Hillary Cass at Scottish parliamet - live

You are gradually shifting your position. We started from it being stated that it was possible able assess the safety, efficacy and effectiveness of PB from non-random children turning up to GIDS having received uncertain treatment, and have moved to ‘“can’t see the value in obtaining observational data from the patient population”

We can certainly get useful data from GIDS but NOT on the safety, efficacy and effectiveness of PB.

@Sloejelly Prospective observational studies don’t need to give treatment. They do need to have ethics approval, as does any study involving humans.

If you’re as clued up on clinical studies as you’re trying to make out, but can’t see the value in obtaining observational data from the patient population that does present to GIDs or even a private service, then I can’t help you any further.

I listened to the podcast Queen's Speech over the weekend. Twice, because there were audio issues with the guest Dr P, and they had to re-record it.
In ( at least )one of the two recordings. The guest, Dr P, explained how treatment for heavily challenged kids worked. To paraphrase it takes at least six sessions before you get anything of use out of the kid.
It's a known fact that kids who think they are trans go to places on the internet like reddit that tell them exactly what to say to a doctor to get what they think they need e.g. PBs. But listening to Dr P I don't think this pre prepared here's what to say would work on Dr P. It definitely works with the affirmation model crowd, but I don't think a decently experienced mental health professional who wasn't a gender priest, could be fooled for long.
I think reasearchers could gain useful information from kids taking off NHS PBs. They would have to conset of course but I don't think it should be dismissed out of hand as an evidence gathering tool. Give it a go, and if no good information comes out of it, fine stop doing it. But I think it's foolish and reflective of the religion of the gender lobby to dismiss it out of hand without trying it first.
I think it would be pretty hard to fool for any length of time an experienced mental health professional playing by the rules.

You sound quite mixed up about what you are actually looking at. If there are ethical concerns about giving a child a treatment then a REC wouldn’t approve a prospective observational study that gives that treatment. If you are talking about a retrospective study then you need a complete cohort, not a biased selection of those who turn up at an NHS centre after following a motley selection of treatments that can not be audited, and missing a chuck of the cohort for reasons that could be related to the treatment in question.

You would not get basic information on those who have taken PB as you would have no idea how representative those who present in front of you are. You wouldn’t even be able to tell if half of those taking blockers had died because they wouldn’t be there to see.

I’m taking about an observational clinical study, following a protocol that has been pre-approved by MHRA and under the gaze of an ethics committee, and that collects data that is “observed” and recorded by trained clinical staff. These kind of observational studies are not unusual in rare diseases, in paediatric studies and/or where there are ethical difficulties in providing a particular treatment. They allow you to get the best quality data you can out of a limited population. The study participants would be anyone that has been referred to the new GIDs replacement clinics and who consent for their data to be used.

What kind of data they collect could be a mixture of physical (eg sex, age, height, weight, blood tests, physical development) and psychological (eg patient completion of standardised psychiatric questionnaires) and done over a period of time. I’m not an expert in paediatric development but even just this basic information from a group of patients who have and have not taken PBs and/or cross sex hormones would be massively beneficial. I’m sure the experts could come up with a comprehensive list of endpoints that are worth studying.

Let's say after Cass that medical research is done. Say all NHS puberty blockers are put on indefinite hold. And the researchers study all the kids who have taken or are taking PBs from abroad. That data is useful, and it may even evidentially show that there are no cases or situations where PBs result in a better outcome for these kids. Then we will have actual research that says "PBs are bad in all cases and should never be used".

We still need definitions. What does "a better outcome" mean here? What are we comparing this outcome to? Each child is an individual and we can only treat or not treat each child. We can't do both and compare the outcomes. We have no way of knowing what the outcome would have been for a child who was treated if they hadn't been treated.

So it comes back to the same questions. What is the condition that is being treated? Why is a mental condition being treated by physically damaging a healthy body? What does a positive outcome of this treatment look like?

Thank you Arabella.

It looks like that MSP woman was mouthing transactivist gobbledygook and Hilary Cass answered a question she hadn't actually been asked.

And the woman, realising she was talking bollocks grabbed hold of it gratefully and said yes thank you you've answered my question.

😀

What do you mean by ‘failure’? Even at the extreme of death, death might be attributed to heart failure or suicide, without knowing who was prescribed the drug you wouldn’t know this was the outcome. Quite clearly they wouldn’t turn up at the nhs clinic. Would it be a failure or success if someone stopped taking it because they were no longer ‘dysphoric’? They wouldn’t turn up at clinic either. And you wouldn’t know they had taken it in the first place because they never crossed your path. Without a comparator or even the number treated you have no idea of efficacy. Even with an observational comparator you cannot prove causation. On adverse effects it is no better than the yellow card system. On ‘success’ it would be based on biased self reporting which it useless.

Hopefully things will start to change in organisations like yours @INeedAPensieve? I thought this was really interesting - Simon Fanshawe (one of Stonewall's founders and now Rector of Edinburgh University) amongst others suggesting that businesses are starting to express reservations about many DEI initiatives:

https://www.telegraph.co.uk/business/2024/05/06/inside-plot-take-back-control-diversity-zealots/

"HR chiefs admit among themselves that some of their peers have embarked on passion projects that have little to do with the workplace"

The extreme levels of emotional incontinence along with an open contempt for safeguarding others and dismissing their rights always seemed to suggest that so much of this will inevitably be reversed once the bullying and intimidation it's founded on is exposed

Edited to apologise for derailing this. I can start a new thread if anyone wants to discuss.
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It's not as good as a prospective or a controlled trial, but it can still give valid and useful data. Certainly on adverse effects, and potentially on efficacy. In the most extreme case, if there's a 100% 'failure' rate it doesn't matter that there's no comparator - you can still determine that it doesn't work.

That sounds bloody awful. INeedAPensieve.

Hopefully, as the ripples from this report spread outwards, things at your work will reflect that.

Strewth.

Does anyone have Cass's answer to that?

Jeez some of the questions they asked Dr Cass?!?!? 🙈🙈🙈

x.com/markthehibby/status/1787794011878539548?s=46&t=AjtjSItRj-kgZwRzL-pdyQ

Basically "some random on Twitter said it was dubious science, is that true?" 🙈🙈

Oh I do hope so, I really do. My trust of Scottish politicians has gone and apart from a tiny number who have tried to push back against this (such as Joanna Cherry, Neal Hanvey and Ash Regan), the rest, to me, are contemptible. Actively shouting down concerns about child harm to further their batshit agenda. No more. Stop.

As an aside I'm still really annoyed that despite Dr Cass shining a light on this I can't be honest about it at my work. Everyone in my wider team has a pronoun declared on their email (not me, thankfully not mandatory yet, but I'm the odd one out!) we work with Stonewall, some colleagues have their logo on their email signatures (even though it is not the official marketing signature). During women's history month in March the internal internet had a story about a transwoman's achievement(!). On international women's day there was nothing mentioned at all, it was not even marked as a day. Yet LGBT history month in Feb was full of internet stories and already they have 3 news headlines promoting June and what they are going to talk about for equality week in June (to mark Pride etc). No mention of women or even men with health problems, it's literally just about trans joy. It's just a constant drip drip of this and it means that despite proof of child harm and the light Dr Cass has shone on this, I can't say anything (even casually) at my work. Ugh. I feel like I'm in some sort of dystopian novel!

⬆️⬆️ THIS Well said MrsOvertonsWindow

As her performance at the Scottish parliament evidences, Dr Cass has dealt with this magnificently. Although many of us who've been battling these incomprehensible levels of child abuse for years were a bit shocked at her perceived pandering to the trans lobby, she was right. As someone said upthread, in ensuring that she listened, included and referenced trans groups and individuals, all the normal wails that emerge whenever anything is said that fails to 100% agree with their demands, can now be ignored.

The evidence along with her patience and ability to respond to every challenge are a joy to see. The medical abuse of children is all unraveling faster than we dared hope.

This is anecdotal data not an observational study. You have no idea how these children would have responded without treatment, let alone with appropriate psychotherapy. It is highly biased and subjective. It tells you nothing about the appropriateness or success of the treatment. You have participates who are hugely invested in their private treatment and have fallen for a sales pitch. You are also asking patients whose brain development has been impacted by the drugs. You do not have a complete cohort - you know nothing about the missing patients…

As far as I can tell 100% were put on the PB pathway by GIDS, but I am not supporting or defending that. I seem to remember reports that there was only one that got turned down?
Cass has thankfully had a massive effect on the gender woowoo religion. I am assuming and hoping that the priests of gender will get no say medical research of this topic going forwards. If you want to argue we shouldn't give them carte blanche, and keep an eye on them going forwards then I would agree.
What I don't agree with is a completly close minded approach to the subject that it just a mirror image of the TRA position.
Let's say after Cass that medical research is done. Say all NHS puberty blockers are put on indefinite hold. And the researchers study all the kids who have taken or are taking PBs from abroad. That data is useful, and it may even evidentially show that there are no cases or situations where PBs result in a better outcome for these kids. Then we will have actual research that says "PBs are bad in all cases and should never be used".
I am literally saying science might and I stress that might heavily, say under these circumstances it can be of benefit. I'm not saying they are of benefit, I'm saying research might find so. I'm not a scientist or in the medical field. I am assuming that research will now be conducted in good faith where it hasn't been previously. In practice they are going have to change from the virtue feelz school of pseudo-science to actual evidence based science, and that's going to take time, and need the removal of some gender champions from the field.

I can see where @lechiffre55 is coming from. Observational data can still be useful if it is collected in a systematic manner.

So, in this scenario, if a patient turned up that had been self medicating, then the doctor would have to hand a script/questionnaire of the information to be collected, and a defined follow up period. The key is that the same information is collected from each patient in order to be able to analyse it. To be honest they should already be doing this for all ex-Tavistock patients as they deserve proper follow up.

It’s not as good as a controlled clinical trial from a statistical point of view, but it’s about as ethical as you can get under the circumstances. And of course, each patient must consent to their data being gathered and used.

So you agree it would be unethical to give any child puberty blockers?

THIS ^
It was a genius move insisting that PBs for children can only be part of a research trial. This puts medics - including all the dangerous ones who've been sterilising children for so long - in the position of having to openly advocate for chemical castration, bodily mutilation, reduced mental / brain functioning, increased risk of osteoperosis and all the other associated harms it's believed these drugs do to children.
They won't get it past an ethics committees and they open themselves up to massive litigation when they prioritise a mental delusion over the right to evidenced base health care for children.

Is it ridiculous? What proportion were put on option B by GIDS?

@lechiffre55
If you want to have a crack a defining transgender, have at it. I have no such desire because I don't believe it, but i still need to be able to use language to describe who I'm referring to.

It's not any of us who need to define this. It's anyone who is proposing a scientific study on the benefits of giving puberty blocking medication to physically healthy children.

You have suggested that some (a tiny proportion) might benefit. So you must believe that it is possible that some condition might exist which would make this treatment beneficial for this tiny minority of children. We need to define what the condition is and be able to accurately diagnose this condition and accurately predict which children with this condition (if any) would benefit from the treatment. And also weigh the benefits against the harms.

But you can't devise a study without defining what the condition is which is being treated and what would constitute a positive outcome. To my knowledge these have not yet been defined. Dr Cass mentioned the possibility of a study, but I don't think she gave any such definitions.

So it amounts to devising a study of an undefined condition, with no accurate diagnostic criteria, where the positive outcomes of treatment have also not been defined. We need definitions.