Tuesday, December 10, 2019

Ryan T. Anderson and Robert P. George Have Reached Conclusions About Trans Youth

Ryan T. Anderson & Robert P. George
Ryan T. Anderson and Robert P. George
Sunday evening, Ryan T. Anderson and Robert P. George authored: Physical Interventions on the Bodies of Children to “Affirm” their “Gender Identity” Violate Sound Medical Ethics and Should be Prohibited. The outlet for this nonsense is Witherspoon Institute's pretentious blog.

I say nonsense because neither author is concerned for the welfare of gender incongruent children. Nor do they voice legitimate concern for medical ethics because ethics are predicated on medical science. Treatment of children should be in accordance with the best available evidence.

Doing so is ethical per se. Neither Anderson nor George care about the medical science. As you will see, it is what they propose that is unethical because it deviates from accepted medical practice.

This entire exercise is a pseudo-scientific effort to support the teachings of the Catholic Church. The term “gender identity” is within defense quotes because the Church teaches that gender identity doesn't exist. The Vatican has explicitly stated that Church teachings about gender are based on conforming with Genesis 1:27.

The next time that Anderson or George are ill I doubt that they will ask a physician to substitute information from ancient texts of dubious provenance for evidence-based science.

We begin with the verbose subtitle:
Rather than teaching children to identify based on how well they fit prevailing cultural expectations on sex, we should be teaching them that the truth of their sexual identity is based on their bodies, and that sometimes cultural associations attached to the sexes are misguided or simply too narrow. There is a wonderfully rich array of ways of expressing one’s embodiment as male or female.
The above is an attempt to create cognitive dissonance. It is intellectually dishonest. Gender identity is not the product of what we teach children. The notion that we teach kids to identify their gender in accordance with “prevailing cultural expectations” is pseudo-intellectual gibberish.

Gender identity is formed by the age of two or three. Parents and others treat toddlers with the assumption that their gender and natal sex are consistent. If children are subject to any influence it is cisgender affirmation. We teach children that they are what their genitalia depicts. Gender identity is independent of parental influence. They continue:
Several weeks ago, many Americans were concerned about a seven-year-old boy in Texas who was the subject of a custody battle after his parents divorced. Fights over the custody of children are always tragic, but what made this one especially disconcerting was that the parents disagreed about medical care for their son. This wasn’t just any usual medical decision for a child, where parents need to consider the treatment options and weigh the respective likelihoods of success, potential side-effects, and risks. No, this was a case where the parents favored radically different treatment options because they disagreed about the identity—the “gender”—of their little boy. One of the parents believes the child is actually a girl, a girl trapped in a boy’s body.
The above paragraph is replete with intellectual dishonesty. First of all, the parents are not on equal grounds. The child's mother is the primary care giver and she happens to be a well-respected, board certified pediatrician. The father, Jeffrey Younger, is an unemployed ne'er-do-well and pathological liar. By publicizing this case, he and a friend conned people out of $140,000 to $185,000 in donations. Perhaps more. It is unknown if any of that went to legal expenses.

In other words, daddy turned his kid into an ATM.

The greater dishonesty is that this case has little to do with the child's medical care. At seven years of age, she will not be a possible candidate for medical interventions for several years. Puberty blockers might be appropriate at age 12 to 13. Whether or not she receives medications will be based upon the persistence of the condition. Persistence is a function of severity.

By the way, the judge who upended a jury verdict in favor of the kid's mother has been recused. Throughout this saga, mom was indifferent to the media knowing that less attention to this case favored the child. Dad, on the other hand, turned this case into a means of support. He was in continuous contact with conservative Christian media. Dad's behavior has been consistent with his history of dishonesty. But I digress.

Getting back to Andergeorge:
It was this disagreement that led to the bitter battle over treatment. So, without saying anything specific about this child’s case, we want to offer readers our best take on what is at stake: the anthropology, ideology, and ethics at issue.
Again, this had little to do with treatment. Anthropology suggests that the treatment of children with gender dysphoria should have a basis in the study of our society and culture. That is bovine exhaust. Ideology is an attempt to turn a medical condition into a doctrine or philosophy. That is an intellectually dishonest attempt to change the subject.

I agree with Andergeorge that ethics are an important consideration. Medical ethics are generally defined by the best available information derived from peer-reviewed research published to respected academic journals. That research is based on evidence.

Based upon the evidence-based science, the ethics of treating gender dysphoria in children are expressed by the American Academy of Pediatrics. The AAP's policy statement defines best practices as the gender-affirmative care model.

Deviating from that policy constitutes a breach of ethics. That is particularly true when the deviation is based upon faith over science. The only way that Anderson and George can support Church teachings is to turn a medical condition into an “ideology.” When either of them can cite peer-reviewed research to support their contention they might have a legitimate argument.
In other words, the following paragraph is, well … baloney:
We argue that “gender affirmation” procedures violate sound medical ethics, that it is profoundly unethical to reinforce a male child in his belief that he is not a boy (or a female child in her belief that she is not a girl), and that it is particularly unethical to intervene in the normal physical development of a child to “affirm” a “gender identity” that is at odds with bodily sex. Childhood and adolescence are difficult enough as it is. Adults should not corrupt the social ecology in which children develop a mature understanding of themselves as boys or girls on the pathway to becoming men or women. Medical professionals certainly should not make radical interventions into the bodies of young people on the basis of a misguided ideology of identity.
Ryan T. Anderson and Robert P. George can argue anything that they want. Both men sport a PhD. Thus, we should expect that they would at least make sense. Their folly is expressed in the final words of the above paragraph: “on the basis of a misguided ideology of identity.” The criteria for a diagnosis of gender dysphoria is not on an ideology. It is based on the criteria established by psychiatric professionals and then published to DSM-5.
In children, gender dysphoria diagnosis involves at least six of the following and an associated significant distress or impairment in function, lasting at least six months.
You can read the criteria here. Note that the science provides separate criteria for adults and children.

Neither Ryan T. Anderson nor Robert P. George have the erudition to assess the science. They do cite some research dishonestly in order to quote:
With approximately one-third of TGD [transgender and gender diverse] adults and 40 percent of TGD youth identifying as nonbinary, care guidelines that reinforce binary systems of gender identity may limit access to clinical services and restrict the ability of nonbinary people to navigate medical systems. Framing gender as solely binary defines therapeutic options and outcomes only in reference to two gender experiences, which impacts access.
They are absolutely appalled that gender is nonbinary:
Moving beyond the binary is the next horizon of medical intervention. It also requires moving beyond medical diagnosis. Indeed, the most recent proposals for “gender care” assert that it need not be based on any diagnosis of gender dysphoria at all, and should merely operate based on an individual’s choice—provided the individual give “informed consent” for that choice.
They do not, and cannot, cite science in conflict with the research that they referred to. It begs the obvious question: As a parent, if you had a child in distress from gender incongruence, should his or her care be based on the best available science or on (as in this case) the ideology of the Vatican? And before you answer that question, keep in mind that the child's distress creates in the child a propensity for self-harm.

They mention the “informed consent” model. This was developed at the Fenway Institute in Boston, at least in part with the guidance of Dr. Sari Reisner at Harvard Medical School. Fenway Institute has published a brochure regarding the treatment of children. At its core is legal (parental or guardian) consent and this:
Demonstrated long-lasting, non-traditional gender identity that results in significant distress or gender dysphoria.
The brochure for adult care is titled: Information on hormone therapy for adults age 18 and over using an informed consent model of integrated care. What does the “informed consent model” entail (in part)?
Persistent, documented gender dysphoria (this is part of what you will discuss with your provider)
So even for adults, where Anderson and George have strayed, informed consent does not mean hormones on demand.

Have another helping of baloney with green mold:
Affirming Falsehoods, Mutilating Bodies

The philosophical problems highlight why this treatment protocol is misguided—indeed, why it violates sound norms of medical ethics. The purpose of medicine is to bring about human health and wholeness, human flourishing in the physical and psychological domains. Here health is understood not as the satisfaction of desires but as the well-functioning of the mind and body, where our various bodily systems achieve their ends—the circulatory system to circulate blood, the digestive system to digest nutrients, the respiratory system to absorb oxygen, etc.—and where our thoughts and feelings achieve their ends of bringing us into contact with reality. Thus, any medical intervention intended to affirm someone’s false beliefs is inherently misguided. Affirming a falsehood via medical technology gets it wrong, right from the start.
“Mutilating bodies?” Hyperbolic nonsense because children are not candidates for gender confirmation surgery. They are arguing that gender identity is a falsehood if it conflicts with natal sex. Then they are saying that medical science “gets it wrong.”

Anderson was a music major turned philosopher. George is a lawyer. The care of children (which is at least what their title refers to) should be based on the best available science. Neither of these gentlemen have the training or experience to attack the science. They assert that gender-affirming care represents “the satisfaction of desires” as if it is gratuitous.

I have news for both of these people. A child in distress does not require a medical intervention to affirm their gender. They are inexorably drawn to do so without the assistance of anyone else.

Anderson's and George's polemic is full of preposterous hyperbole. The do just the opposite with gender dysphoria. They attempt to understate a child's understanding of their gender as some sort of false desire. Tell that to a kid in considerable distress or their parents.

The parents' response to this religious drivel will be one word: “Bullshit.” Shame on Ryan T. Anderson and Robert P. George for attempting to conform medical science to the teachings of the Catholic Church. They are not only manipulating the best science regarding treatment but they are falsely portraying what medical science knows about people (particularly children) with gender dysphoria.

Anderson and George go on to provide “Five Points to Remember.” I am going to give each a drivelectomy because Andergeorge are painfully verbose:

First, these procedures are entirely experimental. There is not a single long-term prospective study of the long-term consequences of blocking an otherwise physically healthy child from undergoing normal pubertal development. Indeed, the drugs being used to indefinitely delay normally timed puberty are not FDA-approved for this purpose and are being used off-label.
Of all the prescriptions provided in the United States 25% to 33% are off-label. Furthermore, the FDA has determined that GnRH agonists are safe for children. Allow me to quote from the AMA Journal of Ethics (emphasis per original and the subject is puberty blockers):
…are these prepubescent children able to provide consent for the treatment? Giordano says that they can, so long as the clinician discusses all potential risks and benefits, as he or she must do with any experimental drug. Because this is the only therapy available for children with GID, it might be considered unethical to deny this treatment option.
Just to be clear, children must provide consent in addition to parental consent. Furthermore, in the United States, prepubescent children do not receive puberty blockers. Rather, puberty blockers are provided they begin puberty at Tanner stage 2. Later on in the same article:
It would be unethical to allow a patient to suffer through the distress of pubertal development when we have a way of preventing the distress it causes. Children and adolescents who suffer from gender identity disorder face significant physical, psychological, and social challenges, and receiving an inconsistent standard of medical care adds to those challenges.
According to Google Books:
[Dr.] Simona Giordano is Senior Lecturer in Bioethics at the School of Law, University of Manchester, UK. She is Programme Director of medical ethics teaching in undergraduate medical education in the School of Medicine, and also teaches for the Master and Postgraduate Diploma in Healthcare Ethics and Law. Simona is a member of the UK Register of Exercise Professionals, and qualified as an exercise instructor in 1999.
Point 2:

Second, parents are told that these procedures are “fully reversible,” but that is not true. Going off of puberty-blocking drugs, with the hope that development resumes, does nothing to reverse the delayed biologically appropriate development. You can’t go back in time and reverse that delay.
They cite no evidence to support this contention. According to the Mayo Clinic (emphasis added):
Use of GnRH analogues doesn't cause permanent changes in an adolescent's body. Instead, it pauses puberty, providing time to determine if a child's gender identity is long lasting. It also gives children and their families time to think about or plan for the psychological, medical, developmental, social and legal issues ahead. If an adolescent child stops taking GnRH analogues, puberty will resume.
Point 3:

Third, many experts fear that these treatment protocols are self-fulfilling. Telling a little boy that he is a girl (or something else) or a girl that she is a boy (or something else), blocking his or her natural biological development into a man or a woman, and then flooding him or her with opposite-sex hormones will simply reinforce false beliefs.
No one is telling a little boy that he is a girl. It is just the opposite. With considerable certainty a gender dysphoric child whose natal sex is male is telling parents and clinicians I am a girl.
Lack of Diagnostic Rigor, Especially for Immature Children

Fourth, while the diagnosis that someone “is” of the opposite sex is medically and scientifically baseless, it is particularly outrageous when applied to children.
Nonsense. Again, they cannot offer any evidence to support their contention. A philosopher and a lawyer are claiming that the criteria published to DSM-5 is without a scientific basis. Furthermore they are ignoring the fact that the diagnostic criteria for adults and children are different. Children must be in severe distress for at least six months and must meet six of eight subjective criteria to be diagnosed with gender dysphoria.
Reassignment Doesn’t Produce Good Outcomes

Fifth, and finally, not only is sex reassignment physically and metaphysically impossible, it doesn’t even produce good psychosomatic results. So even if you disagreed with us about the philosophy of the body and the medical ethics of “transitioning,” you would still need to be concerned that an entirely experimental, self-fulfilling treatment protocol that is based on nonsensical diagnostic criteria doesn’t even produce the desired outcomes of happiness and wholeness. Forty-one percent of all adults who identify as transgender attempt suicide at some point in their lives, and adults who have had sex reassignment surgery are nineteen times more likely than the general population to die by suicide.
“Metaphysically?” Please. GMAFB. There is a cite in the above to another idiotic post to Witherspoon's blog by Ryan T. Anderson. First of all, this is supposed to be about children. Surgery applies to adults. Furthermore, recent research concludes that there is overwhelming satisfaction with gender confirmation surgery measured by a quality of life assessment.

I believe that the suicide statistics they quote is from a study assessing transgender surgery recipients going back 40 years. Surgery did not reduce minority stress. Anti-trans diatribes from religious lunatics increases minority stress. Nice job boys.

Included in point 5 is this bit of bullshit which I am paying attention to only to demonstrate how thoroughly dishonest these two are:
As even the Obama Administration reported in 2016, the best studies of sex-reassignment procedures “did not demonstrate clinically significant changes or differences in psychometric test results” after the reassignment.
They cite an Anderson post which cites a Proposed Decision Memo for Gender Dysphoria and Gender Reassignment Surgery. What Anderson and George sort of forgot to mention is that this applies to Medicare. I agree! I'm not sure that gender confirmation surgery is warranted for senior citizens. Nevertheless, in the same memo, they said that they would make determinations on a case-by-case basis.

One more time, the title of this idiocy is: Physical Interventions on the Bodies of Children to “Affirm” their “Gender Identity” Violate Sound Medical Ethics and Should be Prohibited. What does any of that have to do with children? WPATH recommends that only adults are candidates for surgery.

I have not addressed two-thirds of this tirade. You can read it in full if you have some brain cells to spare. While they do not cite science to support their views Anderson and George provide numerous links to purchase Anderson's idiotic book on this subject which is nothing but an extension of the catechism.

I expect this kind of gibberish from Ryan T. Anderson. He is an over-educated religious zealot with the critical thinking skills of toilet tissue. I am disappointed in Robert P. George. In 2015 George had a meltdown over the ruling in Obergefell v. Hodges. He went so far as to promote nullification. Since then he mellowed on LGBTQ issues. George even came to the defense of Father James Martin who has questioned Church teachings regarding gay people.

Dr. George has considerable skill. I cannot imagine why he would lend his name and gravitas to something that is so profoundly dishonest.

The audience for this trash are like minded religious conservatives. What happens when one of them has a gender incongruent child? Are they going to risk a child's life to conform to the expectations of George and Anderson who torture medical science to conform to the teachings of the Catholic Church? Hopefully, they will consult with a secular psychiatrist for a proper evaluation.

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