Open letter from Australian clinicians concerned about the Sax Institute’s flawed ‘Evidence Check’
By Concerned Australian Clinicians
Open letter from clinicians concerned about the Sax Institute’s flawed ‘Evidence Check’ being used to underpin the NSW Government's blueprint for gender treatment services for children and young people
We write with serious professional concerns about the Sax Institute ‘Evidence Check’ (published 6 September 2024), regarding the effectiveness of medical and psychosocial interventions for young people with gender distress.
You can access the full document here.
We submit that the ‘Evidence Check’ is not a sound basis upon which to proceed with medical or surgical treatments within state-run ‘specialist’ gender treatment services due to its serious flaws as follows:
It did not include the highly relevant systematic reviews and the findings of the Cass Review. This exclusion dramatically lessens the value and relevance of the Sax Institute's report and renders it out of date.
Failure to comply with the NHMRC’s grading system of evidence, leading to inclusion of very low-quality studies that the ‘Evidence Check’ treated as high quality and upon which they based their erroneous conclusions.
It makes false claims about the findings of the UK National Institute for Health and Care Excellence (NICE) 2020 systematic reviews regarding the alleged benefits of puberty blockers and cross sex hormones. Both NICE reviews unequivocally concluded that there was insufficient evidence of benefit for the use of either puberty blockers and cross sex hormones.
It makes scientifically unsupported assertions that puberty blockers are reversible. The references provided do not support their assertion.
It used a study of mature adults to make claims of positive outcomes for adolescents. The report used a review article of transgender adults undergoing gender-affirming chest, genital, facial, vocal cord, and Adam’s apple removal surgeries to make claims of good outcomes for adolescent females undergoing chest surgery. This is despite the report claiming: ‘only studies pertaining to chest and other ‘top’ surgery were eligible for inclusion in this update’.
It failed to declare a major financial conflict of interest with the NSW government. The Sax Institute receives a majority of its funding (67%) from government.
It did not disclose the process by which it selected the Monash Behaviour Works group to conduct the research review. Monash University has a substantial investment in providing gender affirming care through the Monash Health Gender Clinic which is a Victorian statewide service for people aged 16 and over.
In summary, assertions of benefit from gender affirming care for minors must be supported by proper evidence which the ‘Evidence Check’ has failed to provide. It should therefore be publicly retracted as false and/or misleading.
Yours sincerely
Signatories to the open letter:
Dr Jillian Spencer MB.BS, BmedSci, FRANZCP, Cert. Child and Adolescent Psychiatry, Cert. Forensic Psychiatry, Grad Dip For Beh Sci
Child and Adolescent Psychiatrist
Dr Shannon Abeywardena MD, RACGP
General Practitioner
Dr Andrew Amos MB.BS, FRANZCP
Psychiatrist
Dr Rachel Bradley MB.BS, RACGP
General Practitioner
Dr Don Bornstein MB.BS, DPM, FRANZCP, Child and Adolescent Psychiatry
Child and Adolescent Psychiatrist (retired)
Dr Cary Breakey MB.BS, FRACGP, DPM
Child and Adolescent Psychiatrist (retired)
Dr Pia Brous MB.BS, BmedSci, MPM, FRANZCP, Cert Child and Adolescent Psychiatry
Child and Adolescent Psychiatrist
Dr Paul Burt MB.BS, BS, FANZCA, FCICM
Anaesthetist
Dr Danielle Collins BMBS, FRACGP
General Practitioner
Dr Jacqueline Condon BMedSci, MD, FRANZCP, MHL, Cert. Forensic Psych, Grad Cert FMH Psychiatrist
Dr Brian Conway MB.BS, FRACP, DCH
Paediatrician
Dr Alida Connell FRANZCP MBChB, DMH, MMed, FCPsych
Psychiatrist
Dr Roberto Di Angelo MB.BS, FRANZCP, Psy.D. M.Med.(Psychotherapy)\
Psychiatrist
Dr Mei Ling Doery MB.BS, BMedSci, MPH
Medical Doctor
Dr Andrew Firestone MB.BS, DPM, MRCPsych, FRANZCP
Psychiatrist
Dr Gerald Fogarty BSc, MB.BS, FRANZCR, PhD
Radiation Oncologist
Dr George Halasz MB.BS, BMedSc, MRCPsych, FRANZCP
Child and Adolescent Psychiatrist
Dr Christine Huxtable MB.BS, FANZCA, DipPOM, MRCS, DRACOG
Anaesthetist
Dr Aniello Iannuzzi BA, MB.BS, MMedSci, FACRRM, FRACGP, FARGP, FAICD
General Practitioner
Dr Mary Jessop MB.BS, FRANZCP
Child Psychiatrist
Dr Randy Juanta BMBS
Medical Doctor
Dr Vincent Keane MB.BS, DipRACOG, MPH&TM (USA), FAFPHM (RACP)
Public Health Medical Doctor
Prof Dianna Kenny PhD, MA (Sch Couns), BA (Hons), Dip Ed, Grad Dip FDR, FAPs, MAPA
Consulting Psychologist, Psychotherapist, Couple and Family Therapist
Dr Andrew Kis-Rigo, MD
Medical Doctor
Dr Richard Lennon MB.BS, FRACP, FACEM MBioeth
Paediatrician and Emergency Medicine Doctor
Dr Deirdre Little MB.BS, DRANZCOG, FACRRM, GCBioeth
General Practitioner
Dr T. John Martin MD, FRACP, FAA FRS, AO
Emeritus Professor of Medicine
Dr Catherine Llewellyn BA Hons (Cantab), MB BChir (Cantab), AMC, FRANZCP, Cert. Child Adol. Psych. (RANZCP), Cert. Addiction Psych. (RANZCP), FASLM
Dr Eamonn Mathieson MB.BS, FANZCA
Anaesthetist
Dr Philip Morris MB.BS BSc PhD FAChAM (RACP) FRANZCP FPOA FFP FAP
ABPN
Psychiatrist
Dr Ian Munt MB.BS, FRANZCP, Cert. Child and Adolescent Psychiatry
Child and Adolescent Psychiatrist
Dr Luke O’Regan B Med FRANZCP
Psychiatrist
A/Prof Peter Parry MB.BS, Ph.D, FRANZCP, Cert. Child and Adolescent Psychiatry
Child and Adolescent Psychiatrist
Dr Catherine Peterson MB.BS, FRACGP
General Practitioner
Dr Nic Rosoman MB.BS
Medical Doctor
Dr Morry Rottem MB.BS, FRANZCP, FRCP (Canada)
Child and Adolescent Psychiatrist
Dr Carl Scott MB.BS, FRANZCA, FCICM
Anaesthetist and Intensive Care Specialist
Dr Elvis Seman MB.BS, FRANZCOG, EUCOGE, FRCOG, NFPMC, PhD
Obstetrician & Gynaecologist
Dr Vanessa Spiller BPsych (Hons), MPscyh (Clinical), PhD, MAPS
Psychologist
Professor David Torpy MB.BS, PhD, FRACP
Endocrinologist
Dr Joseph Turner MB.BS, PhD, DRANZCOG (Adv), FRACGP-RG, FACRRM
General Practitioner - Obstetrician/Rural Generalist
Dr Guy van Hazel MB.BS, FRACP, FRCP
Medical Oncologist
Dr David Ward MBCHB, MRCPSYCH, FRCPSYCH, FRANZCP
Child and Adolescent Psychiatrist
Dr John Warlow MB, CHB, BIRM, FRANZCP
Child and Adolescent Psychiatrist
Professor John Whitehall BA, MB.BS, FRACP
Paediatrician
Dr Dylan Wilson MBBCh MRCPH FRAC
Paediatrician
Image credit: Gerd Altmann, Pixabay
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Very good sense - also rational/logical .