Listen to the Thought for the Week
The New Cassandras
Too often in medicine, we focus on interim “successes” rather than outcomes. There are various therapies in use that make patients look and feel better, but only temporarily. In the end, the patients suffer the same fate as if the therapy were never used at all, but it has added thousands, sometimes hundreds of thousands of dollars to a hospital bill. Additionally, sometimes the medical establishment becomes fixated on these interim “successes” and pursues the therapies without thought or regard to the outcome. Sometimes, the interim therapies actually worsen outcomes, such that patients have a poorer outcome than if the therapy was never used, even if they appeared better for a little while.
One such therapy is extra-corporeal membrane oxygenation, or ECMO. ECMO is an extraordinary form of life support wherein a patient is placed on what is basically a heart-lung machine, so that the patient’s own heart and lungs can heal from some sort of disease or injury. The ECMO machine circulates, oxygenates, and removes carbon dioxide from the patient’s blood while the patient’s own heart may or may not beat and the patient’s own lungs are not ventilated. ECMO is incredibly complicated and requires a specialized team for its initiation and management. Patients on ECMO suffer a wide variety of severe complications, including stroke, bleeding, and infection, to name a very few. Often, ECMO is employed as a therapy of last resort to prolong a patient’s life following severe illness or complication, as is sometimes seen in the process of heart surgery.
A typical scenario is when a patient has undergone open-heart surgery following a heart attack, in an attempt to bypass blocked coronary arteries and fix damaged heart valves. In this scenario, the patient is placed on a heart-lung machine for the surgery, and, at the completion of the repair, the patient’s heart is unable to be weaned from the support of the heart-lung machine despite aggressive pharmacologic therapy. The surgeon is then faced with the difficult dilemma of a patient in an operating room who cannot be separated from the heart-lung machine without dying.
As in many endeavors, records are kept on surgeons documenting their successes and failures, particularly for cardiothoracic surgeons. Every patient who suffers a bad outcome following surgery, regardless of pre-existing condition or surgical skill, goes on the surgeon’s permanent record, a database open to scrutiny by not only hospitals and insurers but also the general public. Death in the operating room is a particularly bad mark on this record. It is at times like this that some may be tempted to use ECMO to get the patient off the operating room heart-lung machine and transport the patient to the intensive care unit. The thought in these cases is that the heart, over a period of hours to days, will slowly recover from its injuries and eventually be weaned from the ECMO and the patient can then recover. Indeed, once on ECMO, the patient’s lab values do tend to look better, and the patient does leave the operating room alive.
The issue, however, is “sometimes, your arms are too short to box with God,” as a hospital priest once told me. This recovery of the heart over time does not really happen and the patient eventually dies, as the body continues to deteriorate and fails to respond to drugs and other interventions, despite the ECMO. So, the ECMO did not make an outcome difference. The patient suffered a cardiac injury and did not respond to heart surgery. The ECMO kept the patient alive for a while longer, but ultimately the patient died, as he/she would have without the ECMO. The surgeon still gets a bad mark on the permanent record, but the patient has used a lot of resources and incurred a massive increase in their hospital bill. The insightful among you are asking, so why use ECMO? The answer is, sometimes, but rarely, patients do get better. Just like sometimes a person wins the Powerball, sometimes a patient on ECMO may get better. It is impossible to determine whether or not the patient would have gotten better anyway, with or without the ECMO. Large outcome studies for the use of ECMO in a variety of conditions are lacking.
Because ECMO is a last-resort therapy, it is difficult to design an ethically acceptable study where one group of critically ill patients gets the ECMO and the other does not, and the outcomes are subsequently compared. And even when such studies are done, for example, there are studies demonstrating no benefit to ECMO for cardiogenic shock after open heart surgery (1), these large databases do not account for the occasional lottery winner. Every physician treats patients according to his/her clinical judgment; this is the art of medicine. That is, a physician evaluates a patient, considers the medical literature, weighs his/her own skills and experience, and decides on a course of treatment to achieve the desired result. Like any human, physicians have emotional, intellectual, and experiential biases that cause them to choose various paths of action in response to differing diseases or injuries. These conscious and subconscious biases are particularly difficult to consider in the decision of what is the best treatment for a particular patient. This is why ten physicians may have ten different approaches to treating the same patient. Thus, there may be occasions when a cardiac surgeon chooses to place a patient on ECMO after surgery, despite literature demonstrating that there should be no benefit, as the literature draws its conclusion from groups of patients, rather than any one individual.
Just as individual physicians have biases, medical schools, medical journals, professors, and journal editors also have biases. In an ideal world, science should be completely blind and unbiased. A result of a properly conducted scientific study is neither good nor bad, it just is. What one chooses to infer from such a result and whether or not the result affects the delivery of medical care is different than the result itself. The result should be a pure answer to a limited scientific question. Choosing to ignore or disbelieve a scientific result because one disagrees with the result is simply ignorant. A result can be criticized based on flawed study design or statistical analysis, but to refuse to consider a study result simply because, “this is not true” or “we can’t publish this” without reason, is kindergarten-level logic. When that happens, science breaks down and what masquerades as “science” becomes a hollow talking point to drive a political agenda. (Ring any bells, Dr. Fauci?)
Another, slightly more nuanced form of scientific ignorance is to consider only the scientific data that supports one’s foregone conclusion, while ignoring, without reason, data that opposes the conclusion. The old adage “You can’t find a fever if you don’t take a temperature” also applies to scientific studies. You can’t let a study result change medical practice if you ignore the result entirely.
A final version of scientific dishonesty is taking a study result and drawing unsupported conclusions from said result to drive a political agenda. We discussed this last week, where a group with a biased and political agenda drew the unsupported conclusion that physicians would not enter practice in states with abortion restrictions, even if these physicians did not perform abortions (2). The study discussed last week was poorly designed and biased, so junk science was used to draw a junk conclusion. Garbage in, garbage out.
With the approach of June, we are compelled to suffer through another “pride month” of various homosexual, transgender, and other perverse virtue signaling by corporate America. This year, the theme has moved on from simple homosexuality to all things gender fluid, all the time, and the younger the better. We have previously discussed, extensively, the deeply flawed, non-science that led the American Psychiatric Association (APA) to deem gender identity disorder a normal condition and rename it “gender dysphoria” (GD) in DSM 5 (3).
To briefly recap, in 2013 the APA, without any rational scientific basis, deemed Gender Identity Disorder to now be GD and a normal condition. Previously, the mental distress of someone suffering from the psychiatric condition of Gender Identity Disorder was a result of the person believing that he/she was in a body of a gender/sex different than it should be. So, the distress came from a belief that one was, for instance, a man but in a woman’s body. In 2013, as a result of opinion polling and lobbying from transgender advocacy groups, the APA changed Gender Identity Disorder to GD. Significantly, GD was no longer considered a psychiatric disorder, but a normal condition of a normal mind actually in the wrong body, with mental distress resulting from society’s non-acceptance of the person’s “true” gender identity. If one believes this incredibly preposterous concept to be valid, it would make sense that the treatment of GD would be to convert the “wrong” body, to the extent possible, into the “right” body. The APA also advocated this as management of GD in children and adolescents and the medical establishment then began advocating and utilizing hormonal therapies and sexual reassignment surgery for children and adolescents. Of course, this was not limited to simple male-female confusion. There are now a whole host of genders and variations, singular and pleural, binary, non-binary, etc., etc… You really do need a scorecard to keep track of them all. In a very, very short time, gender identity disorder has gone from a miniscule group of men dressing in women’s clothing to a major movement, with drag queen story hours, gender-affirming care centers, genderfluid clothing at retailers, and transgender individuals meeting with the president at the white house.
It does seem that, in 2023, American society is in the grips of a mass hysteria that will eventually result in the destruction of thousands, if not millions of innocent lives, and persons suffering from severe psychiatric illnesses are unable to access the care they so desperately need because the medical establishment considers them normal, despite all proof otherwise. Persons suffering from GD undergo various “gender-affirming” therapies and they feel better, at least for a little while. Their outcome, however, is unchanged and the “gender-affirming” therapies make their psychiatric outcome worse, as it fails to treat, and even amplifies, the underlying psychiatric condition. This is completely akin to the psychiatric establishment offering liposuction to anorexics to ease their mental anguish. It might feel better for a little while, but in the end, they will always be “too fat” and eventually destroy themselves. (On the other hand, the liberal democratic administration of New York City recently signed a law banning discrimination against weight and height, accompanied by speeches from morbidly obese “fat activists.” Mayor Eric Adams said, “I’m a person who believes in health…science has shown that body type is not a connection to if you’re healthy or unhealthy…that’s a misnomer that we are really dispelling (4).” (No, I am not making this up, and it is fairly clear that there is no discrimination against low IQ in political office, but I digress.) This is also true of people suffering GD. Good studies show that, even in societies that widely accept transgender individuals and even when they have undergone aggressive “gender-affirming” care, their rate of suicide is still 19 times higher than the general population (5). Their untreated mental illness makes them a danger to themselves and others (6).
Given the lack of science supporting gender ideology, one would think there would be good science refuting the outlandish hypothesis that a normal mind can be in the wrong body. There is, but that is our Cassandra problem.
In Greek mythology, Cassandra was a Trojan priestess dedicated to the god Apollo. Cassandra was fated to utter true prophecies but was never to be believed. So now come the new Cassandras. These are the scientists who conduct studies and generate data that does not support the popular trans agenda. Like Cassandra, they are simply not believed. They are ignored or castigated and despised because their findings do not support a foregone conclusion.
One such individual is Dr. Lisa Littman who, in 2018, published a study describing what she termed, “Rapid-Onset Gender Dysphoria” (ROGD)(7). In her study, Littman surveyed parents regarding their teenage children, 83% of whom were girls. From the study:
“In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing for the first-time during puberty or even after its completion. Parents describe that the onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity. Recently, clinicians have reported that post-puberty presentations of gender dysphoria in natal females that appear to be rapid in onset is a phenomenon that they are seeing more and more in their clinic. Academics have raised questions about the role of social media in the development of gender dysphoria (7).
It postulates that rather than a true inborn condition of a mind in the wrong body, ROGD is a result of social media use and a response to normal adolescent anxiety and stress. We have previously discussed this, and Littman’s theory makes sense. After all, the rapid increase in GD over the last decade has no biological explanation. GD is not an infectious disease transmitted by bacteria and spoiled food. The incidence of GD directly correlates with the boom in social media use among teenagers and children. Additionally, before this “trans springtime” era in which we find ourselves, GD was nearly always a man feeling that he was really a woman. The opposite, a woman believing she was really a man, was quite rare. The social media contagion makes a lot of sense, particularly given other recent concerns of teenage girls being negatively affected by social media (8). There is even potential legislation under consideration to restrict social media use among children (9).
You would think that Dr. Littman would be championed for discovering this important phenomenon and opening up conversation on the management of this condition. As usual, you would be wrong. Dr. Littman was quickly castigated as “anti-trans” by the academic establishment and Brown University quickly withdrew a press release publicizing her paper. (Academic freedom for thee, but not for me?)
This academic gnashing of teeth continued to the point that, by 2021, the Coalition for the Advancement & Application of Psychological Science published a statement, signed by the APA and some 120 other psychiatric and psychological organizations decrying ROGD and stating:
“As an organization committed to the generation and application of clinical science for the public good, the Coalition for the Advancement and Application of Psychological Science (CAAPS) supports eliminating the use of Rapid-Onset Gender Dysphoria (ROGD) and similar concepts for clinical and diagnostic application given the lack of rigorous empirical support for its existence. There are no sound empirical studies of ROGD and it has not been subjected to rigorous peer-review processes that are standard for clinical science. Further, there is no evidence that ROGD aligns with the lived experiences of transgender children and adolescents. CAAPS supports eliminating the use of ROGD and similar concepts for clinical and diagnostic application given the lack of empirical support for its existence and its likelihood of contributing to harm and mental health burden. CAAPS also encourages further research that leads to evidence-based clinical guidelines for gender-affirming care that support child and adolescent gender identity development. CAAPS opposes trainings that encourage others to utilize this concept in their clinical practice given the lack of reputable scientific evidence to support its clinical utility. Finally, CAAPS recommends expanding community education about these topics to reduce the stigma and marginalization that contribute to mental health burden (10).”
So, exploring whether social media may influence a group of young girls to all rapidly decide they are actually boys is not acceptable, but one can give them puberty blockers, testosterone, and mastectomies? Someone should go to jail over that.
Littman’s original paper did have some methodological flaws. All scientific papers do, particularly in behavioral health, and Littman did acknowledge the limitations of her study. Again, this is common and part of the scientific method. In a normal world, the next steps are to refine and repeat the studies to improve the quality of the data. As we said earlier, data simply is. It is neither good nor bad and only has whatever emotions society chooses to place upon it. In trans-world, however, rather than repeat and validate or invalidate the data, the response is NO! Schedule a mastectomy for the girls and have Littman burned at the stake as a witch!
Someone has now repeated Littman’s study and this recently appeared in the journal Archives of Sexual Behavior, published by Springer Nature. Do you think the medical community welcomed this perspective to further define ROGD? Wrong again. In today’s society, if thy person offends thee, pluck him out, or in contemporary terms, cancel him! Suzanna Diaz and Michael Bailey published a paper titled, “Rapid Onset Gender Dysphoria: Parent Reports on 1655 Possible Cases” in Archives of Sexual Behavior recently. In their study, Diaz and Bailey found:
“Pre-existing mental health issues were common, and youths with these issues were more likely than those without them to have socially and medically transitioned. Parents reported that they had often felt pressured by clinicians to affirm their AYA (adolescent and young adult) child’s new gender and support their transition. According to the parents, AYA children’s mental health deteriorated considerably after social transition.”
“Preexisting mental health issues were common, but so was high intelligence. Most youths had changed their pronouns, and most of these changes were cross-sex rather than gender-neutral. Social transition was far more prevalent than medical transition. There was evidence of immersion both in social media and in peer groups with other transgender-identifying youths (11).
Because males reported their GD about two years later than females, the majority of persons were female and the males were less likely to have begun social transitioning, the authors felt there might be a different mechanism responsible for the female’s GD versus the males (11). The paper concludes:
“The finding supports the worries of parents whose preferences differ from their gender dysphoric children. It is consistent with another finding of this study that parents believed gender clinicians and clinics pressured the families toward transition. The finding is particularly concerning given that parents tended to rate their children as worse off after transition (11).”
In our view, this supports a lot of what we have suspected about the fad of transgenderism and its potential use as a salve to cover more serious psychiatric disorders (3,6). It is an intriguing finding and worthy of further study. It is also important to note the study found that parents felt pressured by clinicians and clinics to support the transition. Of course, they did. Gender fluidity is a woke fad, supported by the liberal medical establishment (and makes them some pretty good income too).
Texas Children’s Hospital, Vanderbilt and Boston Children’s Hospital all have bills to pay and liberal progressive pediatricians to support. Additionally, as we have often said, most medical schools today are somewhere to the left of Vladimir Lenin, producing hordes of woke social justice warrior physicians. Dr. Lauren T. Roth of the Albert Einstein College of Medicine and pediatrician at the Montefiore Children’s Hospital recently went on record with the proposition that parents should implement gender ideology at or even before birth. In a recent news story, she is quoted as saying, “So it honestly starts at birth or even before. I really think we need to try to stop making everything pink and blue [and also] avoid this huge gender reveal party… Toddlers start to notice physical differences and develop gender identity as early as 18 months to two years. They might begin talking about gender, playing dress up, having these established gender roles as early as age three or four… You know, it’s okay to be excited when you find out that your baby’s a specific sex. You know, people have dreams about what they want their families to be, but it’s really important not to push all those expectations on your child (12).
If that is not the most insane thing you have read this month, you are in trouble and should seriously re-evaluate your reading choices. Tragically, like many academic physicians, Dr. Roth is involved in national committees and writing of curricula for medical schools. (How is it possible that this individual has a medical license?) All of this is not only without any scientific basis whatsoever but also willfully ignoring scientific work like that done by Diaz and Bailey. Unsurprisingly, the academic establishment has revolted against the journal that published the Diaz and Bailey paper and, apparently, the journal is planning to retract the paper over feigned concern about whether parents participating in the survey gave informed consent (13). So, in the eyes of the woke establishment, someone going onto a website and filling out a survey needs to read and sign a consent form before completing said survey. Wow, how egregious it is that someone can be forced to do an online survey without their consent! (Insert sarcastic eye roll here.) Not content with that, the mob is also petitioning for the editor of Archives of Sexual Behavior, Dr. Kenneth Zucker to be fired for his egregious and transphobic behavior and has posted an open letter, signed by several trans advocacy groups and 200 or so gender warriors, calling for his removal and threatening to not submit or review articles to the journal until it does so (14). The Diaz and Bailey paper makes for interesting reading and I suggest you download a copy, available here: https://link.springer.com/article/10.1007/s10508-023-02576-9, at least until the thought police take it down.
Lest you think that academic prejudice is limited to the trans agenda, rest assured that it is alive and well for other issues that do not conform to society’s pro-death, anti-family crusade. While the details are confidential, for now, we are aware of at least one well-conducted scientific study, demonstrating the successful reversal of mifepristone, the abortion pill, in an animal model, which is being rejected by the academic establishment journals because it doesn’t fit their foregone conclusion. That is pretty much the opposite of science, and one would think the editors of these journals would be ashamed, although that would require a conscience and integrity, so…
People suffering from disease and injury deserve to be treated with love, compassion, respect, and dignity. They deserve competent medical care, based on scientific and unbiased literature. In the case of gender dysphoria, that is not happening. These suffering individuals are pawns for a political agenda that will leave them broken and damaged. They are being victimized by the system, and the physicians complicit in this are accomplices to their pain, suffering and destruction. Have they no shame? Have they no conscience?
We don’t know whether this will be resolved anytime soon, but there may be hope. Recently, the well-respected Karolinska Institute of Sweden announced that it was discontinuing the use of puberty blockers and cross-sex hormones in minors due to a lack of scientific evidence of any benefit and concern over serious potential side effects and harm (15). We pray that medicine will regain its integrity and common sense to get these individuals the care they need and deserve, and we hope our proposed Saint Padre Pio School of Osteopathic Medicine helps lead that charge. The Lord Jesus Christ himself was very clear on what awaits those who perpetuate the suffering of children in the name of gender ideology:
“Whoever causes one of these little ones who believe in me to sin, it would be better for him to have a great millstone hung around his neck and to be drowned in the depths of the sea.
Woe to the world because of things that cause sin! Such things must come, but woe to the one through whom they come!”
This concludes the audio portion of this article. Thank you for listening.