Dr Cass puts a spotlight on the scandal of a “magical” medical service

[IwantToRetire]

A damning letter from Dr Hilary Cass about adult gender clinics was sent to NHS England in May and published on 7th August (together with a reply from NHSE). The letter draws into question the basis of “gender medicine”.

Although Dr Cass’s mandate was to review services for children, she found herself approached by concerned clinicians who treat adults, both in specialist gender clinics and as GPs. They described a medical and administrative system in disarray, causing the mistreatment of a growing cohort of patients with complex mental-health histories including trauma, abuse, self-harm, criminality, mental illness and learning difficulties.

Article from Sex Matters continues at https://sex-matters.org/posts/updates/cass-puts-a-spotlight-on-the-scandal/

Letter from Dr Hilary Cass sent in May https://www.england.nhs.uk/wp-content/uploads/2024/08/PRN01451-letter-from-dr-cass-to-john-stewart-james-palmer-may-2024.pdf

Response from NHS England https://www.england.nhs.uk/long-read/nhs-england-update-on-work-to-transform-gender-identity-services/

From the Sex matters piece:

But the very idea that a person can change from male to female or vice versa, by changing their name, clothing or hairstyle, taking hormones, having cosmetic surgery or genital remodelling, or getting a government certificate, is in itself a form of magical or unreasonable thinking, which doctors, legislators and the full apparatus of the state have engaged in.

Amen to that! 👏👏

Like Hannah Barnes before her, it's refreshing to see Dr Cass take the gloves off and speak plainly.

Thank you, Dr Cass.

I am optimistic, but not filled with hope by the NHS reply.

&bull;	<span class="italic">finalising the service specification as well as a revised clinical policy for gender affirming hormones</span>

How, when their safety and suitability are not proven? See their later point:

oversee the process for establishing a clinical study into the potential benefits and harms of puberty suppressing hormones for children and young people with gender incongruence,

They don't have the data to carry out the earlier objective.

&bull;	<span class="italic">completing a study that links the data from the services provided by the former GIDS to an adult data set</span>

How, given the lack of follow-up once children left GIDS, and the obstructiveness of adult services to outside investigation? Plus the propensity for adults to self-medicate or go private.

I think this is an inapprporiate and irrelevanta comparison!

A journalist who has been paid for years to do investigations is hardly the same as a professional asked to carry out an investigation into a specifica area of work.

Although, it is interesting to speculate why 3 months later someone (was it Cass herself?) has made this letter published.

It may well have been leaked by someone wanting to back up the letter from Doctors to the BMA.

More relevant is why so few other journalists have bothered to do their actual work, ie reporting, but have preferred to "be kind".

It's difficult to envisage that Cass will be implemented within NHS England when one considers just how many of their staff signal their ideology by stating pronouns.

Likewise the number of NICE staff who do likewise. NICE editors and staff will be the people with final sign-off of relevant guidelines etc. and approval of interventions.

I remain unconvinced that the much talked of clinical trial of puberty blockers in children will make it through an ethics committee. The level of potential harm is so high and with a quoted 80% of children seeing their gender dysphoria resolve with natural puberty I really cannot see how if will be ethical to trial an irreversible treatment.

I imagine this exchange at the Research Ethics Commission meeting-

Ethics committee question: Can you answer the question 'are puberty blockers helpful for childhood gender dysphoria' without doing a clinical trial?

Trial team: Yes - we could follow up people who have already been through children's gender services and look at their outcomes properly. That would be cheaper, easier, very low risk and quicker.

Ethics committee: why haven't you done that?

Trial team: the gender clinics refused to cooperate and release any data

Ethics committee: so why do you think they will cooperate with the trial (which will involve random allocation to blockers or no blockers)?

Trial team: eerrrr...

A study into the potential benefits and harms of puberty suppressing hormones as a treatment option for children and young people with gender incongruence is being developed through the National Research Collaboration Programme (NCRP) in place between NHS England and the National Institute for Health and Care Research (NIHR). The NRCP joint programme provides a collaborative approach to study development; studies being progressed through this route still have to demonstrate that they can materially build the evidence base for potential future NHS treatment options, while meeting a high scientific bar in terms of research methodology, as well as securing other important research approvals, including ethics committee approval.

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/cyp-gender-dysphoria-research-oversight-board/

Much will depend on the protocol although there seems to have been a fair amount of prior agreement and discussion about the trial. With so much pre-work, I'm slightly 🤐 that the protocol hasn't be reviewed and published for scrutiny. It's to be published in December and the trial recruitment starts in Feb 2025.

Ethics committee: so why do you think they will cooperate with the trial (which will involve random allocation to blockers or no blockers)?

You anticipate that it will be a randomised controlled trial rather than a longitudinal observational design? I don't know what they're going to do and will be interested to read the protocol when available.

Inappropriate and irrelevant (exclamation mark)? Bit strong.

Two ethical professionals trying to be even-handed and use their specific expertise to get to grips with a sensitive topic have, over the years, become more plain-speaking in their objections. It's an observation and, I believe, a fair one. Hardly something to get worked up about.

Inappropriate and irrelevant (exclamation mark)? Bit strong.

Meaning i was being cheeky.

Its just the work done by a journalist has a totally different set of working rules and outcome.s

Compared to a exeprt in are area of work being asked to carry out a review.

And presumably why the letter was witheld from the public.

Until now.

Ahh got you @IwantToRetire. Soz.

I'm noting IRL, where I've been raising safeguarding concerns for coming on 6 years, only now are those, with actual safeguarding responsibilities, willing to hear me out. I think clear language from respectable sources, at this time, is an important part of that tide turning.

When the Interim Cass Report came out, it was couched very carefully, presumably, for fear of offence (we might argue the same is true of the full report) but as time moves on, it certainly feels like the activist genderwang is taking a backseat so the message is more clearly understood. Perhaps not offending trans identifying vulnerable young people is not as important as stopping said vulnerable young people from having dangerous, irreversible, experimental and unnecessary surgeries on healthy body parts. I suspect what is happening is a dawning realisation that conciliatory language doesn't lead to sensible discussion and that anything other than absolute fealty to gender ideology amounts to the same deranged responses.

Hannah Barnes came from Newsnight. A highly regarded investigative journalist (an endangered species, tbf) and has been on a parallel journey. Her frustrations at the rejection of Cass by the BMA was not framed with the same diplomacy as her initial forays into this world. She was clearly angry at the obvious display of corruption. (If she'd been on FWR these last few years, maybe should be less surprised.)

I suppose my point being, that unless we speak plainly - particularly those highly respected in their fields - we cannot reach those who are persuadable (the vast majority) who need reaching.