Talk:Cass Review

Title

I wonder whether the page title should have "The" in it. What do we do for other reviews named after people, or is their any MOS guidance about it? The page terms of reference seem to sometimes say "The Cass Review" and sometimes "Cass Review" (e.g. green text bottom left). The review appears to have a sub-title "Independent Review of Gender Identity Services for Children and Young People" which we should probably mention in the article, and perhaps that's its official title. Can we find out? On the interim report every other page header has "Independent review of gender identity services for children and young people". This NHS Page seems to use the longer name as the official title. I'm happy for us to use the shorter name for the article title per WP:COMMONNAME. -- Colin°^Talk 12:53, 9 April 2024 (UTC)

Good point - see eg. Leveson Enquiry, I think it should probably lose the the. Void if removed (talk) 13:46, 9 April 2024 (UTC)

@Void if removed do you want to do the page move then. Have you got the rights (a Move Tool on the right hand side). -- Colin°^Talk 13:56, 9 April 2024 (UTC)

I can move this page but the existing "Cass Review" redirect is in the way, and I don't think I can delete that myself. Should I move it to something like "Cass Review (Old)" and request a speedy delete? Void if removed (talk) 14:17, 9 April 2024 (UTC)

Ah. I think this is fixable by an admin. See Wikipedia:Moving a page#Moves where the target name has an existing page. Would be good to get this fixed today. -- Colin°^Talk 14:20, 9 April 2024 (UTC)

I've raised the request there, thank you! Void if removed (talk) 14:55, 9 April 2024 (UTC)

Do you think I've interpreted the "official title" correctly. I see Leveson Enquiry is titled "An inquiry into the culture, practices and ethics of the press" in the actual publications, but also retains the shorthand form of "Leveson Enquiry" in prominent position. Our article doesn't mention the long form of Leveson. For our purposes, the long form is very handy to explain what it is! I wonder if there are other examples we can compare. If we drop this long-form title from being bolded as though it is the official name, we could still say something like "The Cass Review (Independent Review of Gender Identity Services for Children and Young People) was commissioned in 2020 by..." or similar, and gain from this more explanatory name. -- Colin°^Talk 14:05, 9 April 2024 (UTC)

Exploratory

I agree with this edit which removed a link for "exploratory". The whole debate over whether therapies some describe as "exploratory" are and in all cases are conversion therapy is ongoing. Regardless, the text in question is in quotes and so we'd have to be entirely confident that the ACP-UK were in that quote referring to a therapy who's aim is to convert a trans child back to being cis. This is likely to be a continued battleground following the publication tomorrow. There is likely a divergence between the UK and US wrt what exactly is meant by "exploratory" and even from one clinical practice and another. We must be careful not to put words into people's mouths by linking one meaning when that meaning is not clear or not intended. -- Colin°^Talk 13:55, 9 April 2024 (UTC)

You can debate whether they meant GET or not, but GET is very widely considered a form of conversion therapy. Snokalok (talk) 14:26, 9 April 2024 (UTC)

Snokalok, the point is you and I can't insert our views, even if widely held, into someone else's words. I'm sure there will be opinion sources in the coming days condemning the NHS England position and labelling it so, and that's the place to put the Wiki link. There will likely be opinions on both sides and I very much doubt NHS England nor ACP-UK will agree with you that they are promoting conversion therapy, so we can't link their quoted text as though that's what they meant. That literally is putting words into someone's mouth, even if you think the words you put into their mouth are true. See MOS:LINKQUOTE. -- Colin°^Talk 14:57, 9 April 2024 (UTC)

It's not a personally held view, it's widely established consensus, the conversion therapy page has an entire section on it (which I linked to). As for the NHS and the ACP-UK, this goes back to the longstanding debate between yourself and about five different editors (including myself) across multiple pages now about how much weight to give a country's government on a minority group when said government has a well established and agreed upon (United Nations, Council of Europe, etc etc etc) recent history of targeting said minority group. Snokalok (talk) 15:05, 9 April 2024 (UTC)

I gave up arguing on that page after a pointless debate over whether or not the Cass Review and UKCP are FRINGE. The idea that NHS England is literally recommending conversion therapy is WP:EXTRAORDINARY to the point of absurdity. Void if removed (talk) 15:20, 9 April 2024 (UTC)

If they recommend gender exploratory therapy, we'd wikilink to gender exploratory therapy, which is a subsection on the conversion therapy page. Do you disagree? Snokalok (talk) 15:48, 9 April 2024 (UTC)

Snokalok, the MOS guidance is clear. I don't know why you are trying to make this personal or continue with the Terf Island insinuations. Prejudice has no place here. -- Colin°^Talk 15:24, 9 April 2024 (UTC)

Acknowledging criticisms of a government by human rights orgs and the UN on a topic is neither personal nor prejudiced, any more than it is to acknowledge China's repression of Uyghurs. The British government is not the same as the British people, and one should not take criticisms of the British government as some prejudiced assault on anyone of British heritage.

As for the MOS, they might not agree on conversion therapy, but if they say they're promoting gender exploratory therapy, adding wikilink brackets to that would link to the gender exploratory therapy section of the conversion therapy page. In this case the meaning of "exploratory" is too ambiguous, but if an NHS official comes out and says "We're implementing gender exploratory therapy", that would warrant a wikilink to GET, which is a subsection of the conversion therapy page. Do you disagree? Snokalok (talk) 15:47, 9 April 2024 (UTC)

To illustrate: Gender exploratory therapy. All I've done is add the brackets here, and it automatically redirects to conversion therapy. It is not my insinuation here, it is Wikipedia's itself, and I fully resent any sentiment to the contrary as incivility. Snokalok (talk) 16:09, 9 April 2024 (UTC)

Please stop digging. Your Uyghur comment is as embarrassingly bad as when folk on another page compared gender critical feminists to white supremacism. You may not be aware but NHS England is not Liz Truss and nor is it the mouthpiece of Sunak or Braverman. Nobody of any political or ideological persuasion thinks GIDS was working and the review is explicitly independent - its independence is part of the title.

The GET section of Conversion therapy is a mess in much the same way as "TERF" now means "transphobic person I hate, usually female". That some Americans put three words together and form an acronym doesn't mean that the word "exploratory" has been entirely stolen by the US catholic church, evangelicals or trans activists. Are you seriously telling me that because some random editor created Gender exploratory therapy redirect that "Wikipedia itself" agrees with you that this is uncontestably what ACP-UK meant and the words "exploratory" can never again be used by a psychiatrist again? You know there might be some nuance in what psychiatrists do when they talk to their patients that can't be expressed by whatever some activists fighting political battles in the US think a word in the dictionary now means. Please don't import US political battles to the UK. -- Colin°^Talk 16:34, 9 April 2024 (UTC)

What I'm saying is that, if one mentions gender exploratory therapy, and a wikilink to that redirects to conversion therapy, you cannot accuse someone of making things personal or trying to push their own POV. And sure, the word exploratory in this case might not mean that, but I'd like to note that gender exploratory therapy is not a US political battle, it's one that happens much more heavily on European shores - and I shouldn't have to say this to an editor as venerable as yourself, but WP:AGF and WP:CIVIL. Assume good faith and remain civil. Accusing editors of trying to launch some sort of bigoted soapbox against a country, and calling their stated viewpoints "embarrassingly bad" is neither assuming good faith nor civil. Snokalok (talk) 17:01, 9 April 2024 (UTC)

To clarify, I agree that exploratory might not mean that and thus linking to GET is premature and shouldn't be done, the "And sure, the word exploratory in this case might not mean that, but I'd like to note that gender exploratory therapy is not a US political battle, it's one that happens much more heavily on European shores" is more directly just a rebuttal to your assertion that connecting the word exploratory to GET is an importing of US political battles when GET is primarily a fight taking place in Europe while still acknowledging that it was premature to wikilink Snokalok (talk) 17:16, 9 April 2024 (UTC)

Snokalok, I am sure you are editing in good faith but you are pouring petrol on the fire and have quite literally written that you are prejudiced against NHS England. Your (and others elsewhere)'s Council of Europe comments are pre-dismissing the NHS guidance because some random person in some internationally-ignored European committee once looked at the UK and found some hateful MPs and some nasty journalists have said Bad Things. Yes they did say Bad Things, and most democracies have hateful MPs and nasty journalists, and an order of magnitude more so in the US.

You are prejudging Cass because Truss? I mean, seriously? That's just a pretty horrid thing to do to a respected paediatric consultant who was specifically asked to conduct an independent review on a topic that is toxic. Do you have any idea how it reads, when you are pre-dismissing their views because, let's get this correct, because Xi Jinping's China's oppression of Uyghurs, which has detained over 1 million people on the basis of their ethnicity, means I guess we can say prejudiced things about what some Chinese paediatrician might think. Clearly the entire population of 1.4 billion all think the same way. Stop doing this. It is lazy thinking, offensive, and not how the clinical care of trans adolescents should be judged. Let's see the review judged by wise comments from expert clinicians, not people who can't rise about Terf Island comments. Twitter is thataway. -- Colin°^Talk 19:31, 9 April 2024 (UTC)

I would agree with all of this in its entirety, but I think it's a niave view to take when the review has and is being criticised for taking advice and being shaped by some of these "nasty" people. But I definitely think we should wait untill the report is actually published and very careful of Wikipedia:Recentism And Wikipedia:NOTNEWS On the topic of the full report. LunaHasArrived (talk) 20:08, 9 April 2024 (UTC)

I think it's pretty ironic to accuse someone of "prejudging" Cass when her report is literally out for us all to judge, the interim report has been available for months, and a major part of Cass's review was explaining why she looked at 103 studies, and mostly dismissed all but 2 of them. It's not unreasonable to include in the article concerns raised about why Hillary Cass, who isn't some great authority on paediatric gender medicine, was chosen to lead this review, and why she decided to minimize the vast majority of the evidence by people who actually are experts. 174.87.27.244 (talk) 08:01, 10 April 2024 (UTC)

FYI, the full list of independent systematic reviews the Cass Review is based on can be found here: https://adc.bmj.com/pages/gender-identity-service-series Void if removed (talk) 08:59, 10 April 2024 (UTC)

Mostly news articles?

This article currently relies way too much on news articles covering it for a medical topic. Is there a reason why this published paper isn't in use in the article? Silverseren^C 20:43, 10 April 2024 (UTC)

No, and I agree - I think the sections should be citing the report directly, following the structure and wording of the review and recommendations, and news articles reserved for commentary/reaction. Void if removed (talk) 20:55, 10 April 2024 (UTC)

I agree: it's a long and detailed report and there needs to be a summary of the different focuses of the report, the recommendations noted and then, in the separate criticism section, commentary and reactions from others. Zeno27 (talk) 22:07, 10 April 2024 (UTC)

My main reason for using news articles when writing the sections this morning was that for a 400 page report, I wasn't certain what would qualify as WP:OR, so I wanted to rely on secondary coverage. Snokalok (talk) 22:32, 10 April 2024 (UTC)

The article OP linked should count as a secondary source. Flounder fillet (talk) 03:16, 11 April 2024 (UTC)

I agree Snokalok (talk) 07:09, 11 April 2024 (UTC)

Yes I think that's fair to flesh it out initially, I think we should aim to reference the review and the 9 accompanying MEDRS in the body in preference now: https://adc.bmj.com/pages/gender-identity-service-series Void if removed (talk) 07:52, 11 April 2024 (UTC)

Order of Findings

I think we should follow the order and priority of findings in the summary, and I think the headings can be summed up as follows:

• Rise in cases

• Conflicting clinical views

• International guidelines

• Poor evidence base

• Misrepresentation / Controversy (There's two here but I think they could be combined as "Controversy"?)

• Puberty blockers

• Hormones

• Desistance

• Clinical pathway

• Oversight

Void if removed (talk) 09:23, 11 April 2024 (UTC)

I hesitate in this regard, due to the fact that - it's not our job to repeat the Cass Review or shorten it into a more readable format, it's our job to write an article about it. Snokalok (talk) 09:42, 11 April 2024 (UTC)

Ah wait I missed the word "summary", in that case I think that many of the sections you've listed here are too short to really merit their own subsections, and should instead be condensed into an "other findings" section. That is, I don't think "There are conflicting clinical views and some providers are afraid to work with trans people" really needs its own section or even warrants it, notability wise. But it would go perfectly in an other findings subsection along with "The report came to the conclusion that no international guideline could be fully applied to NHS England" Snokalok (talk) 09:47, 11 April 2024 (UTC)

Also I'd just like to, marvel at the fact that this might be the least friction we've ever had when editing an article together. Snokalok (talk) 09:52, 11 April 2024 (UTC)

I support the use of these sub-headings where relevant, with the caveat that (as Snokalok pointed out) some of them should be left out due to lack of content, after the findings have been refactored into summary style prose. Also, I think statements like There are conflicting clinical views and some providers are afraid to work with trans people could work well in a brief "lead" of the "Main Findings"-subsection, or under "other findings" as proposed. Draken Bowser (talk) 10:59, 11 April 2024 (UTC)

Can I suggest a bit of restructuring to make it flow better? Would it be better to deal with the interim report just below the History section (adding some detail about the interim report - there's currently nothing except under Reception), then have the section on the final report? Zeno27 (talk) 10:09, 11 April 2024 (UTC)

While I can see the rationale, and I think that the interim report does bear weight, I wonder if it shouldn't be better be placed between Other Findings and Reception, due to us having the full report now and wanting to center that for the sake of a better article. Snokalok (talk) 10:18, 11 April 2024 (UTC)

Sorry, between Recommendations and Reception Snokalok (talk) 10:20, 11 April 2024 (UTC)

Alternatively, we could make the interim report a subsection of History Snokalok (talk) 10:22, 11 April 2024 (UTC)

A subsection of History would be OK (and that helps show the timeline of events), but it did have major implications and consequences and set the scene for the final report, so why not give it its own main heading?Zeno27 (talk) 10:54, 11 April 2024 (UTC)

Partially because the Interim Report's findings were largely repeated in the final report. The interim report's findings would thus be largely a repetition of information, but its notability is indisputable regarding the political impact it had - hence why I believe it should fall under history. Snokalok (talk) 15:29, 11 April 2024 (UTC)

Actually, could we rename "History" → "Background", since everything post-release arguably belongs in the "reception"-section? Draken Bowser (talk) 15:46, 11 April 2024 (UTC)

Go for it Snokalok (talk) 16:15, 11 April 2024 (UTC)

Criticism

The sentence that begins "Academic criticism also fell on the report..." in the Criticism section references a paper (Horton, 14 Mar 2024) that pre-dates the publication of the final report. Is there a better source for this? Zeno27 (talk) 15:49, 11 April 2024 (UTC)

Trying to track the original source for this: "Dr. Natacha Kennedy of the Feminist Gender Equality Network described the Cass review as "attempting to establish an all-enveloping ambient conversion therapy approach to trans children".[21]". This cites PinkNews but the article says, "In an opinion piece on the report, Dr Natacha Kennedy, co-chair of the Feminist Gender Equality, criticised the report’s approach to analysing research." but there's no link to where Kennedy says this and a Google returns nothing. Any idea where this opinion piece is? Zeno27 (talk) 16:42, 11 April 2024 (UTC)

Just answering both comments in 1, I believe the Horton paper is a response to the interim report and this should be noted in that section. And with 2 I don't believe it is the editors job to ask where a source got it's sources. However googling that sentence got a blogspot up authored by a Natacha which checking her twitter she does in fact link to so it does seem she did author that comment. LunaHasArrived (talk) 17:20, 11 April 2024 (UTC)

Yes, it should be noted that the Horton paper was referring to the Interim report. I was unable to find Kennedy's blog post - all I got was this page and PinkNews. I'll take another look. Ta! Zeno27 (talk) 17:34, 11 April 2024 (UTC)

Dropping in the PinkNews quote:

“In an opinion piece on the report, Dr Natacha Kennedy, co-chair of the Feminist Gender Equality, criticised the report’s approach to analysing research.

Kennedy wrote that she believes the Cass Report is “attempting to establish an all-enveloping ambient conversion therapy approach to trans children,” saying that the report, if implemented, would remove “their autonomy, freedom of expression, mental health, helpful support and healthcare.”” Snokalok (talk) 17:21, 11 April 2024 (UTC)

This sentence is wrong: "Criticism was also levied for the exclusion of transgender expertise - wherein the original terms of reference for the Cass Review explicitly stated that it "deliberately does not contain subject matter experts or people with lived experience of gender services".[14]"

The quote comes from that reference (Horton) but the full sentence is, "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”"

That quote does not come from the ToR and the ToR make no mention of the Assurance Group, but from an early description of the Assurance Group on the Cass website. It is therefore not about the review itself, but about the Assurance Group. The purpose of the Assurance Group is explained clearly:

"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.

Because the group is advising on process and not outcomes, it deliberately does not contain subject matter experts or people with lived experience of gender services. Professional and lived experience will be used to determine the outcomes of the Review and will be captured through our participative and consensus development approach.

Members have been appointed by the Chair to provide expert challenge from broad perspectives and have proven expertise relating to the conduct of the Review."

So, the Assurance Group is simply about ensuring the review was conducted to high standards.

Therefore, the reference does not say what that sentence says - and neither does the ToR - and is therefore highly misleading and needs to go. Zeno27 (talk) 18:44, 11 April 2024 (UTC)

Criticism sections are generally discouraged as they wrongly create a binary reaction to the subject, and can clump opinions that are more nuanced or varied into being "critical". I don't think we should do that. Also, way way too much room is being given to this opinion piece by some random academic at Oxford Brookes Business School. Not only is it only based on the interim report, but it is just some guy's opinion. If it has weight to be included at all (which I doubt), it would be something like "Dr Cal Horton criticised the interim review as an example of cis-supremacy" and that frankly is it. And our readers would be going "Who the heck is Dr Cal Horton and why should we care what they think" and rightly so. We do not bang on about "the International Journal of Transgender Health" nor do we confused one guy's opinion with facts we can present in Wikivoice. That entire section should be deleted: we don't contrast major four year healthcare reviews with someone from the business school of a minor university. -- Colin°^Talk 19:21, 11 April 2024 (UTC)

Agreed. Zeno27 (talk) 19:26, 11 April 2024 (UTC)

While I understand the view on criticism sections, it's somewhat difficult to not have one here given, everything. Like I get the criticisms of the Cal Horton paper, but a criticism section is somewhat necessary here given the controversial nature of the review. Snokalok (talk) 19:27, 11 April 2024 (UTC)

Oh and this sentence, also sourced to Horton "Academic criticism fell on the report for centering the concerns of professionals who did not believe in the existence of transgender children, for the demand for what is widely recognized as an "infeasible and unethical" level of evidence from studies for affirming treatments, due to requiring a control group to be subjected to what some consider conversion therapy; while non-affirming treatments were not held to the same standard of evidence" is not something we can say in Wikivoice at all, and is frankly such complete bs we should not be even quoting it. Dr Cal Horton is not "academic criticism" as though he speaks for all of academia who are all critical. It is not in any shape or form a universal (or even widespread) belief that what systematic reviews do (assess evidence) is demanding the infeasible and unethical. We are giving way too much voice to extremist positions critical of evidence based medicine.

Snokalok, once you get a Criticism section, it becomes a dumping ground for everyone who gets their opinion published. Do you think all serious minded analysis of the Cass review will entirely fall into wholesale criticism and . oh, wait, nobody created a Praise section. What a surprise. Life is not so simple. There will be serious sources on this review who take a very nuanced reaction. Right now, you only have a place for the critics. That's not NPOV. And it isn't solved by creating a Praise section, I was only joking about that. We just aren't recommended to do this at all. -- Colin°^Talk 19:40, 11 April 2024 (UTC)

I agree with what Colin says. Especially on "criticism"-sections in general, no matter the intention they invariably turn into flypaper for POV-edits. Draken Bowser (talk) 19:47, 11 April 2024 (UTC)

You say this as though crictism/controversy sections are not, incredibly common across Wikipedia. Calling it not NPOV is somewhat ridiculous. As for "infeasible and unethical", it is an incredibly commonly held position in medicine that there are some treatments for which the requirement of blind or double blind tests, are infeasible and/or unethical. Acting as though that's some unique idea here is, flat out incorrect. There are no double blind tests of "One person receives insulin, the other receives water" - that's ethics. Likewise, for feasibility, there are many treatments that are impossible to do blind because when one group starts growing a beard or tits, suddenly everyone knows which side has received hormones. Snokalok (talk) 19:48, 11 April 2024 (UTC)

Many bad ideas are common across Wikipedia, the compendium is a work in progress. Draken Bowser (talk) 19:56, 11 April 2024 (UTC)

I think at the very least if there is going to be a section it needs to be handled with great care. Just a few days ago when reading stuff related to this I came across Great Ormond Street Hospital#Controversies which IMO shows how absolutely terrible such sections can become when not handled properly. [1]

If you don't want to read it, that section currently includes quite a few stuff in the form of "In X date it was revealed". Worse than that, many of these and others in different form seem to be just random mostly clearly bad stuff that undoubtedly happened that was mentioned in the media that some editor decided to add. Some of them might belong, but many of them don't seem to have long term significance. And at least thing there in the gender identities subsection is just a random thing where the controversy isn't even established or obvious.

I mean this article doesn't quite carry the same risks since there won't be so much new stuff all the time, but still the point remains just because plenty of articles have such sections it doesn't mean they're working properly.

Nil Einne (talk) 07:09, 13 April 2024 (UTC)

I don’t actually mind the combined sections here anymore. It’s less organized, to be certain, but not unworkably so Snokalok (talk) 07:40, 13 April 2024 (UTC)

Snokalok, can I suggest you type "RCT on insulin" into your favourite search engine. So much nonsense gets written about this, please let's not be like Twitter where the ignorant argue with the ignorant. Cass is neither stupid nor evil and I'm sure knows more about evidence based medicine than everyone on this talk page many times over. Do you really think they aren't aware of these tired arguments about EBM?

Complaints about infeasibility or ethics are a deflection from basic statistical facts. Let's imagine I toss a coin three times and get heads each time: a 1/8 chance. It isn't proof the coin has two heads. If I now accidentally drop the coin in a drain, continuing the tossing to get a statistically convincing number is now both infeasible and asking you to retrieve it for me would be unethical, as you'd get stuck and drown. That fact doesn't magically make the coin any more likely to have two head. People playing this card, which demonstrates basic statistical ignorance, are like the folk that tell you bumblebees shouldn't be able to fly according to aerodynamics. They are spinning a story while ignoring the obvious: the bumblebees really can fly and the evidence about e.g. puberty blockers really doesn't make the grade any more than my three coin tosses do. -- Colin°^Talk 20:20, 11 April 2024 (UTC)

"Do you really think they aren't aware of these tired arguments about EBM?"

Somewhere around 90% of modern medical practice doesn't have "high quality" evidence backing it up. I think most medical researchers are aware of these arguments, they just don't care about the need for "high quality" evidence because RCT's are an impossible bar for many treatments. My question is why it suddenly matters so much more for this highly politicized and controversial treatment?

"Complaints about infeasibility or ethics are a deflection from basic statistical fact"

They're not, they're an observation that the overwhelming majority of medical care is without such studies backing it up for exactly this reason, and that it's thus unreasonable to demand that standard of evidence for only this specific treatment and no others. Snokalok (talk) 20:32, 11 April 2024 (UTC)

"Somewhere around 90% of modern medical practice doesn't have "high quality" evidence backing it up." This is an old trope caused by a misunderstanding (promulgated extensively by quacks) and usually originates from the BMJ Clinical Evidence page. I don't think that exists any more but it's explained by Prof Ernst here. It's also a tu quoque fallacy. Zeno27 (talk) 21:26, 11 April 2024 (UTC)

https://www.jclinepi.com/article/S0895-4356(20)30777-0/fulltext

As you can see above, "only a minority of outcomes (9.9%) for healthcare interventions are supported by high quality evidence". I'm not saying that high quality means good evidence, I'm saying that the standard for high quality is unfeasible to meet for a wide array of medical treatments, and that's being used here by others to say that there is no good evidence - because for some reason high quality means good evidence only when it applies to gender transition. Snokalok (talk) 21:48, 11 April 2024 (UTC)

No, but what quality of research does the vast majority of children's healthcare require. And let's not pretend that the research is anything like the coin toss example in terms of actual probability (although I do appreciate the good comparison). Also there is this study which is outside of the time period considered but shows that the research is being done and Is there (although the ethics have been questioned about this study). LunaHasArrived (talk) 20:34, 11 April 2024 (UTC)

Your giving undue weight to the review simply because it is a review, and not considering that there is legitimate criticism about it. In general I agree with the points made above, that RCT's is both unethical and largely impossible to implement in the studies rejected. If your review rejects most of the evidence on criteria that has been judged unreasonable on the basis of ignoring the ethical problems inherent with trying to implement said criteria, it is not something that can be ignored in the article itself. I agree Wikipedia shouldn't attempt to balance both sides of the debate in the case where one is overwhelmingly incorrect, but in this case claiming all the opposition are 'extremist voices critical of evidence based medicine' is completely and utterly ridiculous. Not only is there no consensus apart from the Labour Party and a couple of other organisations whether or not the Cass Review is even correct in its findings, it's completely ignoring the legitimate position taken by some critics. Keep and expand the Criticism section if necessary, because it's a reflection of the actual response to the review: Considering how controversial it is to pretend that the response was unending praise and zero backlash is factually incorrect. Angryman120344 (talk) 08:01, 12 April 2024 (UTC)

RCT's is both unethical and largely impossible to implement in the studies rejected

That's not why studies were rejected, and this article should not be a forum for spreading ill-informed opinion about MEDRS. Include the backlash, sure, but some of these specifics need to be backed up and corroborated with far stronger sources IMO.

And just to add, this is now the fourth systematic review into puberty blockers in as many years finding the exact same thing. Void if removed (talk) 13:33, 12 April 2024 (UTC)

The NOS still requires a blind assessment (impossible to do for this form of medicine), and an external control group (meaning one side gets forced through the wrong puberty, raising tremendous ethical concerns) Snokalok (talk) 14:11, 12 April 2024 (UTC)

You can read it in the review itself, but alongside a large number of incredibly vague assertations such as them being 'low quality', yes that is why they were rejected. It's not spreading an 'ill-informed opinion' the point of a criticism section is to reflect the reality that a large group of people have genuine concerns about the methodology and intentions behind the review. Again ignoring this is fundamentally misunderstanding how Wikipedia works. Also you are now making a personal assertation in the same response criticising me for giving weight to a single viewpoint, by once again arguing there is a consensus that puberty blockers are harmful.Just to add, this is now the fourth systematic review into puberty blockers in as many years finding the exact same thing. - This is not only completely irrelevant to my initial point, but is also not a point in of itself, because 1. there is no large scientific consensus on the efficiacy of puberty blockers and 2. To argue that because a review is 'systematic' automatically makes it correct or more worthwhile than the studies that it rejected and should be linked in the article in the Criticism page, is absolutely absurd. This isn't a debate on puberty blockers, but its generally accepted there is no consensus, so kindly stop trying to pretend there is. Angryman120344 (talk) 14:25, 12 April 2024 (UTC)

genuine concerns about the methodology

I think raising specific methodological concerns about a MEDRS, in wikivoice - particularly one of the highest quality - needs a source stronger than popular press, per WP:MEDPOP. Statements from recognised orgs like AUSPATH are, IMO, fine, but a person making an unverifiable claim in passing to the press is not.

To argue that because a review is 'systematic' automatically makes it correct or more worthwhile than the studies that it rejected and should be linked in the article in the Criticism page, is absolutely absurd

That is why a systematic review sits at the top of the MEDRS pyramid. Void if removed (talk) 15:24, 12 April 2024 (UTC)

The Cass Review vs the Systematic Reviews

Let's be careful not to confuse (as many of the weaker sources do) the Cass Review with the various systematic and narrative reviews and studies that were commissioned or that pre-existed. The list of commissioned reviews is here. They are not authored by Cass. Cass takes these various evidences and discusses them and makes recommendations. There will be criticism of those decisions and debate about their practicality, but we must not confuse the two. So when some lazy source says the Cass review included or excluded these papers or followed this or that method of analysing studies, alarm bells should be wringing that this source might be a piece of shit. -- Colin°^Talk 19:28, 11 April 2024 (UTC)

A counterpoint: These reviews were commissioned as part of the Cass Review process, and they are what the actual report itself drew directly from as its evidence base. While they weren't personally carried out by Hilary Cass, the review isn't being solely conducted by her, only led by her. Thus, I would argue that they are, for all intents and purposes, part of the Cass Review. Snokalok (talk) 19:33, 11 April 2024 (UTC)

I think the problem with saying they are part of it are two words. The word "Cass" and the word "Review". None of these systematic reviews were authored by her. The Cass review is at a meta level above the various pieces of research she commissioned, and includes far more than what those reviews looked at (she reviews how GIDS was working and how to replace it), just as those systematic reviews are themselves at a level above the studies they refer to. -- Colin°^Talk 19:48, 11 April 2024 (UTC)

It's a review with her name on it, but again, that's simply because she's leading it. There are other researchers involved in the review - just because one person's name is on it, does not in any way mean that they were the one who did everything. For examples see, literally any scientific anything named after a single person. Snokalok (talk) 19:50, 11 April 2024 (UTC)

The nuclear arms race, for instance, involved several designs named after one or two physicists. They were not the only ones who contributed to those designs. Those designs were the collective work of a large number of physicists carrying out various projects at various facilities that came together under the leadership of one or two physicists, to create the final design. Snokalok (talk) 19:55, 11 April 2024 (UTC)

I don't think your analogies are correct. The Cass review is her opinion and while she no doubt got lots of people to help do research, that report is hers. It isn't like she's the editor and each chapter was written by someone different. It's got her name on it and the buck stops with her on what it says. We really must be careful to describe these other documents carefully, just as we wouldn't dream of confusing a systematic review with one of the studies it looked at. -- Colin°^Talk 20:02, 11 April 2024 (UTC)

The Cass review is her opinion and while she no doubt got lots of people to help do research, that report is hers. Cass wasn't the only person involved in this review. She was the chair of the review panel, and she had others working under her, including but not limited to the assurance group. For example, we know from a competing interests disclosure that Riittakerttu Kaltiala was involved as a member of the advisory board for the review, though her name does not appear in the assurance group list of members nor elsewhere on the review's website nor on the review itself. Exactly how much influence she had as chair is unknown as that's not detailed within the terms of reference or the approach. As I said on the puberty blockers talk page yesterday, the amount of secrecy surrounding the unnamed panel members is concerning, given how her review has criticised other guidelines for having a lack of transparency into how they were developed. Sideswipe9th (talk) 20:08, 11 April 2024 (UTC)

While Cass wasn't the only person involved, Colin seems to be correct that the report and recommendations are presented as ultimately Cass's rather than the other people involved, at least on their official website [2] "Dr Hilary Cass has submitted her final report and recommendations to NHS England in her role as Chair of the Independent Review of gender identity services for children and young people" and "In making her recommendations" Nil Einne (talk) Nil Einne (talk) 20:18, 11 April 2024 (UTC)

Right but whatever her capacity within the inner workings of the review would've been, it would've still been her report by way of leadership and by extension, her recommendations. Beyond that though, we know for certain that Cass was not the only person involved, and without greater transparency, we won't know more.

Not to mention my original point that again, the reviews were still commissioned specifically for the purpose of and as directly part of the Cass Review, and thus that means that "The Cass Review" does refer to them as much as it refers to the introduction or table of contents of the report itself. Snokalok (talk) 20:27, 11 April 2024 (UTC)

I know this might not be correct in most sources but isn't there Cass's report and the reviews Cass commissioned (for lack of a better word) for the report. In that sense the Cass review doesn't really refer to anything in particular and I think people are using it to refer to either. LunaHasArrived (talk) 20:19, 11 April 2024 (UTC)

I'd agree with this sentiment, it seems like "report" refers to the paper itself, and "review" refers to the wider undertaking. Snokalok (talk) 20:28, 11 April 2024 (UTC)

Non-notable opinions

@Snokalok, you've reverted two edits with a note that appears to be based on a misinterpretation of what reliable source means. A source being generally reliable (and green at WP:RSP) means we are confident the information within it is accurate. It does not make the information WP:DUE. In these cases, we have reliable sources reporting the opinion of some people. Since those sources are reliable, we can be confident that those really are the opinions of those people. But as non-notable people, their opinion carries little weight. This is a super hot topic, I'm sure there will be no shortage of commentary from high-profile critics available in the coming days and weeks. I invite someone to revert the reversions. Barnards.tar.gz (talk) 21:04, 11 April 2024 (UTC)

Coverage by RSP media sources *is* a common indicator of due weight and notability though. RSP media sources are covering that this criticism is being issued, that gives that criticism notability and thus due weight. Snokalok (talk) 21:08, 11 April 2024 (UTC)

Additionally, "I invite someone to revert the reversions" somewhat breaks BRD, doesn't it? Snokalok (talk) 21:09, 11 April 2024 (UTC)

Not in a "You have broken the law" sense, but like a "This is not how BRD works" sense Snokalok (talk) 21:11, 11 April 2024 (UTC)

I just meant for someone else other than you or I to get involved and do the obvious thing, since it seems pretty open and shut what policy is:

From WP:UNDUE:

If a viewpoint is held by a significant minority, then it should be easy to name prominent adherents

Barnards.tar.gz (talk) 21:26, 11 April 2024 (UTC)

Alright, for the guardian part fair enough, but a quick search shows that Natacha Kennedy is a lecturer at UCL, so she does have sufficient prominence Snokalok (talk) 21:29, 11 April 2024 (UTC)

Sorry, UoL. Brain autocorrected Snokalok (talk) 21:33, 11 April 2024 (UTC)

I've trimmed some cruft from the responses. There will be a lot noise, please can we stick to:

* Responses from notable bodies (Stonewall, AUSPATH etc)

* Politically relevant responses (Labour adopting the Cass Review is notable, Wes streeting regretting saying TWAW is not)

* Relevant quotes (PATHA decrying the cass review is relevant, espousing conspiracy theories that already clog up several other pages is not)

* Not recounting non peer reviewed rebuttals to MEDRS as if they have any weight whatsoever (ie, we have highest-tier MEDRS backing up the puberty blocker efficacy claims, having some random Australian academic saying nu uh in a media outlet is FALSEBALANCE)

* Not puff pieces stuffed with tweets

There are an embarrassment of HQ sources, no need to go digging. Void if removed (talk) 10:13, 12 April 2024 (UTC)

The sources you've removed in your recent edits (except for a few irrelevant tweets which I agree can be kept out) are largely notable and relevant. Also your falsely claiming there is an overwhelming consensus against the efficacy of puberty blockers which is absolutely false. I'd recommend keeping Ada Cheung's section for the exact same reason. Angryman120344 (talk) 10:29, 12 April 2024 (UTC)

your falsely claiming there is an overwhelming consensus against the efficacy of puberty blockers

Not what I said. The Cass Review is based on multiple systematic reviews by UoY, which are the highest form of MEDRS, and one of which specifically found inadequate evidence for this claim. Having on the one hand a systematic review, and on the other an article in the Sydney Morning Herald claiming the opposite is false balance. It is one thing to have notable reactions, it is another to say in wikivoice "four studies rated as high quality already showed those treated with puberty blockers had less depression, less anxiety, less self-harm suicidality, and fewer problems interacting with peers" with absolutely nothing to substantiate that claim that is in any way comparable to the item being discussed.

When a systematic review says there is one study of high quality in this area, and the rest are moderate or poor, I think you need a better source than the SMH to produce three previously undiscovered and unmentioned high quality studies. Void if removed (talk) 13:14, 12 April 2024 (UTC)

My question is, why did your trimming remove the criticism from the U of Melbourne endocrinologist, but keep the praise given by the UCL professor? Likewise with the BMJ editor.

Additionally, the responses of the GC movement - and in particular Genspect, a group of clinicians who’ve long made these arguments their mainstay - are notable and merit inclusion, as strong secondary source coverage agrees. Snokalok (talk) 10:30, 12 April 2024 (UTC)

For Wes Streeting’s response, I’d argue it’s very notable if the comments are being made in the same breath as his praise for the Cass review, because it suggests that the review is possibly his reason for the change in belief.Snokalok (talk) 10:33, 12 April 2024 (UTC)

Its entirely speculation whether or not that was the reason for his change in belief, and it's not really relevant to the subject of the article which is about the review and response to it. I don't think someone changing their opinion around the same time is a clear enough link to justify including it in the article Angryman120344 (talk) 10:40, 12 April 2024 (UTC)

Alright then, we’ll leave that one out Snokalok (talk) 10:42, 12 April 2024 (UTC)

The BMJ editor is notable, because the BMJ is notable, and the systematic reviews are published in a BMJ journal, and the editor is directly responding to common criticism of the reviews published in that journal. This is all very relevant.

Sallie Baxendale is a highly esteemed and widely published academic, and (I believe) the only person to actually do a systematic review into the effects of puberty suppression on humans and animals.

Given that this is NHS England, it is suprising to me that three paragraphs of criticisms currently come from Australia and New Zealand, frankly. I have no doubt there are more to come, which is why what's there now seems like padding, especially since we're currently deriving two paragraphs from the same SMH article. I think its enough to combine both into one and say they reject the claims about lack of evidence, without going into so much detail. Void if removed (talk) 13:27, 12 April 2024 (UTC)

And Ada Cheung is the head of the trans health research group at Melbourne. I think limiting responses to the UK, when the field is global is strange. We wouldn’t remove the Yale criticisms of the (highly debunked) Florida review just because Yale is in a state other than Florida Snokalok (talk) 14:04, 12 April 2024 (UTC)

The other thing is including the specific nature of the responses. If one side is saying “We’ve reviewed the evidence and this is our evidence based opinion” and the other side is saying “The standard of evidence presented is infeasible”, without further detail that just sounds as though it’s being said that no evidence is needed when really they’re making a very specific point regarding evaluation criteria. To not include that point in even as little as three words (randomized control trial) fundamentally misleads the reader.

For PATHA, the quote is notable because they’re again, making specific points. To simply say PATHA criticized the review without including the nature of said criticisms, makes the reader draw assumptions. Snokalok (talk) 14:09, 12 April 2024 (UTC)

I think insisting that the criticism quoted be from the UK preferentially because the report is from there is a good way to end up with a biased article. I'm going to give an exaggerated example here, so don't kill me for comparing the two, but imagine we did that on a page about a Russian health care report. It would be immediately obvious that the only sources able to be quoted would be highly biased. We need to consider what other countries say about something to make sure the country we're quoting isn't somehow an outlier, and to be able to do that sources from outside the country need to be given equal weight. --Licks-rocks (talk) 14:22, 12 April 2024 (UTC)

I made no such insistence - I'm simply saying that the amount of space given to Australia and New Zealand in the "criticism" is surprising, as that seems to be the part of the world most offended by the review. Void if removed (talk) 15:41, 12 April 2024 (UTC)

I’m trying to look at a way to accurately paraphrase what is being said to make it shorter than the quote, and I’m having trouble doing so; it’s very succinctly worded already. Snokalok (talk) 17:48, 12 April 2024 (UTC)

I should also note that it’s not uncommon for international response to take up more space than national. Any article on something happening in Syria or wherever could show that.

EDIT: The edits below I'm having second thoughts about, because when looking at the paragraph on mobile, yes it looked very large, but on desktop the size appears perfectly fine.

Snokalok (talk) 17:49, 12 April 2024 (UTC)

Perhaps changing

They further stated "Restricting access to social transition is restricting gender expression, a natural part of human diversity. Requiring clinical approval for haircuts and wardrobe changes is intrusive, inappropriate, and a waste of money and time."

to

Regarding the recommendations on social transition, they stated that “Requiring clinical approval for haircuts and wardrobe changes is intrusive” and “inappropriate”. Snokalok (talk) 17:54, 12 April 2024 (UTC)

And chanfing

stated that the Cass Review made "harmful recommendations" and "ignores the consensus of major medical bodies around the world".

to

Called the recommendations “harmful” and said the review ignored global medical consensus. Snokalok (talk) 18:05, 12 April 2024 (UTC)

And then the use of the word recommendations there might allow for

Regarding social transition, they stated that “Requiring clinical approval for haircuts and wardrobe changes is intrusive” and “inappropriate”

which is a much greater cutdown Snokalok (talk) 18:06, 12 April 2024 (UTC)

The statement further said that "a number of people involved in the review and the advisory group previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming ‘gender exploratory therapy’, which is considered a conversion practice."

To

They further stated that several people involved in the review “previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming ‘gender exploratory therapy’, which is considered a conversion practice." Snokalok (talk) 18:11, 12 April 2024 (UTC)

Personally, I would suggest:

The Professional Association for Transgender Health Aotearoa (PATHA), a New Zealand professional organisation, stated that the Cass Review made "harmful recommendations" and was not in line with international consensus, while calling into question the advisory group's independence and comparing recommendations for exploratory approaches with conversion therapy. A joint statement by Equality Australia signed by the Australian Professional Association for Trans Health (AusPATH) and PATHA among others stated the review "downplays the risk of denying treatment to young people with gender dysphoria and limits their options by placing restrictions on their access to care”.

Endocrinologist Ada Cheung of the University of Melbourne and Portia Predny, Vice President of the Australian Professional Association for Transgender Health, disputed Cass’ conclusion that the evidence base for gender affirming care was weak, saying that randomised-controlled trials were neither feasible nor ethical to achieve.

Frankly I am expecting more criticism, from higher authorities than these (and I'm surprised there's been little from the US so far) so devoting so much space to multiple lengthy quotes from an org like PATHA is overkill when it can be summarised like that. And I think Cheung's specific claims about 4 studies are so lacking in substance, in such a weak, passing, non-quoted reference, they should not be repeated here without a corroborating source. Void if removed (talk) 11:54, 13 April 2024 (UTC)

For the first paragraph, I'd counter with:

The Professional Association for Transgender Health Aotearoa (PATHA), a New Zealand professional organisation, stated that the Cass Review made "harmful recommendations" and was not in line with international consensus, and that “Requiring clinical approval for haircuts and wardrobe changes is intrusive” and “inappropriate”. They further stated that several people involved in the review “previously advocated for bans on gender affirming care in the United States, and have promoted non-affirming ‘gender exploratory therapy’", which is considered a conversion practice." A joint statement by Equality Australia signed by the Australian Professional Association for Trans Health (AusPATH) and PATHA among others stated the review "downplays the risk of denying treatment to young people with gender dysphoria and limits their options by placing restrictions on their access to care”.

For the second, I think this mischaracterizes Cheung's criticisms, and I think that we can't reasonably censor or downplay hers while directly quoting the praise issued by her British contemporaries. I'd be willing to change "four" to "several", since that's less committal, while not betraying the overall spirit of her words. Snokalok (talk) 12:04, 13 April 2024 (UTC)

Ada Cheung's four studies rated as high quality

Do we have a better citation than the Sydney Morning Herald for what these four studies are? Since we are stating that they are "rated as high quality", we may need to clarify whether "high quality" is the same "high quality" as used by Cass. Cheung has previously been in the media promoting this RCT (Nolan et al., 2023). The media coverage of course omits mention of the lack of blinding, which was one of the limitations Cass identified as putting a study at high risk of bias, so it seems very unlikely that this study would actually have been counted as high quality by Cass's standard. As Nolan et al. itself says in its limitations section: Therefore, it is possible that the effect of testosterone or patient knowledge of treatment has been evaluated.. Perhaps Cheung's other 3 "high quality" studies are better?

This is just one example of the dangers of relying on popular press articles as a source for casting doubt on a WP:MEDRS source that sits at the very top of the evidence quality pyramid. Barnards.tar.gz (talk) 10:15, 13 April 2024 (UTC)

It's not our job to speculate, nor to take one standard over the other as the gospel. Our job is simply to write what is being said. The fact is, we have the head of transgender health at U of Melbourne leveling this criticism. You can interpret it as you wish.

Additionally, this isn't balancing an MEDRS source with a popular press source, this is an article about a review undertaken by the British govt, and part of that article involves notable responses to the report. The fact that the report happens to be an MEDRS source is coincidental when it's the subject of the article, because we're simply writing about the review as the subject. See the article talking about the Florida review for another example, which is contrasted with the criticisms of Yale researchers as reported in press.

I also don't like your assertion that it's only a problem when the statement of a relevant individual casts doubt on the report, but not when it praises it. That seems like an issue of NPOV. Snokalok (talk) 10:59, 13 April 2024 (UTC)

1) Claims and counter-claims about evidence quality are most certainly within the scope of biomedical information. As described in WP:MEDRS:

Biomedical information requires sourcing that complies with this guideline, whereas general information in the same article may not.

Therefore we must take care not to impugn a higher quality source with a lower quality one. A newspaper article playing fast and loose with the term "high quality", when quality assessment is the crux of the subject, is not a helpful source.

Criticism from non-MEDRS sources is appropriate when it concerns general (non-biomedical) information, e.g. perhaps something about how the review was commissioned.

2) I also don't like your assertion... I'm not sure if maybe you've mixed up my comment with something else you've read, because I certainly did not make any such assertion. We can absolutely report the reactions (praise and criticism) of notable people and organisations, but if those reactions stray into attempts to challenge the biomedical validity of the report, then they will need to come from a much higher quality source than the SMH. Barnards.tar.gz (talk) 12:41, 13 April 2024 (UTC)

"much higher quality source than the SMH"

The SMH is considered Australia's paper of record. It's absolutely reliable for saying that someone said something, and in this case it's saying that Ada Cheung said that the evidentiary conclusions were incorrect, which is what the article repeats.

"but if those reactions stray into attempts to challenge the biomedical validity of the report"

That's your own characterization of Cheung's criticisms. But plainly speaking, they can only be considered criticisms. Snokalok (talk) 12:50, 13 April 2024 (UTC)

As I mentioned to Void, I'd be willing to compromise with changing "four" to a noncommittal "several" Snokalok (talk) 13:01, 13 April 2024 (UTC)

It is, frankly, a very poor source for such a substantive accusation. Not even a direct quote, unverifiable, and the source is someone wholly unconnected from the subject. Void if removed (talk) 11:30, 13 April 2024 (UTC)

It's the head of trans health research at U of Melbourne. We're not repeating it as indisputable fact, we're simply saying that this is what she said, the same as we did for Sallie Baxendale and Kamran Abbasi. The only difference is that the latter two are in favor of the review's methods and findings, whereas the former one is against, but the former still has just as much credibility as the latter. Snokalok (talk) 11:36, 13 April 2024 (UTC)

Request for review of a sentence

Hi all

I'd like someone with a good understanding of research to check the sentence below, my understanding is that the report was criticised by academics for inconsistent standards of evidence. How the sentence in the Background section gives a different impression.

The final report of the Cass Review was published on 10 April 2024. It included several systematic reviews of scientific literature carried out by University of York, encompassing the patient cohort, service pathways, international guidelines, social transitioning, puberty blockers and hormone treatments.

Thanks

John Cummings (talk) 10:50, 13 April 2024 (UTC) John Cummings (talk) 10:50, 13 April 2024 (UTC)

The sentence quoted here isn't incorrect, but I can understand that to a reader that's not used to critically analyzing every source they read (that is, the majority of readers), it could read as lending a credibility to the report when in reality that credibility is in dispute.

It's like how "Studies say XYZ" is a true statement regardless of how credible the studies in question are. The studies could be utter nonsense, but they're still studies and they're still saying XYZ. And most people aren't going to question it beyond that.

Ultimately, if you feel a change should be made, by all means propose it and let it be discussed. Snokalok (talk) 11:03, 13 April 2024 (UTC)

the report was criticised by academics for inconsistent standards of evidence

That is the understanding you will get from reading some opinions in the popular press.

However, Cass is based on 9 MEDRS of the highest quality, none of which have received criticism of equivalent quality. So balancing unevidenced speculation in the press VS the actual MEDRS upon which Cass is based is difficult.

I think that reporting that takes issue with Cass' findings and recommendations is absolutely fair game - but reporting which actually makes specific unverifiable claims about the evidence base should fall foul of WP:MEDPOP, unless it is in an equivalent MEDRS.

For example, I have added the underlying UoY systematic review into puberty blockers to the relevant article - but absolutely none of the evidentiary criticism being levelled at so far Cass would be WP:DUE for inclusion on that page, even though they are actually talking about the same evidence base.

IMO, this page should not be a free for all to inflate non-MEDRS criticism of a highest quality MEDRS. Void if removed (talk) 11:28, 13 April 2024 (UTC)

Why is the praise/agreement regarding the evidentiary findings from Kamran Abassi and Sallie Baxendale considered acceptable then, if the criticism regarding the evidentiary findings from Ada Cheung (to reiterate, the head of trans health research at U of Melbourne) isn't? Snokalok (talk) 11:39, 13 April 2024 (UTC)

I think it is fine to say notable figures and orgs gave their opinion about the standards of evidence - but incorporating the specifics inflate and repeat what are completely unsubstantiated and unverifiable claims about the actual underlying MEDRS in a manner that is a FALSEBALANCE criticism. It isn't even clear what the allegation is about the "four studies" - have they been excluded wrongly? Have they been published after the cutoff? What's actually being said here? It is garbled. Void if removed (talk) 13:46, 13 April 2024 (UTC)

The issue of "inconsistent standards of evidence" is that the actual Cass Review has an absolutely huge scope and so one can find things to criticise and say that recommendation X is has less evidence than recommendation Y. This is not a secret or a surprise. As a statement itself it is pretty meaningly accusation, as one would expect a report of this size to have varied levels of evidence supporting the recommendations. Indeed, I've read quite a few NICE reports on other healthcare matters, and some recommendations have high levels of evidence and some very low, and NICE are very explicit about which recommendations they make are based on solid ground and which are weaker. So really the "inconsistent standards of evidence" is itself nothing more than a statement of reality even though it sounds like and is used as a criticism. Really, it's the sort of argument that indicates to us the source is bs, and not all "academics" are equal. There will be plenty "academics" who think they have an opinion about this, who are not in any shape or form qualified to assess or recommend healthcare practice, but know how to write an essay. -- Colin°^Talk 12:00, 13 April 2024 (UTC)

I mean that's not really what's being said, it's more than there's little to no evidence for the practices the report is advocating, while there is - even by the review's own standards - some degree of evidence for gender affirming care, and yet the recommendations use this presumed lack of evidence for GAC to castigate it in favor of GET which has far less evidence.

It's a matter of confirmation bias, essentially. GET is treated as the default without any evidentiary scrutiny, while GAC needs to prove itself to such a high level as to not be physically possible with medication that changes your physical appearance. Snokalok (talk) 12:14, 13 April 2024 (UTC)

Is it any surprise to me that the "inconsistent standards of evidence" line in our article comes from Cal Horton, see below. You use the word GET as though that appears in the Cass Review. Indeed Cass themselves comment that "Terms such as ‘affirmative’ and ‘exploratory’ approaches have been weaponised to the extent that it is difficult to find any neutral terminology". I think you are attacking a strawman. Please base your arguments on what actually appears in the report and not what twitter feeds. -- Colin°^Talk 12:41, 13 April 2024 (UTC)

Can you go five replies, perhaps, without dismissing what someone else is saying as just twitter? It's beneath you.

Anyway, regarding GET, how would you characterize the therapy it advocates if not as that? Snokalok (talk) 12:53, 13 April 2024 (UTC)

Read section 11 of the report. The evidence base for psychological and psychosocial interventions is also described as low quality. It goes on to recommend that Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress and cooccurring conditions., about which it previously said, in section 11.36: Some therapies, which are well proven for associated mental health problems, already have a strong evidence base.

So what the review actually seems to recommend is to treat co-occurring conditions with standard evidence-based practices, where the evidence is strong. There is a separate recommendation (6) that the evidence base for both medical and non-medical interventions must be improved. Cass advocates for a "holistic" approach so as to identify psychiatric comorbidities, and give them appropriate evidence-based treatment - rather than assume that gender is the only thing going on.

So in fact it's quite consistent, and if you spot sources complaining that Cass promotes a particular type of psychiatric intervention based on low-quality evidence, that could be a sign that the source hasn't read the review. Barnards.tar.gz (talk) 13:45, 13 April 2024 (UTC)

Right but the meat of the report's recommendations are still that medical pathways should not be deployed for the majority of cases, in favor of psychiatric treatment as the default. That's very much privileging one form of care over the other. Even if the level of evidence for them is the same (which is an if that I by no means cede), that's still recommending one based on low quality evidence and recommending against another based on the same quality of evidence. Snokalok (talk) 14:09, 13 April 2024 (UTC)

Which source disputes which part of Cass in this manner? Barnards.tar.gz (talk) 15:26, 13 April 2024 (UTC)

Cal Horton

Why is so much guff from Cal Horton still in this article. The several paragraphs of text beginning "A 2024 article in the International Journal of Transgender Health..." needs entirely removed. It is the opinions of someone who is employed by the business school of Oxford Brooks University (a former polytechnic, not to be confused with Oxford University) who's qualifications wrt criticising the Cass Review appear to be "mother of a trans child" who did a phd on that.[3] Sure, they've done some research on trans issues that may well be valuable and could well be a source of information to the Cass Review itself. But our article is presenting their personal opinions, many of which are false and highly contested, as though we consider them a counterbalance to this review. Dozens of people were interviewed and gave their opinions to the Cass Review, and here we give space to one who feels ignored perhaps?

For a start, I think we need to realise that criticisms about how systematic reviews reject low quality evidence that are based on views about the infeasibility or ethics of RCTs, and guff about blinding, are themselves a striking example of misinformation. And Wikipedia needs to avoid being a source of misinformation. Anyone serious about evidence based medicine rolls their eyes when reading such nonsense. It demonstrates deep ignorance of how evidence based medicine really works, and is what you get when you start quoting people who work in a business school rather who's day job is conducting systematic reviews for NICE or Cochrane or whatever. If you don't believe me, please go read some NICE reviews or Cochrane reports on random other bits of medicine like epilepsy or breast cancer or depression or diabetes, and you will find the systematic reviews commissioned and cited by the Cass review are entirely typical and the ethical issues they face not that unusual.

If the approach of these systematic reviews was as outrageous as some trans activists are suggesting it to be, do you really think the BMJ would have published it, or that Cass and their Clinical Expert Group (who assessed the evidence) would not have gone "Hold on a sec, this is demanding the infeasible and is totally unethical"? These are Trumpian-level arguments that sound great to the activist base but should ring alarm bells. -- Colin°^Talk 12:37, 13 April 2024 (UTC)

Firstly it is important to remember that the Cal Horton part is criticism to the interim report specifically. I agree that I think citing criticism of the solely medical aspects of this is probably undue but Horton has done a PhD on trans kids wellbeing and works advising about that so should be credible for the top 3 points. I also think that crediting criticism of the systematic reviews was by transgender activists and not professional health organisations is intriguing. I would also point that some of the criticisms are saying that members of the clinical expert group was inherintly biased and influenced the decision. This idea that the reviews are infallible when health organisations have criticised them is an idea that should not be entertained. LunaHasArrived (talk) 13:12, 13 April 2024 (UTC)

This review also contained peer-reviewed analysis of those self-same organisations and levelled criticism at the weak evidence base and circularity of their standards of care.

Devoting 5 paragraphs to the opinions of a parent advocate of a trans child is way, way overkill. Void if removed (talk) 13:39, 13 April 2024 (UTC)

I agree that the space taken up was overkill Snokalok (talk) 13:50, 13 April 2024 (UTC)

Please remember this is the interim report. I agree with the change that has been made on the page and that the criticism made from the international orgs is far better. LunaHasArrived (talk) 13:52, 13 April 2024 (UTC)

Boldly deleted Horton as recovering the link to the joint statement revealed the low levels of interesting original thought in that paper. Flounder fillet (talk) 13:52, 13 April 2024 (UTC)

sources for consideration

I have seen this kind of section on other pages and think it could be useful for sources that people think could be used in the article to be placed here.

Feel free to edit and tidy this up to make it more helpful/useable. I am not familiar with the best way to organise information on Wikipedia.

guardian source citing subject matter expert [1] LunaHasArrived (talk) 13:16, 13 April 2024 (UTC)