The Cass report - Peer review

[BeizenderKarneval]

There has been some peer review work done on the Cass review, something that a lot of us in the industry knew was problematic but that has been used by government and a number of notably outspoken individuals to justify their hateful positions

The results and conclusions are quite compelling, and I urge you to read them for yourselves:

Critically appraising the cass report: methodological flaws and unsupported claims

I find this section especially interesting:

“It undermines the legal competence of both children and adults to access medical treatment and dismisses almost all existing clinical evidence on trans people’s healthcare by applying impossible evidence standards which, if applied to other medicines would invalidate more than three quarters of the existing treatments used in paediatric care which, like puberty blockers, are currently being prescribed off-label.”

The report’s primary conclusions rest on excluding 98% of the relevant evidence on the safety and efficacy of puberty blockers and hormones for lack of blinding and controls.

What this means is that they require studies in which some patients are given the treatment, and others are unknowingly given placebos.
This is not only a clear breach of medical ethics and monstrous suggestion, but also impossible due to the obviousness of the impacts of puberty blockers and hormones.

The report also strays far beyond its scope and competence in recommending a review of adult services and in suggesting that young people ought to stay under the care of children and young people’s services until the age of 25.
The latter is based on highly questionable understandings of brain development which have been repeatedly debunked as an oversimplification of the constant changes in human neurology over the course of our lives.

This recommendation, especially in a context of an already broken system of care for both adults and children, has the potential to have a significant negative impact on the lives and wellbeing of trans people in the UK.
Underpinning this report is the idea that being trans is an undesirable outcome rather than a natural facet of human diversity.

This is clear not only from the recommendations but also from the exclusion of trans researchers from the design of the review process and the links individual members of the research team have to anti-trans groups, which the Cass team were warned about.

I look forward to an interesting dialogue.

That’s nice dear.

The report’s primary conclusions rest on excluding 98% of the relevant evidence on the safety and efficacy of puberty blockers and hormones for lack of blinding and controls.

That's just a straight lie. With errors like that, long debunked, why would you trust any conclusions it reaches?

something that a lot of us in the industry knew

If you have relevant experience why don't you give us your own thoughts, rather than outsourcing your thinking?

OK

“We looked for bias and found what we think is bias because it doesn’t give us what we want (£££) and we are going to tell you it’s biased in fancy language, despite the fact we are biased”

To be fair I only replied as an act of random kindness. I didn’t want the OP to be one of those sad threads that no one replies to as they’re just too bonkers. Isn’t there a whole section in Mn
for those threads?

I’m really pleased these <checks notes> psychologists and a random dude who thinks he’s a woman at goldsmiths have published this as it’s an excellent example of trash academia identifying as Very Clever stuff. Unfortunately the bias tilt and methodology stubble is a dead giveaway.

Did you have trouble reading my post beyond "There has been some peer review work done on the Cass review"?

Or perhaps you gave up at the link and decided to ignore my comments below because they didn't align with your blinkered view?

Come back to me when you've actually read everything and formulated robust counter points of your own. Don't worry; I'll wait.

@BeizenderKarneval What’s off with the BMC “critique” in a nutshell

• Built-in activism, not neutrality – several authors hold positions in WPATH, TransKids Belgium, Trans Healthcare Action, etc. That’s a vested-interest crew assessing a report that threatens their professional/ideological turf. Bias is declared in the “Competing interests” section but never mitigated
• Wrong tool for the job – they wave the ROBIS checklist at the Cass systematic reviews, yet ROBIS only tells you whether a review followed its own protocol, not whether the underlying evidence is any good. They never re-examine the primary studies Cass flagged as weak, so their “high risk of bias” stamp is beside the point
• Nit-picking protocol tweaks while ignoring substance – Cass reviewers dropped grey literature and non-English papers to keep to peer-reviewed clinical data (standard practice). The BMC authors shout “bias!” but never show that any excluded study would actually change a single conclusion
• One-size-fits-all search gripe – they complain Cass used the same search strategy across seven reviews, but those searches were broad MEDLINE/Embase sweeps; no evidence is given that relevant trials were missed. It’s speculation dressed up as methodology
• Moving goal-posts on quality scoring – they slag Cass for using AGREE-II and an adapted Newcastle-Ottawa Scale, yet elsewhere praise affirmative-care reviews that use exactly the same or flimsier scoring systems. That’s a double standard they don’t acknowledge
• Selective outrage over “deviations” – every literature review tweaks its protocol as it goes. Cass logged major changes on PROSPERO; the BMC team call this “unexplained”, but the change notes are public. Pot, kettle.
• No alternative synthesis – they never pool the data themselves, run a meta-analysis, or offer new numbers. It’s arm-chair criticism: knock the method, duck the evidence.
• Skates over the wider picture – Sweden, Finland, Norway and now the NHS have all tightened youth gender-medicine on the same evidential grounds Cass highlights. The paper pretends Cass is an outlier and doesn’t grapple with that international convergence.
• Rhetoric over rigour – loaded phrases like “double standard” and “misrepresentation of evidence” pepper the text, yet each claim is backed only by the authors’ own ROBIS ratings – a circular argument.
• Published in a methods journal, not a clinical one – handy if you want to debate paperwork rather than patient outcomes.

In short: lots of activist energy, little fresh data, and no dent in Cass’s core finding – the evidence base for medicating gender-distressed kids is still wafer-thin.

Read it. Understood it. Thought it was batshit and biased. HTH. 😀

I believe we’re done here

The report also strays far beyond its scope and competence in recommending a review of adult services and in suggesting that young people ought to stay under the care of children and young people’s services until the age of 25.
The latter is based on highly questionable understandings of brain development which have been repeatedly debunked as an oversimplification of the constant changes in human neurology over the course of our lives.

Cass is not an outlier in this at all. Many ( most) experts acknowledge that the brain is not fully mylinated until 25 and that these changes are delayed in the case of
a) Trauma
and
b) Autism

Both of which are massively overrepresented in gender questioning children. Those of us who work in this area know that the vast majority of these ND girls are back to identifying as female by 25, they need support and guidance not medication ( other than LARC).

There has been some peer review work done on the Cass review, something that a lot of us in the industry knew was problematic but that has been used by government and a number of notably outspoken individuals to justify their hateful positions

Which "industry" is that?

Thanks for coming for Mumsnet to tell us all about the stuff we overlooked. It is mostly women here so it is possible we missed something. Only Surprise!!! Guess what we already have a thread on this paper, because round here we look at all the evidence usually before anyone else.

You might be surprised by this, but we have open debate here . You don't get this on corporate male focused forums like Reddit where opposing evidence is closed down and banned. This concept of open debate is why Mumsnet keeps winning. Surprised you missed the existing thread here really. You know forums have search capabilities right?

The new paper has obvious flaws and has been debunked here and elsewhere online. TangenitalContrivences above sums it up.* *Basically it is arguing Cass should have used a bunch of extra low evidence reports, while failing to turn up any high quality evidence the Cass reviewers missed. So this just reinforces the facts about the Cass Report we already knew, there were lots of bad science they didn't use. Just turning up MORE weak evidence doesn't show anything. It is the usual attempt to try to undermine Cass by slight of hand without actual scientific proof. The new paper's authors also have obvious biases.

If you want to overturn Cass you need actual strong evidence based science. The Gender industry makes billions of dollars. There are 100,000s of patients surely you must be able to prove all the medical action a good idea from the existing data and patient records. Right? All the follow up patient care they did?

Why can't it do this? The gender industry has had TWO YEARS now since the review was published in April 2024, more if you remember the Cass Review was commissioned in 2020. Plus all the other reviews in other countries which had similar results which predate Cass such as Finland [2020] Sweden [2021]. Clock ticking.

The reason it can't is the gender industry is about making money, and bizarre gender experiments, not good patient outcomes. That is why you lose and keep losing. Try open scientific discussion where you assume that it is possible that mistakes have been made. Humans are emotional, scientific malpractice occurs, that is why we use the strongest evidence and the scientific method.

Existing thread
https://www.mumsnet.com/talk/womens_rights/5333913-cass-report-biased-and-unreliable

revealing true colours; it’s a grifting industry worth £££££££££

Yes its the entire argument behind the Scottish government's rules that give under 25s softer sentences

Now go report something favourable about the cass review on reddit so we can lay to rest the accusations of being an echo chamber.

Yes, the use of 'industry' is what jumped out at me, too.

Gotta keep those bucks rolling in!

OP you don’t understand what peer review is. Peer review is NOT a group of activists with an agenda banding together to criticize a report whose findings they do not like. That is not how the peer review process works.

Nor does medical research work by having people with the condition under investigation on the research team. By this criteria nearly every scientific paper ever written could be thrown out.

You clearly have no understanding of the scientific method of inquiry at all.

Your post is a bias ridden mish mash of slurs and slogans. You really should have avoided that if you wanted people to engage with you on a clear sighted dive into an objective evidence base ( which you don’t have)..

I’m confused! I’ve not read the linked report but have a query about the OPs post - is the section in italics lifted from the paper and then is the non italicised section the OPs consideration of Cass or is it their summary of linked paper??

I ask because the OP seems to be flip flopping on positions - misunderstanding some of S.C. ruling but that could be down to linguistic differences, posting about not wanting TW in ‘our spaces’ (their words) but I’ve read this post as criticising Cass but am wondering if it’s a me problem/formatting??

Have the adult clinics released the data they kept secret from Cass yet? If not, why not?

I’ve been working in the field for 25 years plus and during (and since) my initial training most practitioners I work with think child and adolescent mental health services should be split into children and young people’s services, with the latter being for 14-25 year olds. This thinking is mainstream and underpinned by understanding of development

@BeizenderKarneval What this means is that they require studies in which some patients are given the treatment, and others are unknowingly given placebos.
This is not only a clear breach of medical ethics and monstrous suggestion...

But this is the way that medical and scientific research is done. Some participants in a study are given the drug under test, and some are given placebos.

How do you think a new drug that could potentially treat a particular form of cancer is tested? Some patients get the drug, and others get a placebo. All participants know that this is how the study will be conducted.

During the study, no-one knows who received the drug and who got the placebo, neither the patients nor the researchers who assess whether each patient has improved. Only after the results are collected is the trial unblinded, so the researchers can see whether there is a difference in outcome between those who got the drug and those who got the placebo.

This is the only way you can tell whether the drug is effective or not. It's not a breach of medical ethics, it's the way medical research is done, and effective treatments are found. Most of us have benefited from this kind of research during our lives.

OP you seem like an awfully clever industry insider. Do you think you can persuade Johanna Olsen-Kennedy to stop withholding the findings of her 7 million dollar, longitudinal study into puberty blockers?

I'm sure it'll put all our minds at rest, providing all that much sought evidence.

A peer review is when a neutral academic assesses the academic quality of a piece of work.

This isn't a peer review, it's a shit smearing exercise by people who have strongly non neutral views. I presume its purpose is to give others plausible deniability to ignore Cass, and to argue for non expert politicians to ignore Cass.

a lot of us in the industry

In the lying, grifting, child exploiting industry presumably.