In which the doctor who coined the phrase "evidence based medicine" makes it clear that of course this doesn't apply to "gender-affirming care".
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"After criticism of his reviews showing that gender interventions are based on no good evidence, the man who coined the phrase "evidence based medicine" now says that when there's no good evidence supporting an intervention, you should go with what the patient says they want. 2/3"
"If that wasn't bad enough, there is of course good evidence of harm in gender medicine – namely, that the interventions irreparably damage people's fertility and overall health. You would need strong evidence of large benefits to outweigh the known harms, and there is none. 3/3"
From the paper:
Authors of scientific articles have a responsibility to attend to how their contributions will be used and to modify their presentation in the articles, or other communications, accordingly. We, five authors of recent systematic reviews related to gender-affirming care, are concerned that the conclusions of our work–that only low certainty evidence exists (as determined by the GRADE [Grading of Recommendations Assessment, Development, and Evaluation] approach) regarding the benefits of the gender-affirming care interventions addressed in our systematic reviews–will be misused. Specifically, we are concerned that the assessments of the certainty of evidence using established and standard methodology are interpreted as evidence supporting denial of care to trans, nonbinary, and gender-diverse (TGD) individuals, including youth. We are concerned our findings will be used to justify denying care such as puberty blockers and hormone replacement therapy to TGD individuals. Indeed, our prior work has been used in exactly this highly problematic way.
We therefore feel compelled to make explicit our view regarding how our findings should and should not be used. Following fundamental principles of humane medical practice, clinicians have an obligation to care for those in need, often in the context of shared decision making. It is unconscionable to forbid clinicians from delivering gender-affirming care.
Moreover, following the principles of evidence-based decision-making, clinicians should always have a high respect for the autonomy of patients and their advocates. The high respect for autonomy becomes particularly important when the certainty of the evidence is low or very low. In such circumstances, clinicians should work with patients to ensure that care reflects the experience, goals, and priorities of those needing care – that is, their values and preferences.
It is profoundly misguided to cast health care based on low-certainty evidence as bad care or as care driven by ideology, and low-certainty evidence as bad science.
Gosh. Talk about profoundly misguided. But yes, this is Canada.
