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> “[W]hen we adjusted our models for receipt of PB/GAH [that is, puberty blockers and gender-affirming hormones] we saw that depression and suicidality signific

by awb 5y ago

> “[W]hen we adjusted our models for receipt of PB/GAH [that is, puberty blockers and gender-affirming hormones] we saw that depression and suicidality significantly worsened among youth who had not (yet) started PB/GAH at 3 and 6 months relative to baseline levels.” So the action here, as the researcher admits, comes not from the kids in the treatment group getting better, but rather from the kids in the comparison group getting worse. This is a bit of a perspective argument. According to the small study that was conducted, treatment kept mental health the same, while it declined for those that went without treatment. Pertinent data table: https://cdn.substack.com/image/fetch/w_1456,c_limit,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F51f3f30b-525b-42a0-a655-e059ce5a85df_1001x260.png https://cdn.substack.com/image/fetch/w_1456,c_limit,f_webp,q... So, it's more of a semantic argument. Did it really improve mental health? Relative to where they were at the start of the trial, no. Relative to the decline in the control group, yes.

_-david-_ 5y ago
Many kids in the control group dropped out. This left the kids who did not improve in the control group >The vast majority of kids who dropped out of this study didn’t access GAM. By the end of the study, just 6/63 of the remaining kids who provided mental health data, or 9.5% of the study participants, were in the no-GAM group. Overall, according to the researchers’ data, 12/69 (17.4%) of the kids who were treated left the study, while 28/35 (80%) of the kids who weren’t treated left it If the study had continued to get details from all the kids we probably would not have seen an improvement compared to the control group.
- temp8964 5y ago
  With this kind of attrition rate, I am impressed that the researchers dared to write it up and got it published ... Then I found it was published on "JAMA Network Open", is it even a serious journal?
- awb 5y ago
  > If the study had continued to get details from all the kids we probably would not have seen an improvement compared to the control group. Why do you assume the control group kids that dropped out would have caused the data to trend in a positive direction? Was there data on why they dropped out?
  - _-david-_ 5y ago
    I am assuming the kids who stopped having the issues would have dropped out at a higher rate. If a kid is having an issue their parents would want them to remain in to help find a treatment for the kid. I am not aware of any data on why kids dropped out, but it does call into question the accuracy of the results. When almost everyone drops out of a study you should start over or make sure you get the reasons why they dropped out so you can figure out if they stopped having the issues.
    - Volundr 5y ago
      > I am assuming the kids who stopped having the issues would have dropped out at a higher rate. If a kid is having an issue their parents would want them to remain in to help find a treatment for the kid. This seems like a reasonable theory, but it seems just as likely to me that as things get worse people are more likely to decide this isn't helping and drop out. Which goes to the point of the rest of your comment, the dropout rate calls the whole study into question. Otherwise we are left with guesswork and assumptions.
    - awb 5y ago
      > I am assuming the kids who stopped having the issues would have dropped out at a higher rate. Interesting. I suppose that could happen. I guess the opposite might also be true if they dropped out because they didn’t want to wait on therapy any longer and once they started therapy would no longer be allowed to participate in the control group. > When almost everyone drops out of a study you should start over or make sure you get the reasons why they dropped out so you can figure out if they stopped having the issues. Agreed. I’m not sure why the author didn’t lead with this point. This alone seems like a sufficient critique, along with the small sample size.

by awb 5y ago

_-david-_ 5y ago

Many kids in the control group dropped out. This left the kids who did not improve in the control group >The vast majority of kids who dropped out of this study didn’t access GAM. By the end of the study, just 6/63 of the remaining kids who provided mental health data, or 9.5% of the study participants, were in the no-GAM group. Overall, according to the researchers’ data, 12/69 (17.4%) of the kids who were treated left the study, while 28/35 (80%) of the kids who weren’t treated left it If the study had continued to get details from all the kids we probably would not have seen an improvement compared to the control group.

temp8964 5y ago
With this kind of attrition rate, I am impressed that the researchers dared to write it up and got it published ... Then I found it was published on "JAMA Network Open", is it even a serious journal?
awb 5y ago
> If the study had continued to get details from all the kids we probably would not have seen an improvement compared to the control group. Why do you assume the control group kids that dropped out would have caused the data to trend in a positive direction? Was there data on why they dropped out?
- _-david-_ 5y ago
  I am assuming the kids who stopped having the issues would have dropped out at a higher rate. If a kid is having an issue their parents would want them to remain in to help find a treatment for the kid. I am not aware of any data on why kids dropped out, but it does call into question the accuracy of the results. When almost everyone drops out of a study you should start over or make sure you get the reasons why they dropped out so you can figure out if they stopped having the issues.
  - Volundr 5y ago
    > I am assuming the kids who stopped having the issues would have dropped out at a higher rate. If a kid is having an issue their parents would want them to remain in to help find a treatment for the kid. This seems like a reasonable theory, but it seems just as likely to me that as things get worse people are more likely to decide this isn't helping and drop out. Which goes to the point of the rest of your comment, the dropout rate calls the whole study into question. Otherwise we are left with guesswork and assumptions.
  - awb 5y ago
    > I am assuming the kids who stopped having the issues would have dropped out at a higher rate. Interesting. I suppose that could happen. I guess the opposite might also be true if they dropped out because they didn’t want to wait on therapy any longer and once they started therapy would no longer be allowed to participate in the control group. > When almost everyone drops out of a study you should start over or make sure you get the reasons why they dropped out so you can figure out if they stopped having the issues. Agreed. I’m not sure why the author didn’t lead with this point. This alone seems like a sufficient critique, along with the small sample size.