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[religion-is-a-mental-illness]

The NHS Puberty Blocker Experiment Is Science Theater

How the NHS PATHWAYS trial postpones accountability instead of uncovering the truth about puberty blockers.

By: Andy Lewis

Published: Nov 29, 2025

November 2025, and the NHS has finally launched the PATHWAYS trial. Two hundred and twenty-six children, most only just into puberty, will be randomized: half get triptorelin to switch puberty off today, half are told to wait a year while their young bodies do what maturing bodies do. Everyone receives the new psychosocial package. Everyone receives the puberty blockers eventually. Two years of questionnaires, bone scans, and optional brain MRIs later, we are promised definitive answers about puberty blockers. The Great and the Good of the Science Media Centre dutifully declared the trial “robust” and “essential.”

Forgive me if I remain unimpressed.

I said in February that this trial risked harming more than it helped, and I asked in the previous July what an ethical trial would even look like. Nothing I have seen since has shifted that view. In fact, the more one digs, the clearer it becomes that PATHWAYS is less a scientific endeavor than an expensive piece of theater designed to keep puberty blockers on the table while performing a pantomime of clinical trials.

Start with the Tavistock scandal that now appears to be forgotten. We already have outcomes for at least 9,000 children referred to the Tavistock GIDS clinic and several hundred who actually received blockers. That data sits in NHS desk drawers. Cass repeatedly asked for adult clinic data linkage between child and adult service so detransition and long-term health could be tracked. The clinics refused, citing spurious answers like “data-protection concerns” that have never withstood scrutiny. PATHWAYS is therefore £10.7 million spent to partially re-create some of that data we already possess but have deliberately chosen not to examine. We are putting more children at risk to avoid confronting activist therapists. The evidence that does exist is in papers that were systematically reviewed and found to be so flawed, under-powered, and selectively reported that the Cass Review found no high quality results.

Next, the diagnosis itself. Ethical trials require a clear intent to answer a scientific and clinical question that can inform future treatment decisions. It is hard to see what that question is. The trial is formally to test a treatment for “gender incongruence.” But this is not a clinical diagnosis. Activists insist this means the child is “trans,” that they possess an internal gender essence incompatible with their body, and that the only “remedy” is to alter the body to somehow match this ineffable feeling. There is no scientific evidence that such an intrinsic thing called a “gender” exists. This is postmodernist claptrap: the reification of abstract ideas about the sexes in society.

Gender is a social concept built on sex stereotypes: boys must be tough and sporty, girls must be pretty and gentle, and both must be heterosexual. Many (if not most) adolescents feel they fall short of these stereotypes; some feel it acutely. Puberty sharpens the discomfort. In the overwhelming majority the discomfort resolves without any intervention as puberty progresses. To pathologize this entirely normal process, label it a medical condition, and treat it with powerful endocrine disruptors is not progressive healthcare; it is regressive, cruel, and inherently unscientific.

The trial’s design guarantees we will learn almost nothing useful about puberty blockers themselves. Every single child (treatment arm and delayed arm) receives the same new package of psychosocial support: therapy, family work, psycho-education, regular clinic visits, the full comforting apparatus of being “in the system.” The only variable that changes is whether a child receives triptorelin injections now or in twelve months’ time.

That single difference in treatment timing is the sole thread we have to pull on if we want to isolate the specific effect of the drug. Yet the thread is buried under a dozen powerful confounders: the therapeutic alliance, the placebo effect of finally being believed, the nocebo effect in the delayed group who feel cruelly denied, the natural maturation that happens to every teenager over two years, regression to the mean, and the simple passage of time away from whatever acute crisis brought them to clinic in the first place.

Because the psychosocial support is constant and the drug is the only thing that moves, any observed change in mood, self-harm, or quality-of-life scores can be attributed to the counseling just as plausibly as to the hormone suppression. The trial has no mechanism for disentangling the two. It is rather like testing a new analgesic by giving every patient in the study the drugs and a daily massage and then wondering if the massage or the pills reduce the pain. The protocol may produce reams of numbers, but it is structurally incapable of telling us what the blockers actually do.

Any improvement in quality-of-life scores can therefore be attributed to the counseling, to placebo effects, to regression to the mean, or simply to the relief of finally being taken seriously. We will never know which. The delayed arm, meanwhile, starts the study believing they have been denied life-saving treatment. Nocebo effects and off-protocol self-sourcing of blockers are inevitable. The trial cannot separate these confounders any more than a non-blinded homeopathy trial can separate the effects of sugar pills from the therapist’s reassuring smile. Puberty blockers are a dramatic intervention that is bound to create a psychological response in those who wish them to improve their lives. A chiropractor’s crack is also dramatic, but drama is not the same as effectiveness and prudence.

The follow-up in the trial is just two years. Yet, the major questions are about what happens to children as they mature into young adults and further. Peak bone mass is not reached until the late twenties. Fertility outcomes, late cognitive effects, and long-term cancer risks will remain unknown. The promise of “registry linkage pending further funding” is not a plan; it is an admission that the most important clinical questions have been postponed indefinitely.

This is the same weary playbook Stanislaw Burzynski has been running since the 1980s: an implausible treatment (in his case, peptides extracted from urine) surrounded by fervent belief, wrapped forever in the protective cloak of “ongoing clinical trials” so that no definitive negative result ever has to be published, no license ever granted, and the patients keep paying millions while the clock runs on. PATHWAYS is simply the NHS’s £10.7 million, state-sanctioned version of the same quack trick.

Picture a 12-year-old girl who starts blockers under PATHWAYS this winter. By the time she is 30 she may never know what an orgasm feels like and will certainly never carry a pregnancy. That is not a rare side-effect from what we know already; it is the intended physiological outcome of the treatment this 12-year-old is being invited to “consent” to.

A majority of the children in such clinics arrive with autism, histories of trauma, depression, or eating disorders. Almost all cannot yet imagine adult sexual relationships or parenthood. To ask them to consent to a pathway that carries a substantial risk of permanent infertility and anorgasmia is to ask them to consent to something they cannot meaningfully understand. The consent forms may be legally watertight; they are ethically threadbare. So what sort of results can we expect? Allow me to take a punt. The children who receive blockers immediately will, on the whole, report being “happy.” The children forced to wait a year for the treatment they have been told is life-saving will, on the whole, report being “sad.” The headline conclusion will be that puberty blockers must be offered as early as possible because they improve wellbeing. The two-year follow-up is conveniently too short for the serious skeletal, sexual, and fertility harms to become undeniable, so the treatment will be declared “safe and well-tolerated.” Critics who point out the blindingly obvious methodological flaws will be dismissed as bigoted, hateful, or “anti-trans.” This trial could not have been better designed if the brief had been: “Produce the most quack-friendly trial methodology possible while retaining a veneer of scientific respectability.”

If PATHWAYS had been submitted to the Cass Review as one more observational study it would have been graded low quality and filed under “inconclusive.” Instead it has been granted the status of the definitive trial, the one that will finally settle the matter. It will do no such thing. At best it will generate numbers that can be spun either way. At worst it will provide a veneer of scientific respectability for continuing to offer puberty suppression to children on the basis of ideology rather than science and evidence.

Ten million pounds and two hundred childhoods spent not to discover whether puberty blockers “work,” but to postpone the moment when the NHS finally has to admit they never did and never could.

I remain, as ever, watching.

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About the Author

Andy Lewis is a skeptical blogger and critic of pseudoscience. He founded and runs the Quackometer website, where he exposes quackery and superstitious beliefs about health and medicine. Follow him on X @lecanardnoir

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The quackometer is a project based around the automation of debunking quack medicine on the web. The web is full of pages supporting dubious medical claims and inflated capabilities for cures. The freedom that the web gives us to express our views, entertain and do business also gives quacks a way to make a living by promoting nonsense treatments to unsuspecting people.

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[fucknopseudoscience]

German Homeopathy Companies Pay Journalist who Smears UK Academic

Professor Edzard Ernst attacked by paid writers.

A consortium of pharmaceutical companies in Germany have been paying a journalist €43,000 to run a set of web sites that denigrates an academic who has published research into  their products.

These companies, who make homeopathic sugar pills, were exposed in the German newspaper Süddeutsche Zeitung in an article, Schmutzige Methoden der sanften Medizin (The Dirty Tricks of Alternative Medicine.)

This story has not appeared in the UK media. And it should. Because it is a scandal that directly involves the UK’s most prominent academic in Complementary and Alternative Medicine.

The newspaper accuses the companies of funding the journalist, Claus Fritzsche, to denigrate critics of homeopathy. In particular, the accusation is that Fritzsche wrote about UK academic Professor Edzard Ernst on several web sites and then linked them together in order to raise their Google ranking. Fritzsche continually attacks Ernst of being frivolous, incompetent and partisan.

Thenewspapersaid,

It is simple to use Google to pillory someone: all it needs is a professional-looking Web page in which a person’s credibility is undermined. Then the name of the person to discredit should be mentioned in the text as often as possible. The page will be automatically ranked in the top results when someone searches for the person. For people whose credibility is their capital, such as journalists and academics, this digital character assassination is particularly devastating. [My translation]

Edzard Ernst was the first  Professor of Complementary Medicine and held the Laing Chair at the University of Exeter in South-West England. The chair was set up by Sir Maurice Laing in 1993 to provide  rigorous research into alternative medicines. Laing realised that high quality research was required if various forms of alternative medicine were to become mainstream. Ernst said in aninterviewthat Laing believed that “it was more important to conduct good research to a standard that would be acceptable even to sceptics, than to bend over backwards in an attempt to generate positive findings”.

And that is what Edzard Ernst has done over the past two decades. In particular, Ernst has pioneered and championed the idea that alternative medicine can be subject to the same rigours of evidence-based medicine as any other treatment. He has produced many systematic reviews of treatments that draw together all available evidence to assess what overall conclusions it is possible to come to. When the evidence has been positive, he has said so. But his problem has been that, for a wide range of treatments, including homeopathy, the evidence is overwhelmingly negative, non-existent, or at best, inconclusive.

This has angered many proponents of the various forms of supersitious and pseudoscientific health practices. Homeopaths in particular have been furious that Ernst has not used his Chair to promote alternative medicine. They see his results, not as scientifically objective, but as a betrayal of their beliefs.

For his efforts, Ernst is continuously attacked. The Vice-Chancellor of Exeter has been written to by foaming homeopaths. His blogs for the GP magazine,Pulse, see a hoard of homeopaths turn up for every article to shout their abuse. But most worryingly, Ernst was attacked by Prince Charles when he was critical of a politicised report into the funding of alternative medicineby the NHS, insitigated by Charles, and funded by Dame Shirley Porter. Prince Charles’s principal private secretary, Sir Michael Peat, sent a letter to Exeterthat almost cost him his job.

I spoke to Edzard about these revelations that homeopathy companies are funding his attackers. In particular, he noted how Fritzsche conducted an interview with him that resulted in an article that suggested Ernst had been lying about having homeopathic qualifications. The article was published in the Deutscher Zentralverein homöopathischer Ärzte (German National Association of Homeopathic Physicians) which presented Ernst as having no qualifications, of misleading people about them, and not being fit to judge homeopathy. Ernst claims that the discussion he had was misrepresented in the write-up of the interview which resulted in him looking as if he was being defensive about his qualifications.

UK Homeopaths havejumpedon this with gusto in order to discredit Ernst. Of course it isnonsense. Ernst started his career in a homeopathic hospital in Germany, and is fully familiar with its claims. He was accepted into Exeter because of his skills and experiences. But to claim that he cannot speak about homeopathy because he has not formally trained in such areas is to insist that you have a degree in Invisible Imperial Textiles before mentioning the Emperor has no clothes on.

The CAM Media.Watch blogstatesthat it is a blog for journalists to challenge the misrepresentations of alternative medicine in the media and to address ‘grievances’. In practice, the blog attacks, not just Ernst, but journalists who do not uncritically promote pseudoscientific therapies. When Max Rauner wrote anarticlein ZEIT discussing Edzard Ernst and his critics, Fritzsche attacked the piece. Ernst said to me that there were at least 31 ‘untruths’ in that response about him.

Another contributor to Fritzsche’s blog is Harald Walach. The Süddeutsche Zeitung wrote an article about Walach and his ideas that quantum theory could come to the rescue of the problems of homeopathy. Walach is in charge of the  Institute for Transcultural Health Sciences at the European University Viadrina Frankfurt (Oder), a group that researches clairvoyance and esoteric healing beliefs. His chair is endowed by homeopathy manufacturer Heel, who are also one of the companies funding the CAM Media.Watch blog.

Harald Walach is a quantum flapdoodler. That is, he writes papers trying to insert quantum theory into homeopathy. They impress homeopaths. I had anexchange of emailswith him a few years ago where I was able to show he had no idea what he was talking about when it came to quantum theory. As a social scientist and postmodernist, this is not a surprise. In response to the Süddeutsche Zeitung  article that was critical of Walach’s ideas and quantum theories, Walach criticised the ‘bad journalism’ and claimed  Markus Schulte had not understood his quantum flapdoodle. As he would.

As a result of the report in Süddeutsche Zeitung, a long discussion ensuedon the Facebook page of one of the ‘sponsoring’ companies. People were asking Weleda, the anthroposophical health company, why they were engaging in such questionable practices. As a result, Weleda have now pulled out of their agreement with Claus Fritzsche. Other companies appear to continue to support him. Ernst has been trying to engage with one of the largest, the Deutsche Homöopathie-Union (DHU), a subsidiary of the Schwabe Pharmaceuticals Group, but a planned meeting has been cancelled.

There is something of an irony is this scandal. Of course, people should be free to express their views in blogs and newspapers. People should even be free to be consistently wrong and absurd. But this is a clear example of where a writer is being paid by a vested interest to continue activities systematically denigrating an academic over his published work. What is ironic is that it is an axiomatic belief in homeopathic circles that people like me are paid large sums of money by pharmaceutical companies to carry out the writing and speaking that I do. It is of course nonsense. And yet here are homeopaths doing exactly what they say is so immoral and despicable about sceptics of homeopathy.

One month ago,Edzard Ernst retiredfrom his position at Exeter. He is doing so amidst a continued attack on his integrity from all corners of the alternative medicine world. In contrast to this constant attack from vested interests and paid attackers, we should look at what whatEdzard saysabout his own motivations and obligations:

People mistakenly think I must be a promoter of complementary medicine – that I should have an allegiance to the camp. I don’t. My allegiance is firstly to the patient – I feel that very strongly as an ex-clinician – and secondly to science. If in the course of that I have to hurt the feelings of homeopaths I regret that, but I can’t help it.

Ernst will continue to write and be outspoken about alternative medicine. His retirement may actually give him more freedom to do so. It is a shame there are not more academics like him. Most are highly partisan and see research as a way of validating their preferred quackery  rather than a means to uncovering the truth. In this world of “quackademia”, it is the patient that will end up being misled and suffering. And if you attempt to put the truth and the patient first, you will be pilloried by the believers in pseudoscience and superstition.

Ernstsaysthat academics of alternative medicine,

must not “misunderstand the job as promoting alternative medicine”, a failing, he believes, to which all the other professors of complementary medicine that have been appointed around the world since 1993 have succumbed.

“They present themselves as scientists but they are all using science as a drunk man uses a lamp post: for support and not for enlightenment,” he said. “My unit is the only one that actually understands critical assessment as it should be.”

Itweetedthe other day that,

If you are researching complementary and alternative medicine (CAM) and you are not hated by the CAM world, you’re not doing it right.

This has now been accepted as Ernst’s Law. I hope it is an insight that more people will get: that alternative medicine is not medicine and it is not alternative, and if you want unbiased information about it, you do not consult with practitioners, or sadly even the vast majority of academics who specialise in CAM. They are holders of sacred truths, and critics must be squashed and to hell with the ethics of it all.

Quackometer 

This is a link to the original article that spawned the above:

The Dirty Tricks of Alternative Medicine