Thread by @benryanwriter

NEWS: Alabama Attorney General submits motion for summary judgment in District Court case over ban on pediatric gender-transition treatment.
The document offers a scathing @WPATH's credibility, based on subpoenaed documents, dismissing it as an "activist interest group." 🧵

This summarizes the Alabama Attorney General's assessment of @WPATH, based on a trove of subpoenaed internal communications that have been unsealed this week, plus more yet to be unsealed: "In short, neither the Court nor Alabama need treat WPATH as anything other than the activist interest group it has shown itself to be. The Constitution allows States to reject WPATH’s model of “care” and protect vulnerable minors from life-altering transitioning “treatments.” The Court should grant Defendants summary judgment."

The AL AG's motion for summary judgment borrows liberally from the UK Cass Review to portray the scientific literature on gender-transition treatment as weak and unreliable. It also relies on the words of @WPATH's president, Dr. Marci Bowers: "Asked whether 'reasonable people could conclude that there is not enough evidence to support the safety or clinical effectiveness of puberty blockers,' Bowers replied: 'There’s not enough high level evidence. Yes, you can – you can – you can say that.'”

The AL AG also points to Dr. Eli Coleman, the chair of @WPATH's Standards of Care 8 trans-care guidelines, when arguing that a 12-year-old cannot assent to gender-transition treatment that may make them infertile: “at their age – they would not know what they want."

The Alabama AG posits what has become a highly contested argument that most gender dysphoric young children will desist and stop identifying as transgender during adolescence.

The Alabama Attorney General argues in its motion for summary judgment in District Court regarding suit over the state's pediatric gender-transition ban: “Minors, and often their parents, are unable to comprehend and fully appreciate the risk and life implications, including permanent sterility, that result from the use of puberty blockers, cross-sex hormones, and surgical procedures." Thus, “the decision to pursue a course of hormonal and surgical interventions to address a discordance between the individual’s sex and sense of identity should not be pre-sented to or determined for minors who are incapable of comprehending the negative implications and life-course difficulties attending to these interventions.”

The plaintiffs suing Alabama over its ban of pediatric gender-transition treatment rely on guidelines by @WPATH and the Endocrine Society. The AL Attorney General points to the Cass Review to characterize them as "unreliable and methodologically unrigorous."

The Alabama AG again refers to the Cass Review when characterizing what Cass called "circularity" in the WPATH and Endocrine Society's pediatric gender-transition treatment guidelines, but which the AG refers to as laundering.

The Alabama AG argues that the major medical associations that back the gender-affirming care model for children do not, in fact, explicitly endorse @WPATH or the Endocrine Society's treatment guidelines per se.

When @WPATH's Dr. Eli Coleman couldn't get the @AmerMedicalAssn to back WPATH's Standards of Care 8 guidelines for trans care, he emailed his colleagues in a fury and said the AMA is run by “white cisgender heterosexual hillbillies from nowhere."

The Alabama AG criticizes @WPATH for not seeking to prevent intellectual conflicts of interest from biasing its Standards of Care 8, meaning the guidelines were made by those "professionally engaged in performing, researching, or advocating for the practices under review."

Activists have made much of the fact that Hilary Cass was appointed by the NHS to conduct a review of pediatric care for gender dysphoric children despite no experience with such patients. But that is why she was chosen, because she lacked that intellectual conflict of interest.

WPATH, the AL AG asserts, leaned into intellectual conflicts of interest when crafting the SoC8. Its president, Dr Marci Bowers, says she made more than $1 million from such surgeries last year and said it was "absolutely...important for someone to be an advocate" for gender-transition treatment to sit on the guideline committee.

Despite the fact that the head of WPATH's Standards of Care 8 trans treatment guidelines, Dr. Eli Coleman, said that most of those who contributed to them had financial and/or nonfinancial conflicts of interest, WPATH denied this in public.

Despite asserting that they were creating the Standards of Care 8 according to evidence-based medicine principles, WPATH did not do so. Dr. Eli Coleman, who headed the effort, said, "we were not able to be as systematic as we could have been (e.g. we did not use GRADE explicitly)

WPATH admitted using the term "recommend," which per the principles of evidence-based medicine is reserved for treatments backed by strong evidence with few downsides and a high degree of acceptance among providers and patients, to describe treatments with low-quality evidence.

The systematic literature reviews that @WPATH commissioned from Johns Hopkins and that it subsequently largely buried found "little to no evidence about children and adolescents" with respect to gender-transition treatment. HHS acknowledged this in Sept 2020.

WPATH denied Johns Hopkins the requisite independence for conducting and publishing the systematic literature reviews on trans care that the organization commissioned.

Social justice lawyers told @WPATH that evidence-based reviews of the science behind gender transition treatment for children would put the organization "in an untenable position in terms of affecting policy or winning lawsuits."

WPATH, the Alabama AG alleges, were "explicit in their desire to tailor SOC-8 to ensure cover-age for practically any 'embodiment goal' a patient has by labelling it 'medically necessary.' That label was given to a staggeringly broad list of treatments, seemingly without regard to the evidence base."

Biden Admin health official Rachel Levine put political pressure on WPATH to remove the age restrictions for gender-transition treatments in the Standards of Care 8.

After the @AmerAcadPeds threatened to withhold support for the SoC8 and to come out against it if @WPATH didn't remove the age limits on gender-transition treatment, WPATH relented and then fabricated a story for the public about why they did so.

WPATH's Dr. Eli Coleman said trans health care is "not only under attack by politicians, but by:” (1) “academics and scientists who are naturally skeptical,” (2) “parents of youth who are caught in the middle of this controversy,” (3) “increasing number of regret cases” who “blame clinicians for allowing them[] to transition,” and (4) “continuing pres-sure in health care to provide evidence-based care.”

Erica Anderson, former USPATH head, told me how she locked horns with her WPATH colleagues after telling @AbigailShrier that some care of gender dysphoric kids was "sloppy." Anderson wanted more openness with journalists, USPATH wanted a moratorium on talking to the press. Anderson lost that battle.

One author of the SoC8 adolescent chapter said: "My fear is that if WPATH continues to muzzle clinicians and relay the message to the public that they have no right to know about the debate, WPATH will become the bad guy and not the trusted source."

In public, WPATH denies that social contagion may contribute to gender dysphoria in minors and that rapid-onset gender dysphoria may be a real phenomenon, but in private they are more circumspect, the Alabama Attorney General asserts.