A Tragedy and a Farce
The commentariat respond to Jan River's piece in the New Zealand Herald.
The public debate on the risks and benefits of early medical intervention in New Zealand adolescents who question their gender has begun. Thus far, signs point to supporters of medical intervention descending into farce –promoting misinformation and conspiracy theories in service of a well-meaning but misguided political agenda.
The go-to proponent of early medical intervention willing to engage with critics appears to be teacher and member of the Professional Association of Transgender Health Aotearoa (PATHA) John Palethorpe. Palethorpe has authored an op-ed and published a complaint targeting Jan Rivers’ 24 April piece criticising medical intervention. The complaint was praised by some commentators as “outstanding” and “comprehensive”. This article provides a point-by-point rebuttal of Palethorpe’s complaint. Seven out of fifteen of Palethorpe’s points are easily shown to be false. The majority of the remaining points are red herrings.
Background
The issue has been developing for some time with New Zealand at the leading edge of liberalising access to cross-sex hormones and puberty blockers for adolescents. Doctors start these treatments at earlier ages and treatments are increasingly delivered through the primary care system (1). Other jurisdictions, notably Finland, England, and Sweden, have conducted reviews, done an about turn, and moved to restrict access. The contradiction between these directions makes it difficult for New Zealand commentators to maintain a pseudo-consensus –that the treatments are beneficial, with uncertain but low risks, “affirm” the true nature of the child, and promote mental health.
The pseudo-consensus began to fray with the publication of a handful of articles. Two recent examples were authored by public health researcher Dr Sarah Donovan and Emeritus Professor of epidemiology Charlotte Paul –both in August last year. Donovan’s piece received pushback that it was somehow bad faith to “ask questions” and Palethorpe was given an op-ed in response. Oddly, Paul’s detailed article pointing to documented harms of the treatment in one New Zealand case, and the lack of evidence for the ministry of health’s description of puberty blockers as “safe and fully reversible”, never received the same level of pushback. This is perhaps because the article does not just ask questions, but suggests some rather damning answers; or perhaps because it is difficult to construe a professor of epidemiology as lacking expertise. Proponents of medical intervention seem to prefer frame critics as “anti trans” cranks motivated by confused bigotry.
In September 2022 the ministry removed language describing puberty blockers as “safe and fully reversible” with officials’ correspondence obtained through the Official Information Act response revealed that senior clinical advisors believe that the statement was not supported.
The change in advice was initially reported as technicality, and that the ministry still endorsed the PATHA guidelines which use similar language. Then in March 2023 journalist Marc Daalder of Newsroom latched on to the fact that in one ministry email a non-clinical advisor with no medical qualifications believed the former advice was true but suggested, after the decision had already been made, that it could be changed to reduce the queries from doctors and members of the public. On the slimmest of footings the article promoted a conspiracy theory that “anti-trans activists” had influenced the ministry to remove supposedly accurate medical advice. Daalder’s story has since been updated three times due to several inaccuracies, Daalder has also deleted the tweet promoting the article, and the article is now the subject of a Media Council complaint.
For its faults, the Newsroom article did flush out the ministry’s revised view withdrawing endorsement from the PATHA guidelines, and the ministry has pushed back firmly against the suggestion that the burden of correspondence had played a part in the decision, instead citing the recent systematic evidence reviews in Europe as the reason.
Rivers' piece in the New Zealand Herald also used the ministry removal of the "safe and fully reversible" description as a starting point, and detailed the reasons why the advice was dubious and the clinical practice in New Zealand is reckless. Palethorpe responded quickly by publishing his complaint and encouraged social media followers to write to the Herald asking for retraction. Palethorpe relies on bluster and bravado and, as will be shown below, his complaint is a paper tiger.
The fact that Palethorpe, hardly someone with relevant qualifications or experience, is one of the most active defenders of early medical intervention in adolescents raises questions about how the public debate in New Zealand will develop. PATHA leadership have been a step removed preferring to issue bland statements rather than engage directly. So far no New Zealand journalist has yet asked PATHA probing questions because PATHA will only work with journalists when they are confident of getting patsy questions, and it has never occurred to some journalists to challenge PATHA’s claims.
The keen observer will now realise that there is now daylight between the positions of PATHA and the ministry. Daylight that may grow wider when the ministry publishes and evidence brief due this month. If the evidence brief is in line with those of England, Finland and Sweden, it remains to be seen how the proponents of medical intervention and their media proxies will take this news.
Claims:
Palethorpe’s modus operandi is to either make a blatantly false claim knowing that the majority of readers will never check for themselves, or to make a tangential point that he would prefer Rivers to have made and then claim that the absence of this point means that Rivers is being deliberately misleading. I label the former a “false”, and the latter as “red herring”
1. The Ministry of Health has confirmed that they retain confidence in the safe and reversible nature if puberty blockers
False. Palethorpe has now acknowledged that the ministry does not retain confidence in the safety and reversibility of puberty blockers. While the ministry has made no public announcement, information that an evidence review is due this month has been supplied to journalists and is an OIA response published to the ministry’s website.
2. The NICE study did not find “evidence for the use of puberty blockers is poor”.
False. NICE did indeed find the “evidence for the use of puberty blockers is poor”.
The NICE review examined eight studies looking at bone health and mental health impacts of puberty blockers. The NICE review labels all eight of the studies as “[o]verall quality is assessed as poor.” (2)
Contradicting himself, Palethorpe then outlines some of the reasons why the evidence is poor: the lack of control groups, small populations included in the studies and the difficulties with human experimentation. Not mentioned is the high number of participants lost to followup (2)
3. According to Palethorpe, Rivers paraphrased a particular sentence in Dr. Abassi's editorial in the British Medical Journal on the risk of overtreatment to avoid discussing the draconian laws against medical intervention in some US states.
False. Red herring. The main themes of Dr Abassi’s editorial are the challenges faced by health professionals in providing care to young people with gender dysphoria, the importance of evidence-based care, the risks of overtreatment, and prioritising research to address the evidence void.
Abassi mentions the risk of overtreatment three times, it is one of his main themes. By highlighting that clinical guidance is not supported by evidence and the risk of overtreatment, Rivers isn’t paraphrasing a particular sentence, she is summarising two of the main points of the editorial. Palethorpe would prefer Rivers to focus on the draconian laws, but this is a minor detail of the editorial and in an opinion piece Rivers is under no obligation to comply with Palethorpe’s preferences. Palehorpe’s claim that a particular sentence has been paraphrased is false and serves only to distract the reader from Rivers’ point.
4. Palethorpe believes that his search of Media Council rulings is complete and that Rivers has made up the claim that the “Media Council recognises there is a legitimate debate.”
False. The ruling is here “Fern Hickson against the Nelson Mail”, September 2022 and the relevant section is quoted below”
“However coverage of the debate about the treatment of gender dysphoria in children is slightly different. This is a sensitive, complicated and important topic, where there appears to be evolving scientific debate. The Council rejects Stuff’s argument that it is analogous to climate change. In the case of climate change there is an overwhelming consensus of scientific opinion, whereas on the issue of childhood gender dysphoria there seems to be a variety of genuinely held and differing opinions internationally.”
5. Palethorpe claims that Rivers is deliberately misleading by not mentioning that one of the two drugs is approved for children in another indication (age 6-11)
Red herring. Palethorpe never addresses Rivers' point that the manufacturer of Goserelin, one of the two drugs used off label to suppress puberty, explicitly advises against its usage in children.
Pharmac has not approved either Goserelin or Leuprorelin for adolescents with gender dysphoria in the normal age of puberty (11-16). Palethorpe attempts to distract the reader by pointing out the Leuprorelein is approved for another indication (precocious puberty, age 5-11), but this is inconsequential to the point at hand.
Drug approval processes are separate for these age groups because of physiological differences (3) and potential impacts on “critical windows” of development (4). When puberty blockers are used to treat precocious puberty the child (typically aged 5-11) will have puberty delayed until the normal age for puberty at around age 12. But this is not the case for a gender-questioning adolescent treated age 11-16 who will not experience puberty in the normal age range. Sex hormone production may restart with delay but it is unclear if adolescents coming off treatment at age 16 experience a physiologically equivalent “puberty” from ages 16+. The limited scientific literature indicates that this is not the case (5–7).
Palethorpe makes much of the fact that both drugs are “open listed”, but that simply means that doctors do not need to request special authority to prescribe off-label. Doctors have leeway to prescribe unapproved drugs as long as the physician provides all the information that a patient would expect to know about a treatment, information on alternatives, and ensures that the patient has the capacity to understand the information and the potential consequence of the treatment. It is not clear that these latter conditions for prescribing puberty blockers “off label” are being met and common practice may be unlawful. The divisional court in the UK found that it would be “highly unlikely” for a child 13 or younger to be able to consent to puberty blockers. The judgement was overturned on appeal, but on a point of jurisdiction, not disagreement with the divisional court on specific points regarding consent.
Questions of lawfulness aside, Rivers’ point is that if the drugs are unapproved for usage in gender dysphoria, and one of the drug manufacturer’s of one of the drugs explicitly warns against its use for children, then that adds further weight to withdrawing advice that the usage is “safe and fully reversible”. Palethorpe presents no arguments against this point.
6. Palethorpe disagrees with Rivers' emphasis on the abnormally low bone density found in some patients after puberty suppression. Palethorpe suggests that the issue has been covered because it is mentioned in consent forms.
Red herring. If a substantial proportion of treated adolescents end up with abnormally low bone density, and do not recover, or only partially recover post-treatment then then the treatment cannot be described as “reversible” –the main question addressed in the article. The fact that clinicians are aware of potential bone health consequences, mentioning this in consent forms, but continue to promote the treatment as “reversible” demonstrates the incoherence of their position. The reference for the analysis of academic research is Biggs (2021) (8) which is an analysis of the data in Joseph et al. (2019) (9) both published by the Journal of Pediatric Endocrinology and Metabolism. In up to a third of patients, the bone health measures were so low that combined with an elevated fracture history (not reported) these levels would meet the diagnostic criteria for paediatric osteoporosis.
Palethorpe does not appear to be aware of the scientific literature of the bone health impacts or of the growing number of reports of adolescents developing osteopenia or osteoporosis, the fact that many subjects do not recover their pre-treatment bone health many years after treatment withdrawal, and other permanent health impacts after treatment with blockers.
In Sweden a 14 year old “Leo” was diagnosed with osteoporosis after 4.5 years of puberty suppression. Leo reports constant back pain. An investigative news team found 12 other adolescents with impacts such as worsened mental health and liver damage from hormone treatments.
BBC Newsnight journalist Hannah Barnes reports a young adult patient previously on blockers that now has osteoporosis in her book Time To Think. The patient’s doctor believes that “there are others with cases like mine” (10).
Also in the UK 16 year old “Jacob” began on blockers at age 12. Jacob claims that taking blockers was “the worst decision I’ve ever made…I go to school and I feel like other people are developing and I still feel like a child…I’d never broken a bone before [taking puberty blockers],” he says. “I’ve since broken four bones. “I stubbed my toe, it broke. I fell over, my wrist broke. Same with my elbow.””
The New York Times reported on the bone health issue in November last year and highlighted the case of a teen who developed osteoporosis after 2 years on blockers. The Times commissioned an analysis of seven studies of the bone health impacts from puberty suppression and any recovery after treatment withdrawal. The analysis shows that bone health does not recover in many patients:
“Many doctors treating trans patients believe they will recover that loss when they go off blockers. But two studies from the analysis that tracked trans patients’ bone strength while using blockers and through the first years of sex hormone treatment found that many do not fully rebound and lag behind their peers.”
““There’s going to be a price,” said Dr. Sundeep Khosla, who leads a bone research lab at the Mayo Clinic. “And the price is probably going to be some deficit in skeletal mass.””
The two studies mentioned are likely Schagen et al, (2020) (7) and Klink et al. (2015) (11). In the Klink et al. study follow-up was 5 years after puberty blocker withdrawal but most male subjects still had bone health scores below pre-treatment levels. There are no studies demonstrating a complete recovery in the majority of subjects. No studies have addressed patients who come off puberty blockers and do not receive cross-sex hormones.
Rivers’ point that the treatment is not “safe and fully reversible” stands and Palethorpe’s point that bone health impacts are mentioned in consent forms is a red herring and does not refute this.
7. Palethorpe dismissed the WPATH President’s statement on the potential impact of puberty blockers on male sexual function as unsubstantiated by academic research.
Red herring. False. Dr Bowers’s views were expressed in a meeting of experts and repeated in interviews that early puberty suppressed adolescents will never orgasm. Dr Bowers has performed over 2000 vaginoplasties, an unknown but increasing number of which would have been on patients previously receiving early puberty suppression –most famously Jazz Jennings. Bowers’ views should therefore be taken seriously. That these views are not substantiated or disproven by academic research demonstrates the dereliction of duty by gender clinicians who have not investigated the issue in follow-up studies.
Separate to Bowers’ statements, a case in the UK reports reduced sexual function “Two years on, since coming off the blockers [at age 18] Alex has still not experienced any sexual feelings”.
That most male patients will have a micropenis after early puberty suppression is substantiated by academic research. In follow-up Dutch research 70% of puberty suppressed males who later received vaginoplasty had to undergo intestinal vaginoplasty (a less common technique where a section of the colon is repurposed as a simulacrum of a vaginal canal) because there was not enough penile and scrotal skin for the more common penile inversion technique (12).
8. It is not clear what Palethorpe is disputing in the Brik et al. (2020) and Carmichael et al. (2021).
Red herring. Several papers track continuation to cross sex hormones following on from puberty blockers and show the vast majority continue to cross sex hormones (13,14).
Palethope brings up the supposedly detailed assessments the adolescent will receive but it is not clear what his point is. Palethorpe may be suggesting that “detailed assessments” mean doctors have determined that the adolescent has a stable innate identity and will benefit from increasingly consequential medical interventions (hormones and surgery).
However, the WPATH guidelines state that “there are no reliable means of predicting an individual [prepubescent] child’s gender evolution” (15), and there is no evidence that this differs for adolescent children. The Cass Review interim report highlights the complex aetiology of gender-related distress, including sexual abuse, LGB sexualities, and autism; and how distress can resolve and gender identity can change without medical intervention (16).
The Dutch researchers who pioneered the use of puberty blockers for gender dysphoria have also recently admitted that puberty blockers could be locking the child into dysphoria and a medical pathway: “One cannot exclude the possibility that starting [puberty-blockers] in itself makes adolescents more likely to continue medical transition” (17). The same point was made by Dr Cass in her letter of recommendations to the NHS.
In any case, Reuters reports that in their investigation into 18 gender clinics in the USA: “[n]one described anything like the months-long assessments de Vries and her colleagues adopted in their research”...Seven of the clinics said that if they don’t see any red flags and the child and parents are in agreement, they are comfortable prescribing puberty blockers or hormones based on the first visit, depending on the age of the child.”
If detailed assessments have been informally dropped in the USA it is relevant to ask if this is also the case in New Zealand and, even if they are being done, can determine if an adolescent is ‘truly trans’.
9. Palethorpe believes that Rivers’ claim that pelvic pain from testosterone treatment encourages hysterectomy and chest binders encourage mastectomy is misleading.
Debatable. New onset pelvic pain after testosterone treatment is a common complaint in trans identified females (18–21). One study finds that the only effective treatment for this pain reported by study participants was hysterectomy (18). It is therefore reasonable to speculate in an opinion piece that testosterone treatment may be encouraging patients to later opt for hysterectomies (and sterilisation) that they would not have otherwise desired.
A similar argument could be made regarding chest binders and chest pain. As with puberty blockers described above, early initial steps in the early medical intervention pathway appear to create additional problems, with later steps presenting as the ‘solution’.
10. Rivers claims that there is no evidence that hormonal treatments on adolescents will lower or prevent suicide. Palethorpe counters with high reported rates of attempted suicide in non-representative surveys of transgender people.
Red herring. Rivers claim was “Clinicians and others may tell parents their child will commit suicide without treatment” (emphasis added). Palethorpe’s statistics are from non-representative surveys and are not relevant to the question of whether treatment lowers (or raises) suicide rates. Palethorpe misleadingly draws an equivalence between reported suicide attempts and completed suicides and reports the statistics as representative of the transgender population at large when they are from non-representative sample surveys. We do not know the suicide rate of trans identified adolescents in New Zealand pre- or post-treatment.
Overseas research is not encouraging. Suicide in trans identifying adults post-surgery intervention is elevated (22). In a recent USA study 2 adolescents out 315 participants receiving cross-sex hormones committed suicide after 2 years of followup. A suicide rate of 317 per 100,000 per year (23).
In another study, the completed suicide rate of trans identifying adolescents on the waiting list for treatment, or receiving treatment in the UK was 13 per 100,000 per year. This is slightly lower than 15 per 100,000 per year suicide rate of 15-19 year olds in the general New Zealand population (24), and despite the UK prescribing puberty blockers at 10x less per capita than New Zealand (25). If puberty blockers did prevent suicide you would expect to see elevated suicide rates in gender-questioning adolescents where puberty blockers are much less available.
There is no evidence that shows that, without treatment, suicide rates are raised. However clinicians in the USA often raise the spectre of suicide to bully parents into assenting to treatment: ‘would you rather have a dead daughter than a live son’.
11. Palethorpe quibbles with the fact that the Tavistock Gender Identity Development Service (GIDS) is not yet closed when Rivers article reported this “was closed”
Red Herring. This was changed by the Herald editors. Rivers’ original article worded it as “being closed”
12. Palethorpe claims that the clinic was not closed due to unsafe practices and that the main problem at the GIDS was the lack of access to treatment. He later claims that the 10x greater usage of puberty blockers in New Zealand versus England is inline with the Cass Reviews’ recommendations implying that the NHS, following Cass’ recommendations, is going to dramatically expand prescriptions of puberty blockers.
False. Dr Cass expresses concern at the “affirmation model” used by clinicians at GIDS and promoted by PATHA in New Zealand:
“From the point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations and the extent of social transition that has developed due to the delay in service provision.”(16)
Indeed, PATHA published a statement expressing “[concern] about statements in the [Cass Review] questioning an affirmative approach to gender affirming care.” It is surprising that Palethorpe was not aware of PATHA's position. One explanation is that Palethorpe is aware that the Cass Review questioned the “affirmative, non-exploratory approach” but is deliberately spreading false information.
The Care Quality Commission (CQC) also investigated GIDS in October 2020 due to concerns relating to “clinical practice, safeguarding procedures, and assessments of capacity and consent to treatment”. The CQC rated GIDS as inadequate. Amongst findings was that some assessments were only two or three sessions and two was in breach of the NHS service specification (10).
Palethorpe’s suggestion that “Effectively, [the 10x per capita usage of blockers] demonstrate a system working in a regionally devolved manner, which is what Dr. Hilary Cass recommended in her report.” is an egregious lie. Dr Cass recommended that puberty blockers only be used in the context of a formal research program (emphasis mine).
“In light of these critically important unanswered questions, I would suggest that consideration is given to the rapid establishment of the necessary research infrastructure to prospectively enrol young people being considered for hormone treatment into a formal research programme with adequate follow up into adulthood, with a more immediate focus on the questions regarding puberty blockers. The appropriate research questions and protocols will need to be developed with input from a panel of academics, clinicians, service users and ethicists”
In practical terms, restricting blockers to formal research will scale back usage –the opposite of Palethorpe’s suggestion.
The NHS has published a draft service specification in response to Dr Cass’ recommendation. The specification confirms that puberty blockers will only be used within a formal research protocol (emphasis mine).
“Consistent with advice from the Cass Review highlighting the uncertainties surrounding the use of hormone treatments, NHS England is in the process of forming proposals for prospectively enrolling children and young people being considered for hormone treatment into a formal research programme with adequate follow up into adulthood, with a more immediate focus on the questions regarding GnRHa. On this basis NHS England will only commission GnRHa in the context of a formal research protocol.”
13. Rivers’ criticises the practice of treating a child as an expert and the lack of diagnosis prior to treatment. Palethorpe draws attention to assessments recommended in guidelines.
Motte and Bailey. Palethorpe leans on the ambiguity of the term “assessment”. Is an assessment performed to investigate the background factors that may have led to the child’s belief they are the opposite sex? Or is the assessment merely to ensure that comorbid issues such autism and depression are addressed concurrently with medical intervention?
If the child is treated as an ‘expert in their own gender’ then there is little space for the clinician to question the background factors as that would undermine the child’s supposed expertise. PATHA highly discourages background exploration conflating it with conversion therapy. In PATHA’s August 22 statement, referring to the Cass Review interim report, PATHA “is concerned about the use of language in the review that talks about causation of gender incongruence. Such language is often used as a preamble to conversion therapy.”
The Cass review highlights the importance of these factors, such as questioning sexual orientation, sexual or other abuse, and autism (16).
When critics like Rivers point out that comprehensive background assessments are not being done or are highly discouraged by the guidelines, and background issues are overshadowed by the clinicians acceptance and foregrounding of a self-declared trans status, Palethorpe and defenders rush in to point out that “assessments” are being done conflating the quite different intentions of the Cass- vs PATHA- recommended assessments. The paragraph quoted by Palethorpe reinforces River’s point, specifically:
“it is important to ensure that.. [mental health support] is not enforced as a requirement for accessing gender affirming care.”
PATHA could clarify the situation by publishing the number and proportion of adolescents who requested puberty blockers but were refused after assessment. If the proportion of refusals is significant it would demonstrate that PATHA associated clinicians regularly make a differential diagnosis and assessments meaningfully account for background factors, rather than simply a checkbox exercise for the medical intervention pathway.
Arguments regarding whether assessments are actually happening and can determine if the child’s identity is innate and stable are addressed in [8] above.
14. Palethorpe claims that WPATH’s guidelines have NOT removed surgery age limits.
False. Palethorpe quotes from an article published in June 2022 three months before the guidelines were issued in September. The British Medical Journal and The Economist covered the removal of age limits from the WPATH guidelines in detail. The guidelines originally had minimum age limits of 14 for cross-sex hormones, 15 for double mastectomy, and 17 for orchiectomy (removal of testicles). The age limits were removed in a haphazard process after initial publication. Surgeons in the USA have performed double mastectomies on 13 and 14 year olds who identified as boys in the USA (26). Guidelines have a quasi-legal status and the removal of age limits from the guidelines mitigates medical malpractice liabilities should these patients come to regret these procedures and take legal action against the surgeons.
15. Palethorpe disagrees that the Relationship, Sexuality and Education (RSE) guidelines and surveys on gender identity present being transgender as an option for all primary children.
Debatable. Adolescence is a time when young people form identities to navigate the social world. Children also have concrete ideas of sex stereotypes but many resist socialisation into the sex stereotypes and face social consequences for doing so (27–29). Young lesbians in particular are vulnerable to conceptualising their resistance to female sex stereotypes and their emerging same-sex attraction as an innate male identity, leading some to pursue male imitation medical treatments (30–32).
Palethorpe will be familiar with the concept of a “Push Poll” when a survey encourages participants to frame or align their views to the framings made by the researchers.
We see this resistance to female stereotypes reflected in the Now We Are Eight survey of 7000 children. The findings showed that:
2.7% of females identified as either a boy or mostly a boy compared with 0.5% of males who identified as either a girl or mostly a girl.
22% of females identified as “between genders” compared with 6% of males.
3.4% of females were unsure about their gender compared with 1.7% of males.
A feminist analysis of the survey results would argue that the stereotypes imposed on girls are more restrictive and that status as a woman or girl is more vulnerable to violence and unwanted male attention. When significantly more girls state that they are unsure, identify as “between genders”, or identify as the opposite sex this does not represent accurate reports of these girls’ fixed, inherent non-female status, but deeper issues related to the social position of women and girls in a patriarchal society. More girls fear growing up to become women than boys fear to become men, and more girls resist the imposition of femininity. Many detransitioners reported such fears and misconceived of themselves as transgender when they encountered transgender concepts (30,33,34).
But this analysis is not present in the Now We Are Eight report, the RSE guidelines or the InsideOut Guidance used in schools. These documents conceptualise an opposite sex identification as evidence of an innate opposite-sex or non-binary self –a theory for which there is no scientific evidence. Whether or not the survey or guidance “encourages” a child to think of him or herself as having an innate opposite sex or unsexed status is debatable. In any case, there is no explanation for why many more girls than boys identify away from their own sex.
Further, The RSE guidelines and InsideOut Guidance normalise puberty blockers as a “[variation] in puberty.” This is likely a breach of section 20 of the Medicines Act which prohibits providing information about medicines for an unapproved indication. What business is it of the Ministry of Education, the teachers who will develop lesson plans from this guidance and InsideOut coordinators to promote a medicine to children which other countries have labelled “experimental” and restricted to medical trials (35–37)? Nurses are not allowed to discuss specific medicines with patients, let alone experimental drugs, so why should teachers and untrained coordinators?
The RSE guidelines have no business promoting medical treatments to impressionable young people, particularly ones that appear to offer the medical and conceptual ‘solution’ to the anxieties of puberty and the adolescent identity crisis.
Conclusion
Palethorpe is clearly acting in bad faith. Half of his claims are easily shown to be false and he must be at least somewhat aware of this. Commentators have have been taken in by confidence and bluster. Rivers’ Herald article seems to have survived Palethorpes’s complaint and looks likely to survive a Media Council ruling.
To make policy and participate the body politic needs a minimal set of facts. That the ministry of health does not believe supressing an 12 year-old’s puberty for four years is a “safe and fully reversible” intervention is one of these facts. But to bring this and the other facts found in Rivers’ piece into public awareness first means getting past the tantrums, denials, and conspiracy theories of the New Zealand commentariat.
Acknowledgements
Jan Rivers contributed to this article.
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