To nominate the principle authors of the CASS review for this..

[NameChangeCass]

“Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.”

https://www.bmj.com/content/327/7429/1459.short?fbclid=IwAR0hTt57o-yFS61aJE-IGCpKSPaDs--rdrPlbiby_wBCF1czpAWDaCcAEcM_aem_ATiWMtvZxiSzw8pj9CX271gyDByuMHTOKwQskBcCXx9aZOj1IPusHJ_z79olcRiFlhE

Apologies I am on my phone. It’s from here:

https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf

Okay, so we're getting somewhere. Not the Cass-commissioned review being discussed earlier. That's a review produced by NICE in 2020.

And the bit that was cropped out from the zoom was that in this NICE review (which was not Cass's review), each reference to "double blind" is of the form:

Downgraded 1 level - the cohort study by Achille et al (2020) was assessed at high risk of bias (poor quality; lack of blinding, no control group and high number of participants lost to follow-up).

So "downgraded 1 level", not "omitted"/"discarded"/whatever, and NOT EVEN FROM THE CASS REVIEW OR THE PAPERS PRODUCED FOR IT!

FFS...

saying ‘it’s a joke’ doesn’t make it ok.

We can see what you are doing here.

😂😂 it’s totally fine. And both funny and pertinent.

You are literally the only person saying this on the thread.

Can we at least get the title changed for accuracy to

"To nominate NICE for this.."

?

It's a joke that you didn't understand and misapplied.

It only works if not getting puberty blockers = death (not just possible "social" benefit to a minority)

Or

If we have such a wealth of high quality evidence (for eg, large, well conducted observational studies if rcts not possible) that puberty blockers are a definite good that it would be unethical to conduct trials.

Not the case here as I'm sure you know.

What I find utterly devastating is that children have been irreparably harmed over the past several years based on a body of evidence that, when assessed, has been found to be absolute bullshit, to use the correct medical terminology.

They've sterilised children. 15 year olds were shipped from Scotland to England to have their breasts amputated. Children have had body parts surgically removed. FOR NO REASON.

I don’t think accuracy is high on this OP’s priority list.

Who has created hundreds of bullshit articles with the aim of encouraging children to have body parts removed?

And for god's sake WHY?

Observational evidence isn't useless but it's much more vulnerable to bias and difficult to draw reliable conclusions from, especially if small.

You should show how you've mitigated for these problems to avoid producing a low quality study that can't be used except by cheerleaders and media releases.

Imagine being someone who'd had life-changing treatment based on this pseudo science? Imagine that being your child?!

108 studies of low quality, and that's what the NHS based treatment on?!

That and WPATH's decision to pursue 'eunuch gender' as a valid identity, of course.

OP I am presuming you are male and not a mother.

The ‘robust ladies’ of mumsnet you dismiss are also a collection of women who are doctors, medical researchers, biologists and teachers etc etc.

And of course we have personal experience of going through puberty as girls and, many of our children going through puberty.

Because many of us know scientific methodology - we know why Cass was right. Because many of us have been through the cohort of children who have had this ideology thrown at them, we know of what she’s talking about fits with our personal experience.

Observational evidence isn't useless but it's much more vulnerable to bias and difficult to draw reliable conclusions from, especially if small

yes of course this is true.

And it is also true that not using biased and ungeneralisable studies in a systematic review of evidence for healthcare practice.

Just to make it absolutely clear - the document OP is highlighting is the initial NICE review that was undertaken in 2020 for Cass, before the "Cass Review" itself was conceived.

From the Cass Review:

3.1 In January 2020, a Policy Working Group (PWG) was established by NHS England to undertake a review of the published evidence on the use of puberty blockers and masculinising/feminising hormones in children and young people with gender dysphoria to inform a policy position on their future use.

3.2 Given the increasingly evident polarisation among clinical professionals, Dr Cass was asked to chair the group as a senior clinician with no prior involvement or fixed views in this area.

3.4 [...] the National Institute for Health and Care Excellence (NICE) was commissioned to review the published evidence, again following a standardised protocol that has strict criteria about the quality of studies that can be included (NICE, 2020a; NICE, 2020b).

3.13 The evidence produced by the NICE reviews was inconclusive to the extent that NHS England could not form a policy position on the use of these medications.

3.16 The need for an independent review was clear and driven by the changing situation over the last 10-15 years: [...]

3.17 This independent Review was commissioned to make recommendations on models of care, appropriate treatment approaches, audit, long-term follow-up and research, as well as workforce requirements. It was also asked to explore the reasons for the increase in referrals and the change in the demographics of the referred population.

The Cass Review commissioned a load of new work (some of which was thwarted by non-cooperation).

That includes the Taylor et al papers which OP falsely claimed to be the source of the screenshots. The NICE work was just a precursor to the Cass Review and its papers, not really part of the review proper. But it's there as part of the evidence. (Because we wouldn't want to omit anything...)

There is deception layered on top of deception in this Cass critique. Which, like the gender clinic non-cooperation, is very telling.

See my surprised face @NecessaryScene

So, parachutes were only invented about twenty years ago, and for tens of thousands of years before that, children were routinely thinned out by being dropped from a height at the age of twelve?

And those evil killjoys want to do away with the life-saving parachutes because of a few friction burns sterility, osteoporosis, and loss of sexual function.?

THIS. And we have terrifying numbers of adults ARGUING in FAVOUR of this.

If someone could help me understand how this came to be the case, I'd be very grateful. Because it blows my mind

From Cass' Foreword:

'This is an area of remarkably weak evidence,
and yet results of studies are exaggerated or
misrepresented by people on all sides of the
debate to support their viewpoint. The reality is
that we have no good evidence on the long-term
outcomes of interventions to manage gender-
related distress.

It often takes many years before strongly
positive research findings are incorporated into
practice. There are many reasons for this. One
is that doctors can be cautious in implementing
new findings, particularly when their own clinical
experience is telling them the current approach
they have used over many years is the right one
for their patients. Quite the reverse happened
in the field of gender care for children. Based
on a single Dutch study, which suggested that
puberty blockers may improve psychological
wellbeing for a narrowly defined group of
children with gender incongruence, the practice
spread at pace to other countries. This was
closely followed by a greater readiness to start
masculinising/feminising hormones in mid-
teens, and the extension of this approach to a
wider group of adolescents who would not have
met the inclusion criteria for the original Dutch
study. Some practitioners abandoned normal
clinical approaches to holistic assessment,
which has meant that this group of young
people have been exceptionalised compared
to other young people with similarly complex
presentations. They deserve very much better.'

Power. There are various groups pushing this. Use your imagination, why would people want a crop of young people with arrested physical and mental development with low boundaries around sexuality. Many of them abused, neurodiverse or looked after children and already vulnerable.
Rather than marginalized those cheerleading this hold an enormous amount of power.

Honestly? Because we know that withholding vital health services from an extremely vulnerable group of children is only going to cause them immeasurable suffering.
Because we know that PBs are a safe and effective medicine that can help until children are ready for HRT. Because we know that the assault on transgender medicine is based on erroneous and flawed politically driven beliefs that being trans is not a real and legitimate thing and this is so so wrong.

withholding vital health services

Unevidenced medical interventions are not 'health services'.

Lupron is a horrific drug. I've had a friend decline it despite late stage terminal prostate cancer, because of the side effects.

The Cass Report shows there is no evidence to support the assertion that PBs are safe or effective.

We don't know any of those things but nice try.