Health Secretary updates MPs on Government and NHS England’s work to improve gender identity services & implement recommendations of Dr Hilary Cass’s independent review. Includes extension of puberty blocker ban to Nov 26th & review of adult svcs

[TorghunKhan]

https://questions-statements.parliament.uk/written-statements/detail/2024-09-04/hcws70

This is it.

It's not like a cancer drug where the child is certain to die within two years from such cancers that are rare but fatal, so any experimental treatment is a potential hope.

I knew one such child, it sadly didn't work for her as with many others, but since her death one child has been cured and cancer free for a number of years.

PBs are entirely different whereby we already know that the stats from the Tavi say that in the past 80-90% of children desist and grow out of it, and who knows if even the remaining set might desist even later, given there are adult detransitioners.

I look forward to our taxes being drained to fund the public enquiries in the future 🙄

Honest to goodness how much more of this shit do we have to keep explaining?

Here's some info from Any Sousa on the 'condition'.

x.com/KnownHeretic/status/1831711199718994428

Yep. Define 'gender incongruence' and define 'gender congruence'.

Feeling unhappy in your body?

Why does that necessitate medical alteration of said body?

If not for anorexia or BDD or BIID, why for 'gender incongruence'?

Posting for those not on Twitter as it's an excellent analysis

Amy Sousa:

To be clear, when I say that gender dysphoria is not real I am not basing this analysis on what I wish gender dysphoria meant or what I think it could mean or what I think it should mean. I am basing my analysis on the given diagnostic criteria provided by the DSM-5-TR.

The diagnosis is premised on a bogus religious claim that all humans are born with an innate gender identity that coincides with western hierarchal sex role stereotypes. The "dysphoria" is defined as distress at being nonconforming with sexist tropes. But conformance with sexist tropes is not a natural or healthy way of existing, it is only able to be signaled by purchasing external products such as clothes, haircuts, toys, makeup, etc. Preferences for purchasing these products are literally listed as diagnostic criteria for children within the DSM-5-TR. Thus within the diagnostic criteria, one's consumer purchases are the basis of a mental health diagnosis!

Debunking gender dysphoria as a bogus, toxic, manipulative ploy:

1. There is no such thing as an innate "gender identity" that all people have. There are no innate identities of any kind. Identities are abstract mental self-defining concepts that are necessarily fluid and fragile.

1. There is no such thing as an identity incongruence. It is impossible to have an identity that is wrong for your body. Again, an identity is something one thinks about oneself, a self-referential mental concept. Our made-up personal conceptions may cause us comfort or discomfort, but there is no right or wrong mental conception for any particular body.

1. The diagnosis of "gender dysphoria" strips all political agency from patients who could be activated to critique regressive cultural standards and challenge systemic sexism. Instead, the diagnosis ignores all other underlying issues, holds the patient's body personally responsible for their discomfort, and turns the patient into a compliant lifelong medical dependent. The patient now needs to continue to buy products and services in order to be able to signal their "true identity."

1. The term "gender dysphoria" is being used for two things: As a cover for male fetishism (@WomenReadWomen) and as a marketing tool for synthetic sex surgeries and drugs (@bjportraits).

Without this diagnosis, we would observe the dangerous experimental surgical interventions on healthy children as what it is: the most brutal mass torture of children the world has ever seen.

There is nothing physically wrong with children who experience feelings of gender incongruence. They are physically healthy. Their bodies are good and right and developing normally, whatever their feelings about them. So there is nothing that needs physical treatment and no reason to think that physical treatment will improve their condition.

I don’t see how any trial can be ethically set up that gives a treatment which doesn’t address the underlying mental condition and instead gives a harmful drug to a healthy body.

https://cass.independent-review.uk/nice-evidence-reviews/

Just for completeness.

'In January 2020, a Policy Working Group (PWG) was established by NHS England to undertake a review of the published evidence on the use of puberty blockers and feminising/masculinising hormones in children and young people with gender dysphoria to inform a policy position on their future use. Given the increasingly evident polarisation among clinical professionals, Dr Cass was asked to chair the group as a senior clinician with no prior involvement or fixed views in this area.
The evidence reviews were published in March 2021. Unfortunately, the available evidence was not deemed strong enough to form the basis of a policy position.'

The original trials were rejected by en ethics committee. They just kept going to different committees until one relented. They immediately crossed their own ethical boundaries that had been approved on age restrictions.

Thinking all ethics committees and designers of trials have the same ethics as you/me/most people is part of the problem. Where are the original members of the original ethics committee that approved it now? As the guy who started all this is incredibly powerful in the NHS and it doesn't seem that he is going to be held to account for any of it. He will probably be on any ethics committee.

en.m.wikipedia.org/wiki/Russell_Viner

This thread might be of use in how we got here.

https://www.mumsnet.com/talk/womens_rights/5057269-5057269-puberty-blockers-how-exactly-did-we-get-here?

Gender dysphoria is a subjective diagnosis. (At best.)

Are medical ethics also subjective?

An exceptionally useful thread thank you

Thsnk you, very useful.

The government update OP links to says this at the end that I think is ultimately reassuring:
We will proceed with caution at every step, always putting the evidence first, and putting people above politics.

The government are not stopping kids who have already taken PBs from continuing. They are just saying no new routine prescriptions of PBs. They also want those kids already having PBs to have warnings of the risks of continuing. I haven’t seen what improvements the government or NHS is requiring in terms of the record keeping around how the group continuing to take PBs are getting on. That would seem to be essential.

so I’m going to assume until I read otherwise that the clinical trial Streeting is talking of could only be allowed to include
-kids who are already taking PBs
-kids in future exceptionally getting given PBs as a new thing

Important to remember, it’s not a total outright prescribing ban of all PBs to all kids in the UK. PBs have not been made against the law for all young people to take.

It’s also worth bearing in mind that the bar for ‘exceptionally’ accessing PBs might be so high that it actually pretty much never is permitted in practice, bearing in mind the emerging picture of high risks of taking PBs.

You can't assume anything. The people wedded to this will try any and every means possible to get these, as still yet unlicenced for this use drugs, into kids.

Sloth did you read the reach of the guy that started all this back in the 1990s? Russell Viner? https://en.m.wikipedia.org/wiki/Russell_Viner

He is the person most likely to be on any ethics committees. He is the one that first gave blockers to kids 35 odd years ago.

I personally do think we should go through the motions of initiating a clinical trial, possibly because I'm an administrator and like paperwork and attention to detail. And I mean "initiating", because I'm confident once it's written down in black and white it would fail the ethical parameters, and act as a clear dividing line between the previous Wild West approach and scientific standards going forwards.

As has been discussed above, what condition is the trial treating? Wearing the wrong clothes? Not being enthusiastic about puberty? Being gay? What is classed as a "successful" treatment outcome? How can it be quantified?

Seeing the long list of co-morbidities most patients present with would also highlight how much help is needed in other areas eg eating disorders and autism.

Clinical trials involve serious paperwork and the highest standards of data management. None of this has been applied to children so far, and I would like to see this further exposed for the medical scandal it is.

Yes, Beowulfa, that is similar to how I feel. We need the trial because we need to get to the point where we are seeking clear definitions and gathering high-quality evidence in a meaningful way.
The very process of creating appropriate protocols would formalise the presumably highly exceptional nature of any child even beginning to qualify for PBs. This in itself would clarify the extent of their casual over-prescription in the past.
And if the trial itself (or even its preliminary stages when the protocols were being established and scrutinised) revealed that no child would, in fact, meet the criteria for prescription of PBs, then that would be a formalisation and proof of their inappropriateness.

I looked at the NHS information on medical trials for children:

https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/research-involving-children/

I find the assumption that informed consent is seen (legally) the same as consent for treatment concerning - see first highlight in screenshot. Obviously any prospective trial patient should be able to trust that that a) an ethics committee approval for the trail to go ahead is actually ethical in itself and b) the trial will be managed responsibly. However, it's all prone to human influence and error. On point b, I'm sure many people remember the medical trial that went wrong because of a flawed protocol: https://www.bbc.co.uk/news/magazine-35766627.amp

The second highlight below is equally as important. The WPATH files and the Cass Report both demonstrate that informed consent is meaningless where there is no viable evidence base. Obviously it's a circular argument: you can't build an evidence base without trials. So again, all roads lead to ethics approval.

You can't assume anything

Absolutely @AlisonDonut
Does anyone know if ethics approval information would be exempt from FOI requests? I would hope not, given it's in every child's (and their parents') interest to have a full understanding about any potential involvement in this trial. Without full transparency it's a massive future legal risk for the NHS. The NHS' quiet removal of their previous words about puberty blockers and the unknown risk to the development of the teenage brain, plus the quiet back-pedalling from WPATH SOC 8, doesn't mitigate this risk. Medical lawyers will have a field day on this in the future if it can be easily proven that informed consent to the trial was not sought. Obviously the human cost of this would be heartbreaking - no amount of compensation would undo permanent brain damage (or loss of fertility, sexual function or bone density) or fix the guilt of parents who thought that they were getting good advice from the NHS.

That is fair comment, Beowulfa.

If we have to go all the way back to basics then that is perhaps the only way to do it.

I think part of the problem is that we have had years of people claiming that 2+2=5 being embedded into the processes and procedures. So subsequent policies have been built on all that bullshit. In the way of a frog being slowly boiled, we've not really woken up to it until it's got so far down the road that people are suggesting that we really ought to consider if putting a frog in boiling water is definitely bad for the frog's health.

The temptation to say 'experimenting on healthy children with dangerous drugs is wrong full stop' is strong, but there will need to be a process of unwinding, over and over again, until we get back to the basics of questioning and defining the words that we have had 'repurposed' by activists over the course of years.

I suppose rewinding that, and looking again at first principles, incredibly painstakingly, is the way this will have to go.

And just to add, the concern about this medicalisation of children has always been about the massive sudden increase in the numbers of people presenting with "gender dysphoria". Prior to that, there was a steady, very small, number of children who presented at clinics not because of a huge and contagious social phenomenon , but for reasons that - in principle - may possibly need us at least to consider the appropriateness of a medical response.

Yes. But the Cass Report covers this already because it comes from a position that gender identity is a real thing. If even the believers in gender identity are urging caution and saying that the evidence for medical interventions is weak, this demonstrates that objectivity can be applied over and above belief.

So the logical consequence is that a) there will always be people who believe that they have an inner gender identity that differs from their body (and that some will find this distressing) b) they deserve access to evidence-based care.

So we've come back round in exactly the same loop as before, where all roads lead to ethics approval.

Perhaps I am being overly naive with my faith in paperwork (apparently the Domesday Book was uniquely possible in England out of all European countries at the time, due to the admin efficiency of the Anglo-Saxons).

It may seem as stupid as completing a risk assessment form to confirm whether or not a cement mixer is a good place for a baby to sleep, but this is where we are.

No, giving vulnerable autistic teenage girls experimental drugs to cure them of Wrong Body is an unethical nonsense. Let's see this signed off and formalised.

This ⬆️

Here’s a bit more about Hilary Cass’ thinking about the review and some of the challenges it faced:

https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/gender-identity-services-for-children-and-young-people-navigating-uncertainty-through-communication-collaboration-and-care/D0F6B23F37C3D82B38C2470DF65854C9

A bit about PBs:

”This leaves many unanswered questions, including whether puberty blockers may be beneficial for a subgroup of young people, and if so which ones, as well as whether there might be negative outcomes for other young people.

A recent study found that gender non-contentedness (i.e. unhappiness with being the gender aligned with one's sex) was highest in early adolescence and continued to drop into the mid-20s.Reference Rawee, Rosmalen, Kalverdijk and Burke7 This is consistent with accounts shared with the Review by people with lived experience whose gender-related distress resolved in late teens or early adulthood. If pubertal changes are essential to both psychosexual development and resolution of gender-related distress in some individuals, does treatment with puberty blockers change the trajectory for that group? Unfortunately, because we have intervened with the later-presenting group by using a treatment that was intended for those presenting in early childhood, and in the absence of an evidence base, we do not know what their natural history would be, nor the appropriate treatment response.

In light of all these uncertainties, the Review recommended that a puberty blocker trial should be established as part of a wider programme of research, and NHS England and the National Institute for Health and Care Research (NIHR) have already initiated this process.”