BMJ take on - The Cass review: an opportunity to unite behind evidence informed care in gender medicine

[LogicLoverLlama]

https://www.bmj.com/content/385/bmj.q837

I particularly enjoyed this

One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret

No fence-sitting/toxic-debate/two-sides here!
"The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider—from social transition to hormone treatment.
For example, of more than 100 studies examining the role of puberty blockers and hormone treatment for gender transition only two were of passable quality."...
"A spiralling interventionist approach, in the context of an evidence void, amounted to overmedicalising care for vulnerable young people"

That’s an editorial and their “official” line rather than an opinion piece. That’s pretty fantastic.

And the backing from the BMJ on the standard Cass set for studies will help in highlighting how irresponsible that line of criticism is.

There needs to be a long hard look at the training pathways for some of these professions. How the fuck there are people in charge of national services that have no understanding what what good research is, and why it is vital in informing emerging area ls of treatment. There has been zero academic rigour in the field of gender medicine. There needs to be some back to basics re education.

Great article. The BMJ is a hugely influential publication for anyone working in medicine. Good to see this has come from the editor-in-chief and is not just a random writer’s opinion piece.

Excellent - the adults are speaking their minds at last.

Finally - adults speaking in the medical profession. More please.

However, despite encouragement from NHS England, “the necessary cooperation was not forthcoming.” Professionals withholding data from a national inquiry seems hard to imagine, but it is what happened

Yes, it is what happened. This editorial couldn’t be clearer, could it?

This is the BMJs interview with Prof Hilary Cass about her report. It’s fascinating and shows how captured the NHS is and how the adult gender clinics refused to share their data with her and the health secretary had to pass a new law to make them do so. I’m a NHS employee and if I refused I can imagine what would happen to me which suggests the people running these clinics were protected by some pretty powerful people like senior civil servants such as those who advised Kemi Badenoch not to meet and speak to Keira Bell. It all smells very fishy.

Can;t help but think this is the best rebuttal to the rapidly spreading conspiracy theories about the Cass report

Rebuttal? Nonsense. I have much more faith in some Twitter random with no healthcare research qualifications whatsoever.
…said every tra ever.

Fantastic. Clear, unequivocal, and direct.

'Without doubt, the advocacy and clinical practice for medical treatment of gender dysphoria had moved ahead of the evidence—a recipe for harm.

People who are gender non-conforming experience stigmatisation, marginalisation, and harassment in every society. They are vulnerable, particularly during childhood and adolescence. The best way to support them, however, is not with advocacy and activism based on substandard evidence. The Cass review is an opportunity to pause, recalibrate, and place evidence informed care at the heart of gender medicine. It is an opportunity not to be missed for the sake of the health of children and young people. It is an opportunity for unity.'

Fantastic. Particularly as I seem to remember they have published opinion pieces before that took a less than scientific view.

Can I ask a question? When research is done in the future, how exactly might it work? Ideally you want a randomised, double blind trial, which as I understand it means one where if medication is given, neither patient nor doctor knows whether it is being given or not. But surely, here, the fact that puberty blockers were or weren’t being given would soon become obvious?

And would everyone also be given non medical interventions (talking therapy etc)?

This is Keira Bell’s experience of GIDS which lead to the Cass report being commissioned. Reading it I can’t imagine how any clinician who advocated for the mass medicalisation of children in that clinic should still be allowed to practise and not face criminal prosecution
https://www.crowdjustice.com/case/challenge-innate-gender/#:~:text=WHO%20AM%20I%3F,at%20the%20age%20of%2016.

Just bumping this to encourage sharing, any think of a less political more evidence based piece to support the review