Some new information from Dave Hewitt about the BMA 'evaluation' of the Cass Review.
https://www.voidifremoved.co.uk/p/embodiment-goals
Here are some excerpts from his article:
Last year I wrote a piece about the BMA Council’s decision to publicly critique the Cass Review. In that, I made numerous criticisms of a preprint paper which the BMA relied upon.
This week, this preprint has finally been published, and very little of substance has changed. It has been reformatted and reordered, some of the claims and citations updated, others toned down a little but in essence it is broadly the same, so every criticism I made last year still applies. To summarise here though, the majority of the paper is directed at the methodology used by the York University systematic reviews of the evidence base, and seizing upon trivia to cast doubt on their results.
The real starting point of the critique is that, whatever methodology was used, the Cass Review and the York University team proceeded from a faulty perspective.
That is, they approached this by thinking about children and young people in distress, and investigated whether treatments provided to them did actually improve their mental health and wellbeing. This, according to the critique, is the wrong thing to do….
….The authors believe this, because to them the purpose of allegedly “life-saving” interventions is not to improve mental wellbeing, but to fulfil cosmetic goals - and it is this fulfilment that will then consequentially improve mental health through realising one’s authentic self….
….This is somewhat contradictory, in that mental health improvements are promoted as a “logical consequence” but attempting to evaluate whether this is actually true by checking to see if there are actually any mental health benefits is “misguided”.
…. This is quite fundamental to their critique: that Cass should have considered puberty blockers to be as straightforward as taking the contraceptive pill, and by not taking that as the starting point the findings and recommendations are flawed. The argument being made by analogy is that we do not pathologise young people seeking contraception nor do we consider contraception an intervention to improve their mental health, but instead see it as a choice relating to bodily autonomy. So, is that a valid comparison?
There is one citation for this sentence in the paper, and it goes to an earlier paper by one of the co-authors, Florence Ashley, in an ethics journal, making this argument from a rhetorical, ethical and philosophical standpoint. This is not a definitive medical consensus, rather it is the strong opinion of one of the authors…..
….This is not evidence based medicine - it is a philosophical argument to conceptualise medical interventions not as actual healthcare, but as liberal, consumerist choices that cannot be denied. The customer, after all, is always right…..
….Florence Ashley is positing a specific conceptualisation of gender, gender identity and transition - one rooted in consumerism and justified by idealised notions of the self and personal autonomy. From Ashley’s perspective, this overrides the need for evidence - indeed, attempting to collect evidence that doesn’t already accept this perspective is condemned. The evidence must be considered enough already, for this conceptualisation to be true…..
….Ashley’s work is itself a tangled web of philosophical claims held together by self-citations, circular arguments and begged questions that sits right at the heart of the current debate: the ethics and safety and rationale behind paediatric transition. If clinicians can’t even agree why a treatment is being carried out, what it is supposed to do, and what a “good” outcome is supposed to be, how is anyone supposed to evaluate whether it is working?
The Cass Review made the fatal mistake of diligently checking to see if a medical treatment actually had any sort of clinical justification, or led to any improvements whatsoever. As such, every piece of evidence gathered is suspect, because it starts from a perspective of pathology, of treating a condition, of alleviating distress, of minimising harm, of paternalism, of gatekeeping, of thinking doctors know best, of not believing children when they say who they are, of interfering with self-actualisation.