TThe BMA is both a trade union and a professional association, and its professional work, such as successful campaigns for seatbelt laws and smoking, has strengthened its standing as a union. It is not known for dramatics or theatrical performances.
As a result, its governing body, the BMA Council, recently Cast ReviewIt is an independent inquiry commissioned to look into NHS gender identity services in England and was fully endorsed by the previous administration and its successor administration.
BMA members were genuinely outraged. letter BMJ They accused the council of “bringing the BMA and the medical profession into disrepute.” One reporter stated, “I can think of nothing in my 40 years of medical practice that has shocked me more.” Some members were so appalled that the BMA would adopt such an irrational policy that they quit after decades of membership. A letter accusing the BMA of being secretive and opaque, and of violating the principles of evidence-based medicine and ethical practice, quickly garnered 1,500 signatures, 1,000 of whom are BMA members. Signer It includes many prominent figures in the industry who would not normally be inclined to sign letters of protest.
The opposition to this review is hard to understand, because the review's chair, Dr Hilary Cass, has made it clear that she wants to improve the evidence base for treating people with gender dysphoria. She found the evidence base to be severely lacking. She and her team spent four years researching evidence from around the world and speaking to more than 1,000 people, including children and their families, clinicians and experienced people. Her conclusions are supported by seven peer-reviewed papers. Systematic reviewDoctors and professional bodies expressed relief, saying they feel children and young people have been subjected to potentially life-changing treatments without sufficient evidence for too long.
Why has the BMA become so completely out of touch with its members? Simply put, the union is a victim of entryism – a political strategy in which members of an organisation join a larger organisation to influence and change its policies. Trainees (previously called juniors) are outraged by the steep decline in pay since 2008, Doctors' Vote They campaigned for the restoration of full pay. Part of the group's strategy was to get its members onto the BMA Council, which they did very successfully, winning almost half of the seats up for election in 2022.
So far, this is quite reasonable: the BMA is a trade union and its main role is to improve working conditions for doctors.
But the presence of a large, well-organised pressure group on the council has created predictable problems, with DoctorsVote being disciplined in pursuing its agenda (which has been found to go beyond full pay restoration and also include stereotyping on the transgender debate) and in voting its members onto the BMA committee.
A toxic atmosphere pervaded the council chambers, and a climate of fear and intolerance towards sincerely held beliefs made some people afraid to voice opinions that were out of step with DoctorsVote. Thus the stage was set for the debacle surrounding the Cass Review.
The motion to disallow the review, tabled in Parliament, was leaked to the press and has since drawn public criticism and criticism from the BMA. Blocking the implementation of the review's recommendations.
The motion passed, but the vote was not unanimous. Further leaked figures show that the number of MPs who abstained or voted against key parts of the motion was: Voted in favorThe leaking of materials that should never have been kept secret in the first place led to an unpleasant witch-hunt against the leakers, but the BMA would have been much wiser to ask itself where it went wrong in the whole process. The rift between council and members was inevitable, and it was made even deeper by a dismissive leadership more concerned with whistle-blowing than with fostering open debate.
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So why did the BMA NiceDo they feel that they could criticise and undermine Cass's work? The BMA has found itself in a position where a small number of anti-Cass councillors are making policy that the membership has not been consulted on or agreed to. They are sincere in their beliefs but have no hard evidence to the contrary and good intentions alone are not enough to guide medical practice. They must be backed up by evidence.
The BMA now stands isolated in its opposition to Cass, its reputation and integrity tarnished. The union's prospects are not hopeless, but it needs to acknowledge the mess it finds itself in and recover from what one critic called a “descent into madness”.
Firstly, members should recognise that they cannot afford to keep discussions about important issues secret or hidden. Members who elect their representatives to council have a right to know who supported motions and who voted. Discussions about trans issues have unfortunately been rife with abuse, but that is no excuse for a lack of transparency. If you are not prepared to be accountable to the members who elected you, then you should not run for office.
The BMA needs to embrace democracy and consult with its members as it has done in the past on sensitive and contentious issues such as euthanasia. If it does not, one is forced to conclude that it is afraid of the opinion of its membership as a whole. The BMA has set up a “Task and Finish” group to evaluate the Cass review. That evaluation will proceed, but in the meantime the union should remain neutral to the review and commit to consulting with its members once it has found its findings. Only then can we begin to restore trust in the medical industry, and ultimately patients.
Unions that don't represent the interests of their members have a problem. Union leaders who ignore the concerns of their members ultimately pay the price. And if the BMA takes any action that damages its own reputation, it threatens the reputation of all UK doctors. That's why the medical community is making such an uproar about this.
