Cass Report into Gender Identify Services - myths debunked

[Tristan]

The Cass report came out last week, a thorough and detailed review of gender identify services for children and young people. It includes reviews of the evidence on the treatments that were/are being offered and makes a number of decent recommendations. It's been welcomed by many, but as expected there are critics. Some of these critics are attacking the report on utterly nonsensical grounds, essentially making stuff up about it. These myths about it are getting traction.

Andy Lewis (formerly of this parish) wrote a decent blogpost debunking the 4 most prominent myths about it. It's worth a read: https://www.quackometer.net/blog/2024/0 ... -know.html

[quitethrilling]

Andy tweeted a link to this open letter:

https://feministgenderequality.network/ ... ss-review/

which at the time he shared it had a list of signatories including none other than Dr Andrew Wakefield. That version has disappeared from the original link but can still be viewed here:

https://archive.fo/2024.04.14-173725/ht ... t.html?m=1

Finally the current version of that page - http://uncommon-scents.blogspot.com/202 ... about.html - seems to be an updated one where the AW’s name is missing. Curious!

Anyway, hoping that the Cass review is the starting point for a discussion that’s more focused on evidence than it has been to date.

[Tristan]

I'd noticed the Andrew Wakefield thing, although I think it's possible for anyone to sign without verification, so there's always a possibility someone else added him. That's why I didn't mention it above, though I wouldn't be surprised if he had.

[Tristan]

And here we have David Gorski who runs the Science Based Medicine blog promoting twitter rumour and accusing someone by name of doing something she simply didn't do.

The behaviour of a lot of so called "skeptics" on this topic is really poor.

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[lpm]

TBH, I was pleasantly surprised by the reaction.

Most normal trans activists welcomed the report and were pleased it brought evidence into the discussion.

There is always going the lunatic fringe who reject scientific approaches and scream their slogans, but I don't think it's worth highlighting their rants.

[snoozeofreason]

The report is coming in for criticism on Twitter because some of the images using to illustrate it are AI generated. Not sure how relevant that is (and I can understand why one wouldn't want to use real people's faces).

[Tristan]

The report is coming in for criticism on Twitter because some of the images using to illustrate it are AI generated. Not sure how relevant that is (and I can understand why one wouldn't want to use real people's faces).

I fail to see what relevance it could possibly have.

[Tristan]

TBH, I was pleasantly surprised by the reaction.

Most normal trans activists welcomed the report and were pleased it brought evidence into the discussion.

There is always going the lunatic fringe who reject scientific approaches and scream their slogans, but I don't think it's worth highlighting their rants.

I think it certainly could have been worse. For example, Stonewall’s response was better than I’d have expected.

But as we can see with the likes of Gorski, misrepresentation of it can easily gain traction.

[snoozeofreason]

The report is coming in for criticism on Twitter because some of the images using to illustrate it are AI generated. Not sure how relevant that is (and I can understand why one wouldn't want to use real people's faces).

I fail to see what relevance it could possibly have.

Me neither. It was a silly thing to do though, given the way that debate on this subject tends to play out, and the willingness of all sides to reach for any available stick to beat the other side with. Of course using real people's faces would have been even sillier, but they could have just not used anyone's face at all. I imagine that the decision to use the images was made by some graphic designer rather than any one involved in the research itself.

[Gfamily]

So, do you think that there are valid criticisms of the Cass report; and what would you say they are?

[dyqik]

The report is coming in for criticism on Twitter because some of the images using to illustrate it are AI generated. Not sure how relevant that is (and I can understand why one wouldn't want to use real people's faces).

I fail to see what relevance it could possibly have.

A serious report would not be illustrated with irrelevant imagery. If you don't have a relevant real image, then there shouldn't be an image there at all.

[lpm]

The report is coming in for criticism on Twitter because some of the images using to illustrate it are AI generated. Not sure how relevant that is (and I can understand why one wouldn't want to use real people's faces).

I fail to see what relevance it could possibly have.

A serious report would not be illustrated with irrelevant imagery. If you don't have a relevant real image, then there shouldn't be an image there at all.

A serious criticism would not raise irrelevant points about imagery. If you don't have relevant real criticism, then there shouldn't be a post there at all.

But perhaps you intended to write "This is great, finally an evidence-based report that calls for individualised care and treatment for all young people seeking support from NHS gender services, let's all pressure MPs to read it."

[snoozeofreason]

I have a horrible suspicion that the imagery is an academic equivalent of dad dancing. In other words that somewhere along the line someone decided that it would make the report more engaging to the age group most affected by it.

[Tristan]

The report is coming in for criticism on Twitter because some of the images using to illustrate it are AI generated. Not sure how relevant that is (and I can understand why one wouldn't want to use real people's faces).

I fail to see what relevance it could possibly have.

A serious report would not be illustrated with irrelevant imagery. If you don't have a relevant real image, then there shouldn't be an image there at all.

This is just nonsensical. Stock images are a thing and are used regularly in all sorts of "serious" documents. We're going to be seeing AI generated ones replacing photographed ones more and more. By all means start a discussion on whether this is a good thing or not for the design and photography industries, but it's utterly irrelevant to this thread.

[Sciolus]

I haven't read the report but I've skimmed through looking at the pictures (but not AlL tEh pIXeLs) and they are exactly what I would expect in a report of this sort -- a selection of images of people between chapters. Apart from the usual glossy relief from the wall-of-text, pictures are useful to remind ourselves that the report is about real people and not abstract concepts. The only thing that struck me was that all the pictures of people from behind got a bit creepy after a while, and it would have been nice to actually see some more faces (tying in to my previous sentence)-- but we all know why that is difficult.

[Tristan]

How to win hearts and minds

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[Tristan]

This is so disingenuous of Stonewall. The information about the methodology used was in the report all along. Why are they pretending it’s new information?

https://x.com/stonewalluk/status/178246 ... iksLglQFYQ

[bjn]

There may be a few myths out there, but the report does seem to have systemic bias as to what they considered and what they did not and draws invalid conclusions from the papers it did survey. Reasoned outlines to various objections reported by Rebecca Watson.

https://skepchick.org/2024/06/the-cass-repo

[IvanV]

There may be a few myths out there, but the report does seem to have systemic bias as to what they considered and what they did not and draws invalid conclusions from the papers it did survey. Reasoned outlines to various objections reported by Rebecca Watson.

https://skepchick.org/2024/06/the-cass-repo

Skepchick refers us to some academic papers that draw attention to some problems with the Cass Review. Some of those problems, like a particularly unfortunate misprint of a number, are clearly quite correct. Others, I'm not convinced I'm reading something that comes from a neutral, objective position, but rather one that starts from the position that what the Tavistock Clinic was doing was the correct thing. Which at the moment I'm not very willing to accept as being a neutral, objective position.

I would be delighted to read such a review paper if I was sure that it was coming from neutral objective position, but I see a lot of signs that this is not the case here.

Skepchick refers to the "rabid anti-science transphobic mob" (RASTM). They certainly exist and make a lot of noise. And they have their own problems with the Cass Review for not confirming their particular position as they would like it, and have been telling porkies about what the Cass Review actually says to try and pretend it does, as documented earlier in the thread. But I see no reference to what I perceive as the other extreme. And I somewhat fear that a large fraction of the population is being painted as transphobic, if not quite in the rabid anti-science mob, for not signing up to what I perceive as the other extreme. I have a perception, please correct or clarify if this is wrong, that the academic gender studies area tends to exclude you if you don't come from what many would perceive as a fairly extreme position, and won't publish you unless you affirm that position. I think that has been said on this forum.

When I previously enquired on this forum about ROGD, which comes from the RASTM, I was given useful references which seemed to come from a more neutral, objective position that what I am perceiving here from Skepchick and the papers she cites.

When Skepchick refers to "gender affirming care", and the paper Skepchick particularly quotes, Biological and psychosocial evidence in the Cass Review: a critical commentary, refers to as the established "standard of care" (SOC) as commonly applied in the US and now being denied here in England, I read that as being basically what the Tavistock Clinic was recently doing. So it seems to me that this whole argument starts from the premise that there was nothing wrong at the Tavistock Clinic, as it delivered the SOC as supported by the (limited and defective) literature. And if I think otherwise, apparently I'm transphobe, along with the great majority of the population. That seems to me to be what it is subtly implying.

There was a documentary on the BBC about the Tavistock Clinic. Now the BBC doesn't mind being, from time to time, of late, the right wing instrument of government, in fear at being abolished or defunded. But I didn't perceive that in this particular case. I was given the impression that a lot of the disquiet came from internal experts who had been frightened to speak out, as there is pressure to conform to the particular position. They also indicated that there was very little data on people who detransitioned or who were otherwise dropped out or were unhappy with their care at the Tavistock, as Tavistock dropped such patients and didn't follow up on them or record their outcomes. The documentary showed us both someone who was very happy with being helped to transition, and someone else who was very angry at being supported to transition and, after a mastectomy, was detransitioning. The issue is finding a way to make sure the first can happen while the latter doesn't happen. The perception I have is that the extreme position is more happy to support the former and sweeps the latter under the carpet, as indeed the Tavistock seems to have been doing.

The article quoted by Skepchick is in the International Journal of Transgender Health. Since I have that perception that gender studies has been largely monopolised by people coming from a particular position, that raises the suspicion that you mainly see articles from that viewpoint in that journal. So I'd prefer to see an article in a journal that doesn't have that particular specialty, with a broader editorial board. For example, the paper quotes the main peer-reviewed papers Taylor et al (2024a to d), which were put together for the Cass Review, and they were published in such a more general pediatric journal. If I have time, I'd like to look through those Taylor papers, but I was rather hoping someone else could give me an overview, someone that I wasn't suspecting of coming from a particular viewpoint.

But that is a minor point. What concerns me more is the 2nd sentence of the introduction, which runs:

"The Review was commissioned in the context of particular hostility in the UK toward trans individuals (Walters et al., Citation2020), and a high-profile legal case regarding trans children’s ability to consent to puberty blockers (de Vries et al., Citation2021)."

That is plainly completely true. But it also seems to neglect other important aspects of the context. Why does it mention only that one legal case, and not the broader concern from both experts and the general public about what was going on at the Tavistock? Is that all summarised as "particular hostility"?

One of the arguments that the Cass Review makes is that "experimental treatments" were being applied. That is not denied, or I haven't spotted that, in these articles. But it is asserted that it is the established SOC is at least supported by the (admittedly inadequate) literature and what Cass proposes is equally experimental. But I would say that from the point of view of the important medical criterion "first, do no harm", in choosing between the two "experimental treatments", what the Cass Review recommends much better meets that criterion.

So, in sum, I have a perception that this is the particular extreme position, that was never unhappy with what was going on at the Tavistock, reminding us of why it was happy with it. If that is the case, then I would not call that an objective and neutral review of the Cass Review and the research it was based on. Which we could certainly do with.

[IvanV]

As an addendum to the above, one of the points that is referred to by Skepchick and in the papers she cites, is a claim puberty blockers are excellent and claims otherwise are misinformation. As shown by the literature, they work excellently, are reversible and unharmful. They do indeed give people more time to make choices. Take them, and life stands still. Stop taking them and puberty will happen if that is what you choose, or else make your physica transition if that is what you choose. They are safely used in a number of contexts outside of gender dysphoria. It says, this is what the literature supports. Other claims are misinformation. Perhaps I've overstated this a bit, but they are seemingly saying there is no downside.

So when I have a memory of there being an increasing amount lot of stuff about how puberty blockers do in fact have downsides, (was in that BBC documentary) don't work as perfectly as described above, that was pseudoscientific misinformation that was being fed to me?

I'm rather suspicious of any claim that something works perfectly in medicine. Normally there are at least some issues. We wish to ascertain their size. So I find what is in the article inherently suspicious. There should be some acknowledgment of issues, and some sizing of those issues. That is how things are in the real world. At the same time, maybe others have been exaggerating the downsides, as anti-vaxxers do.

[bjn]

If puberty blockers are so horribly dangerous, why are they still proscribed to young people with precocious puberty, which has been done for decades? Of course no medical treatment is perfectly safe, but from my digging they seem to be very safe, the main side effects are related to a reduction in sex hormones, which is unsurprising.

For another take on the Cass report being problematic that is somewhat less polemical than Watson’s, the Science Vs pod cast has a well referenced response to it. A transcript is available if you can’t do the listening thing. https://gimletmedia.com/shows/science-v ... getting-it

Re: the tavistock clinic, Jo Maugham today presents evidence that the Tavistock clinic has seen a massive uptick in suicides after the Bell decision in 2020, which force changes to trans care as a result. In the seven years before the 2020 changes there was a total of one suicide among young people on the waiting list, in the three years after the decision there were at least sixteen deaths, which was kept quiet. Talking of suppression of evidence…

W2 says that when staff working at the Tavistock planned an open letter they were threatened with disciplinary proceedings and being reported to their regulatory bodies if that letter contained the death numbers.

https://threadreaderapp.com/thread/1803 ... 06489.html

[IvanV]

It was interesting to click through to Stonewall's initial response to the Cass Review, which is quite measured. In effect Cass's recommendation is to move to properly evidence-based medicine, with some precautions brought in to cover the problem that the evidence is not currently good enough. The evidence on suicides, etc, is that maybe actually some of the recent approaches, were, on average, better than these precautionary approaches. Stonewall note that Cass did not recommend a blanket ban on social transitioning under 18, nor on puberty blockers. But it seems that the practical reality will be making these very difficult. And a misunderstanding that the temporary precaution may not reflect evidence-based medicine. One of the last acts of the out-going government was banning all new prescriptions for puberty blockers for subjects with gender dysphoria.

To the extent that ultimately Cass is arguing for evidence based medicine, then ultimately a future government can facilitate that and we can end up somewhere sensible. I least I can hope that.

[dyqik]

If puberty blockers are so horribly dangerous, why are they still proscribed to young people with precocious puberty, which has been done for decades? Of course no medical treatment is perfectly safe, but from my digging they seem to be very safe, the main side effects are related to a reduction in sex hormones, which is unsurprising.

And banning them for under 18s is, or course, a complete ban on puberty blockers. Because you have to take them during puberty. The whole point of them is to allow an adult to make a choice.

[Tristan]

deleted double post

[Tristan]

I have a perception, please correct or clarify if this is wrong, that the academic gender studies area tends to exclude you if you don't come from what many would perceive as a fairly extreme position, and won't publish you unless you affirm that position. I think that has been said on this forum.

I think you’re right. Case in point that’s just come out in emails and documents released as part of a legal case in the US, is WPATH doing exactly that.

They paid Johns Hopkins University to undertake systematic reviews on trans healthcare. WPATH interfered throughout and insisted on seeing both the study design AND the results before deciding whether to let JHU complete and write up the study.

An email from the WPATH incoming president Walter Bouman in 2020 said research must be “thoroughly scrutinised and reviewed to ensure that publication does not negatively affect the provision of transgender health care in the broadest sense.”

Thread with a link to The Economist’s article on this here: https://x.com/jessesingal/status/180635 ... iksLglQFYQ

I look forward to Rebecca Watson’s outrage at this ideological interference in academic freedom.