circleWe entrust our health to our physicians, and patients have a right to expect that their decisions will be based on evidence-based clinical guidelines, not on trends and guided by the principle of “first do no harm.” This is perhaps most important when it comes to life-changing medical interventions for children.
So the British Medical Association, the governing body of the medical union, Pass the motion It criticises a groundbreaking evidence review led by prominent paediatrician Hilary Cass about health care for gender-questioning children.
This is a highly controversial area of medicine, so much so that NHS England commissioned an independent review in 2020. Cath published a damning report. Final Report A report published in April concluded that now-closed NHS specialist child gender clinics gave puberty blockers and sex-changing hormones to an unknown but significant number of children who were questioning their gender, despite there being no evidence this worked and potentially very serious risks to their long-term health.
This happened despite research suggesting that gender dysphoria resolves naturally in many children, that young people associate it with other underlying factors such as their own homosexual tendencies, neurodiversity, childhood trauma, fears of puberty (especially in girls) and mental health issues, and that a childhood diagnosis of gender dysphoria does not predict a permanent transgender identity as an adult. In other words, steering children down the medical path carries a real risk of turning temporary distress into something more permanent.
The review recommended an overhaul of NHS services for gender questioning children – a holistic, treatment-first approach, with puberty suppressants only being prescribed to new patients as part of NHS research trials. The NHS is acting on this recommendation.
There is no either/or. The Cass inquiry has revealed how gender-questioning children have been spectacularly abandoned by the medical profession. You might think this would prompt reflection. But not at the BMA. The BMA announced that its board of 69 doctors had passed a motion condemning the Cass inquiry for making “unfounded recommendations”, and called on the BMA to “review and revise the recommendations”.publicly criticizeThe Cass Council has called for the Cass Review to be “halted” and for “lobbying against the implementation of its recommendations”, including the cessation of evidence-free use of drugs in children outside clinical trials. The BMA has also, ludicrously, called for the government not to conduct the Cass Review while it conducts its own review. It would be different if the BMA were seriously criticising the review, which it is not. When I asked, the BMA said it could not tell me which of the recommendations the Cass Council considers unsupported and that it was not prejudiced by its own review. In its press release, the BMA cited two papers that were neither peer-reviewed nor published in a reputable scientific journal (and therefore would be obliged to declare a conflict of interest) as evidence that concerns about the review’s methodology were sufficient to justify a suspension of its implementation.
of Yale Law School dissertation The guidelines cited by the BMA were written by a mix of legal and medical academics, most of whom are members of the World Professional Association for Transgender Health. WPATH is a US organisation whose clinical guidelines for gender questioning children were directly criticised in the Cass review for lacking developmental rigour and not referencing a systematic review of the evidence. Suppressing systematic reviews Cass dropped the study because results from a study it commissioned from Johns Hopkins University undermined the institute’s recommended approach and because it came under pressure from the Biden administration to remove the minimum age for treatment from its standards of care in 2022. The Cass review also found poor quality research by at least one of the paper’s authors.
of Second paper The preprint cited by the BMA takes the ideological position that evaluating these medical interventions on mental health outcomes is a misguided attempt because it contradicts the “denial of the pathologization of transgender people”. One of its authors writes: Open Letter Spreading misinformation about the Cass Review methodology, which has since been comprehensively verified Exposed.
How did the BMA get into a position where it is asking NHS doctors to start prescribing unproven drugs to children again? Royal Academy of Medical Sciences And that Association of Clinical Psychologists I have spoken to several councillors to make statements in support of the review, but they are infuriated by the lack of consultation outside the council, which is elected by just 1,000 votes. 7% of the BMA’s 160,000 membersThe matter appears to have been engineered behind closed doors, despite the consultant committee passing a motion last year calling on the BMA to do so. Facilitate discussion on Cass ReviewsOne council member said the BMA’s position was Not in step with members.
This is not the first time the BMA has embarrassed itself by intervening in an important health policy issue without properly understanding it: in 2021 it did the same thing over the Covid-19 vaccine.
After newsletter promotion
The BMA leadership appears embroiled in a polarising debate characterised by a misinformation campaign by activists and academics who do not like the findings of the Cass inquiry, including its failed judicial review of the government’s decision to ban the private prescription of puberty-suppressing drugs for gender identity disorder (the Supreme Court ruled last week that the Cass inquiry was “inappropriate”).Strong scientific evidence There have been statements in support of restricting the supply of puberty-blocking drugs, and a government suicide prevention adviser said last month:Disastrous and dangerous“
Yes, the BMA is run by doctors, but it was clinicians who were behind this scandal in the first place, and its intervention is a reminder of how easily some doctors can be misled by misinformation and lose sight of reason, rationality and evidence that are so crucial to the best interests of patients.
This shows that the publication of the Cass Review alone is not enough: the many doctors who advocate “first do no harm” must ensure their colleagues go back to the evidence when it comes to this vulnerable group of children who deserve better from the medical profession.
