I was critical of the Cass Report earlier, talking about how discounting studies that weren't double blinded RCTs was bad form. Apparently Dr Cass has responded, saying that '"obviously" young people could not be blinded as to whether or not they were on puberty blockers or hormones because "it rapidly becomes obvious to them [...] But that of itself is not an issue because there are many other areas where that would apply"' https://www.bbc.co.uk/news/health-68863594
I have to say that I don't actually understand what she's saying here. Is she saying that she did use non double-blind RCTs? or that she thinks they're fine but discounted them anyway? Apparently she's quite cross about "misinformation", but the fact is she called non double blind RCTs not up to standard, and they were discounted. So I'm not sure what she thinks is misleading here - the fact is that in this situation they are impossible, and in such cases the alternatives are still good practice
Maybe there is more detail in the podcast episode linked but I don't really have time to listen to that right now - the article accompanying it is very unclear though about what she's actually talking about.
@CatherineFlick@glyph The parts of the final report that I have skim-read seem rather muddled and rambling. Either she is not a good communicator, or she is not on top of the brief, or she has been confronted with evidence which does not accord with her preconceptions and she’s struggled to make sense of that cognitive dissonance. Plenty of people think it’s the last option, and that she’s pretty much a TERF.
@CatherineFlick the podcast is a lot clearer. They interviewed the York professor who reviewed the studies and ranked them high, medium and low quality, and included the high and medium, and the BMJ editor who published the 2 out of 103 stat were high that implied the rest were ignored. Cass blamed the tweeters reposting that rather than the BMJ bloke who published the misleading numbers and didn't apologise.
@Sbectol even if there’s no possible way to do a RCT? That seems ridiculous if you then develop your policy advice discarding the other trials that work for that scenario.
@CatherineFlick Perhaps it would have helped if she'd clarified that double blinding wasn't an issue IN the report
Or even mentioned what any of these "many other areas where that would apply" are, given that the report discusses medication that only includes puberty blockers or hormones
@CatherineFlick So she was misrepresented on both these counts, and what she's quoted as saying about RCTs here is I think her saying "of course I know what an RCT is" and then giving an example.
What hasn't happened though is engagement with trans people who have provided evidenced criticisms, e.g. TransActual.
Rhetorical question. And she is, of course, wrong about acupuncture. A placebo devised to test its alleged effects was devised some years ago and is described in the book "Trick or Treatment" by Edzard Ernst and Simon Singh.
@anarchic_teapot I think it’s also a bit of a distraction. There are plenty of interventions we use in medicine that don’t require such a high level of evidence - especially if the experience of patients is taken into consideration.
I'd love to see a paper in the same genre as the "RCT for testing the efficacy of parachutes" or the "dead salmon recognizes faces" studies that did an evidence review for something like knee surgeries, anesthesia (where as of 2022 per Rong et al "standardised criteria for clinical practice guideline development do not currently exist"), or some commonly-used-but-off-label pediatric medicine.
Add comment