Cass review captured? Prepare for disappointment

[Apollo441]

mobile.twitter.com/shahw1/status/1599851731004772352

The review closed yesterday. Remarkable that they waited until the last moment to respond.

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I have quite a bit to say about this (I find it very worrying) but no time at the moment. There’s quite a good thread about it here:

twitter.com/nurtural_uk/status/1600190119238983680?s=61&t=RrzdQ2z99dWGTI-cztfGyQ

It’s mostly about the fact that the Cass Review is built on “consensus” where there a lack of evidence, but consensus is only going to result in effectively the same model as the moment, save children on PBs going into a trial, and we know there is no evidence so the whole thing will end up being built on “consensus”!

NICE and NHSE are captured to the extent that their public-facing and admin staff use pronouns in their signatures refer to pregnant people in some recent guidelines, and use Stonewall material in their EDI training and assessments.

They're supposed to be neutral.

I'm confused. Is this discussion referring to the actual document on the review page or Twitter interpretations of this?

I'm not clear, but I wonder if it's referring to the first publication listed here, which is the Cass Review's response to NHS England's consultation on the Draft interim service specification for specialist gender dysphoria services for children and young people:

cass.independent-review.uk/publications/

I wondered that but I don't see what the fuss is all about if it is.

I mean, it's not taking a GC stance but it hasn't shifted towards the other side either.

Yeah, I read it (admittedly skimmed much of it) and it seemed fairly non committal and reasonable.

Yea, this is about the Cass Review’s submission to the NHSE consultation. The Cass Review’s submission is very muddy and worrying, particularly around social transition and the NHSE recommendation that families obtaining PBs/CSH via unregulated providers should be referred for safeguarding procedures. The Cass Review is arguing this will lead these parents to avoid the NHS. I would argue such safeguards are desirable, that it will put off parents who might be wavering or under pressure from their child to go to GenderGP and the remaining ones who ignore the risks and safeguarding issues and proceed anyway, should be subject to safeguarding referral. To turn a blind eye to GenderGP children is dangerous.

It's fairly neutral and unbiased. I think some people need to remember that the idea of Cass is to shape a service that will be used and will be effective.

I read that and agree that it indicated a level of ideological capture in contrast to the factual / ethical /safeguarding / child centred approach in the interim review and the NHS proposals.
Given the extreme levels of capture in the NHS and open dismantling of safe child health care as evidenced at GIDs it's not surprising that trans zealots will criticise healthcare proposals that centre children's needs and safety rather than fly the trans flag.

I'm just not seeing it. Sorry.

I wonder if people were expecting too much. There is a political dimension and ultimately the Cass Review has to compromise between reason and lunacy. Which necessarily means endorsing some lunacy.

Thanks, rogdmum, I expect you have a deeper and more informed view than I do.

'muddy' I get.

My thanks too, we cross posted. That has given me something to ponder.

I think she is trying to build a golden bridge. The fact is that they will have to work with the rainbow believers in order to move this all forward. I think she is being pragmatic, the point is there is no evidence...so, we need evidence.

I'm not sure what else she could have done, really. She's got to negotiate and have solid evidence. We need someone to do the work, but the challenge is getting funding and finding the academics who are brave enough to do it!

I am about to read this but I am also keen on reading the different interpretations here. Thank you.

I don’t think it is nearly as bad as the video makes out, but it is a statement effectively aimed at reining in NHSE.

It talks about “artificial binary opposition between exploratory and affirmative approaches”, but the affirmative approach at a minimum hampers exploratory therapy and at worst prevents the child from being able to engage in it. NHSE will need to be absolutely clear about the approach therapists will take because any hint of affirmation in the final service specs will lead to the status quo with the new regional centres insisting they undertake exploratory therapy but in an affirming environment.

it talks about children and young people who “require” a medical pathway or medical intervention. Particularly in the absence of an evidence base for the medicalisation of children and young people, which ones “require” medical interventions and how will this be determined? Particularly when considering that this is an area of healthcare with no certainty and clinicians openly admitting this (eg episode 2 of the Tortoise podcast where Polly Carmichael witters on about thriving on uncertainty).

There appears to be a move away from social transition as a medical intervention (as NHSE have made clear it is). They seem to have gotten themselves into a muddle over clothes and hair after the unfortunate misinterpretation in some of the press (and picked up by the lobby groups) about restricting these. Social transition is more about the people around the child than the child themselves. The child already sees themselves as the opposite sex - it’s not about the hair or the clothes, it’s about other people embedding the child’s belief that they are the opposite sex by use of preferred name/pronouns etc. NHSE have made it clear this should only happen under certain criteria including a gender dysphoria diagnosis and under clinical supervision

Obviously you can’t change the child’s or their peer group’s use of name/pronouns/reinforcements, but as a medical intervention, a clinician can make a recommendation about how the adults in the child’s life should react to this. The Cass Review is saying: “The role of the professional is to facilitate parents/carers, children and young people to engage in an in-depth process of discussion and thinking around this decision…” which is quite different to the NHSE position.

If the service ends up the way the Cass Review has responded to the NHSE consultation, it will be fundamentally no different to the current service (other than the PB trial). They will be asking parents to effectively take a leap of faith despite their being no evidence base for what is being recommended, and their recommendation is still very much child led. I can’t see parents on the more cautious side buying it. Neither side trusts the NHS in this issue but ultimately, there is no middle ground and a decision will need to be made as to which direction to take.

'...not all children will want or require a medical pathway...'

The response is barking.
How about NO healthy children require these harmful chemical 'treatments'?

vivariumvivariumsvivaria - yep I think you nailed it.

But the burden of proof should be on the other side?
We say, leave healthy kids alone. They say, give them bizarre chemical treatments, known to cause harm.
It should be up to the other side to prove that doses of Testosterone are good for confused girls, not for us to disprove it?

Frankly at this point any step from mad extremism to middle ground is a positive one.

And this is going to be only the first in a number of inquiries over the next few years as more and more binfires like Mermaids burst out.

The key to all of this is a Cochrane Review for trans health.

Isn't it interesting that they can't do one? They do keep trying, but the evidence isn't there.

Presumably, Cass is building a case for Carmichael and Webberly to justify what they have been doing - and then she can say "ah, there is no evidence" and insist on watchful waiting, CAMHS support for these distressed kids and stop schools from affirming undiagnosed children.

I feel less worried about it than Jester. It's a long game.

I understand that women might be upset but I can also see that progress Needs to be incremental given the paucity of evidence as is

I don't get that. We need to just STOP giving young people these damaging drugs. Not to 'incrementally' stop damaging them. It just needs to stop.
THEN the NHS can look at the available research, which we know shows that the best cure for these individuals is an uninterrupted, un-socially-transitioned puberty.
In no other branch of medicine would we be testing damaging drugs on healthy young people. We need to stop that testing, not to do more of it.