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Messages - JEdwards

#1
Quote from: John Mundinger on April 11, 2024, 08:38:17 PM
Quote from: Robert Johnson on April 11, 2024, 08:04:32 PM
Quote from: John Mundinger on April 11, 2024, 11:12:58 AMOne point on which I think both of us can agree.  There is a lot we do not know about the transgender issue.  There is need for more objective information on the subject.

Meanwhile, stop doing permanent things to people who often regret it later when it cannot be fixed.

Meanwhile, proceed with caution.  If you are going to default to anecdotal accounts, there are many more examples of the permanent damage that would have been done had gender affirming care been denied.
The whole point of the Cass report is that your assertion is speculative, and current data are insufficient to verify or refute it. More data are needed, which is why it is regrettable that the Gender Identity Development Service in the UK declined to cooperate with Dr Cass. As recounted in the BMJ editorial linked above:

The Cass review attempted to work with the Gender Identity Development Service (GIDS) and the NHS adult gender services to "fill some of the gaps in follow-up data for the approximately 9000 young people who have been through GIDS to develop a stronger evidence base." However, despite encouragement from NHS England, "the necessary cooperation was not forthcoming." Professionals withholding data from a national inquiry seems hard to imagine, but it is what happened.

Peace,
Jon
#2
Quote from: John Mundinger on April 11, 2024, 01:26:08 PM
Quote from: JEdwards on April 11, 2024, 12:57:17 PMMETHODS
PubMed, Scopus, and Embase databases, as well as clinical trial information from ClinicalTrials.gov, were searched for articles and data published in English that included the search terms transplantation, liver, cancer, oncology, primary, metastatic, outcomes, graft, and survival. There was no restriction on the date of publication
.

There is nothing remotely like this in the article you cited.

There is nothing remotely like that in what I posted because it is just the abstract.  Do you have a subscription such that you are able to read the whole article?
Yes
#3
Quote from: John Mundinger on April 11, 2024, 12:19:24 PM
Quote from: JEdwards on April 11, 2024, 11:32:33 AMAn opinion piece with footnotes is still an opinion piece.  As most medical journals do, JAMA organizes the contents of each issue by the type of contribution.  In the same issue, there a separate article listed as a review.  The article you cited is classified as an opinion piece.  It is not standard to describe such articles as "studies."

Technically, it is a review paper, drawing conclusions based on the review of multiple published studies.  It may be the journal's practice of publishing review papers as a "point of view".  But, that is not the same as an "opinion" published on an editorial page.  And, if you disagree with the authors' "opinion", the correct approach to express that disagreement is not to dismiss the review article as an opinion.  Rather, read the same articles that the authors reviewed and point out the discrepancies that you discovered.
You really should stop digging, but since you insist...

The peer review process and the format of a "Viewpoint" piece and a review article are quite different.  The authors of a review paper are expected to describe their process of identifying relevant studies in order to provide some assurance that a balanced summary of original research is provided.  Reviewers will have less tolerance for selective presentation of underlying research.  Authors of a "Viewpoint" get more leeway precisely because it is openly acknowledged to be an opinion piece.  For example, in the same issue as the article you cited, there is an actual review article, "Liver Transplant as a Treatment of Primary and Secondary Hepatic Neoplasms", which includes the following:

METHODS
PubMed, Scopus, and Embase databases, as well as clinical trial information from ClinicalTrials.gov, were searched for articles and data published in English that included the search terms transplantation, liver, cancer, oncology, primary, metastatic, outcomes, graft, and survival. There was no restriction on the date of publication
.

There is nothing remotely like this in the article you cited.

I have already pointed out some of the substantive limitations of the meta-analyses cited in the viewpoint article you cited.  In addition, it is worth noting that one of the authors of the viewpoint article you cited is a plastic surgeon who serves as the medical director of the "Center for Transgender and Gender Expansive Health" at Johns Hopkins University, and she lists "Gender Affirmation Surgery" as an area of expertise.  Interestingly, neither she nor either of her coauthors listed any conflicts of interest associated with the article.

Peace,
Jon
#4
Quote from: John Mundinger on April 11, 2024, 11:12:58 AM
Quote from: JEdwards on April 11, 2024, 10:50:15 AMThis is not a study; it is specifically labeled "viewpoint".  It cites separate meta-analyses of observational studies of regret after mastectomies for gender affirming purposes versus for cancer prevention purposes.

I can't access anything except the abstract because I do not have a subscription to that journal.  But, note it is a study and not just an opinion piece.  It is not original research.  It is a review of several other pieces of original research.

One point on which I think both of us can agree.  There is a lot we do not know about the transgender issue.  There is need for more objective information on the subject.
Quote from: JEdwards on April 11, 2024, 10:50:15 AM
Quote from: John Mundinger on April 11, 2024, 10:24:28 AMAnd, interestingly, the following study suggests that far fewer transgender males regret breast removal surgery when performed as a gender-affirming procedure, than do cis-gender females regret breast removal surgery as a cancer preventative procedure. 

https://jamanetwork.com/journals/jamasurgery/article-abstract/2813212
This is not a study; it is specifically labeled "viewpoint".  It cites separate meta-analyses of observational studies of regret after mastectomies for gender affirming purposes versus for cancer prevention purposes.  While studies of this type may have a role in the debate, a lot of questions come to mind.  How comparable were all of the underlying studies in terms of follow-up time?  Gender affirming surgery is relatively new.  Does regret tend to develop after one year, five, twenty?  Also, when interpreting a meta-analysis, one of the first items on the checklist is to look at the heterogeneity of the underlying studies.  As seen in the figure from the meta-analysis of studies of regret after gender affirming mastectomies (linked below), heterogeneity was very high.  In this scenario, standard techniques for pooling data from disparate studies may give an unwarranted sense of precision to the findings. 

https://pubmed.ncbi.nlm.nih.gov/33968550/#&gid=article-figures&pid=fig-2-uid-1

Peace,
Jon
An opinion piece with footnotes is still an opinion piece.  As most medical journals do, JAMA organizes the contents of each issue by the type of contribution.  In the same issue, there a separate article listed as a review.  The article you cited is classified as an opinion piece.  It is not standard to describe such articles as "studies."

Peace,
Jon
#5
Quote from: John Mundinger on April 11, 2024, 10:24:28 AMAnd, interestingly, the following study suggests that far fewer transgender males regret breast removal surgery when performed as a gender-affirming procedure, than do cis-gender females regret breast removal surgery as a cancer preventative procedure. 

https://jamanetwork.com/journals/jamasurgery/article-abstract/2813212
This is not a study; it is specifically labeled "viewpoint".  It cites separate meta-analyses of observational studies of regret after mastectomies for gender affirming purposes versus for cancer prevention purposes.  While studies of this type may have a role in the debate, a lot of questions come to mind.  How comparable were all of the underlying studies in terms of follow-up time?  Gender affirming surgery is relatively new.  Does regret tend to develop after one year, five, twenty?  Also, when interpreting a meta-analysis, one of the first items on the checklist is to look at the heterogeneity of the underlying studies.  As seen in the figure from the meta-analysis of studies of regret after gender affirming mastectomies (linked below), heterogeneity was very high.  In this scenario, standard techniques for pooling data from disparate studies may give an unwarranted sense of precision to the findings. 

https://pubmed.ncbi.nlm.nih.gov/33968550/#&gid=article-figures&pid=fig-2-uid-1

Peace,
Jon
#6
Quote from: Brian Stoffregen on April 11, 2024, 01:03:05 AMFollowing the science is mostly theoretical. What about experiences with real people? What will you do when a 22-year-old you confirmed announces that she is transitioning and is using a new name - and his mother approves of it? What will you do when a 22-year-old whose wedding you did, whose wife you confirmed, announces that he is transitioning and is going by a new name? Do you pull out the science articles? Do you continue to be their pastor and a friend as you were before the announcements?

Because I have retired and moved, I'm no longer in direct contact with these people - except through Facebook. I still consider them friends. Should they show up in a church I'm serving, they would be invited to receive communion.
As I explain to students and residents, the rigor of evidence needed to justify a decision depends in large measure on the cost and risk of the proposed treatment. If one of my patients wants to try something unorthodox but basically harmless, I will usually go along, but I'm not going to order something risky or expensive (usually paid for by a third party) without solid evidence to support that decision.
While one can debate the value of using chosen pronouns—-even silly ones—- that is a whole other discussion than whether there is adequate evidence for the irreversible medical and surgical "treatments" regularly given to adolescents.

I think using ivermectin to treat COVID is quackery, but still more justifiable than a lot of what is being done to kids with gender dysphoria.

Peace,
Jon

#7
The Cass Review damns England's youth-gender services
https://www.economist.com/britain/2024/04/10/the-cass-review-damns-englands-youth-gender-services
from The Economist
#8
Your Turn / Re: Highlighting the Walkout
February 27, 2024, 01:17:09 PM
Quote from: John Mundinger on February 27, 2024, 12:13:14 PMMarriage, as people keep insisting was instituted by God, has nothing to do with the legally binding contract for which is under the jurisdiction of civil authorities.
I disagree.  While society's understanding of marriage has evolved dramatically over time, one constant has been that marriage brings specific obligations -- to one's spouse, to one's children, and, in some cases, to the community.  Different societies enforce obligations in a variety of formal and informal ways.  In some societies, public disgrace or disapproval may have been the only "enforcement" mechanism.  In our society, a legally binding contract is the standard way to enter into a publicly enforceable commitment.  It's not that marriage requires "a piece of paper"; it's that marriage by its nature is publicly accountable.

Some legal systems include an extensive body of common law definitions of crimes.  In our society, one can only be criminally convicted of violating a specific statute with a specific definition of a crime.  But that does not mean that the Seventh Commandment has "nothing to do" with legally-codified definitions of theft.  A just legal code gives specificity and clarity to some of the actions the Seventh Commandment forbids, just as a legal contract can give specificity and clarity to some of the obligations associated with marriage.

Peace,
Jon
#9
Your Turn / Re: Eucharistic Sharing at Valpo
February 18, 2024, 10:11:41 PM
Quote from: Charles Austin on February 18, 2024, 09:47:29 PMHuh? What is the problem of the ordained communing each other? As a solo presider, I communed myself.
I'm going to go out on a limb and guess that it's probably that one is LCMS and the other is ELCA (and female to boot).
Peace,
Jon
#10
Your Turn / Eucharistic Sharing at Valpo
February 18, 2024, 09:10:40 PM
I worshipped at the Chapel of the Resurrection this morning for the first time in nearly 3 years. I was struck by a couple statements in the bulletin that seem to mark a change in Eucharistic practice. First, the directions to prospective communicants seemed to reflect a more "open" table. There was an acknowledgment that some might choose to refrain from Communion due to "personal convictions" or the "rules of [their] church body"; such persons were invited to come forward for a blessing. There was no admonition (as there was previously) that not sharing the same faith precludes Eucharistic sharing.

On the flip side, there was also a notice that the pastors of the Chapel had "suspended" their practice of communing each other "at the request of" the President of the Indiana District "in view of his ecclesiastical authority over the ministry of" the LCMS pastor. There was a further notice that the "suspension" would be reviewed at the end of the 23-24 academic year "in light of the ecumenical situation."

Any insight into this change?  Was it in response to anything specific?  New DP with a new perspective?  Or just another sad marker of the ongoing drifting apart of the ELCA and LCMS?

Peace,
Jon

#11
Your Turn / Re: God Made Trump
January 11, 2024, 07:20:28 PM
Quote from: John Mundinger on January 11, 2024, 06:57:55 PM
Quote from: JEdwards on January 11, 2024, 06:53:44 PMSorry to hear that you don't think twice about increasing the debt load for the next generation by cutting taxes for the current generation. That's a policy that causes me concern.

It's a policy that causes me concern, too.

It also causes me concern that you focused on that sentence and ignored the rest of my reply to you.
Perhaps you should use a pronoun other than "we" if you exempt yourself from the criticism that follows.
Peace,
Jon
#12
Your Turn / Re: God Made Trump
January 11, 2024, 06:53:44 PM
Quote from: John Mundinger on January 11, 2024, 04:48:04 PMYet, we don't think twice about increasing the debt load for the next generation with tax cuts for the current generation.
Sorry to hear that you don't think twice about increasing the debt load for the next generation by cutting taxes for the current generation. That's a policy that causes me concern.

Peace,
Jon
#13
Your Turn / Re: God Made Trump
January 11, 2024, 03:45:55 PM
Quote from: John Mundinger on January 11, 2024, 02:15:44 PMI have just suggested that the Lutheran understanding of Two Kingdoms and the commandment to love the neighbor ought to inform how Lutheran Christians engage civil society.
I suspect there is universal agreement on that point.  The challenge is that it can be very difficult to ascertain the extent to which, for example, the commandment to love the neighbor "informs" the civic engagement of someone you don't know.  In the first place, we are not commanded to love "the" neighbor; we are commanded to love all our neighbors, who may have conflicting needs.  Many of our political disputes involve balancing needs that are in tension.  To take some random examples, money spent on treating opiate addiction is money not spent on refugee resettlement.  Money spent on refugee resettlement is money not spent on improving community policing.  Money spent on all of these things might mean a higher debt load for the next generation.  Higher interest rates are good news for retirees dependent on income from certificates of deposit, but bad news for young families hoping to buy a house.  There are few, if any, political issues where the commandment to love the neighbor produces a self-evident answer, so it is nearly impossible to determine, and usually offensive to suggest, that a specific individual's engagement with civil society is not "informed" by love of neighbor.

Peace,
Jon
#14
Your Turn / Re: Ecumenical setback in Portland
January 08, 2024, 02:35:25 PM
Quote from: Charles Austin on January 08, 2024, 02:30:34 PMBishop/Pastor Benke:
How would anything this one-of-a-kind congregation was up to go unnoticed by the RC officials? 

Me:
I suspect it did not go unnoticed. But the church franchise in that territory got new management, that is, a new bishop. And the new bishop said, we are not doing that nonsense anymore. And he has the authority to shut it down.
Try again.  Alexander Sample was installed as Archbishop of Portland over a decade ago:

https://catholic-hierarchy.org/bishop/bsample.html

Peace,
Jon
#15
Your Turn / Re: Ecumenical setback in Portland
January 07, 2024, 07:44:43 PM
Quote from: Brian Stoffregen on January 07, 2024, 03:28:01 PM
Quote from: JEdwards on January 07, 2024, 02:40:32 PMSad story of the apparent demise of an innovative ecumenical community. While it sounds like there were plenty of missteps on all sides, I don't think anyone can credibly claim to be surprised that posting criticism of the RC Archbishop on the parish web page would lead to a result like this. It's another demonstration that many in the ELCA place a higher priority on "prophetic" speech on LGBTQ issues than on concrete progress on ecumenical endeavors with the RCC.

https://www.ncronline.org/news/portland-archbishop-bans-mass-rare-lutheran-catholic-ecumenical-community

Peace,
Jon

The Lutheran pastor now serving the congregation, Robyn Hartwig, is a good friend of mine. We were in the Sierra Pacific Synod together. I lead a retreat for her congregation council on MBTI back in 2004. She has promoted LGBTQ issues long before she was called to Spirit of Grace.
Thanks for that background. With that information, it seems plausible that she disagreed strongly with Archbishop Sample's "Guidelines on gender identity."  I take Charles' point that we don't really know all the issues in play, and we don't know the author or the substance of the criticisms posted on Spirit of Grace's website. But the NCR article suggests that items published on the website contributed to the Archbishop's decision.  I don't doubt that whatever criticisms were expressed were the sincere convictions of someone who felt compelled to speak out, but it was also predictable that doing so might jeopardize the ecumenical arrangements, and a choice was made as to what was most important.

PS - I recognize that the National Catholic Reporter is a partisan source — they generally take an editorial stance aligned with a progressive view of the Church.

Peace,
Jon
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