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I feel like there's a 'gonna die if you don't, gonna die if it doesn't work, not gonna die if it does' unstated exception to that particular tenet of the Nuremberg code.
Honestly, this is one of the situations where I say "fuck it"; the amount of trans surgeries from doing the RCT, assuming it finds that they're bad, will be lower than the amount from not doing it (in contrast to the usual case), so I'm not seeing the "do no harm" issue.
The bigger issue is that trans activists will attempt to defy you and transition the control group anyway. I don't see a way to get around that that isn't either "deploy the counterterrorism apparatus in full to prevent such attempts" or "ban transition as a whole in order to saturate the trans movement's covert-ops resources and draw them away from the trial". These are both pretty drastic actions, with significant PR costs even if you personally aren't bothered by using that level of force.
Yeah, I haven't settled on an opinion, but I feel you. There is currently some brouhaha about an NHS puberty blocker trial, with the anti-trans side arguing that it shouldn't be done because we already have the evidence (they also have other criticisms, but that tends to be the opener). A part of me feels like the political capital would be better spent saying "Oh, you want a trial? Fine, we'll do a trial, but we're doing this one properly", but I've been wrong on political tactics before (I was against blanket bans, until Alabama and Tennessee did them, and ACLU in their infinite wisdom decided to sue them, which allowed WPATH's internal docs to go into discovery).
When I was reading the papers on chemical castration, I think one of them said you can detect non-compliance with a blood test (though it may have been about taking counter-measures, instead of unauthorized taking of chemical castration / puberty blockers).
Oh, it's easy enough to tell if somebody's been taking hormones against your instructions. That just doesn't solve the problem.
If you count defiant transitioners as part of your control group, it biases your study in favour of transition, because defiant transitioners amount to "transition with a bunch of extra annoyance" and as such are near-guaranteed to do worse than the transition group regardless of how good or bad transition is.
If you kick defiant transitioners out of the control group, it biases your study against transition, because desisters will stop trying to defy you at some point, and as such success stories will make up a larger chunk of your control group than they would have if you'd successfully prevented the defiant transitioners from transitioning.
If the trans activists manage to subvert enough of your control group (which is pretty likely without the extreme measures I mentioned), these two effects will destroy the study's value; it will give the "do transitions!" answer with one set of rules and the "don't do transitions!" answer with the other. Whoops, looks like the clear liquid you poured on that fire was petrol instead of water.
Oh, and this is assuming that you picked outcome measures that don't allow for easy lying; it's not like people can't go on Twitter and yell "hey everybody, put down that you're ecstatic if you were in the transition group and suicidal if in the control group; it's for the sake of all the other transfolk". As Scott said, "sometimes people might just be actively working to corrupt your data".
Your overall point is correct, but:
That's not necessarily true: suppose transition, even with transition-with-extra-annoyance, always leads to strictly better outcomes. The control group will then have better outcomes if the defiant transitioners are counted than if they aren't, possibly on par with transitioners within margins of error depending on how many there are and how much the extra annoyance impacts outcomes.
This point aside, I also think any study of this sort would need extremely careful design to separate the effects of social transition vs the actual puberty blockers. I think you'd need two control groups: one where the kids socially transition but don't take puberty blockers, and one where they don't transition either way. And while it's very easy to tell if somebody's been taking unsanctioned hormones, it's rather harder to tell if they switched pronouns among friends, so you really couldn't run a study like that with participants who don't play fair.
By "biases in favour of transition" I mean "makes it more likely to put transition ahead". This cannot flip the study from "transition good" to "transition bad", but it can flip it from "transition bad" to "transition good".
I was arguing that it could conceivably flip it from "transition has better outcomes" to "transition and non-transition have equally good outcomes within margins of error" (if there are a lot of defiant-transitioners, all defiant-transitioners get outcomes as good as overt transitioners, and outcomes between the two groups weren't far apart anyway).
Yes, I know, but that's just a "this reduces your study's power" issue; this is trivially fixable assuming you have enough funding (and you should).
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What if it's a surgery that doesn't solve a life-threatening problem, but holds the possibility of significantly improving quality of life? There are no end of heart conditions that won't kill you, but will make you miserable and make a normal life hard.
Why did we decide to stop (most) further study of lobotomies? The inventors of the procedure won a Nobel Prize for it! At some point it seems we decided that it wasn't actually worth it, as far as I can tell.
I think it's a hard question, honestly, even before the pediatric ethics complications. How do we decide what experiments are reasonable to run on people? Definitionally, sometimes experiments find negative outcomes, and if we never run such experiments, we never find ways to make things better. To me, at least, there needs to be some level of reasonable confidence on the theory for why a potentially-harmful, irreversible experiment would be likely to succeed, and clear consent to participate.
Medicine isn't my wheelhouse, but the repeated failure to turn what should be lots of test data into verifiable claims of strong evidence suggests that the evidence isn't as glowing as the rhetoric would require. Which colors me cynical about much of the whole movement, but that's just my opinion.
The main reason is that we invented neuroleptic drugs that worked. It's cheaper and easier to treat a raving, flagrantly psychotic schizophrenic with antipsychotics instead of surgery, and you don't have to cause nearly as much collateral damage.
They made violently mad lunatics docile. While risking destroying higher cognition, being dangerous surgery, and so on. The drugs sometimes suck donkey cock, but they're better than that. Lobotomies were also often used for people who weren't violent lunatics, just to make them easier to handle, which certainly didn't help their reputation.
These days, in rare cases, we perform surgeries like stereotactic cingulotomy, which is a far more targeted technique of cutting or destroying aberrant parts of the brain. Same theory as lobotomy, if you squint, but nowhere near as messy. Works okay, if nothing else does.
I happen to share that opinion, presuming you're talking about gender affirming/reassignment care.
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To make the analogy work, the heart would have to be perfectly healthy, and the benefits of the surgery would have to be purely psychological*. "Oh no, your girlfriend broke up with you? You must be brokenhearted! Here, have a heart transplant!". This is about as much sense as gender affirming care makes.
*) If you want the analogy to be even more accurate, the surgery would have to have fairly massive, well-known, and acknowledged by everyone downsides, it's just that they are deemed to be a price worth paying for the psychological benefits.
Looking back, I didn't even mean it as an analogy. I sought to show that the standard he was advancing ruled out something considered benign or noble. It's the equivalent of someone pointing out that a No Parking prohibition on a street should make allowances for emergencies or an ambulance.
Hence that if you want to condemn such a procedure, you need different considerations. Which there are, which I haven't denied.
Posts get pretty bloated if you want to say something snappy but then also have to put in every single thing wrong with gender changing operations. I see this as a point where pretty much everyone knew what hydroacetylene was getting at, but more... analytical? minded people could want to demonstrate that that argument alone is bad. I suppose he should have written it better. I've always gotten annoyed at the "I know what you meant but let's argue out the phrasing" types.
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