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religion-is-a-mental-illness · 9 months

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By: SEGM

Published: Aug 13, 2023

Near-zero regret” findings among adults suffer from a critical risk of bias and have low applicability to youth

Recent research published in JAMA Surgery evaluated satisfaction and regret among individuals who had undergone chest masculinizing mastectomy at the University of Michigan hospital. The average patient age at the time of mastectomy was 27 years; no patients who were under age 18 were allowed to participate in the study.

The participants reported high levels of satisfaction and low levels of regret at an average of 3.6 years following mastectomy. The study authors lauded the “overwhelmingly low levels of regret following gender-affirming surgery,” and framed their findings as in conflict with the “increasing legislative interest in regulating gender-affirming surgery,” referring to current legislative attempts to restrict or ban “gender-affirming” procedures for minors. Another group of authors provided an invited commentary on the paper, reinforcing the view held by the study authors, and asserting the presence of a “double standard:” “gender-affirming” mastectomies have come under undue scrutiny by states’ legislators, while other surgical procedures with higher regret rates do not appear to concern legislative bodies.

The study suffers from serious methodological limitations, which render the findings of high levels of long-term satisfaction with mastectomy among adults at a "critical risk of bias"—the lowest rating according to the Risk of Bias (ROBINS-I) analysis. ROBINS-I is used to assess non-randomized studies for methodological bias. The "critical risk of bias" rating signals that the results reported by the study may substantially deviate from the truth. The results also suffer from low applicability to the central issue the study and the invited commentary sought to address, which was whether legislative attempts to regulate “gender-affirming” surgeries are warranted in minors. Unfortunately, these highly questionable findings are misrepresented as certain and highly positive by both the study authors and the invited commentators, several of whom have significant conflicts of interest.

Below, we provide a detailed explanation of the key methodological issues in the study which render its claims untrustworthy and not applicable to the patient population at the center of the debate: youth undergoing gender reassignment. We also comment on the alarming trend: several prestigious scientific journals appear to have deviated from their previously high standards for scholarly work and instead have become vehicles for promoting poor-quality research, seemingly to influence judicial policy decisions rather than advance scientific understanding. We conclude with recommendations about how journal editors can restore the integrity of scientific debate and raise the bar on the quality of published studies in the field of gender medicine.

[ For in-depth analysis, see: https://segm.org/long-term-regret-satisfaction-mastectomy-critical-appraisal ]

SEGM Take-Aways

Although this study reports extremely high rates of satisfaction and low regret, the timeframe in which these outcomes were assessed is insufficient—just 3.6 years post-mastectomy on average. The sample is also highly skewed: 50% of the participants had mastectomies in the last 3.6 of the 30 years. This skewing of the length of time since surgery is expected, given the sharp rise in the number of people (especially adolescents and young adults) identifying as transgender and undergoing chest masculinization mastectomy. It is also a short time in which to assess regret, particularly since one quarter of study participants were younger than age 23 at time of surgery and the median age of first birth in the US is 30 years.

The conclusion of high satisfaction/low regret suffers from a critical risk of bias due to the high non-participation rate, important differences between participants and non-participants, and lack of control group. Problematically, the authors misuse the (critically-biased) results from adults to argue against regulations for irreversible body alternations for minors and do so with a decidedly politicized spin.

The only intellectually honest commentary is that we do not have good knowledge of the likely rates of detransition and regret following chest masculinization mastectomy, nor do we know how many people experience regret but remain transitioned. There is an urgent need for quality research in this area. Previously, detransition and regret rates were considered to be low: they may have indeed been low due to the much more rigorous screenings, or the results may have been biased by the notoriously high dropout rates that plague “regret” research. Regardless, there is now growing evidence of much higher rates of medical detransition.

A recent study from a comprehensive U.S. dataset with no loss to follow-up revealed a 36% medical detransition rate among females within just 4 years of starting hormonal transition. At least two recent studies suggest that average time to regret among recently-transitioned females is about 3-5 years, but there is a wide range. Much less is known about detransition among those who undergo surgery. A growing number of detransitioners now express regret associated with the loss of breastfeeding ability, with one case study detailing breastfeeding grief experienced some 15 years post-mastectomy.

The study and invited commentary exemplify three problematic trends that plague studies emerging from the gender clinics: problematic conflicts of interest of the authors; leveraging scientific journals to disguise politically-motivated pieces as quality research; and a conflicted stance by the gender medicine establishment on surgery for minors. We expand on each briefly below.

Conflicts of interest of study authors and commentators

The significant conflicts of interest of the gender clinicians who study and report on the outcomes of “gender-affirming” interventions cannot be overlooked. These clinicians are conflicted financially, since their practices specialize in “gender-affirming” interventions, as well as intellectually. While conflicts of interest among experts are common, such experts should still attempt to be balanced in their discussions and should acknowledge and reflect on their conflicts of interest.

The interpretations of the data in the study is neither rigorous nor balanced, and both the study and the invited commentary have a decidedly political spin. Further, the invited politicized commentary does not disclose that at least one of the authors is a key expert witness opposing states’ efforts to regulate “gender-affirming” surgeries for minors. This role alone precludes the ability to provide a balanced commentary.

There is a fundamental problem with research emerging from gender clinic settings. The same clinicians provide gender-transitioning treatments to individual patients in their practice; serve as primary investigators and custodians of data used in research informing population health policies; and increasingly, provide paid expert witness testimony in courts defending the unrestricted availability of hormonal and surgical interventions for minors.

As a result, such clinicians cannot express nuanced perspectives. Since any balanced statements may be used against them in a court of law when they serve as expert witnesses, they must resort to the lowest common denominator of the "winner-takes-all" adversarial approach. Such an approach does not tolerate nuance. Unfortunately, this approach contributes to the erosion of the quality of the published work in the arena of gender medicine and accelerates loss of trust about the integrity of the scientific process.

Misuse of scientific publications to promote politically-motivated articles disguised as scientific research

That prestigious medical journals now serve as platforms for promoting misleading, politically motivated research that aims to apply a veneer of misplaced confidence in highly invasive, irreversible treatment should worry everyone committed to evidence-based medicine and the integrity of science. Moreover, it impairs our ability to accurately assess and improve the long-term health outcomes of the rapidly growing numbers of gender-diverse and gender-distressed youths.

This is not the first time that a JAMA has been used as a platform for positioning advocacy for “gender-affirming” care as scientific research. In 2022, JAMA Pediatrics published a study that assessed bodily happiness in a group of subjects aged 14-24 three months after chest masculinization mastectomy. Despite the very short follow up and dropout rate of 13%, the authors argued that their findings supported the premise that there was no evidence to suggest that young age should delay surgery. They also asserted that their research would help dispel the misconception that such surgeries are experimental. The editorial commissioned to bolster the authors claims was descriptively titled, “Top surgery in adolescents and young adults-effective and medically necessary.”

Another troubling trend is the misuse of statistical tools to reframe research findings that contradict the author's own position. For example, a well-known study that claimed that access to puberty blockers reduce the risk of suicide disregarded the fact that individuals reporting use of puberty blockers use had twice as many recent serious suicide attempts as their peers who did not use puberty blockers. Like the finding cited above, the doubling of suicide attempts was not statistically significant due to a small underpowered sample—but the magnitude of the effect was striking and should have tempered the authors’ enthusiastic conclusion that puberty blockers prevent suicides. Another recent gender clinic study, widely and positively covered by major media outlets, claimed that puberty blockers and cross-sex hormones led to plummeting rate of depression—even though the rate of depression among youth taking those medications remained demonstrably unchanged. More information about problems with research originating from gender clinics is detailed in this recent analysis.

Gender medicine’s stance on pediatric surgery

More generally, the gender medicine establishment is in a curious state of internal conflict about its stance on “gender-affirming” surgeries for minors. On the one hand, it has become common for advocates of “gender-affirmation” of minors to insist that surgeries for minors are not performed and anyone who suggests otherwise is spreading “scientific misinformation” and “science denialism.” On the other hand, gender clinicians publish mastectomy outcomes for minors in major medical journals, and laud surgeries for minors as “effective and medically necessary.” It is not uncommon for these opposing claims to be made by the same group of researchers and clinicians, as they test various arguments, searching for the "angle" that is most likely to convince judges and juries--and public at large--that scrutiny of the practice of pediatric transitions, which is increasingly occurring in European countries, is not warranted in the United States.

Notably, none of the European countries that are enacting severe restrictions on the use of puberty blockers or cross-sex hormones for minors have ever allowed surgeries for youth under 18. That the U.S. gender affirmation professionals continue to fight regulation of these problematic procedures speaks volumes about how far the U.S. healthcare has drifted when it comes to "gender affirmation" of minors.

Final thoughts

While it is challenging to determine how best to reduce the temperature of the highly politicized nature of the debate in gender medicine, the editors of scientific journals can begin to restore balance by recognizing how far the field has drifted from the standards of quality scientific research, and begin to expand their circle of peer-reviewers to those with diverse views. Inviting those concerned with the state of gender medicine (and not just the practices’ advocates) into the peer-review and commentary process is the first essential step to improve the quality of research published in the field of gender medicine.

The activists are predictably - and consistent with the superficiality of their own ideology - upset that anyone should look below the surface. It seems to be more troubling that anyone would notice the shoddiness of the research, than that the research is shoddy.

If this is supposed to be "healthcare," you would think that they would want the best healthcare, and be more alarmed at the misrepresentations of the study, than by people finding those misrepresentations.

Could it be that this is ideological rather than medical? 🤔

The conflicts of interest and funding sources alone are remarkable.

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a-dinosaur-a-day · 10 months

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Conflict of Interest Disclosure: because cats cause billions of bird deaths a year, I very much detest cats*. Please keep this bias in mind when reading my posts.

*I do not detest my friends' cats because I am not a monster and my friends do not let them outside. @evilwickedme can confirm.

#conflict of interest #My Bias #in fairness to me birds did not survive that asteroid just to be killed by human negligence and overeager hypercarnivores #like just keep them inside!!! inside!!! you fools!!!#gAH

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jokingluna · 3 months

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#princess luna #princess celestia #crows #court #joke #conflict of interest #Caw!

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porterdavis · 1 month

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SCOTUS shenanigans

#alito #conflict of interest

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neoninky · 5 months

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Inky: ….welp I’m conflicted

My boi Floyd, limited Noodle Edition?

Oooor Diasomnia Boss Lv. 2, Shiny Legendary Gallade Silver???? Also is it just me or is Sebek friggin EVERYWHERE right now?!

*massively torn between beloved mermafia dorm or historical dragoon drama dorm whose color scheme is deviously more appealing* HNNNNGGGGGGGG-

Also Inky: why yes Octavinelle is my favorite dorm OF COURSE-

Guest Room:

#neoninky #twisted wonderland #conflict of interest #diasomnia season is upon us #diasomnia #octavinelle #im not having a good time #decisions decisions #the decor betrays me #twst guest room #twst silver #silver vanrouge #sebek zigvolt #floyd leech #diasomnia arc #dragon dorm coming in with a vengeance

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mostlysignssomeportents · 1 year

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Clarence Thomas and the generosity of a far-right dark-money billionaire

Clarence Thomas has set some important precedents in his career as a Supreme Court justice — for example, the elevation of the unrepentant rapist Brett Kavanaugh to the bench could never have occurred but for the trail blazed by Thomas as a sexually harassing, pubic-hair distributing creep boss:

https://www.politico.com/news/magazine/2021/10/01/30-years-after-her-testimony-anita-hill-still-wants-something-from-joe-biden-514884

If you’d like an essay-formatted version of this post to read or share, here’s a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/04/06/clarence-thomas/#harlan-crow

Today, Thomas continues to steer the court into new territory — for example, he’s interested in banning same-sex marriage again:

https://www.politico.com/news/2022/06/24/thomas-constitutional-rights-00042256

And of course, he’s set precedent by hearing cases related to the attempted overthrow of the US government, despite the role his wife played in the affair:

https://www.npr.org/2022/03/30/1089595933/legal-ethics-experts-agree-justice-thomas-must-recuse-in-insurrection-cases

Thomas is not alone in furthering the right’s mission to destroy the morale of constitutional law scholars by systematically delegitimizing the court and showing it to be a vehicle for partisan politics and dark money policy laundering, but he is certainly at the vanguard:

https://pluralistic.net/2023/03/25/consequentialism/#dotards-in-robes

Today, Propublica published an expose on the vast fortune in secret gifts bestowed upon Thomas by the billionare GOP megadonor Harlan Crow, who is also one the most significant funders of political campaigns that put business before Thomas and the Supreme Court:

https://www.propublica.org/article/clarence-thomas-scotus-undisclosed-luxury-travel-gifts-crow

The story, reported by Joshua Kaplan, Justin Elliott and Alex Mierjeski is a masterwork of shoe-leather investigative journalism, drawing on aviation records, social media posts and other “open source” intelligence to expose the illegal, off-the-books “gifts” from a billionaire to an unaccountable Supreme Court justice with a lifetime appointment.

Here are a two of those gifts: a private jet/superyacht jaunt around Indonesia valued at $500,000; and a $500,000 gift to Ginni Thomas’s Tea Party group (which pays Ginni Thomas $120,000/year).

On top of that are gifts that are literally priceless: decades’ worth of summer vacations at Camp Topridge, Crow’s private estate, with its waterfall, great hall, private chefs, 25 fireplaces, thee boathouses, clay tennis court, batting range, 1950s-style soda fountain and full-scale reproduction of Hagrid’s hut.

Summer retreats to Topridge allow business leaders like Leonard Leo — the Federalist Society bankroller and mastermind who set Trump up to pack the Supreme Court — to coordinate in private with Thomas:

https://pluralistic.net/2020/09/29/betcha-cant-eat-just-one/#pwnage

They also allow top execs from PWC, Verizon and other corporations who may have business before the court to establish a warm, collegial relationship with a judge whose decisions can make billions for their employers. In its reporting, Propublica points out that Thomas got to hang out on Crow’s superyacht with Mark Paoletta, who was then general counsel for Trump’s OMB, and who has opposed any tightening of ethics rules for Supreme Court judges: “there is nothing wrong with ethics or recusals at the Supreme Court.”

Crow and Thomas also hobnob together at Crow’s Texas ranch, and at the Bohemian Grove, the Bay Area’s ultra-luxe retreat for rich creeps. Crow bought Thomas a private superyacht cruise through New Zealand, another through the Greek islands, and a river trip around Savannah, GA. He also traveled around the country on Crow’s private jet — even a short private jet trip is valued around $70,000.

Crow also makes many donations on Thomas’s behalf, from a $105,000 donation to Yale Law School for the “Justice Thomas Portrait Fund” to paying for a 7 foot tall, 1,800 lb bronze statue of the nun who taught Thomas in the eighth grade, which now stands in a New York Catholic cemetery.

This is without precedent. No Supreme Court justice in US history received comparable gifts during their tenure on the bench. Federal judges quoted in the story call it “incomprehensible,” noting that US judges bend over backwards not to owe anyone any favors, going so far as to book restaurant reservations without using their titles.

Virginia Canter, a former US government ethics lawyer of bipartisan experience said Thomas “seems to have completely disregarded his higher ethical obligations,” adding “it makes my heart sink.”

The Supreme Court’s own code of ethics prohibits justices from engaging in conduct that gives rise to the “appearance of impropriety,” but the code is “consultative,” and there are no penalties for violating it. But US judicial officers — including Thomas — are legally required to disclose things like private jet trips. Thomas did not. In general, justices must report any gift valued at more than $415, where a gift is “anything of value.” This includes instances in which a gift is given by a corporation whose owner is the true giver.

Crow is a Red Scare-haunted plutocrat who says his greatest fear is “Marxism.” He was a key donor to the anti-tax extremists at the Club For Growth, and has served on the board of the American Enterprise Institute — climate deniers who also claimed that smoking didn’t cause cancer — for 25 years.

Crow is a proud dark-money source, too, whose $10m in acknowledged donations to Republican causes and candidates are only the tip of the iceberg, next to the dark money he has provided to groups he declines to name, telling the New York Times, “I don’t disclose what I’m not required to disclose.”

Crow claims that the vast sums he’s lavished on Thomas — who, again, presides over the test cases that Crow is helping to put before him — are just “hospitality.” Crow called the private retreats with business leaders and top government officials “gatherings of friends,” and added that he was “unaware of any of our friends ever lobbying or seeking to influence Justice Thomas” while at his private estates or on his superyacht or private plane.

For his part, Thomas publicly maintains that he hates luxury. In a Crow-financed documentary about Thomas’s life, Thomas tells the camera, “I prefer the RV parks. I prefer the Walmart parking lots to the beaches and things like that. There’s something normal to me about it. I come from regular stock, and I prefer that — I prefer being around that.”

Judges often have to make determinations about conflicts of interest, and lawyers have an entire practice devoted to preventing conflicts from arising. I doubt whether Thomas himself would consent to have a dispute of his own tried in front of a judge who had received millions in gifts from his opponent.

The Supreme Court’s power comes from its legitimacy. The project of delegitimizing the court started with the right, and Democrats have been loathe to participate in any activity that would worsen the court’s reputation. As a result, the business lobby and authoritarian politicians have had free rein to turn the court into a weapon for attacking American workers, American women, and LGBTQ people.

It doesn’t have to be this way. When the Supreme Court blocked all of FDR’s New Deal policies — which were wildly popular — FDR responded by proposing age limits for Supreme Court judges. When the Supremes refused to contemplate this, FDR asked Congress for a law allowing him to appoint one new Supreme Court judge for every judge who should retire but wouldn’t.

As the vote on this bill grew nearer, the Supremes reversed themselves, voting to uphold the policies they’d struck down in their previous session. They knew that their legitimacy was all they had, and when a brave president stood up to their bullying, they caved.

https://theconversation.com/packing-the-court-amid-national-crises-lincoln-and-his-republicans-remade-the-supreme-court-to-fit-their-agenda-147139

The Supreme Court has moved America further away from the ideals of pluralistic democracy than we can even fathom, and they’re just getting started. They are taking a wrecking ball to the lives of anyone who isn’t a wealthy conservative, and they’re doing it while accepting a fortune in bribes from American oligarchs.

Have you ever wanted to say thank you for these posts? Here’s how you can: I’m kickstarting the audiobook for my next novel, a post-cyberpunk anti-finance finance thriller about Silicon Valley scams called Red Team Blues. Amazon’s Audible refuses to carry my audiobooks because they’re DRM free, but crowdfunding makes them possible.

Image: Mr. Kjetil Ree (modified) https://commons.wikimedia.org/wiki/File:US_Supreme_Court.JPG

CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/deed.en

[Image ID: An altered image of Clarence Thomas, standing in gilded judicial robes on the steps of the Supreme Court. Looming over the court is a line-drawing of a business-man with a dollar-sign-emblazoned money-bag for a head.]

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not-safe-for-democracy · 1 year

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For over 20 years, Supreme Court Justice Clarence Thomas accepted luxury gifts from GOP megadonor Harlan Crow that included vacations on Crow’s superyacht and trips on the billionaire’s private jet as well as a week each summer at Crow’s private resort in the Adirondacks.

Source

#supreme court #clarence thomas #CONFLICT OF INTEREST #john roberts #ethics violations

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ikamigami · 7 days

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I'm scared that the longer Sun's alcohol problem will be ignored the more reckless he'll act and it'll eventually lead to a drama..

"What reckless things he did?" You probably ask yourself now.

After he started drinking alcohol he became more aggressive when angry, he was flirting with Foxy when he seemed weirded out whenever ship was mentioned before, he gave Dazzle 5 boxes of Dum Dums (the smallest box that I found had 120 lollipops which is 780g of candy 😭 and he gave Dazzle 5 boxes which is 3,9 kg of candy.. 🫠) and he stole sushi for 100$.. it's a lot of money.. this restaurant lost close to 15 500 yen.. you can for yourself how much this amount is valuable but it's a lot..

So you can see that Sun acts more and more recklessly.. I'm betting that Moon's mental breakdown happened later then Sun teaching Dazzle because we know that Sun took care of Moon afterwards.. or that's what I think.. Sometimes it's really hard to tell when it comes to the timeline of events in these shows..

Anyway even if this may not seem as a big deal for you.. it may become a big problem sooner or later..

I'm afraid that Sun will do either something really dangerous or stupid and the drama will ensue..

He already broke a law because he stole something..

I'm slightly disappointed (I can't find better word) with Earth because while surprised at first that Sun wanted to give Dazzle 5 boxes of Dum Dums she let him do this eventually..

It doesn't matter that Dazzle is huge.. I think that no one should it almost 4 kg of candy.. 😕 (if human ate this amount of candy in one sitting they'd risk having cardiac problems which can end up with death)

Like I said in one of my posts I think that Earth ignores signs that Sun has some serious issues because she feels safe around her older brother and doesn't want to disrupt this. Even if it's understandable that she wants to rely on her older brother I think that she knows better than that and should at least recommend Sun going to a different therapist..

I like Earth and I'm sure that she wants to have some peace in her life after all these traumatic events that happened. Even if she was sharing most of her problems with Solar it's easy to see that she views Sun as a safe person, a safe place she can rest in..

The first person she went to after Lunar killed Eclipse was Sun. I bet that she feels comforted by the fact that Sun is the oldest and despite that he went through a lot he's still the same caring person. She views Sun as someone who is smart especially in regard to social and emotional matters..

Around Sun she lets herself act like a younger sister she is. She feels safe and lets herself act silly knowing that her older brother is right there for her..

That's why she can't be Sun's therapist. Because even if she cares about Sun deeply she favorizes their sibling relationship more than therapist - patient relation. It's because it's a conflict of interests. Sun is Earth's older brother so she seeks comfort in him so when he comes for therapy from her it completely switches their places, it flips their relationship totally..

Even if she tries her best to distance herself from being Sun's younger sister during therapy sessions it's impossible to completely eradicate the way she views him. Also it's way harder for Sun to open up to her because she's his younger sister - someone he takes care of, not the other way around..

So now when Earth is physically distanced from Sun due to him living in completely separated area from her and he's seemingly doing better - he seems more relaxed (due to alcohol intake), she ignores any signs that Sun has some serious issues because he's her older brother and she feels safe around him so naturally she doesn't want to disrupt it..

"He seems so happy. The happiest I've ever seen him. If he had a problem, he'd definitely tell me about it." - I can imagine that's what Earth is thinking to herself.

It's completely fine because it's normal that she wants her older brother to feel better.. but it's not okay that she tries to give him therapy when she clearly isn't suited to help him due to conflict of interests..

#sun and moon show #sams #sams sun #sun and moon show sun #laes earth #laes dazzle #sams moon #tw alcohol #therapy #conflict of interest

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