NEW: Grounds in support of intervention in the Bell v Tavistock JR appeal published

[ItsAllGoingToBeFine]

twitter.com/RadFemLawyer/status/1354002497753538562?s=19

This is going to fascinating to follow.

GIRES, Stonewall, Brooks and the Endocrine society are intervening.

One young person went to the same surgeon for detrans surgery who performed the original transition procedure. Insurance paid this surgeon the first time then the patient paid $$$ of their own money to get it fixed. When you have a model like that it's not going to matter if their patients have regrets because it just means more money for more surgeries

I can't work out why there is not a steady flow of litigation in the US in the cases of regret. Does the "informed consent" process in the US mean that girls are signing away their right to sue when things go wrong?

I suspect that's all correct Michelle. Many years ago I briefly had a job in a niche third sector org. I spent the whole time wondering what on earth was the purpose of much of what we did other than keeping us all employed. Hence why it was a brief foray into that sector for me.

Partyofpun on Brook Cynically however, I can’t help wondering if they have one eye on Planned Parenthood in the US who are providing hormone treatment (18+)
I hadn't thought if that. It would be impossible and completely out of the picture if the appeal fails.

@Signalbox

One young person went to the same surgeon for detrans surgery who performed the original transition procedure. Insurance paid this surgeon the first time then the patient paid $$$ of their own money to get it fixed. When you have a model like that it's not going to matter if their patients have regrets because it just means more money for more surgeries

I can't work out why there is not a steady flow of litigation in the US in the cases of regret. Does the "informed consent" process in the US mean that girls are signing away their right to sue when things go wrong?

Yes, I think girls sign away their right to sue when they get these surgeries. The detransitioners are only in their twenties now - I'm not sure they recognise that asking someone to sign away their rights at age 16 is ethically dubious.

Also, litigation is a hard, emotionally draining battle. For a detransitioner, physically and emotionally scarred by the experience and unsure of her rights, I can imagine it's the last thing she would want to do. I find it telling that Keira Bell joined a case already put in motion by Mrs A than starting from scratch.

Detransitioners in the States would need a huge amount of support, both emotionally and legally to take this forward. I get the sense from reading detrans reddit etc. that they blame themselves, not others. Also, a lot of them are trying to focus on the future and not regret transitioning, as it makes them who they are today.

I think the court cases will come, but I also think it will happen a few years down the line when detransitioners are a little bit older and can realise that of course a teenager can't consent to cross-sex hormones and mastectomies.

@OldCrone

Perhaps the appeal might be able to call trans people in their late 20's and early 30's who were the early days patients to receive blockers.

They wouldn't be that old, would they? The Tavistock only started their experimental treatment on under 16s in 2010.

www.transgendertrend.com/tavistock-experiment-puberty-blockers/

But you seem to have misunderstood what the judicial review was about. It was about the ability of children to consent to treatment which would have a profound effect on their sexual function and fertility as adults.

You could present dozens of 'happy adults who transitioned as children', but this wouldn't prove that children could give informed consent to treatment at an age when they are too young and immature to have the capacity to fully understand all the effects of that treatment.

This isn't true. Whilst provision was unformalised and patchy, puberty blockers have been used in the UK since at least 1997. Here's an article from The Sunday Times discussing their use. It seems 24 years later this treatment is still 'experimental'.

<a class="break-all" href="https://www.webarchive.org.uk/wayback/en/archive/20061214120000/www.pfc.org.uk/pfclists/news-arc/1997/msg00047.htm" rel="nofollow" target="_blank">www.webarchive.org.uk/wayback/en/archive/20061214120000/www.pfc.org.uk/pfclists/news-arc/1997/msg00047.htm

It seems 24 years later this treatment is still 'experimental'

Presumably that's because for that whole period of time it has not been studied in a scientific way. No long term data collected, patients not follow up and assessed. Something could be used for 100 years and still be "experimental" if the only data is anecdotal. Personally I think this is one of the biggest scandals because the Tavistock are in the best possible position to study GD and have had years to put together a decent evidence base for what they are doing and they basically came to the court with nothing. Really shocking.

That article from 1997 is really interesting. Thanks for pointing out that it started so long ago.

The language is much clearer than you see today in explaining what exactly is happening. One mother says 'its better to have a living daughter than a dead son' (early outing if the phrase?) but refers to her male-to-female transitioning child as 'he' and son which was surprising to me.

The portman clinic doctor says that one in four children will change their mind.

The reason it is still viewed as 'experimental' by the high court was because, despite the 24 yrs, no one has bothered to follow up these children and actually show, with empiracle data, that life improved for them as a cohort, compared to children who did not receive the treatment.

This isn't true. Whilst provision was unformalised and patchy, puberty blockers have been used in the UK since at least 1997.

As a teenager in the 90s, I definitely remember reading an article in a teen magazine about a ftm transitioner who was probably about 11 or so at the time. IIRC correctly, the transitioner was born Rebecca but wanted to transition and be known as Fredd.

Puberty blockers were definitely mentioned in the article I read. Fredd wasn't on them yet but wanted to be.

This would have been around 1995 or 1996. I think the article was written following a TV documentary that I didn't see.

I have since tried to look into what happened to Fredd but my cursory Internet searches haven't thrown up anything.

Anyway, I agree that puberty blockers have been around for a while. Strange that there aren't any long term studies into their use.

Thanks for that link jj. There are some interesting points in there that I was unaware of.

Margaret Griffiths ran Mermaids before Susie Green, and has a very similar story about her male child who wanted to be a girl. In the article it mentions "the gender identity development service at the Portman clinic in London where Griffiths's son was treated". This must have been before 1997 when the article was published, yet a decade or so later, when Susie Green wanted treatment for her child, she had to go to the US for it.

I'm going to see if I can find evidence that this treatment was actually taking place in under-16s at GIDS before they started their experimental 'study' of early treatment with puberty blockers in 2010. If they'd been doing this routinely before 1997, why was it framed by them as a 'new' experimental treatment in 2010?

Here's an article from 2012 which quotes Margaret Griffiths of Mermaids.

www.huffingtonpost.co.uk/2012/01/23/nhs-puberty-delay-drugs-children-gender-identity-disorder_n_1223166.html

Until now, under-16s in Britain seeking treatment for Gender Identity Disorder had the choice of going overseas or waiting until the age of 16 to proceed with gender reassignment surgery.

In the past decade the hormone-blocking drugs have been used increasingly in countries such as the US and the Netherlands.

Margaret Griffiths, liaison officer for Mermaids, a charity that offers support to families and children affected by GIS, also supports the drug trials.

“Most children with GID have suffered for as long as they can remember. But previously they could only seek treatment at 16. By this point boys have already developed facial hair and a deep voice and girls have grown breasts," she told The Huffington Post.

Bernard Reed of GIRES is also quoted in this article: “We have been campaigning since 2005 to bring Britain in line with other countries, such as Belgium and Canada, by offering children the opportunity to suspend the process of puberty while they make a decision.”

So perhaps Griffiths's child was 16 or over when treated by GIDS with puberty blockers, not 14 as implied by the 1997 Sunday Times article, so although that article starts with the headline "Children of 14 get sex change treatment on NHS", it doesn't actually say that any child under 16 had been given puberty blockers on the NHS.

I can't say more but I think there are more applications to intervene - from at least one person with a very different perspective.

Hopefully nocure but even with the extra interveners, I just find the whole thing a real mess from the Tavistock side. I assume because of the importance of the case, they will allow but I pity the Judges

It’s probably in the public interest that Stonewall et al get to intervene even if the only thing they have to add is ideology. At least then people can’t say it isn’t a fair judgment because only one side of the argument was heard.

Signal box I agree. Justice being seen to be done. It will be better in the long run if they get to put their case, and absolutely all the evidence is put before the court.

I wonder how this will all affect the cass review? Will she have to wait and see what the court of appeal say?

I expect the American endocrine organisation want to intervene because they think that if keira's team won again, waves will slowly ripple out through the world. It won't effect them directly, but they must think that if the court of appeal in London are on record saying "children cannot consent to this, this is experimental medicine with a dodgy evidence base" it will not be good for business in the long run. The tanker has started to turn and they are trying to nip it in the bud. (3 metaphors for the price of one!)

It will be better in the long run if they get to put their case, and absolutely all the evidence is put before the court.

And I'm absolutely willing to be convinced. If there is a case to be made and evidence to be assessed that hasn't yet been shared then yes, very important that this is put forward in full daylight.

But I'm still confused as to how when I thought no new evidence can be put forward, and as to why when the Tavistock were the experts and it was between the court and them why activists seem to feel its between them and the court. That's something I'd like to understand more off, because the Tavistock went to court as the experts, submitting the evidence they had and the policy and practice and case studies that they had and wished to use to justify their position and practice. What activists have to do with that is debatable unless you're looking at concerns raised by CQC and whistleblowers.

Unless this is a case of a technicality of law that somehow three (two very senior) judges got wrong - which again will be fascinating to see proven and explained. Or that it's felt that it is better to let all this be said, since in the refusal to intervene and refusal to grant an appeal it was made plain that the emotion, personal accounts and anecdotal evidence was not relevant to the case.

I think those activists do indeed think that they own the Tavi, and that the clinicians there should be doing what they're told with no questions. Much like the activists who have taken ownership of WPATH.

That grounds for intervention by is wonderful- really cheered me up.

It's like they haven't even read the reasons the initial appeal was denied. They bang on about how their staffs (lived) experience is that kids are gillick competent and transition really helps them but:

a) the first court already had that 'evidence' and it wasn't nearly enough to outweigh the known and potential harms or the difficulty in any child assessing such long term risks.

b) the appeal court already strongly implied that the appeal was likely to fail on that basis, when it allowed the appeal

c) the case for PBs being efficacious got a lots worse the day after the verdict when GIDs finally released their data showing no evidence of MH benefits.

I expect the American endocrine organisation want to intervene because they think that if keira's team won again, waves will slowly ripple out through the world. It won't effect them directly, but they must think that if the court of appeal in London are on record saying "children cannot consent to this, this is experimental medicine with a dodgy evidence base" it will not be good for business in the long run.

Is this org the same endocrine society whose guidelines were developed by Norman Spack et al?
I'm actually amazed that Stonewall want to continue their involvement. They are the only ones in this who could still back away from the 'trans kids' agenda relatively unscathed.

I expect the American endocrine organisation want to intervene because they think that if keira's team won again, waves will slowly ripple out through the world.

I think that's exactly the case. I imagine there are a few ambulance chasers in the US sniffing the air and turning a predatory gaze towards some of the ES's members.

@NotBadConsidering

I’m not a legal person, but they seem to be claiming that Gillick allows kids to do whatever they want to do. It says Gillick recommends a child centred approach that recognises children develop at different rates. Therefore they would have to admit that there are children with gender confusion that are not as fully developed.

And if these children are able to consent according to them, then they should have no problem meeting the eight criteria set out in the original judgment.

And to me, it’s laughable that they are going to base this on a challenge regarding Gillick, and somehow Stonewall et al are experts on children consenting to treatment?

There was a case just the other week which ruled that Gillick did NOT allow children to make their own minds up before the age of 18 IF there was a possibility of serious harm or death?

So they would be over turning that ruling in order to get this through on this argument.

is this org the same endocrine society whose guidelines were developed by Norman Spack et al?

I have no idea. I have never heard of Spack I'm afraid. Do I dare ask?

@Manderleyagain

is this org the same endocrine society whose guidelines were developed by Norman Spack et al?

I have no idea. I have never heard of Spack I'm afraid. Do I dare ask?

Norman Spack is the doctor who treated Susie Green's child with puberty blockers. There's a bit more about him in this article.

www.nytimes.com/2015/06/17/nyregion/transgender-minors-gender-reassignment-surgery.html

One of the first and biggest hormone programs for young teenagers in the United States is led by a Harvard-affiliated pediatric endocrinologist, Dr. Norman Spack, at Boston Children’s Hospital.

Dr. Spack recalled being at a meeting in Europe about 15 years ago, when he learned that the Dutch were using puberty blockers in transgender early adolescents.

“I was salivating,” he recalled. “I said we had to do this.”

Salivating.

Ugh.

I am confused about where an endocrinologist would fit into the diagnostic process in the U.K.

I understand that they would prescribe and monitor, but to diagnose, wouldn’t they need to demonstrate a hormone disorder?

So an endocrinologist can diagnose hyperthyroidism, but how can they make a diagnose that depends on a psychiatric assessment? The document actually says that endocrinologists diagnose diseases related to the glands. However, I don’t think it has ever been suggested that there was anything wrong with KB’s glands.

There seems to be a misuse of the word ‘referral’ in the grounds for intervention. A GP refers - they pass the case on to somebody else, but presumably in this case an endocrinologist should work as part of a team and is only responsible for a discrete part of treatment.