A ticking time bomb
Is ‘Gender Identity Healthcare’ the next major medical scandal?
The opioid epidemic in the US was fuelled by aggressive unethical marketing and overprescribing of OxyContin. It is now recognised as one of the most catastrophic public health failures in US history.
Are we on the brink of another catastrophic public health crisis with gender interventions?
OxyContin
When Purdue Pharma launched OxyContin in 1996, they claimed it was safe and carried a low risk of addiction. That turned out to be untrue. The drug was aggressively marketed to doctors, not just for end-of-life pain, but also inappropriately for chronic, non-severe pain.
Despite having evidence that OxyContin was highly addictive, Purdue downplayed the risk, falsely claimed the drug’s slow-release formula made it less likely to be abused.
Doctors, pressured by aggressive marketing and patient demand, began prescribing opioids widely. Medical institutions and regulatory bodies were slow to react. The result was a national epidemic of addiction, overdose deaths, and the eventual transition of many addicts to heroin or illicit fentanyl.
The US healthcare system prioritised prescribing oxycontin without doctors having the correct information to be able to adequately weigh up the long-term risks.
By 2007, Purdue pleaded guilty to misleading the public and paid $600 million in fines . In 2019, the company filed for bankruptcy under a storm of lawsuits. The Sackler family, Purdue’s owners, agreed to pay billions.
Does this sound familiar?
Parallels with gender-affirming interventions
Many are now raising the alarm about ‘gender-affirming care’. We are repeating the same mistakes:
weak evidence base
strong external influence
institutional capture and
the silencing of dissent.
Medical institutions and regulatory bodies captured by lobbyists
Purdue influenced regulators, just as gender activists and lobby groups have influenced the NHS, GMC, RCGP, BMA and many other regulatory bodies. As a result, ideology has shaped gender care guidelines.
WPATH, a self-appointed organisation, is quoted in many shared care agreements despite having a low evidence base.
Suppression of medical dissent
Early critics of OxyContin were dismissed. Whistle blowers at the Tavistock and Portman NHS Trust, which runs the England’s only gender service for children, Gender Identity Development Service (GIDS) described the ‘shutting down of debate’ and a culture of fear and silence. Concerns were ignored, enabling harmful practices to continue.
External pressures to override evidence
Purdue’s marketing shaped prescribing habits in the US. Today’s gender affirmation model is heavily influenced by lobby groups and activists, rather than by clinical evidence.
Unregulated use and off label medicines
OxyContin use was unregulated, but at least it had been through the licensing process.
Off-label or unlicensed means that the person prescribing the medicine is not using it for the purpose stated in its licence. If a healthcare professional wants to prescribe an unlicensed medicine, or a licensed medicine off-label, they must discuss the possible benefits and harms so that the person has enough information to decide whether or not to have the treatment. This is called giving informed consent.
In the UK, cross-sex hormone medicines are being used off label by Gender Identity Clinics (GICs). Young patients are being fast-tracked towards medical transition, even though these medications are known to cause irreversible long-term harms. Puberty blockers now have been banned because of safety concerns.
Lack of clinical governance
Responsibility for off-label prescribing sits with the prescriber and many GPs are being asked to prescribe. At present it is unclear who is regulating Gender Identity Clinics (GICs) in the UK.
Suppression of evidence on long-term outcomes
Six out of the seven GICs refused to participate in a study for the Cass review to track the outcomes of approximately 9,000 patients. This impeded the review’s ability to assess the long-term impact of puberty blockers and exogenous hormones. WPATH suppressed evidence that did not support gender affirmative care, thereby compromising patient safety.
Purdue also suppressed evidence. As a result, patients in both situations were not, and are not, able to give fully informed consent.
An over representation of vulnerable patients
Low-income and rural communities were overprescribed opioids. The Cass Review highlighted significant comorbidities in this patient cohort and safeguarding concerns. In both cases, some of the most vulnerable patients were and are the ones most exposed to harm.
Time to stop
When medical practice is influenced by external pressures, losing sight of medical ethical ethics, the consequences are catastrophic.
If the current situation continues, this medical scandal will dwarf the opioid crisis.
We must act now. It is time for the government, the NHS, all regulatory bodies and clinicians to start putting patient safety before ideology.
Medical historians in the future will look back at "gender affirming care" the same way that we look back at bloodletting. https://lucyleader.substack.com/p/looking-back-from-the-future
Very similar except the Pharmaceutical company lied to the Drs to get them to prescribe Oxycontin. In gender medicine the Drs in gender clinics are prescribing knowing the risks and likely outcomes, they deem them acceptable. However the 27 year old detransitioner, that was put on testosterone at 16, is living with the consequences, may feel very differently. The question is, how many in Primary care that pick up prescribing in the long term for this group, are thinking about the long term risk to patients and potential for litigation against them? Two things we can be sure of, the pharmaceutical company will not be paying out this time, because the Drs are prescribing off licence, but the NHS will be!