DAB No. 2576 - NCD 140 3 Transsexual Surgery by EvanMcSan
A follow-up to a previous post on the issue.
Reading between the lines, there are some very damning comments about how the original decision was arrived at - such as the dismissal of studies with follow-up over many years as "not long-term" without defining what "long-term" meant; or the citing of treatment as "controversial", not in a scientific sense, but a political one.
We note that in addition to stating that transsexual surgery was experimental, the NCD and the 1981 report stated that transsexual surgery was "controversial." NCD Record at 18(1981 report stating that "[ o ]ver and above the medical and scientific issues, it would also appear that transsexual surgery is controversial in our society"). The AP and the new evidence dispute the relevance of this statement. The AP objected that this point relies on two "polemics" that are "are either completely unscientific or fall far outside the scientific mainstream," and Dr. Ettner stated that the views expressed therein "fall far outside the mainstream psychological, psychiatric, and medical professional consensus and call into question the objective reasonableness of the NCD. AP Statement at 15-16; Ettner Supp. Decl. at,;,; 17-18. CMS has not asserted that the Board's decision may be based on factors over and above the medical and scientific issues involved. Considerations of social acceptability (or nonacceptability) of medical procedures appear on their face to be antithetical to Medicare's medical necessity inquiry, which is based in science, and such considerations do not enter into our decision that the NCD is not valid.
One of those appears in this post, 50,000 deaths. I'll try to find the source of the other one, a religious tract. Though the first one is a religious tract too, or at least, ideological.
Neither Religion nor Ideology have any place in medicine, or indeed, science generally.
