Wednesday, December 16, 2020

Spreading Misinformation About Trans Youth

Hans Bader claims to have a law degree from Harvard. Nevertheless, Bader is attempting to conform medical science to scripture. The outlet for Bader's rhetoric is L. Brent Bozell III's cnsnews.

Bozell, by the way, is on the board of the Catholic League which does not file required annual reports with the IRS. Sorry but it is one of those things that infuriates me. But I digress.

According to Mr. Bader: Transgender Treatment Is Medical Malpractice for Many Teens. Apparently his law degree provides medical erudition.

It is the usual religious nonsense disguised as secular concern for children.
Growing numbers of teenagers are being given puberty blockers after being deemed transgender. Those puberty blockers can lead to fragile bones, hip fractures, and other harms caused by early-onset osteoporosis. Teens are not being informed about this potential harm by most doctors and clinics that profit from performing transgender treatments. That is classic medical malpractice, in my view, and the view of other lawyers who also have practiced law for decades.
“Other lawyers” are anonymous validators. Earlier today I wrote about the Endocrine Society and the Pediatric Endocrine Society. The two organizations have issued a position statement regarding the treatment of gender-diverse youth. In doing so the experts regarding puberty blockers have established clinical practice guidelines.

What really bothers me about Bader's BS is the notion that interventions are somehow gratuitous and the patients are not fully informed. Presumably, Mr. Bader has not spoken with clinicians who actually treat pediatric gender dysphoria. Nor has he reached out to the parents of gender-diverse youth.

Typically a kid and his or her parents first see a behavioral health professional for a diagnosis. Then a second opinion. Then they receive a referral to an endocrinologist. Aside from legal responsibilities which require the informed consent of a minor's parents, Mr. Bader is reckless in claiming that children and adolescents are not fully informed.

Nothing could be further from the truth than claiming an absence of informed consent. The youth and parents are fully informed in order to make sure that they report adverse events. Aside from that, these are caring clinicians. Everyone I have spoken with has demonstrated great concern for the wellbeing of these kids who are especially vulnerable.

Yes, there are potential side effects from using puberty blockers which Bader is greatly exaggerating. It is the equivalent of telling someone not to take aspirin for a headache because you could get bleeding ulcers.

One of the most common forms of puberty blockers is SUPPRELIN LA which is an implant that provides puberty suppression for one year. The manufacturer has established patient counseling guidelines. The notion that these are not followed is absurd.

Doctors have a general adversity to being sued because it not only damages their reputation but it increases the cost of malpractice insurance. Informed consent is essential. I doubt that Mr. Bader can provide evidence to parents and children who have received puberty blockers without proper guidance.
Non-expert “experts:”
As Michael K. Laidlaw, MD, notes, "'treatment' with puberty blockers is leading these adolescents to a much higher risk of early osteoporosis and fractures." Normally, bone density increases a lot during adolescence -- but not for teens on puberty blockers, which prevent this essential process at a key time in life. As Will Malone, MD notes, "humans acquire more than half the bone density they will ever have during their teen years. This is the most critical time for long term bone/skeletal health."
Dr. Laidlaw is not board certified. Dr. Laidlaw does not treat transgender people. Dr. Laidlaw is best known as a Defender of the Faith™.

William J. Malone is board certified and practices in Idaho. He is also a religious crackpot who does not treat transgender people. His expertise is in diabetes and metabolism and he is at odds with his own professional organization.

Both doctors subscribe to the religious theory that there is no such thing as a transgender person.

More importantly, what both doctors fail to do is to compare benefits to risks. Perhaps they are unable to do so because they do not treat gender dysphoria. 

Aside from the Endocrine Society and the Pediatric Endocrine Society, the American Academy of Pediatrics' established clinical practice guidelines are based on the gender affirming care model.

Neither doctor is willing to consider the risks of not treating acute pediatric gender dysphoria. They have aerosol fog handy which is used obscure reality with the claim that a majority of kids grow out of the condition. While that is true, persistence is a function of severity. The kids who do grow out of it never transition in the first place.
As Dr. Laidlaw observes, puberty blockers sabotage this process: "Bones that should be rapidly building were blocked from doing so. Normal physiologic function was pathologically altered by puberty blockers." Most of this is irreversible: Adolescents can never regain the years lost to the blockade of normal bone, brain, and pelvic development.
Laidlaw's “observations” are not really observations given that he does not provide puberty blockers. More importantly he is at odds with the Endocrine Society which asserts that puberty blockers are fully reversible. Mr. Bader likes what he is hearing which precludes sufficient intellectual curiosity for him to understand the issue.

I have observed (real observation) that the religious zealots do not want to even hear opposing points of view. They are dogmatists who accept, as incontrovertible truth, religious teachings without evidence, despite evidence to the contrary and in spite of the learned opinions of others.
Transgender teens and their parents are not being informed of this risk. Instead, notes Dr. Laidlaw, "the trans industry sets out to deceive patients, parents, and the legal system to push their drug (high dose hormone & pituitary blocker) based ideology."
Laidlaw offers no evidence to support his religious rhetoric that parents and children are not informed of the risks. It's all a sinister conspiracy to make more money. Laidlaw doesn't seem to think very much about his own professional colleagues.

Pro forma:
Malpractice litigation against gender-transition clinics got a boost recently from a court ruling in the United Kingdom, which called into question whether teens below age 16 can consent to certain transgender treatments. As The Wall Street Journal's Abigail Shrier notes, "Keira Bell prevailed in UK court based on the simple idea that those under 16 can't give real consent to gender treatments" with "irreversible consequences." The court "noted the clinic couldn't explain" the sudden "spike in adolescents seeking transition - nor why they were overwhelmingly teen girls."
I have written about this before. and I have been in touch with the folks at the Tavistock clinic. The parents of children under 16 are certainly capable of providing informed consent. The Court did not address that issue. It is up in the air.

I am not going to indulge Abigail Shrier with more ink in exchange for her profound ignorance.
Being “gender affirming” shouldn’t be an excuse for a doctor to commit medical malpractice. But that may be happening in many cases.

The National Review provides a possible example. Doctors affirmed a man’s false belief that he had a female gender identity, and then mutilated his body by giving him a sex change he came to regret.
[…]
He says he was never given an independent psychological evaluation before getting surgery.…
The above seems highly unlikely. WPATH guidelines, hospital guidelines and surgical requisites all include two behavioral health referrals. One from the psychologist the patient regularly sees and one from a psychologist who has never previously evaluated the patient.

In addition, there is a requirement for one year of real life experience; living as the patient's gender. If a surgeon is not following WPATH guidelines then, yeah, sue his ass off. Nevertheless, Bader's post is about the treatment of youth. No one is providing gender confirmation surgery to anyone under 18 years of age.

There is more to this verbose post. It's all pointless. It is the opinion of every mainstream medical association that youth in distress from gender dysphoria are best served with gender-affirming care. That is based on the best available medical science published to respected academic journals with robust peer-review.

Hans Bader offers no evidence that he has spoken with clinicians who actually do provide transgender care. If he has not then Mr. Bader is being irresponsible. Bader's rhetoric is offered by a conservative Christian outlet rather than a more discerning medium.

Who is he trying to convince and why? State legislators who are plumbers, chiropractors, farmers, lawyers and shopkeepers? 

The medical professionals who do understand this matter have beaten back every effort. Any parents who would follow the advice of a lawyer rather than a qualified doctor require adult supervision themselves.

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