Monday, September 16, 2019

Out of the woodwork - Out from under rocks they come

Katherin Kirkpatrick
Katherin Kirkpatrick
via LinkedIN
Katherin Kirkpatrick (no “e” at the end of Katherin) appears to be an unemployed technical writer in Portland, OR. She is a Certified Medical Transcriptionist. Yet, she presumes to be an expert in human sexuality with: How Oregon Built A Transgender Medical-Industrial Complex On Junk Science. Oh do tell how a mountain of peer-reviewed research published to respected academic journals is relegated to “junk” status. What are the odds that this idiot has a religious objection to gender diverse people?

The subtitle of this masterpiece of critical thinking and intellectual curiosity reads:
Oregon now allows adverse gender surgery outcomes to go largely untracked, restricts health workers’ right to advise patients about the risks, and strips custody from parents who object to transgender experimentation on their children.
Aesop's challenge:
As a group of suburban Portland psychiatric nurses sat for training in late 2016, they had no idea they were witnessing a paradigm shift in public health policy. They simply wanted to know what to do about a sudden upsurge in young psychiatric patients who believed themselves to be in the wrong body. They had turned to a colleague from Oregon Health and Science University (OHSU) for help.

The reply was astonishing: The children’s claims should be taken at face value, and the children should be referred to OHSU, or like institutions, for a “Dutch Protocol” of puberty blockers and cross-sex hormones. Further, the nurses should expect such referrals to comprise 3 percent of the children in their care.
Please. People — including children — who are gender incongruent do not claim to be in the wrong body. Conservative Christians claim that those people claim to be in the wrong body. Furthermore, diagnosis and treatment is far more complex than Ms. Kirkpatrick is suggesting. The correct answer is to refer those kids to a psychiatrist for evaluation consistent with DSM-5.

The first part of a diagnosis is to determine, through the child and their parents, the duration and intensity of symptoms, A diagnosis of gender dysphoria begins with “significant distress for at least six months.” Then the kid must meet at least six of eight subjective criteria. Furthermore, according to the World Professional Association of Transgender Care (WPATH):
In most children, gender dysphoria will disappear before, or early in, puberty. However, in some children these feelings will intensify and body aversion will develop or increase as they become adolescents and their secondary sex characteristics develop …
That is why puberty blockers are delayed until the actual onset of puberty (Tanner stage 2 to 4). In simplest terms, the persistence of gender dysphoria directly correlates to its severity. Ms. Kirkpatrick would have people believe that children claim to be “trapped in the wrong body” (something they never do) and then immediately go into drug therapy. An eight-year-old, for example, is not going to receive meds. His or her transition, if required, will be through hairstyle and clothing.

Moreover, there is no “surge” as if being transgender became a fad. The treatment protocol for gender diverse children has changed. In a 2017 New Your Times piece, Dr. Jack Turban, now with Harvard Medical School, wrote:
[Ten years ago] The hope was that early treatment would “diminish the risk of a continuation of gender identity disorder into adulthood” — in other words, make children stop being transgender. Transgender youth during this time suffered high rates of depression and anxiety. By young adulthood, nearly half had attempted suicide.
According to recent research, kids who transition earlier are doing very well. They have levels of depression consistent with the general population and only slightly elevated levels of anxiety. These children are substantially less likely to harm themselves.

“They” are not going to wear me out in spite of requiring a half-dozen paragraphs to refute two paragraphs of bullshit.
OHSU has since taken down the URL, but you can find the original PDF from which all quotes are taken here.
I left the link intact. As you can see it is a post-graduate nursing student's paper, not Oregon Health & Science University policy. What? Did she think nobody would bother to look or that they would not notice the word “student?” These same people want to influence others.
OHSU is Oregon’s premiere high-volume gender center, with more than a century of experience performing gender-based medical intervention on adults. Lawmakers increasingly trust OHSU to help reshape policies “at the system, community, state and federal level,” and to shape education from kindergarten to doctoral studies, so that on-demand gender-based medical intervention, subsidized by state Medicare, is available to all ages.
Those links do not generally support what she is claiming. For example to prove “high volume” there is a link to a urologist who treats trans people. The link to support a century of gender medicine is to an old paper: Homo-Sexuality and Its Treatment. Very enlightening. Reshaping policies is supported by a link to a refutation of some discriminatory Trump administration statements, and so on.

More importantly, there is no such thing as “state Medicare.” Perhaps she is referring to Medicaid. Medicare is for people who are 65 and over. Ms. Kirkpatrick is very careless.
The effect on Oregon’s regulatory atmosphere is palpable. Oregon law now considers anyone over 15 an adult for the purpose of consenting to medical gender intervention without parental knowledge (14 when the intervention happens in a mental health setting); and health providers are immune from liability for acting against parents’ objections “in good faith.”
That is partially true. Under Oregon law a 15-year-old can consent to virtually any medical procedure without parental consent. She is claiming a cause (transgender care) and effect relationship which does not exist. The legal immunity is irrelevant. It applies to the treatment of a mental or emotional disorder or a chemical dependency.

Kirkpatrick indulges in a dissertation on the meaning of “good faith” which largely inaccurate and also irrelevant to legal immunity which is largely irrelevant to gender diversity care. I'll spare myself and readers the brain cells. Then we get:
Oregon now:
  1. Allows adverse gender surgery outcomes to go largely untracked
  2. Restricts health workers’ right to advise patients about the risks of gender-based medical intervention
  3. Strips custody from parents who object to gender-based medical intervention on their children.
I write in native HTML and the links are tedious to reproduce but I have linked to Kirkpatrick's post

Item 1 is an unsubstantiated claim by ex-trans-crank-for-a-living Walt Heyer.

Item 2 relates to bans on harmful juvenile conversion therapy. Kirkpatrick would do well to read the September 11 paper out of Harvard Medical School. It concludes that any exposure to gender identity conversion efforts leads to a lifetime of misery.

Item 3 is a 2017 blog post claiming that a woman claims that a teacher conspired to terminate her parental rights. It links to a nonexistent page at the Portland Tribune. There isn't enough information for me to track the legal case, if one exists. Nevertheless, it does not support the notion that the state “strips custody …”
She doesn't get any smarter as she continues
OHSU Distorts the Figures

To put the 3 percent claim in context, it’s helpful to consult numbers the American Psychological Association (APA) published just a few years earlier. In its “Diagnostic and Statistical Manual, Fifth Edition” (DSM-5), the APA estimated that patients believing themselves to be in the wrong body were exceedingly rare, historically comprising only 0.005-0.014 percent of the male population, and 0.002-0.003 percent of the female population.

By contrast, the OHSU told the Oregon nurses they should refer children for gender intervention at a rate between 200 and 1,500 times the DSM-5’s figures (0.03 ÷ 0.00014 = 214.29 for the lower limit of the range, to 0.03 ÷ 0.00002 = 1500.00 for the higher limit).
Needless to say, DSM-5 doesn't say anything about people in the “wrong body” but those percentages are in the manual. The generally accepted statistic is that about 0.5% of the population is transgender. The second paragraph is bullshit. A post-graduate paper and experiment does not constitute what was told to nurses by the university.

To help put this in perspective, the CDC asked a group of middle school students if they felt that they were transgender. If you look carefully at the question, they really asked if those kids had any thoughts of being gender incongruent. About 2% answered in the affirmative. Proforma this fits nicely with statistics that I am generally comfortable with. Proforma because I am about to mix two sets of data with different populations and timing differences.

Indulging my statistical fallacy, 2% with feelings of gender dysphoria to 0.5% transgender means that about 75% of youth desist before transitioning. Persistence correlates to severity so the most acute cases go on to transition. I welcome email from anyone who might have a different interpretation of the statistics. Moving along …

Actually, I am finding it difficult to move along because Kirkpatrick insists that an post-graduate paper is OHSU policy and she is out to disprove what the student has written.

The paper is actually quite well done but irrelevant to incoherent claims that the Oregon Health and Sciences University is doing anything improper or unethical but she is obsessed with the paper's 3% claim. I mean obsessed. Here is the core of what the grad student did:
Methods: This project involved 2 phases. First, an initial online questionnaire was sent to staff seeking to determine specific questions to answer in the training module. Second, an online training module was developed combining 2 online training modules from The Fenway Institute and a pre- and post-survey called the Sexual Orientation Cultural Competency Scale (SOCCS) to measure effectiveness was used and embedded in training. The span of the project was 6 months.
Results: Comparing the mean scores of the pre- and post-survey showed a statistically significant increase in clinical skills and cultural competency, with a slight decrease in negative attitudes towards transgender youth.
The Fenway Institute is an independent organization affiliated with Harvard Medical School. It is one of the nation's leading research and education centers focusing on the LGBTQ population.
Continue at your own risk
Training Pediatric Nurses in Gender Affirmation Theory

Because OHSU has denied nothing in the document, and its author clearly believed the training took place as described, I’ll refer to the event here as the “CAPU training” per its own description, with disclosure that Willamette Falls disputes that description.

According to the description of the training, nurse volunteers from the CAPU learned gender affirmation theory, a treatment protocol in which children’s identity struggles are taken as evidence that they are in the wrong body and will commit suicide unless medical professionals give them a new one. This model rejects traditional “gatekeeping,” such as waiting periods and psychiatric evaluation, and proceeds directly to pharmacological and surgical intervention on demand.
For starters, gender-affirming care is a treatment model, not a theory. There's that “wrong body” bullshit again. I am beginning to feel like I am in the wrong body. Ms. Kirkpatrick's description is not only inaccurate but psychotic. Okay, I lack the training for a formal diagnosis so I'll settle with crazy, perhaps deranged. It is the state in which I sometimes see conservative Christians when confronted with scientific realities that conflict with dogma.

Simply stated, gender-affirming care means affirming and supporting individual gender identity. Gender is a continuum with male and female at the extreme ends. It is very complex — and fascinating for people who relish nature's diversity. It is based, in part, on this 2008 statement from the American Psychiatric Association:
Being transgender or gender variant implies no impairment in judgment, stability, reliability, or general social or vocational capabilities; however, these individuals often experience discrimination due to a lack of civil rights protections for their gender identity or expression.… [Such] discrimination and lack of equal civil rights is damaging to the mental health of transgender and gender variant individuals.
None of this changes the diagnostic criteria for determining if an individual has gender dysphoria. No minor is receiving puberty blockers or hormones (let alone surgery) without a psychiatric evaluation. Did I mention that this woman is nuts? Surgery is most definitely not available on demand. It requires approvals from two mental health professionals (one known to the patient and one previously unknown) plus a year or more of “real life experience” (living as one's gender).

Puberty blockers and hormones require a psychiatric evaluation and then a referral to an endocrinologist. Kirkpatrick is confusing how patients are treated as people by medical professionals with how they are medically treated. Those are two different things.

I need to skip over a great deal of incoherent blather supported by links to trans-denial websites and blogs. Ms. Kirkpatrick is noticeably short on links to peer-reviewed research published to a respected academic journal.
Oregon did not ask, as the United States still might: To what extent does the CAPU training’s errant citation reflect upon the quality of the “substantial body of research” behind that “consensus” about gender medicine? And to what extent might public health policies based on this “consensus” be helping to turn the erroneous 3 percent figure into reality?
What “errant citation?” WTF lady? So what if the 3% is on the high side (it may have come from Dr, Sari Reisner and Harvard Medical School and Fenway)? It has no relevance. Whether it is 3%, 10% or 1% has no effect on how people are treated, socially or medically. Science is based on evidence. It is evidence which ultimately shapes medical science. The percentage of people the evidence applies to makes no difference whatsoever.
On one hand, Medicare regulators are duly skeptical about gender industry data:
Medicare is making decisions on a case by case basis on how people 65 years of age and older are treated if they are gender diverse.
And the Centers for Disease Control and Prevention now asserts that 1.8 percent of surveyed children — many of whom happen to live near major gender centers — believe themselves to be in the wrong bodies. The question remains: Will Americans check the citations and speak up? Or will they stand silently by as these numbers too become a self-fulfilling prophecy?
I mentioned this before, rounding it up to 2%. If only this idiot would learn how to read. The question that was asked is:
Some people describe themselves as transgender when their sex at birth does not match the way they think or feel about their gender. Are you transgender?
We tend to think of transgender describing people who have transitioned. The CDC used it as an umbrella term. The CDC's question clearly describes young people who might have some sense of gender dysphoria.
According to The Federalist:
Katherin Kirkpatrick is Legal Strategies Coordinator for the Kelsey Coalition, a non-partisan organization whose mission is to promote policies and laws that protect young people from medical and psychological harm. She lives in Portland, Oregon.
Give me a fucking break. The Kelsey Coalition is nothing but an anonymous website. I have speculated that it is the handiwork of trans-obsessed Dr. Michael K. Laidlaw.

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