimental (prayed-for) and the control (not-prayed-for) group). The authors do give some caveats, including the small sample size and the fact that the method of identifying patients changed mid-study from initials to hospital bed number (Brazilian law was invoked), but if there is an omniscient God, He should know these things.

This is three out of three studies that haven’t worked.  The possible explanations include these:

1.) There is no God to hear the prayers.

2.) There.is a God, but he can’t hear the prayers.

3.) There is a God who hears the prayers, but he pays no attention to them.

4.) God doesn’t want to be tested, and so ignored the whole experiment. But note that God was effectively tested in a Bible passage (1 Kings 18) in which sacrifices were offered to a false god versus the real God simultaneously, and only the sacrifices to Yahweh worked. This was a controlled experiment!

5.) Protestant prayers are less effective than prayers of other denominations.

Inventive readers can think of other explanations.

Of course as an atheist I think that #1 is the right answer. As the late Victor Stenger said, “The absence of evidence [for God] is indeed evidence of absence if the evidence should be there.”

Naturally this study won’t make a dent in the belief of the godly, for they will simply discount it on one ground or another—probably #4 above.  All we can say is that three sincere attempts to see if prayers work showed that they don’t.

And did I mention that although Lourdes is full of discarded crutches and wheelchairs, there are no false eyeballs or prosthetic limbs on display? Apparently God can cure lots of stuff, but is impotent before blindness and amputation.

________________

Soubihe Junior NV, Bersch-Ferreira ÂC, Tokunaga SM, Lopes LA, Cavalcanti AB, Bernadez-Pereira S. 2023. The remote intercessory prayer, during the clinical evolution of patients with COVID -19, randomized double-blind clinical trial. Heliyon. 2023 Nov 17;9(11):e22411.

doi: 10.1016/j.heliyon.2023.e22411. PMID: 38045114; PMCID: PMC10689938.

 

The World Health Organization buys into woo

October 23, 2023 • 12:40 pm

Or, if you want a rhyme, “WHO goes woo.”  This article comes from Jonathan Jarry, a science communicator at McGill University’s Office for Science and Society.  I was surprised to learn that the WHO, a highly respected organization run by the United Nations, has, on the sly, bought into a lot of woo, including homeopathy, acupuncture, traditional Chinese medicine, ayurvedic medicine, and naturopathy, as well as other dubious remedies. Apparently the motivation for this is that WHO, whose goal is to ensure that everyone in the world has medical care, realized that this is not possible if by “medical care” you mean “modern science-based medicine.” Many people just can’t get it, or perhaps don’t trust it.  Thus WHO buys into woo so that people without access to that care can use the local nostrums. Presto: they get medical help!

Click to read:

You can see the document from 2013, “Traditional Medicine Strategy 2014-2023“, laying out how “traditional and complementary medicine” (“T&CM”) are to be used.  Here’s the rationale from the pamphlet. Look at the quackery that WHO wants to promulgate! (Bolding is mine.)

It is increasingly recognised that safe and effective T&CM could contribute to the health of our populations. One of the most significant questions raised about T&CM in recent years is how it might contribute to universal health coverage by improving service delivery in the health system, particularly PHC: patient accessibility to health services, and greater awareness of health promotion and disease prevention are key issues here. Insurance coverage of T&CM products, practices and practitioners varies widely from full inclusion within insurance plans to total exclusion, with consumers having to pay for all T&CM out of pocket. Simultaneously, there is emerging evidence that T&CM, when included in UHC plans, may reduce pressure on the system and diminish costs. This shows why it is important for Member States to consider how to integrate T&CM into their health systems and UHC plans more comprehensively/

Many countries have their own traditional or indigenous forms of healing which are firmly rooted in their culture and history. Some forms of TM such as Ayurveda, traditional Chinese medicine and Unani medicine are popular nationally, as well as being used worldwide. At the same time, some forms of CM such as anthroposophic medicine, chiropractic, homeopathy, naturopathy and osteopathy are also in extensive use. Health systems around the world are experiencing increased levels of chronic illness and escalating health care costs. Patients and health care providers alike are demanding that health care services be revitalized, with a stronger emphasis on individualized, person-centred care (9). This includes expanding access to T&CM products, practices and practitioners. Over 100 million Europeans are currently T&CM users, with one fifth regularly using T&CM and the same number preferring health care which includes T&CM (10). There are many more T&CM users in Africa, Asia, Australia and North America (11).

From Jarry’s article:

What the WHO sees in T&CM—interventions that include Ayurveda, traditional Chinese medicine, and naturopathy—is an easy way to fulfill a goal. Training enough medical doctors and building enough hospitals to cover the globe seems like an impossible task. Instead, let’s acknowledge the presence of healers of various stripes, with little attention given to the kind of care they provide.

The WHO wants the integration of these prescientific healing practices into national health systems as a way to contribute to universal health coverage, and the arguments it musters for this integration are sloppy and predictable. T&CM is affordable, we are told. This is debatable, as practices like chiropractic and acupuncture commonly depend on regular “maintenance” treatments for life, and affordability is of course no gauge of effectiveness. T&CM is popular, the WHO argues, which is a faulty argument. Bloodletting was widespread for centuries, not because it worked well but because there was little else to do. The WHO also carves out a niche for T&CM in addressing chronic health issues and providing individualized, holistic care, which is a copy-and-paste job from reams of marketing material aimed at glorifying so-called alternative medicine.

The WHO’s poorly argued strategy to convince Member States to integrate prescientific practices into their healthcare system has led them down a worrisome road paved with good intentions. After all, how do you distinguish a traditional healer using “best practices” (whatever that means) from a charlatan? The WHO’s answer has been to release benchmarks for training in the various T&CM interventions it supports.

More from Jarry:

The WHO’s Traditional Medicine Strategy is peppered with allusions to testing these interventions for their effectiveness. Indeed, the number one difficulty their Member States note regarding the regulation of T&CM is the lack of research data. These healing practices must be supported by evidence, the WHO agrees, but what kind of evidence? “While there is much to be learned from controlled clinical trials,” they note, “other evaluation methods are also valuable,” including “patterns of use.” This is a worrying way to promote popularity as an indication of validity.

“Patterns of use”? That means that the effectiveness of treatments can be judged by how widely they’re used?? Like bloodletting used to be, and ayurvedic medicine and chiropractic is now? I don’t even have to tell you how bogus that means of assessment is (see p. 27 of the pamphlet for verification). But according to Jarry, “Orac” (David Gorski), who runs the site Science-Based Medicine, has already been bashing WHO for this.

Dr. David Gorski, an oncologist and science blogger, has covered the WHO’s embrace of quackery many times in the past, pointing out how interesting it is that the people arguing for medical integration make no mention of European humoral therapy and our need to integrate it into common practice. While anthroposophy’s four classical elements and acupuncture’s rivers of qi are seen as conducive to good healthcare, the debunked idea that phlegm, blood, yellow bile and black bile determine our health has been ignored by the WHO. They are all antiquated notions, but the ones we buried are not being resurrected by the WHO. Strange.

Read the document for yourself to see the abnegation of WHO’s mission. You don’t get people well by using these species of quackery.

Guest Post: What a student pharmacist thinks about puberty blockers

August 29, 2023 • 9:30 am

Today’s post comes from Joseph Shen, a pharmacology student in Chicago. He has guest-posted here once before (see link below), and this week sent a contribution on what he’s learned about puberty blockers. I am not a pharmacologist and haven’t checked all the claims in this post, so please do so yourself if you have concerns. Also I am not giving any medical advice here and am not responsible for whether people decide to take or not take these drugs.

Shen is worried about the overuse of puberty blockers in “affirmative care” by doctors and therapists who don’t know about possible side effects of these blockers or the fact that they haven’t been tested properly for their effects on blocking puberty.

Finally, there’s a felid lagniappe to this post that I’ve put below the fold.

Without further ado (and see the “Update” at bottom.

What a Student Pharmacist Thinks about Puberty Blockers

Joseph Shen

He­llo readers, I have been on this website once before when Prof. Ceiling Cat (Emeritus) kindly shared my post about UIC’s mishandling of the Jason Kilborn controversy. What I didn’t mention at the time was that I am a pharmacy student. The ultimate role of the pharmacist is to optimize drug therapy, which means following best-practice guidelines, understanding side effects, and avoiding unnecessary therapies. You can see how this will connect to the transgender debate around puberty blockers.

I’m sure most readers here are familiar with articles giving critiques of puberty blockers like the one in the New York Times and the ones by Jesse Singal on his Substack site. While their content is good, I wanted to share with you how I viewed this topic through the lens of a pharmacist, focusing more on the drugs: what they are and how they are (mis)used. My goal is to inform you so that the next time you tell an affirmative care supporter that puberty blockers are not safe, they retort “what do you know about them?” or “why do you care that they need to be safe?”, you will have an answer.

 

Background Knowledge.

To understand drugs like a pharmacist, you must do a basic review of anatomy and physiology, specifically the hypothalamic-pituitary-gonadal (HPG) axis pictured here.

From Wikipedia

For anyone unfamiliar with this, the simplified version is that the hypothalamus releases gonadotropin-releasing hormone (GnRH) into the pituitary gland in front of it. The pituitary gland secretes two more hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates cells around immature ova and spermatozoa to help them mature. More importantly, LH triggers other cells nearby to synthesize progesterone, testosterone, and estrogens. This process triggers all the changes in puberty.

 

What, Exactly, are Puberty Blockers?

To block puberty, you have to interrupt the effects of the HPG axis. The most popular way is to inhibit the function of LH so that no hormones are synthesized. GnRH agonists are synthetic peptide molecules that mimic GnRH. They bind the same receptor and trigger the release of LH. At first, there is a release of LH and temporary increase in sex hormones. But after around 10 days, the stores of LH are depleted and desensitization reduces the number of receptors for GnRH, so releasing LH becomes harder. There are also GnRH antagonists: other synthetic peptides which bind the same receptors but don’t trigger any reaction, stopping the cycle immediately. While they work faster, these drugs are more costly and have more side effects, making them far less popular. When a person stops taking either class of drug, the HPG-axis resumes its cycles. This is what leads activists to claim that their effects are reversible. The cycles may resume on the molecular level, but that does not mean puberty will resume as normal on the bodily level.

Among GnRH agonists, just a few are used in most cases. Leuprolide is the most common drug in the class. It can be injected as a suspension into the muscle/fat every month, or it can be a biodegradable implant. Two other very similar drugs are goserelin and triptorelin, though they are available only as an implant and injection, respectively.

While known to the public as “puberty blockers” thanks to the controversy, GnRH agonists have several uses. They are first-line treatments for all stages of prostate cancer, depriving the tumor of growth-stimulating testosterone. They can also be used to treat endometriosis, in which uterine-like tissue grows somewhere else in the body, causing severe pain. Since that tissue is stimulated by sex hormones, GnRH agonists make it inactive. And during in vitro fertilization, a woman takes a dose to make sure she doesn’t ovulate early.

Notice anything about these uses? They are all either short-term or used to correct a hormonal abnormality. What GnRH agonists are not well-supported for using is stopping normal onset of puberty, leaving the body in a developmental limbo. Leuprolide, in fact, has a shady history. Its initial approval by the FDA was based on very limited data, with some small sample sizes and short durations. Some post-market studies carried out after approval also had issues, with serious side effects such as bone disease omitted from a 2010 study. The poor literature means we can’t definitively predict what will happen when you start and stop using the blockers. Human bodies going through puberty are not tardigrades that will hibernate when the environment is hostile and later restart as if nothing happened. Pausing puberty is more like pulling on a Slinky: leave it stretched too long—and it may never slink again. With no big longitudinal studies, we just don’t know.

The thing most people want to hear about GnRH agonists are their side effects, and there’s a lot to discuss. Mainstream articles frequently mention poorer bone health. Sex hormones trigger the cartilage known as the growth plate in the femurs to grow and then turn to bone. They also maintain a balance between bone growth and breakdown. For someone on puberty blockers, the growth plate may not mature, and the balance shifts towards bone breakdown, both of which make fractures more likely. Sexual issues are another real possibility. The lack of sex hormones can reduce or eliminate development of libido in both trans boys and girls. What I haven’t seen discussed is what happened to many girls who were given leuprolide for years to delay puberty so that they grew taller. Decades later, these girls who had normal puberties and who have never been on other treatments developed osteoporosis, weak joints, and fibromyalgia. What reason is there to believe similar cases won’t happen with trans kids without normal puberties? Beyond that, leuprolide and the others currently carry warnings for increased risk of heart attacks, dizziness and fainting, and a host of other conditions, all based on thousands of cases of reported adverse effects—how can these drugs possibly be perfectly safe?

 

A Pharmacist’s Concerns

It confuses me why all the debate over these drugs rarely involves pharmacists, who are the drug experts. Doctors may know treatments, but it’s pharmacists who are more keenly aware when a drug therapy is lacking evidence.

Improper prescribing is a huge, pharmacist-specific concern. Contrary to popular belief, pharmacists don’t just fill prescriptions made by physicians without question. Pharmacists are required by law to exercise “corresponding responsibility” and dispense drugs only when they’re safe and appropriate. I see the transgender controversy as having some of the biggest potential for improper prescribing. Without solid guidelines and with influence from various organizations like WPATH, pharmacists are put into a bind. We can either sign off on unwarranted med orders or refuse to fill them and be condemned by societal and professional peer pressure. We will have to stand up for our profession by saying NO when decisions are not based on good science. It is our duty to stop potential harm to patients, sometimes even if it’s what they want.

Another pharmacist-specific concern erodes trust in modern medicine. Physicians live by the Hippocratic Oath, often condensed into the phrase “first, do no harm.” At times, doctors withhold information from patients to spare them emotional and psychological harm (e.g., giving “affirmative” advice without telling parents so that they can’t be obstacles). This causes doctors to butt heads with pharmacists who, in contrast, live by the Oath of a Pharmacist [side note: the 2021-2022 updated oath includes the line “I will promote inclusion, embrace diversity, and advocate for justice to advance health equity.”] We tend to emphasize patient autonomy, being truthful, and giving enough information for them to make rational choices. It is unethical to deceive patients about a drug’s safety to increase the likelihood of using that drug. This kind of behavior makes practicing medicine seem like it’s based on reckless opinion rather than on evidence from clinical trials. When patients think their doctor’s suggestions are just opinions, then all they need to refuse a suggestion is their own opinion—the same kind of opinion that could make them refuse vaccinations or turn to alternative medicine.

 

Conclusion

This controversy would not exist if there was simply enough evidence. But we can’t do large-scale, longitudinal studies because they’re ethically and practically impossible. Subjects would have to be prepubescent and started on these drugs for years with consent from their parents. No thinking parent would allow this. Studying only children who claim to have gender dysphoria seems like the clear next option. But sample sizes would be much smaller, and the zealous proponents of affirmative care don’t want to wait years and delay transition. Observational studies are the best we can do, and we know their results so far are not promising.

I genuinely sympathize with the young, dysphoric people who are in a catch-22. If they use blockers but then lose their dysphoria, they may incur irreparable damage to their bodies for nothing. If they wait until they’re sure they want to transition, but their bodies develop, they may never be satisfied with themselves. But when I choose patient safety over satisfaction, I’m doing it not out of malice but because I care enough to value their wellbeing.

I apologize if this sounds like a polemic. While I speak from the principles taught to me as a pharmacist, I speak only for myself. I hope this piece was at least somewhat engaging and not as dull as the actual lectures we all had to sit through to learn this. I’ll end on a high note. As is customary for a cat’s staff member, I must share pictures of my boss. They tell a comedy in 3 acts.

UPDATE:

One commentor (#9 below) correctly pointed out that I implied without evidence that physicians are frequently not discussing the risks of GnRH agonists with patients. This was wrong of me. What I should have written was that the medical field (at least in the U.S.) is largely supporting GnRH agonists regularly despite the lack of evidence for their safety, and not admitting to that. It is this air of support, not individual people, that concerns me. If and when individual physicians downplay the risks, then that is even more unethical; I’m certain that’s not the vast majority of doctors treating gender-dysphoric kids.

Here is the evidence for that support. The Endocrine Society (ES)’s 2017 guideline claims “pubertal suppression is fully reversible,” implying that long-term side effects are negligible. They “recommend,” (a strong statement) not “suggest,” (a weaker statement) that puberty suppression be used when indicated. They give a lukewarm review of the effects on bone and say next-to-nothing about brain development. Wikipedia conveniently lists the American organizations. that give position statements supporting GnRH agonists and/or the ES’s position. Position statements are not scientific evidence but carry scientific credibility in people’s minds.

This is exacerbated by mainstream media, in which articles from progressive-leaning venues (see here, here, and here) cite individual professionals who claim that puberty blockers are “well-studied, well-documented, and well-tolerated”, are “a benign medication”, and that the side effects are “not enough of a reason to allow a child … to continue going through puberty.” This small number of professional opinions (one of the lowest forms of scientific evidence) can shape what the public perceives to be the state of medicine. And again, it’s aways about what the doctors think in these articles, not the drug experts. Doctors are not always perfectly scientific and rational, needing pharmacists to help guide them with drug therapy. It’s just that no one in the media bothers speaking to a clinical pharmacist.

Guidelines are the starting-point resources for doctors before they make their own professional decisions. It is not a good thing when they hold poorly supported statements and when people are hesitant to challenge them because of social pressure. It is misleading at best and needs to be addressed with evidence and compassion, not instinctively calling critics transphobic.

 

[JAC: Read the story below the fold (click “read more”)]

Continue reading “Guest Post: What a student pharmacist thinks about puberty blockers” →

An international group of gender-change specialists urges caution for American doctors and therapists

July 16, 2023 • 10:00 am

A bunch (21) of doctors and Ph.D.s from nine countries (Finland, the UK, Sweden, Norway, Belgium, France, Switzerland, South Africa, and the U.S.) published the following op-ed in Friday’s Wall Street Journal. It might be paywalled, so I reproduced the entire short letter below.

First, be aware that this, as noted below, was in response to a letter from the President of the Endocrine Society published recently, a letter that staunchly defends the efficacy of “gender-affirming care.” That care involves a combination of therapy and, nearly always, medical intervention through hormones. That letter, from Dr. Stephen Hammes, said this:

Roy Eappen and Ian Kingsbury’s op-ed “The Endocrine Society’s Dangerous Transgender Politicization” (June 29) ignores scientific evidence and the conclusions reached by the American Medical Association, the American Academy of Pediatrics and other reputable medical organizations. More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.

If you already know the evidence, you’ll know that this claim is wrong: there is not enough evidence to form a “clear picture” of either well-being or suicide. In response, the signers of the letter below (not shown) took issue with Hammes’s claims.

Click the headline to read, but here’s the whold thing.  And I’ve put the important parts in bold:

As experienced professionals involved in direct care for the rapidly growing numbers of gender-diverse youth, the evaluation of medical evidence or both, we were surprised by the Endocrine Society’s claims about the state of evidence for gender-affirming care for youth (Letters, July 5). Stephen Hammes, president of the Endocrine Society, writes, “More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.” This claim is not supported by the best available evidence.

Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret. For this reason, more and more European countries and international professional organizations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.

Dr. Hammes’s claim that gender transition reduces suicides is contradicted by every systematic review, including the review published by the Endocrine Society, which states, “We could not draw any conclusions about death by suicide.” There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.

The politicization of transgender healthcare in the U.S. is unfortunate. The way to combat it is for medical societies to align their recommendations with the best available evidence—rather than exaggerating the benefits and minimizing the risks.

This letter is signed by 21 clinicians and researchers from nine countries.

There’s also a coda to this letter, which appears to be a kind of addendum (like a Supreme Court Justice’s partial dissent) coming from someone who may have been asked to sign the op-ed:

Transgenderism has been highly politicized—on both sides. There are those who will justify any hormonal-replacement intervention for any young person who may have been identified as possibly having gender dysphoria. This is dangerous, as probably only a minority of those so identified truly qualify for this diagnosis. On the other hand, there are those who wouldn’t accept any hormonal intervention, regardless of the specifics of the individual patients.

Endocrinologists aren’t psychiatrists. We aren’t the ones who can identify gender-dysphoric individuals. The point isn’t to open the floodgates and offer an often-irreversible treatment to all people who may have issues with their sexuality, but to determine who would truly benefit from it.

Jesus L. Penabad, M.D.

Tarpon Springs, Fla.

I agree with that letter, too. I would never ban transsexual medical treatment for those people old enough to make an informed decision (I’m thinking about 18 years old), but young people need objective therapy, not “rah rah—>hormones” therapy.  If a therapist prescribes puberty blockers for a young person on the very first visit (or worse, sends them to doctors prescribing gender-change hormones), that is not a good therapist.

Of course the solution to this dilemma is research, which is why several European countries have put puberty blockers into the class of “clinical experiments” and are starting to practice less “rah-rah: transition” therapy in favor of actually listening to children without instantly affirming their desire to transition. That’s especially important because the large majority of young people experiencing gender dysphoria (about 80%, I think), eventually grow out of it, often by simply becoming gay.  And being gay doesn’t run the risks of medical complications, sterility, and the inability to have orgasms: some of the side effects of hormone treatment.

And it would help if extreme gender activists would stop politicizing this issue. In all my years of writing on this site, I don’t think I’ve ever gotten such nasty and ignorant pushback as I have from gender activists who accuse me of transphobia simply because I think we need more research before we start injecting hormones into children and adolescents, lopping off bits of their bodies, and giving them objective rather than “affirmative” therapy. That view is not “fear of trans people”, for crying out loud. But the activists, who have ideology but not evidence on their side, resort to name-calling to intimidate their opponents. And it often works.

The pile-on also comes if one suggests, as did Abigail Shrier, that there can be social pressure that influences people to change their gender, a claim that by now I think is undeniable. (Adults, of course, are free to make their own decisions, but again, these should be informed decisions, and the long term effects, both medical and psychological, of transitioning are not often discussed. One reason is that gender activists rain down hatred on anyone who brings up these issues.)

In Friday’s Weekly Dish, Andrew Sullivan picked up on this letter and wrote about it, giving some statistics in response to the oft-heard claim made by some doctors and therapists advising parents of gender-dysphoric children, “Do you want a live boy or a dead girl?” That, of course, implies a very high risk of suicide by girls who aren’t allowed to transition to the male gender. Sullivan:

To give a sense of the bullshit, here’s Stephen Hammes, president of the Endocrine Society:

More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.

Note the vagueness, and the absence of any mention of children — the only population we need to be concerned about. And here is the Endocrine Society’s own study on sex reassignments for kids:

We could not draw any conclusions about death by suicide.

Today, in the Wall Street Journal, 21 pediatric clinicians from nine countries call Hammes out. In those countries that have conducted systematic evidence-based reviews of all the studies involving children, all of them have concluded that “the evidence for mental-health benefits of hormonal interventions for minors [is] of low or very low certainty.” The risks — permanent sterility, inability to experience orgasm ever, irreversible changes to the body, voice and face — are very real. Yet the American Academy of Pediatrics refuses to conduct a similar systematic review, five years after its last guidance.

A survey of a decade of child transitions in the UK, from 2010 to 2020, found that the data “shed no light” on whether reassignment affects the suicide rate. But here’s the stunner: of the more than 15,000 children treated for gender dysphoria, the number of suicides was four. It is insane to believe that every child with dysphoria will kill themselves if not subjected to a sex change. If a doctor tells you this, find another doctor.

Why would they lie like this? I honestly don’t know. Here are some possibilities: misguided compassion for children in distress; believing you are part of a cultural revolution that starts with children; banking on the vast revenues of having patients for a lifetime of treatment; or just following ideological fiats, intimidated by woke peers, and fearing liability for past missteps.

I think that pretty much covers all the possibilities. I’m not sure why the U.S., compared to other countries, is particularly resistant to discussion of medical and psychological issues like this, especially given that this isn’t just an ideological discussion, but a discussion with medical consequences.  As far as I can see, we should be doing what the Europeans are increasingly doing about this issue: collecting more data.