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#31

Off the Record / Re: Brexit and the waning days...

Last post by Gups - Today at 01:43:04 PM

It's not a question of opinion, it just is wrong and anyone saying otherwise is either lying or has believed lies without bothering to go anywhere near the report.

#32

Off the Record / Re: Israel-Hamas War 2023

Last post by DGuller - Today at 01:33:10 PM

Recent experience shows that genocide fulfillment ratio, defined as the number of innocents killed divided by number of innocents you have the capability to kill, is close to 100% for Hamas, and close to zero percent for Israel.  It's not quite 100% because Hamas chose to take some innocent civilians as hostages, but it's close enough.  Sure, you can make an argument that if you give Hamas the power to kill every Israeli, they may start using it more judiciously and the fulfillment ratio would go down, but frankly I'd rather not test that theory.

[Dr Hilary Cass said her report was not about defining "what it means to be trans" or "undermining the validity of trans identities", but about "how best to help the growing number of children and young people who are looking for support from the NHS in relation to their gender identity". Here are the review's key findings.]

#33

Off the Record / Re: Brexit and the waning days...

Last post by Sheilbh - Today at 01:32:24 PM

As background, I thought the Guardian explainer on the Cass Review was good:

What are the key findings of the NHS gender identity review?
Report by Dr Hilary Cass finds young people being let down by lack of research and evidence on medical interventions
Denis Campbell and Sally Weale
Wed 10 Apr 2024 00.01 BST
Last modified on Wed 10 Apr 2024 09.37 BST

A review into the NHS's gender identity services has found that children and young people have been let down by a lack of research and evidence on medical interventions in a debate that has become exceptionally toxic.

Dr Hilary Cass said her report was not about defining "what it means to be trans" or "undermining the validity of trans identities", but about "how best to help the growing number of children and young people who are looking for support from the NHS in relation to their gender identity". Here are the review's key findings.

The evidence

"This is an area of remarkably weak evidence," Cass writes in the foreword to her 398-page report.

Despite that, she adds: "Results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress."

When Cass began her inquiry in 2020, the evidence base, especially about puberty blockers and masculinising and feminising cross-sex hormones was "weak". That was exacerbated by the existence of "a lot of misinformation, easily accessible online, with opposing sides of the debate pointing to research to justify a position, regardless of the quality of the studies."

Cass commissioned the University of York to undertake systematic reviews of the evidence on key issues, such as puberty blockers. It found that "there continues to be a lack of high-quality evidence in this area". York academics, as part of their research, tried to document the outcomes seen among the 9,000 young people who the Tavistock and Portman NHS trust's gender identity development service (Gids) treated between 2009-2020. However, it was "thwarted by a lack of cooperation from [six of England's seven NHS] adult gender services".

The new NHS services for these young people must routinely collect evidence of what treatments work, and learn from them to improve clinical practice, the report states.

The debate

Cass acknowledges that the discussion around how to care for such young people is polarised, both among health professionals and in wider society. For example, some clinicians believe that most people who present to gender services "will go on to have a long-term trans identity and should be supported to access a medical pathway at an early stage".

"Others feel that we are medicalising children and young people whose multiple other difficulties are manifesting through gender confusion and gender-related distress. The toxicity of the debate is exceptional," the report says.

Cass has been criticised for talking both to groups who support gender affirmation – the medical approach – and also those who believe greater caution is needed. Some experienced doctors who have offered different viewpoints have been "dismissed and invalidated", she says.

"There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media and where name-calling echoes the worst bullying behaviour. This must stop."

The toxicity of debate has made some clinicians fearful of working with these young people.

The Tavistock and Portman NHS Trust

When its Gids service was set up in 1989, it saw fewer than 10 children a year, mainly birth-registered males who had not reached puberty. Most received therapy and only a few hormones from the age of 16.

But in 2011 the UK began trialling the use of puberty blockers, as a result of the emergence of "the Dutch protocol", which involved using them from early puberty. However, a study undertaken in 2015-16, although not published until 2020, shows "a lack of any positive measurable outcomes".

"Despite this, from 2014 puberty blockers moved from a research-only protocol to being available in routine clinical practice." This "adoption of a treatment with uncertain benefits without further scrutiny" helped increase the demand among patients for them, the report finds.

An NHS England review in 2019, which examined the evidence on medical intervention and found evidence of its effectiveness to be "weak", led to Cass being asked to undertake her review.

Changing patient profile

Referral rates to Gids have rocketed since 2014, but there has also been a shift in the profile of those using services. For centuries transgender people have been predominantly trans females who present in adulthood. Now the vast majority are teenagers who were registered as female at birth.

An audit of discharge notes of Gids patients between 1 April 2018 and 31 December 2022 showed the youngest patient was three, the oldest 18, and 73% were birth-registered females, according to the review, which tries to discover why things have changed so dramatically.

One area it explores is the deterioration in mental health among young people, and the links with social media, which have brought pressures to bear on them that no previous generation has experienced.

"The increase in presentations to gender clinics has to some degree paralleled this deterioration in child and adolescent mental health," the review says. "Mental health problems have risen in both boys and girls, but have been most striking in girls and young women."

Youngsters who present with gender identity issues to services may also have depression, anxiety, body dysmorphia, tics and eating disorders, as well as autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD). Referrals to Gids are also associated with higher than average rates of adverse childhood experiences, the review says.

"There is no single explanation for the increase in prevalence of gender incongruence or the change in case-mix of those being referred to gender services," the review says, concluding instead that gender incongruence is a result of "a complex interplay between biological, psychological and social factors".

Transitioning

Young people's sense of their identity is not always fixed and can evolve over time, Cass says.

"Whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down," the report says.

"For some, the best outcome will be transition, whereas others may resolve their distress in other ways. Some may transition and then de/retransition and/or experience regret. The NHS needs to care for all those seeking support."

Social transitioning

Social transitioning is the process by which individuals make social changes in order to live as a different gender, such as changing name, pronouns, hair or clothing, and it is something that schools in England have been grappling with in recent years.

According to the Cass review, many children and young people attending Gids have already changed their names by deed-poll and attend school in their chosen gender by the time they are seen.

The review says research on the impact of social transition is generally of a poor quality and the findings are contradictory. Some studies suggest that allowing a child to socially transition may improve mental health and social and educational participation.

Others say a child who is allowed to socially transition is more likely to have an altered trajectory, leading to medical intervention, which will have life-long implications, when they might otherwise have desisted.

"Given the weakness of the research in this area there remain many unknowns about the impact of social transition," the review concludes. "In particular, it is unclear whether it alters the trajectory of gender development, and what short- and longer-term impact this may have on mental health."

The review recommends that parents should be involved in decision making, unless there are strong grounds to believe this may put a child at risk, and where children are pre-puberty, families should be seen as early as possible by a clinician with relevant experience. It also suggests avoiding premature decisions and considering partial rather than full transitioning as a way of keeping options open.

Future care

The report says that in the future any young person seeking NHS help with gender-related distress should be screened to see if they have any neurodevelopmental conditions, such as autism spectrum disorder, and also given a mental health assessment.

NHS England has already in effect banned the use of puberty blockers because of limited evidence that they work. Cass found that there is "no evidence that puberty blockers buy time to think", which their advocates have claimed. There is also "concern that they may change the trajectory of psychosexual and gender identity development" as well as pose long-term risks to users' bone health, the review says.

There is also a lack of evidence to prove that masculinising and feminising hormones improve a young person's body satisfaction and psychosocial health, and there is concern over the impact on fertility, growth and bone health. There is also no evidence they reduce the risk of suicide in children, as their proponents have claimed.

Lastly, the evidence base showing whether psychosocial interventions – therapy – work for those who do not undergo hormone treatment is "as weak" as for puberty blockers and cross-sex hormones.

All this means that there is "a major gap in our knowledge about how best to support and help the growing population of young people with gender-related distress in the context of complex presentations".

Although worth noting that this is taking place in the context of a very stretched NHS. Last I read there's something like 7.5 million treatments on waiting lists in the NHS right now, that's particularly acute for mental health services. I think the ideas set out here are good - but there's lots of very good ideas and demands on NHS resources, which are limited:

Review of gender services has major implications for mental health services
Tobi Thomas Health and inequalities correspondent
Cass report calls for move away from mainly medical treatment as part of dramatic shift in approach to gender dysphoria
Wed 10 Apr 2024 00.01 BST
Last modified on Wed 10 Apr 2024 06.00 BST

A long-awaited review by consultant paediatrician Hilary Cass into the NHS's gender services for children calls for a dramatic shift in the type of treatment offered to children and young people with gender dysphoria.

The report proposes that instead of being offered mainly medical treatment, young people referred to NHS gender services should "receive a holistic assessment of their needs to inform an individualised care plan", meaning that questions of gender identity should be treated alongside other possible mental health concerns.

It found that a medical pathway, such as puberty blockers, would not necessarily be the best option for children with gender dysphoria, and should not be provided "without also addressing wider mental health and/or psychosocially challenging problems". The review suggests this "should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment".

The idea of a holistic assessment has so far been welcomed by medical experts, such as Dr Lade Smith, the president of the Royal College of Psychiatrists, who said: "Children who are gender questioning also commonly experience mental illness. It is extremely important that every child who is gender questioning has timely access to services that are holistic and respond to their individual needs."

But the proposals will have major implications for wider children's mental health services, which are already overstretched.

The waiting lists for gender-affirming care on the NHS are incredibly long. As of August 2022, there were 26,234 adults waiting for a first appointment with an adult gender dysphoria clinic, of whom 23,561 had been waiting more than 18 weeks. The number of children on the waiting list was approximately 7,600, of whom about 6,100 had been waiting more than 18 weeks.

In October, a coroner concluded that long waiting lists and barriers that prevent transgender people accessing gender-affirming care in the UK contributed to a decline in the mental health of Alice Litman, a young trans woman who killed herself in 2022.

The Cass report acknowledges that long waiting lists are a barrier to the NHS's ability to provide effective gender-affirming care. It states: "It is only when they have been on very long waiting lists, and sidelined from usual care in local services, that they are forced to do their own research and may come to a single medical answer to their problems."

However, general mental health services for young people are no better.

More than a quarter of a million (270,300) children and young people in England are still waiting for mental health support after being referred to children and young people's mental health services in 2022-23, according to the children's commissioner.

Between July and September of last year, children and young people who had an appointment for suspected autism had waited on average nine months (295 days) after their initial referral. This is despite the National Institute for Health and Care Excellence recommending that people with suspected autism should be diagnosed within three months of a referral.

Cass's report said long waiting lists for gender services were in part due to an "unprecedented" increase in demand in recent years, which created "an unsustainable service model". "Prior to 2009, Gids (the gender identity development service) did not attract significant attention. At that time, the service saw fewer than 50 children a year, with even fewer receiving medical treatment," the report states.

Since the closure of the Gids clinic at the Tavistock and Portman NHS foundation trust in London in 2023, NHS England pledged to open eight regional clinics delivering a "different model of care". The report has welcomed this, saying the regional centres "should allow care and risk to be actively managed ... reducing waiting times for specialist care". But since only one of these regional centres has opened, waiting lists will remain high for the foreseeable future.

More on the specific care recommendations:
https://www.theguardian.com/society/2024/apr/10/gender-medicine-built-on-shaky-foundations-cass-review-finds

But online I think this has all been positioned as basically the same as American states literally criminalising trans healthcare, which I think is wrong.

#34

Off the Record / Re: [Canada] Canadian Politics...

Last post by Jacob - Today at 01:12:53 PM

Time will tell. Maybe. If Carney gets into that position.

My thoughts are:

• While Carney may be easy to attack, the operative question is whether he'll be easier to attack than Trudeau.
• If voters care about the economy, someone with significant economic credibility may be an asset; especially since Poilievre still comes across as mostly fluff and little substance on that topic.
• While the Conservative line of attack on Carney might be similar to the line of attack on Ignatieff, the key issue is how well Carney responds to it - and I don't think we have any real evidence there yet.
• There are differences both in the political moment and in the resumes. Ignatieff is an academic and public intellectual, Carney is from the world of finance. That has very different vibes, even if it happened outside of Canada. "Harvard Academic" and "Head of the Bank of England while it weathered a significant crisis" sound very different to my ears (not to mention "Head of the Bank of Canada while it weathered a significant crisis").
• Poilievre's main advantage in my eyes is Trudeau-fatigue, and his main strategy is vibes based attacks and "everything sucks, right? We'll do things differently!" Seems to me that the most useful Conservative line of attack would be attempts to link Carney with Trudeau and claim "more of the same", rather than "this guy is an outsider", which would play right into Carney's likely play of depicting himself as a hard reset for the current Liberal establishment.

That said... isn't it kind of academic at this point? Is there any real chance that Trudeau is going to step down?

#35

Off the Record / Re: Israel-Hamas War 2023

Last post by The Minsky Moment - Today at 01:08:36 PM

As I see it, if one imagines a scale of military response from 1 to 10, if we assume as a matter of international law and the right to self-defense, Israel is within its rights to be at a "6" (the specific number doesn't matter for the example), there are concerns because Israel is actually at a "7."  That's a real issue and a real concern and fair basis for critical comment.  It's not anti-semitic or even "anti-Zionist" to say that Israel should back off from the "7" or even for the United States to say we don't and won't support seveny kind of behavior from the Israelis.

But the other concern is that critics of Israel are using Israel's improper prosecution of 7 level intensity as an excuse to argue that Israel MUST go to zero or at least to some very low number that leaves Hamas freedom of action and compromises Israel's security.  And in that sense the Horowitz/OvB critique has some merit.

#36

Off the Record / Re: Israel-Hamas War 2023

Last post by grumbler - Today at 01:05:06 PM

Point fails - no one is genociding Jews.

Only because of lack of capability to accomplish the task. For Hamas, the will and intent is there.

As is the will and intent to genocide/ethnically cleanse the Palestinians among members of Israel's government.  Israeli terrorism on the West Bank is being completely ignored (or even encouraged) by the Israeli government while the world is distracted by Gaza.

#37

Off the Record / Re: [Canada] Canadian Politics...

Last post by crazy canuck - Today at 01:01:56 PM

What the hell, I'll engage against my better judgment.

I stopped reading after this.

If you want to have a civil discussion.  Don't start it by being uncivil.

#38

Off the Record / Re: Israel-Hamas War 2023

Last post by The Minsky Moment - Today at 12:58:56 PM

Point fails - no one is genociding Jews.

Only because of lack of capability to accomplish the task. For Hamas, the will and intent is there.

#39

Off the Record / Re: Israel-Hamas War 2023

Last post by grumbler - Today at 12:34:56 PM

Point fails--no one is genociding Palestinians. That is part of a false narrative intended to delegitimize Israel.

The current war is one of the least deadly in modern times.

https://imgur.com/a/DHOUcW3

Point fails - no one is genociding Jews.  And no one is claiming that this war compares in total deaths to WW2.

#40

Off the Record / Re: Israel-Hamas War 2023

Last post by Razgovory - Today at 12:27:24 PM

I don't want to print a sign saying I'll burn Tehran to the ground.  First because I couldn't do it, and second because I believe that would make me a bad person.

I will continue to come here and express my negative judgement of protestors who call for more dead Israelis.  You can call it whining if you want but I see things differently.

The issue isn't whether these people are cunts. They obviously are.
Its those pointing to them and going "See! See! Anyone who dares to speak against Israel is like this! Anti zionism is anti semitism!"
Its like saying there's no difference between those criticising the Saudi or Iranian regime and the "muslims are subhuman and should all be killed" brigade

Zionism is the idea that Jews have a right to their own country.  Anti-Zionism is idea that Jews do not have a right to their own country.  There is no real comparable ideology to this.  There aren't a large group of people arguing that Iran should be abolished.  This is not about criticism, praising rocket attacks, cheering on the death of soldiers and the destruction of the cities isn't criticism.  They want Israel gone.  That is the core of the Anti-zionism movement.