Talk:Cass Review

sources for consideration

• Vinter, Robyn (11 April 2024). "Trans children in England worse off now than four years ago, says psychologist". The Guardian.
• "The Guardian view on the Cass report: rising numbers of gender distressed young people need help". The Guardian. 11 April 2024.
• Barnes, Hannah (10 April 2024). "The Cass review into children's gender care should shame us all". New Statesman.
• "The Observer view on the Cass review: children were catastrophically failed by the medical profession". The Observer. 14 April 2024.
• "RCPCH responds to publication of the final report from the Cass Review". RCPCH.
• "Cass Review 'should mark a watershed moment' – charity chief". The Shropshire Star. 9 April 2024.
• Hansford, Amelia (10 April 2024). "Cass report urges 'caution' in prescribing puberty blockers to trans youth". PinkNews | Latest lesbian, gay, bi and trans news | LGBTQ+ news.
• Dyer, Clare (9 April 2024). "Guidelines on gender related treatment flouted standards and overlooked poor evidence, finds Cass review". BMJ: q820. doi:10.1136/bmj.q820.
• Abbasi, Kamran (11 April 2024). "The Cass review: an opportunity to unite behind evidence informed care in gender medicine". BMJ: q837. doi:10.1136/bmj.q837.
• Abbasi, Kamran (9 April 2024). ""Medication is binary, but gender expressions are often not"—the Hilary Cass interview". BMJ: q794. doi:10.1136/bmj.q794.
• Cass, Hilary (9 April 2024). "Gender medicine for children and young people is built on shaky foundations. Here is how we strengthen services". BMJ. 385: q814. doi:10.1136/bmj.q814. ISSN 1756-1833.
• "Evidence for puberty blockers and hormone treatment for gender transition wholly inadequate | BMJ". BMJ.
• Penna, Dominic (16 April 2024). "Chris Whitty: Debate around transgender issues 'too vitriolic'". The Telegraph.
• Reed, Erin. "Why Hilary Cass' NHS report is wrong about trans health care". The Advocate.
• "Gender care review: Children 'let down' by research amid 'exceptionally toxic' debate". ITV News.
• "Hilary Cass: Ideology on all sides directed gender care of children". ITV News.
• Horton, Cal (14 March 2024). "The Cass Review: Cis-supremacy in the UK's approach to healthcare for trans children". International Journal of Transgender Health: 1–25. doi:10.1080/26895269.2024.2328249.
• "Gender Identity Service Series". Archives of Disease in Childhood.
• Thornton, Jacqui (April 2024). "Cass Review calls for reformed gender identity services". The Lancet. 403 (10436): 1529. doi:10.1016/s0140-6736(24)00808-0.
• Ghorayshi, Azeen (2024-05-13). "Hilary Cass Says U.S. Doctors Are 'Out of Date' on Youth Gender Medicine". The New York Times. ISSN 0362-4331. Retrieved 2024-05-14.
• Grijseels, D. M. (8 June 2024). "Biological and psychosocial evidence in the Cass Review: a critical commentary". International Journal of Transgender Health. doi:10.1080/26895269.2024.2362304.

Critical papers

There are a couple new papers out that are critical of the review. This critical commentary was published. Then there's this paper which is still in prepublication and may look a bit different in final publication. I would say we could watch for when the latter reaches publication. VintageVernacular (talk) 01:59, 13 June 2024 (UTC)

I disagree with how this was added - these are not "responses from journals" these are individual responses, and so are they DUE?

Maybe we need a section for academic responses, but this sort of thing has to be attributed opinion to the author per WP:RSOPINION if significant. Void if removed (talk) 11:48, 18 June 2024 (UTC)

It can be re-attributed and the section renamed "Responses in medical journals"; why remove the whole addition even initially? It's written by a neuroscience postdoc, while touching on e.g. brain development, comorbidity with neurodevelopmental conditions, and brain structure. Elsewhere the commentary highlights that a systematic review which the Cass report relied on had falsely reported an increased incidence of autism in a gender dysphoric group from 1.8% to 15.1%; the cited study actually said it was 13.8% to 15.1%. Stands on its own, but referentially, are these sorts of critiques in a specialist journal any less "DUE" than the already included statements by politicians, lobby groups, etc.? VintageVernacular (talk) 12:39, 18 June 2024 (UTC)

It's written by a neuroscience postdoc

Is this a notable neuroscience postdoc, or just the one who published some critical commentary first?

The new section was written as if to attribute opinion to the journal - not the researcher - and consisted of three quotes, which would seem excessive. To trim it down to the meat of the conclusion, I think you'd end up with something like:

A critical commentary on the Cass Review by postdoc researcher Dorieke Grijseel, published 14 June 2024, called into question "the robustness of the evidence the Review bases its claims on.".

Is that due, and even if it is is it worthy of a new section? In that form would it just go under "assorted opinion"? I'm not sure this is of any significance yet. I don't know to what extent we can even summarise what's in this paper, possibly the only part worth mentioning is:

highlights that a systematic review which the Cass report relied on had falsely reported an increased incidence of autism in a gender dysphoric group from 1.8% to 15.1%; the cited study actually said it was 13.8% to 15.1%.

From what I can make out that appears to be a legitimate howler, though not one that changes anything other than to increase the autism prevalence estimate fractionally. Still that's a point to watch.

than the already included statements by politicians

The political response is due, because this is taking place in a political context and politicians are manifestly acting on the results of the review. "Response from lobbying organisations" and "assorted responses", feel free to delete as far as I'm concerned, I think they are pointless fluff.

A "Responses in medical journals" section could work, but I think that any such section that could conceivably include this individual response, should also reinstate the BMJ editorial by Kamran Abbasi and other followup publications. Void if removed (talk) 13:32, 18 June 2024 (UTC)

Wikipedia represents a global view and all of those 4 pieces you mentioned are from the U.K., which the Cass Review itself is from too. Since the Cass Review itself has run counter to the most common current worldwide medical standard on transgender care, which is set forth by WPATH and followed by many countries of the world, so WP:DUE may apply here to ensure that, while the British medical community seems to rally behind the Cass review, the worldwide medical community on transgender care does not, since they mostly have criticized, or ignored it.

We can add those 4 British papers, noting they multiple people from the country of the Cass review have come out in support of it, but it needs to be contextualized as such, to ensure we maintain a WP:NPOV. Raladic (talk) 14:29, 18 June 2024 (UTC)

Your reversion took no account of my comments that this needs to be rewritten with attribution to the author, and I have no idea why you brought up WP:NOTCENSORED. Void if removed (talk) 14:52, 18 June 2024 (UTC)

It is already attributed. to be specific, it is attributed to "a paper in the international journal of transgender health". Which is the appropriate type of attribution to give in a case where we describe a publication in a paper from a non-public figure. --Licks-rocks (talk) 15:04, 18 June 2024 (UTC)

No it really isn't appropriate. It is the kind of aggrandising puffery that we have guidelines against. I can't remember the shortcut right now. @WhatamIdoing will know. It is important that D. M. Grijseels is a postdoc in brain research and might know a thing or two about marmoset vocalising but why on earth should an international encyclopaedia find their views on the Cass Review important? Seems WPATH's house journal accepts any papers critical of the Cass Review, no matter what one's qualifications or expertise is. -- Colin°^Talk Colin°^Talk 10:35, 19 June 2024 (UTC)

Because those views are published in a proper, internationally recognised, peer reviewed, academic journal, which means it's not just the name and reputation of the author that matters, but at least three other qualified experts in the relevant field (all of whose opinions alone would likely qualify as DUE under WP:EXPERTSPS) have gone over it and given their seal of approval.

Seems WPATH's house journal accepts any papers critical of the Cass Review, no matter what one's qualifications or expertise is.

Do you expect a serious reaction to this? Because this is the kind of comment I expect to see on WP:FRINGE, and I don't mean from any of the long term editors there. --Licks-rocks (talk) 11:17, 19 June 2024 (UTC)

It's WP:MEDSAY: "Do not hype a study by listing the names, credentials, institutions, or other "qualifications" of their authors. The text of the article should not needlessly duplicate the names, dates, titles, and other information about the source that you list in the citation. Always omit professional titles and academic degrees: use "Smith" or "Jones" rather than "Dr Smith" or "Prof Jones". It is necessary to specifically include such information only when a specific individual is being cited as an example of a person holding a minority view..."

We should not write things like "In June 2024, a critical commentary about the Cass Review was published in the International Journal of Transgender Health..." A more normal way to say this is "The Cass Review was criticized for..." (if you believe this view to be representative of a view held by a fairly large group) or to give the author's name with a brief description, e.g., "Neuroscientist Dorieke Grijseels said..." (if you believe this view to be held by a smaller group of people). In the latter case, these descriptions are usually just one word and profession-focused ("postdoctoral researcher" would be another option in this case[1]), but if you thought you needed a non-professional label, then Grijseels identified as "Dutch" and "queer" in this source. WhatamIdoing (talk) 14:32, 19 June 2024 (UTC)

There are many articles on Wikipedia that mention the journal that the article was published in. I don't believe there are any guidelines against that. It's very common, so it seems quite silly to blow up this one issue about it. Hist9600 (talk) 14:44, 19 June 2024 (UTC)

WP:MEDSAY is part of Wikipedia:Manual of Style/Medicine-related articles, which is a guideline. Naming the journals is WP:NEWSSTYLE ("A study published in the Journal of Important Things today says...") and should generally be avoided, especially when the journal is reputable, because it sounds like WP:HYPE. WhatamIdoing (talk) 16:28, 19 June 2024 (UTC)

When a paper has been through peer reviewed, that does not indicate that the peer reviewers agreed with our endorsed its conclusions. It simply means that the reviewers thought the paper was good enough to publish. 86.21.75.203 (talk) 22:31, 14 July 2024 (UTC)

Agree. What Lick-rocks wrote about there being at least three other highly notable experts all agreeing with the paper and "approving" it is total nonsense. Think about it for a second. What kind of experts would you want if you wanted to publish and review a paper critical of seven systematic reviews that had been published in a top tier journal. Well, I think you'd want an expert in systematic reviews. Or at least someone who had done a few in human clinical medicine. Even the author fails to qualify on these grounds (in fact, none of the critical publication or PDF on a webservers that have been presented here are authored by experts in systematic reviews and it very very much shows). If WPATH can't find someone better qualified than a lab-based monkey researcher to criticise these reviews doesn't suggest they can find anyone better to peer review them. It suggests that WPATH are so desperate to respond to the serious criticism they have faced about their scientific integrity, that they'll accept anything they can get. Which is sad, because science should be better than that. The team at York have, over 20 years, published over 200 systematic reviews, and teach the world how to do it. -- Colin°^Talk 07:42, 15 July 2024 (UTC)

The Economist recently reported on unsealed court documents that show WPATH commissioned systematic reviews from Johns Hopkins but demanded that they get final approval on what got published; the reviews have subsequently never seen the light of day. Given that all the published reviews seem to undermine WPATH's position it's not hard to imagine why. 212.36.63.7 (talk) 12:04, 15 July 2024 (UTC)

The author of that article is Jesse Singal (1). I'm unsure about his guidance on scientific consensus since seeing him argue it's a "mainstream scientific opinion" that Jeffrey Epstein isn't a pedophile. VintageVernacular (talk) 12:25, 15 July 2024 (UTC)

I agree with the analysis, neither of them are due. Draken Bowser (talk) 11:33, 19 June 2024 (UTC)

This is an important commentary on the review, and it obviously should be included. A criticism published in a peer-reviewed journal is not merely an "opinion", and you are incorrect to characterize it as such. Hist9600 (talk) 15:04, 18 June 2024 (UTC)

It looks a lot like an expert opinion by a non-notable expert, are you claiming it is something else? Draken Bowser (talk) 15:03, 19 June 2024 (UTC)

It's an analysis of the Cass Review published in a peer-reviewed academic journal on the topic of transgender health, that examines the methodology and findings of the Cass Review. Hist9600 (talk) 15:18, 19 June 2024 (UTC)

You are not disputing anything I said, what's the specific point you're trying to make? Draken Bowser (talk) 16:11, 19 June 2024 (UTC)

There is also this paper - The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children that was published two months ago and also raises some serious concerns on the report, highlighting the lack of transgender health experts in the authoring of the report and its resulting cisnormative bias, and pathologization, which should likely be included in the new Cass Review#Academic response section. Raladic (talk) 03:11, 19 June 2024 (UTC)

Raladic, that "Cis-supremacy" paper has been discussed to death already. It is now also irrelevant as it was commenting on the interim review and the speculation about "the lack of transgender health experts in the authoring of the report" would seem to be entirely that: speculation. See earlier discussions. -- Colin°^Talk 10:22, 19 June 2024 (UTC)

That wasn't speculation, that was an explicit part of the Cass Review's original Terms of Reference: Wider stakeholders around Cass were likewise selected for an absence of trans specific knowledge or experience, including exclusion of those with lived experience of being trans. The original published Terms of Reference (ToR) for the Cass Review’s assurance group explicitly excluded trans expertise, stating that it “deliberately does not contain subject matter experts or people with lived experience of gender services” [Report 1, version 1]. The current (updated) assurance group ToR is worded less clearly, yet still conveys exclusion of those with expertise or lived experience, as such individuals would naturally be expected to have an interest in the outcome of the review: Members are independent of NHS England and NHS Improvement and of providers of gender dysphoria services, and of any organisation or association that could reasonably be regarded as having a significant interest in the outcome of the Review. [Report 1, p. 2] (emphasis added)

I still believe the article should be included, handwaving away all peer reviewed criticism of a report/recommendations criticized by health organizations around the world cheapens the article and does not follow WP:NPOV. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:56, 19 June 2024 (UTC)

You know, this is typical silo-amateur-chitchat-nonsense. Read the actual words here. The "assurance group" is designed "to provide expert advice and challenge about the approach and processes used to conduct the review, and to ensure that the Review is conducted in accordance with its terms of reference". It contains just seven people. They are to be process nerds, utterly utterly unconcerned with the topic being analysed, but concerned with process. That link concludes "The Assurance Group advises on the Review process and not its outcome. Professional and lived experience will be used to determine the outcome and recommendations of the Review and will be captured through our participative and consensus development approach." Honestly, this is like complaining that the creative design team for the publication PDF and the IT department who arranged zoom meetings didn't contain any activist voices or people with lived experience.

YFNS you've just emphasised why we don't juxtapose serious medical reviews with the opinions of someone's mum. The whole sentence "the lack of transgender health experts in the authoring of the report" is bullshit through and through. This "assurance group" aren't authors at all. They have no opinions about trans healthcare at all and weren't asked for them. They were explicitly chosen to be independent (because, you know, it is an independent review) in order to ensure nobody could say they came to it prejudiced. This emphasises my point about the dregs that people are googling for and digging up. One the one had we have world renowned experts who spent years on this review, and on the other hand we have complete amateurs who are so filled with activist rage that they don't even read the documents carefully before banging out their criticism. -- Colin°^Talk 10:39, 22 June 2024 (UTC)

I think we need to be careful to avoid the trap that many culture-war articles fall into. There's a great tendency, for a subject one hates, to google articles that criticise it and then push hard for them to be included. We see it on all sides of these debates. The hope is that some of the shit thrown will stick. I despair. It isn't how articles should be written. We have here a respected consultant paediatrician asked to conduct an independent review. They spend four years consulting with experts on all sides and with patients and their parents. They commission a bunch of systematic reviews from the top academics who are expert in in conducting such reviews. Their systematic reviews are published in a top journal. Their final report is published and recommendations put into practice. And then some marmoset researcher from Germany gets their criticism published in a big paragraph on Wikipedia as though that's it: Cass Review is a pile of crap after all, because someone who studies monkey calls for a living says so. Can you imagine if our cancer or diabetes articles were written that way. That the UK approach to diabetes treatment was held up to criticism because some car mechanic from Croydon disagrees, and claims the whole thing is dodgy because they found a typo on page 13. If you sat down and wrote an article on diabetes treatment in the UK, would you consider a car mechanic to have any relevance? So why on earth should a monkey brain researcher be relevant? -- Colin°^Talk 11:01, 19 June 2024 (UTC)

Why are you bringing up Grijseels' past paper about monkey neuroscience in this thread as if to insinuate they aren't a human neuroscience expert? If I just wanted to insert any old paper criticizing the review, I would have started with Horton's published before the final report, but I started this section about two papers (one forthcoming) that offer very substantial critiques of the evidence base. Grijseels' paper published in a top transgender medicine specialist journal deals with, as I mentioned: brain development, structure, and comorbidity with neurodevelopmental conditions, which are key to the critique. VintageVernacular (talk) 11:31, 19 June 2024 (UTC)

On top of that, Scientific journals, by design, don't care about author credentials. They aren't allowed to care, and it would majorly dent their credibility if they did. We cite people by their initials and use things like double-blind peer review to avoid tunnel-visioning on author credentials. This is scientific method 101. --Licks-rocks (talk) 11:38, 19 June 2024 (UTC)

This might be so for actual scientific research. Not so for commentary pieces like this one (I have absolutely no idea why it is tagged "research article" in the header, as it certainly isn't scientific research: the introduction describes itself as a "commentary" so the question for any journal editor or journal reader is why we should care to listen to their commentary). The author's credentials do actually matter to Wikipedia. Are they someone who is notable for their expertise with systematic reviews (doesn't appear they have ever done one, let alone written about them). Are they someone who is notable for their expertise with clinical studies of healthcare in humans (no, they do their science on mice, monkeys, or computer models). Are they an expert in trans healthcare or at least adolescent or mental healthcare (no, they work in a lab). This paper gives us an idea of motivation for why the sudden shift to writing an attack piece on a review, but motivation is not expertise and motivation of editors here to include this piece is also not a reason we should include it. It's a rather weak document, a rambling list of things the author decided to be critical about, with no knockout findings (such as a missing gold-standard study that actually provides the evidence that Cass says isn't there). -- Colin°^Talk 11:01, 22 June 2024 (UTC)

Why is it significant the writer signed a letter in a top journal, Cell, calling for challenging discrimination? It may tell us where the writer is coming from but has no actual bearing on the merit of the arguments in the paper. VintageVernacular (talk) 11:40, 22 June 2024 (UTC)

You're correct that promoting their vision for justice in one letter does not tell us anything about the merits of the arguments in another paper. It suggests a certain amount of bias (remember that bias is okay in reliable sources), but does not tell us whether the arguments are good or bad. To find out whether the arguments are good or bad, we would need another reliable source. In between now and the appearance of such sources, the best we can usually do is to follow the WP:PRIMARY policy: we avoid relying on primary sources at all, and say only things that can be clearly supported from them, without commentary, editorializing, hyping, etc. WhatamIdoing (talk) 21:18, 22 June 2024 (UTC)

An article on the Cass Review requires sources that analyze it multiple perspectives, using different methods. There is no reason why a study that analyzes the Cass Review, and points out certain issues, should be omitted from the article. Hist9600 (talk) 14:47, 19 June 2024 (UTC)

There is an important context in this, which is that medical organizations around the world have similarly given harsh criticism of the Cass Report, so it's not like this paper is some isolated opinion.

We also have to keep in mind that the Cass Report has been ordered by a government from a country that has shown a dramatic rise in "the extensive and often virulent attacks on the rights of LGBTI people for several years" as highlighted in a report by the Council of Europe and scientists from a country are not immune to the pressure of scientific misconduct as a survey in the BMJ has shown is Scientific misconduct is worryingly prevalent in the UK, shows BMJ survey in the very journal that the Cass Review is based on, or that there are politics of LGBT+ Health Inequality at play in the UK.

So rather than repeating the arguments that the Cass Report is unimpeachable, it is not, we should ensure that we give due weight to the global response of it, be it from WPATH, EPATH or other scientists that publish papers in reputable peer-reviewed journals. Raladic (talk) 15:26, 19 June 2024 (UTC)

We don't bring in sources that are not due because they say the same thing as other sources that are due. The opinions of relevant medorgs are already in the article. Draken Bowser (talk) 16:14, 19 June 2024 (UTC)

medical organizations around the world have similarly given harsh criticism of the Cass Report

And the Cass Review gave harsh criticism of the standards produced by those medical organizations. So we have a dispute between high-level MEDRS, between what are supposed to be top-of-the-pyramid medical standards, and an equivalently-top-of-the-pyramid systematic review of those standards which found them wanting.

This is a hard disagreement to navigate, but it isn't on its own an excuse to bring in any old random paper that rubbishes the Cass Review as if it carries any weight.

as highlighted in a report by the Council of Europe

I am strongly in favour of a moratorium on trying to disparage sources from the UK by citing that Council of Europe declaration. Void if removed (talk) 09:04, 21 June 2024 (UTC)

How did you come to the conclusion it's just some "random paper" and not a reasonable critique of the review by a scientist with relevant expertise + published in a specialist journal? It does seem to have due weight. VintageVernacular (talk) 11:27, 21 June 2024 (UTC)

The author appears to have no professional expertise (only personal experience). WhatamIdoing (talk) 21:20, 22 June 2024 (UTC)

Well, a PhD in neuroscience might equip you to better interpret brain research. But is that required to make a statement like: "A set of key points (7.16-7.20) [in the Cass Review] poses a possible link between increased availability of sexually explicit materials and gender dysphoria, based on an article by Nadrowski (2024). This article does not contain any primary research, but rather poses a yet untested theory. Indeed, the article itself notes that 'no studies have yet directly linked exposure to pornography with gender dysphoria' (Nadrowski, 2024, p. 294). The argument in the Nadrowski paper is not supported by data, and as the only source, is not sufficient to suggest a link"?

Or "they wrongly report the incidence of autism spectrum condition (ASC) as reported by Morandini et al. (2022), writing '[o]ne study reported data separately for 2012 and 2015 and demonstrated an increase from 1.8% to 15.1%' (Taylor et al., 2024d, p. 5), when the reported numbers were a non-significant increase from 13.8% to 15.1% (p= .662) (Morandini et al., 2022)."?

The journal editors, many of which I would expect do have professional expertise given the background, may have seen some value. VintageVernacular (talk) 22:11, 22 June 2024 (UTC)

"The author is an expert in the subject matter" and "There is value in this publication" are largely unrelated concepts.

The author has studied questions like how a particular gene changes blood flow in the mouse brain and which part of the brain is used when monkey perceive a voice. That is not really relevant to the Cass Review, which is largely not about neuroscience.

But let me engage with the two bits you've quoted, because they might make good examples of the sort of decisions Wikipedia editors need to make.

1. "Access to sexually explicit content" (7.16–7.20 in the report) is 11 sentences long. It is largely a recitation of statistics.
   • Grijseel says it "poses a possible link between increased availability of sexually explicit materials and gender dysphoria". If you wrote that in a Wikipedia article, we'd probably slap Template:Failed verification on it, because the relevant section in the final report says that other sources (e.g., "Research commentators recommend...") have posed this possible link.
   • Ditto for "as the only source", because anybody can see that three sources are named in that section: Children’s Commissioner, 2023" in 7.16, "Hanson 2020" in 7.19, and finally "Nadrowski, 2023" in 7.20. IMO Nadrowski could have been fairly described the only cited source from an academic journal, but that is not quite the same thing as "the only source".
   • Consider the claim that "The argument in the Nadrowski paper is not supported by data". This is a bit of a pot calling the kettle black situation, as Grijseel's publication is also not "supported by data" – in the narrow sense of "providing new data". There's nothing wrong with not providing new data; commentaries aren't intended to present new data, and neither are proposals for future research directions. But underneath it, all three (the Cass Review, Nadrowski, and Grijseel) agree: Nadrowski says there's not been much research about this, Cass says there's not been much research about this, and Grijseel says there's not been much research about this.
2. About "they wrongly report the incidence of autism spectrum condition (ASC) as reported by Morandini et al. (2022), writing '[o]ne study reported data separately for 2012 and 2015 and demonstrated an increase from 1.8% to 15.1%' (Taylor et al., 2024d, p. 5)..."
   • This is not in the final Cass report, and as far as I can tell from a quick search, that paper was not cited in support of any claim about any alleged increase in autism in the final report.
   • The error appears to be accurately described, but it seems like it would be more relevant to alert the editors of the journal where the error was published, so they can issue a simple correction (losing a single character is often the result of a typo).
   • Neither the Cass report nor the paper that contains the error claims that these numbers show a significant increase. Therefore this error doesn't seem relevant for us here, when we are writing Cass Review.

Overall, it feels like these statements are true (in some sense) but sort of stretching to find every possible complaint – less "This is fundamentally misguided" and more "How dare they rely on a paper that contains a typo!" WhatamIdoing (talk) 23:32, 22 June 2024 (UTC)

I'd also add that since 13.8 is higher than 1.8, the only result will be to fractionally increase the estimated prevalence of ASC in this demographic.

This really does seem to be the only substantive criticism. The rest is padding. Void if removed (talk) 08:06, 23 June 2024 (UTC)

We would slap a "failed verification" label on it? In the "Increase in referrals" section, that exact same claim about the review is made.

The ASC incidence is significant to what the Cass final report says on pages 93 and 97 where "ASD" stands for "autism spectrum disorder", and it cites the exact same systematic review, quoting it to say the increase in referrals was accompanied by "higher than expected levels of ASD". VintageVernacular (talk) 10:29, 23 June 2024 (UTC)

The systematic review assessed multiple papers and synthesized an average, this is detailed in the paper.

If one of the two dozen or so figures they used was erroneously too low due to a typo, will correcting it make the average go up or down do you think? Void if removed (talk) 11:14, 23 June 2024 (UTC)

VintageVernacular, that section does not contain "the exact same claim", or any claims about the prevalence of autism at all. WhatamIdoing (talk) 18:39, 23 June 2024 (UTC)

Meant the other part: "Suggested influences included ... early exposure to online pornography." VintageVernacular (talk) 18:43, 23 June 2024 (UTC)

That doesn't actually say that the final report has come up with this idea. I'd have chosen less ambiguous wording, but it's reasonable to read "suggested influences" as ideas that were suggested to the Cass team, rather than ideas they came up with themselves. WhatamIdoing (talk) 18:48, 23 June 2024 (UTC)

Also, Grijseel's criticism is about the change in the prevalence (from the incorrect 1.8% to the correct 15.1%). The claim in the Cass final report is only that the actual amount (which is not stated) is higher than expected (=the population baseline percentage, probably 1–2%, depending on your definition). The claim in the Cass final report is only that a lot of trans kids are also on the autism spectrum, and would still be true even if the review article had correctly type 13.8% as the 2012 prevalence. WhatamIdoing (talk) 18:44, 23 June 2024 (UTC)

It's all a bit notwithstanding, my point was basically you don't need to have written prescriptions to make basic arguments like those in a journal article; the ones I cited were just examples and selected because I perceived them as some of the most straightforward. Though whether these specific points showed up in the final report or not, they would have probably influenced it since these systematic reviews were its key basis. (Not every conversation Cass & co. had in consultation was cited directly either.) VintageVernacular (talk) 09:54, 24 June 2024 (UTC)

So, we've got two papers attacking the Cass review which have been shown to be seriously flawed themselves, and authored by people with no clinical expertise or in clinical research or systematic reviewing, which the review is founded upon. The "Cis-supremacy" paper that YFNS keeps banging on about contains a total falsehood about the "authorship" of the review, a falsehood that doesn't seem to stop people repeating it all over the internet on the basis that it is too good to be checked to see if it is actually true. And the monkey-researcher paper that has as its most challenging argument a typo that when corrected actually just reinforces the argument Cass was making about the levels of autism in the cohort. Almost as if Cass was totally familiar with the correct numbers all along, which one might expect if one had spent four years working on a report. -- Colin°^Talk 07:41, 2 July 2024 (UTC)

Any news on the BMJ correcting the "typo"? It's been over a month since this paper, whose author you continue to repeatedly refer to as a mere "monkey researcher" for unknown reasons, was published. VintageVernacular (talk) 12:16, 15 July 2024 (UTC)

I agree with Void about this Council of Europe thing. I'm utterly fed up with this xenophobic nonsense that no researchers in England are capable of higher thoughts because Liz Truss once said something awful. And the commentary is not by a scientist with "relevant expertise". That very very much is not the case. They are an activist who is writing outside their field of expertise. This frankly is a repeat of MMR and Covid silliness, where people are given a platform because they are on a particular side in a culture war, not because they actually know anything about the science or healthcare matters from an expert position. -- 11:05, 22 June 2024 (UTC) Colin°^Talk 11:05, 22 June 2024 (UTC)

Could you explain how brain science is outside the expertise of a neuroscientist? VintageVernacular (talk) 11:24, 22 June 2024 (UTC)

With all due respect, Colin, you are increasingly sounding like the people over at race and intelligence who whine that the current state of the field is only the way it is because most scientists are just biased or taking a side in a culture war or too afraid to say otherwise, and that therefore J. Philippe Rushton and the Pioneer Fund are the only credible scientists. Constantly complaining that one side of a scientific dispute is only saying the things it is because of culture war bullshit is a space that's more aligned with WP:PROFRINGE than opposed to it. Loki (talk) 02:52, 24 June 2024 (UTC)

The comparison to scientific racism is false; this is something rejected by the scientific community pretty much everywhere, whereas there are disagreements on the issue of gender dysphoria in children, with notable differences between countries.

I agree that the Council of Europe thing means nothing about the validity of British researchers, just as the antics of Donald Trump and his party means nothing about the validity of American ones.

As for the original topic of the discussion, I'll say that I don't have a problem with the author or journal, and this could be used as an addition citation to the statement that among academics, "others in both the UK and internationally disagreed with the report's methodology and findings." But here's a question: what does this source add to the article that isn't provided by other critical (in the negative sense) sources? Anywikiuser (talk) 16:38, 24 June 2024 (UTC)

I think the comparison to scientific racism is not entirely wrong. What we are seeing is a movement against the rights of a minority group, using fringe theories promoted by advocacy groups like Genspect and SEGM, that do not represent the scientific mainstream. The statements by the Council of Europe are useful in providing context about anti-LGBTQ+ sentiments that have increased in the UK in recent years. Hist9600 (talk) 21:14, 24 June 2024 (UTC)

This is a kind of meta-WP:OR, cobbling together negative sentiment from a variety of sources to cast doubt on WP:RS and it just isn't on.

This isn't adding anything, it is just being insulting. Please stop, it has absolutely no place on this page, where we are talking very specifically about the Cass Review, and none of this has any bearing whatsoever. Void if removed (talk) 08:14, 25 June 2024 (UTC)

What you're describing seems to be us contesting you on WP:WEIGHT. WP:OR is inapplicable on the talk page and the sources used are WP:RS. --Licks-rocks (talk) 14:43, 25 June 2024 (UTC)

I'm well aware that policy against WP:OR doesn't apply to talk pages, what I was referring to was cobbling together negative sentiment from a variety of sources to cast doubt on WP:RS and it just isn't on.. You are not judging WEIGHT by any empirical assessment of the source itself, or even conducting WP:OR in directly critiquing the source, you're defending the completely unwarranted citation of a random statement by a committee of the Council of Europe and some wild speculation to downweight sources from the UK and elevate the importance of criticism of them. The context was the statement:

We also have to keep in mind that the Cass Report has been ordered by a government from a country that has shown a dramatic rise in "the extensive and often virulent attacks on the rights of LGBTI people for several years" as highlighted in a report by the Council of Europe and scientists from a country are not immune to the pressure of scientific misconduct

The logic is: the government of the country that conducted the Cass Review was criticised by a committee in the Council of Europe for rejecting legal change of sex on basis of self-declaration, therefore the UK is institutionally suspect, therefore we should treat this completely unrelated, independent, expert report as suspect and throw terms like scientific misconduct around and therefore this absolutely terrible paper by some random postgrad is WP:DUE as a response.

This whole line of argument is egregious and offensive and veering into conspiracism, and I am asking again that it stop, and also that you stop defending it. None of this is relevant or useful, just inflammatory. Void if removed (talk) 08:00, 26 June 2024 (UTC)

Right, because a report carried out on behalf of a government is obviously unrelated to that government and what it thinks. Also, let's not pretend that this council of Europe thing is the strongest argument here, or that I agree with you on how you describe that paper, or that it's just that paper making these arguments.--Licks-rocks (talk) 11:03, 26 June 2024 (UTC)

A few comments ago, an editor was calling others "xenophobic" for contextualizing the Cass Review in relation to the poor and declining state of transgender rights in the United Kingdom. However, that context is important, and it should be considered when we see a sharp contrast between the support given to the Cass Review in the UK, and the more cautious or skeptical stances taken internationally. Hist9600 (talk) 01:10, 26 June 2024 (UTC)

This might be the only useful comment to come out of any complaint about the UK's bias and the Cass review. However this does not affect the Cass review by itself and should probably only be kept in mind with the reception section. LunaHasArrived (talk) 15:59, 26 June 2024 (UTC)

i think this page needs to be rewritten. the subject is of a scientific matter. better to include less news articles and more papers about the issue. Bird244 (talk) 01:57, 27 June 2024 (UTC)

@Hist9600 no editor has called other editors xenophobic". There's a difference between talking about what someone wrote and making a personal attack on their character. I don't think anyone here is xenophobic but some are getting carried away when repeating arguments they've read elsewhere and which seemed to resonate with that different crowd. Xenophobia is "having or showing a dislike of or prejudice against people from other countries" and every mention of that Council of Europe memo in order to discredit either Cass, their four-year independent review, or the world experts at conducting systematic reviews at York, is literally that. It needs to stop. Not least from the "people in glass houses" angle, bearing in mind the latest news about the rise of the Far Right in Europe and Trump in the USA. This low-brow level of debate might work when preaching to the converted on a blog or among one's twitter crowd, but has no place on Wikipedia. This review can be criticised for whatever claimed facts are wrong or disputed ,or disagreed with for whatever recommendations someone else thinks differently about. But criticising it because both Liz Truss and Cass have English accents is just plain offensive. -- Colin°^Talk 07:31, 2 July 2024 (UTC)

I'm not aware of anybody here disliking the UK, but it's interesting to me that you think that editors here have a personal dislike of that country. Being critical of the state of transgender healthcare in the UK, as well as the relatively poor state of trans rights in the UK, and the context in which the review was developed and published, is not xenophobia. Maybe you could stay on topic and assume WP:GOODFAITH of other editors, rather than making baseless accusations. People may be critical of something within a country, without having personal antipathy towards that country. As an example, being critical of the healthcare system in the United States, is not the same as anti-Americanism. Hist9600 (talk) 22:24, 2 July 2024 (UTC)

@Hist9600 please stop trying to turn this into a personal accusation. I am talking about what people wrote. Editors here are repeating stuff they read elsewhere (I've read it elsewhere too) and putting words on the page that are xenophobic. I have no interest in what they think in their own heads when they think their own thoughts. I'm not the one posting nonsense here that a nation of tens of millions are an unreliable source on trans issues because some document moaned about what Truss once said or the Telegraph once published. -- Colin°^Talk 07:15, 4 July 2024 (UTC)

You are construing the words of others in the worst possible ways, and also creating straw men along the lines of because both Liz Truss and Cass have English accents. The development and overall context of the Cass Review matter. Especially when we see the strong difference between reception of the review in the UK, and reception internationally. Hist9600 (talk) 15:19, 4 July 2024 (UTC)

Loki, this is not at all a subject like scientific racism or global warming or vaccines where the science is overwhelming and solid. There can be disagreements about what to do and how to act when we don't have good evidence for this therapy or that approach. But pretending one does have good evidence, when plainly one doesn't, is not science. Relying on old evidence based on cohort X when today we have cohort Y is also not science. This review has disappointing findings for some. What those York researchers did is not fringe science, but gold standard evidence-based-medicine, and their criticisms that some clinical guidelines should be more honest about their lack of evidential grounding is valid. I have yet to see any serious expert challenge to this, and the most repeated challenge on this page seems to be that because Cass has an English accent, she must be transphobic. -- Colin°^Talk 07:56, 2 July 2024 (UTC)

@VintageVernacular: I just read Grijseels article. My reading suggests that Colin's description of this as being authored by someone without relevant expertise is largely correct.

The following is the every mention of neuroscience in Grijseels' article:

• page 4, in one sentence, Grijseels rejects Cass Report's claim that the brain completes maturation in the mid-20s instead asserting that the brain continually changes throughout the lifespan. I note that our article Human brain development timeline § Childhood and adolescence seems to support the Cass Report against Grijseels on this issue.
• page 4, in two paragraphs, Cass Report notes the existence of critical period of adolescence and suggests this should be considered in their care. Grijseels recalls the definition of a "critical period" in brain development in the source cited by the Cass Report, "a time of increased plasticity when the neuronal network and its individual parts are particularly sensitive to incoming stimuli", and suggests such a period may not be relevant for brain maturation. (Which is confusing, because Grijseels just rejected the concept of brain maturation entirely.) Grijseels says there is not sufficient evidence on brain development for this line of study to have any impact on legal policies.
• page 5, in one paragraph, Grijseels criticizes the lack of a control group in available studies of the impact of cross-sex hormones on brain structure.
• page 5-6, in one paragraph, Grijseels argues that Cass misinterprets Mueller et al. (2021) on the neurobiology of transgender persons. I haven't dug into this deeply, but I note that Maite Arraiza Zabalegui says that Mueller et al. (2021) paradoxically endorses both brain mosaicism and neuroanatomical dimorphism. (Details on author, journal)

In my judgement, 13% of the article (655 of 5071 words) is about neuroscience. There is no indication in this article that the author has relevant prior knowledge and expertise in neuroscience. Rather, the entire article could plausibly have been written by an academic in any field. Further, the neuroscientific issues raised on page 4 are passing mentions in the Cass Report which are very peripheral to its conclusions. Only the last item in my list is a substantial disagreement between Grijseels and Cass on neuroscience. Daask (talk) 17:11, 27 June 2024 (UTC)

That's one's judgment (WP:OR). There's multiple ways to measure what's relevant. It excludes the part about comorbidity with autism, and the criticism of Cass citing Nadrowski's commentary positing a pornography–gender dysphoria link in autistic people from "reduced mentalization capacities" and "social contagion". I would say that's relevant to brain research since autism is categorized as a neurodevelopmental condition (discussed above, and I'm not arguing how important it is overall, but as an example of a subject excluded from this count). Yet I'd rather have it play out among published researchers approved by relevant expert editorial boards than Wikipedia editors... if I wanted to post every technical criticism of the Cass report on this talk page, I could, but they aren't all in WP:RS so what would be the point. VintageVernacular (talk) 17:49, 27 June 2024 (UTC)

Looks like the author has this title: Postdoctoral scholar at Max Planck Institute for Brain Research. In other words, an academic neuroscience background. I daresay far more of a background in neuroscience, than Hilary Cass had in transgender healthcare. And as you mention, there are some very outdated ideas about autism and transgender identities in the Cass Review, that are not in line with modern review studies on the subject. Hist9600 (talk) 20:16, 27 June 2024 (UTC)

I note that the article you're citing to reject Grijseels' first claim cites the claim that the brain stops maturing to a Slate article (i.e. very much not a WP:MEDRS source), and not only that but the source itself is making the directly opposite argument: that the brain does not stop maturing in the mid-20s.

Out of the two scholarly sources in that paragraph, one (bizarrely) has a note on it that says in this paper, the age 25 statement is attributed to another paper which actually makes no claims whatsoever about brain development, while the other directly refutes the claim by demonstrating a type of brain development that continues into the mid-30s. Or in other words, Grijseels' is both clearly correct here, and we really need to improve the article you've linked. Loki (talk) 22:50, 27 June 2024 (UTC)

Having said that, this talk page is getting far more edits than the article itself. Further conversation here may not be the best use of your energy. Daask (talk) 17:11, 27 June 2024 (UTC)

There is also criticism of the Cass Review in Pang, K. C., Wiggins, J., & Telfer, M. M. (2022). "Gender identity services for children and young people in England". BMJ (Clinical Research ed.), 377, o825. https://doi.org/10.1136/bmj.o825. Nosferattus (talk) 23:43, 12 July 2024 (UTC)

No, that is an editorial about the Cass interim report, not the Cass Review. Zeno27 (talk) 00:00, 13 July 2024 (UTC)

And consists of three Australians complaining that the report commissioned by NHS England to advise NHS England is too focused on the UK and doesn't need to do any further research as we already know the Correct Answer. -- Colin°^Talk 17:39, 14 July 2024 (UTC)

report to consider

this Yale report Is more criticism to consider. It's place on the evidence hierarchy has to be considered, but it's been a while since I got involved here and just wanted to add to evidence. LunaHasArrived (talk) 08:52, 2 July 2024 (UTC)

The link here seems to be a Yale Law School blog post about a Microsoft Word document sitting in a documents folder in a Yale Law School server. The "Integrity Project" seems to be just two people who are focused on American youth trans healthcare activism. Is this some kind of draft document intended to get published somewhere in future? At the moment, this isn't even what I'd call "published", never mind "published in a reputable journal". It may well be an important critique but maybe we can discuss it more if it actually gets properly published as I'm not sure this is citable at present. -- Colin°^Talk 10:02, 2 July 2024 (UTC)

I see now the actual file is a PDF, but my browser tab says "Microsoft Word - Cass Response.docx", so it looks like someone has just done "Save as PDF" or similar. This really isn't a published source we could cite yet. -- Colin°^Talk 10:09, 2 July 2024 (UTC)

That's what I thought might be the case, thank you for putting in your input. LunaHasArrived (talk) 11:17, 2 July 2024 (UTC)

That page lists more than two authors. Did you read it?

"In addition to Alstott and Dr. McNamara, the distinguished authors include Kellan Baker, Ph.D., Executive Director of the Whitman-Walker Institute; Kara Connelly, M.D., Associate Professor of Pediatrics, Division of Endocrinology, School of Medicine, Oregon Health & Science University; Aron Janssen, M.D., Associate Professor of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine; Johanna Olson-Kennedy, M.D., Professor of Clinical Pediatrics, Keck School of Medicine of USC; Ken C Pang, FRACP, Ph.D., NHMRC Leadership Fellow and Senior Principal Research Fellow, Murdoch Children’s Research Institute, VIC Australia; Ayden Scheim, Ph.D., Assistant Professor of Epidemiology, Drexel University Dornsife School of Public Health; Jack Turban, M.D., Assistant Professor, Psychiatry, University of California, San Francisco." VintageVernacular (talk) 00:20, 3 July 2024 (UTC)

That page lists more than two authors.

What Colin said was:

The "Integrity Project" seems to be just two people

This isn't a comment about the full list of co-authors its about the size/notability of the grand-sounding "Integrity Project" and their focus. Void if removed (talk) 11:36, 3 July 2024 (UTC)

It has has been picked up by the press in Scotland now, so it’s definitely citable and as VintageVernacular pointed out above, it was co authored by a lot more than just two people. Raladic (talk) 01:25, 3 July 2024 (UTC)

With that citation I think this is, at best, another cite that can be added to the line:

The report was praised by some academics in the UK, who agreed with its findings stating a lack of evidence; while others both in the UK and internationally disagreed with the report's methodology and findings

If it gets published in a peer-reviewed journal, then the report itself would likely be WP:DUE because of the notability of the authors. Void if removed (talk) 11:30, 3 July 2024 (UTC)

I'm struggling to get past the first line of that report's introduction because it's balatanty factually incorrect: "In 2020, the United Kingdom’s National Health Service (NHS) commissioned an inquiry to provide recommendations for the healthcare of transgender adolescents." Zeno27 (talk) 11:38, 3 July 2024 (UTC)

"The Independent Review of Gender Identity Services for Children and Young People (The Cass Review) was commissioned by NHS England and NHS Improvement in Autumn 2020 to make recommendations about the services provided by the NHS to children and young people who are questioning their gender identity or experiencing gender incongruence. "

Is from the Cass reviews own website. If you want to argue about NHS UK not existing thats fine, but it's a response to the Cass review mainly, I don't think it's too relevant who exactly commissioned it. LunaHasArrived (talk) 12:30, 3 July 2024 (UTC)

I'm not arguing about it, just pointing out they get off to a bad start by getting basic facts wrong. Still working my way through the rest of it. Zeno27 (talk) 16:07, 3 July 2024 (UTC)

I don’t think confusing UK/England is fatal. The organisational structure of healthcare in the UK is not the material point, and papers aren’t materially harmed by making simple errors outside of their core chain of reasoning. It’s the kind of issue that might get picked up in peer review, the lack of which is the main issue with this paper. Let’s see if it gets published, and then evaluate the published version. Barnards.tar.gz (talk) 09:24, 4 July 2024 (UTC)

Or any kind of review, peer or editorial. It's self published. I'm perplexed about their comments on NOS. When the earlier NICE reviews were published, activists complained that they use GRADE, which is weak for studies that aren't RCTs. Now they use NOS, which is more appropriate for the studies being looked at, and this paper seems to be saying they should have used GRADE. They use "political language" like "not recommended by" to say things in a dishonest way. Well it seems Cochrane did recommend NOS for systematic reviews of non-randomised studies, but then developed their own in house "Risk of Bias" tool. That sounds to me a bit like saying Apple doesn't recommend using Google Pixel phones. Well they would, wouldn't they. They go on at length about why they think this tool is bad. You know the old phrase "If you're explaining, you're losing". Well, if their opinion on NOS was widely accepted, they could just cite someone and move on. Instead, we have here a self-published doc trying to discredit a major review and it has to try to conduct original research in front of its readers about why the authors think NOS is bad. That's a big red flag. Futhermore, it is all like complaining about the font the author's used, if it doesn't change the result. The result, about lack of good evidence, has been something systematic reviews have been saying for years, and wouldn't change if they did it another way. -- Colin°^Talk 09:57, 4 July 2024 (UTC)

reading section 6 (as only 6 and 7 actually consider the York SRs) they don't seem to have made any recommendation on which quality appraisal tool to use. They do recommend GRADE and the AHRQ approach when it comes to assessing the entire body of evidence (something the York SR's didn't seem to use a tool for whatsever) and They do in fact cite multiple studies to say NOS is inaccurate. The robis tool that Noone uses is a tool to assess whether a systematic review is at risk of bias, not a tool to assess the quality of individual studies. LunaHasArrived (talk) 12:31, 4 July 2024 (UTC)

You mean the study they cited to say "Using NOS, reviewers often come up with different quality appraisals" but the study was one where they asked two researchers to use NOS and assessed whether they come up with similar. So "two researchers" in one study isn't "reviewers often come up with different quality appraisals". The point is, if NOS was explicitly "not recommended" then they'd be able to cite one or two big names that say "We do not recommend using NOS for this kind of thing". And they don't.

Their line "NOS includes items that are immaterial to assessing risk of bias" cites source 96 which is here and which says "The Cochrane Handbook highlights two other tools for use in nonrandomized studies: the Downs and Black and Newcastle Ottawa Scale. They implicitly recommend the Newcastle Ottawa Scale over the Downs and Black because the Downs and Black is time-consuming to apply, requires considerable epidemiology expertise, and has been found difficult to apply to case-control studies. The Newcastle Ottawa Scale is frequently used in systematic reviews for articles about studies with this type of design. It contains separate questions for cohort and case-control studies. It was developed based on threats to validity in nonrandomized studies" which I suppose was being positive about it so they didn't cite that bit. Another source they cite seems very very old, making me think it even predates NOS.

If you google the scale, you find that it is widely widely used and also like all such tools, widely discussed for its strengths and limitations. The criticism here seems to be a bit like someone saying they used a PC to write the Cass Review and then citing lots of "Mac User" articles and forums saying how Macs are better. -- Colin°^Talk 14:31, 4 July 2024 (UTC)

Macs actually are better. ;-p WhatamIdoing (talk) 02:41, 5 July 2024 (UTC)

That's honestly what I was thinking at the moment, they're clearly subject matter experts and the reports been used by others. We might at some point want to reconsider the balance attributed in that sentence, but I can see that being a point to consider down the road. LunaHasArrived (talk) 12:33, 3 July 2024 (UTC)

Based on what others have said, I support including it. Snokalok (talk) 02:18, 3 July 2024 (UTC)

The Yale Integrity report by eight distinguished legal scholars and scientists presents the mainstream perspective and is essentially the most comprehensive (for now) mainstream counter-report, and clearly needs to be discussed. The Cass report has been widely criticized and promotes ideas that are quite fringe. Badenoch has admitted that it was meant to promote gender-critical ideas. Gender-critical ideology was recently described by the UN as an extremist movement that uses "hateful propaganda and disinformation to target and attempt to delegitimize people with diverse sexual orientations, gender identities, gender expressions, and sex characteristics". [2] --Amanda A. Brant (talk) 21:46, 3 July 2024 (UTC)

What is this "Yale Integrity report"? The "Integrity Project" is two people who happen to work at Yale Law School. The document itself has some medical co-authors but that doesn't make it a Yale university official body. It is also not a "medical organisation" so I've removed the two refs to it from the lead. Also the document is at present not actually in any publication at all, but a PDF on a documents folder on the server of a law school. Until it is published by a reliable source, we can't cite it. At present it itself is no more reliable than a Substack post or an Unherd rant. I have absolutely no idea why Badenoch is being mentioned. Could editors please contain their rants to their personal blog space or whatever. -- Colin°^Talk 07:27, 4 July 2024 (UTC)

@Amanda A. Brant, can you provide a source for that contentious statement about a living person?

I'm not sure why it's relevant (was Badenoch involved in the report?), but if the BLP rules apply on talk pages, too. WhatamIdoing (talk) 17:04, 5 July 2024 (UTC)

Refers to this (non-X link), and while it can be interpreted the way that was mentioned, it's ambiguous enough I don't think it's worth discussing here without interpretation by RS. VintageVernacular (talk) 17:53, 5 July 2024 (UTC)

I think that is an unfair interpretation. The comment is in response to why , and the politician's response is that it happened because she (the minister of equalities) is gender-critical herself. IMO it's a stretch too far for our BLP rules to say that a comment that says "The Cass Review would **never** have been commissioned under a Labour govt" actually means "it [the Cass Review] was meant to promote gender-critical ideas". WhatamIdoing (talk) 19:48, 5 July 2024 (UTC)

It is a perfectly reasonable interpretation of it. See journalist Erin Reed's comments on it[3][4][5]. --Amanda A. Brant (talk) 22:46, 6 July 2024 (UTC)

Amanda, Reed is an activist blogger who's work is occasionally reprinted by activist publications. They aren't a "journalist" of standing enough to support BLP claims. Wasting our time with conspiracy theories about the purpose or origin of the Cass Review is not helpful, as is all the stuff below about the UK and Russia. This is not a forum. -- Colin°^Talk 15:03, 7 July 2024 (UTC)

The removal of sourced content for no other reason than WP:IDONTLIKEIT is completely unacceptable, as is the attempt to portray Amnesty and anti-trans hate groups as being "the same" with a misleading and biased title. Also, the lead should accurately reflect the content of the article, also regarding what kind of organizations that have criticized this report. It or the use/weaponization of it by anti-trans groups has been widely criticized by human rights organizations (such as Amnesty), LGBTIQ+ rights groups in addition to medical organization, and is indeed a key feature of it, from a US perspective indeed its main claim to fame. This is a matter of human rights as much as it is a matter of medicine, in a climate where the UK has become known internationally for "virulent attacks on the rights of LGBTI people".[6] --Amanda A. Brant (talk) 22:39, 3 July 2024 (UTC)

Amanda, please read the discussion above, and self revert. You're massively over inflating a non peer reviewed document. Void if removed (talk) 05:45, 4 July 2024 (UTC)

Having removed the link to Yale's own blog post, the only "reliable" independent source mentioning this report that we are citing is to Ross Hunter, Multimedia Journalist at The National, which is a niche newspaper (circulation less than 3,000) focused on Scottish Independence. We need to do better than that for this to be notable. -- Colin°^Talk 07:32, 4 July 2024 (UTC)

Nobody has claimed it is a "medical organization". Transgender/LGBTIQ+ rights are matters of human rights and law, just as much as they are matters of medicine. The claim that the report isn't "published" is flatly wrong and misunderstands how the legal field works. In law, peer reviewed journal publications are not the only authoritative sources, other kinds of opinions are too, including judgements and expert opinions by prominent jurists. In the legal field, what matters is whether the opinion is authored by reputable jurists. Additionally, what matters for us is whether there are reliable sources describing this report[7]. I understand that medical science works somewhat differently, as it relies much more on peer-reviewed journal articles.

Note that the Cass report is not a peer-reviewed publication like an article in a peer-reviewed journal. It is a "report," similar to the Yale report. There is nothing wrong with that; academics sometimes publish reports to investigate various issues. Typically, peer-reviewed publications aim to advance knowledge, but reports can be aimed at a broader group of stakeholders and provide an overview of a topic. The Cass report is clearly not just aimed at academics, and the response from a group of prominent legal scholars, published in the same format, is part of the conversation around it. The claims about "two people" are nonsensical when there are eight co-authors, and there are no policy-based reasons for the removal of this sourced content. WP:IDONTLIKEIT is not an acceptable reason to remove it

Also, the attempt to portray Amnesty and extremist anti-trans hate groups as being "the same" by having them in the same section with a biased title insinuating they are the same kinds of organizations, is unacceptable. --Amanda A. Brant (talk) 16:20, 4 July 2024 (UTC)

I'm not following the conversation very closely (apologies), but in The National's report it seems to attribute to both "Yale Law School and the Yale School of Medicine". VintageVernacular (talk) 16:33, 4 July 2024 (UTC)

Alstott is from Yale Law School and McNamara is from the Yale School of Medicine. The report is from "The Integrity Project" which they both run, but which seems to be attached to the Law School. Void if removed (talk) 16:54, 4 July 2024 (UTC)

This looks like a self-published WP:PREPRINT.

There are bits that seem silly. For example, Expertise is not considered bias in any other realm of science or medicine... The MDs among the authors, at least, should be familiar with the idea that if you don't want surgery, you shouldn't ask a surgeon for advice, because surgeons are biased towards surgery.

Much more generally, thinking about the critical sources in general, I think the two "sides" are talking past each other. The Cass Review seem to be starting from the POV that you have kids in distress. They need help, and you've no idea which ones will be helped long-term with gender-affirming social and medical care. The critics seem to be starting from the POV that you have trans kids who need gender-affirming social and medical care.

Here's an example of how that plays out in the Integrity Project report: The report asserts that anyone who wants to make a clinical recommendation (e.g., about trans kids) must be a subject-matter expert (e.g., in trans kids). Cass and her committee are not experts specifically in providing gender-affirming care; therefore, (according to the Integrity Project) they are not even allowed to ask a qualified team to perform a systematic review on the subject. The Cass team, on the other hand, are saying that these are distressed kids, and they are experts in distressed kids, so they actually are qualified to commission research by other experts on this subject.

(For myself, I keep cynically thinking that all of these critics would cheerfully accept large grants from utterly unqualified people/foundations to conduct such systematic reviews themselves, because the main problem really isn't that the Cass team commissioned the systematic reviews. The problem is that the systematic reviews accurately showed that the emperor is missing part of his clothes, and that's being politically exploited to produce some very severe practical problems in the short-term. I doubt that any of actual experts believed that the evidence base was spectacular. They just very sensibly don't want the dirty laundry to be aired in public, especially since part of the reason the evidence base is so bad is because of chronic underfunding due to bigotry.) WhatamIdoing (talk) 02:31, 5 July 2024 (UTC)

The Cass Review seem to be starting from the POV that you have kids in distress. [..] The critics seem to be starting from the POV that you have trans kids who need gender-affirming social and medical care.

That is the entire dispute in a nutshell. Void if removed (talk) 09:36, 5 July 2024 (UTC)

dispute over sources in this article

due to disputes in this talk section over which sources used in this article are reliable, i ask that anyone who edits this article in future only cite peer reviewed scientific papers and medical journals such as Scientific American, new England journal of medicine and the British Medical Journal. this is a matter of medical and scientific importance that is complicated, and it would be immoral to add misleading information. Bird244 (talk) 11:10, 4 July 2024 (UTC)

We use sources in accordance with their reliability and due weight. For biomedical claims we have stricter standards: WP:MEDRS. We consider sources in context, and we do not have a pre-determined list of which sources are usable. Often it is necessary to discuss each one on its own merits.

By the way, are you aware that Scientific American is not a peer reviewed medical journal or source of scientific papers? Barnards.tar.gz (talk) 11:21, 4 July 2024 (UTC)

oh. my mistake Bird244 (talk) 23:39, 4 July 2024 (UTC)

As Barnards said, we use sources as they become relevant. If for instance the Cass Review is cited as the reason for a change in political policy, we can very well cite a new report on that change. If a medical org puts out a statement on the report, we can cite that statement as a source for that org saying whatever it said. Snokalok (talk) 11:46, 4 July 2024 (UTC)

There is no need to reinvent WP:MEDRS. Flounder fillet (talk) 13:42, 5 July 2024 (UTC)

Bizarre title "Response from lobbying organisations"

The title "Response from lobbying organisations" is biased and misleading. This section groups opinions from anti-trans hate groups with those of recognized human rights organizations like Amnesty. This misleading title implies equivalence between these groups – in fact that appears to be the whole point of the title. Additionally, including the Yale Integrity Project report and labeling Yale Law School and reputable legal scholars as a "lobbying organization" is inappropriate. Since there has been no attempt to even justify this biased title, and since the title is clearly biased and inappropriate, I am correcting it. --Amanda A. Brant (talk) 22:19, 4 July 2024 (UTC)

These headings are still a bit of mess and the content doesn't always match the heading:

Response from human rights organisations: a human rights organisation and two lobbying organisations.

Response from gender-critical organisations: two lobbying organisations, one of which is a human rights organisation

Yale report: I can't see why this has its own heading and why it's in here.

Assorted responses: a UK Government statutory body, various others and a UN Special Rapporteur

Suggestions for improvement? Zeno27 (talk) 23:01, 4 July 2024 (UTC)

None of the anti-trans groups are "human rights organizations". The Yale report merits its own sub heading, and it also doesn't fit in any of the other sections, or the section where it had been placed, on purported "lobbying" (sic!) organizations alongside the opinions of anti-trans fringe/hate groups. How can a report by eight Yale scholars be a "lobbying organization"? --Amanda A. Brant (talk) 01:13, 5 July 2024 (UTC)

A government agency also can't be a lobbying organization, because lobbying is about trying to influence the government. The Yale Integrity Project probably counts as "an organization". Back in the day, we probably would have called them a Special interest group. WhatamIdoing (talk) 02:14, 5 July 2024 (UTC)

The Yale Integrity Project is a project at a law school. They focus on bridging the gap between law and medicine. More here[8] --Amanda A. Brant (talk) 03:09, 5 July 2024 (UTC)

Sex Matters is a registered charity and their charitable objects - as accepted by the Charity Commission - state they aim "TO PROMOTE HUMAN RIGHTS (AS SET OUT IN THE UNIVERSAL DECLARATION OF HUMAN RIGHTS AND SUBSEQUENT UNITED NATIONS CONVENTIONS AND DECLARATIONS) THROUGHOUT THE WORLD"[9] To not describe them as a human rights organisation in the face of this cannot be NPOV unless and until balancing evidence to the contrary is provided. Zeno27 (talk) 09:30, 5 July 2024 (UTC)

That doesn't make them a human rights organization. Working against trans people's (human) rights is the very opposite of working for human rights. The Soviet constitution described the Soviet Union as a perfect democracy, which didn't make it true. Sex Matters is an anti-trans hate group, and a fringe group. It doesn't even have its own article, it's really just an anti-trans activist who claims to have lost her job and now spends her time campaigning against trans rights. Comparing that to Amnesty is absurd. --Amanda A. Brant (talk) 12:33, 5 July 2024 (UTC)

I have provided evidence they are considered a human rights organisation by the Charity Commission: for balance, what's the NPOV evidence this is incorrect? Zeno27 (talk) 13:41, 5 July 2024 (UTC)

The counter is that the United Nations has called out gender critical organizations being against human rights, such as the recent callout by UN Women as outlined in our article on Gender-critical feminism. The consensus is that they are not a human rights organization, but against human rights. Raladic (talk) 15:35, 5 July 2024 (UTC)

That is not any sort of consensus. Void if removed (talk) 15:46, 5 July 2024 (UTC)

There is clear consensus on Wikipedia that anti-trans hate groups cannot be described as "human rights organizations," that we don't describe them as such in Wikipedia's voice. It's really quite an extreme statement. Any racist, anti-semitic or transphobic organization may claim to work for "human rights", but it doesn't make it true. The abuse of human rights language and concepts by anti-gender and other extremist movements has in fact been commented widely upon in scholarship and by recognized human rights organizations. --Amanda A. Brant (talk) 16:27, 5 July 2024 (UTC)

There is no clear consensus on various such groups being "anti-trans hate groups" in the first place: please renounce your inflammatory POV. Zilch-nada (talk) 22:26, 17 July 2024 (UTC)

The question isn't whether the United Nations has called out gender critical organisations as being against human rights; the question here is whether Sex Matters has been called out and whether that criticism is well-founded. Sex Matters was not even mentioned by UN Women in their 'explainer'. That Gender-critical feminism article also does not say that Sex Matters is not a human rights organisation. So all we have here is vague hand-waving versus the Charity Commission's acceptance of them as such. Zeno27 (talk) 16:02, 5 July 2024 (UTC)

I can't believe I have to type out "sex matters is not a human rights group" on Wikipedia. While I'm stating the obvious: the earth is not flat and vaccines don't cause autism.

Sex Matters describe themselves as a human rights organisation that aims to promote clarity about sex in law, policy and language. But it has also been labelled anti-trans, with their website boasting statements such as: “No child or teenager believes they need to modify their body to match their gender non-conformity.”[10]

the director of advocacy at Sex Matters, Helen Joyce[11] has said while we’re trying to get through to the decision-makers, we have to try to limit the harm and that means reducing or keeping down the number of people who transition. That’s for two reasons – one of them is that every one of those people is a person who’s been damaged. But the second one is every one of those people is basically, you know, a huge problem to a sane world.[12]

Transphobes are blasting the razor company Braun for its ad featuring a trans man who shaves while shirtless with visible mastectomy scars on his chest. ... Maya Forstater, executive director of the transphobic activist group Sex Matters, told The Telegraph that the ad goes against the Advertising Standards Authority (ASA).[13]

Here's a piece in the Times where Sex Matters acknowledges that UN Women has called gender-critical campaigners (including them) an anti-rights movement (which they complain about - arguing that UNW is wrong because trans rights pose a threat to cis women, the exact argument that UNW calls out as nonsense)[14]

What about academic sources?

• anti-trans feminist groups, perhaps seeing faith-based conversion practices as the devil they know, are conscientious to avoid breaking ranks. One such group, Sex Matters, argues in its consultation response that, because ‘the UK is an increasingly secular country’ and conversion practices in religious settings are now contained to ‘small pockets’, targeting religious conversion therapy would be ‘fighting yesterday’s battles’ (Sex Matters, 2022, pp. 1-2).[15]
• a paradox of contemporary ‘gender critical’ feminism: that it claims to be a movement for liberation from gender at the same time as it advocates for the surveillance and control of gender deviants - the article frequently calls out sex matters on those grounds.[16]
• the ball was rolling on a new and, at the time, UK specific iteration of trans-exclusionary feminism, bringing together long-time trans-exclusionary figures and newly concerned individuals.This single-issue movement quickly gave rise to campaign groups in the UK (e.g. Women’s Place UK, Fair Play for Women, Filia, Resisters, Sex Matters, LGB Alliance, to name a few)[17]
• The core members of SEGM frequently serve together on the boards of other organizations that oppose gender-affirming treatment and, like SEGM, feature biased and unscientific content. These include Genspect, Gender Identity Challenge (GENID), Gender Health Query, Rethink Identity Medicine Ethics, Sex Matters, Gender Exploratory Therapy Team, Gender Dysphoria Working Group, and the Institute for Comprehensive Gender Dysphoria Research[18]

This was a small sampling of dozens upon dozens of sources calling them anti-trans, transphobic, etc. There is not a single thing they advocate that advances human rights in any way and the only people who call them a human rights org are other gender critical campaigners. We can call them a "human rights group" in wikivoice the same day we state in wikivoice that "YFNS is the Queen of England". Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:13, 5 July 2024 (UTC)

So Pink News and LGBTQ Nation don't like them, then there's some academic essays that are good for attributed opinion if they're notable academics, and - oh look - a previous report from Allsott and McNamara of the "Yale Integrity Project" denigrating organisations like Sex Matters (babout whom they seem to know absolutely nothing) on the basis of overblown claims about the strength of evidence which are of course completely refuted by the Cass Review.

This report, directed at legal battles in the US (eg. in Texas and Alabama) to challenge or overturn bans on transgender healthcare, includes many contentious statements like:

Puberty blockers are fully reversible

The evidence suggests that the vast majority of adolescents who are diagnosed with gender dysphoria will persist in their gender identity and will benefit from gender-affirming medical care

The claimed “spike” in referrals [at GIDS] certainly reflects the reduction in social stigma over the past decade and the expansion of care options.

The Texas Attorney General claims that “[t]here is insufficient medical evidence available to demonstrate that discontinuing [puberty-blocking] medication resumes a normal puberty process.” The Alabama Law contains similar statements.The claim is false: puberty blocking medication has been shown to be safe, effective, and fully reversible.

And many more.

So it turns out they not only have a pre-existing stance against what are now the findings of the Cass Review, but also a legal strategy based on that. As part of this they have attacked other organisations which do not share this interpretation of the evidence, but the Cass Review completely undercuts the basis of those criticisms.

So on June 26th, the Alabama Attorney General cited the Cass Review in a motion for summary judgment that is withering in its criticism of WPATH among other things:

Against these findings, Plaintiffs rely on guidelines by WPATH and the Endocrine Society. Plaintiffs claim these standards are reliable and have “been adopted by the major medical and mental health associations,” including the “American Medical Association” and the “American Academy of Pediatrics.” The Cass Review determined that both guidelines are in fact unreliable and methodologically unrigorous.

And less than two weeks later the "integrity project" release a new report rubbishing the Cass Review in hyperbolic language and the thinnest of grounds. This is partisan lawfare emanating from the toxic political situation in the US. Void if removed (talk) 20:59, 5 July 2024 (UTC)

Gonna skip right past their director of advocacy saying trans people are "damaged", "a problem for a sane world", and should be kept from transition? They're a WP:FRINGE group, not a human rights org.

I also have no clue how Alabama's AG making it a felony to provide gender affirming care (sourcing "expert" witnesses from places like the Alliance Defending Freedom) is relevant [19] - every single medical organization in the US has opposed bullshit like that so I've no clue where you got "partisan lawfare" from. The evidence suggests that the vast majority of adolescents who are diagnosed with gender dysphoria will persist in their gender identity and will benefit from gender-affirming medical care - this is also 100% true. Cass admitted the first part and said the evidence for GAC is weak, not non-existent.

Also, per WP:MEDRS, when you have a lot of medical orgs saying "you treat X with Z", one report says "we should treat X with Y instead", one government internationally criticized by human rights groups for their treatment of X agrees, and the rest of medorgs continue to say "no, you treat X with Z" - then we go with the MEDORGS. The Cass report is not a trump card or the end all be all of trans healthcare, and your logic is circular (you can't discount criticisms of the Cass report based on "if they criticize the Cass report they're unreliable"). Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 00:04, 6 July 2024 (UTC)

"the vast majority of adolescents who are diagnosed with gender dysphoria will persist in their gender identity" is only true if their puberty is blocked. When their puberty is NOT blocked only ~15% persist in trans identity and the rest begins healthy gay young adults. Wherefore GAC for children is considered by many, in especial lesbians and gays, to be gay conversion therapy.

The counterargument that the change in persistence rates is due to stricter standards is not a plausible argument, either, not least of which it was already known several years before the switch from GID to GD that blocking puberty causes a shift from 85% desistence to 99% persistence.

The claim to the contrary is medical disunfirmation, the propagation of which actually can lead to increased & unnecessary deaths. (Keep in mind at no time were there mass suicides in the past due to lack of pediatric gender medicine!!) 73.2.86.132 (talk) 01:39, 6 July 2024 (UTC)

Completely untrue - kids who were gender nonconforming or trans used to be diagnosed with "gender identity disorder". The majority never said they were trans, so they couldn't "desist". The real medical disinformation is saying "decades ago, some gay kids who never said they were trans never said they were trans, so therefore kids who say they're trans are gay"

Calling affirming trans kids gay conversion therapy is only done by a small group of fringe activists, no medical org in the world agrees (not least of all, because the majority of trans people are LGB) Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 02:01, 6 July 2024 (UTC)

It's sometimes helpful to lay out the arguments on this side or that. I have done this myself many times over the years, and I find it most useful when someone can then tell me that I've misunderstood one or both of the sides. (Thank you to all such editors, including at least three editors on this page.)

But at this moment, I think we're headed into WP:NOTFORUM territory, so I think we should either drop this, or that subsequent comments should be in a form that is similar to "We should change the article from X to Y because this independent source says Z". WhatamIdoing (talk) 16:39, 6 July 2024 (UTC)

Which of these references could be cited as stating that Sex Matters is not a ''human rights organisation''? Zeno27 (talk) 23:10, 5 July 2024 (UTC)

Do you have WP:RS that regard it as human rights group? You cited a primary source for why they registered their charity, I presented a lot of RS saying they're notable only for campaigning against the human rights of transgender people. Should go without saying, but "human rights group" and "anti-trans group" are, for the record, mutually exclusive descriptors.

The onus is on you to prove that RS consider it a human rights org, furthermore, to prove that enough RS do to counterbalance the multitude I provided who regard it as a discriminatory group. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 00:11, 6 July 2024 (UTC)

Moved Yale under "Assorted", until it gets wider coverage or peer-reviewed publication it is not due for a whole section to itself like this. Void if removed (talk) 09:34, 5 July 2024 (UTC)

That's not a good solution. We're talking about a thorough counter-report by scholars, reactions from large human rights organizations, opinions of SPLC-designated hate groups, and individual opinions from, for example, a former children's author. What on Earth do all these have in common? They belong in separate sections. Badenoch has openly said the aim of the report is to promote the gender-critical narrative, so a section on the gender-critical response would be appropriate. The reception by academics and mainstream human rights organizations has very little to do with the beliefs of SPLC-designated hate groups and individual anti-trans activists. --Amanda A. Brant (talk) 13:33, 5 July 2024 (UTC)

My preference is to remove them all, per WP:NOTEVERYTHING. More important responses have come along since these were chucked in at the report's release, so these seem like unnecessary/irrelevant padding to me. Eg. get rid of all of the following:

Amnesty International criticised "sensationalised coverage" of the review, stating "This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people." Trans youth charity Mermaids and the LGBTQIA+ charity Stonewall endorsed some of the report's recommendations, such as expanding service provisions with the new regional hubs, but raised concerns the review's recommendations may lead to barriers for transgender youth in accessing care. Gender-critical organisations including Sex Matters and Genspect welcomed the report. Stella O'Malley of Genspect expressed concern that if a conversion therapy ban were to criminalise any exploration into why a child identifies as trans, it "would ban the very therapy that Cass is saying should be prioritised". Void if removed (talk) 13:40, 5 July 2024 (UTC)

No, Amnesty's response definitely belongs there. The anti-trans groups' response can be included too, but it shouldn't be mixed with the reactions from recognized human rights bodies. --Amanda A. Brant (talk) 13:46, 5 July 2024 (UTC)

Glancing through the l-o-n-g list of orgs listed in the article at the moment, Amnesty is the only one that I'm comfortable calling a human rights organization. WhatamIdoing (talk) 19:53, 5 July 2024 (UTC)

Even if we leave Amnesty etc in, I'd gladly lose Gender-critical organisations including Sex Matters and Genspect welcomed the report. Stella O'Malley of Genspect expressed concern that if a conversion therapy ban were to criminalise any exploration into why a child identifies as trans, it "would ban the very therapy that Cass is saying should be prioritised

It just seems nowhere near WP:DUE. Void if removed (talk) 20:24, 5 July 2024 (UTC)

I have no settled opinion about whether to keep any of them, as I think that we should be developing a rubric for inclusion (think Wikipedia:List selection criteria, except that it's not technically a list) and make our decisions based on that. If we don't do this, then editors are open to the charge of cherry-picking and POV pushing, and we do not need that risk with this article. WhatamIdoing (talk) 16:43, 6 July 2024 (UTC)

Due weight

Why exactly do we use 231 characters to report the opinion of a single person affiliated with an SPLC-designated hate group (Genspect), while the paragraph on a report by eight Yale scholars – essentially the counter-report from a mainstream academic perspective – has been shortened to just 130 characters? --Amanda A. Brant (talk) 13:33, 5 July 2024 (UTC)

I reverted that change. Yale’s opinion is obviously more notable than that, and it’s peculiar to me that breadth of coverage was never the bar for previous statements by relevant orgs, but it somehow is here Snokalok (talk) 14:02, 5 July 2024 (UTC)

It is not the opinion of "Yale".

It is a self-published document by a small political project at Yale Legal School that has received little coverage.

We give due weight to notable organisations, which this isn't. Void if removed (talk) 15:33, 5 July 2024 (UTC)

the counter-report from a mainstream academic perspective

This is overblown, can you please stop inflating the importance of this opinion. Void if removed (talk) 15:34, 5 July 2024 (UTC)

This is not how academia works. Universities don't have "opinions". Scholars do. In this case a group of eight prominent scholars and scientists working on the intersection of law and medicine/health policy who are affiliated with a very prominent university. The expert opinion carries weight. The report is essentially the most comprehensive (for now) counter-report from a mainstream academic perspective and should be treated as such. What they do is summarizing peer-reviewed scientific knowledge for a legal audience[20] and the report reflects mainstream scholarship and science in this area. Your absurd claim that this is a "political project" really says it all. --Amanda A. Brant (talk) 16:10, 5 July 2024 (UTC)

If the expert opinion carries weight in academia, where are the other academic publications citing this? WhatamIdoing (talk) 16:14, 5 July 2024 (UTC)

Again, this comment fundamentally misunderstands how this field works. Academic publications don't cite a report released days ago because academic publications don't appear within days, but years, months at best. Plus, the report isn't really intended as an academic publication, but aimed at a broader legal audience, per the goals of the project[21]. It's not a report that advances any new scientific claims, but that engages with another report (also not peer-reviewed or anything) by summarizing existing scholarship and knowledge. --Amanda A. Brant (talk) 16:19, 5 July 2024 (UTC)

So it is an unreviewed, self-published document by some US-based legal academics and members of WPATH that for some inexplicable reason has (so far) been reported in a tiny Scottish Nationalist paper, and Teen Vogue.

And as such it should be given very little weight because this is not a MEDORG statement or a statement from a notable organisation, nor is it a peer-reviewed MEDRS response, nor is it some comparable "counter-report", and it should definitely not sit in its own whole section.

Its also, as an aside, really, really poor. Void if removed (talk) 16:28, 5 July 2024 (UTC)

This is a matter of law and human rights, just as it is a matter of medicine. MEDORG and MEDRS have no relevance. The legal field has quite different traditions than medicine, and works quite differently. If you are going to push this point, the Cass report is an "unreviewed, self-published document" too – a really poor one, to boot, judging by its reception from many academics and recognized organizations in the field. --Amanda A. Brant (talk) 16:39, 5 July 2024 (UTC)

If this document is to be treated as a legal document rather than a medical one, then it’s essentially a case of WP:MANDY: a group of people who are responding to the threat of a (likely) incoming president who wants to put them out of business, or even in jail, and whose sympathetic lawyers have already used the Cass review as a pretext to argue for this. They’re not publishing reliable medical information, they’re raising a shield in a legal fight for their survival. Cass has implicitly levied an accusation, and this is them denying it. Well, they would, wouldn’t they? Barnards.tar.gz (talk) 08:07, 6 July 2024 (UTC)

What? 24.63.3.107 (talk) 21:55, 13 July 2024 (UTC)

I have a general concern, which includes but is by no means limited to, the Yale Integrity Project, that we are choosing sources that have the Right™ POV, even though they are self-published and do not seem to get much attention outside of this article.

For example, the first sentence has two inline citations, and I'm pretty sure that both of them could be replaced by proper Wikipedia:Independent sources, such as a BBC article. In fact, I wouldn't be surprised if they could be replaced by one of the news articles that is already cited in the article.

I think it would be desirable to get some agreement on the characteristics of sources that we would like to be relying on, and see if we can match that. WhatamIdoing (talk) 16:13, 5 July 2024 (UTC)

It's not "self-published" any more than the Cass report is. The Cass report is a "report" too, just published by the authors, not in a peer-reviewed journal or anything. Badenoch has openly admitted it was meant to promote a gender-critical (i.e. fringe and pseudoscientific) narrative, a narrative recently described as extremist by UN Women[22]. The insistence that the counter-report (that engages with the Cass report based on mainstream scholarship) should meet a completely different standard is just weird. It's an expert report by eight reputable scholars, published by Yale. --Amanda A. Brant (talk) 16:21, 5 July 2024 (UTC)

AIUI the Cass Report was technically published by the UK government, rather than by the authors themselves.

The Yale Integrity Project, on the other hand, is published by the authors themselves, as are the various press releases and open letters that we're citing. Some of these self-published documents have received significant attention from independent media outlets, which I think argues in favor of those being important for us to include. Others have been largely ignored by news, which suggests to me that we should probably not include them. Obviously, as things change over time (e.g., if a previously ignored statement gets attention, or if attention to an early statement turns out to be a very brief flash in the pan, and others are preferred afterwards), then the article would change, too.

This would be a typical approach for other subject areas and consistent with both our usual practice and the relevant policies and guidelines. Does that sound reasonable to you? WhatamIdoing (talk) 17:01, 5 July 2024 (UTC)

It was technically published by Yale University, as part of their work as experts in this area[23]. But all this is hairsplitting. From such a perspective the Cass report is also self-published, by a government that has been internationally condemned for its attacks on LGBT+ rights. So that is hardly an argument in its favor. It's not published by an academic journal, it's not peer-reviewed. It's a "report" that advances the opinions of the UK Government, and Badenoch said the aim was to promote a gender-critical narrative, i.e. a fringe anti-trans ideology and pseudoscience. So it's comparable to a report self-published by the Government on Russia on LGBT+ issues; we would certainly treat such a report with a fair amount of skepticism as a source too. If eight distinguished Yale scholars released a similar report critiquing the Russian anti-LGBT+ report, published by Yale, from a mainstream perspective, that would be regarded as a very solid source too. --Amanda A. Brant (talk) 20:56, 5 July 2024 (UTC)

It's a "report" that advances the opinions of the UK Government, and Badenoch said the aim was to promote a gender-critical narrative, i.e. a fringe anti-trans ideology and pseudoscience

None of this is true. Void if removed (talk) 22:30, 5 July 2024 (UTC)

Amanda, it's not published by the university, even though the PR team put out a press release about it. If it were published by the university, the authors would have no chance of getting it into a peer-reviewed journal (which I'm confident is their plan).

As for the Cass Review being self-published: If the report had come out as a strongly pro-trans stance, do you think it would have been published, or do you think the government (i.e., the Tories) would have suppressed it? If the latter, then you have to admit that the publication was not entirely under the control of its authors, and therefore it is not self-published. WhatamIdoing (talk) 16:49, 6 July 2024 (UTC)

Why are you using such conspiratorial language, and disconnected logic? That the Cass Review was published "by" the UK government, "advanc[ing] the opinions" of it -> the UK gov't. has often been "internationally condemned" for its attacks on LGBT+ rights -> Cass is unreliable. That is absolute SYNTH to the extreme.

The Cass Review is substantially peer reviewed itself, regardless of self-publishing or not. Seriously, consider stopping it with the inflammatory language. Zilch-nada (talk) 22:33, 17 July 2024 (UTC)

The context of the report matters. The Cass Review was not a review study done in a peer-reviewed journal without any clear purpose and goals. It was a review that was commissioned by NHS England, for the purpose of providing recommendations for the NHS, which had already failed to keep up with demands for trans healthcare. As such, it's inseparable from the larger context of a healthcare system run by the UK government. And of course, the UK government has gone to significant lengths in recent years to align itself with gender-critical positions. Hist9600 (talk) 00:22, 18 July 2024 (UTC)

Criticisms of the Cass Review - which are mentioned - relate to its methodology and, in the most fundamentally sense, science. What the above user is doing is not only employing original research to prove unreliablity, but also detracting from such criticisms. Cass has itself been the subject of significant reviews; those sources matter, not absurd personal synthesis. Zilch-nada (talk) 00:30, 18 July 2024 (UTC)

For instance, citing Kemi Badenoch - a polemical politician in this case - and not the substance of the report itself (or even meta-analyses of such "intentions") - to make supposed claims about the report's intentions - is immensely dishonest from a Wikipedia editor. Zilch-nada (talk) 00:32, 18 July 2024 (UTC)

It's Wikipedia editing policy to assume good faith on the part of other Wikipedia editors, and to remain civil on the talk pages. That may mean not accusing other editors of being "immensely dishonest" about what amounts to a different point of view, or a different way of thinking about a situation. Would you be willing to strike through that comment? Hist9600 (talk) 01:35, 18 July 2024 (UTC)

Are you accusing me of bad faith? I'm calling the argument dishonest, not the user themselves. Can you please explain how such aforesaid original research is justified? Zilch-nada (talk) 01:46, 18 July 2024 (UTC)

I'm reminding you to assume good faith. When you give an example of something that another editor has written here, and then say that it's "immensely dishonest" to say such a thing, that doesn't seem like a positive and constructive way to engage with other editors on an article talk page. Hist9600 (talk) 03:18, 18 July 2024 (UTC)

I am not assuming bad faith. Can you answer my question above? Zilch-nada (talk) 11:48, 18 July 2024 (UTC)

@Hist9600, could you think of just letting this go. Reading what someone else wrote in the worse possible light, because one disagrees with what they are saying, in a contentious topic area, is not a good look. Similarly, @Zilch-nada, perhaps be quicker to strike and rephrase something that upsets another. Digging your heals in is also not a good look.

I think we've already established that the argument that "Badenoch therefore Cass Review bad" is logically incoherent. I wish some editors would stop repeating nonsense they read elsewhere in this talk page.

I've already outlined above how the scientific studies used for much of the Cass Reivew's systematic reviews (which were indeed published in a scholarly journal and peer reviewed) are international, as are the previous systematic reviews which produced similar results. There are dozens of recommendations and hundreds of evidence points in this 300 page review. Merely saying "it" is likely to be unhelpful when raising a criticism like "not a review study done in a peer-reviewed journal" because it really looks like an attempt to cherry pick without actually stating what on earth it is cherry picking and is neither a convincing argument or useful argument for anyone to agree or disagree with.

I think it is long past time that this page stopes being WP:NOTFORUM abused for editor's xenophobic content about British healthcare and academic professionals. This prejudice because they happen to share the same birthplace as some windbag politicians (many of which are now ex politicians and all of which are now ex government) is not acceptable on Wikipedia. It is no more sensible an approach than to dismiss US healthcare and academic professionals because you had Trump and are going to get Trump again.

Let's end this section. The "due weight" of a PDF that has been almost entirely ignored by the world's press is very very low. -- Colin°^Talk 14:17, 18 July 2024 (UTC)

Several international medical orgs

@Kronix1986

You’ve been reverted several times at this point for changes to the lede in direct contradiction to the article. Take it to talk. Snokalok (talk) 14:43, 5 July 2024 (UTC)

I'm not Kronix. When challenged to provide citations showing non-WPATH orgs critising the Cass Review, you pointed to this article which contains statements from the AAP and the Endocrine Society. Neither of these statements criticises the Cass Review. The AAP's does not mention the review at all. The Endocrine Society's simply said that the evidence presented didn't cause them to update their guidelines. None of the other international health bodies summarised in the body are described as criticising the Review either, the closest thing is the Dutch org disagreeing about the state of evidence for puberty blockers. This is all in very stark contrast to the WPATH responses summmarised immediately below, which contain harsh criticism of the credibility and methods of the Report. It is misleading to lump these two very different kinds of responses together. 212.36.63.7 (talk) 15:08, 5 July 2024 (UTC)

I don’t know how to tell you that an org saying “This paper’s conclusions/recommendations are wrong and outside of best practice” *is* a criticism. And if you read the entire Endocrine Society statement, it says “NHS England’s recent report, the Cass Review, does not contain any new research that would contradict the recommendations made in our Clinical Practice Guideline on gender-affirming care” and then spends a page explaining how puberty blockers and the like continue to be important despite Cass. That is a criticism. It’s saying very simply, “The Cass Review didn’t do any research that justifies a change in best practice, and its conclusions are out of step with the best ones, set forth here”. I don’t disagree WPATH’s criticism is harsher. But criticism of conclusions and outcome is still criticism. Snokalok (talk) 15:14, 5 July 2024 (UTC)

criticism of conclusions and outcome is still criticism. It doesn't even say what Cass' conclusions and outcome are to criticise them! The ES statement says that Cass produced no new evidence that would change its position, and then gives an almost boilerplate outlining of what that existing position is. This is a very creative interpretation of a document that doesn't engage with the content of Cass at all as 'criticism' of it. 212.36.63.7 (talk) 15:25, 5 July 2024 (UTC)

I don’t think that given the sheer publicity of the report and its impacts, it needs to restate the obvious. Anyone reading the Endocrine Society statement on the Cass Review is already well familiar with the matter; and either way, “This report did not present a compelling case to get us to change our view” is a criticism. Snokalok (talk) 19:32, 5 July 2024 (UTC)

I think an acceptable compromise to this would be using language to the effect of 'disagreed with its conclusions' with the existing citations. It is simply not true, given the evidence currently in the article, that the report has been substantively criticised by any non-WPATH medical organisations. 212.36.63.7 (talk) 15:31, 5 July 2024 (UTC)

It should also be noted that the 'several international medical organisations' language in the article predates the AAP and ES statements by a week or two. In my view it's always been a misleading attempt to characterise WPATH and its regional affiliates as independent expert authorities. 212.36.63.7 (talk) 15:14, 5 July 2024 (UTC)

They are independent expert authorities. That’s their entire point, they are the expert medorg on trans healthcare. Before 2013 they recommended conversion therapy. After 2013 they changed their approach to affirmation as that proved to be a better mode of treatment. They’re not some sort of activist org as you seem to think, simply because they disagree with the British media Snokalok (talk) 15:16, 5 July 2024 (UTC)

The regional affiliates of WPATH are not independent of WPATH, obviously, so presenting them as assorted 'international medical organisations' rather than one umbrella organisation is highly misleading. 212.36.63.7 (talk) 15:25, 5 July 2024 (UTC)

Can you back this up? Lots of separate medorgs have close relationships, that doesn’t mean they’re not independent. The American Pediatric Association and the Canadian Pediatric Association are probably on good terms, but they’re still separate, independent orgs Snokalok (talk) 19:27, 5 July 2024 (UTC)

The APA and Canadian Paediatric Society aren't regional affiliates of an umbrella organization. WhatamIdoing (talk) 20:00, 5 July 2024 (UTC)

Prove that the different trans health orgs are Snokalok (talk) 05:04, 7 July 2024 (UTC)

This is a tangent:

I think we have done a poor job of highlighting areas of agreement. For example, the Cass Report and its critics all agree that some sort of gender-affirming care is appropriate for some people. Everyone agrees that the UK needs to put more money/resources into caring for trans kids. Everyone agrees that the UK needs to put more money/resources into caring for kids with mental health issues (trans and non-trans). Everyone agrees that the number of people seeking care is higher than it used to be. Everyone agrees that the percentage of trans kids who have autism (15% of all trans kids) is higher than the percentage of non-trans kids without autism (1 or 2% of all non-trans kids). Everyone even agrees that the state of research isn't ideal; the only dispute is over whether it's (barely) good enough in certain specific areas to justify those specific treatments, or not really good enough.

If you glance down this article, it doesn't give that impression. The overall impression is that Cass says some things, and they're wrong, wrong, wrong! (Or, if you're on the other political side, that they're right, right right! to draw opposition from the pro-trans groups.) I wonder if we could fix this, so that we highlight areas of agreement. Imagine a world in which people, perhaps first hearing a speech from a conservative politician and then reading this article, could discover that the Cass Report actually recommends (for example) enrolling trans kids in a research program that will give them puberty blockers. WhatamIdoing (talk) 16:26, 5 July 2024 (UTC)

I have moved the Integrity Project doc down to "Assorted". It absolutely must not be described as the Yale Report as the authors do not speak for Yale University. The Integrity Project is two academics so its WEIGHT is way way down the scale below national and international bodies. At the moment, we have a minority Scottish newspaper as a source. The WEIGHT for even mentioning this is at present just plain not there. And that's before we even get into how ridiculously bad the report is from an academic medical POV. I don't think any serious journal would publish this but am prepared to be surprised. Editors wishing to push this report to a more prominent self-titled section need to demonstrate with sources that the world considers the Integrity Project more important than Amnesty or WPATH or various British bodies and so on, and that this PDF is itself a notable rebuttal of the Cass Review. Arguments on this page that somehow legal academics get a free pass wrt WP sourcing and weight requirements are not even worth our time arguing about. -- Colin°^Talk 19:05, 5 July 2024 (UTC)

Yes, it can absolutely be described as the Yale report, or more formally as the Yale Integrity Project report. No academic "speaks for" their university, this is simply not how academia works. It's not a matter of law but whether a report is associated with a particular university. If eight scholars associated with Yale release a report, published on Yale's website,[24], it's perfectly reasonable and normal to refer to it as the Yale report. Here is the first minister's response to the Yale report, for example: "John Swinney responds to Yale's 'serious flaws' warning" which specifically refers to the report as "the Yale report". Also, please stop repeating the nonsense about "two people". The report has eight authors. The fact that two people lead the Yale Integrity Project is immaterial. The Cass report has not been published by any academic journal either, and the counter-report is not a medical publication, nor is it original research, but rather a summary of existing scholarship and knowledge in line with the project's aims (see [25]). I also noticed how you moved the Yale report to a section on response from "lobbying organizations" and this really says it all. --Amanda A. Brant (talk) 20:47, 5 July 2024 (UTC)

That article is bizarre. You don't get Swinney's response until the 10th paragraph, and it's basically "we're going to listen to our multidisciplinary team's recommendations in light of Cass thank you". It has nothing to do with the integrity project report.

This is dreadful clickbait. Void if removed (talk) 22:35, 5 July 2024 (UTC)

I would agree with that. It makes sense that it should be able to be referred to as the "Yale report", or as the "Yale Integrity Project report". I would not call it the "Yale Report" (uppercase "R"), because that might make readers think that is the title of the report itself. There is no such issue if there is a lowercase "R". Hist9600 (talk) 23:40, 5 July 2024 (UTC)

Or "the report from Yale's Integrity Project", which I don't think even the most ardent critic would be able to object to while still sounding even slightly reasonable. The report isn't Yale's directly, but the project itself is. WhatamIdoing (talk) 16:57, 6 July 2024 (UTC)

Amanda, the Integrity Project consists of two people. That they got help writing a draft PDF document that is yet to appear in any publication, does not make the Integrity Project any bigger than two people. It isn't nonsense. And it is deeply weird that a report on English healthcare, criticised by a wee group of activists at Yale, is being reported on and cited by you via The National. What next? Golfer's Monthy? Teen Vogue (oh, wait, someone already did that). You've already been told by WAID that the Cass report has been published by the UK government and the various systematic reviews that this Integrity Project criticise ARE published in the most respected of medical journals. In contrast, as WAID already said, this Integrity Project is self published. I'm not sure why you are claiming this "counter-report" is "is not a medical publication, nor is it original research, but rather a summary of existing scholarship and knowledge" as every single word, every single one, of that sentence is entirely untrue.

Much of the discussion of this Cass Review exists in the world of politics and culture wars. In that world, the speeches of the Badenoch's of this world, and the activist blog posts that pick up on it, all bear no more resemblance to reality than a soap opera or Marvel film. The political point scoring by both sides is activists and politicians telling stories to their gullible bases. We should be careful about credulously believing what either side are saying. The story of our how the Cass Review came about and its purpose is grounded in healthcare concerns and the background is one where youth mental healthcare was allowed to decline under Tory rule, leading to a clinic, GIDS, that was overwhelmed. A politician going "Voters, everyone look please at this toxic culture war and forget our 14 years of neglect of the NHS" and an activist blogger who takes the bait and pleases their readers with yet more tales of hateful politicians being hateful are not, neither of them, reliable sources on the Cass Review. -- Colin°^Talk 14:31, 7 July 2024 (UTC)

One difficulty is that the points of commonality aren’t the controversial ones so don’t get as much source coverage, which presents an issue for us in allotting due weight. If no sources point out agreement on autism prevalence, for example, then it would be undue for us to give that much weight in the article. It is common for any kind of analysis to focus more on points of difference than of commonality. Red and blue tribe people share >99% of their DNA with each other, but that’s not what makes the headlines. Having said that, your examples do seem like they might be sourceable, so it could be worth an attempt. Barnards.tar.gz (talk) 19:42, 5 July 2024 (UTC)

I think we have done a poor job of highlighting areas of agreement. For example, the Cass Report and its critics all agree that some sort of gender-affirming care is appropriate for some people.

I think a major problem is that the US is really quite polarised between "clinicians who medically transition kids should be in prison" and "clinicians who prevent kids from medically transitioning should be in prison". In that environment, a major evidence based review from another country that says the evidence for paediatric medical transition is weak has to be discredited by those who have been insisting for many years that the evidence is conclusive and anyone who says otherwise is a hateful lying bigot peddling pseudoscience because winning their legal battles depend upon that being true. Void if removed (talk) 14:09, 6 July 2024 (UTC)

The United Kingdom has an abysmal reputation—on par with Russia[26][27]—as far as anything related to LGBTIQ+ issues are concerned, so it's not an "evidence based review" that people are willing to take at face value in countries where transphobia is not accepted. It's a report that was commissioned by the Tory government—a party whose members "have come to embrace conspiracy theories more usually associated with the far-right"[28]—whose "equalities" minister "admitted that “gender-critical” individuals were placed in health roles to facilitate the Cass Review—a mechanism remarkably similar to how Florida’s review led to the banning of care in the state, borrowing from DeSantis’ strategy."[29] Gender-critical ideology, as we know, is described as an extremist ideology by UN Women and many others[30]. The fact that far-right politicians have been in power in the UK doesn't make their views true, authoritative, or any less extreme, something that also applies to Trump, DeSantis, Putin and many others, and their claims on a range of issues from LGBTIQ+ rights to climate change. This report has no standing in the US or anywhere else, it's not an academic or peer-reviewed publication, it's not published by a body that is widely recognized as an authority in the field, it's a "report" commissioned by the increasingly far-right and conspiracist Tory Party to further their anti-trans agenda. It is "not an authoritative guideline or standard of care, nor is it an accurate restatement of the available medical evidence on the treatment of gender dysphoria" as a group of Yale scholars recently found.[31] The report is best known for "being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people."[32] --Amanda A. Brant (talk) 23:01, 6 July 2024 (UTC)

That interpretation by Erin Reed of what Badenoch said is, and I am being extremely charitable here, ignorant nonsense. Kindly stop spreading this. Void if removed (talk) 23:40, 6 July 2024 (UTC)

The third reason was having gender-critical men and women in the UK government, holding the positions that mattered most in Equalities and Health. You mean that quote, for why England took the lead in banning puberty blockers? Hist9600 (talk) 01:26, 7 July 2024 (UTC)

Yes. It's a completely silly interpretation of it. Ludicrous on its face, more so in context. Void if removed (talk) 07:39, 7 July 2024 (UTC)

Wow. We've gone to planet Mars here. Why is this nonsense on this page? -- Colin°^Talk 14:35, 7 July 2024 (UTC)

Is Mars where we can find these countries where transphobia is not accepted? That can't be referring to the US. WhatamIdoing (talk) 23:16, 10 July 2024 (UTC)

@WhatamIdoing, not for long -- Colin°^Talk 07:17, 11 July 2024 (UTC)

I believe that this idea could be feasible under the context heading (though there's a case to be made to maintain its focus on the UK only; that being said, either way it needs a proper rewrite). This has become an increasingly polarised topic since the beginning of this decade, so explicitly mentioning, for example, that the Cass Review isn't so much about if trans kids should receive clinical treatment at all, but if the evidence is strong enough for a justification of one particular course of treatment and under which circumstances said pathway should be induced, is really refreshing after back-and-forth discussions of including source A for saying B or source C for arguing against/in favour of D. I think we could all appreciate a more constructive discussion rather than fighting each other over what some sources have to say about the review. Cixous (talk) 19:52, 6 July 2024 (UTC)

Yes, @Cixous, that's the sort of thing I'm thinking of. The Cass Review supports trans kids receiving clinical treatment. We should make that clearer. WhatamIdoing (talk) 23:17, 10 July 2024 (UTC)

@Snokalok: The current description implies that all medical organizations criticize the Cass Review. In reality, it's just the professional organizations for transgender health practitioners. 212.36.63.7 and Kronix1986 are right because your comment violates WP:PRIMARY, as your entire analysis relies on reading between the lines.

WP:VERIFIABILITY is clear that the source material needs to directly support the claim being made. WP:PRIMARY says Do not analyze, evaluate, interpret, or synthesize material found in a primary source yourself; instead, refer to reliable secondary sources that do so. Neither the AAP nor the Endocrine Society statements (primary sources) say they are criticizing the Cass Review. If you have to analyze and interpret what the statement is really saying, you've already failed WP:V.

Please provide secondary sources explaining why the AAP or the Endocrine Society's statements serve to criticize the Cass Review. Otherwise, we might need an RfC on this issue. Chess (talk) (please mention me on reply) 02:48, 7 July 2024 (UTC)

Hmmmmm clearly what reads as

obvious on its face to me, is not reading as obvious to others, so with that in mind, I’m willing to accept the IP’s proposes consensus of “disagreed with its conclusions” and make the edit. Snokalok (talk) 05:27, 7 July 2024 (UTC)

I think we need to make it clear in the lede that Cass was highly critical of these international organisations and the standards they produced. This was a significant part of the final review and we mention this down the page, but this is a highly relevant factor when weighing up the international response. Void if removed (talk) 07:33, 7 July 2024 (UTC)

Yes. These are orgs that have essentially been caught red-handed. Of course they’re going to disagree with their accuser. Their non-independence is salient. Barnards.tar.gz (talk) 09:22, 7 July 2024 (UTC)

Which organisations are you talking about here, if you're talking about the endocrine society and WPATH they actually seemed to score not too badly on the agree II (from the York SRs part 1), obviously it's a bit hard to tell with no reference for how one would expect a guideline to score but they seem to be doing well. The SR's conclusion basically says they lack developmental rigour and transparency (something the Cass review has been said itself to lack from the interim report), which strikes me more as a "could do better" than "they should never be used at all". If Cass decides to criticise it more than this evidence base suggests it seems more like a pre response to being criticised than actual valid criticism and ultimately if we have both criticising each other, I'd take the international organisations over the Cass review (not the York SR). LunaHasArrived (talk) 10:04, 7 July 2024 (UTC)

The Cass Review is one review study, and it disagrees with the conclusions of most other studies on the matter. It was not published in a peer-reviewed journal, and it was produced for a government that was already shutting down trans healthcare for minors. The UK is now known for poor trans rights among European countries. Cass does not currently represent the consensus of mainstream medical reliable sources. Hist9600 (talk) 15:45, 7 July 2024 (UTC)

The Cass Review is one review

And, among other things, nine published papers including eight systematic reviews, two of which are into international guidelines.

It was not published in a peer-reviewed journal

The systematic reviews upon which it is based all are.

produced for a government that was already shutting down trans healthcare for minors

They halted puberty blockers in response to the interim findings of the Cass Review, while commissioning greater capacity to deal with these issues in a more holistic, multi-disciplinary way.

And are you questioning the independence of the review? I think you're going to need a very strong source for that.

The UK is now known for poor trans rights among European countries.

The UK has a stellar record on trans rights, which have not changed in 14 years, other than to make accessing a GRC cheaper and easier. And this is an irrelevant digression, can you please, please stick to the Cass Review, which has precisely nothing to do with "trans rights".

Cass does not currently represent the consensus of mainstream medical reliable sources.

And the systematic reviews question that consensus. Which brings us right back to how we handle what is a disagreement between what are supposed to be equivalent level MEDRS (medical body guidelines vs systematic reviews). Void if removed (talk) 16:11, 7 July 2024 (UTC)

The UK has an abysmal reputation, on par with Eastern Europe,[33][34] on trans/LGBTIQ+ rights. This report is not widely recognized internationally. On the contrary, to the extent it is even mentioned, it is criticized for continuing the Tory party's assault on LGBTIQ+ rights in the UK and for being weaponized by extremist anti-LGBTIQ+ groups. --Amanda A. Brant (talk) 16:51, 7 July 2024 (UTC)

Amanda, you have been asked repeatedly to stop doing this. This is not a forum for conspiracy theories or xenophobic attacks on an entire country.

Hist9600, mostly what Void said but please remember this article is called "Cass Review" and writing "it disagrees with the conclusions of most other studies on the matter" doesn't demonstrate careful reading and is over-simplifying a review that highlighted dozens of findings and that made ten recommendations. The core of the evidence the review uses was published in peer review journals and in terms of MEDRS is the absolute highest quality of evidence. When this Integrity Project decided to embarrass themselves on the internet, they were attacking systematic reviews published in the most prestigious journals by a team that is world renowned. The York team are world experts. They are the people you go to to learn how to do systematic reviews. This silly PDF that is wasting all our time is a political toy designed to be credulously read at face value by activists/politicians in a US war, but not really a serious medical publication. The Cass Review forward says "This Review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people’s rights to healthcare." The review, unlike anti-trans politicians and writers, doesn't bang on about "gender ideology" or suggest clinicians are abusing our children. It would be good if people editing this page read it, and not some blogger, before repeating false claims on this page.

Cass recommended many things, many of which are entirely uncontentious. The UK, unlike some states in the US, is really not "shutting down trans healthcare for minors" on ideological grounds or religious grounds. It would be very helpful if people didn't bring US politics into what was a healthcare-initiated and evidence-based independent review. Colin°^Talk 18:09, 7 July 2024 (UTC)

The editor who moved the Yale report by a group of Yale scholars to a section on response from "lobbying" organizations is hardly the right one to lecture others. The UK does not have a "stellar record on trans rights" as bizarrely claimed above, it has, as demonstrated by numerous reliable sources, an abysmal reputation over its ‘virulent attacks’ on LGBT+ rights, and this report, commissioned by its government – noted for its drift to the far right by many political scientists – has a very poor reputation too. --Amanda A. Brant (talk) 17:19, 8 July 2024 (UTC)

The Integrity Project is a lobbying organisation. Its mission literally is to influence "health policy for children and adolescents" made by "legal decisionmakers" such as "litigators, regulators, legislators, and journalists". The rest of your comments aren't worth arguing about and seem to be based on a misunderstanding about what "rights" even are. I'm not sure why you keep repeating these points and links on this page, other than to amass diffs for an eventual topic ban. But you know, please yourself. -- Colin°^Talk 12:11, 9 July 2024 (UTC)

The core of the evidence the review uses was published in peer review journals and in terms of MEDRS is the absolute highest quality of evidence. We already know the Cass Review does not represent the consensus view of medical reliable sources, because it diverges so much from established findings. The authors also had basically no background in transgender healthcare, unlike the authors of most review studies and guidelines for care. And there has already been significant criticism of the review internationally already for its methodology, etc., and at least skepticism among international medical organizations. Rushing to claim that Cass represents more than one review study is overly ambitious and does not represent due weight. Hist9600 (talk) 01:45, 9 July 2024 (UTC)

You're overegging divergence from the consensus view of medical reliable sources by not weighting in accordance with the hierarchy of evidence. If there had been multiple other equivalent independent systematic reviews that had found there were plenty of high-quality evidence, then Cass would be an outlier. But in reality, there has been no other review with the same level of independence, scope, in-depth analysis, and scientific rigour - and there are other systematic reviews that concur with it (e.g. from Karolinska Institutet). That there is a whole industry of clinicians who don't like being told their practice has been built on shaky evidence, does not mean their views should be weighted as the "consensus view", because science is not a democracy. Barnards.tar.gz (talk) 11:00, 9 July 2024 (UTC)

Having clinical practitioners resist research evidence is normal. Consider, e.g., the history of arthroscopic knee surgery. It was proven worthless in top-notch research, and the knee-surgery specialists said the research was all wrong, because they could see that their patients were being helped, no matter what the research claimed to say. They didn't stop doing it for well over a decade, and then they stopped because the health insurance programs started refusing to pay for worthless surgery, not because they actually believed they'd spent their careers doing something useless. See also drug withdrawals, which are usually accompanied by someone insisting that the drug really does work their patients, or really doesn't have that harmful side effect.

PMID 37018006 and related papers indicate that it usually takes 15 to 20 years for the evidence to be seen in by patients any significant way. Whenever you have a situation in which a whole industry of clinicians resists the message that their practice has been built on shaky evidence, you should not be surprised. This is by no means unique to this specialty. This is absolutely normal. It would, in fact, but shocking if a whole industry actually could spin around on a dime just because the academic evidence said so. WhatamIdoing (talk) 23:47, 10 July 2024 (UTC)

If the clinical studies that were looked at were done by people who had no experience in trans healthcare, you might have had a point. But they weren't. The best studies, done by people with huge experience in trans healthcare, when systematically reviewed by one of the best teams in the world at doing systematic reviews, are shown to demonstrate a lack of beneficial effect. And this is the story of systematic reviews for quite some time now. They don't diverge in any way. The criticism of the methodology has been done by people who have never even done a systematic review, let alone teach the world on how to do them. There are differences of opinion about what to do in the absence of evidence, and about how honest some bodies have been about their lack of evidence. But the studies are there and the best studies correspond with what Cass reported. -- Colin°^Talk 12:16, 9 July 2024 (UTC)

Maybe the UK media and medical establishment would agree with you, but internationally, that doesn't seem to be the general perception of the Cass Review. There have already been quite a few criticisms of its methodology, such that it's probably fair to say that it is a controversial and non-mainstream source. Hist9600 (talk) 01:51, 10 July 2024 (UTC)

Hist9600, when you write "diverges so much from established findings" this is normally the argument made against fringe science where the "research" claiming some plant cures cancer or horse medicine treats Covid is being actually done by cranks and involves small flawed studies that "found" results. These systematic reviews looked at what you are calling "established findings". They looked at the existing body of research done by real actual trans healthcare practitioners. And these real actual trans healthcare practitioners time and again report the same thing that the systematic reviews concluded. How otherwise is a systematic review supposed to work? Just invent studies out of thin air? Do them itself? The critics presented here are themselves unqualified in conducting systematic reviews (or in the case of our monkey researcher, anything to do with clinical medicine) and frankly are embarrassing themselves on the internet with their forms of attack. Here we have the very normal situation where small flawed studies are claimed to show a benefit but larger better designed studies do not. All these studies were done by researchers with their heart in trans healthcare. It isn't like some of the studies were done by some gender-critical cabal or by wingnuts funded by the far right. But most of them, the best of them, have disappointing results for some activists. That's the reality at present. To anyone looking at these reviews from a neutral evidence-based-medicine POV these reviews are deeply standard stuff. There are no surprises whatsoever. Seven systematic reviews published in Archives of Disease in Childhood is as close to the peak of "mainstream medicine" as one can get. Could you perhaps consider that who you are listening to or reading, who say otherwise, are not really interested in science or evidence based medicine at all, but are playing political games. I lose interest in political games when people supposedly on "my side" start telling lies and making stuff up and spreading misinformation. How about you?

Wrt "source", I think also you are confusing which article you are on. This is the article on the Cass Review. We aren't judging it as a "source" but as the topic of the article. The seven systematic reviews (and the earlier NICE reviews) are all mainstream medicine of the highest order published in the finest medical journals. That some activists don't like their conclusions doesn't magically make it bad science no matter how much it would help some people playing US politics if that were so. -- Colin°^Talk 07:20, 10 July 2024 (UTC)

It's possible for a review study to be done poorly, and to misrepresent or misinterpret findings. When researchers analyze the review study and publish criticisms, I don't think it's appropriate to call them "monkeys", accusing them of "lies", or "spreading misinformation", or to smear them as being merely "activists". I think those types of accusations and personal attacks are inappropriate for article talk pages. The distinction we are seeing is not between US and non-US politics, but between the UK, and the majority of international reception. The Cass Review has not been received particularly well outside the UK, and there is a unique relationship between UK politics and the Cass Review. Hist9600 (talk) 22:48, 13 July 2024 (UTC)

@Hist9600, nobody has called anybody a monkey. The "monkey researcher" is a researcher whose recent research was conducted on marmoset monkeys. Compare:

• "Cancer researcher" = researcher who studies cancer, not a researcher who has cancer.
• "Computer researcher" = researcher who studies computers, not a researcher who is a computer.
• "Monkey researcher" = researcher who studies monkeys, not a research who is a monkey.

I think we're probably about two years too early to know what the actual "majority of international reception" is. At the moment, we've only heard from a very small slice of what might be called "international". 60% of the world lives in Asia, and we've heard basically nothing from Asia.  20% of the world lives in Africa, and we've heard nothing from Africa.  "The majority of international reception" is apparently silence. What we have heard so far is from some stakeholders who feel disagreed with, patient groups who feel threatened, and a few business owners who feel like this could disrupt their profit-making plans – and almost all of those belonging to a mere 15% of the world's population. So far, what we have is "the reception among the minority of people who are from Western, Educated, Industrialized, Rich, and Democratic societies and still willing to talk about this subject in public". That's like saying Wikipedia is "the encyclopedia anyone can edit", when a fairer description probably sounds like "the encyclopedia that anyone who understands the norms, socializes him or herself, dodges the impersonal wall of semi-automated rejection, and still wants to voluntarily contribute his or her time and energy can edit" (to quote Halfaker's paper). WhatamIdoing (talk) 02:08, 14 July 2024 (UTC)

The Cass Review is really two things. A body of commissioned reviews on existing studies and guidelines that is international in focus and got published in world class journals. And a report for NHS England that used that research, along with meeting professionals and patients and so on, and other existing research, and looking at the state of NHS England today, and came up with recommendations for NHS England. Both the outgoing and incoming UK governments have committed to the recommendations. NHS England have reported that it is already making progress on several aspects. Of course it remains to be seen if the new clinics can really be setup successfully and the NHS sees the money needed to achieve the various goals. The author was made a crossbench life peer in the House of Lords in recognition of their work. I'd say that was a success. What other countries make of all this is really a secondary thing and some of it probably belongs in some article on US trans politics. -- Colin°^Talk 17:52, 14 July 2024 (UTC)

Time to bring up the Russia analogy again:

When Russia does something regarding LGBT rights and relevant western orgs condemn it, we absolutely include that in the article. Snokalok (talk) 18:33, 14 July 2024 (UTC)

Snokalok, would you have a look at the Puberty Suppression Review to pick one example. Scroll down to the inline-supplementary-material-3. Look at the second column of where the studies were performed. I count

• 15 from United States
• 1 from Germany
• 6 from UK
• 17 from Netherlands
• 4 from Canada
• 3 from Israel
• 3 from Belgium
• 1 from Brazil.

The data that is synthesized to produce this review is international. You can read the studies yourself. If you find the bit in the systematic reviews where they decided to only include studies performed by English TERFs then do let me know. The review mentions six previous systematic reviews. Their summary of those reviews is Systematic reviews have consistently found mainly low-quality evidence, limited data on key outcomes or long-term follow-up. These reviews report that while puberty suppression may offer some benefit, there are concerns about the impact on bone health, and uncertainty regarding cognitive development, psychosocial outcomes and cardiometabolic health. They conclude there is insufficient evidence to support clinical recommendations. Lets look at them.

• NICE review, 2022 from England.

Studies that found differences in outcomes could represent changes that are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance....The results of the studies that reported bone density outcomes suggest that GnRH analogues may reduce the expected increase in bone density (which is expected during puberty). However, as the studies themselves are not reliable, the results could be due to confounding, bias or chance.

• Pasternack I, Söderström I, Saijonkari M, et al, 2019 from Finland
• Ludvigsson JF, Adolfsson J, Höistad M, et al, 2023 from Sweden

Evidence to assess the effects of hormone treatment on the above fields in children with gender dysphoria is insufficient.

• Baker KE, Wilson LM, Sharma R, et al, 2021 from US

Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety. Associations were similar across gender identity and age. Certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions. We could not draw any conclusions about death by suicide.

• Chew D, Anderson J, Williams K, et al, 2018 from Australia

Low-quality evidence suggests that hormonal treatments for transgender adolescents can achieve their intended physical effects, but evidence regarding their psychosocial and cognitive impact are generally lacking. Future research to address these knowledge gaps and improve understanding of the long-term effects of these treatments is required.

• Thompson L, Sarovic D, Wilson P, et al, 2023 from Scotland and Sweden

The evidence base for the outcomes of gender dysphoria treatment in adolescents is lacking. It is impossible from the included data to draw definitive conclusions regarding the safety of treatment. There remain areas of concern, particularly changes to bone density caused by puberty suppression, which may not be fully resolved with hormone treatment.

So these previous international systematic reviews have results broadly in line with the one from York. There are no systematic reviews from any country saying we have good evidence of good results. On any measure. This is not a TERF Island thing. We do not assess medical evidence by xenophobic prejudice. There is no evidence at all that these York systematic reviews are outliers internationally despite what you might read from low quality sources and random PDFs on webservers. -- Colin°^Talk 22:03, 16 July 2024 (UTC)

Expand lede

With all the debate about how to refer to "international criticism" I realise the lede as it stands is woefully vague.

We don't even give the casual reader a headline description of what the reports recommendations even were!

Where it says:

The final report was published on 10 April 2024, and its recommendations were endorsed by NHS England and both the Conservative and Labour parties.

I think we need something like the following:

The final report was published on 10 April 2024, and concluded that the evidence base for medical interventions on adolescents was weak. The review assessed existing international standards of care and determined the majority lacked methodological rigour and independence. The final report delivered 32 recommendations covering multiple areas, and overall recommended a more cautious, holistic approach. These recommendations were endorsed by NHS England and both the Conservative and Labour parties. Void if removed (talk) 09:57, 7 July 2024 (UTC)

Seems okay. Probably doesn't require your second sentence. First and third sentence seems like a full summary. Zenomonoz (talk) 11:18, 7 July 2024 (UTC)

I want to be very careful about MOS:CLAIM here, the word choice here reads like something that treats the report as ironclad and infallibly reliable when - as we’ve seen - that is a position only really held in the UK. Additionally, it didn’t only conclude the evidence for medical interventions was weak. It said the same of psychotherapy, but endorsed those as the primary method of treatment regardless, and I feel that needs mentioning.

Consider:

The final report was published on 10 April 2024, and stated that the evidence base for both medical and psychotherapeutic interventions on adolescents was weak, but recommended the latter as the primary course of treatment; along with a number of other proposed changes to gender-related treatment as part of its 32 recommendations. These recommendations were endorsed by NHS England and both the Conservative and Labour parties. Snokalok (talk) 13:14, 7 July 2024 (UTC)

@Void if removed as I said in the edit summary, see the thread. BRD. You should know this Snokalok (talk) 19:53, 8 July 2024 (UTC)

2:1 is not a consensus and you well know it Snokalok (talk) 19:54, 8 July 2024 (UTC)

Per BRD, self revert. Had you reverted my change and brought it here, fine. You did not, you added your own, minority wording. Void if removed (talk) 19:58, 8 July 2024 (UTC)

I’ll restore it to before we started fighting over this entirely Snokalok (talk) 20:01, 8 July 2024 (UTC)

I don’t actually know how to do that, so I’ll just revert them all Snokalok (talk) 20:03, 8 July 2024 (UTC)

Thank you. I'll leave this till others offer an opinion. Void if removed (talk) 20:03, 8 July 2024 (UTC)

I think I prefer Snokaloks paragraph, but I'm hesitant in imposing a pov not included in the article (perhaps "and recommended..." Instead of "but recommended..."). I will add that if we go with Voids paragraph more clarity might be needed in the comparative words (i.e "a more cautious, holistic approach than NHS England previously provided"). Also voids 2nd sentence seems to be too strong, the quote comes from the analysis of all the guidelines but most of the guidelines analysed were not international guidelines (we should probably change the title of that part of findings as well) LunaHasArrived (talk) 13:02, 9 July 2024 (UTC)

I’m okay with changing “but” to “and” Snokalok (talk) 13:26, 9 July 2024 (UTC)

I prefer Snokalok's version but I don't think the opinions of political parties on a medical report should be in the lead. So something like:

The final report was published on 10 April 2024, and stated that the evidence base for both medical and psychotherapeutic interventions on adolescents was weak, but recommended psychotherapy as the primary course of treatment. It also recommended several other proposed changes to gender-related treatment. These recommendations were endorsed by NHS England.

would be preferable. Loki (talk) 05:16, 14 July 2024 (UTC)

Sorry Loki but that's pretty awful prose and the "but" in there is editorialising (not neutral). The review's opinion on the evidence for medical interventions is the most important as it directly led to changes in that area in the UK and generated the most controversy. The opinions on psychotherapeutic interventions is more complex to explain, a tiny aspect of the overall review, and the proposed texts by Snokalok/Loki are not presenting it neutrally. I think that is probably too contentious an area to try to resolve in a lead sentence and not a major shift: these kids were and are being referred to psychiatrists at a child and adolescent mental health clinic so this is what's expected anyway. I like Void's third sentence, which seems to be dropped in the other variants in favour of totally vague "several other", not all of which are "gender-related treatment" as such, but practical things like setting up new clinics and new research. The second sentence is also important since if the review looked at existing guidelines and thought they were great, it would have adopted or been based on them. We need to explain to the reader the reason given by the authors for not doing so. The endorsement of the outgoing and incoming governments is important. This is primarily a review to advise NHS England, but that there is political support from those who count is leadworthy.

Overall I think Void's summary is an excellent proposal and hugely superior to the other two proposed at present. -- Colin°^Talk 18:20, 14 July 2024 (UTC)

Yale integrity project

@Void if removed For the record, the integrity project is described on their website as a collaboration between Yale law school and several different departments from the school of medicine, and one of the two leads on the project is from the school of medicine as well. --Licks-rocks (talk) 11:40, 8 July 2024 (UTC)

Yes, I linked to it - it is not described as a project from Yale Law School and Yale School of Medicine. It is a Yale Law School project, that works collaboratively with some smaller departments elsewhere.

faculty members from the Yale Law School, Child Study Center, Department of Psychiatry, and Department of Pediatrics came together to synthesize and disseminate scientific and legal knowledge in support of LGBTQ+ youth and their families.

None of this says Yale School of Medicine. The project is part of Yale Law School, and sits on their website, and works with academics nationwide. And what you've done with your latest change actually misrepresents the document by implying that it is by academics solely from Yale Law School and Yale School of Medicine, when the majority of authors are not.

Your change is not an improvement, can you please self-revert, there really is no need to go to these lengths to try and shoehorn the Yale School of Medicine into this source's credentials. Void if removed (talk) 11:51, 8 July 2024 (UTC)

Yale law school is a department of Yale university, just like the other three mentioned. They do not themselves have a department of psychiatry. Yale university on the other hand, does. And when you click on it in their list of departments, you are redirected to the website of the Yale school of medicine's psychiatry department.

In conclusion, I won't be self-reverting, and I ask you to strike your comment about shoehorning. If anything, I'm being too accommodating in that edit. --Licks-rocks (talk) 12:30, 8 July 2024 (UTC)

And when you click on it in their list of departments, you are redirected to the website of the Yale school of medicine's psychiatry department.

This is all your own WP:OR. Neither the cited source, nor the WP:PRIMARY source here say that the Yale Integrity Project is from the Yale School of Medicine.

In fact, the currently cited source doesn't even mention the "Yale Integrity Project".

Then there is this, which only refers to it as "the Yale report".

Then there is this press release from Yale which says, explicitly:

The Integrity Project at Yale Law School

I'm asking you once again to self-revert. Void if removed (talk) 13:59, 8 July 2024 (UTC)

In case you missed it, my request to strike was my way of informing you that I think you've crossed over into unwarranted belligerence when you claimed I was going to "lenghts" to "shoehorn" something in. The version of the article present at that time did not mention the yale integrity project, and was intended as a compromise, however, based on my looking at the page where the integrity project describes themselves your claim that the medical school has nothing to do with it is obviously mistaken, it's a collaboration between four different departments at Yale university, which is (indeed, if you want to call that a victory) hosted at Yale Law School's website. The other three departments all belong to the Yale school of Medicine.

You cited the source for that claim yourself, it's the web page for the integrity project, which falls under WP:ABOUTSELF, by the way, so no need for the shouty link to WP:PRIMARY. Anyway, if you want to argue that Yale's law school somehow has a pediatrics department, be my guest, but personally I have no reason to think it counts as WP:OR to not (mis)interpret that sentence the way you did. --Licks-rocks (talk) 16:16, 8 July 2024 (UTC)

Taps source

The Integrity Project at Yale Law School

You are engaging in WP:OR by creating a claim that the source you're relying on does not explicitly say.

It says:

faculty members from the Yale Law School, Child Study Center, Department of Psychiatry, and Department of Pediatrics came together

I don't care if the last three are part of the School of Medicine, you are engaging in WP:SYNTH. The source does not say that the "Integrity Project" is part of the Yale Law School and the School of Medicine. I know it is founded by two people, one from each, that still doesn't mean it is part of both. As they describe themselves, per WP:ABOUTSELF, they say only that the Integrity Project is at Yale Law School. Both founders consistently say this.

We're now multiple replies and reverts into a thoroughly pointless debate over something plainly unsupportable. You're expending a lot of effort adding and now defending something that isn't explicitly stated in any source.

I ask a third time, self-revert. Void if removed (talk) 16:35, 8 July 2024 (UTC)

I see. Thanks for clearing that up. I'll grant you that it is indeed described by them as a collaboration that happens "at" Yale law school. Now if you could please strike your accusations of bad faith above, that'd be golden. I've implemented an alternative wording I suggested in my first edit summary, which describes it in a similar way to the source quoted for the sentence, which I hope will satisfies you better. Another solution would be to just take the way that they've worded it in the lead there and leave out the mention of the integrity project entirely, as I did in my first version. Whichever you prefer. --Licks-rocks (talk) 12:55, 9 July 2024 (UTC)

Here ABC describes it as by Yale law school and Yale school of medicine. LunaHasArrived (talk) 19:15, 10 July 2024 (UTC)

That says "a report by". It doesn't say "the integrity project".

Pick a wording. You can either have "a report by Yale law school and Yale school of medicine", per this source, or you can have "the integrity project at Yale law school" per the others. You can't combine them to say what the original edit said. Void if removed (talk) 19:48, 10 July 2024 (UTC)

@LunaHasArrived, that's a much better source than The National we are currently using. Maybe we can get another to help resolve this naming dispute. There are some responses from Cass's team in this article too which need to be included otherwise we give the wrong impression that this critical report is accepted. The challenge for us, as writers of an Encyclopaedia, rather than activists pushing "Bad things about a topic I hate" onto the page, is we are required to (per all our key policies) summarise what our secondary sources say in our own words. So can someone have a go at summarising this source rather than cherry picking quotes, which is not at all encouraged and considered a last resort.

I'm confused about the detransition section. It clearly says we can't know the detransition rate as followup details are unknown (they were withheld from the team). So I'm not sure how this critical report can possibly state the rate is 0.3%. Maybe someone can explain to me how Yale know the follow up details when adult services withheld them? -- Colin°^Talk 19:57, 10 July 2024 (UTC)

It's covered by 13.9-13.12 in the Cass review, effectively one adult GIC did give over information and out of the ~3400 patients audited <10 detransitioned. I'm pretty sure that's where the numbers come from

I'll admit part of this was just adding a better secondary source on this review (I'll add also of note is probably the analysis of where the Cass review agrees with international consensus) LunaHasArrived (talk) 20:06, 10 July 2024 (UTC)

I've read the Cass Review pages 168/169 and Appendix 8 again. The thing about the audit is it is a snapshot of a period in time at this clinic for children. There wasn't any intention to follow up patients for X years to determine the detransition rate. Of the 3400 patients, only 892 were referred to endocrinology for hormone treatment. The rest were effectively still working through their treatment decisions with GIDS and two thirds went on to adult services where their status is unknown. All we can do with that detransition figure, is say there were some. Anyone claiming the "This is a “detransition” rate of 0.3%" is displaying statistical incompetence of the very highest order. It is like if 500 people went to a concert. Only 50 went to an after party. Of those that went to the after party, 5 told you they didn't like the concert. And concluding that only 1% of concert goers didn't like it. We have no idea of the opinions of the 450 who didn't attend the party. Just as we have no idea about those who were still waiting or contemplating the medical pathway when they aged out of GIDS. These are people who perhaps had a couple of talking meetings before moving into the unknown. This is not a detransition study. -- Colin°^Talk 20:22, 10 July 2024 (UTC)

politicians positions

In our section "reception among UK politicians" almost all the positions are now outdated (thank you general election). Having read part of MOS adding former or at the time before any positions would seem correct however I think this would probably bloat the paragraph a lot. I'm opening up the discussion here for any advice on how to fix this problem as I'm not certain about the solution. LunaHasArrived (talk) 13:17, 9 July 2024 (UTC)

I think at most an extra line saying that the labour manifesto included it is sufficient. I don’t think much has changed in the way of “both major parties supported it” beyond that. Snokalok (talk) 13:44, 9 July 2024 (UTC)

Saying Prime minister Rishi sunak is inaccurate as he's no longer prime minister (this is in the body of the article). This was the major point, sorry if I didn't make this clear. LunaHasArrived (talk) 13:57, 9 July 2024 (UTC)

Background

Creating this topic so @WhatamIdoing's interesting tangent/proposal doesn't get buried beneath the never-ending discussion about medical organisations: what do editors think of dedicating the 'background' section to agreements both Cass and critics have (e.g., trans kids should receive some form of treatment). It would clarify what the Cass Review is actually about and could provide us with a more constructive discussion rather than the same old 'Cass is wrong/right because A/B/C'. I personally propose to add a small history section as well delving into the British context why the Cass Review was commissioned in the first place. While the systematic reviews will most likely shape research and clinical practice internationally, I think we could dedicate more space of the article what led the NHS to such a review in the first place. Any thoughts and/or remarks? Cixous (talk) 13:17, 11 July 2024 (UTC)

I think it's a good idea if well sourced but it might be difficult to establish due. For the parts about where critics and Cass agrees this article (a summary of the Yale integrity project report) Includes part of where they agree and could be useful (I can't think of another source that has both support and criticism). LunaHasArrived (talk) 13:47, 11 July 2024 (UTC)

It is potentially interesting and useful for the reader. But it is also a topic fraught with disagreement.

I would say yes as long as this is sourced principally to the background laid out in the review and interim review themselves, ie:

• The adoption of the Dutch Protocol at GIDS in 2011 under a research protocol
• The shift to general usage in 2014, even though the outcomes of the research were not published until 2021
• The sharp increase in referrals from around that time, along with a sex ratio shift
• The Governer's report in 2018
• The Trust's review of the service in 2019
• The 2019 Keira Bell judicial review of the service
• The negative CQC report on GIDS in 2020

(All from chapter 3 of the Interim Cass Review)

Outside the Cass Review, the definitive source for the background is IMO Time to Think (book). If we can neutrally present something like this as the background then fine. Void if removed (talk) 14:10, 11 July 2024 (UTC)

I agree with referring to the background sections in the (interim) review and your layout seems to include all the major events (though I would like to note that GIDS practice diverted from the Dutch protocol in various important aspects, most likely due to the steep increase in referrals). As for Time to Think: I haven't read it so I can't stand in for its neutrality, but it's been ubiquitously praised in the UK media Cixous (talk) 15:10, 11 July 2024 (UTC)

GIDS practice diverted from the Dutch protocol in various important aspects, most likely due to the steep increase in referrals

This is where it starts to get contentious. How and why GIDS made the decision to deviate from the Dutch Protocol in around 2014, and lower the age for administering puberty blockers, is quite murky, and when pressed the Trust could offer no real justification other than that they made a clinical practice decision based on "international findings and careful consideration of our own experience". Void if removed (talk) 21:57, 11 July 2024 (UTC)

I see. It probably suffices to say that they started to divert from the protocol. On page 18 of the Interim Report they mention that "GIDS staff would recommend more frequent contact during this period, but the fall-off in appointments reflects a lack of service capacity, with the aspiration being for more staff time to remedy this situation". So CR recognises that staff shortage has had a hand in this situation, but, as you say, it does not unambiguously claim so. Cixous (talk) 12:40, 12 July 2024 (UTC)

The thing is, GIDS weren't novel in deviating from the Dutch Protocol. As Cass says:

Based on a single Dutch study, which suggested that puberty blockers may improve psychological wellbeing for a narrowly defined group of children with gender incongruence, the practice spread at pace to other countries. This was closely followed by a greater readiness to start masculinising/feminising hormones in mid-teens, and the extension of this approach to a wider group of adolescents who would not have met the inclusion criteria for the original Dutch study. Some practitioners abandoned normal 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.

Cass is not referring to GIDS here - she is talking about clinicians worldwide. GIDS was comparatively unusual in its cautious approach. The Dutch Protocol published in 2006 had a minimum age of 12, but when adopted by Norman Spack at Boston Children's Hospital moved to a "stage, not age" approach, ie no age limits, but from Tanner 2.

In 2007 Norman Spack established a clinic in Boston, USA modelled on the Dutch protocol and began prescribing puberty blockers from early puberty (Tanner stage 2).

Practice in the USA began to diverge from the models of care in Canada and the Netherlands, following instead a gender affirmative model advocated by Diane Ehrensaft (Eherensaft, 2017).

Where it gets contentious is that (according to sources like Time to Think) in this period parents from England took their children overseas for treatment at Boston, and then parent advocacy groups lobbied GIDS to adopt this new model as "international best practice". With a change in leadership in 2011, GIDS adopted something similar to the Dutch Protocol approach under a research framework.

The ‘watchful waiting’ approach continued in the UK until 2011, when puberty blockers were trialled under a research protocol; the ‘early intervention study’. This was an uncontrolled study with inclusion criteria in line with the original Dutch protocol, and similar outcome measures.

However they did not publish any results (and when eventually published after the Keira Bell review, failed to replicate the Dutch results, and by some measures found some worsening). Despite that, they declared the intervention a success 3 years after starting and relaxed the inclusion criteria, more in line with the emerging "affirmative" US model:

From 2014, puberty blockers moved from a research-only protocol to being available through routine clinical practice. In light of the above findings, the rationale for this is unclear.

In addition, the strict inclusion criteria of the Dutch protocol were no longer followed, and puberty blockers were given to a wider range of adolescents than would have met the inclusion criteria in either the Dutch or UK studies. These included patients with no history of gender incongruence prior to puberty, as well as those with neurodiversity and complex mental health presentations.

Then as the caseload increased and clinical opinion within GIDS became divided on how to treat this cohort (ie, exploratory psychotherapy to address underlying causes vs an affirmative model) we got a series of safeguarding whistleblowers, internal reports, a Newsnight investigation, a judicial review, a CQC inspection, and the Cass Review. But - aside from the overloaded case backlog - the actual practice was by no means unique to GIDS, and was actually theoretically in line with what was happening worldwide by this point, erring towards the conservative end. Nobody seems to be following the Dutch Protocol as originally specified.

And it is against that backdrop that we have to understand the polarised reaction to the Cass Review, where a call for more holistic, evidence-based model of care with proper multidisciplinary assessment is widely decried as a return to "gatekeeping" by international bodies who have moved beyond even the assessment criteria of the Dutch Protocol in favour of "informed consent". Void if removed (talk) 15:08, 15 July 2024 (UTC)

Hmmm, I see. How would you frame the diverging practice in the text? Cixous (talk) 17:14, 23 July 2024 (UTC)

My biggest concern is that, background implies before the review, when many of these topics weren’t agreed upon until after.

Wait times, for example. Now both Cass and her critics agree with reducing wait times. But we didn’t know that before, and indeed the prevailing narrative in the wider environment was one of trans kids “being rushed” into treatment (thank you BBC) Snokalok (talk) 15:50, 11 July 2024 (UTC)

I just noticed Snokalok's comments about waiting times and "being rushed" or blaming the BBC for that narrative. Firstly you are confusing where the speed is. It was known for years that the waiting list for GIDS was growing exponentially and they were not getting through their patients quicker than they were being added to the list. The GIDS website had a notice on it telling readers how long ago the people they are seeing today were added to the list to give some idea of how long anyone being referred today might wait (i.e. not any less). This was very much agreed on before and one of the reasons for commissioning the review. The BBC reported a statement by a former governor of GIDS, who had resigned the previous week, who they quote as saying they thought the team were looking for "quick solutions" under pressure for various directions. This is standard reporting and quoting a person who was important enough to be quoted. Let's not blame the BBC for doing its job in that department please. -- Colin°^Talk 18:29, 14 July 2024 (UTC)

I'm a bit nervous about history based on recent posts on this talk page, but if we can source this to the review itself, or quality sources that do proper journalism/research like interviewing people at GIDS and going through reams of boring meeting minutes, rather than blogging from their bedroom in some random US state, then we might get somewhere.

I'm not sure that areas of agreement are "background" and think this is more something to ensure we cover rather than having some section listing things people agree on (which suggests everything else is one huge Controversy section). Agreement is difficult to source because the professionals this is aimed at just read it and get on with their job implementing things. We have had a few responses from NHS England about what they have done and intend to do, which is in the article. And people don't tend to write articles about how great a systematic review was. They just use it and cite it when making their own recommendations, which might drip out over the coming years.

I agree that the systematic reviews (the York and NICE ones) are of international focus whereas the Cass Review publication itself is NHS England focused and is concerned with things like GIDS and child mental health services in our NHS.

I've read Time To Think back when it was published. My feelings were that it is over-long and over-detailed. I think in terms of a history of GIDS, it is fine, but not sure how much of that we would include here. I don't recall the book mentioning the Cass Review but if it did it probably only could say that it had been initiated. -- Colin°^Talk 17:38, 11 July 2024 (UTC)

In line with Wikipedia:Criticism#Integrated throughout the article, it might not all be in the ==Background== section.

For example, the article currently says that one group "agrees with the goals of reducing wait times and improving research". AFAICT nobody loves the NHS wait times, except maybe the private providers who are making money off of patients who have already waited too long. So perhaps there should be something in the ==Recommendations== section that says the wait times are appalling and they recommend early contact with the medical system, and everyone else agrees that the wait times are appalling. Instead of putting this in the ====Response from other health bodies==== subsection, the fact of their agreement should go wherever in the article we are mentioning wait times. WhatamIdoing (talk) 18:09, 11 July 2024 (UTC)

As a minor detail, perhaps the lead should end with "organisations have expressed disagreement with some of its conclusions." WhatamIdoing (talk) 18:10, 11 July 2024 (UTC)

I agree and just changed it into your suggestion. If the change is objected by a majority of editors, I'll self-revert. It seems to me, though, that we can all see eye to eye on this one. Cixous (talk) 18:41, 11 July 2024 (UTC)

You're probably right about the fact that it can (and will) remain a contentious section regardless of its content. I do believe that this article could benefit from more scientific context (e.g., what was the basis/rationale behind puberty blockers, when did they become routine, what do earlier meta-analyses/policy documents say etc.), with a redirect to puberty blockers and Dutch protocol (really hope that will get its own separate article sometime soon). That way readers will hopefully have a better understanding of the kind of environment in which the systematic reviews saw the light of day. Cixous (talk) 18:39, 11 July 2024 (UTC)

The Cass Review is far more than just puberty blockers. The Terms of Reference mentions the shift "from a psychosocial and psychotherapeutic model to one that also prescribes medical interventions by way of hormone drugs" but also the "significant increase in the number of referrals to the Gender Identity Development Service". Pedantic arguments about whether that increase was literally "exponential" or not miss the point that it is a huge increase, accompanied by a shift in several characteristics of patients, and one that simply overloaded what had been a small clinic. It reached the level where children referred to GIDS aged out before they reached the head of the queue. Child and adolescent mental health services are all currently hugely overloaded, not just this aspect, but this was perhaps the worst and certainly most visible example. Even without the controversy about medical pathways, this was a service in need of a review. Many of the recommendations are uncontroversial and even those that are are in the end a matter of emphasis. There are AFAIK no child psychiatric clinics anywhere that put 100% of referrals onto puberty blockers or hormones or surgery, even if that seems to be the impression given by various sides. Everyone agrees these matters need to be evidence based and everyone agrees more research is needed. -- Colin°^Talk 07:51, 12 July 2024 (UTC)

Yeah, you're completely right about that. Perhaps a 'scientific context' section is WP:UNDUE here, but a more proper focus on the background of the review and why it was commissioned in the first place could probably help the reader understand why the Cass Review derived at some conclusions in the first place. Cixous (talk) 12:34, 12 July 2024 (UTC)

Peerage

Should we add in the peerage? And if so, lede too or just body? Snokalok (talk) 03:48, 15 July 2024 (UTC)

While it may seem obvious Cass got the cross bench peerage due to their work on this review, the actual appointment doesn't mention that and Cass already had an OBE and had very senior roles elsewhere. I don't think we'd have a source doing anything other than speculating to link this to the review itself. If some official straight out stated that Cass was nominated for their work on the review, then it might mention a brief note in the body. It isn't leadworthy and sadly the appointment is often used to reward political friends than because the person has any competence. -- Colin°^Talk 07:53, 15 July 2024 (UTC)

While they don’t say “because”, multiple RSP sources present it as being implicitly due to the review. They all say “Hilary Cass, who wrote the Cass Review, will receive one”[35][36][37].

If nothing else, I think that earns a “Following the release of the Cass Report, in July 2024 Cass was awarded a lifetime peerage” since that seems to more or less be the style in which they’re all reporting it. Snokalok (talk) 11:27, 15 July 2024 (UTC)

Two of them lead with "the former president of the Royal College of Paediatrics and Child Health". I think the weight is clearly present at Hilary Cass's own page. The weight for this page would occur if sources were writing about the Cass Review mention its author was subsequently made a peer. -- Colin°^Talk 20:55, 16 July 2024 (UTC)