Letter from academics concerned about the Cass Review

There's an article in the Critic that dismantles this letter quite thoroughly

https://thecritic.co.uk/correcting-casss-critics/

There's also a link to the form if anyone wants to sign it🙄

RethinkingLife · Yesterday 16:04

This is an area known as epistemic trespass.

That's very interesting, thanks. There's also a name for the pub bore types, who wang on endlessly about subjects they have no understanding of:

Ultracrepidarian

https://www.dictionary.com/browse/ultracrepidarian

noting or pertaining to a person who criticizes, judges, or gives advice outside their area of expertise

Very odd, I can't see the signatories at all (my devices are telling me it's unsafe) but when I do get through it invites me to sign. I'm an academic in a totally unrelated field so it must be specially programmed to let us in.

A bunch of TRAs angry that they’re losing their grip in academic circles to police other people’s language and thoughts, tell people what to think and use children as their Guinea pigs for some weird experiment.

No thank you.

@WhatsTheUseOfWorrying could you expand? Do you think the Cass report says it's proven that puberty blockers do more harm than good?

@RedToothBrush has already given a great comment on this, but with regard to Social Sciences or anything else outside the core subject(s), it might not necessarily be the subject that's wrong but how scientifically it is being applied (or that critical thought is not applied at all).

Often other sciences can be a corrective to the own one, for example at some universities, engineering students need to take addictional classes in history of technology or technology ethics/philosophy. That could help prevent technocratic thinking and the assumption that technology can solve anything, without checking whether a certain problem could be approached from different angles at all.

History of clothing and textiles is also very informative, as it shows that the high heel has developed from a riding boot and originally was a male item of clothing and is just one of many examples that clothing changes its meaning and doesn't determine biology.

Bollocks.

In a purely demotic and not cis/trans sense.

Yes this is true.
One of the York University crack medical statistics team is my dh(mathematician)’s ex student. She went on to do a Health Sciences PhD, so not a medical doctor, but clearly has a vast amount of expertise in clinical trials after 20 years and now a professorship in the subject. An epic amount of specialist knowledge compared to these utter twunts who think they can pronounce on the quality of her work.

I couldn’t help noticing that nobody from York University has signed the letter. It’s a lot easier to slag off someone’s work when you’re not going to be sitting next to them in Library Committee, or indeed, come up before them in a promotions panel…

@RethinkingLife thank you for that information about the proposed Siminov study. Of course exactly what's needed.

I am wary of the anti-anti-cass backlash - broadly an unscientific interpretation that the review shows early hormonal intervention is harmful and not helpful. The review shows that there is no robust evidence that it is helpful, and is definitely harmful in some ways. Absence of evidence is not the same as evidence of absence.

Arguing that Cass has said definitively that no children could or would benefit from puberty blockers is not accurate.

I agree and I think there are people who know this too but can't say this out loud. It has to go to the ethics committee and for them to say it because they have the authority. If the authority says this it gets, once again, harder to push back and complain.

I believe we have a number of steps to go through on this but I also believe that there are people who are trying to end this who are very aware of this too and are playing the long game. Because they have to.

Pretty much the argument of the OU academics who were asked why they'd signed the anti-Jo Phoenix letter during the employment tribunal:

• I don't recall
• I didn't agree with all of it and wanted to be an ally and this was the only way I could express that in the face of colleagues' distress that I assumed to be well-founded
• I don't remember this and certainly couldn't say who drafted or circulated the letter because we all bought new phones and not one of us had our WhatsApp backed up to the cloud.

The Simonoff trial is under development and they mention the high bar for ethics approval.

A study into the potential benefits and harms of puberty suppressing hormones as a treatment option for children and young people with gender incongruence is being developed through the National Research Collaboration Programme (NCRP) in place between NHS England and the National Institute of Health and Care Research (NIHR). The NRCP joint programme provides a collaborative approach to study development; studies being progressed through this route still have to demonstrate that they can materially build the evidence base for potential future NHS treatment options, while meeting a high scientific bar in terms of research methodology, as well as securing other important research approvals, including ethics committee approval.
It is envisaged that children and young people in both England and Wales will be able to participate in the study with access through NHS children and young people’s gender services. A multi-disciplinary team approach will be taken to identify those children who, with the consent of their parents, may be deemed clinically suitable for consideration of puberty suppressing hormones through the study. Children participating in the study will also continue to receive comprehensive psychosocial support.
The study will measure a range of potential treatment benefits and harms (for example whether puberty suppressing hormones impact in a meaningful way on levels of anxiety or depression, on body image, or brain development) using a range of validated tools, questionnaires and user feedback. Key measures included in the study, and the way data are collected, will aim to bridge gaps in existing research and will also be shaped by engagement with a range of stakeholders, including children and young people referred into NHS gender services and their families or carers.
Professor Emily Simonoff has been confirmed as Chief Investigator for the study.

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/cyp-gender-dysphoria-research-oversight-board/

Yet more evidence (as if we needed it) that gender woo rots your brains. If I was asked to sign a letter such as this, my first question would be-am I qualified to give an informed opinion? If, as in this case, the specialism is medicine then a Phd in grievance studies or a diploma in interperative dance isn't going to cut it. Still, it gives a measure of how desperate the koolaid gang are becoming and we can expect to see three responses to Cass. 1-it wasn't me guv, I never said those things (otherwise known as the Hunt gambit). 2 keep shctum and hope it goes away. 3 go down with the ship whilst wearing full evening dress, which you have expressly donned for the purpose, which is what these fucking clowns are doing.

It is absolutely reasonable to say that double-blind controlled trials are an impossible standard to asess some interventions. [...] Lots of surgical interventions (eg amputation) cant be double-blinded, so evidence will be downgraded to weaker, but will still have meaning.

Yes, you've found a grain of truth in the bald-faced lie:

It does not include a proper systematic literature review since it disregards most research evidence because it fails to reach the impossibly high bar of a double-blind trial.

The statement is a lie because the review did not disregard evidence for not meeting that bar. Even their screenshot (from the NICE review, not the Cass review) only shows papers being "downgraded 1 level", not "disregarded".

Lucky offence is taken rather than given, eh?

I'm a doctor and have written systematic reviews. I would not claim to understand review papers in unrelated fields - I could read a history paper but I'd have to go back to uni to know enough to critique it.

I work in a field with difficult to treat conditions and high risk therapies where we may say to someone - well we don't have any medicines licensed your condition, but we could try this immunosuppressant that sometimes works in a similar condition but has the risk of major side effects. I'd suggest that where I thought benefit was plausible and the risk of side effects was worth it (ie. life limiting condition and we have nothing else to try).

Gender dysphoria in children is reported to resolve in about 80% without treatment. No way would I suggest a high risk unlicensed treatment for a condition where around 80% of people see their symptoms resolve without treatment. The sensible approach is watch and wait.

I would be very, very surprised if an ethics committee allows a clinical trial of puberty blockers - their use on any basis for gender dysphoria is clearly wildly unethical.

It is absolutely reasonable to say that double-blind controlled trials are an impossible standard to asess some interventions. Double blind meaning neither the assessor not the patient knows what intervention they have had. So for a new drug treatment - placebo vs active drug - possible - so long as the patient cannot work out by the effects of the treatment whether they are on active or placebo treatment. If the active treatment causes you to develop a beard, cliteromegaly and a deep voice, then it's not double-blinded and so such a trial can never take place. That's not to say that decent trials with measurable outcomes cant and shouldnt be devised, just that they can never reach the holy grail of double-blind control. Lots of surgical interventions (eg amputation) cant be double-blinded, so evidence will be downgraded to weaker, but will still have meaning.

Just like there are excellent, good, adequate, bad, terrible etc medical doctors, the same goes for PhD doctors. Just because this list of signatories includes PhD's with questionable credentials, don't think that distinguishing between MDs and PhDs is a good way to identify those with quality thoughts. Your comment is also slightly offensive to the non-medical scientists doing scientifically robust research/work in this area that absolutely puts them in the 'expert' area.

Exactly.

https://x.com/saralikeclara/status/1779593226120216885

This is an area known as epistemic trespass.

"Epistemic trespassers are experts who pass judgment on questions in fields where they lack expertise. What's wrong with epistemic trespassing? I identify several limitations with a seminal analysis to isolate three desiderata on an answer to this question and motivate my own answer. An answer (i) should explain what's wrong in the cases that motivate inquiry into epistemic trespassing, (ii) should explain what's wrong with epistemic trespassing even if trespassers do not acknowledge their trespassing, and (iii) these explanations should not be independent of the fact that epistemic trespassing involves expertise. I also independently motivate a fourth desideratum: (iv) this account should explain the evaluative difference between different kinds of trespassing. To satisfy these desiderata, I develop a social analysis: epistemic trespassing is wrong because it is an abuse of expert authority that neglects novice vulnerabilities."

https://pubmed.ncbi.nlm.nih.gov/34024942/

I strongly agree that novices and people who've not performed due diligence may be classed as epistemic trespassers. Ballantyne lays out interesting arguments.

Nathan Ballantyne, Epistemic Trespassing, Mind, Volume 128, Issue 510, April 2019, Pages 367–395, https://doi.org/10.1093/mind/fzx042

https://philpapers.org/archive/BALET-2.pdf (accessible version above paper)

I'll go further and say that the harms of epistemic trespass in some spheres is rarely limited to the individual as it can harm other people. Bystanders may be led into error when they trust epistemic trespassers for whatever reason seems acceptable (outsourced thinking, lots of social support for an idea). Genuine experts can deplete precious, limited resources refuting the popularised errors of epistemic trespassers or leave it to PR campaigns to correct those errors (which may have limited success, look what's happened here with Cass).

However, people like Stephanie Davies-Arai have expertise in adjacent areas and have carried out analyses of the evidence that have effectively been formally confirmed by York and Cass. This is very much in lane for some people who have relevant research skills and knowledge. There is space for acknowledged autodidacts whose accuracy is verified by others.

This by no means exculpates Muang or others but it would be wrong to deride anyone as a commenter because so much of healthcare can now be beyond niche in its narrowness.

NB: it's can be wholly correct to roll eyes at people complaining about the make-up of the authorial line for systematic reviews. As people have pointed out, clinicians have done their bit in obtaining funds, running the trials in mandated phases, and publishing their results. For a systematic review and/or meta-analysis, you need trial methodologists, statisticians, information retrieval specialists, data analysts etc. - a multi-disciplinary team of people with relevant skills and expertise that they leverage for the review.

I mean anyone can write an open letter. Nothing wrong with that. The military wing of the united flower arrangers of Sutton Boggley can all write a strongly worded letter criticising Cass, if they like.

Doesn't mean anything.

@NecessaryScene haha don't get me started on all the "queering" of everything, and I say that as a lesbian!

What's interesting about that list as well is that it includes PhD students and GTAs, so people who have not even completed their studies yet.

How many years of experience does Dr Cass have? Over 40 years of practice by my maths. But so and so working towards a non-medical PhD who has not even finished so much as a literature review yet knows better eh?

An arts PhD (which a lot of the people on that list have) does not make you an expert on evaluating the potential dangers and/or efficacy of puberty blockers on children. Leave that to the actual experts.

And vice versa, please.

I liked this comment that Helen Joyce retweeted:

This is complete nonsense. I’m a biologist and I don’t go around telling you that you’re queering Jane Austen wrong or that you didn’t find enough heterocissuppression of marginalised voices in Teletubbies, so can you all stay in your lane

My PhD was in the arts but in a field related to medical ethics, with a specific focus on forms of embodiment. Yes I am a Dr whose research tangentially touches on some of these issues, but I do not belong anywhere near these public debates. I actually recognise some of the people who have signed that letter, and they absolutely are not experts in this field. An arts PhD (which a lot of the people on that list have) does not make you an expert on evaluating the potential dangers and/or efficacy of puberty blockers on children. Leave that to the actual experts.

I would actually love to hear from surgeons and consultants on this. Not from academics in the arts or social sciences. If the review is wrong or was incorrectly researched, it's the surgeons and consultants who we need to hear from. Those on the front line of all this. I want to hear from people whose work goes beyond the theoretical.

afaict, it's a published paper.

Edited to avoid confusion.