In a triumph of hope I was still holding out for some tiny shred of evidence for the necessity of putting distressed children on a path to infertility, sexual dysfunction and a host of physical and mental health issues.
But no, GIDS really actually do not have a clue what they are doing or even what they are dealing with. They are completely winging it. It really is a big uncontrolled experiment on children and they don't even seem all that interested in the results.
I cannot understand how the NHS allows this level of malpractice and clinical negligence to continue.
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TRANSCRIPT
Emily Maitlis interviews Elizabeth van Horn
Newsnight 25/11/19
EM: Dr Elizabeth van Horn is a consultant psychiatrist in gender identity services at the Tavistock and Portman NHS Foundation Trust. Dr van Horn, we know many people transition without problem but this film is about people like Charlie and Debbie who found that their decision to transition was a mistake. Your response?
EvH: Well, my response is that obviously, on hearing about anybody who has transitioned and then feels that it has been a mistake, I'm obviously extremely sympathetic, I find that very, very distressing. You know, as doctors and psychologists, we want to help our patients through their journey, not thwart them or put them at any more sort of disadvantage. But on the other hand, I mean your piece actually showed this really well, this is a very tiny proportion of our patient population, and by saying that I don't wish in any way to sort of ... um ... to sort of limit the impact that it has on those particular individuals. But what we know from our population is that actually well less than 1% of our population choose to detransition.
EM: Isn't that the point, that as Deborah Cohen made clear, we don't know that that number is small, because we don't know the number? Many that we talked to just said that they can't return to the Tavistock for whatever reason that is. And your duty of care, presumably, should be to find out how people are feeling, to find out what has happened afterwards, where there isn't the extensive medical research or evidence to take care of those people.
EvH: I wouldn't disagree with you at all and I would actually encourage anybody who's in that situation to go and see their GP and to seek to get a referral back to a gender identity ...
EM: But it's not just about going back is it?
EvH: ... ser ... hang on ...
EM: It is a concern that you are putting people on these pathways without enough evidence of the treatment or of the long term consequences of what that treatment is doing. This can be life changing treatment in many situations and circumstances and that pathway is something that you're putting people on without the requisite evidence.
EvH: Well, I accept that we can always have a better evidence base, I don't accept that there is no evidence base. I think it depends on how you define your evidence base, and what I would add ...
EM: Well how do you define it? [inaudible]
EvH: ... well I was just about to say that. You know, the children's service at the Tavistock has been running for 30 years, they have seen more than 10,000 patients. The adult Charing Cross gender identity service has been running for ... a year less than I am, which I think is 53 years. In that time they've seen tens of thousands of patients. So there may not be the sort of gold standard, as we would say in medicine, randomised controlled trials, but actually you are rarely going to get ... sorry?
EM: I'm just ... I'm just curious, because the NHS is meant to be dispassionate, isn't it? It is ... for people to have faith in all treatments, whether it is a disease, a cancer, an asthma or a gender reassignment, it has to be peer reviewed, it has to be evidence based research. It's not enough to say, 'We failed to be clinically curious, or acquire the relevant data and evidence that we need to make sure this is right.'
EvH: Well, I think that's both harsh and inaccurate actually. I mean, I think a lot of research has gone on over the years. I think that it's quite difficult to do very long term research in any field, and if you're looking at people's reactions to transitioning, and you're looking at what happens five, ten, fifteen, twenty years - very few studies will ever be set up that will actually take that into cons ...
EM: Well ...
EvH: If you look at the av ... hang on ... if ...
EM: Let me just ask you about the numbers, OK? Because the numbers are astonishing. We know that in the last four years the number of adults and children being referred to gender identity clinics has more than doubled, it's now at 8000. Now, what do you attribute that to?
EvH: I don't know. I don't think any of us know.
EM: But why aren't you finding out? I mean ... you can't just say ...
EvH: Well I'm not just saying that people are ...
EM: ... 'I don't know and we're not looking into it.'
EvH: I didn't say that. I said we don't know ...
EM: Well are you looking into it?
EvH: ... and we probably won't know until some time has passed. You know, I mean, I think you have to be realistic about what people are capable of achieving. So, you know, it's all very well for people to cast aspersion and opinion, but we are faced, in a day to day ...
EM: Are you looking into it?
EvH: ... we are ... can I just f ...
EM: Answer the question.
EvH: ... please ... we are faced, in a day to day situation, with extremely distressed people coming to us and we are trying to give them the best health care that we can.
EM: Of course, and when you have people coming through your door you need to have the research to understand why. So are you looking into it? Can you explain, for example, why more than 75% of those referred to you are assigned female at birth? Do you know that?
EvH: No, not yet, we don't. No.
EM: So in that gap between not knowing and ...
EvH: And equally ...
EM: ... not doing the research ...
EvH: ... and equally, Emily, prior to that we didn't know why the majority of people that were being referred to our service were assigned male at birth. So something has shifted. You know.
EM: But you are the NHS. If you do not understand the cause, how can you direct people on the right path when this could be a life changing moment? I mean, is it enough to say, 'We don't know, and actually there is no body of research I can point to that is investigating this, we're just - we're dealing with whoever comes in the door'?
EvH: Well no, I think that's - that is a bit disingenuous actually, I mean, I think, you know, gender services have now been operating since the 1960s. It's been a very difficult field to even get clinical provision for due to various issues around stigma and prejudice. That is now thankfully changing. It's been a very difficult area in which to do research for a whole variety of reasons, of which that's one of them, and there is also I think a wealth of clinical expertise that's evolved and I think, you know, it's very easy to put all your faith into what I would describe as quantitative research, but actually there is a wealth of qualitative research, you know, that has gone on in terms of clinical expertise and experience ...
EM: But ...
EvH: ... and the majority ...
EM: ... but you heard, it's not - it - it's not enough. When you hear gender dysphoria can often be part, or sometimes be part, of a complex web of issues, isn't it really important how you untangle those issues? So that you don't actually say, 'Oh, we can't start looking at quantitative results, we can't start looking at numbers'? These are numbers that you have to look at, because they ... how ...
EvH: I'm not saying ... hang on ... I'm not saying for a moment that we're not going to look at quantitative numbers, we're looking at ...
EM: You're going to look at, but these numbers are here, they're in front of you, and I can't ...
EvH: Well ...
EM: ... I can't see you telling me that you're looking at data or you're looking - you're looking at research now, that is actually going to try and help you put these people on the right path for them. That's what's missing.
EvH: Well, I think you've misunderstood me, and in which case I apologise if anything I've said has led you to misunderstand me, because I think we are constantly, as a service, reviewing our processes, taking into consideration feedback, and we are constantly developing our service. And I think that's one thing that has happened, for example recently, in the children and young person's service, is that there's been some feedback that makes that service think that maybe they should delay the age that people have access to puberty blockers from. So, you know, it's a dynamic process. We don't have all the answers, we try very hard, as much as anyone can, but I think at the end of the day, what people have to understand is that the people that come to us don't not have a problem to begin with, so it's not a question of 'do no harm', it's a question of how to mitigate that harm as best as you can, in a very, very difficult circumstance.
EM: Elizabeth van Horn, thank you. Thanks very much for coming in.