Letter to the BMJ re gender services

[pattihews]

Courtesy of Glinner:
Dear Editor,
The Clinical Advisory Network on Sex and Gender (CAN-SG) (1), a group of UK and Ireland based clinicians calling for greater understanding of the effects of sex and gender in healthcare, welcomes Dr Hilary Cass’s interim report and recommendations (2). Serious concerns about the Tavistock Gender Identity Development Service (GIDS) were raised by parents, staff and governors, an initial Judicial Review judgement (3), the Care Quality Commission (4) and an Employment Tribunal involving the Trust’s Lead for Child Protection (5).

The origin of poor governance and lack of data collection needs to be openly addressed as GIDS is not unique. Globally, there are significant difficulties in discussing, let alone challenging, the practice of gender clinics, due to the belief systems of those who adhere to gender identity theory – a non-clinical ideological perspective for which there is little to no empirical support. This position requires clinicians to believe that everyone has an innate, subjective gender identity and that individuals whose bodies do not match this should be provided with ‘gender-affirming’ medical interventions regardless of the harms and lack of evidence of benefit (6,7,8). However, a child or adolescent’s sense of gender is part of a complex inner sense of self that can change during the process of development. Medicalising young people on the basis of unsubstantiated theory is unethical: there are many reasons why they might feel dysphoria, disgust, dissociated or ‘cut off’ from their physical bodies, including internalised homophobia, histories of trauma, cognitive difficulties and mental health problems. Each person suffering from such distress requires space and time to understand their feelings.

Offering puberty blockers, cross-sex hormones and radical surgery with the implicit promise of almost magical transformation may cause, and has caused, serious harms. With inadequate follow up by GIDS, no comprehensive long-term observational studies, and no reliable clinical trial data, there is simply no evidence on which to base these interventions (2,6,7,8). It is unsurprising that ‘detransitioners’ (disillusioned people who wish to reverse the effects of ‘treatments’) are coming forward; some may want legal redress and plaintiffs’ firms are seeking them out (9). Without outcome information - let alone understanding how any pre-pubertal child could make a decision to alienate adult functions they cannot understand (like sexual pleasure) - patients and their parents were never in a position to give properly informed consent to uncontrolled experimental interventions (6) clinicians failed to properly describe. These initial cases may herald more as increasing numbers of patients, parents and clinicians question the so-called ‘affirmative model’.

We would advise that the NHS proactively set up clinical services to support detransitioners, and that the NHS Litigation Authority and Medical Defence Organisations prepare. The government should look closely at materials provided by advocacy groups (such as Stonewall, Mermaids, Gendered Intelligence, and others) that teach children and clinicians (e.g. GPs, nurses, medical students and mental health professionals) gender identity theory as if it is fact, without referencing the concerns and uncertainties in the evidence. Until this is addressed young people will be at increased risk of misinterpreting their complex difficulties as proof they are ‘trans’ and believing there are simple and medical solutions to their distress.

Dr Louise Irvine, General Practitioner; Dr Juliet Singer, Child and Adolescent Psychiatrist; Dr Aileen O'Brien, Consultant Psychiatrist; Dr Seth Bhunnoo, Consultant Psychiatrist; Dr Tessa Katz, General Practitioner; Dr Jane Martin, retired Consultant Psychiatrist; Stella O’Malley, Psychotherapist; Dr David Bell, retired Consultant Psychiatrist, former President British Psychoanalytic Society; Dr Bob Withers, Jungian Analyst; Dr Antony Latham, General Practitioner, Chair of Scottish Council on Human Bioethics; Dr Angela Dixon, General Practitioner; Dr Sinead Helyar, Registered Nurse; Dr Robin Ion, Registered Nurse; Dr Az Hakeem, Consultant Psychiatrist.

On behalf of CAN-SG

This is the link that provides the original and all the footnotes/ references etc
www.bmj.com/content/378/bmj.o2016/rr?utm_source=substack&utm_medium=email

An excellent letter. These doctors in hock to the queer theory extremists are only going to be deterred by the threats of financial and reputational consequences for their actions.

Good - particularly about the help and support detransitioners need. Here's hoping

Great letter. Seeing it in black and white makes it incomprehensible that highly educated medical professionals, who sign up to 'do no harm' could ever have thought that it was ethical or acceptable to give untested drugs to children or perform drastic and irreversible surgery on children, in the absence of any evidence base that this works.

Truly depressing.

Sandy Ford In Glasgow is the same as Tavistock in that they so they same “treatment” but aren’t suspended.

i think there is on in the midlands roo.

Thousands of kids. Thousands

I hope this means more clinicians stand up against gender woo ideology. Many medical students are getting Stonewall influenced "education" as well.

Stonewall are truly dangerous to kids

We will see you in 10-20 years time how much this lunacy costs the NHS / taxpayer in court cases. There are already some in the pipeline.

👏

Sad thing is, none of this needed saying. You and I have always been able to see the problems with letting teens (and preteens 😱) make irrevocable changes to their bodies on the basis of the internet musings of a fanatic lobbyist movement - so why can’t the BMJ see it? Why does it take a wave of detransitioners suing the NHS to stop taxpayers money being used for sex changes? It’s all so disappointing.

”Do no harm.” Ha. If only.

This is why Thailand stopped doing sex changes on teenage boys. The boys grew up and sued.

That information was readily available on a quick google before the NHS started subscribing to all this nonsense. Some people in the NHS should be liable personally for negligence, in my opinion. If the doctors prescribing chemical castration drugs to kids aren’t personally liable, they’re not motivated to stop doing it.

Weird thing is, the country is broke. So why isn’t this nonsense top of the pile to be defunded? There needs to be a massive cut in what taxpayers money is wasted on.

And yet until very recently a Consultant Paediatrician of my acquaintance — head of her department in her hospital — was arguing that sex is a spectrum and doesn't really exist because hormones fluctuate throughout life and hormones are what makes a person male or female. She would argue that gender identity is who one truly is. She also happens to be very masculine-looking, which she cultivates. She never actually uses the phrase 'born in the wrong body' but that was essentially what she was arguing. For all I know she still is because we reached a stage where we could no longer communicate. Her DP is a GP and shares the same views.

Watching what's happened in the NHS and knowing several aggressively pro-trans medics (my social circle used to include three other female GPs who no longer speak to me because of my 'transphobic' views) I can never again enter a hospital or clinic or surgery with a basic expectation that I can trust the people looking after me to be rational or sharing the same understanding of basic biology.

Well, that's horrifying, @pattihews

I can only hope some of the BMJ readers will not only hear the warnings in this letter but will start arguing against ridiculous policies at their own trusts.

We need senior clinicians to push back against social science ideology with facts.

Years ago, that letter would have made no sense at all.

It speaks to the mess of the changed landscape in evidence-based treatment that the letter was necessary at all.

Maybe, but I'm starting to realise that very, very clever people who think in the kind of ways very clever people think (which I've started to think is often different to the ways ordinary fairly clever people like you and me think) can persuade themselves to believe in anything.

Do you remember Cathryn McGahey (I hope I've got the correct name and spelling there) who argued at Allison Bailey's tribunal that Allison (a black working class lesbian) was behaving like a white South African apartheid supporter for refusing to consider transwomen as lesbians and therefore as potential sexual partners? It was a repugnant comparison: you have to wonder what kind of person McGahey is to even think of it, let alone insist on saying it in a tribunal. What she demonstrated, in my opinion, was a horrifying lack of judgment. She's an example of an exceptionally clever person who — I would say — has lost touch with reality.

My former friend the Consultant Paediatrician is a bit like that. She'd argue with me in a highly scientific way about the chemical make-up of the human body and hormones and when I countered with large gametes and small gametes and the human race (and all mammals) being binary she'd just say 'it's more complicated than that' with the strong implication that someone like me could never hope to understand.

Helen Lewis in one of her interviews for her series The Spark on Radio 4 talked briefly about how sometimes people are so clever and their brains so flexible they can persuade themselves of anything. That series has some fascinating insights and is well worth listening to. You can Listen Again on BBC Sounds.

George Orwell used to say that you had to be a member of the intelligentsia to believe this sort of stuff because ordinary people aren’t that stupid.

I'm starting to realise that very, very clever people who think in the kind of ways very clever people think (which I've started to think is often different to the ways ordinary fairly clever people like you and me think) can persuade themselves to believe in anything.

It seems to be the case that although we often sincerely believe that we base our beliefs in the facts, that's not how the human brain really works, and we instead marshal what facts we can find to build arguments to justify our beliefs. Very clever people have all the same cognitive setup as the rest of us, they're just better at putting the facts into arguments. Which is why some of the very clever people, when they noticed this, developed techniques which have been incorporated into the scientific method that bypass these cognitive biases (like double-blind controlled trials) so they could avoid being fooled by their own brains.

So how do we get all the very clever people in powerful positions who don't challenge their own mindset regularly (ie non Scouts) to do so?

You'd need to ask a cleverer person than me about that 🤣

During the 1960s there were anarchists who were set on the breakup of society. They realised, however, that the British would not join a revolution so they infiltrated the higher echelons of learning with this sort of ‘progressive’ teaching which has a ‘drip drip’ effect to break up the normal family and normal relationships.

Oh, really? Might be interesting. Tell us more.

This is very much what happens if you don't know the first principles you are starting from in any particular argument, or really the first principles you think underpin reality and the possibility of knowing anything.

The fact is that you can argue any position rationally if only you begin from the right first principles. And most of the time people unconsciously argue backwards - they know what feels right, and so they argue from a starting point that will get them there. This is part of the reason political tribalism is so entrenched. You learn from your "tribe" that you are supposed to support some idea, and you never really query that because you don't query the fundamentals.

The only way to avoid this is to know what your first principles are, and why you believe them as opposed to some other starting place (and typically this is not a question of evidence, it's about things like how you evaluate evidence.) A few people do this naturally but most people need to be taught in some way to think it through, and probably taught what the options are in terms of starting places.

But schools in most western countries, at least publicly funded ones, have largely given up on that. Partly because of secularism - you can't get too deep into the foundations of different epistemic systems without treading on toes. And that is compounded by the way social justice issues are now being taught as if they are themselves the first principles students should be using to judge claims.

It's really quite fucked, we have created a whole generation for whom thinking clearly is like trying to run a race with their feet cut off.

A few people do this naturally but most people need to be taught in some way to think it through, and probably taught what the options are in terms of starting places.

You make it sound like teaching philosophy might help! But philosophy as a discipline is captured. I don’t know what the answer might be but it doesn’t seem that’s enough.

We don't call it 'sex change operations'. It's known as SRS, sexual reassignment surgery. Which is equally misleading, I grant you.

SRS usually doesn't involve castration if by that you mean removal of the penis as well as the testicles. Though some non-binary people do opt for that (and removal of nipples) in order to remove any superficial indication of sex.

I’m not sure that you need to look as deeply as that. ‘Very clever people’ have proved themselves in an educational system ( not arts*) which encourages them to argue for their point of view , and not to give it up ( My Nan would have said ‘like a dog with a bone ‘). The adversarial system seems to have crept out of our law courts into many other professions. And of course, our current societal mores don’t encourage anyone to change their mind or admit an error. You just have to double down or lose face. I think one could observe a similar mindset hindering our reaction to Covid: it didn’t seem to be acceptable to have an evolving view on disease or treatment, you had to stick to your corner.

This not how the great discoveries were made.

(* or at least not when I studied; now I suppose cancel culture has seen off enquiry and discussion there, too)