Cass review - out on Wednesday

[ArabellaScott]

https://www.telegraph.co.uk/news/2024/04/06/children-socially-transition-face-grave-psychological-risks/

Major.

Thank you brainworms! I love how you've explained it. I hope you teach it. And I was right with with you...

... cos I totally got apples are apples, they're round fruity things and I completely got bananas, they're bent yellow things and oranges are dimply with pips.

But then I lost it because that means appley dappley, orangey worangey, bananerisms.

😄

@Brainworm

Thanks, that's a great summary.

Regarding this bit:

What is interesting about criticisms floating around today is the insistences that gender identity is an objective phenomenon and it existed long before humans 'discovered' it

Are people saying that they have demonstrated that it does actually exist? Because I think that's probably the first hurdle to clear if we are starting from first principles...

I think the problem is that they are simultaneously claiming that

1. it does exist because trans people say they have experienced it

AND

1. That it exists as an objective reality and always has before we knew what it was

BUT

1. We shouldn't/can't discover or try to locate it by scientific means because...1.

Can't edit on my phone, but formatting is buggered. It should read 1, 2 and 3.

'Impossible standard'

Let's reflect on that.

Why would medical testing on children with drugs that could shorten their life, lead to infertility or have a known rate of exceptionally high life changing side effects be so difficult to do in an ethical way?

Let's ponder that.

We also stopped reviewing newer studies released in the last two years. As a result, we were left with very little evidence

What are the new studies that Caraballo feels should have been included?

I haven't had the time yet to read the review, but where does this issue of the double blind study come from? I've listened to a couple of interviews (for example the BMJ one on YouTube) and she named longitudinal studies. The study she wanted to conduct (checking the outcome of 9000 former patients of GIDS) was not a double blind study. She also claimed that the biggest problem of the studies available was lack of (long enough) follow up.
Finally, not her words but mine, when a blind or double blind study can't be conducted because the effect of a drug unblinds the study, you can still conduct randomised trials, simply not blind ones.

Peter Boghossian talks about "idea laundering" which is like a disturbing cargo-cult version of the academic ideal. It goes something like:

• social 'sciences' academics submit their made-up nonsense trendy ideas to a tame stable of journals, where the articles are supposedly 'peer-reviewed' by other academics who agree with said made-up nonsense trendy ideas and want to propagate them.
• then, those other academics who wanted to spread said made-up nonsense trendy ideas submit their articles to said journals, being able to cite the earlier lot of made-up nonsense articles.
• thus a false 'body of work' built upon 'published peer-reviewed citations' is born.
• and around it goes, basically a big pseudo-intellectual circle-jerk of high-on-their-own-righteous-farts pyramid schemers.

I understood that the “weak evidence” was a more or less total lack of evidence on account of not bothering to collect any reliable data on outcomes (probably in the knowledge that they would be unlikely to support the case for the use of the medication anyway).

People who don’t understand or care much about research methods catch on to attractive terms like “double blind” and roll them out at every opportunity to give the impression that they do know something.

It doesn’t take much pondering 🤔

Idea laundering wrt "trans children" has been very much a thing in educational academic circles.

There's been an awful lot of academic posturing about Cass's "methods" - it shows how really stupid they are if they can't comprehend that

1/ the government threw everything she needed at this,

2/ it's the biggest review of all the research ever published

3/ you're very limited by the methods due to the nature of the drug.

4/ ITS CHILD ABUSE.

@Brainworm I don't think I followed completely but here is what I don't understand:
'Gender identity' or the stereotypical roles associated with those identities are socially constructed but biological sex is irrefutable fact. A male body and a female body can make a baby. It is literally the defining feature of our species.

I'm going to throw a spanner in to the works.....

Section 6 of the final report talks about gender identity as if it were factual.

Whilst it's great that it explores why certain behaviours might be exhibited stereotypically by males and females, this is the loophole that Mermaids, Stonewall et al will use to promote gender identity as fact.

😞

On a positive note, if a gender identity believer (from this section, it seems that Dr Cass is such) still concludes that medical intervention is inappropriate based on current evidence, this is a good outcome from a medical perspective. However, there is quite a compromise when it comes to holistic care and challenging the notion that "we all have a gender identity" - and the potential impact on schools' curriculums and (educational) psychologists' approach to mental health in this area.

Yes, in blunter terms I think that's KJK's point.

I agree with you @BonfireLady that it’s one fundamental aspect that really needs examining in greater depth but I think Hilary Cass would say that that would be beyond the scope of her remit. It’s also far harder to articulate and pinpoint using black and white statistics and evidence.

@BonfireLady I have some issues with the whole thing and also her interview on the today programme yesterday.

There was a huge gaping hole 🕳️ where she was asked about the outside influences and she wrote it off as "everyone was doing their best."

No.

On what planet do you stop following normal paediatric procedures for mental health issues? Who were they listening to instead?

Don't forget how much the whistleblowers were silenced.

Thank you for your armchair diagnosis. I am sure we all feel you are eminently qualified to make this sort of determination of your friend's child. Especially as one of the takeways is the harm caused by key board warriors.

Agreed.

Evidently some people are unaware of just how bloody hard it is to get an actual diagnosis and how many specialists need to agree.

Sigh.

I honestly think some people believe we just toddle along to the paediatrician where a diagnosis is handed out just for attending.

The number of children I know who have been referred for assessment but not received a diagnosis as the paediatrician wanted to see how certain things developed first…it really can take a while before a diagnosis is confirmed. It can also be a fight to get a diagnosis if there’s any hint of disagreement from one of the professionals - plus lots of children are still missed and not even referred. Usually girls.

I really really hate this rhetoric that’s prevalent in some quarters on MN that implies autism and ADHD aren’t real.

@CasadeCoca id never make an arm chair diagnosis. I witnessed the psychological abuse of her and her mother for years. Her anxiety reduced hugely when he recently was given a restraining order. I've known her since she was born. And I've taught in a specialist school for autism for nearly two decades.

My main point is that it's all very well dishing out autistic diagnoses but there's often no real practical help for these children when they get them. The difficulties they're dealing with should be being targeted, not least as no one experiences autism in the same way.

And if they're not autistic, what then? They're still struggling. What provision will be put in place?

(Cahms have abandoned the idea of autism in her and that's the only instance I've ever felt it was right to not follow it up. Her trauma was caused by her father.)

CAHMS have been at breaking point for years. Whilst I think it's worth assessing any child for these specific diagnosis, just incase it opens doors to supportive approaches (though the resources have shrunk enormously) at the same time I'm seeing less evidence that it's helpful in real terms. Which is exactly what happened to the children shunted off to gids.

I have seen it being useful if the child is already in specialist send setting, without a specific autistic diagnosis, as it ensures they remain there rather than being sent to a pupil referral unit.

The supportive approaches should be there for all children who are struggling.

Which is the issue with the "trans diagnosis." It led to magic pills, or the potential for them. Operations that would "fix it all." Except it didn't.

@SpidersAreShitheads id only say it with confidence in this situation. I teach children with autism.

Testing Treatments and the Cochrane Handbook are linked above. They

• explain trials, variations on randomised controlled trials (no blinding, single to triple blinded, cluster etc.)
• explain placebo (and there is a tool to describe the varieties of these, the TiDiER)
• explain all of the methods, processes and tools use to assess studies for risk of bias (RoB), quality (GRADE) etc.
• explain literally how you perform a systematic review -
• you publish what you'll do
• you'll give the terms for your literature search
• you describe the studies you'll looking at and their design
• you state the outcomes you'll look at
• you explain the analyses you will perform
• you summarise the trials, you exclude and include
• you state the cut-off data beyond which you don't include publications (yes, reviews take so long to conduct in such grinding detail that, by the time they're published (its own additional delay), they may be out of date but not always because not all areas of research are fast-moving.

There is literally nothing to stop a group of people, getting together, and adopting the methods of the evidence review, and performing the same on the studies that have been published since the cut-off point of the review.

If they don't want to perform something to that standard, they need to pre-publish their protocol, roll up their sleeves, and do the work. Given the importance of this evidence (given the wretched state of the literature), I'd advise them to follow the well established protocol or those that govern rapid evidence syntheses.

They could then rework any analyses that were done with Cass and publish a rapid update to the review's findings.

They could crowdfund the employment of an Evidence Advisory/Assessment Group who carry out rapid evidence syntheses all the time. There's a fair number in the UK and Europe.

People who want to critique Cass have many options that would advance the field of knowledge and add to the evidence base. It will be interesting to see what they actually do.

'TLDR of the Cass Review: "we disregarded nearly all studies because they weren't double blinded controlled studies. We also stopped reviewing newer studies released in the last two years. As a result, we were left with very little evidence." This is an impossible standard.'

My overview of Testing Treatments and Cochrane Handbook was in response to Callebrano's unfounded claims. (I see Callebrano's speciality is Cyberlaw although AC also claims to have a clinical speciality which seems to manifest in claims that laws regulating "gender-affirming care" amount to "genocide.")

I despair of academics who are playing into the hands of those who want all of higher education deconstructed.

Indeed.

That's where the belief vs fact threshold becomes critical.

If everyone who is doing their best is doing so through a lens of gender identity belief, their "best" will always include a bias towards an affirmation model. Particularly if they are on the psychology/psychiatry end of things.

KJK is right to hold people to account on this issue. My preference would still be that she doesn't call doctors morons. I don't think it helps to do so.

Whilst I'm very disappointed to see Dr Cass validating the existence of gender identity as a truth in her report, I don't think she's a moron. It just highlights the power of belief when it comes to explaining complex issues about the human psyche. It also highlights the difficulty of the journey ahead in getting queer theory out of public institutions.

Thankfully, there seems to be enough in the Cass Review to stop the conveyor belt to medical intervention from happening, and also to stop social transition automatically being part of that. But through a lens of gender identity belief, the route for the children and young people who are caught up in this is paved with risk and potential loopholes. Loopholes that will be exploited by activist groups and individuals.

Not appropriate to a) discuss someone else's child's trauma in detail in this way to illustrate an unrelated point, b) bracket autism diagnosis, with this discussion, as though it was similarly medically contested, and c) use the rhetoric of 'dishing out' autism diagnoses. As PP has said, it is phenomenally hard to get an assessment. Families wait years.