Monday, April 27, 2020

I would be less "antagonistic" if they were honest

The religious right has little concern for the fate of transgender people. Their only interest is defense of Christian dogma.
I received a painfully verbose email over the weekend accusing me of being antagonistic and openly hostile to religion. The animus is selective.

My antipathy is generally reserved for those who feign concern — even “love” — for LGBTQ kids when their real interest is in preserving the authority of their religion.

Case in point is Jane Robbins who writes at Witherspoon Institute's pseudo-intellectual blog (edited by Ryan T. Anderson): The Impossibility of Informed Consent for Transgender Interventions: The Paradigm.

Ms. Robbins would like people to falsely believe that she is concerned for the well-being of the LGBTQ people she disapproves of. In point of fact, Robbins, who is a lawyer, believes that she must be a robust advocate for her assumed client: Christianity.

The truth is that Robbins' real concern is for the authority of conservative Christian teachings. Aside from her current piece of prose, Robbins has a history of attempting to discredit gender-affirming clinicians.

Robbins — as a Defender of the Faith — seemingly wants people to distrust the science and the scientists. She has, at times, made the attacks personal. Faith-based dogma becomes more persuasive if she can dismantle the evidence-based research:
Assisting a gender dysphoric patient in “transitioning” without laying out the full panoply of medical, psychological, and social consequences violates the physician’s ethical obligation to obtain truly informed consent. The first of two essays.
The tell in the above is that the word transitioning is within smear quotes. The first sentence is actually true but Robbins' goal is to suggest that clinicians are not meeting their informed consent obligations.

In other words, she is claiming that transgender people are making reckless decisions. They are being misled by reckless doctors whom people should not trust.
[Informed consent] becomes substantially more complex when the patient suffers from gender dysphoria and if the contemplated medical intervention is so-called gender-affirming treatment (GAT). GAT could involve administering drugs called GnRH agonists to block normal puberty; administering cross-sex hormones to diminish the appearance of the biological sex and create the appearance of the desired gender; and surgically removing sex-specific body parts and perhaps fashioning imitations of others.
Why would informed consent for GnRH agonists taken as puberty blockers be any more complex for a patient with pediatric gender dysphoria than a patient taking the same drug for other conditions such as prostate cancer? There's that old saying: “Baffle 'em with your bullshit.”
Because this area of medicine is so new and indeed experimental, medical providers disagree about appropriate interventions and certainly about the paradigm for obtaining informed consent from patients (or from the parents of minor patients). The consequences of GAT extend far beyond physical outcomes. They encompass mental health, family relationships, intimate relationships, and overall ability to function in society over the long term.
It's really not so new. The first recipient of gender confirmation surgery was probably Dr. Allan L. Hart (no relation) who was a radiologist, tuberculosis researcher and novelist. Dr. Hart received his surgery over 100 years ago.

“Experimental” is misleading given the amount of research in this area. Later on, Robbins provides a link to another polemic at Witherspoon by Paul R. McHugh (another cultist) to support the notion that “medical providers disagree.” Very persuasive indeed.

As for the behavioral health consequences, a 2014 Dutch study of transgender adolescents who received puberty blockers and then hormones reveals that they turn out just as happy as their peers, avoiding the depression and anxiety often associated with transgender youth.

That research has been repeated several times with the same results. Rather than mental health “consequences,” gender-affirming care yields mental health benefits. Family? The mental health of kids with gender dysphoria is enhanced with parental support.

As for the “overall ability to function in society over the long term,” that depends, to a large extent, on how transgender people are treated by others. Acceptance decreases when people listen to religious fools with a medical opinion.
Too many GAT practitioners either do not recognize this reality or consider themselves bound to inform the patient only about physical consequences, and only those related to their particular area of practice. …
How many clinicians has Robbins spoken with in order to appreciate what they believe? None? She is asserting an opinion based on mind reading as fact.
Thoughtful analysis of these thorny issues comes from Dr. Stephen B. Levine of the Center for Marital and Sexual Health at Case Western Reserve University School of Medicine. Relying on his extensive experience treating patients with gender dysphoria, Levine wades into the medical/psychological/political morass that transgender treatment has become. …
Witherspoon has one of the links wrong but Dr. Levine has authored two papers on informed consent: Informed Consent for Transgendered Patients (2018) and Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria (2017). In the first of those articles, Levine writes:
The World Professional Association for Transgender Health’s Standards of Care recommend an informed consent process, which is at odds with its recommendation of providing hormones on demand. With the knowledge of these 12 risks and benefits of treatment, it is possible to organize the informed consent process by specialty, and for the specific services requested. As it now stands, in many settings informed consent is a perfunctory process creating the risk of uninformed consent.
I do not agree with the premise that WPATH recommends providing hormones on demand but I am not a physician. Nowhere does Dr. Levine imply that the concerns outweigh the benefits of gender-affirming care which is what Robbins is trying to sell.

Levine thinks that informed consent needs to be improved. Good for him. In the 2017 article, Levine writes:
… clinical science has a rich tradition of resolving controversy through careful follow-up, which is not yet well developed in this arena.
Dr. Levine is a gender-affirming practitioner. In a 2015 interview with Diane Sawyer (as part of her interview with Caitlyn Jenner), Dr. Levine offers:
As Dr. Levine tells us, sometimes the most important step before any medical intervention is understanding. “I want every parent with a gender atypical child,” Levine tells ABC, “to be fascinated with that child, to be interested in that child, to protect the child and to help the child understand the world.”
Ms. Robbins is full of opinions:
Levine illuminates the folly of assuming that every gender-dysphoric individual must be automatically affirmed in his desire to live as the opposite sex and be offered GAT upon demand.
Levine does not write about the generally accepted treatment protocol. His concern is for people to have a comprehensive understanding of risks and benefits. As a lawyer, Robbins should realize that medical malpractice litigation is often about reasonable expectations.

Robbins would prefer that patients are turned away from gender affirmation. That is not a function of medical science but one constituted from religious beliefs.

Robbins wants to pass herself off as someone with deep concerns for people with gender dysphoria. That is unadulterated bullshit. Her concern is for Christian teachings which, on this subject, (I know it is tedious to repeat) are the result of avoiding a conflict with Genesis 1:27.

I am reasonably certain that medical treatment should not be based on ancient texts written by people at a time when the average human life expectancy was around 18 years of age.
Assumptions about assumptions
This normalization of gender dysphoria (GD) has been driven less by scientific research into the causes and treatment of the condition and more by political advocacy focused on the civil rights of a sexual minority. A prominent influence has been the World Professional Association for Transgender Health (WPATH).
The above is more baffling bullshit. Over the last decade, based on scientific research (not politics), the treatment protocol for adolescents changed from preventing transition to enabling transition through a measured approach. The total number of trans people probably hasn't changed but they are transitioning earlier in life.

Therefore, there are more gender-diverse youth in public schools. This reality caused the Obama administration to offer guidance into transgender accommodations in public schools. This, in turn, caused the religious right to blow a gasket. Disapproved people were being accommodated by a disapproved president.

The influence of WPATH is most prominent in the Standards of Care, not political activism.
Contrary to its name, WPATH is not a medical organization—while many of its members are medical or mental-health professionals, there is no such requirement for membership. WPATH is thus unduly influenced by political activists …
There is no way for Robbins to draw conclusions over who is influencing WPATH. Her assertion is dishonest. She is trying to discredit the organization in order to discredit the Standards of Care. The SoC is a work of medical science, not political activism.
More dishonesty
[The 2011 Standards of Care] decreed that even children and adolescents should be trusted to decide what sex they are and to have their wishes honored. WPATH thus de-emphasized the role of the mental-health professional in determining whether and when a patient should be offered GAT …
The above is simplistic BS. Children in distress due to gender dysphoria will often attempt to relieve their anxiety and depression by transitioning. To “decide what sex they are” is an attempt to suggest something that is trivial.

In no way, whatsoever, has WPATH diminished the role of mental-health professionals. Gender-affirmative care, before puberty, consists of changing attire and, perhaps, hairstyle. After an adolescent enters puberty he or she might receive puberty blockers which are fully reversible.

Included in the above link to the Pediatric Endocrine Society is this (emphasis added):
Support of gender-affirming care derives from scientific evidence showing that such care improves the well-being and mental health of transgender youth …
The BS of an outlier offered as evidence of a standard which does not exist
The WPATH model is duplicated in one offered by an advocacy group called Informed Consent for Access to Trans Health (ICATH). Decreeing that “[psychotherapy] is an option, not a requirement, for accessing gender confirming health care,” …
Robbins linked to the wrong site. ICATH does not present a duplication. (How does she know the content?) According to ICATH (which consists of nothing more than a Wordpress.com blog):
Informed consent is the process that happens between you and your medical provider: the medical provider describes the intended effects and side effects of the treatment; after you have been informed of the effects and potential side effects, you may choose to give consent to receive the treatment.
Apparently they are trying to eliminate the psychiatric approval, whomever “they” might be. While I am cis and lack perspective, I think that they are wrong.

This is the After the Ball process. After the Ball is a book authored in 1989. The religious right claims that it represents the homosexual agenda. Lots of religious people seem to know about this book but no gay people seem to have read it.

Similarly, I never heard of ICATH before. Given that Robbins is quoting from a link that does not work, I gather that this is circulating among the religious set. This is supposed to introduce a danger which is nothing more than an artifice.

Surgeons and endocrinologists are likely to continue to ensure that patients qualify for certain treatments. Doctors run small businesses and medical malpractice insurance is already very expensive. It skyrockets after malpractice litigation.
According to Levine, the WPATH/ICATH model blends an entirely medical explanation for transgenderism (diagnosing GD as the wrong body rather than a confused mind and “curing” it with GAT) and a political view that focuses on minority rights (patients, even minor patients, are entitled to any treatment that helps them fulfill any gender expression they wish).
There is no WPATH/ICATH model. ICATH is different and irrelevant and Levine does not claim that gender affirming care “cures” anything. Symptoms are alleviated. Robbins is trying (I think) to suggest that Dr. Levine claims that gender dysphoric people are confused. That is religious drivel — not medical science.

Furthermore, gender-affirming care isn't provided to help people fulfill “any gender expression they wish.” Gender affirmation is intended to relieve distress. In doing so, it saves lives. That is not opinion but fact.
Misrepresentation
Levine contrasts the WPATH/ICATH approach with what he labels the Developmental Paradigm, which treats gender dysphoria as resulting from the interaction of changing biological, social, psychological, and cultural forces.…
There is no “WPATH/ICATH approach”. The minuscule ICATH is irrelevant and WPATH does not accept informed consent as a substitute for psychiatric approval.

Nor does Levine label anything the “Development Paradigm” in that fashion. Robbins is trying to muddy the waters by falsely claiming that gender identity is a political and social construct.
The bottom line is that what was not long ago recognized as a mental disorder has now been pushed by professional and political activists into the realm of the perfectly normal, and indeed an entitlement.…
The above is a familiar form of sophistry. “Not long ago” does not translate to: It was right then and it is right now. Medical science progresses and the overwhelming majority of that progress provides improvement.

This idea that gender-affirming care is the result of political activism is false. And what does “normal” mean? What is perceived as normal is the many expressions of human sexuality in terms of gender identity and sexual orientation.

“Entitlement?” What does that even mean? A small percentage of humans are gender incongruent. Being so does not require anyone's permission. It's just another way of expressing one of conservative Christianity's favorite saws that sexual minorities seek and require their approval.
What risks are practitioners ethically obligated to explain? And if they do so, have they achieved fully informed consent? In tomorrow’s essay I will discuss these issues.
Jane Robbins hasn't the vaguest clue about any of that. And none of this has anything to do with informed consent.

In October, 2018 the American Academy of Pediatrics published a paper titled Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Therein, the AAP issued clinical practice standards for the gender-affirming care model.

The Christian right pitched a fit and has been trying to discredit gender affirmation ever since. They do not approve of transgender people. Jane Robbins does not approve of transgender people. She is an advocate of some form of toxic conversion therapy.

Her advocacy does not reflect what is best for gender incongruent people but is based on Christian apologetics. Robbins is indifferent to medical science.

If some trans kid kills herself, people like Robbins will blame everyone but themselves. How many times have we seen it written by religious fanatics that transgender people should not be affirmed because of the high suicide rate? It is not only dishonest but insidious.

I will remain cranky for as long as religious zealots attempt to dishonestly conform medical science to scripture. Doing so does not serve the best interests of patients.

Related content:



No comments:

Post a Comment

Please be civil and do NOT link to anti-gay sites!

Note: Only a member of this blog may post a comment.