Mick Hartley

Kathleen Stock at UnHerd – How a cult captured the NHS:

Pity poor Dr Hilary Cass, the eminent paediatrician charged with managing an independent review of NHS gender services for young people, whose final report was published this week. Given the hair-trigger sensibilities of interested parties, she seems to have been unable to state unambiguously that now-popular treatments for young people confused or distressed by their sexed bodies are blatant quackery: keeping pre-pubescent kids in suspended chemical animation on the basis of a single, discredited study; dosing teenagers liberally with opposite-sex hormones; or — when a child reaches the tender age of 18, though even earlier in other countries — empowering her to have major body parts cut off.

Instead, time and again in Cass’s report she is forced back into the conceit that the most pressing problem for contemporary gender medicine is the lack of good evidence for such interventions either way. It is as if a modern-day medic had been tasked with reviewing the efficacy of trepanning, and then ordered to defend her findings in front of fanatical fifth-century devotees. “It’s not that drilling a hole in a child’s skull to release demons is necessarily harmful, you understand — indeed, it may be the best outcome in some cases. The main issue is the lack of long-term follow up.”

Alongside Cass’s cumulatively devastating account of reckless decision-making, poor evidential standards, and patchy record-keeping at Gids and elsewhere, a whole section of the report gently attempts to educate its readership about “the components of evidence-based medicine” — complete with basic explainers about randomised controlled trials, blinding processes, and the possibility of bias. She might as well be addressing an archaic people who have just emerged blinking from a time capsule, still convinced that disease is God’s punishment for insufficient acts of propitiation.

In a sense, though, this is indeed very like one group to whom the report is addressed: those clinicians, parents and patients immersed in bubbles of identity affirmation, and cognitively isolated from any reasoning or evidence that would confound their worldview. Perhaps unusually for a medical review, it is clear from Cass’s overtly respectful tone and at times still-euphemistic language that her aim is not just to inform these readers but also to deprogram them.

The very first sentence of her report begins with a weary disavowal of Stonewall-endorsed paranoias (“This Review is not about… undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people’s rights to healthcare”). Somewhat nonsensically, references to “birth-registered females” are scattered throughout the text, as if the author were somehow only concerned with those with birth certificates — presumably an attempt to build bridges with child-like souls still convinced sex is something coercively assigned to neonates at random. Generally, there is a sense of gingerly addressing a group of emotionally labile people who are not quite ready to face the whole truth….

One could be forgiven for thinking that medical culture should easily be able to condemn bizarre physical interventions performed upon children in the name of religion, without having to undertake a four-year clinical review first. Indeed, lawmakers have previously criminalised practices such as FGM without requiring any such tests. But one instructive thing we can learn from the wreckage of gender medicine is that, with the right kind of institutional and rhetorical scaffolding, doctors can become unsure about what their goals are supposed to be. It’s no good telling them to first do no harm, when they can’t work out how to reliably detect it.