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PaperclipPerfector  7mo ago (text post)   25441 thread views

Culture War Roundup for the week of April 8, 2024

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And the critics are wrong. If you give a treatment to one group, and not give it to another to another, that's still an RCT. Or you can offer an alternative treatment to the control group. It's a plus when you can blind a patient to what they're getting, but it's not a strict necessity. In this case it's probably just as important to blind the researchers when they're assessing results as to blind the patients themselves.

You're right of course. I think the concerns are more nuanced in some areas of medicine.

I doubt it applies to trans medicine, but I have heard of cases where medicine has such obvious positive effects for the sample group early on, that it then becomes unconscionable to not provide it to the control group (mostly in cases involving terminal diseases with quick turn arounds.) This would be one instance where a study initially meant to be a RCT trial for a terminal disease, might turn into an observational study instead.

And I was clearly thinking of double-blinded RCTs being nearly impossible in some cases, which I believe is true in some areas of medicine, but I can admit that GRADE only requires RCTs period for evidence to be considered high quality. That said, reading through the actual GRADE hand book it does seem like Lack of Blinding is considered a risk for study bias, which can drop a piece of evidence one level:

Example 3: High Risk of Bias due to lack of blinding (Downgraded by One Level)

RCTs of the effects of Intervention A on acute spinal injury measured both all-cause mortality and, based on a detailed physical examination, motor function. The outcome assessors were not blinded for any outcomes. Blinding of outcome assessors is less important for the assessment of all-cause mortality, but crucial for motor function. The quality of the evidence for the mortality outcome may not be downgraded. However, the quality may be downgraded for the motor function outcome.

I'm going to edit my original post to reflect this information, but I'll make clear what I'm adding. Basically, it appears to be the case that non-double-blinded RCTs cannot easily be high quality evidence according to GRADE.

Where did you get the idea that the decision was arbitrary?

I tried to search through the report, and they just used GRADE without really explaining why. I suppose "arbitrary" isn't quite the right word, but "unjustified within the report" is probably defensible.

And I was clearly thinking of double-blinded RCTs being nearly impossible in some cases

Ok, but what does that have to do with the Cass Review then?

I haven't even started reading the report yet, but I looked up the excerpt you quoted about only one study on puberty blockers being high quality. If you check the report, the excerpt references "Taylor et al: Puberty suppression", CTRL+Fing for that takes you to table 1 on page 53. The full title of the systematic review is Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review, and the "one study" is Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers. The "methods" section from the abstract says:

Methods: In this cross-sectional study, emotional and behavioral problems were assessed by the Youth Self-Report in a sample of 272 adolescents referred to a specialized gender identity clinic who did not yet receive any affirmative medical treatment and compared with 178 transgender adolescents receiving affirmative care consisting of puberty suppression and compared with 651 Dutch high school cisgender adolescents from the general population.

You can even look up the break down of it's score in the supplemental material of the systematic review (it's the last entry in the table - "van der Miesen"), it only got dinged for "controls for co-interventions" and "assessment of outcome", and still got a final grade of "high quality".

So where is this idea that Cass was autistically demanding a double-blinded study, where it was not applicable, coming from?

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