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Jeremy Shaw, MD

@JeremyShawMD

Sep 23

Turban et al. (2021) published a study that concluded that gender identity conversion efforts (GICE) are detrimental to mental health.

This study was thoroughly refuted by D’Angelo et al. (2021). They attempted to publish their Letter to the Editor in the same journal, JAMA Psychiatry, where the original study had been published. But their letter was rejected due to “space limitations”. (Quite convenient)

I’ll summarize some of the problems with Turban’s paper in this 🧵:

• BIASED SAMPLE

This study and several of Jack Turban’s other studies rely on data from the 2015 US Transgender Survey (USTS). This survey used mostly online convenience sampling. Participants were recruited through Trans advocacy groups (underrepresenting trans individuals not politically engaged and ideologically aligned), and restricted participation to those who currently identify as transgender (excluding detransitioners). The researchers also revealed that the goal of the study was to “highlight the injustices suffered by transgender people” which feeds into a demand bias.

This is the same survey in which 73% of participants claimed to have started puberty blockers at >18 years. This biased survey is clearly not a reliable or valid data source for policy recommendations.

• INVALID MEASURE OF GENDER CONVERSION THERAPY

The USTS question they relied on was too non-specific to serve as a valid measure of gender conversion therapy. The question was unable to differentiate between ethical non-affirmative encounters and unethical conversion therapy, essentially defining GICE as “encounters that were non-affirmative”.

The question also biases the recall of neutral encounters toward recall of conversion by using emotionally charged language (“stop you being trans”) and by conflating recall of religiously motivated encounters with clinical ones.

There was also no indication of whether the focus was on gender dysphoria or another condition. For instance, a therapist who refrains from approving for treatment of gender dysphoria because they suspect that the individual’s gender dysphoria is secondary to another psychiatric condition would fit the description of “stop you being trans”

There was also no determination of whether unethical tactics like shaming or threats were used.

Read 8 tweets

Jeremy Shaw, MD

@JeremyShawMD

Aug 22

In a paper published in the Journal of Med Ethics titled, “Gatekeeping HRT for transgender patients is dehumanising”, the author argues that requiring psychological assessments prior to the prescription of cross-sex hormones suppresses the diversity of trans embodiment.

See ‘Creative Transfiguration’.

“I have myself had to sanitise my narratives of trans embodiment to access care. I have seen many others in my community report similar experiences, and instances of lying to meet clinical expectations have also been reported in the academic literature.”

“I would argue that HRT poses no more risk than various other medical interventions for which no psychological assessment is required. We do not typically think that it is ethical to require psychological assessments prior to abortions, for instance...”

Read 4 tweets

Jeremy Shaw, MD

@JeremyShawMD

May 1

Why Did So Many Doctors Become Nazis?

The Holocaust was a tragic event caused by a corruption of moral philosophy and the complicity of the medical establishment in implementing its horrors.

Contrary to popular belief, many of the doctors involved were not coerced. 🧵

These doctors subscribed to the Nazi ideology & actively operationalized its atrocities, from eugenics & pediatric euthanasia to the inhumane, ‘Mengelian’ experiments in Auschwitz.

They believed they were conducting "good science" & rationalized their actions accordingly.

They prioritized the legality of their actions over morality, justifying themselves through the concept of the "veil of ignorance."

They believed they were better equipped to determine what was in the best interest of their patients, & thus saw no need to disclose the details.

Read 12 tweets

Jeremy Shaw, MD

@JeremyShawMD

Apr 29

“Preferred third-person pronouns”

This is one of the more insidious distortions of language that is usually downplayed as innocuous.

(The photo illustrates the relationship between language & thinking)

🧵

As you know language influences thought, which in turn influences reality.

Third-person pronouns are unique in that they allow for a more OBJECTIVE and detached manner of describing the world around us.

You don’t need to use the third-person pronouns of a person you are conversing with directly. The goal is thus to influence how you think about that person in their absence. It cements the false & subjective notion of that person as OBJECTIVE truth in the minds of the speaker…

Read 7 tweets

Jeremy Shaw, MD

@JeremyShawMD

Apr 28

I understand the reasoning behind not regulating the off-label use of drugs by medical doctors.

However, in light of the ongoing scandal involving the widespread prescription of "puberty blockers" for use unapproved by the FDA… to minors, it may be worth reconsidering.

The conclusion of this study by Eguale et al:

“Off-label use of prescription drugs is associated with Adverse Drug Events (ADEs). Caution should be exercised in prescribing drugs for off-label uses that lack strong scientific evidence.”

Source: jamanetwork.com/journals/jamai…

Read 4 tweets

Jeremy Shaw, MD

@JeremyShawMD

Apr 28

Doctors across the United States are regularly prescribing puberty blockers for off-label use to children. These drugs are NOT approved by the FDA for this purpose
They are currently approved for the treatment of prostate & breast cancer, severe endometriosis & precocious puberty

Below is an excerpt from an FDA label spelling out the possible adverse effects of the use of Lupron (a so-called puberty blocker)

One of the complications spelled out is worsening of psychiatric symptoms. Do these doctors really care about decreasing the risk of suicides?

Doctors are currently using clinical discretion as a pretext to prescribe dangerous drugs that they naturally would not be able to without pharmaceutical companies conducting clinical trials and submitting a supplemental new drug application (SNDA) to the FDA for approval.

Read 7 tweets

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