Wednesday, November 30, 2016

A physician with a comprehension problem - prone to hyperbole

Dr. Grazie Pozo Christie
Today Dr. Grazie Pozo Christie writes at The Federalist: “Mom Sues To Prevent Teen Son From Amputating His Genitals.” Christie is a board certified diagnostic radiologist. She is also an orthodox Catholic and a policy advisor for the Catholic Association. A 1995 graduate of Miami's Miller School of Medicine, Christie doesn't seem to have experience and training in psychiatry or human sexuality, or law for that matter. Christie holds no hospital privileges — working out of a nondescript low-rent office building in a nondescript part of western Miami.

Dr. Grazie Pozo Christie's office
Apparently the good doctor is unaware of the fact that minors are not candidates for gender affirming surgery. If she is aware of that fact then she has a fetish for click bait. What she is referring to is Annmarie Calgaro v. St. Louis County et al, a case that I have been following since it was filed less than two weeks ago.
The mother of a 17-year-old boy in Minnesota is suing her child’s school district and the county health board. It seems that the teen, who suffers from gender dysphoria, has been receiving (without his parents’ consent or even knowledge) hormonal treatments to change his secondary sex characteristics to those of a woman. The suit even refers to “life-changing surgery,” which for a boy would mean amputating his genitals and cosmetic reconstruction.
First off, the person identified only as “J.D.K.” is a transgender girl. Unlike mommy's idiotic attorney, let's get gender and pronouns correct. Also, although she has the phrase in quotes there is no mention of surgery in the complaint. The closest it comes is:
32. Conversely, even though Ms. Calgaro as a mother objects to J.D.K.’s life-changing operation and narcotic drug prescriptions, Ms. Calgaro has no legal rights under Minnesota Statute § 144.341 to bring a cause of action …
Attorneys for Calgaro (the suit is underwritten by the Thomas More Society) are challenging Minnesota law and that statement is correct. Calgaro has no rights under Minnesota law. She threw the kid out of the house and she has been self-supporting (while still enrolled in high school) for more than six months. To the best of my knowledge, J.D.K. has not had gender affirming surgery and the word “narcotic” usually refers to an opiate which is highly unlikely as an agent of gender affirmation.

Aside from the substitution of words, neither Calgaro nor her lawyers know if J.D.K. has any inclination for surgery. Usually surgery is offered in in a patients's 20s at the earliest.
The child’s mother is challenging a Minnesota law that allows a minor who is living alone to make his own health-care decisions. She calls it a violation of her rights as a parent that major and permanent hormonal and surgical interventions should be performed on her minor child without her consent or even informing her. She believes these treatments may not be in her son’s best interests, and she ought to have a say in the momentous decision.
Now I realize that the Vatican eunuchs profess that transgender people do not exist. They are theologians. Scientists disagree. Whether or not Calgaro or Christie approve, Calgaro has a daughter. More importantly, Ms. Calgaro is in no position to determine what is best for her daughter with whom she has had no contact in some time. Why this sudden interest in a child that she estranged herself from? And how did the conservative Catholic Thomas More Society get involved?

Based upon my reading of the attachments to the complaint I surmise that J.D.K. has had hormone treatments that are now, to some extent, irreversible. Suppose mom was able to control his medical treatment (shudder the thought), what's first? An exorcism followed by some version of reparative “therapy?”
Transgender activists commenting on the case have a completely different view of the matter. They believe the treatment for gender dysphoria, the clinical term for feeling uncomfortable with one’s biological sex, is always “gender affirming,” followed by “transition” to the desired sex. The depression, suicidal ideation, and tendency to self-harm that gender-dysphoric youths experience will improve when the youth is treated by others as the sex the youth prefers. Any brooking of the child’s desire is a kind of violence, even using the “wrong” or undesired pronoun.
I suppose that I am an “activist” but I am certainly not a medical professional. What I do know, however, is that there is no known medical intervention for gender dysphoria other than gender affirmation. If Dr. Christie knows otherwise she fails to state so in specifics. And, yes, intentionally treating a transgender person as the wrong gender inflicts harm on the individual. It goes beyond being obtuse. It is as if, by forcing the issue, they are going to cause a transgender boy to become a girl. Did I mention exorcisms?
Is Immediate ‘Transition’ the Right Treatment?

Laying aside important questions of parental notification and consent, the medical issue that confronts our society is whether “transition” with hormones and surgery ought to be used as the default therapy for children with gender dysphoria. Does this treatment ameliorate their psychiatric pain? Is the improvement in mental health for these young people so vast as to justify the radical nature of the treatment, its invasiveness, permanence, and side effects? Could there be other, better therapy? If nothing were done, would the child grow out of it naturally?
The correct answer to the first question is “Possibly.” It depends upon the joint decision making of the patient and clinicians. We all know what comes next but I'll let it play out.
These are the usual questions the medical community asks whenever new therapies are proposed for any illness. The answer lies, of course, in scientific studies, such as an excellent new comprehensive study, published in the journal New Atlantis, taking a look at sexuality and gender from the social, biological, and psychological perspectives. The lead authors are peerless in their fields, the study is methodologically sound, and their findings have profound implications.
A few years ago, Christie was sued for malpractice to the $250,000 limit of her insurance. The carrier settled for an undisclosed amount. It is intellectual malpractice for a physician to cite a study that has been neither peer reviewed nor published to a scholarly journal. Moreover, it is not a study; it is a literature review which is entirely different given that the authors did no independent research. To say that the authors are “peerless in their fields” is unsupported hyperbole. I will not mention their names (which end up in Google News to their delight) but one is a staunch defender of the faith. The other (with whom I spent a considerable amount of time on the telephone) made some incorrect assumptions. To suggest that a literature review that has not been submitted to referees is “methodologically sound” has no more appropriate label than bullshit. How the hell does Christie arrive at this conclusion? Wishful thinking? Divine inspiration? The fact that a medical doctor is making these judgments is just astounding.
To summarize, scientific research shows that the “hypothesis that gender identity is an innate, fixed property…independent of biological sex…is not supported by scientific evidence.” In other words, the fact that a young girl feels she ought to have been born a boy does not “make” her in any scientific way a boy.
What scientific research is she referring to? It is the conclusion of the American Psychiatric Association that a transgender person, for all intents and purposes other than reproduction, is the sex comparable to their gender.
Most important when considering dramatic hormonal transformations of children, only a minority of children “who experience cross-gender identification will continue to do so into adolescence or adulthood.” This means that gender dysphoria in children is, in most cases, a passing phase.
I do not know what the percentages are nor which group is in the minority (and neither does Christie). However, J.D.K. has been treated by expert clinicians with years of experience. Only when a patient is determined to be transgender to a virtual certainty might that individual receive hormones that could have irreversible effects. J.D.K. has not received care at the hands of traveling Bedouins in a bizarre.
Do the hormonal treatments work? Does the children’s distress abate when their bodies start to change? No. Studies have found “little scientific evidence of the therapeutic value of interventions that delay puberty or modify the secondary sex characteristics of adolescents.” This means the psychic pain the children experience is generally of the same intensity, or even worse, after “transition.” The study says there is no scientific basis to encourage all children who experience gender dysphoria to become transgender.
More bullshit. One literature review published to what amounts to a Christian blog absent peer review does not constitute “studies. According to actual peer reviewed and published research:
To describe the treatment of gender dysphoria in adolescents. Careful study and evaluation of children with persistent severe gender dysphoria has led to the recommendation that puberty be suppressed at Tanner Stage II. If the dysphoria persists until age 16, treatment with sex steroids of the appropriate gender may begin at age 16 and be followed by gender-appropriate surgery. Protocols and results of treatment of early adolescents have demonstrated that the harmful effects of persistent gender dysphoria can be prevented. Pubertal suppression in early puberty not only prevents the severe distress, but also allows healthy adolescent development living in the appropriate gender.
I used Google Scholar. Surely this fucking physician has the resources at hand to investigate what the real research demonstrates. There is a mountain of responsible (peer reviewed and published) research regarding juvenile gender dysphoria. I expect a fucking physician to be more fucking responsible! Is that really too much to ask?
In Fact, Transitioning Can Make Things Worse Going down the transgendered path is not only not a sure “cure” for gender dysphoria, it is actually very risky to mental health. Research has shown that those who live as the opposite sex into adulthood are especially affected by the high rate of mental health problems that affect non-heterosexuals. Transgendered people have a lifetime suicide rate more than eight times higher than the general population. For adults who have had sex-reassignment surgery, the figure jumps to a staggering 19 times.
There are two cites in that paragraph to the same moronic literature review. Why is a fucking physician unable to cite peer reviewed literature to support her statements? None of that paragraph is true other than the fact that transgender people do have a higher suicide rate than the general public. We can credit people like Dr. Christie for some of that. The intended inference is that gender affirming treatments increase the suicide rate. There is no credible research to support that contention — even if we allow for some confusion of correlation and causation.
The lack of social acceptance of those living as the opposite sex and rejection from their families (social stress) are often cited as the reason transgender people suffer so disproportionately from mental health problems and suicide. Scientific research, however, does not show that stigma and prejudice can account for these disparities.
There is a cite for that too. You know where that goes to. An editorial in a Catholic blog does not constitute “scientific research.” If Molly Hemingway wrote this piece I would be annoyed. The fact that a medical doctor is spewing this nonsense is going to cause me to walk down to a remote area of the beach this afternoon and scream all of the expletives that have not been included in my commentary.
The mother suing in Minnesota may not have all this research at her fingertips. But she may know some of the risks her child is running by choosing the hormones and surgery to treat his gender dysphoria. Her son will have to take high-dose estrogen for life to develop breasts, a high voice, and other secondary female characteristics. This drug significantly increases the risk of blood clots, stroke, dementia, invasive breast cancer, and heart attack. Genital amputation, of course, is not reversible, and cosmetic repairs are just that: repairs. Infertility, which to a 17-year-old boy may not seem like a big deal, is irreversible.
So mom “may not have all this research at her fingertips.” Dr. Christie doesn't seem to have any research at her fingertips. Even here our physician is hyperbolic. There are risks associated with taking estrogen. However, according to the PDR, nowhere is there the use of the word “significant.” Exaggerating means that one is lying.
This Is Science Versus Ideology

It is vastly important, for the good of children experiencing gender dysphoria, that science triumph over ideology. Gender ideology is heavily charged, both socially and politically. For transgender activists, the question is one of sexual expression and self-actualization. It’s about “choosing” one’s identity, or “discovering” one’s hidden but immutable self and having society conform to this choice or discovery. In this worldview, natural and biological realities that have always informed and shaped cultures are only barriers on the way to self-realization.
[Pause while I regain some self-control]…

The science is what it is. It is available to anyone with enough intellectual curiosity to seek it out. Just because the pope calls gender dysphoria an ideology doesn't mean that it is. Gender dysphoria is a real medical condition that requires real treatment. Dr. Christie is wed to pseudo-science that has neither been arbitrated nor published to a medical or academic journal. The reason that Christie prefers the pseudo-science is that it conforms to her religious beliefs. That makes Dr. Christie a dangerous crackpot.
For parents confronted with a son or daughter suffering the pain of gender dysphoria, the most important thing is the medical and psychiatric health of their children. The preferred outcome for all loving mothers and fathers is to see their child reach a healthy adulthood, safe from the kind of psychic pain that drives the sky-high suicide rates of these troubled youngsters. If this can be achieved without amputating surgeries, intense life-long hormone treatments, and infertility, so much the better. If these therapies can’t be counted on to cure gender dysphoria, and even result in higher suicide rates, parents need to know it.
That constitutes a form of medical malpractice. Parents need to find the most expert clinicians they can find, preferably practicing in an academic environment. It is a certainty that priests and prelates have no answers other than Bronze Age simplistics. Dr. Grazie Pozo Christie, hampered by the same superstitions, is equally clueless.

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