Open letter from Australian clinicians concerned about the Sax Institute’s flawed ‘Evidence Check’

By Genspect Australia

Posted: 23rd September 2024 • Australia  

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:

  1. 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 This exclusion dramatically lessens the value and relevance of the Sax Institute’s report and renders it out of date.
  2. 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.
  3. 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.
  4. It makes scientifically unsupported assertions that puberty blockers are reversible. The references provided do not support their assertion.
  5. 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’.
  6. 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.
  7. 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 FAPABPN 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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