The Eamnier have published a lengthy article challenging the finding of the Cass report.
Btw, Dr Hilary Cass OBE is a consultant in Paediatric Disability at Evelina London Children's Hospital, Guy’s and St Thomas’ NHS Foundation Trust, so she is vastly experienced and highly qualified in her field.
Anyway, judge for yourselves :
Britain's Cass Review into healthcare for young trans people
Under scrutiny now in Britain is last month's Cass Review into healthcare for young trans people. Commissioned by the NHS in 2020, its findings, broadly, are that healthcare for young trans people is administered without sufficient oversight, and so should be restricted.
Sadly but predictably, the review was greeted with triumphalism by campaigners who feel the expansion of trans people's rights has strayed into over-reach. Just as predictably, it was met with dismay by trans people and their advocates. Commentators trying to thread a precarious path across the middle ground stressed it was important to follow the science, especially in such an important matter as child healthcare.
Generally, that middle ground is correct, but not if the science is brand new, because potential error and bias has not been scrutinised, and especially not if the science is not science but in fact a review of science, which adds a second layer where error and bias can creep in.
On its release, various arms of the NHS vowed to implement the review's recommendations, and it was welcomed in the British parliament by both major parties. Outside of the officialdom that commissioned it, however, the reaction was more challenging, with health organisations from Canada, Australia, New Zealand and others remarking it did not follow international best practice.
And if you follow the science, it doesn't get much better for Cass. One of its key methodologies was to disregard almost all evidence that medical interventions for trans or gender-questioning young people were safe — "no conclusions could be drawn", says the review — as they did not meet the standard of being 'double blind', the gold standard of medical testing, whereby one group receives the treatment being tested and the other receives a placebo.
This sounds like a good thing — after all, we want gold standard healthcare for children. However, double-blind studies on trans youth healthcare, in review chair Hilary Cass's own words in an interview with The Kite Trust, are "inappropriate and not possible" — inappropriate because it would be the depths of cruelty to tell test subjects they're receiving life-affirming treatments when they're in fact getting a sugar pill, and impossible because the placebo group soon notices the lack of results.
It would be like if you broke both your legs and the doctor healed one of them and expected you not to notice which was still broken.
A common methodology in scientific reviews, the Mixed Methods Appraisal Tool, recommends including 'low quality' studies in the absence of any or many 'high-quality' studies; that 'low quality', in layman's terms, is still an 9/10 where double-blind studies are 10/10. Where 10/10 is "inappropriate and not possible", do you reject 9/10 for not being 10/10?
So it seems the Cass Review spuriously rejected multiple reports that could have led to a different outcome. It also ignored reports not in English — and scientific communities outside of the Anglosphere are much more positive on medical interventions for young trans people.
On the other hand, Cass considered in its findings reports from the 1980s, YouTube videos, and studies with sample sizes as small as 24.
If you follow the science, the review does not withstand much scrutiny, even before you consider its headline recommendation, that trans healthcare should be banned up to age 25, is brd on the pseudoscientific idea that the brain doesn't stop developing until you're 25.
The review also speaks favourably of other pseudosciences, social contagion and rapid-onset gender dysphoria, as well as gender exploratory therapy — conversion therapy by another name. And, addressing the Scottish parliament earlier this month, Dr Cass told politicians anti-anxiety medicine and antidepressants, which do have well-documented side-effects, and "psychological treatments" could be a more suitable treatment than puberty blockers.
Academics have questioned Cass's methodology, including in areas such as suicidal ideation and neurobiology. Trans advocates say the review team was working towards a predetermined outcome. Speaking of gold standards, the Cass Review is not peer-reviewed.
Context is important, too — culture war-riven Britain does not have a good record with government-commissioned reports on minorities, with the 2022 Sewell Report (which found there was no such thing as institutional racism and there were positives to the slave trade) laughed almost out of existence.
Where does this leave Ireland?
So where does this leave Ireland, considering calls that our trans healthcare be re-examined in light of Cass, and when our trans healthcare is ranked the worst in the EU? Well, where Britain does government-commissioned reports on minorities badly, what we do well here is the committee, which considers a plurality of views to find the most reliable, robust outcome.
Take the recent Oireachtas joint committee on assisted dying. Chairman Michael Healy-Rae made no secret of his opposition to assisted dying, yet steered the assembly to a conclusion largely in favour of it, notwithstanding objections that will also inform legislation.
The Citizens Assembly on abortion is another example of the best of plurality when, in consultation with 100 different views, it found the Irish public was ready to lift the ban on abortion.
Waiting lists for trans healthcare in Ireland are up to 10 years long, effectively meaning there is no trans healthcare here. Just as it was with abortion, this ban means people will either travel for it or access the black market.
Yes, trans healthcare needs to change in Ireland, but it is far too important to blindly follow the misinformed, unrigorous Cass.
In some cases, contested knowledge can be incredibly harmful
www.irishexaminer.com
The Cass report can be viewed here.
https://cass.independent-review.uk/home/publications/final-report/
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