Hillary Cass at Scottish parliamet - live

That’s not answering my question. I asked for your proposal on what we should do.

You seem very resistant to the idea of critical appraisal of study design, of bias and poor quality studies leading to false conclusions. You seem very wedded to the idea that observing a non-randomly selected group of individuals receiving harmful treatments will give us answers that they simply cannot give.

Explore fully the reasons and motivations behind their distress, rather than assuming children grow up in a vacuum - not absorbing dominant cultural memes and tropes around the relatively recent concept of 'gender'?

What IS ISSUES AROUND GENDER IDENTITY?

You don't want to get into splitting hairs on definitions, and that is because these definitions don't make coherent sense in the first place.

I’m just reflecting the language of Cass. I’m not going to split hairs on the definitions, we all know we have a sudden increase in children with issues around “gender identity”. And these children are presenting to medical services wanting medical treatment.

That’s the reality, so how do we get the evidence to develop appropriate courses of action for these patients?

What IS GENDER DISTRESS?

😁

@Sloejelly You appear quite resistant to the idea of any kind of study involving children, even non-treatment observational studies. What do you suggest should happen to get the best possible quality evidence to support the appropriate course of action for children presenting with “gender distress”?

Oh Snowy... are you saying that it's all a lie?

Following on from Ingenieur's post, let's not forget that the severely, persistently gender-distressed child wants to be a boy/girl - not just look like one. Medical and surgical transition is sold to children as if it can achieve that outcome. It can't. Nothing can. So even disregarding the ethical considerations, that is a major reason why it should not be offered to children.

We (general 'we') appear to have completely thrown away the idea that having a healthy body that works and doesn't hurt is a good thing that should be cherished. If you live long enough, it probably isn't going to stay that way due to the ravages of time, illness and injury. How is it ever acceptable to damage a child's healthy body in this way?

We really need that 'first do no harm' idea back in both medicine and society.

@Sloejelly

It starts with indoctrination into an ideology that tells young children, with very limited understanding of the world

This is an important point. Part of the indoctrinational grooming process is the rejection of critical thinking and the lowering of inhibitions such that the child doesn't know when something is wrong.

In a similar way that we raised concerns with the NSPCC's definition of child abuse (the child knows the abuse is wrong), the children in this case have been convinced of the existence of gender identities, and that transition will solve their maladies - both unevidenced - as part of a long conveyor of love-bombing, misinformation and isolation from loved ones. They therefore do not accept that they are being mistreated by the process.

With this grooming in mind, can there ever be true consent from a child to this process? Even before we ask whether a child can properly comprehend and weigh the outcomes of a course of action? (I won't use the word "treatment" here).

My main point was that if you track the children carefully and analyze the data on outcomes, there may be subgroups within the larger whole for whom testing various treatments could make sense, even if it would be unethical to give a proposed treatment to the whole group.

It would be impossible to tell if some might benefit from simply tracking children. You could only say that some appeared harmed less than others. You could not tell if they are in a better position, despite the harms they have suffered, than they would have been had they received alternative treatment (eg psychotherapy) or no treatment.

Remember ‘treatment’ doesn’t start with PB or even forcing others to pretend you are something you are not (aka social transitioning). It starts with indoctrination into an ideology that tells young children, with very limited understanding of the world, that they can choose their sex based on regressive stereotypes.

I think Cass erred on the side of diplomacy when she said puberty blockers should only be assessed as part of a rigorous research trial because I highly suspect Cass knows damn well that such a trial would never get past any proper ethics committee because of the harm that would result, not to mention the very real problem as OldCrone points out of there being no clear indication as to what is being treated.

She knew if she said “not now, not ever” it would be a stick to beat her report with. Saying what she said doesn’t mean there’s a valid option of doing just that.

I had also come to the conclusion that this was probably the most likely reason for Cass acting as she has. The reactions on both sides have also been interesting as both sides seem to have reacted as if she had taken the much harder line.

Now all that remains to be seen is whether the NHS are actually capable of/will make any attempt to control the rogue clinicians who have been in the driving seat for so long. Those clinicians still hold too many cards. Persuading new and unbiased clinicians into this niche, toxic corner of medicine is going to be close to impossible. The waiting lists are presumably still huge.

While I admire the game I suspect Cass is indeed playing, I wonder whether, in time there will come to be regrets over not taking a harder line. If we eventually want to bring these doctors to justice, giving them any kind of wriggle room that allows them to justify continued experimentation on children might be seen, with hindsight, to have been a misstep.

@UtopiaPlanitia Thanks. I enjoyed the interview. I like that it had a transcript as well as the podcast.

Meghna Chakrabarti, the interviewer, brought up some of the criticisms of the Cass Report and Dr. Cass addressed them directly and diplomatically. She's so good at this! Chakrabarti had good questions; I was glad that she gave Dr. Cass the opportunity to address some of the concerns with her report, including WPATH's. The interview seemed balanced and informative. If ppl have a chance, it's worth a listen or read.

Good point. In my hypothetical, there would be no point in giving PBs bc 100% of the children in group A persist in their gender incongruence if you don't intervene. There would probably be no benefit in postponing puberty for them bc they're unlikely to change their minds and there are known harms with PBs. I should have instead used cross sex hormones in my example of an intervention for Group A (e.g., measure physical health, happiness, mental health, social adjustment, educational outcomes, gender incongruence, etc over several years for a group who had hormones vs counseling only vs both vs wait list only).

My main point was that if you track the children carefully and analyze the data on outcomes, there may be subgroups within the larger whole for whom testing various treatments could make sense, even if it would be unethical to give a proposed treatment to the whole group.

Found an American podcast interview with Dr Cass:

https://www.wbur.org/onpoint/2024/05/08/nhs-hilary-cass-review-gender-transgender-care

Produced by WBUR in Boston, distributed by American Public Media.

The weakness in this instance was that they were already licensed in children but for completely different use [the treatment of precocious or early puberty], for which they are totally safe… It should have been subject to greater scrutiny.”

They are NOT totally safe for precocious puberty.

That's such a good interview. Her understated comments are really damning of what's been done to children:
“If puberty blockers had been a new drug, they’d have gone through very strict controls before being prescribed. The weakness in this instance was that they were already licensed in children but for completely different use [the treatment of precocious or early puberty], for which they are totally safe… It should have been subject to greater scrutiny.”

**

Yes this could be done as a cohort study. While not as strong empirically as an RCT, it would give useful information. Im
shocked that gender clinics haven’t been doing this kind of research. … OK not
actually shocked, but it would have given @some evidence base for PBs and cross sex hormones.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120971/

Hannah Barnes has interviewed Dr Cass:

https://www.newstatesman.com/ns-interview/2024/05/hilary-cass-interview-review-transgender-identity-tavistock-puberty-blockers-do-i-regret-it

Started a new thread to discuss the debate today and to note Kate Forbes' promotion to Deputy First Minister.
https://www.mumsnet.com/talk/womens_rights/5071226-scottish-parliament-votes-to-accept-cass-report-forbes-made-deputy-first-minister

I understand where you are coming from. It's true that without research we don't "know" anything scientifically for sure.

But doing good research means being able to define the condition, and what constitutes a good or bad outcome.

It's also not usual to give kids any experimental treatments unless they really think they will be less harmful than the disease. Which we can't evaluate until there is a clear diagnostic criteria.

Nope, I’ve never said it was possible to assess the safety and efficacy of PBs under those circumstances. I don’t think it’s possible to design any ethical clinical study with the objective of determining the safety and efficacy of PBs in children with “gender distress”.

What I have said, repeatedly, is that observational data from current patients would be useful and relatively straightforward to obtain.