Pathways Puberty Blocker Trial - High Court Proceedings start 27th July

Yes loads, psychotropic drugs for eg. For serious problems such as schizophrenia.

but these are delusional children with a none verifiable disorder that is most likely, a social contagion in girls, homophobic influencing, and parental personality disorders, such as munchhausen by proxy.

Just to name a few. I have a book someplace on the bollocks spouted in psychiatry, where plenty of loons reside. I will see if I can rummage it out.

And is there any other mental health condition which is treated by administering medication to a patient with a healthy body which will harm their body and have no physical benefit, in the hope that the harm to their body will somehow improve their mental health?

What is the supposed benefit meant to be for girls?

Thank you to @Lougle and @MarieDeGournay for your excellent posts laying things out so clearly.

Yes. Two key things highlighted that have bothered me from the start:

1. The definition of 'benefit' in this context

2. The impact both OF and ON society.

I thought Cass made mention of the social discourse element in her report?

But maybe I inferred or am mis-remembering.

It seems such a key point to me!

Thank you Lougle, that was very well put, and I agree completely.

I have no expert knowledge about the ethics of medical trials, but I see an obvious difference between testing a treatment on children who are very unlikely to survive because all other treatments have failed, and testing a treatment on children who are very likely to survive what they are experiencing.

Most children who experience what is sometimes know as 'gender dysphoria' [I'm using it as a shorthand, pace the disagreement about its nature or even existence] recover/get better/grow out of it, in most cases without any 'treatment' at all, because most of them are never considered in need of medicalisation in the first place.

Many children have problems with their sex/associated gender stereotypes and many of them wish they were the opposite sex; some may even feel suicidal about their natal sex - I did..

Families handle it - hopefully with love and support and pragmatism and understanding and that essential ingredient: the truth, i.e. that nobody can change sex.

[At this point you have to factor in the effect of the whole social discourse around transitioning, true selves, gendered souls, pronouns, etc etc which are acting against the therapeutic effects of reality and pragmatism.]

Surely intervention at an early point with PBs is most likely to be superfluous, when time/support/reality/the truth is more likely than not to 'cure' the child's gender dysphoria?

I agree with you.

The difficulty, surely, is that 'benefit' is not a term with a fixed point of reference. Taking cancer as an example, if a child will die without treatment, then a treatment that might possibly stop that is easy to justify - they can't be worse off.

The reality of GD is that some kids will go on to be adults who truly believe they were born in the wrong body and will experience such distress that they kill themselves (but realistically, they are also likely to be the ones that might have killed themselves for other reasons), or they will go on to be adults who truly believe they were born in the wrong body but will somehow manage. Or, they may be kids who grow up and realise that their misery was not to do with their birth sex and become happy with their identity, or that their misery was not to do with their birth sex but they're still deeply miserable so they kill themselves anyway for another reason. Or, or, or, or....

Because mental health doesn't have 'disease pathways' in the same way as physical health. You can't give a prognosis at an early stage of illness. As time progresses, it's a fair bet that someone who has been mentally ill for several years is unlikely to be totally free of it. It's also a fair bet that if therapy is provided quickly and skillfully there will be many for whom their mental distress will be just a memory of a difficult time in their life.

Additionally, matters of mental health and identity distress don't exist in a vacuum - how we as society respond directly influences the impact of it. So lots of focus on this area and validation of the distress, etc., will likely directly lead to an increase in incidence and 'severity' because vulnerable people are being told that they are right to feel this way and that is is the root of their difficulties.

I can't see how anyone could say that a child of 11 will fall into any particular one of those groups, so I can't see how they would then assert that there is a defined benefit.

Catching up on Nick Wallis’ tweets and my feeling is maybe the arguments aren’t going back far enough. The REC (I think) barrister (JM) pretty much made the point in passing while dismissing the point about benefits. I think many of us here would argue we do already know the risks v benefits don’t stack up. Therefore there should be no trial. But it seems the conversation is starting with the assumption that a trial is reasonable- just not this one

J AM's point was about misconstruction of the text. Saying it might benefit was not enough.
JR that's wrong – otherwise you'd never get clin trials involving children. There are always inherent uncertainties. If you don't have that you can't justify a trial. if you already know, you don't have a trial.

@BonfireLady yes, I think one of the grounds relates to the ethics committee and process/ legal thresholds.

it definitely is written down that you can’t experiment on children for the greater good alone. That’s what they were arguing yesterday. There needs to be a benefit for the group (not all in the group necessarily but at least one or more should be expected to benefit). If I’ve understood correctly KCL stop short of saying there is likely to be a benefit and caveat it with “reasonably” likely.

The defendant’s barrister yesterday argued mor or less: come off it you’re splitting hairs now.

once again IANAL and may be misunderstanding/filling in gaps with what I think should be there so approach with extreme caution

Thank you, that's helpful. If frustrating!

The ethics committee on the other hand bloody well should have looked properly at the trial design.

I wonder if there were any procedural failings when they did so. I remember that the number of people in each stage of the ethics review dropped down every time it went to the next stage.

The logical assumption is that they chose to drop out because they felt too uncomfortable saying they opposed the medical trial but too uncomfortable to pass it either.

It would be incredibly frustrating if this were true and due process was still found to have been followed. But as your mum said, all that can be done is fight to change the law if that's what we end up with as the outcome (assuming it gets to be heard as a JR case).

But step one is getting the JR heard.

Edited to add: I really hope it is written down in law that you can't experiment on children for "the greater good". If it is, that presumably means the ethics committee didn't follow process properly, given nobody will be able to prove that the individuals in the trial are expected to have better outcomes than if they didn't go on the trial. Everyone has admitted, one way or another, that nobody knows this because there is no evidence either way (except in the data linkage study, potentially)

I think the difficulty with the law is it is supposed to focus forensically on what is written down in law and case law. Because no one thought they needed to write down “the law says you can’t experiment on children with powerful drugs that are likely to create long lasting negative impacts”, the court can’t look at it.

That’s why the grounds here are so narrow. The ethics committee on the other hand bloody well should have looked properly at the trial design.

IANAL but my mum was a barrister. I’ve had endless arguments with her about things that I argued were obviously wrong to which her response was always “if you don’t like it then you will have to work to change the law”!

TLDR the court cannot make a moral or ethical judgement, it’s constrained to the letter of the law (I think IANAL)

Fingers crossed that the claimants get to grasp the "physically healthy" and the "afterwards" nettles and that the judge gets the point!

Agreed! It's difficult for a non-legal like me to understand how important it is that this judge understands this right now, as it feels like something that should be a core argument in the actual JR hearing. But either way, it needs to be heard loud and clear, to give the JR the best chance of success overall.

@SodThisHeadache Thank you for going along and helping us understand what's going on. Very frustrating though having to listen to them miss the point!

Fingers crossed that the claimants get to grasp the "physically healthy" and the "afterwards" nettles and that the judge gets the point!

Am going today. Don't know if I will last the whole day - it's hot and uncomfortable in there, but will do my best. It's fascinating but also so frustrating and ponderous - at one point I wanted to stand up and yell out a 'point of information' 😂

Interestingly, Dr Cass said exactly the opposite about the children from the trial potentially going on to CSH in the letter that she sent all all MPs. See screenshot.

This is the thread in which that letter was discussed:

https://www.mumsnet.com/talk/womensrights/5552735-hilary-cass-sent-a-document-to-every-single-mp-and-peer-justifying-and-defending-the-puberty-blockers-trial

Edited to add: I knew I'd remembered seeing it somewhere. Perhaps it is also in the original trial paperwork (as per my comment above) but where I saw it was in the letter that Cass wrote to MPs. I didn't believe it then and I certainly don't believe it now.

The stopping of CSH for 16 and 17 year olds must have been very inconvenient for them because it really does expose the "what next?" question.

Had that not happened, the original stated assumption that children would stop taking the PBs at the end wouldn't be under such a spotlight.

This bit in particular needs full exposure in the press:

The discussion about CSH seemed to be focussing on the risk that the kids won't get the CSH, not the risk to their health of getting them!

Thank you @SodThisHeadache

Really interesting insights.

Despite the judge not getting it about them being physically healthy, it's a positive that he's hearing all this discussion. Hopefully he's hearing enough that suggests judicial review is warranted. I guess the JR hearing would most likely be under a different judge anyway.

It's sounding less and less like a boundaried clinical trial of PBs.... and more and more like the first step of a PB + CSH experiment, where nobody has yet published the second bit.

I think I remember reading from the original paperwork that they stated they expected everyone to resume puberty again as normal after the trail - minus a few exceptions. That never sounded plausible and I'm really glad that the bit about what happens next has been drawn into the open.

That's all surely got to sound dodgy enough for him to say yes to going ahead to JR.

The other things that struck me (I did not catch everything, nor understand some of it):

PBs have been banned, yet they'll prescribe them to these kids, and when the trial ends, apply to allow them to continue to use them, by extending the trial.

They fully expect kids who've been on PBs to go onto cross sex hormones - there is no pretence that it's a time to think (so why even bother with psychotherapy??). Frustratingly, no discussion of the fact that this is not in the patient info leaflet - the leaflet lists side effects, says most are mild but will go away after stopping PBs - but with the other side of their mouth they are saying they expect these kids not to stop PBs!! Make it make sense.

And since CSH are now banned for 16 and 17 year olds, they'll aim to enable those to be prescribed to the trial participants. The discussion about CSH seemed to be focussing on the risk that the kids won't get the CSH, not the risk to their health of getting them!

This all came in discussion with defendants barrister about what happens after the trial.

Edited for clarity and detail

All I kept thinking was - what a disappointment Cass turned out to be, in supporting not just a trial but THIS shoddy excuse for a trial. The point did come out in court that the Data Linkage study should be done first, and animal evidence, but that has come from the claimants, not Cass (the Judge asked claimants' KC how can we find out about the effects of PBs if we cannot do this study?)
Cass, it seems, wants to crack on.

edited for typos/punctuation

I am not sure he will grant an injunction to halt recruitment of participants. He may nonetheless grant the Judicial Review. So they'd start their recruitment but not be able to begin administering PBs.

@Cairngormwildfire
No. That was not the subject of the discussion in court. V frustrating. But it will be in the written evidence

@BonfireLady

Yes I was there, and it seemed to me that for now, the Judge had not grasped that they are healthy children with a mental health condition.

Have they discussed the fact that the trial won’t be able to show any outcomes due to short follow-up and confounding (not least pleasure at receiving a desired drug sooner rather than later)? The inability of the trial to provide the desired answers should be enough to make a trial unethical.