A good example of how "circular referencing" works in the real world. See the entire thread.
https://twitter.com/buttonslives/status/1778491281305378884
New systematic review exposes deceptive practices among medical organizations that endorse youth transition. Rather than relying on robust evidence, medical authorities fabricated consensus by deferring to each others' guidelines.The new review reveals that medical organizations have misled the public by basing their recommendations on insufficient evidence, inaccurately labeling their approach as "evidence-based," and engaging in a corrupt practice known as "circular referencing."
The review found that clinical guidelines globally used to treat gender-questioning children and adolescents were crafted in violation of international standards for guideline development and recommended medical interventions for minors despite insufficient evidence.
The review identified initial guidelines recommending youth transition, published by the Endocrine Society (ES) in 2009 and the World Professional Association for Transgender Health (WPATH) in 2012, that were foundational to numerous other national and regional guidelines.
Dr. Hilary Cass highlighted the ways in which WPATH and ES were closely interlinked, noting their mutual co-sponsorship and input into each other’s drafts. This coordinated effort suggests that WPATH and ES were colluding to grant undue credibility to their guidelines.
The corruption persisted in the formulation of national and regional guidelines by prominent organizations. Rather than grounding their recommendations in robust evidence, these guidelines deferred to the endorsements from the initial guidelines of WPATH and ES.
Years later, when WPATH and ES updated their guidelines, they referenced the same national and regional guidelines that had initially drawn from their recommendations. This perpetuated a cycle, each time without sufficient evidence to support the recommendations.
Dr. Cass highlighted the problematic nature of this circular referencing, stating, “The circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.”
This figure shows how nearly all the national and regional guidelines identified were influenced by ES (2009) and WPATH (2012) guidelines, how these guidelines cite and rely on each other, and how the latest ES (2017) and WPATH (2022) guidelines have cited and drawn on others.
WPATH, which aims to promote "evidence-based care," and ES, which calls its approach "evidence-based transgender medicine," along with any organization advocating medical transition for minors, mislead the public by claiming to be "evidence-based."
In the end, the review team was only able to recommend two guidelines for practice: the 2020 Finnish guideline and the 2022 Swedish guideline. Both adhere to the best available evidence and do not recommend medical transition treatments for minors.
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