Dr Hilary Cass has now published her long-awaited review into support and treatment options for children who suffer from gender confusion, with the paediatrician criticising “ideologically driven” clinics that refused to cooperate with her investigation and warning that the wider social debate on this issue remains “exceptionally toxic”.
The Cass Review offers a strong – some would say unanswerable – challenge to the ‘gender affirmative model’ which in recent years has become the norm in the NHS’s Gender Identity Development Service (GIDS). Faced with cases of gender distress, this approach encourages clinicians to ‘affirm’ rather than question a child’s chosen gender identity, before then putting them on a medical pathway that can have lifelong, irreversible consequences.
Part of the problem, Dr Cass says, is that as this model took hold, the process of ‘differential diagnosis’ which the NHS typically adopts during diagnosis and management of every other form of distress, was entirely ignored. Or, as the report puts it: “Some practitioners abandoned clinical approaches to holistic assessment, which has meant that this group of young people have been exceptionalised compared to other young people with similarly complex presentations.”
More generally, the Report cautions that extreme care should be taken before anyone under the age of 25 transitions; calls for an end to the prescribing of puberty blockers and cross-sex hormones to under 18s; warns that children who change gender may regret it; finds that many gender confused adolescents have experienced trauma, neglect and abuse; and says there is no “good evidence” on the long-term benefits of the treatments that have been given to children.
In other words, the days of NHS England handing out puberty blockers “as if they were sweets”, as Kathleen Stock once put it, look to be numbered. GIDS whistleblowers like Dr David Bell, Dr Kirsty Entwhistle, Dr Marcus Evans, Sue Evans and Sonia Appleby, as well as lay critics of the worst excesses of gender medicine like Graham Linehan – who lost his career and reputation at the hands of a complacent, bien pensant middle class mob for daring to speak out – have been vindicated.
So how can anyone say its conclusions do not apply in Scotland? “It is, of course, a very good question and one that has been put many times to the SNP-Green administration since the report, written by Hilary Cass, was published last Wednesday,” writes Times senior reporter Mike Wade. “But in a government of 29 ministers, not one has offered a reply.” He continues:
The uncomfortable truth for Humza Yousaf and his colleagues is that Cass strikes at the heart of two of their most contentious pieces of legislation, the Gender Recognition Reform Act and the Hate Crime Act.
Both have elements predicated on “affirmation”, the clinical approach that enables gender self-identification (known as self-ID) by vulnerable children and young adults, even though that approach is based on “incredibly weak evidence” according to Cass, a former president of the Royal College of Paediatrics and Child Health.
Bell and others have called for the Sandyford in Glasgow, Scotland’s only gender-identity clinic, to close, because the clinical practice of prescribing hormones to under-18s to halt puberty or transition to the opposite sex was based on “wholly inadequate” research. Scottish government officials have resolutely declined to enter a debate.
Instead, as the academic Lindsay Paterson put it, officials and politicians have only talked about “the toxicity of the public arguments, without acknowledging where the toxicity started, or — to give them the benefit of the doubt — that each side has responsibility for it”.
This approach is indicative of a government that has essentially been captured by an ideology
There remains an extraordinary lack of rigour in the ministers’ and civil servants’ approach. Typical in this was a survey published last week by LGBT Youth Scotland — another Scottish government-funded group — reporting a decline in the happiness of young transgender people.
“It wasn’t in any sense a scientific survey at all,” Paterson said. “It was a self-selected sample whose representativeness is not even discussed. But — and this is the key point — they nevertheless received methodological comments on the design of the work by the ‘Scottish government LGBTI equality team’.”
Paterson added: “In effect, the Scottish government is outsourcing its evidence on this group of people, and also the government people in this team don’t seem to have the methodological expertise to do this properly. This exercise, in microcosm, sums up the entire problem which the response to Cass amplifies enormously.”
In this extraordinary situation, where ministers will not respond to legitimate questions and officials lack the expertise to write legislation and understand research, two enormous crises are coming down the track towards the Scottish government, with the potential to make headlines all around the world — and not in a good way.
Worth reading in full.
