Talk:Cass Review/Archive 4

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Inclusion of specific criticism that report was too selective of research

Hi @Snokalok, hope you're having a nice day.

I think the article should include the specific claims that the report was too selective of research because it excluded 98% of research it found and only accepted double-blind experiments. The claims were widespread, formed a large part of the critical reception to the report, and are notable, so warrant inclusion outside of Cass' response to the reception. These two specific claims aren't covered elsewhere in the article, even if other statements covered in the reception section also conclude the report was too selective, so including them is not redundant. Several of those statements may also be removed in the future for lack of sourcing from secondary sources and notability. They are markedly less notable than these claims, so they should be removed if anything. The entirety of the content I added on these claims is well-sourced. Being so widespread, readers are likely to have encountered these claims, so discussing them factually leaves the reader better informed and with better context than neglecting to doing so.

Please let me know what your thoughts are. Thanks! 13tez (talk) 18:26, 23 April 2024 (UTC)

They are covered already, the 98% double blind one along with the 60% response is still there in the Cass response subsection, and all the orgs and people saying that it excluded too much evidence and that its criteria were too strict are also there. The only difference between your edit and mine is that you repeat the generic topic intro of “too strict” when the article already says that thoroughly, and you for some reason make it one of the top paragraphs. But otherwise, 98% is still there, the 60% rebuttal is still there.

”Several of those statements may also be removed in the future for lack of sourcing from secondary sources and notability”

This has been thoroughly litigated on this talk page already, and this is the consensus achieved due to the sources of these criticisms (major international medorgs and figures in the field) being notable. Snokalok (talk) 21:14, 23 April 2024 (UTC)

Also making it one of the top paragraphs is so incredibly farcical, why are you putting the response the criticisms before the criticisms themselves Snokalok (talk) 21:16, 23 April 2024 (UTC)

Hi @Snokalok, thanks for getting back to me again.

"They are covered already"

I'm afraid not. Your edit does not feature the claim that only double-blinded studies were accepted. It also does not feature these two specific claims with other prominent points of reception to the report. These two claims do not exist solely within Cass's rebuttal of them, so should be included separately within the Reception section.

"all the orgs and people saying that it excluded too much evidence and that its criteria were too strict are also there"

You might have misunderstood what I was saying before; these statements should be removed. They're almost all only referenced from primary sources (when articles should primarily be referenced from secondary sources) and received no news coverage, so their inclusion is also WP:UNDUE. By contrast, these two claims are substantiated from secondary sources and received widespread coverage, as evidenced by the references I used. I'm advocating for these other statements, which also say the report was too strict in which research it included (while not these two specific claims) to largely be removed for poor sourcing and undue weight.

"The only difference between your edit and mine is that you repeat the generic topic intro of “too strict” when the article already says that thoroughly"

Again, your edit is missing the claim regarding non-double-blind studies being dismissed and these claims as prominent points of response. Furthermore, it says that Cass claims 60% of the papers collected were included, when this is a fact substantiated by the references I used.

"you for some reason make it one of the top paragraphs"

This is because, after the response from politicians and NHS policies changing, these two claims were the most notable and widespread response to the report. They have widespread coverage in secondary sources (news articles from reliable outlets) unlike the litany of responses and statements currently included. I placed them in the correct order as to the prominence of these claims within the wider response to the report.

"This has been thoroughly litigated on this talk page already, and this is the consensus achieved due to the sources of these criticisms (major international medorgs and figures in the field) being notable."

Looking at the WPATH statement and GenderGP Response sections, I see general opposition to the inclusion of these responses. In More International Responses, Void if removed said the responses from Sandyford and the Amsterdam UMC are notable as prominent groups within transgender healthcare. Looking at Condensing the individual responses, the consensus seems to be to group together academics if they generally agree (maybe we should do this for groups too). I can't see a clear and obvious consensus here on whether these responses should be included (albeit from skimming), hence why I made the "We should remove several responses to the report" topic to address this exact point. Even if they are notable, we should probably still summarise their responses - after all, as you've pointed out, they're very similar - and source them from a secondary source if possible. If they are indeed notable people and groups in this field, their statements should have news coverage we can use as a reference.

"Also making it one of the top paragraphs is so incredibly farcical, why are you putting the response the criticisms before the criticisms themselves"

I did intend to put these claims as part of the response here for the reasons I discussed above - they are the most prominent response other than those from politicians and NHS England and Scotland. Most of the coverage was within Cass responding to them, hence why it made sense to combine the two subjects together in the same paragraph. We could, however, separate these two points with the use of named references? That way we could describe the claims where I placed them and later feature Cass's response to them in the Cass response section. We may need to provide a caveat, however, that the claims are incorrect if we don't immediately give that context afterwards, as was the case in my edit.

Please let me know what your thoughts are. Have a great evening! 13tez (talk) 23:31, 23 April 2024 (UTC)

I’ll the double blind bit back in in a sec.

“Looking at the WPATH statement and GenderGP Response sections, I see general opposition to the inclusion of these responses”

GenderGP is 2-2 and you’ll notice it isn’t in the article.

WPATH, I just see two comments - one lamenting that we don’t have a better source, and you linking to the news article discussion in which you argue that we should only be writing info about this report based on news articles (which to me reflects a deep lack of understands of how editing medical articles works).

“This is because, after the response from politicians and NHS policies changing, these two claims were the most notable and widespread response to the report.”

By your determination, because the BBC (very biasedly) said they were being made, but I’d rather think from the medical community’s perspective, it matters much less what the BBC says and much more what the international orgs on the subject say.

“ Looking at Condensing the individual responses, the consensus seems to be to group together academics if they generally agree (maybe we should do this for groups too).”

That is not said anywhere and in fact we decided in an earlier thread several days prior to not group the responses based on positive vs negative.

“ If they are indeed notable people and groups in this field, their statements should have news coverage we can use as a reference.”

Okay you’ve been making this argument throughout this entire talkpage to unanimous disapproval and I need you to read over WP:PRIMARYNOTBAD, WP:MEDRS, and WP:MEDORG. Snokalok (talk) 10:15, 24 April 2024 (UTC)

Also WP:MEDPOP Snokalok (talk) 05:05, 25 April 2024 (UTC)

Hi @Snokalok, hope you're having a nice day.

Unfortunately, the current content is still problematic. It still doesn't include the specific claim that all studies that weren't double-blind weren't considered. Furthermore, it says "She (Cass) characterized statements by critics, of the report dismissing 98% of studies reviewed as "completely incorrect", saying that although only 2% of the papers collected were considered to be of high quality, 60% of the papers, including those considered to be of moderate quality, were considered in the report's evidence synthesis."

This phrasing indicates that the facts that 60% of papers and those of moderate quality were included are only claims in turn by Cass. Per WP:VOICE, we should "Avoid stating facts as opinions". The multiple references I provided (all of which are from reliable sources) as well as the report itself (which per consensus is also a reliable and acceptable source for use in this article) all substantiate these facts as being true. Therefore, we should be stating them as facts rather than as a retort from Cass against the claims re being too selective.

A smaller point that I still maintain is that these claims didn't only exist within Cass's response to them, so should also be covered outside of her response, given their notability.

"By your determination, because the BBC (very biasedly) said they were being made, but I’d rather think from the medical community’s perspective, it matters much less what the BBC says and much more what the international orgs on the subject say."

What is the nature of the bias you feel the BBC was showing in their reporting? Do you think it makes them inappropriate to use as a reference? I was using their article solely to substantiate the facts as to these claims being widespread (which anyone can go and verify with Google), Cass saying they were wrong, and the actual facts as to how many papers were actually used in the review. I don't see how reporting objectively true facts could be biased. If multiple reliable sources such as the BBC, the Times, the Guardian, and ITV News, as well as the report itself, all concur that these facts are true (as they do), we can and should include them as facts per WP:VERIFY and WP:VOICE. The Cass Review was commissioned by the NHS and was based on systematic reviews carried out by the Centre for Reviews and Dissemination. It's the most credible source there is on these matters, including (and more than) the various medical organisations and charities who released critical responses to the report. What the BBC (and other outlets) reported was the same as what was in the report, so there isn't any conflict between medical knowledge and the content of the news reports.

Have a good one! 13tez (talk) 19:58, 25 April 2024 (UTC)

@13tez, you said It still doesn't include the specific claim that all studies that weren't double-blind weren't considered.

I am now going to tell you why it does not contain that specific claim. Here is the reason: It does not contain that specific claim because that claim is not true.

Firstly, I suspect that some people have misunderstood the difference between a randomized controlled trial (maybe you get the experimental treatment, and maybe you don't – if you don't, you might get a sham treatment, a non-experimental treatment, or no treatment) and a blinded experiment (neither the provider nor the patient knows what treatment the patient is getting). It is easy to do blinded studies for most drugs; however, it is basically impossible to do a double-blind experiment for some treatments, like talk therapy or social transition.

Secondly, there seems to be quite a lot of confusion about how many studies were "considered" or "used". So to help you make sense of this, why don't you look through the report and make a list of all the studies that were used. You can post the list here on the talk page if you want, or in your sandbox. If you tag them with Template:PMID and ping me, I'll tell you which ones (if any) were blinded studies.

For example, if you see a statement in the report like "A subsequent re-analysis of the early intervention study (McPherson & Freedman, 2023), using original anonymised data from the study, took account of the direction of change in mental health outcomes for individual young people rather than just reporting group means. This secondary analysis found that 37-70% experience no reliable change in distress across time points, 15-34% deteriorate and 9-29% reliably improve", then:

• the study being "considered" and "used" in the Cass report was written by "McPherson & Freedman",
• it was published in 2023 (so if you see people claiming that nothing from the last two years was used in the report, then you know they're wrong),
• you can use the authors' names to find the full citation at the end of the report, which is "McPherson, S., & Freedman, D. E. (2023). "Psychological outcomes of 12–15-year-olds with gender dysphoria receiving pubertal suppression in the UK: Assessing reliable and clinically significant change." Journal of Sex & Marital Therapy, 1–11. https://doi.org/10.1080/0092623x.2023.2281986
• you can search https://pubmed.ncbi.nlm.nih.gov to get the PMID for the study, which in this case is PMID 38030953,
• and from that, I can tell you that this particular study is non-controlled, non-randomized, and non-blinded.

Therefore, anyone who says that only double-blinded studies were considered and that everything else was rejected is either so woefully uninformed that you shouldn't believe anything they say, or they're willfully lying to you, so you shouldn't trust them at all.

So here we have a paper that was definitely considered in the report, and that is definitely not double-blind, and therefore the statement that all studies that weren't double-blind weren't considered is obviously and categorically false. This article is not supposed to contain false information. The reason that the specific claim that all studies that weren't double-blind weren't considered is not in the article is because that specific claim is wrong.

I hope that this explanation has cleared up this matter for you. If you are still confused, please let us know. WhatamIdoing (talk) 07:31, 26 April 2024 (UTC)

Hi @WhatamIdoing, thanks for your input; I hope you're having a great day.

"It still doesn't include the specific claim that all studies that weren't double-blind weren't considered...I am now going to tell you why it does not contain that specific claim. Here is the reason: It does not contain that specific claim because that claim is not true."

I know. You can see this in my last edit, in which I said "There were widespread, false claims from critics of the report that it had dismissed 98% of the studies it collected and all studies which weren't double-blind experiments." Both these (false) claims were widespread and had substantial coverage, so warrant inclusion, albeit only while stating them as factually incorrect - as I have done. It will leave the reader more informed to know about these claims, that they're incorrect, and why they're incorrect than to omit them entirely. Apart from anything else, readers will come across these claims elsewhere, so it's a good idea to address and debunk them here.

"Firstly, I suspect that some people have misunderstood the difference between a randomized controlled trial...It is easy to do blinded studies for most drugs; however, it is basically impossible to do a double-blind experiment for some treatments, like talk therapy or social transition."

I know. The report itself discusses this in its methodology chapter, Cass said this in an interview, and the critics who put forward these claims do as well. I've read all the aforementioned different places this point is made, weirdly on both sides of this claim.

As to the rest of your comments, I think they're based on the misconception I believe the claims that the report dismissed 98% of the studies it collected and all studies which weren't double-blind experiments are correct. I don't. I hope this clears that up.

Thanks. 13tez (talk) 09:38, 26 April 2024 (UTC)

A lot of your editing philosophy here rests on the belief that because the Cass Review was carried out ‘by the proper authorities’, that makes it incontrovertible, especially if MEDPOP sources treat it as so. And yet we have countless MEDORGs now saying otherwise, criticizing everything from its methodology to its findings, and thus we cannot treat the Cass Review as this great bastion of objective truth, we have to treat it as POV regardless of what the British media (which has a thorough history of fearmongering about trans medicine) says. Snokalok (talk) 12:31, 27 April 2024 (UTC)

The review was commissioned and carried out by the NHS to form national guidelines, so is from a higher quality organisation from which to take BMI than the various critical charities and patient advocacy groups per WP:MEDORG. It is based upon peer-reviewed systematic reviews, which are the highest level of evidence in medical research, as discussed at WP:MEDASSESS. It's nothing to do with the media, which agree with the report (the most credible source on the topic) and thus present no conflict anyway. I'm sincerely sorry if you don't like the findings or perceived outcomes of the report, but it is the most authoritative source on the topics it covers. I'm not sure what changes you wish to see in the article anyway? The criticisms from the countless charities etc are already in this article, despite these organisations being less credible than the report and their statements largely contradicting it. 13tez (talk) 12:47, 27 April 2024 (UTC)

“it is the most authoritative source on the topics it covers”

I don’t know how to break this to you, but the UK’s public health service is not the most authoritative source on transgender healthcare. That honor goes to WPATH, the international medical org dedicated specifically to trans healthcare. Snokalok (talk) 12:51, 27 April 2024 (UTC)

I'd argue it's the WHO, but their guidance hasn't been developed and released yet. Anyway, we're now off-topic, so I'm going to leave my comments here. I hope you have a great day! 13tez (talk) 12:56, 27 April 2024 (UTC)

LunaHasArrived - why did you remove mention of WPATH but leave their link?

In https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=1221294180&oldid=1221291091 you replaced readable text:

> The review has been criticized by the World Professional Association for Transgender Health and associated regional organizations

to

> The review has been criticized by some international medical organisations

Yet left all the sources unchanged.

— Preceding unsigned comment added by Peckedagain (talk • contribs) 02:54, 29 April 2024 (UTC)

I just moved some existing text around, for easier reading

90% of what I did was move existing text around, for a clearer read. And added or renamed subheadings where that helped too.

But I now release that there has been loads of Talk here about some of the things I moved. I hope everyone is happy with the changes I made.Peckedagain (talk) 21:43, 28 April 2024 (UTC)

and I just added the BMJ's response to the report; as it wasn't there before and the BMJ are central in UK health. Peckedagain (talk) 22:16, 28 April 2024 (UTC)

@Snokalok - I replaced my changes that you just reverted - please comment here on your thinking.

I wrote in my comitt: "I am replacing what @snokalok reverted - their claim that "These matters have been extensively discussed and consensused already" is not true: searching for just the BMJ article, I could find no discussion of it in Talk.   Snokalok, please use the Talk section I had created before your revert: "I just moved some existing text around, for easier reading" Peckedagain (talk) 22:40, 28 April 2024 (UTC)

@Snokalok: Did you even read my commit notes before you reverted? Part of what did was this: "Moved the content around, because some 2024 content had been wrongly listed under the 2022 Interim report section." !! Peckedagain (talk) 22:49, 28 April 2024 (UTC)

BRD. Bold, revert, discuss. It’s been reverted, now we discuss Snokalok (talk) 22:50, 28 April 2024 (UTC)

Not to mention that, reading that over, it clearly - and I believe was actually discussed - falls under the interim report. Snokalok (talk) 23:02, 28 April 2024 (UTC)

wrong! Just as I wrote, there were links to 2024 content under the section about the Interim report which was in 2022: hence I renamed the heading to include '2022' and moved the links further down.

And I also rewrote that big paragraph: because before it was not clear that it was about a comment by ACP UK and a reply to that by some ACP UK members.

Incidentally - I could find no wiki page for ACP - nor searching their site could I find how many member they have. Is it possible that they are trivial organisation that don't deserve the coverage here they have? Or conversely, can I just create a new page in wiki for them? Peckedagain (talk) 23:17, 28 April 2024 (UTC)

Yeah, people were still talking in 2024 about the interim report. Shocking, I know, but the final report was not published on January 1, 2024.

As for the ACP, I’m trying to track down a reliable sources thread where this was discussed Snokalok (talk) 23:38, 28 April 2024 (UTC)

@LokiTheLiar Do you remember where it was? Snokalok (talk) 23:42, 28 April 2024 (UTC)

Not off the top of my head. Loki (talk) 23:44, 28 April 2024 (UTC)

So, that whole paragraph (Some criticisms of the operation of GIDS ...) is very confusingly written compared to the better one I wrote that Snokalok reverted.

Shall I put back my text, or shall I delete all mention of ACP, unless someone finds how substantive they are? Peckedagain (talk) 01:29, 29 April 2024 (UTC)

I don't want to unilaterally condemn the ACP here, because I remember there was a not insignificant amount of back and forth over their inclusion and I don't feel like it's my place to controvert that, but also I can't find a tremendous amount about them online beyond self-published sources, so, create a thread about it perhaps? Snokalok (talk) 12:26, 29 April 2024 (UTC)

Where was this? I've had a look and while they came up here Talk:Cass Review/Archive 1#Exploratory, the discussion wasn't really about their inclusion, and only barely about them as an organisation. The only other place I found them or their statement discussed is Wikipedia:Fringe theories/Noticeboard/Archive 97#Conversion Therapy and "Gender Exploratory Therapy", but again only very minimally. There seems to be a lot more discussion of United Kingdom Council for Psychotherapy, both that earlier discussion and Talk:Conversion therapy#GET - UKCP statement and maybe elsewhere. (Didn't look for them since they're irrelevant to ACP, just noticed then when looking for ACP stuff.) Nil Einne (talk) 15:26, 29 April 2024 (UTC)

UKCP! THAT'S WHAT I WAS THINKING OF. THANK YOU Snokalok (talk) 15:54, 29 April 2024 (UTC)

Alright let’s start with Abassi. Kamran Abassi was discussed at length in several threads with the prevailing consensus that if we’re going to shorten other more relevant academics (such as the UCL neuro professor and the U of Melbourne head of trans health research), then the guy who only had a couple years of medical experience nowhere near the field of trans health and then spent the rest of his career as a health writer, shouldn’t be given privilege over that decision. Snokalok (talk) 22:49, 28 April 2024 (UTC)

But the article, before I edited it -had NO mention of Abassi - nor of his BMJ article. (The BMJ is pretty central to UK healthcare, and no matter what his personal profile is, Abassis is the Editor. )

I looked back in Talk before I posted, but I saw no signs of consensus to simply exclude that article. Can you point out the sentence I missed? Peckedagain (talk) 23:24, 28 April 2024 (UTC)

It wasn’t excluded, it was cited under “some academics agreed, others disagreed” as one of the sources of that statement. Snokalok (talk) 23:27, 28 April 2024 (UTC)

OK: if you prefer strict precision: my meaning was 'it was not mentioned in any text a reader would see in the page'.

Can you point me to the sentence in Talk where that had been agreed? Given the profile of the BMJ, it seems hard to justify such down-playing?

I just added some more new contact and sources. Please don't just revert it. I wrote: "The United Nations Special Rapporteur on Violence Against Women, Reem Alsalem, on 24th April welcomed the announcements by NHS Scotland and the Welsh Government that they would suspend the prescription of puberty blockers to children, and writes: "The Cass review findings and recommendations are seminal, and its implications go beyond the United Kingdom.. it has – in my view – very clearly shown the devastating consequences that policies on gender treatments have had on human rights of children, including girls.". Peckedagain (talk) 23:47, 28 April 2024 (UTC)

See the Condensing Individual Responses thread. Anyway the Reem Alsalem edit is not something I have an issue with; but if you want to bring back Kamran Abassi, then we have to bring back the various other academics far more qualified and relevant on the issue than he. Snokalok (talk) 23:59, 28 April 2024 (UTC)

I looked back: I see comment that BMJ had been 'balanced' by the Canadian body quote. And that BMJ had then been deleted.

Yet looking at the Canadian body - they are doing what @Colin stated as: "the strawman that the Cass Review ignores any evidence that didn't come from a blinded RCT."

So : what's your view @Snokalok on colin;s view: is that claim possibly a strawman? If so, then the Canadian body and several others quoted here are also potentially straw-men?

Unless you can see anything about the BMJ article that is also 'potentially a straw-man': then it seems that the BMJ deserves space here more than the Canada article? Peckedagain (talk) 00:34, 29 April 2024 (UTC)

Yes because the BMJ statement is not actually the BMJ, it’s Kamran Abassi, an individual academic who happens to be THE editor of the BMJ, just like how Ada Cheung is an individual academic who happens to be the head of trans health research at U of Melbourne, or Portia Predny, who is an individual academic that happens to be Vice President of AusPATH.

As for the Canadian Pediatric Society, A. No it doesn’t, B. It’s very telling about your editing perspective that you try and make false claims about the Canadian source in order to digress into a talk on a completely unrelated point while simultaneously removing a MEDORG critiqueSnokalok (talk) 00:39, 29 April 2024 (UTC)

@snokalok - please retract your statement:

> It’s very telling about your editing perspective...

Because it is in breach of wiki rules 'no personal attacks': "As a matter of polite and effective discourse, arguments should not be personalized; that is, they should be directed at content and actions rather than people" Peckedagain (talk) 01:08, 29 April 2024 (UTC)

Stricken, now I’d ask that you kindly strike your incorrect claims about the Canadian Pediatric Society statement Snokalok (talk) 01:11, 29 April 2024 (UTC)

Thank you for admitting you broke wiki rules. You're not obligated in any way to me - but I'd welcome hearing from you whether you intend to apologise to me for your personalising things?

I don't need to strike my statement, as it is merely a statement of my opinion: and Wiki allows that on the Talk page. My opinion may be right or wrong, but can be shared here.

Just as you are entitled to your opinion that I made 'incorrect claims about the Canadian Pediatric Society statement ". Which may be true or not.

What part of my claim was incorrect in your view? Peckedagain (talk) 01:19, 29 April 2024 (UTC)

I admitted to nothing. I merely struck it in the interest of deescalating a potential conflict, as any good editor might.

As for your misinformation, the fact that the source flat out doesn’t say anywhere that the Canadian Pediatric Society made such claims, and yet you stated that it does. Snokalok (talk) 01:24, 29 April 2024 (UTC)

@Snokalok

so you don't think you broke the wiki rule 'arguments should not be personalised': when you commented on my 'editing perspective' ?

Anyway - for the 2nd time -why do you think it was a false claim when I wrote:

>the Canadian body - they are doing what @Colin stated as: "the strawman that the Cass Review ignores any evidence that didn't come from a blinded RCT."

Because I read that canadian source and see:

"There actually is a lot of evidence, just not in the form of randomized clinical trials," ..."That would be kind of like saying for a pregnant woman, since we lacked randomized clinical trials for the care of people in pregnancy, we're not going to provide care for you.… It's completely unethical."

And later

"The gold-standard in determining effectiveness of a treatment is a randomized controlled trial where neither patient nor doctor know if they are receiving the treatment or the placebo. But Wong says that's not always feasible." Peckedagain (talk) 02:02, 29 April 2024 (UTC)

What is Wikipedia using this source for, because none of that has anything to do with what Wikipedia uses it for. These are comments from individuals, not the Canadian paediatric society. LunaHasArrived (talk) 02:07, 29 April 2024 (UTC)

Because the Canadian Pediatric Society didn’t say anything about RCT’s, some random family physician the CBC article unrelatedly quoted did. Any attempt to try and turn this into a debate about RCT’s in relation to the Cass Review is a digression, and any attempt to try and attribute that quote to the CPS is either a knowing or unknowing misrepresentation of the source. Doing so to argue for the CPS paragraph’s removal is thus a misrepresentation of the source for the purpose of removing a MEDORG’s critiques. Snokalok (talk) 02:11, 29 April 2024 (UTC)

@Snokalok

so you don't think you broke the wiki rule 'arguments should not be personalised': when you commented on my 'editing perspective' ?

Anyway - you think it was a false claim when I wrote:

>the Canadian body - they are doing what @Colin stated as: "the strawman that the Cass Review ignores any evidence that didn't come from a blinded RCT."

But when I read that canadian source and the Canadian Paeditric Society letter and see the same names in their letter, quoted in the newspaper source saying:

"The gold-standard in determining effectiveness of a treatment is a randomized controlled trial where neither patient nor doctor know if they are receiving the treatment or the placebo. But Wong says that's not always feasible." Peckedagain (talk) 02:19, 29 April 2024 (UTC)

And Wong didn’t say anything about RCT’s in relation to the Cass Review, simply that - in what was delineated as a very separate section of the article - RCT’s are not feasible for puberty blockers. And even if he did say it in relation to the Cass Review, that’s his statement as an individual doctor, not the CPS, and certainly not cited anywhere in the source as coming from the CPS is any way. So yes, I do think it’s a false claim to attribute such a statement to the CPS Snokalok (talk) 02:39, 29 April 2024 (UTC)

Firstly it isn't the entirety of the bmj it is Kamran Abassi. Secondly the comment used in the article has nothing to do with that strawman, that the source might repeat doctors who say RCT's are infeasible and that the report may be biased is unrelated LunaHasArrived (talk) 00:42, 29 April 2024 (UTC)

I don't see how this person's opinion is that notable for a medical report, giving her this huge paragraph comparable to international medical organisations seems like false balance. I agree with maybe adding her to the paragraph with other gender critical commentators but remember this is an article on the Cass review, not the state of transgender healthcare in the UK. Someone's comments about the later seem extreme (unless it was Cass or another highly relevant medical expert). LunaHasArrived (talk) 00:28, 29 April 2024 (UTC)

But 'this person's opinion' is the opinion of the Editor of the BMJ !

> this is an article on the Cass review, not the state of transgender healthcare in the UK.

Ok, would you be happy to keep say the 1st half of their statement: which was: "reports conclusion is alarming for anybody who genuinely cares for child welfare: gender medicine is “built on shaky foundations”', and 'The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider—from social transition to hormone treatment.' Peckedagain (talk) 00:38, 29 April 2024 (UTC)

Sorry, this was all meant to be about the Reem Alsalem statement. My apologies for not making this explicit. LunaHasArrived (talk) 00:45, 29 April 2024 (UTC)

apology accepted.

So you're saying a UN Special Rapporteur does not deserve 'huge paragraph.

What shortened statement from them, would you be happy to include.?

Are you happy to include a sentence from the BMJ editor? Peckedagain (talk) 01:12, 29 April 2024 (UTC)

“ Are you happy to include a sentence from the BMJ editor?”

Not unless you want to start bringing back sentences from other, more relevant, academics Snokalok (talk) 01:13, 29 April 2024 (UTC)

As I said I think that adding Reem Alsalem next to J. K Rowling in that paragraph as welcoming the report is all that is due. Whilst I personally disagree with the way the bmj editor and other academics have been handled (I don't think it's obvious to anyone on first glance that the citations would each represent a separate person in that short paragraph). I think the state at the moment is stable and an ok compromise. So unless we want to rejig that whole paragraph I think the comment from the BMJ editor is ok. Honestly speaking it's possible more of the reception part might need a treatment similar to what happened to the academics but I think it would have to be a broader discussion first. LunaHasArrived (talk) 01:18, 29 April 2024 (UTC)

OK @LunaHasArrived - do go ahead with your proposed edit for the UN SR and phrase it the way you prefer.

> I think the comment from the BMJ editor is ok.

for clarity - what exact text change are you proposing? Peckedagain (talk) 01:24, 29 April 2024 (UTC)

I propose no change to the bmj editor comment at the moment. I think the reception part might be slightly activist / charity heavy and they could do with being summarised but that's a discussion for another time LunaHasArrived (talk) 01:26, 29 April 2024 (UTC)

But @LunaHasArrived - to a reader of this article, there is no mention that the Editor of the BMJ has taken a view on Cass?

Is that balance?

Yet the Canadian reference gets this text:

> The Canadian Pediatric Society responded to the report by saying "Current evidence shows puberty blockers to be safe when used appropriately, ..

Yet they don't quote any evidence for that claim. Whereas Cass has 4 years and comprehensive work behind it's statements. Peckedagain (talk) 02:24, 29 April 2024 (UTC)

Wikipedia isn't saying whether the Canadian paediatric society is right or not, we are saying what the international medical response has been. There are paragraphs dedicated to organisations responding, and one paragraph dedicated to a few academics differing response. From memory the BMJ editor response was more about the systematic reviews than Cass's report anyway. LunaHasArrived (talk) 02:36, 29 April 2024 (UTC)

@LunaHasArrived

So - the wiki page does not even mention that the Editor of the BMJ commented favourably on Cass?

I just don't get the logic? One sentence will be too much for the reader? Peckedagain (talk) 02:46, 29 April 2024 (UTC)

Compared to subject matter experts they are all treated equally, if you want to give them all 1 sentence feel free LunaHasArrived (talk) 03:01, 29 April 2024 (UTC)

My feeling on this is: the specific response of the editor in chief of the BMJ, as the parent journal that published the systematic reviews at issue, is independently notable and due, beyond being merely an "expert response".

There are many "expert responses" that are little more than opinionated commentary and they should not all get a sentence each as it becomes a WP:COATRACK.

As part of the back and forth on that the then-consensus was to condense all individual responses, and that included the BMJ one.

Consensus can change, and I'm not rushing to reopen this argument, but I still think the BMJ response is notable in and of itself, and if there's a majority for including it separately at any point I would support that, even if all other independent individual commentary (that would include favourable commentary from eg. David Bell, Sally Baxendale, possibly even Reem Alsalem etc, as well as the critical commentary from Australian clinicians, for example) is merely condensed. However, if the cost of getting the BMJ response in means all manner of other random clinicians get a line too, I would oppose that.

Editorial comments are not peer-reviewed like the rest of the BMJ, so it doesn't have quite the weight it might, but even so - it is a notable refutation to direct criticism from what is ultimately the academic publisher, not just "an academic/clinician gave opinion X Y and Z in the popular press". Void if removed (talk) 09:20, 29 April 2024 (UTC)

See and this goes back to the eternal balance issue, because effectively what the critics of the Cass Review have been largely saying is “There is plenty of evidence” and what those giving rebuttals have been saying is “Nuh uh, no there isn’t”, and while ‘The Editor of the BMJ’ may sound nice to the uninitiated, what does that actually add up to here? A long and celebrated career as a health writer to be sure, but does a long and celebrated career as a health writer really mean his opinion outweighs those who have built equally long and celebrated careers actually researching in the exact field relevant here? Snokalok (talk) 11:34, 29 April 2024 (UTC)

It is the position that matters. Editor in chief of the parent journal defending published research from unfounded criticism is relevant beyond just individual opinion.

Like I say, I don't feel strongly enough to revisit this argument, and certainly not at the expense of tons of other cruft making its way in, just chiming in that that's a consensus that could change.

And re your last revert: we did go back and forth on PATHA - and as I said at the time I expect more international responses. We've now had those, from more significant orgs, so a trim down of this bloat seems sensible. That they co-signed a statement with Auspath is IMO enough, I don't think two sentences and multiple quotes from their own statement is due at all. Void if removed (talk) 12:23, 29 April 2024 (UTC)

And that was also said as I recall in light of the rest of the article being much shorter and wanting to keep the responses proportional (which was a very reasonable concern). The rest of the article has now gotten much longer, and thus we have more space to incorporate more specific points of criticisms beyond simply "X organization criticized this", which I find to be somewhat one-sided given that we have no issue listing specific points of praise from those praising it (even though many of the points of praise are just repeats of each other)

Actually now that I think about the extra space we have, we could reasonably at the very least expand the individual academic paragraph a bit more. Perhaps a compromise at "Some UK academics, such as the editor of the BMJ (...) while others, such as the head of transgender health research at U of Melbourne"? That way we incorporate the specifics of who is saying what, while not having to completely expand into several lines per each academic. Does that seem fair? Snokalok (talk) 14:26, 30 April 2024 (UTC)

I think it's worth noting that, as far as space to cut goes, we could consider choosing between Wes Streeting and Yvette Cooper, since we don't need two prominent labour politicians both saying that labour is committed to implementing the recs, either one is authoritative enough on their own. We could also combine them into "Wes Streeting and Yvette Cooper both said" Snokalok (talk) 14:29, 30 April 2024 (UTC)

(Personally I'm in favor of keeping Wes Streeting over Yvette Cooper, both due to his position being more directly relevant, and due to the fact that - at least as far as I've seen - he's had a much greater media presence in regards to the Cass Review than Yvette has) Snokalok (talk) 14:31, 30 April 2024 (UTC)

We have twelve hundred words of response, I don't think letting it swell because more content was added elsewhere is the right way to go. If this is about making minor clarifications that don't inflate the word count much, then that's fine by me. Draken Bowser (talk) 18:35, 30 April 2024 (UTC)

The collapse of the Scottish Government is caused partly by unwillingness to accept the Cass review - is it time here on Wiki to accept the report too?

Scottish newspaper the Herald:" Just last week, the First Minister admitted that Patrick Harvie's unwillingness to accept the findings of Dr Cass’s review had played a part in the collapse of the coalition government, which ultimately led to his downfall." Peckedagain (talk) 14:48, 4 May 2024 (UTC)

… What? Snokalok (talk) 14:55, 4 May 2024 (UTC)

The full text continues:

"Last month, during an interview with the BBC’s Sunday Show, Mr Harvie - who was a minister at the time - was asked if he accepted that the Cass report was a valid scientific document. He replied: "I've seen far too many criticisms of it to be able to say that.” The next day, during an interview with the BBC’s Today programme, he was asked if he accepted the findings of the Cass Review. He said it had been “politicised and weaponised” against trans people. The comments triggered a motion of no confidence from Alba MSP, Ash Regan.

While the SNP's chief whip claimed publicly that none of her members would back the vote, reports have suggested that a number were likely to rebel.

In his first interviews since announcing his intention to resign, Mr Yousaf said the comments had caused problems. Mr Yousaf told the BBC: “I made it very clear my position and the government’s position was on the Cass review, but it is fair to say that of course those comments that were made by Patrick Harvie on the Sunday Show did upset a lot in my group. Peckedagain (talk) 15:38, 4 May 2024 (UTC)

What is the point you're trying to make here? Snokalok (talk) 15:40, 4 May 2024 (UTC)

That the consensus of reliable sources is that the Cass Review:

• is a valid scientific document
• it's findings are essentially sound.

After all - we have 2 governments, 2 National Health System in alignment: and a quick google shows many commentators agreeing - here in the UK whether in the left-leaning Guardian or the right-leaning Telegraph.

This is in contrast to you saying here that Cass is: "Is not the most credible and important source out there." And that WPATH publishes 'similar reports' - a claim that is laughable in it's lack of support. Peckedagain (talk) 15:52, 4 May 2024 (UTC)

And none of this changes the mountains of international medical orgs criticizing them.

So no, the consensus of the reliable sources is not that the Cass Review is valid or sound. The consensus in the United Kingdom alone might be that, but as I said previously, the UK is not the only country in the world.Snokalok (talk) 16:28, 4 May 2024 (UTC)

So if you believe that WPATH has published 'similar reports': please do show the exact URLs here. And 'similar report' does NOT mean 1 or 2 bits of research already reviewed by Cass which reviewed over 100 such!

No one in this page has so far pointed to anything close to Cass in it's scope and thoroughness and credibility. But if you have something up your sleeve, do share.

Don't link to anything at the BBC, because you've argued at length here to ban them, and other RSs from this page! You wrote: "Oh. Yay! Then let's do so! Right, do we just need sources from the telegraph and times themselves demonstrating their unsuitability, or do we need other outlet to directly say "The Times and The Telegraph write anti trans propaganda" ... I'd argue we could also perhaps get the BBC to yellow on trans issues. There's a ton of info on the trans rights in the UK page as to why" Peckedagain (talk) 17:40, 4 May 2024 (UTC)

As far as I'm aware, the Cass Review was only prepared for NHS England, and is mainly relevant for the NHS, and not for other countries. Can you provide more information on what changes you are proposing to make, and what sources support those changes? Hist9600 (talk) 17:57, 4 May 2024 (UTC)

@Hist9600 - your points have been covered several times already - have you read the long discussions on this page? Or the Cass report?

It pulled in international evidence and current practise:

Eg Cass report "An appraisal of international guidelines ...", "Only five guidelines described using a systematic approach to searching for and/or selecting evidence (AACAP 2012, Endocrine Society 2017, Finland 2020, Sweden 2022 and WPATH 2022).", "... Only the Swedish and Finnish guidelines linked the lack of robust evidence about medical treatments to ... they are also the only guidelines that have been informed by an ethical review conducted ... " . And three times: "...in the UK and internationally..."."the practice of pausing puberty at Tanner Stage 2 was initiated in the Netherlands, and subsequently adopted in the UK and nternationally."

And yes you're right, it was commissioned for NHS England and that is only one country - but Scotland have followed suite already. No other country has done such a comprehensive, 4 year study: so it is highly likely that the report will influence worldwide health practise. Peckedagain (talk) 18:20, 4 May 2024 (UTC)

I think you have quickly veered off-topic from a collapse of the Scottish government, to a general defense of the Cass Review (WP:OR). The posts here are barely coherent, and I haven't seen any clear indication of what you are proposing or why independent reliable sources could be said to support those changes. Hist9600 (talk) 19:33, 4 May 2024 (UTC)

Hi @Hist9600

So you read the Cass Review and the FAQs - and then asked above: " the Cass Review was only prepared for NHS England, and is mainly relevant for the NHS, and not for other countries"

Wasn't that question already answered by Cass:

> ... looked at 237 papers from 18 countries, providing information on a total of 113,269 children and adolescents.

Can you find any review, from anywhere in the world, by an equivalent national health service, that gets close to that breadth? Peckedagain (talk) 00:48, 5 May 2024 (UTC)

While the breadth of the studies considered is important, it is only one factor, and the review is only one review. It was also endorsed universally by gender-critical organizations, and international medical organizations in the field have criticized its methodology and findings. We should take care when covering this review and be sure to use independent reliable sources.

Again, wasn't this section about the collapse of the Scottish government? Why are you now changing the topic to a general defense of the Cass review? I don't think that is necessary, since we follow reliable sources on the matter. Determining whether the Cass Review as a whole is "correct" is not our role as Wikipedia editors. Hist9600 (talk) 14:50, 5 May 2024 (UTC)

The Cass review is afaik the most thorough review of the subject matter since the SBU review of 2022. Saying the Cass review is only important with respect to the NHS is like saying the SBU 2022 was only important to the Swedish healthcare system. Sure, the recommendations are with respect to the NHS, but the ramifications of an in-depth review considering the international body of research are more far reaching. Draken Bowser (talk) 22:39, 4 May 2024 (UTC)

The Cass Review was prepared for NHS England, and its purpose was to provide recommendations. The NHS had failed previously to provide adequate timely services for transgender people. If the Cass Review has implications beyond that, then we can follow independent reliable sources about those events, and we don't need to speculate about them. Hist9600 (talk) 14:53, 5 May 2024 (UTC)

"So if you believe that WPATH has published 'similar reports': please do show the exact URLs here."

Why, I can't find anywhere that I said such a thing. That's not to say that I don't believe it or that I do, simply that I never made this claim. If you have otherwise, please by all means provide a diff.

As for the BBC, my sole comment on that has been "I'd argue we could also perhaps get the BBC to yellow on trans issues". Hardly the grand litigation, the verbose, impassioned diatribes that would constitute an argument at length. Again, not that I don't believe it, nor that I do. Simply that it's an inaccurate characterization. Snokalok (talk) 18:20, 4 May 2024 (UTC)

Actually it was not you but @Licks-rocks, an edit sandwiched between yours, apologies.

> That's not to say that I don't believe it or that I do.

Do share a URL, if you do believe it, it'll help the page. Peckedagain (talk) 18:26, 4 May 2024 (UTC)

You mention the BBC - has your view on these RS's changed, or not?

> The Times and The Telegraph write anti trans propaganda Peckedagain (talk) 18:30, 4 May 2024 (UTC)

I think the Bute House Agreement ultimately collapsed over disagreements on net zero targets. The Cass Review currently isn't mentioned in Bute_House_Agreement#Dissent_over_continuation. If it did contribute, it might make more sense to develop this information in that article first? 13tez (talk) 15:56, 4 May 2024 (UTC)

I'd say that you're not wrong - Harvie's comments on Cass were merely 1 factor Peckedagain (talk) 17:42, 4 May 2024 (UTC)

I think you might be right. It's definitely worth adding to the article on the Bute House Agreement. 13tez (talk) 18:39, 4 May 2024 (UTC)

@13tez - I've now done that. Peckedagain (talk) 01:03, 5 May 2024 (UTC)

References

The page has been protected- but I can't find out why?

Sorry if my ignorance is showing: The page says: "This article is currently protected from editing until May 7, 2024 at 18:22 UTC, or until editing disputes have been resolved."

Apparently: "For more information on who protected the page and for what reason, see: The talk page of the protected page"

But there is no explanation here? Peckedagain (talk) 19:00, 4 May 2024 (UTC)

• Looking at the history of Cass Review, El C (talk · contribs), an administrator, protected the page for three days, citing "Edit warring / content dispute". Might be best to ask at their talk page. ArglebargleIV (talk) 19:43, 4 May 2024 (UTC)

  There was some low key edit warring going on before the lock -- see the page history for details. Draken Bowser (talk) 22:00, 4 May 2024 (UTC)

https://en.wikipedia.org/w/index.php?title=Wikipedia:Requests_for_page_protection/Increase&oldid=1221582638

The relevant page protection request is near the bottom. Flounder fillet (talk) 22:21, 4 May 2024 (UTC)

Thanks @Flounder fillet, that was well hidden!

> Reason: IP Editor making persistent disruptive edits to the lede three times now despite being reverted by multiple editors. Requesting Semi-Confirmed Protection Snokalok (talk) 17:41, 30 April 2024 (UTC)

Ive searched for 'IP Editor' but can't find out what that means?

And how do folks find out which specific edits those were. Apologies if these are questions you all know well: I've spent time trying to find this stuff, and somehow the wiki UI does not make it easy.(why wasn't Flounders link in the page where it says protected? Or am I missing something obvious and making a fool of myself? Peckedagain (talk) 00:00, 5 May 2024 (UTC)

IP editors are editors who are not logged in, whose "usernames" are their IP addresses. If you ever see an edit by someone whose username is a bunch of numbers with dots or a really long sequence of letters and numbers, that's an IP editor. As for the edits that led to page protection, they are currently near the top of the edit history of the article. Also, the link I posted wasn't accessible in any straightforward way, I had to manually retrieve it from the page history of Wikipedia:Requests for page protection/Increase. Flounder fillet (talk) 00:17, 5 May 2024 (UTC)

@Flounder fillet -many thx for helping my understanding. I only see two IP articles at the top, both by '147.219.171.237' and both just 1 word changes. So 'Edit warring' can be so small? Peckedagain (talk) 12:55, 5 May 2024 (UTC)

There’s also the new account with one edit and that one edit was re-implementing the IP’s reverted edit, that can thus be reasonably taken as the same editor. Snokalok (talk) 13:03, 5 May 2024 (UTC)

@Snokalok thanks. Why doesn't Wiki put that kind of detail in the Protection message at the top of the page? It seems like the wiki software has an error or something, that those facts are obfuscated down in the depths? Peckedagain (talk) 13:52, 5 May 2024 (UTC)

They probably have their reasons Snokalok (talk) 14:06, 5 May 2024 (UTC)

@Snokalok - you raised the Protection. Where can the text be viewed that you wrote at the time to support that action? Peckedagain (talk) 14:14, 5 May 2024 (UTC)

It’s literally just the message you copied and pasted above requesting semi-confirmed protection. No other text was given. Snokalok (talk) 14:16, 5 May 2024 (UTC)

• You may want to read WP:PROTECT. In this case the article is fully-protected, such that only administrators can edit it; this is relatively uncommon, compared to extended-confirmed protection or semiprotection, but does happen every once in a while. It implies that some more-obnoxious-than-usual shenanigans are going on (usually that the edit war involves extended-confirmed users). I haven't really been paying attention to this article, so I couldn't say what the deal was (I just came here to read it to figure out what the heck a "Cass Review" was, noticed it was fully protected, and came to the talk page to see what was going on). A page getting fully-protected for a few days is typically a way for the protecting admin to tell everybody to calm the hell down and I really mean it this time I will turn this encyclopedia article around if you don't stop hitting each other back there. El C has been around for quite some time so he knows what he is doing and I am inclined to assume he had some smart reason for doing this. jp×g🗯️ 17:13, 5 May 2024 (UTC)

If the problem involved an IP and an account with 1 edit, why was it fully protected? Skyshiftertalk 23:16, 5 May 2024 (UTC)

Well he's right there we can just ask him. @El C: jp×g🗯️ 06:12, 6 May 2024 (UTC)

The protection was in response to a request at RfPP (diff). I saw edit warring by various parties over the last couple of weeks. I'm not obliged to confine the scope to a couple of days. Anyway, a couple of days till the protection expires. Hopefully, the break from the all the edit warring proved productive. El_C 07:47, 6 May 2024 (UTC)

These 12 lines seem undue: Interim report, the ACP-UK section

Firstly, these comments are about the 2022 interim report, which are now moot given that the final 2024 report is out. Secondly, despite conversation here in Talk, no editor has brought up evidence that ACP-UK is a meaningful organisation: it has no Wiki page and no one here has found out how large it's membership is.

So 12 lines about it's views, and some of it's members disagreeing, seems undue.Peckedagain (talk) 14:21, 4 May 2024 (UTC)

The ACP-UK seems to have no independent significant coverage (a grand total of 4 (four) news articles on the internet mention them, and they provide next to no information on what ACP-UK is) so 1. no wiki page should be created for this organisation per WP:NORG 2. I agree this is undue.

The two articles about the ACP-UK not already used as sources in this article are:

https://www.theguardian.com/uk-news/2023/nov/12/psychology-body-says-costs-ruling-unfair-in-appeal-on-use-of-unregulated-experts-in-england-and-wales

https://www.lawgazette.co.uk/news/intervenor-hit-with-20000-costs-for-acting-unreasonably/5117811.article Flounder fillet (talk) 13:52, 6 May 2024 (UTC)

The WPATH is silent on the criticisms by Cass - will active editors here help improve it?

There are several editors on this Cass page who are arguing consistently for the approach that valid criticisms should get coverage: Snokalok (talk), LunaHasArrived (talk), Loki (talk)

The WPATH page has no mention of the Cass report's comments/criticisms of it; nor anything in the Talk page about it - despite the fact that the Cass report mentions WPATH 394 times, so would benefit from the approach that you three advocate. I see that Snokalok and LunaHasArrived have already been active there in the Talk page.

The aim would be to follow the exact approach that you three have argued for in this page: that criticisms are important to have in a page.

A side note, the WPATH talk page is very quiet - less than 100 edits, versus this pge with ~ 1000 - so a little more TLC there wouldn't hurt Peckedagain (talk) 11:59, 5 May 2024 (UTC)

Wikipedia:Be bold

LunaHasArrived (talk) 13:45, 5 May 2024 (UTC)

@LunaHasArrived Thanks. Would you agree that the WPATH page should have comments and criticisms from Cass? And @Snokalok - you too?

Because... your comment to 'being Bold' - my experience here in Cass, is that I was immediately reverted by @Snokalok: (despite much of the text I added being direct quotations from Cass and RS sources like the BMJ) - and later even had my personal motives criticised by him: "It’s very telling about your editing perspective that you try and make false claims..." Peckedagain (talk) 14:34, 5 May 2024 (UTC)

I suggest reading WP:BRD. Being bold and being reverted are part of the natural process. Snokalok (talk) 14:37, 5 May 2024 (UTC)

I was more focusing on, if you think stuff on the WPATH page needs fixing, fix it. People might disagree but this is heavily Wikipedia:NOTFORUM territory. Also please remember good faith LunaHasArrived (talk) 14:49, 5 May 2024 (UTC)

The main reason for that is that WPATH isn't the right target for it, as the Cass Review is about the Standards of Care (SOC) published by WPATH, in particular primarily the older SOC7 as the underlying systemic review for the most part concerned itself with the older standard as the newer SOC8 came out around the same time that the systemic review that the Cass Review is based on concluded with looking at data prior to 2022 (and the newer SOC was published in 2022).

And thusly, we do have a mention of the Cass Review on the more appropriate target of Standards of Care for the Health of Transgender and Gender Diverse People#Version 7 already after it was discussed on the Talk page. Note that the SOC article is a medical article, so WP:MEDRS and WP:MEDDEF apply, which is why there is limited commentary, other than mentioning that the systemic review that is the actual medical paper was used to inform the Cass Review, but we did not include direct Opinion commentary from Cass as they are primary. So if you want to discuss this further, you should head to Talk:Standards of Care for the Health of Transgender and Gender Diverse People#Systematic review by University of York as that is the appropriate venue. Raladic (talk) 18:32, 5 May 2024 (UTC)

@Raladic- your statement that Cass primarily looked at Soc 7 and not Soc 8 is disproved by a cursory search of the Cass Review -

The word 'WPATH is used 35 times, of which 13 are 'WPATH 8'. 'WPATH 7' occurs 4 times, in most cases 'WPATH 8' is in the same sentence: ie Cass is contrasting 7 and 8.

A whole page is titled: "World Professional Association for Transgender Healthcare (WPATH) 8 guideline (2022). (page 131).

I have created a seperate section specifically for the mentions in Cass of WPATH, so that it is easy for all Editors to reference. — Preceding unsigned comment added by Peckedagain (talk • contribs)

It appears you misread what I said - I said the underlying systemic review did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did - it looked at guidance to 2022, just prior to the WPATH SOC8 being published and only cursory included reference to SOC8.

You have to differentiate between the peer-reviewed systemic review, that is Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1) | Archives of Disease in Childhood (bmj.com) and the Cass Review that drew from it and some other parts, but they are not interchangeable. The other important part is that the Cass Review is the guidance for gender-affirming care for one country, the UK. Whereas much parts of the rest of the world do still follow WPATH as worldwide guidance. So while the Cass Review provides criticism of much of the WPATH SOC standards, this isn't a universal or worldwide view, so we have to be careful to put not put too much undue WP:WEIGHT of it and rush to conclusions what it means for the rest of the world as we do not have a WP:CRYSTALBALL. We follow what the WP:RS, and in this case because we are concerning a medical topic, more specifically WP:MEDRS, which has a higher standard (in which case, the Cass Review itself, which is not peer reviewed, may fall short) on what inclusion is warranted or which is not. Raladic (talk) 22:05, 5 May 2024 (UTC)

@Raladic

You have edited your own earlier comments (to insert the 2 words "underlying systemic".

And then quoted the changed text saying:

• "It appears you misread what I said - I said the underlying systemic review did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did review did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did."

A) Why try to mislead in this way?

B) Why are you simply ignoring the actual text from Cass that I provided here, and simply re-stating your opinion without providing any evidence to support it? Peckedagain (talk) 22:44, 5 May 2024 (UTC)

Part of working with other editors on Wikipedia is to assume good faith. Please be mindful of this when engaging with other editors here. Hist9600 (talk) 22:54, 5 May 2024 (UTC)

As you can clearly see from the edit history, I first replied to you to clarify what I had meant (since it appeared to have caused confusion) and then edited the prior comment to make it clearer to avoid any further confusion for other editors.

I did not try to mislead anyone as even my original comment did already say ...that the systemic review that the Cass Review is based on..., but that nuance was lost, which caused you to make your reply to begin with, which is why I first clarified it and then edited it.

I recommend you take a read of WP:ASPERSION before casting any further accusations of intentional misleading. Please assume good faith when interacting with other editors.

Also, I am not ignoring your text, I just pointed out that there is a difference between peer reviewed medical articles, and synthesis thereof, which the Cass Review is, which is why I pointed you to the relevant WP:MEDRS guidelines as a possible reason of why the WPATH page has no mention of the Cass Review and why we have a very brief mention of it on the SOC7 article after a talk page discussion happend there as WP:DUE was relevant on what, if any, is relevant. Raladic (talk) 22:57, 5 May 2024 (UTC)

@Raladic

I am not ignoring your text,

You are, and have ignored it again. The history is straightforward:

• you stated of Cass that it "did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did review did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did."
• I supplied a score of quotations form Cass itself that disproved that claim.
• you reply yet did not say whether those facts had caused you to review your statement or not.

So either there is supporting evidence for your statement: or we agree that it is not founded on fact. Peckedagain (talk) 23:29, 5 May 2024 (UTC)

Raladic is 100% correct here. The studies that compose the actual review barely mentioned SoC 8. It's the report that mentioned it more, but the report is just the professional opinion of the authors, not a review, nor even a study at all. It's a government report. Loki (talk) 23:41, 5 May 2024 (UTC)

@LokiTheLiar

You are expressing a Wikipedia:Fringe theories when you caricature the Cass Review as merely 'a government report'

> just the professional opinion of the authors, not a review, nor even a study at all. It's a government report.

That has been debunked here in talk already. -eg read back to Colin's clear statements. Peckedagain (talk) 23:51, 5 May 2024 (UTC)

@LokiTheLiar

You are expressing a Wikipedia:Fringe theories when you say Cass is:

> just the professional opinion of the authors, not a review, nor even a study at all. It's a government report.

That has been debunked here in talk already. Peckedagain (talk) 23:59, 5 May 2024 (UTC)

What? No it's not. The reviews are high quality peer reviewed academic studies. The report isn't. It is compiled by a qualified group of people but it's not the reviews, it's a professional opinion about the reviews... and many other things, as you appear to have discovered.

Like, I am not saying this just to trash it. The DSM is also in this category: it's not a peer reviewed study either because it's not a study, it's a series of professional recommendations. WPATH's guidelines are in a similar boat. To the extent any of these things are evidence based they are high quality MEDRS sources. However, this is clearly a case where the report is getting ahead of the studies it's based on, right? The actual reviews could not have done any serious evaluation of SoC 8 either way, so when the report criticizes SoC 8 it is necessarily not based on peer reviewed studies. Loki (talk) 00:12, 6 May 2024 (UTC)

That's true, I think Peckedagain is confused on this point. There is a difference between a review study, like a systematic review and meta-analysis, published in a peer-reviewed academic journal, and a report prepared for a government medical service like the NHS. Hist9600 (talk) 04:24, 6 May 2024 (UTC)

@Hist9600 you write:

• There is a difference between a review study... published in a peer-reviewed academic journal, and ... (one) for a medical service like the NHS.

True, by definition, in all cases.

Why is that relevant to Cass?

PS - I'd appreciate if you avoid personalising our conversation:

• (your) posts here are barely coherent
• (you) are confused on this point.

Peckedagain (talk) 11:40, 6 May 2024 (UTC)

This is relevant because the final report of the Cass Review is not a systematic review itself. The systematic reviews commissioned by the Cass Review and the report are not the same. The reviews can be found here. Flounder fillet (talk) 13:03, 6 May 2024 (UTC)

@LokiTheLiar

> ... when the report criticizes SoC 8 it is necessarily not based on on peer reviewed studies.

Why do you think it a criticism of Cass, If WPATH have not published any 'peer reviewed studies. under WPATH 8 -and therefore Cass can't mention them?

You DO already know about the wide extent of WPATH and WPATH 8 facts that Cass included - because you commented on 'List of Mentions of WPATH 8 in Cass' which I created to assist editors on both sides of this issue. See Talk:Cass Review#List of mentions of WPATH in Cass - dis-proving claims that WPATH 8 was not thoroughly reviewed there

Your comment seems a (weak) variant of the claim yesterday by @LunaHasArrived that Cass only included WPATH 7 and not WPATH 8. Which the list of Cass quotes above undermines. And to date, no editor here has produced a RS that says otherwise. Peckedagain (talk) 11:26, 6 May 2024 (UTC)

Several editors disagree:

• "this isn't to say Cass isn't Medrs or unreliable" ( @LunaHasArrived)
• "it is published on the official Cass Review website. To me, this gives it credibility in the same way as something published on the NHS website." @13tez

And anyway, you've already been round this loop before with Colin - at great length. Did you take up his suggestion you seek advice at WT:MED  ?

• The fact we are discussing the Cass report on this article page doesn't magically stop it being a first class MEDRS compliant secondary source on biomedical facts and claims. If you can agree with me (and WAID) that the Cass review can be BOTH a primary source for certain things on this page AND a MEDRS compliant secondary source for other things on this page, we can all move on. Otherwise, please go post a request at WT:MED for clarification, and I'm sure someone will be along shortly to put you right.

Peckedagain (talk) 00:21, 6 May 2024 (UTC)

Last time I try it. I pointed out that the Cass review concerns itself with the Standards of Care published by WPATH and we do already have it mentioned there as I pointed out in my very first response to you further up- And thusly, we do have a mention of the Cass Review on the more appropriate target of Standards of Care for the Health of Transgender and Gender Diverse People#Version 7 already after it was discussed on the Talk page.

My side-note about SOC7 vs SOC8, was that, a side note.

You asked why the WPATH page doesn't have a mention and I provide an answer to it - that the more appropriate target for it was the SOC article, where we already have it referenced. The Cass Review, or from a medical sourcing view, the underlying systemic review, concerned itself with the SOC, not WPATH as an organization. Raladic (talk) 23:46, 5 May 2024 (UTC)

>My side-note about SOC7 vs SOC8, was that, a side note.

As you have not provided evidence that the Cass report "did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7"

Then reading between the lines, you now agree that Cass did thoroughly include Wpath 8 in it's scope, Ie, that your are withdrawing your 'side note'. Peckedagain (talk) 23:55, 5 May 2024 (UTC)

Pecked, I think it's time for you to read WP:BLUDGEON and stop posting here for at least a bit, the sheer mass of your comments alone makes this and other discussions on this page almost unreadable. --Licks-rocks (talk) 13:13, 6 May 2024 (UTC)

@Licks-rocks

'Sheer mass', you think?

I did post alot yesterday (20) - partly uploading a useful resource that editors of all sides can refer to: 'List of mentions of WPATH in Cass'

But 20 in a day is less than Snokalok's 27 on the 4th May.

And Raladic did 13 yesterday - there was to-and-fro between us on her claim that Cass didn't include Wpath 8 just 7.

Comparing editors History shows:

• Found 70 edits by Peckedagain on Talk:Cass Review (8.78% of the total edits made to the page)
• Found 189 edits by Snokalok on Talk:Cass Review (23.71%
• Found 47 edits by LunaHasArrived on Talk:Cass Review (5.9%

Peckedagain (talk) 14:03, 6 May 2024 (UTC)

Given that your first contribution to this page was the 28th of April and there's been 243 edits since the start of that day, your % is 28.80 over these past 8 days. LunaHasArrived (talk) 14:18, 6 May 2024 (UTC)

Right, well, looking it up, 32 of these my edits were to my own comments, 29 more were replies to myself [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] (to elaborate on my thought without having to dig through the source code).

This brings it down to 128 edits by Snokalok, which is still a fair bit, but far less so considering that I've been actively involved on this talk page since April 9. 128 edits out of 800 comes down to 16% of edits. Snokalok (talk) 15:19, 6 May 2024 (UTC)

To be fair If you're removing doubles you should remove them from total as well. So it would be 128 out of 740 so 17.3%. Now a lot of work would have to be done to remove other people's "doubles" from the total as well but even taken a generous estimate of 140 other doubles, 128 out of 600 is still 21%. LunaHasArrived (talk) 17:09, 6 May 2024 (UTC)

I, would be very surprised if other editors' doubles added up to such a high number. I'd be surprised if they came in above 50, for that matter. I've found that most people don't reply to themselves or edit their own comments nearly as frequently as I do.

Regardless, you're correct about subtracting from the total. 128/740 is 17.3% Snokalok (talk) 17:28, 6 May 2024 (UTC)

List of mentions of WPATH in Cass - dis-proving claims that WPATH 8 was not thoroughly reviewed there

This list is intended as a reference list. It's suggested that editors NOT comment inside this list, but leave it intact as useful archive available to all editors'. The list was created after it was argued here that Cass had not covered Wpath 8 but primarily Wpath 7: by editor @Ralidic, who wrote:

• "as the Cass Review is about the Standards of Care (SOC) published by WPATH, in particular primarily the older SOC7 as the review for the most part concerned itself with the older standard as the newer SOC8 came out around the same time that the systemic review that the Cass Review is based on concluded with looking at data prior to 2022 (and the newer SOC was published in 2022).

Archive list of Wpath coverage in the Cass Review:

The word 'WPATH is used 35 times, of which 13 are 'WPATH 8'. 'WPATH 7' occurs 4 times, in most cases 'WPATH 8' is in the same sentence: ie Cass is contrasting 7 and 8.

A whole page is titled: "World Professional Association for Transgender Healthcare (WPATH) 8 guideline (2022). (page 131). In addition

• (a) "however, none of the WPATH 8 statements in favour of social transition in childhood are supported by the findings of the University of York’s systematic review (Hall et al: Social Transition)." p163

• (b) "There has been a shift in recommendations between WPATH 7 (2012), which was more cautious about social transition, and WPATH 8 (2022) which argues in favour of social transition in childhood." p 163 and
• (c) " WPATH 8 cited many of the other national and regional guidelines to support some of its recommendations, despite these guidelines having been considerably influenced by WPATH 7. The links between the various guidelines are demonstrated in the graphics in the guideline appraisal aper (Hewitt et al., Guidelines 1: Appraisal). 9.22 The circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor"
• (d) "Clinical consensus is a valid approach to guideline recommendations where the research evidence is inadequate. However, instead of stating that some of its recommendations are based on clinical consensus, WPATH 8 overstates the strength of the evidence in making these recommendations" p132
• (e) "Swedish (2022) and Finnish (2020) guidelines 9.33 The Swedish guideline took a different stance to WPATH 8 based on three considerations:..." 132
• (f) "International Practise ... WPATH 8 guidance has moved from a ‘watchful waiting’ approach for children to a position of advocating for social transition as a way to improve children’s mental health" p158
• (g) "a shift in recommendations between WPATH 7 (2012), which was more cautious about social transition, and WPATH 8 (2022)... WPATH 8 justifies this change in stance on the basis that ... " p163
• (h) .. the earlier requirement to wait for the patient to reach age 12 before they can access puberty blockers has been removed from some guidelines (for example, WPATH 8). T p174
• (i) The University of York concluded that there is insufficient and/or inconsistent evidence about the effects of puberty suppression on psychological or psychosocial health. This is in line with the finding of the NICE review (2020) and other systematic reviews, apart from the systematic review commissioned by WPATH (Baker et al., 2021), which reported some benefit. However, in the latter systematic review, eight of the 12 studies reporting psychological outcomes were rated as low quality, which may explain the difference. p176
• (j) The Swedish and WPATH guidelines mention the need to support those who discontinue treatment or detransition, but no detail is provided on how this should be managed p182
• (k) The Swedish and Norwegian guidelines do not recommend hormone treatments in this group due to lack of evidence, whilst WPATH recommends providing tailored hormones treatments in a separate chapter on non-binary people, rather than in the adolescent chapter, so it is unclear if this applies to adults only or includes adolescents. p183 Peckedagain (talk) 21:38, 5 May 2024 (UTC)

"The Cass Review" in this context is confusing. Are you talking about these two studies or the final report?

If you're talking about the studies, then indeed they do not have much reference to WPATH SoC 8. A little bit, but since the majority of the research for those studies was compiled in April 2022 and WPATH SoC 8 was released in September 2022 it just can't have been given any significant scrutiny. The timeline doesn't add up.

On the other hand, if you're talking about the final report (and I believe this to be more likely because of the high page count in your references), criticism it makes of WPATH SoC 8 that was not part of the underlying reviews (and again, the underlying reviews make little mention of SoC 8 either way) is ultimately just the professional opinion of the authors. It's not systematic, it's not even a study. It's a government report. Loki (talk) 23:38, 5 May 2024 (UTC)

Can I suggest that if you want to edit the page for WPATH or Standards of Care for the Health of Transgender and Gender Diverse People you edit one of those pages? I don't disagree that the Cass Review is critical of WPATH's guidance but I think that's covered by the section "International guidelines". Void if removed (talk) 18:04, 6 May 2024 (UTC)

Bibliography

Flounder fillet posted a link to https://adc.bmj.com/pages/gender-identity-service-series above. I think it is usual, in the case of a report that has multiple separate pieces, to provide a ==Bibliography== or ==Further reading== section at the end that simply lists all of them.

Is there anything missing from that page? Personally, I'm inclined to skip the editorial and include only the externally peer reviewed papers. I suggest providing no commentary beyond perhaps labeling reviews in the citation (which means adding "Review." at the end). WhatamIdoing (talk) 23:47, 6 May 2024 (UTC)