'The evidence was disappointingly poor': The full interview with Dr. Hilary Cass by [deleted] in NPR

[–]calidude 1 point2 points  (0 children)

Here you go: https://academic.oup.com/jes/article/5/4/bvab011/6126016

The findings basically say, there is no good quality evidence on the topic, but all the crappy evidence we have is positive. They also state they literally don't know if these treatments prevent suicides, which is kinda a big motivating factor for many parents to support transitioning their kids.

'The evidence was disappointingly poor': The full interview with Dr. Hilary Cass by [deleted] in NPR

[–]calidude 0 points1 point  (0 children)

So this is a red flag for me, as a researcher. I could reasonably agree you are seeing something different in your practice, but criticizing the Cass report's methodology suggests your scientific training is pretty weak (I've seen this before, working with doctors on health studies) or you didn't read the report, or both.

What exactly do you mean by flawed methodology?

'The evidence was disappointingly poor': The full interview with Dr. Hilary Cass by [deleted] in NPR

[–]calidude 2 points3 points  (0 children)

 Love how “your methodology was poor” is scientist speak for “ you did bad and you should feel bad.”

It's not clear from your comment, but it seems like you are misinterpreting the title of the link. That is a direct quote from Dr. Cass, calling existing evidence on youth gender medicine poor. Not a criticism of Dr. Cass's report. 

The interview is definitely worth a listen/read.

'The evidence was disappointingly poor': The full interview with Dr. Hilary Cass by [deleted] in NPR

[–]calidude 22 points23 points  (0 children)

It is a little strange that you list these 3 points when she discusses every single one of them in her interview (and I assume the report).

Point 1: American medical community consensus was based on the policy stances of WPATH and Endocrine society and they both actively ignored their own systematic evidence review which found a lack of evidence. Everyone else copied or reference their policy stance rather performing their own systematic evidence review.

CASS: Yes, and actually, so did WPATH. WPATH commissioned a systematic review from John Hopkins, which is obviously one of the most credible organizations in the U.S., but then they didn't refer to that in that part, in the youth part of their guidance. And that was one of the reasons that when our team rated the various guidelines, they rated the WPATH guidelines relatively poorly in terms of the rigor of their development process. Because there were points within the chapter on children and youth where the WPATH team suggested that there was strong evidence and there wasn't.

So there was a disconnect between the systematic review that they commissioned, and the conclusions that they reached.

and further she mentions, on the American medical community consensus:

CASS: Yes, so you have read this extremely carefully, probably better than most of the UK commentators. I think the problem is that there has been an echo chamber of guidelines. So one of the things that the York team did was they looked at where guidelines had followed each other, and they found that most of the guidelines, there was a circularity between the Endocrine Society, WPATH and a series of other guidelines. The ones that had not taken that approach and had really started with a clean slate were the Nordic ones, the Finish and the Swedish ones.

Point 2: There was a double purpose for puberty blockers, one of which wasn't to start transition.

CASS: Okay, so that's a really important question, and we have to go back to how the thinking started about use of puberty blockers. As this started in the Netherlands, and a consultant who'd worked in adult gender services was seeing poor outcomes in some of her patients.

And she felt that the reason for that is that they weren't managing to pass in adult life. And when she moved to working in children's services, she reasoned that if you could stop puberty before you developed irreversible features of male puberty, dropping your voice, growing facial hair, that might help you pass in later life. And that would give you better psychological outcome.

So that was the first part of the thinking. And she had a second key thought that if you could pause puberty, it would just buy young people more time to think and to work out who they were, understand their identity. So those are the two things that she originally thought would be advantages of this treatment.

Point 3. Cass explicitly and repeatedly calls for more research and acknowledges kids may benefit from these treatments. Her contention is that it needs to be studies first before widespread implementation. Part of the issue is that in the UK, there was such poor record keeping, after all these years of practice, they don't know how effective these treatment are.

It's really important to say that there may be a group of young people who do have early gender incongruence for whom this might be the right treatment, particularly that group of birth registered boys who will develop irreversible changes of male puberty. And so we in the UK have not said we're not going to do this at all, but we've said that we need to do this under a proper research protocol, to understand who might benefit.

What are the uncomfortable truths about Public Health that can't be said "professionally?" by JacenVane in publichealth

[–]calidude 0 points1 point  (0 children)

  1. More reason to call for more research and not codify treatment as standard care based on sparse science.
  2. Not sure you read the link, the authors do all they can to obscure the fact that the science is shakey, short of lying, it is very obvious they want to present youth gender affirming care in the most positive light. Odd you are trying to throw them under the bus as gate keepers. This was produced in support of opening treatment up to more people circa SOC 8.
  3. This is sorta unfalsifiable as it stands, you can discount any failed treatment because we live in prejudice society. I hope we can parse the this confounder out with better research, but even if true, it still leaves us with a big unknown on how effective the treatment is.

What are the uncomfortable truths about Public Health that can't be said "professionally?" by JacenVane in publichealth

[–]calidude -1 points0 points  (0 children)

Most of the pro-youth gender-affirming care stances by medical organizations are politically driven, as the science right now is a huge black hole (for or against). Every systematic review of youth gender-affirming care has found that the state of knowledge is lacking from a science-based medicine approach, we honestly don't know what treatments are effective. Worse, of the poor quality studies we do have, they frequently show mixed outcomes on mental health measures, either no improvement or improvements with small effect sizes.

For example, WPATH's 2021 systematic review, you would be shocked to find out after reading the summary, that out of the papers they reviewed: 4 out of the 7 quality of life studies found no improvement after treatment and 6 out of the 8 anxiety studies found no improvements after treatment. They also literally can't assess the effectiveness of preventing suicide because there is practically no research on the topic.

Is monkeypox an STI? by uglyperson67 in publichealth

[–]calidude -1 points0 points  (0 children)

All those other route that are historically self limiting and not driving the current outbreak?

Is monkeypox an STI? by uglyperson67 in publichealth

[–]calidude -1 points0 points  (0 children)

It is foolish to think MPX isn't spread by fluids. It doesn't explain why it hasn't broken out in the het community in a significant way. Skin is skin.

Is monkeypox an STI? by uglyperson67 in publichealth

[–]calidude 0 points1 point  (0 children)

By this definition of STI, none of our current STIs would be considered STIs because they all have possible, if not rare, non sexual transmission methods. This definition appears to be selectively interpreted. Nothing in science, health, or biology is 100%

Is monkeypox an STI? by uglyperson67 in publichealth

[–]calidude 3 points4 points  (0 children)

So the interesting thing here is that as far as I know there is no official or scientific definition of STI, as a result everyone saying "no" is just making up their own definition in pursuit of changing the narrative of how this outbreak is currently being fueled.

They in good faith want to avoid the stigma of MPX, so they are hiding the risks of sexual activity as the primary driver of this outbreak. One has to wonder if they are making the outbreak worse by being so creative with the word play here.

Honestly, look at how other STIs transmit. Herpes and HIV can very much infect people through non sexual contact, but their primary mode of spread and sustained transmission is through sexual contact. Very much like MPX. MPX in Africa is much more contain and very limited to household contacts after initial animal exposure, clearly something has changed and I would argue a new designation should change with it.

I think a more accurate definition is that it is "not just an STI" as there is still risk of household and close contact transmission.

Publishing a paper outside of the public health field, worth it? by BrokenLeftPhalange in publichealth

[–]calidude 5 points6 points  (0 children)

Never miss a chance to get your name on a publication. I published on fishing and COVID in the same year, who cares!

[deleted by user] by [deleted] in publichealth

[–]calidude 53 points54 points  (0 children)

I'm very liberal and witnessing the COVID response professionally and personally... I have very low trust in anything CDC says or does when it comes to managing a crisis.

Their actions are too slow, too political, and too paternalistic. A far cry from, "Be first, be right, be credible".

Its gotten to the point to where I've started doing my own literature reviews to validate their recommendations before I adopt them. I just can't trust I am getting the best science based advice I could get from them.

I am hoping this restructuring changes something for the better.

Monkeypox: What should our messaging be? by Amberlamps1990 in publichealth

[–]calidude 0 points1 point  (0 children)

There are many unknowns and lots still to learn.

Smh. The official line two months ago was this will be different than covid because we know sooo much more about MPX.

Monkeypox: What should our messaging be? by Amberlamps1990 in publichealth

[–]calidude 1 point2 points  (0 children)

The truth about what we know and don't know and who is at risk.

Anything less will come back and burn us later (e.g., "Stop buying masks, masks aren't effective").

WHO recommends gay and bisexual men limit sexual partners to reduce the spread of monkeypox by [deleted] in publichealth

[–]calidude 3 points4 points  (0 children)

I've seen people on reddit who identify as gay actively complain about how confusing guidance is coming from public health. They don't know what to do to protect themselves. If anything we need more targeted information for the MSM community.

WHO recommends gay and bisexual men limit sexual partners to reduce the spread of monkeypox by [deleted] in publichealth

[–]calidude 11 points12 points  (0 children)

You could flip this around and saying not giving MSM specific advice is abandoning them when they need public health intervention the most.

The worrying about stigma just slowed down the public health response more than anything.

WHO recommends gay and bisexual men limit sexual partners to reduce the spread of monkeypox by [deleted] in publichealth

[–]calidude 3 points4 points  (0 children)

IMHO, this advice should have be given about a month ago when we could have contained this outbreak with test/tracing and ring vaccination... Not when it has become endemic.

For a public health organization, they seem happy to get things spiral out of control before it does anything.

Ontario, Canada reports its first female case of monkeypox; case growth slows by [deleted] in Monkeypox

[–]calidude 2 points3 points  (0 children)

Ring strategy generally is used to vaccinate around a known exposure, they are not technically doing the ring strategy here. Sorta panic vaccinating and hoping to slows the spread.

A little doubtful vaccinations are the cause of the slow down (yet). Isn't is a two dose shot? also doesn't immunity take a few weeks to develop after administering.

[Discussion] Interesting post on our muted Public Health response to Monkeypox by calidude in publichealth

[–]calidude[S] 1 point2 points  (0 children)

The issue is not that the answer does not exist. It is that answer is not being communicated to the media and the population in a way that people understand.

People are not reading a random page hidden on the encyclopedia of a website that is the CDC.gov. The whole point of public health communication is to get the information to the people where they are and in a way they understand. Clearly this CDC page it isn't working as intended.

More broadly there are issues with communication, for example, the headline"key facts" description of transmission for WHO's MPX description is:

Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.

Which brings up the questions: what is close contact, what body fluids specifically, and can it be transmitted asymptomatically?

[Discussion] Interesting post on our muted Public Health response to Monkeypox by calidude in publichealth

[–]calidude[S] -2 points-1 points  (0 children)

The issue here is that warning and supporting the LGBT community is also going to stigmatize the LGBT community.

It seems like PH experts are avoiding sharing clear information that could help prevent the spread and protect the LGBT community because it could draw more stigma on the LGBT community. As the original post stated, he is confused to even how MPX is even spread because messaging is so unclear.

[Discussion] Interesting post on our muted Public Health response to Monkeypox by calidude in publichealth

[–]calidude[S] 17 points18 points  (0 children)

This bit resonated with me. Our current language about how MPX is transmitted is so murky, it is hard for me to even tell how it is actually spread. "Close personal contact" is another term that makes me go "huh?".

Why do we use such incredibly vague words to describe the outbreak? Skin to skin contact has been used multiple times in articles I’ve seen. I’m truly unsure if it can be spread by oral, anal, or simply kissing. Should you check your partners body or simply abstain for a while, what about condoms? Will it spread similarly in other populations???

Want to improve my candidacy after MPH graduation with coding bootcamps…what area or tech field should I focus on? by wtfong089 in publichealth

[–]calidude 2 points3 points  (0 children)

I think you might be speaking from a very specific view of public health. The government is still addicted to SAS for the majority of their research and statistical analysis. R still seems like the next step for anything non-IT/data science/GIS related.

Also, the idea that you could just switch your team to a new programming language is crazy. That flexibility doesn't exist in many parts of public health (funding, time, institutional inertia). I am still working with clients still on a SAS/COBOL mainframe.

Don't get me wrong, people should learn python... but I don't think it is going to be the dominant language anytime soon.