Cass review captured? Prepare for disappointment

How that bloody woman has the nerve to continue I don't know. Then again, her oddly distanced, disconnected behaviour in court suggests that self reflection isn't something she is capable of.

Her PR is fucking wondrous though! So many parents and kids being reassured by her and her team that they are doing what is right, saving lives etc. Gaaaaargh!

The recommendation for GP’s to initiate safeguarding procedures for children/parents sourcing drugs from unregulated or online sources shouldn’t be controversial- it’s already in the Tavi’s safeguarding documentation for their staff.

GenderGP are delighted with the Cass Review telling NHSE to pull back on this point.

www.gendergp.com/gendergp-welcomes-advice-and-clarification-from-the-cass-review-to-the-nhs-interim-service-specifications/

This also affects families where one parent does not agree to their child being medicated via GenderGP but the estranged spouse/partner is supporting the child down that route.

When the Cass Review tweeted a link to their response, replies were dominated by accusations of transphobia and the review being a government stitch up to further their plans to eradicate trans people.
I think Cass is working hard to step outside ideology whilst acknowledging that service users and wider stakeholder's ideological positions are fundamentally important to them.
I think the response was ok

But I'm also not a parent of a ROGD child.

Unsure end point of not referring to safeguarding. We have a hard line with other drugs and fgm.

My only possible thought is that they really are trying to maintain a middle road at the moment and get the trust of kids and parents who want treatment. So they get them into clinics and therapy. Particularly the children's trust.

I struggled to agree with jester but I didn't feel 100% comfortable with the report.

My feelings were along these; Frankly at this point any step from mad extremism to middle ground is a positive one.

I had issues with the "binary... blah ideology" phrase. Struck me as a tautology. And the people questioning the whole idea of trans and medical interventions in children aren't coming from an ideological perspective at all, no matter how much TRAs like to use that phrase.

Oh FGS! The 'yes, I agree' was in reply to @oldwomanwhoruns last post

Yes, I agree

I agree, I’m nobody. The inquiry is about evidence and not politics and the evidence just isn’t in yet. It’s the job of the inquiry to find the evidence.

I don't find this alarming or sinister. It is about creating an holistic evidence based service to replace GIDS. There isn't any way she can declare what the specific approach should be at this stage without the evidence and clear rationale. Children in distress still need to be treated seriously and with compassion.

I've been thinking about this - her remit is to look at services and engage with stakeholders, and evaluate the evidence isn't it?

I wonder if she has been in touch with the Cochrane people, Fins, Swedes and all those who are raising concerns - maybe there will be a joining of forces for a "this is lunacy" report as next steps?

It needs to be timed to be inarguable - e.g. if Mermaids was shown to be acting out of scope, WPAth was shown to be linked to fetishists, clear evidence of social contagion, case studies on detransitioners, increasing evidence that transition does not improve distress...all of which is ramping up. The resistance against shutting it all down is going to be huge.

If I was politik I might consider being tactical. Best to have Cass as a building block because it's not big enough on it's own to change the societal attitudes that my social circle believe.

I worry that the thing that will be big enough to do that is a staggering tragedy. Or series of them.

It's genuinely scary.

cochrane link

I think obviously we'd all have liked it if she'd said "What GIDS has been doing is mad and dangerous, and the new clinics must follow the route of sanity", but I suppose she's trying to mollify the lunatics. Let's just wait and see what she says when the final review is out.

It’s not just about women being upset. Many of the parents who are currently directly impacted by the eventual outcome of the review are upset.

I don't get that. We need to just STOP giving young people these damaging drugs. Not to 'incrementally' stop damaging them. It just needs to stop.
THEN the NHS can look at the available research, which we know shows that the best cure for these individuals is an uninterrupted, un-socially-transitioned puberty.
In no other branch of medicine would we be testing damaging drugs on healthy young people. We need to stop that testing, not to do more of it.

I understand that women might be upset but I can also see that progress Needs to be incremental given the paucity of evidence as is

The key to all of this is a Cochrane Review for trans health.

Isn't it interesting that they can't do one? They do keep trying, but the evidence isn't there.

Presumably, Cass is building a case for Carmichael and Webberly to justify what they have been doing - and then she can say "ah, there is no evidence" and insist on watchful waiting, CAMHS support for these distressed kids and stop schools from affirming undiagnosed children.

I feel less worried about it than Jester. It's a long game.

Frankly at this point any step from mad extremism to middle ground is a positive one.

And this is going to be only the first in a number of inquiries over the next few years as more and more binfires like Mermaids burst out.

But the burden of proof should be on the other side?
We say, leave healthy kids alone. They say, give them bizarre chemical treatments, known to cause harm.
It should be up to the other side to prove that doses of Testosterone are good for confused girls, not for us to disprove it?

vivariumvivariumsvivaria - yep I think you nailed it.

'...not all children will want or require a medical pathway...'

The response is barking.
How about NO healthy children require these harmful chemical 'treatments'?

I don’t think it is nearly as bad as the video makes out, but it is a statement effectively aimed at reining in NHSE.

It talks about “artificial binary opposition between exploratory and affirmative approaches”, but the affirmative approach at a minimum hampers exploratory therapy and at worst prevents the child from being able to engage in it. NHSE will need to be absolutely clear about the approach therapists will take because any hint of affirmation in the final service specs will lead to the status quo with the new regional centres insisting they undertake exploratory therapy but in an affirming environment.

it talks about children and young people who “require” a medical pathway or medical intervention. Particularly in the absence of an evidence base for the medicalisation of children and young people, which ones “require” medical interventions and how will this be determined? Particularly when considering that this is an area of healthcare with no certainty and clinicians openly admitting this (eg episode 2 of the Tortoise podcast where Polly Carmichael witters on about thriving on uncertainty).

There appears to be a move away from social transition as a medical intervention (as NHSE have made clear it is). They seem to have gotten themselves into a muddle over clothes and hair after the unfortunate misinterpretation in some of the press (and picked up by the lobby groups) about restricting these. Social transition is more about the people around the child than the child themselves. The child already sees themselves as the opposite sex - it’s not about the hair or the clothes, it’s about other people embedding the child’s belief that they are the opposite sex by use of preferred name/pronouns etc. NHSE have made it clear this should only happen under certain criteria including a gender dysphoria diagnosis and under clinical supervision

Obviously you can’t change the child’s or their peer group’s use of name/pronouns/reinforcements, but as a medical intervention, a clinician can make a recommendation about how the adults in the child’s life should react to this. The Cass Review is saying: “The role of the professional is to facilitate parents/carers, children and young people to engage in an in-depth process of discussion and thinking around this decision…” which is quite different to the NHSE position.

If the service ends up the way the Cass Review has responded to the NHSE consultation, it will be fundamentally no different to the current service (other than the PB trial). They will be asking parents to effectively take a leap of faith despite their being no evidence base for what is being recommended, and their recommendation is still very much child led. I can’t see parents on the more cautious side buying it. Neither side trusts the NHS in this issue but ultimately, there is no middle ground and a decision will need to be made as to which direction to take.

I am about to read this but I am also keen on reading the different interpretations here. Thank you.

I think she is trying to build a golden bridge. The fact is that they will have to work with the rainbow believers in order to move this all forward. I think she is being pragmatic, the point is there is no evidence...so, we need evidence.

I'm not sure what else she could have done, really. She's got to negotiate and have solid evidence. We need someone to do the work, but the challenge is getting funding and finding the academics who are brave enough to do it!

My thanks too, we cross posted. That has given me something to ponder.

Thanks, rogdmum, I expect you have a deeper and more informed view than I do.

'muddy' I get.

I wonder if people were expecting too much. There is a political dimension and ultimately the Cass Review has to compromise between reason and lunacy. Which necessarily means endorsing some lunacy.