#Segmed

[segmed]

❓ Are data gaps limiting your AI development? Data voids - such as underrepresented cohorts or scarce outliers - are a persistent challenge in building robust and generalizable medical AI models. (Segmed.ai) ⭐ The good news? RYVER.AI, a Segmed alliance partner, published research showing that synthetic and pre-annotated medical images can effectively fill these gaps without compromising model performance. This means: ✅ Easy access to diverse and balanced datasets ✅ Broader training scenarios for improved AI generalization ✅ Less time spent searching and annotating suitable data 🔗 Discover how this works and what it means for your AI development.

[innonurse]

Noah Medical has received $150 million in venture capital funding for its lung biopsy robot

- By InnoNurse Staff -

The Silicon Valley-based company raised $150 million to assist in the development of a commercial engine for its Galaxy system, which is designed to do guided lung bronchoscopies with disposable probes.

Read more at Fierce Biotech

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Other recent news and insights

How AI is being used by healthcare informatics leaders (Becker’s Health IT)

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AI is being used by researchers to better identify the weaknesses of lung cancer cells (University of Montana)

A bioinformatic investigation of the perivascular area uncovers 24 genetic risk loci (Medical Xpress)

Tricog Health, an Indian healthtech startup, has raised $8.5 million (The Economic Times)

[religion-is-a-mental-illness]

By: SEGM

Published: Aug 13, 2023

Near-zero regret” findings among adults suffer from a critical risk of bias and have low applicability to youth

Recent research published in JAMA Surgery evaluated satisfaction and regret among individuals who had undergone chest masculinizing mastectomy at the University of Michigan hospital. The average patient age at the time of mastectomy was 27 years; no patients who were under age 18 were allowed to participate in the study.

The participants reported high levels of satisfaction and low levels of regret at an average of 3.6 years following mastectomy. The study authors lauded the “overwhelmingly low levels of regret following gender-affirming surgery,” and framed their findings as in conflict with the “increasing legislative interest in regulating gender-affirming surgery,” referring to current legislative attempts to restrict or ban “gender-affirming” procedures for minors. Another group of authors provided an invited commentary on the paper, reinforcing the view held by the study authors, and asserting the presence of a “double standard:” “gender-affirming” mastectomies have come under undue scrutiny by states’ legislators, while other surgical procedures with higher regret rates do not appear to concern legislative bodies.

The study suffers from serious methodological limitations, which render the findings of high levels of long-term satisfaction with mastectomy among adults at a "critical risk of bias"—the lowest rating according to the Risk of Bias (ROBINS-I) analysis. ROBINS-I is used to assess non-randomized studies for methodological bias. The "critical risk of bias" rating signals that the results reported by the study may substantially deviate from the truth. The results also suffer from low applicability to the central issue the study and the invited commentary sought to address, which was whether legislative attempts to regulate “gender-affirming” surgeries are warranted in minors. Unfortunately, these highly questionable findings are misrepresented as certain and highly positive by both the study authors and the invited commentators, several of whom have significant conflicts of interest.

Below, we provide a detailed explanation of the key methodological issues in the study which render its claims untrustworthy and not applicable to the patient population at the center of the debate: youth undergoing gender reassignment. We also comment on the alarming trend: several prestigious scientific journals appear to have deviated from their previously high standards for scholarly work and instead have become vehicles for promoting poor-quality research, seemingly to influence judicial policy decisions rather than advance scientific understanding. We conclude with recommendations about how journal editors can restore the integrity of scientific debate and raise the bar on the quality of published studies in the field of gender medicine.

[ For in-depth analysis, see: https://segm.org/long-term-regret-satisfaction-mastectomy-critical-appraisal ]

SEGM Take-Aways

Although this study reports extremely high rates of satisfaction and low regret, the timeframe in which these outcomes were assessed is insufficient—just 3.6 years post-mastectomy on average. The sample is also highly skewed: 50% of the participants had mastectomies in the last 3.6 of the 30 years. This skewing of the length of time since surgery is expected, given the sharp rise in the number of people (especially adolescents and young adults) identifying as transgender and undergoing chest masculinization mastectomy. It is also a short time in which to assess regret, particularly since one quarter of study participants were younger than age 23 at time of surgery and the median age of first birth in the US is 30 years.

The conclusion of high satisfaction/low regret suffers from a critical risk of bias due to the high non-participation rate, important differences between participants and non-participants, and lack of control group. Problematically, the authors misuse the (critically-biased) results from adults to argue against regulations for irreversible body alternations for minors and do so with a decidedly politicized spin.

The only intellectually honest commentary is that we do not have good knowledge of the likely rates of detransition and regret following chest masculinization mastectomy, nor do we know how many people experience regret but remain transitioned. There is an urgent need for quality research in this area. Previously, detransition and regret rates were considered to be low: they may have indeed been low due to the much more rigorous screenings, or the results may have been biased by the notoriously high dropout rates that plague “regret” research. Regardless, there is now growing evidence of much higher rates of medical detransition.

A recent study from a comprehensive U.S. dataset with no loss to follow-up revealed a 36% medical detransition rate among females within just 4 years of starting hormonal transition. At least two recent studies suggest that average time to regret among recently-transitioned females is about 3-5 years, but there is a wide range. Much less is known about detransition among those who undergo surgery. A growing number of detransitioners now express regret associated with the loss of breastfeeding ability, with one case study detailing breastfeeding grief experienced some 15 years post-mastectomy.

The study and invited commentary exemplify three problematic trends that plague studies emerging from the gender clinics: problematic conflicts of interest of the authors; leveraging scientific journals to disguise politically-motivated pieces as quality research; and a conflicted stance by the gender medicine establishment on surgery for minors. We expand on each briefly below.

Conflicts of interest of study authors and commentators 

The significant conflicts of interest of the gender clinicians who study and report on the outcomes of “gender-affirming” interventions cannot be overlooked. These clinicians are conflicted financially, since their practices specialize in “gender-affirming” interventions, as well as intellectually. While conflicts of interest among experts are common, such experts should still attempt to be balanced in their discussions and should acknowledge and reflect on their conflicts of interest.

The interpretations of the data in the study is neither rigorous nor balanced, and both the study and the invited commentary have a decidedly political spin. Further, the invited politicized commentary does not disclose that at least one of the authors is a key expert witness opposing states’ efforts to regulate “gender-affirming” surgeries for minors. This role alone precludes the ability to provide a balanced commentary.

There is a fundamental problem with research emerging from gender clinic settings. The same clinicians provide gender-transitioning treatments to individual patients in their practice; serve as primary investigators and custodians of data used in research informing population health policies; and increasingly, provide paid expert witness testimony in courts defending the unrestricted availability of hormonal and surgical interventions for minors.

As a result, such clinicians cannot express nuanced perspectives. Since any balanced statements may be used against them in a court of law when they serve as expert witnesses, they must resort to the lowest common denominator of the "winner-takes-all" adversarial approach. Such an approach does not tolerate nuance. Unfortunately, this approach contributes to the erosion of the quality of the published work in the arena of gender medicine and accelerates loss of trust about the integrity of the scientific process.

Misuse of scientific publications to promote politically-motivated articles disguised as scientific research

That prestigious medical journals now serve as platforms for promoting misleading, politically motivated research that aims to apply a veneer of misplaced confidence in  highly invasive, irreversible treatment should worry everyone committed to evidence-based medicine and the integrity of science. Moreover, it impairs our ability to accurately assess and improve the long-term health outcomes of the rapidly growing numbers of gender-diverse and gender-distressed youths.

This is not the first time that a JAMA has been used as a platform for positioning advocacy for “gender-affirming” care as scientific research. In 2022, JAMA Pediatrics published a study that assessed bodily happiness in a group of subjects aged 14-24 three months after chest masculinization mastectomy. Despite the very short follow up and dropout rate of 13%, the authors argued that their findings supported the premise that there was no evidence to suggest that young age should delay surgery. They also asserted that their research would help dispel the misconception that such surgeries are experimental. The editorial commissioned to bolster the authors claims was descriptively titled, “Top surgery in adolescents and young adults-effective and medically necessary.”

Another troubling trend is the misuse of statistical tools to reframe research findings that contradict the author's own position. For example, a well-known study that claimed that access to puberty blockers reduce the risk of suicide disregarded the fact that individuals reporting use of puberty blockers use had twice as many recent serious suicide attempts as their peers who did not use puberty blockers. Like the finding cited above, the doubling of suicide attempts was not statistically significant due to a small underpowered sample—but the magnitude of the effect was striking and should have tempered the authors’ enthusiastic conclusion that puberty blockers prevent suicides. Another recent gender clinic study, widely and positively covered by major media outlets, claimed that puberty blockers and cross-sex hormones led to plummeting rate of depression—even though the rate of depression among youth taking those medications remained demonstrably unchanged. More information about problems with research originating from gender clinics is detailed in this recent analysis.

Gender medicine’s stance on pediatric surgery

More generally, the gender medicine establishment is in a curious state of internal conflict about its stance on “gender-affirming” surgeries for minors.  On the one hand, it has become common for advocates of “gender-affirmation” of minors to insist that surgeries for minors are not performed and anyone who suggests otherwise is spreading “scientific misinformation” and “science denialism.”  On the other hand, gender clinicians publish mastectomy outcomes for minors in major medical journals, and laud surgeries for minors as “effective and medically necessary.” It is not uncommon for these opposing claims to be made by the same group of researchers and clinicians, as they test various arguments, searching for the "angle" that is most likely to convince judges and juries--and public at large--that scrutiny of the practice of pediatric transitions, which is increasingly occurring in European countries, is not warranted in the United States.

Notably, none of the European countries that are enacting severe restrictions on the use of puberty blockers or cross-sex hormones for minors have ever allowed surgeries for youth under 18. That the U.S. gender affirmation professionals continue to fight regulation of these problematic procedures speaks volumes about how far the U.S. healthcare has drifted when it comes to "gender affirmation" of minors.

Final thoughts

While it is challenging to determine how best to reduce the temperature of the highly politicized nature of the debate in gender medicine, the editors of scientific journals can begin to restore balance by recognizing how far the field has drifted from the standards of quality scientific research, and begin to expand their circle of peer-reviewers to those with diverse views. Inviting those concerned with the state of gender medicine (and not just the practices’ advocates) into the peer-review and commentary process is the first essential step to improve the quality of research published in the field of gender medicine.

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==

The activists are predictably - and consistent with the superficiality of their own ideology - upset that anyone should look below the surface. It seems to be more troubling that anyone would notice the shoddiness of the research, than that the research is shoddy.

If this is supposed to be "healthcare," you would think that they would want the best healthcare, and be more alarmed at the misrepresentations of the study, than by people finding those misrepresentations.

Could it be that this is ideological rather than medical? 🤔

The conflicts of interest and funding sources alone are remarkable.

[gloriousmonsters]

ok just a quick Q because I keep seeing stuff that makes me wonder if a lot of people think differently than me or i'm just encountering the few cases that disagree in the wild

[tigerexe]

Picked up the Pandora Principle for a thrid time for reading on my trip and Yeah. its's still the best book ever

[aethernalstars]

Hey, @staff @support what the fuck is this ad? Why is an ad about SEGM, a well known anti-trans lobbyists group which is oft cited by transphobic legislation, on my dash?

"Queerest place on the internet" doesn't stop you from advertising for these assholes it seems

It links to this article btw: link. And for contrast, SEGM's Wikipedia page: link

[mako-neexu]

TRAUM IS INSANE bc i keep remembering verse's posts about guda not seeing shit clearly/they have trouble differentiating people smth like that and it applies to Servants especially where they used something like the Saber-face example where Morgan is "Saber-face" even as she has white hair blue eyes compared to Artoria idk i vaguely remember the post but VERSE IS ALWAYS RIGHT AGHH

[shrike-dyke]

reminder btw that segm are best buds with david "jews are lizard people" icke

[segmed]

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[nando161mando]

Fuck SEGM fuck Genspect, they are enemies of freedom and the working class

[religion-is-a-mental-illness]

By: SEGM

Published: Jun 11, 2023

A new peer-reviewed article, “Transition Regret and Detransition: Meaning and Uncertainties,” published in the Archives of Sexual Behavior, reviews clinical and research issues related to transition regret and detransition. The article emphasizes that “although recent data have shed light on a complex range of experiences that lead people to detransition, research remains very much in its infancy,” and there is currently “no guidance on best practices for clinicians involved in their care.”   

The author, Dr. Jorgensen, notes that the term “detransition” can hold a wide array of possible meanings for transgender-identifying people, detransitioners, and researchers, leading to inconsistencies in its usage. Although regret and detransition overlap in many people, not everyone who regrets their transition takes steps to detransition and conversely, not all of those who detransition regret their transition. Proponents of the “gender-affirming care” model typically focus on the latter group who are driven to detransition by external forces such as discrimination, lack of support from family and friends, or difficulty accessing health care. Euphemisms such as “gender-identity journey” and “dynamic desires for gender-affirming medical interventions” have been used to describe this process.

But the author highlights studies and personal testimonies of detransitioners who do deeply regret their transition, mourn the physical changes made to their bodies, and feel betrayed by the clinicians and medical institutions that offered hormones and surgery as antidotes to their gender confusion and distress. For this group of young people, internal factors such as “worsening mental health or the realization that gender dysphoria was a maladaptive response to trauma, misogyny, internalized homophobia, or pressure from social media and online communities,” were the primary drivers of their decision to detransition.

As the author highlights, a consistent theme in studies and personal testimonies of detransitioners is that there are major gaps in the quality and accessibility of medical and mental healthcare: “Many detransitioners reported not feeling properly informed about health implications of treatments before undergoing them (Gribble et al., 2023; Littman, 2021; Pullen Sansfaçon et al., 2023; Vandenbussche, 2022). Likewise, many felt that they did not receive sufficient exploration of preexisting psychological and emotional problems and continued to struggle post-transition when they realized gender transition was not a panacea (Littman, 2021; Pullen Sansfaçon et al., 2023; Respaut et al., 2022; Sanders et al., 2023; Vandenbussche, 2022). Despite ongoing medical needs, most patients did not maintain contact with their gender clinic during their detransition.” Detransitioners report wanting more information about how to safely stop hormonal therapies and surgical reversal or restorative options, but few clinicians are sufficiently knowledgeable about these issues to manage their care.

The author notes that our ability to predict who will be helped by transition-related medical interventions and who will be harmed by them is limited and we currently have no idea how many of the young people transitioning today will eventually come to regret their decision: “no one is systematically tracking how many young people regret transition or, for that matter, how many are helped by it.” However, the increasing number of detransitioners publicly sharing their experiences suggest that historical studies citing low rates of regret are no longer applicable. Moreover, these studies suffered serious methodological flaws that would tend to underestimate the true rates of regret including high rates of attrition and narrow definitions of regret.

More recent studies that have included the current case mix of predominantly adolescent-onset gender dysphoria suggest that up to 30% of those who undergo medical transition may discontinue it within only a few years (Roberts et al., 2022). It is likely that a number of them will experience significant regret over lost opportunities and permanent physical changes.

So how did we get here?

The author suggests that less restrictive eligibility criteria for accessing transition-related medical interventions under the gender-affirmation and informed consent models, coupled with the rapid rise of adolescents and young adults presenting to gender clinics, many of whom suffer from complex mental health problems and neurodiversity, has important implications for the incidence of transition regret and detransition. Under these models of care, standard processes of differential diagnosis and clinical assessment are seen as “burdensome, intrusive, and impinging on patient autonomy.”  Moreover, the author points out that hormonal therapies and surgery are now conceptualized as a “means of realizing fundamental aspects of personal identity or ‘embodiment goals,’ in contrast to conventional medical care, which is pursued with the objective of treating an underlying illness or injury to restore health and functioning.” 

Furthermore, adolescents and young adults might not be mature enough to appreciate the long-term consequences of their decisions about the irreversible medical interventions used to achieve “embodiment goals,” and/or their capacity to give informed consent may be limited by comorbid mental health problems or neurodevelopmental challenges. Additionally, “feelings of profound grief about lost opportunities and negative repercussions of transition might not be fully captured by framing the emotional experience in terms of regret” because “regret is an emotion that is unique in its relation to personal agency (Zeelenberg & Pieters, 2007), but the exercise of personal agency in the transition process might have been limited for people who began transition as minors, whose decision-making capacity was compromised by mental illness, or who were not fully informed of known and potential adverse health implications.” 

The author offers some suggestions for how detransition may be prevented and inappropriate transitions avoided:

Improving the process of informed consent.

Prioritizing treatment of co-occurring social, developmental and psychological problems.

Using precise language about medical interventions.

Helping young people expand their understanding of what it means to be a man or woman.

Being transparent about the quality of evidence supporting medical interventions and the uncertainty about long-term harms.

The author ends by emphasizing that when clinical cases are complicated by a lack of knowledge about the natural trajectory of the condition and a paucity of evidence supporting treatment options, “minimizing iatrogenic harm requires application of cautious, thoughtful clinical judgement, meticulous examination of the data that are available, as well as a willingness to change practice in the face of new evidence.”

Jorgensen calls on the gender medicine community to “commit to conducting robust research, challenging fundamental assumptions, scrutinizing their practice patterns, and embracing debate.”

--

Read more about the phenomenon of detransition:

Boyd I, Hackett T, Bewley S. Care of Transgender Patients: A General Practice Quality Improvement Approach. Healthcare. 2022; 10(1):121. https://doi.org/10.3390/healthcare10010121

D’Angelo, R. (2020). The man I am trying to be is not me. The International Journal of Psychoanalysis, 101(5), 951–970. https://doi.org/10.1080/00207578.2020.1810049

Entwistle, K. (2020). Debate: Reality check – Detransitioner’s testimonies require us to rethink gender dysphoria. Child and Adolescent Mental Health, camh.12380. https://doi.org/10.1111/camh.12380

Expósito-Campos, P. (2021). A Typology of Gender Detransition and Its Implications for Healthcare Providers. Journal of Sex & Marital Therapy. https://www.tandfonline.com/doi/abs/10.1080/0092623X.2020.1869126

Hall, R., Mitchell, L., & Sachdeva, J. (2021). Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: Retrospective case-note review. BJPsych Open, 7(6), e184. https://doi.org/10.1192/bjo.2021.1022

Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-021-02163-w

Marchiano, L. (2021). Gender detransition: A case study. Journal of Analytical Psychology, 66(4), 813–832. https://doi.org/10.1111/1468-5922.12711

Roberts, C. M., Klein, D. A., Adirim, T. A., Schvey, N. A., & Hisle-Gorman, E. (2022). Continuation of Gender-affirming Hormones Among Transgender Adolescents and Adults. The Journal of Clinical Endocrinology & Metabolism, 107(9), e3937–e3943. https://doi.org/10.1210/clinem/dgac251

Vandenbussche, E. (2021). Detransition-Related Needs and Support: A Cross-Sectional Online Survey. Journal of Homosexuality, 20. https://doi.org/10.1080/00918369.2021.1919479

==

Genderists often say things like "detransition/regret is rare" and "detransition is only due to discrimination." These run in the opposite direction to genderist assertions, as this means "detransition/regret due to discrimination is rare."

Most of the numbers they cite are either poorly sourced as mentioned above, or worse, from the days of "watchful waiting," where transition only came at the end of a comprehensive care process; a completely different model.

Not only is it dishonest, given they regard watchful waiting, or anything else as "harmful" and "gatekeeping," but the low regret rate actually supports that more cautious, thoughtful process.

And besides, claiming to know the success rate under the "affirming"/"informed consent" models is itself dishonest too. Detransitioners are not going to rush back to the same doctors who facilitated their mistake. Especially in a climate where they'll be blamed or vilified.

[fennexin]

This is such a neat and random ad to get on tumblr dot com today c:

[justinspoliticalcorner]

Erin Reed at Erin In The Morning:

In a major move, the Southern Poverty Law Center has formally designated the anti-transgender pseudoscience organizations Genspect and the Society for Evidence-Based Gender Medicine as anti-LGBTQ+ hate groups. This designation is part of the civil rights organization’s latest release of its “Year In Hate & Extremism” report, which tracks hate groups and extremist groups throughout the United States. Members of these and other anti-LGBTQ+ organizations listed have played significant roles in the passage of anti-LGBTQ+ legislation and policy by concealing and underplaying their ties to anti-LGBTQ+ extremism. Most recently, members of the newly designated hate group, Society for Evidence-Based Gender Medicine, helped advise the Cass Review in the United Kingdom, which has led to the criminalization of possession of some forms of transgender care there and is currently being used to argue for heavy restrictions in the United States.

The designation is significant, placing these organizations alongside other extremist groups like the Alliance Defending Freedom and the Family Research Council—Christian fundamentalist organizations pushing anti-LGBTQ+ policies in the United States and internationally. Justifying the new designations, the report points to conferences held by these organizations that featured “expert witnesses” employed by the Alliance Defending Freedom to target LGBTQ+ people in the United States. It also highlights an investigative analysis that discovered the organizations were at the center of a massive “anti-LGBTQ pseudoscience network.” The analysis further determined that in the case of SEGM, the organization’s funding stream included Koch Foundation money funneled through the Edward Charles Foundation. Notably, SEGM shared funding streams with right-wing Christian groups like the Alliance Defending Freedom and the Family Research Council.

[...] The latest report from the Southern Poverty Law Center (SPLC) indicates that in 2023, the number of anti-LGBTQ+ hate groups increased by one-third to 86 groups, the highest number ever tracked by the organization. According to the group, this surge is primarily due to the rise of “family policy councils” that push right-wing Christian agendas and members of anti-LGBTQ+ pseudoscience networks that often share the same goals. “As in previous years, the anti-LGBTQ policy push was grounded in demonizing LGBTQ people and using pseudoscientific claims about LGBTQ people, but the weaponization of pseudoscience as a tool of trans suppression and the targeting of fundamental freedoms like free speech, expression, and assembly through book and drag bans has become a more prominent feature in recent years,” the report says, highlighting the increasing use of organizations weaponizing disinformation to target transgender people.

The SPLC has given anti-LGBTQ+/anti-trans extremist organizations such as SEGM, Genspect, Do No Harm, and Awake Illinois the hate group designations as part of their 2023 review of hate and extremism.

[industrydelevelpoments]

The Global Outdoor Apparel Market size is expected to grow from USD 15.79 billion in 2022 to USD 34.72 billion by 2030, at a CAGR of 25.17% during...

[is-ve-kariyer-dunyasi-haberleri]

Ödeme ve Elektronik Para Kuruluşları Sektörü Sürdürülebilirlik Çalıştayı Yaptı Türkiye Ödeme ve Elektronik Para Kuruluşları Birliği (TÖDEB) ve Sürdürülebilir Eğitim Gelişim ve Mükemmellik Derneği (SEGM) iş birliği ile “Ödeme ve Elektronik...

[if-haber]

Ödeme ve Elektronik Para Kuruluşları Sektörü Sürdürülebilirlik Çalıştayı Yaptı Türkiye Ödeme ve Elektronik Para Kuruluşları Birliği (TÖDEB) ve Sürdürülebilir Eğitim Gelişim ve Mükemmellik Derneği (SEGM) iş birliği ile “Ödeme ve Elektronik...