Mick Hartley

Eleanor Hayward, the Times health editor, on the influence of the Cass Review, how it's been misrepresented in America, and how the BMA has helped to spread the disinformation.  

The retired paediatrician, now Baroness Cass of Barnet, had spent four years meticulously researching the most toxic and complex question in modern healthcare: how should we care for transgender children? The fact that she has emerged from the other side a universally respected crossbench peer is a remarkable testament to the impact of her 388-page report, which found no good evidence to support the prescribing of sex hormones to under-18s.

Not a good start, I'd argue. In fact not a good headline – "How the Cass Review has reshaped care for transgender children". It's not a position that Baroness Cass, as she is now, set out to answer, concerned as she was with the question of puberty blockers and the treatment of children deemed to be transgender. But I'll register my protest here: there are no transgender children. There are no children born in the wrong body. It's a philosophical, medical, any-way-you-want-to-look-at-it, nonsense. What it is, the idea of "transgender childen", is a social contagion that's led troubled kids to be fooled into thinking that a change of sex will solve their problems – but a change of sex is not possible. It's a wicked lie. That there are gender non-conforming kids – kids who don't conform to gender stereotypes – is of course absolutely true. That indisputable fact, though, requires acceptance, not medical intervention.

But I digress… 

Six months on from the Cass Review, the medical landscape has been permanently reshaped: puberty blockers are illegal, the controversial gender clinic at the Tavistock has shut and new NHS services providing “holistic” care are up and running.

This is despite Cass having to contend with a wave of “misinformation” which, it can be revealed, largely originated in the United States and has been spread by groups including the British Medical Association (BMA). Cass believes the political backing for her report’s 32 recommendations have been crucial to its success, telling The Times this week that the “broad cross-party support means it didn’t become a political hostage to fortune”….

While Cass has commanded support from across the political spectrum and within the NHS, she has faced an unexpected backlash from an ideologically driven “vocal minority” of fellow doctors. A pocket of influential figures within the BMA attempted to halt the implementation of the Cass Review this summer by seizing on an error-strewn online paper published by academics and lawyers in the United States.

In July, the doctors’ union suddenly announced that it would lobby against the Cass report, without consulting its 195,000 members. To support their position, the BMA Council cited as their top source a 39-page document published by the Integrity Project, an organisation based at Yale Law School. The paper is titled “an evidence-based critique of the Cass Review”, and claims Cass’s work — which was the largest ever conducted and reviewed data from 113,000 children — has “serious methodological flaws”.

Its lead author is Dr Meredithe McNamara, a paediatrician who has argued that giving children puberty blockers is “one of the most compassionate things” a parent can do, and acts as an expert witness in US court cases arguing for gender-affirming care. This McNamara paper, which was widely shared online and fuelled an international backlash against Cass, has now been exposed as having a “significant number of errors and misrepresentations”.

In an article published this week in the Archives of Disease in Childhood, a peer-reviewed British medical journal, a group of leading paediatricians identified a series of unfounded claims, misrepresentations and factual errors in the US paper that underpins the BMA’s stance. They found the McNamara paper was “tailored for the courtroom” and written with the “primary purpose” of supporting lawsuits in the US, where the issue of gender medicine remains bitterly divided along party political lines and is settled through legal action. It warned that doctors should not use the flawed paper to “jeopardise the implementation of crucial reforms” in the NHS.

The lead author Dr Ronny Cheung, a paediatrician based in London, said the US report had been “very influential in swaying online discourse” and he was “very surprised” it was cited by the BMA, whose stance is at odds with the rest of the medical profession. “The overwhelming response from medical royal colleges, and politicians on both sides of the debate, has been to recognise the potential for the Cass Review to help us move things forward,” Cheung said.

When her final report was published, Cass concluded that an entire global field of child gender medicine, including puberty blockers, was “built on shaky foundations”. The findings of her review reverberated around the world, and (unusually for an NHS-commissioned report) are now laying a new international foundation for a branch of medicine.

“The lack of evidence base leading to a change in the approach to gender care is not unique to England,” Cass said. “We are fortunate that our health system allows us to set up independent reviews that guide national policy, act on the evidence and implement improvement across the country.”

In other words our health service is not governed, as in the US, by profit. 

For more on US disinformation, see here.