Talk:Cass Review/Archive 1

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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)

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)

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 [1] "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)

I’m not sure why Sallie Baxendale is a notable person either. Barnards.tar.gz (talk) 15:39, 13 April 2024 (UTC)

TransActual analysis of the Cass Review

Hi all

TransActual have compiled an analysis of the Cass Review, many of the points are repeated by others. Section 4 seems the most relevant to this article.

• https://transactual.org.uk/wp-content/uploads/TransActual-Briefing-on-Cass-Review.pdf

Thanks

John Cummings (talk) 17:05, 13 April 2024 (UTC)

This is a fine example of why primary, self-published sources from partisan activists should not be held up against high quality MEDRS. To pick just on of the many examples at random:

In the section "Claims Without Evidence" it says:

The Report states that “in the UK and internationally, it is now the norm for many children and young people to present to gender clinics having undergone full or partial social transition.”50 There is no evidence supplied to support this assertion.

There is a whole systematic review titled "Characteristics of children and adolescents referred to specialist gender services: a systematic review", which summarises very clearly near the start, in the section "What this study adds":

Very few studies report data on gender status (self-reported gender identity, gender dysphoria/incongruence, age at onset and social transition) but from the limited data reported, approximately 60% of those referred were described as making steps to present themselves in their preferred gender.

(Emphasis added). Later we get more detail on this:

Nineteen studies reported social transition data from seven countries. The US reported higher proportions of social transition (combined 77%, 95% CI 70% to 90%) compared with most other countries (combined 59%, 95% CI 52% to 66%).

This is not a claim without evidence, this is a claim for which an entire systematic review exists to support.

This transactual doc is garbage and should be nowhere near this page. Void if removed (talk) 18:17, 13 April 2024 (UTC)

That's a good example of how this debate has reached Trumpian levels of misinformation (and Cass's review explicitly calls out all sides on this). Anyway, as a self-published source, complete with personal attacks on the people involved, doesn't meet RS. -- Colin°^Talk 19:07, 13 April 2024 (UTC)

I'm not commenting on the quality of analysis, but as far as trusted sources go, this does not particularly pass wikipedia standards Snokalok (talk) 19:28, 13 April 2024 (UTC)

I agree with that. It'd be usable if TransActual was some sort of reputed medical organization, but as far as I can tell they aren't, they're just an activist org.

It's a bit unfortunate, because I do think some of the criticisms in this document are likely to be repeated in other sources. But we gotta wait for those. Loki (talk) 20:11, 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)

I think Horton put it well In several sections the Cass Review emphasizes the risk or significance of any affirmative medical or social interventions, whilst negating or ignoring the potential harms of nonintervention or denial of social or medical transition. Trans healthcare is referred to as comprising “challenging decisions about life-changing interventions” [Report 5, p. 18], whilst the denial of trans healthcare is not weighed as a significant or life-changing intervention. This is another example of the Cass Review centering a cisnormative perspective to evidence or decision-making. A trans person being denied affirmative healthcare and being forced through incongruent puberty is not considered “life-changing.”.

Additionally, Support for affirmation of a trans child’s identity is upheld as a medical “intervention” requiring high quality evidence. Rejection or non-affirmation of a child’s identity is presumed the natural default position, requiring no evidence at all. Arguably, denying and rejecting a child’s self-knowledge is a far greater intervention in that child’s life, requiring a greater burden of clinical proof, than simply letting each child assert and affirm their own identity. Yet the Cass Review considers acceptance of a child’s identity as trans as a significant “intervention.” The Cass Review’s position frames rejection of a trans child’s identity as neutral and benign, requiring no evidence for such a policy proposal. Accepting and embracing a trans child is viewed as more extreme and in need of “high quality” evidence. This position demonstrates extreme cisnormativity, with only cis children viewed as natural or inherently worthy of respect and acceptance. This position is also pathologizing, with acceptance of a trans identity considered a medical intervention.

The paper gives many more examples, but the TLDR is that there is "low-quality" evidence transition helps, but no evidence of any quality that denying it helps (with plenty of evidence denying it causes suffering), so concluding that transition is risky and denying it should be the default based on looking at the former and ignoring the latter is not sound science. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:57, 13 April 2024 (UTC)

Just to use one very clear example where I think this sentence is missleading, the report choses to ignore 100 of the 102 studies into puberty blockers and hormones they found (Puberty Blockers, para 14.19, and Masculinising/feminising Hormones, para 15.16). John Cummings (talk) 16:59, 13 April 2024 (UTC)

John, did you read that section, or did someone else tell you "the report choses to ignore 100 of the 102 studies into puberty blockers"? Let me quote them (and add one paragraph for better context):

• 14.19 The systematic review on interventions to suppress puberty (Taylor et al: Puberty suppression) provides an update to the NICE review (2020a). It identified 50 studies looking at different aspects of gender-related, psychosocial, physiological and cognitive outcomes of puberty suppression. Quality was assessed on a standardised scale. There was one high quality study, 25 moderate quality studies and 24 low quality studies. The low quality studies were excluded from the synthesis of results.
• 15.15 In addition to the systematic review on care pathways (Taylor et al: Care pathways) discussed in Chapter 13, the University of York conducted a systematic review of the use of masculinising/feminising hormones in adolescents with gender dysphoria (Taylor et al: Masculinising/feminising hormones). This systematic review aimed to synthesise the evidence for gender-related, psychosocial, physiological or cognitive outcomes for the use of feminising/masculinising hormones in adolescents with gender dysphoria/incongruence.
• 15.16 A total of 53 studies met the inclusion criteria. The most frequently reported outcomes were adverse physical health outcomes and the intended development of puberty in the identified gender. A smaller number of studies looked at side effects in relation to bone health and fertility

The 14.19 paragraph refers to Taylor et al: Puberty suppression. When it says "Due to high risk of bias in low-quality studies, these were excluded from the synthesis" this is exactly normal and what systematic reviews do all the time. The 15.15 and 15.16 paragraphs refer to Taylor et al: Masculinising/feminising hormones. The breakdown of what was high/moderate/low for that one is that there was one high quality, 33 moderate and 19 low. It repeats the same sentence about low quality studies. You'll likely find that sentence in pretty much every systematic review. What is the issue here? Snokalok complains about me assuming this crap comes from twitter. Well, where does it come from? The "inconsistent standards of evidence" line comes from an opinion piece that was written well before the Cass Review was published, before either of the systematic reviews were completed, never mind published. Confusing the various criticisms of the Cass Review with two papers that are very much "Taylor et al" is likely a deliberate ploy by some activists, because there's a lot of recommendations that reasonable people may criticise in Cass's review, but the systematic reviews that underpin it less so. They are solid high quality science in one of the worlds most respected medical journals. We really should not be wasting our time with criticism of them by random people on the internet who can't even add up. -- Colin°^Talk 17:35, 13 April 2024 (UTC)

Here! Here! Well said. I agree with and am impressed with Colin's assessment of the situation. It is good to have knowledgeable people on Wikipedia. ---Steve Quinn (talk) 03:18, 15 April 2024 (UTC)

References

Kamran Abassi

@Void if removed

Kamran Abbasi, according to his page, did five years in internal medicine and then spent the rest of his career as a health writer.

Five years is, I’d be willing to bet, easily the length of Cal Horton’s doctorate on trans kids or whatever it was. It’s far less almost certainly than Ada Cheung’s career in transgender medicine. Kamran’s statements do not warrant privilege over those with directly relevant field experience that outpaces his own medical experience entirely, and especially not with those of higher recognition in this specific branch of medicine (such as Ada Cheung) Snokalok (talk) 10:05, 16 April 2024 (UTC)

Reading Horton's paper, which was published in the month before the final report of the Cass Review came out, it only deals with the earlier stages of the Cass Review, including its terms of reference and interim report. It is not a response to the final report. Anywikiuser (talk) 11:24, 16 April 2024 (UTC)

I don't think we need to estimate are compare careers in this detail. It is comparing apples and oranges. This is a review for public health policy and clinical care and guidelines for such. Those topics are in-scope for experts in those fields to comment on. The fact that someone has a phd looking at social issues affecting trans kids doesn't really make them a public health expert, have the first clue about whether a systematic review is well done, or how to transform evidence and clinical experience into guideline practice. The problem with Cheung is the source is a newspaper, and even if Cheung got a letter to the editor of the BMJ it doesn't mean we can suggest to the reader that they are in any shape or form a counter to the systematic review. MEDRS doesn't let us do that. The world is full of people with a medical degree and an opinion. If there are four better studies, someone needs to do a systematic review that includes them. -- Colin°^Talk 12:32, 16 April 2024 (UTC)

Okay putting Cal aside for a moment, this is why we shouldn’t be singling out names, we should have them consolidated into a generalized paragraph as I implemented. Snokalok (talk) 13:14, 16 April 2024 (UTC)

Missing key findings

We are missing some of the key findings of the report. i News, Pink News, and the Guardian all summarised its key findings. Several they mention are missing from this article, with other stuff in the "findings" section instead. Some are mentioned elsewhere, but you'd expect to find the key findings of the report in the findings section of the article. Namely, we are missing the findings that:

• care for children and young people questioning their gender identity should be holistic, including screening young person seeking help for gender-related distress for neurodevelopmental conditions
• finding that there is “no clear evidence” that social transition in childhood has any positive or negative mental health outcomes and “relatively weak” evidence for effects in adolescence
• there should be different approaches for the youngest children seen vs teenagers (specifically, though the clinical pathways point is close)
• professionals have been reluctant to engage in the clinical care of gender-questioning children and young people due to the weak evidence in the area, toxicity, and fear of mistakes (leading to a lack of people to care for gender questioning young people and the present waiting times)
• recommending creating a follow-up service for 17-25 year olds in adult gender identity clinics (and resulting concern this could restrict access to HRT for adults between 18 and 25)
• widespread toxicity of debate exists, and it hinders helping trans and gender questioning children and young people

some further points that were reported less widely include:

• proposal that all referrals should come via secondary care (services for which a GP referral is needed)
• the NHS should consider setting up services for people wishing to detransition and support everyone who has been or is gender questioning
• GPs shouldn't be pressured to share care with private puberty blockers after they have been banned in the NHS nor to prescribe hormones after private providers have done so
• change in profile of patients from mostly AMAB to now AFAB in vast majority

13tez (talk) 15:28, 17 April 2024 (UTC)

Condensing the individual responses

I think that we should perhaps look at condensing the medical and academic responses of individuals (Sallie, Kamran, Ada, Portia, Cal, and Aiden) into something like "The report was praised by some academics and professionals in the UK, who agreed with its findings stating a lack of evidence;[Sallie, Kamran] while others both in the UK[Cal, Aiden] and in the the international community[Ada, Portia] criticized the report, saying that it ignored high quality evidence already available,[Cal, Ada] and that its required standard of evidence for the studies it did evaluate would be "infeasible and unethical" to achieve.[Cal, Portia] Snokalok (talk) 04:41, 15 April 2024 (UTC)

So would, anyone be opposed if I went ahead and did this? Snokalok (talk) 16:08, 15 April 2024 (UTC)

I'm fine with it, go ahead. Loki (talk) 17:03, 15 April 2024 (UTC)

I am fine with condensing most of them and any future ones, but the BMJ response is important on its own. This is a spokesperson of the parent journal of the published evidence specifically rejecting claims about the evidence base. It isn't just bystander commentary, it needs including on its own.

I also think adding in Horton to the final review is simply untenable, since the paper was about the NICE review and the interim review. It says absolutely nothing about the final report or its evidence base. Void if removed (talk) 09:43, 16 April 2024 (UTC)

I agree with Voice if removed on all points. Anywikiuser (talk) 11:28, 16 April 2024 (UTC)

On Cal, fine fine.

On Kamram, at that point though does it become an NPOV and weight issue? Because suddenly we’re left with “Some people said XYZ, but the editor of the BMJ said ABC” which frames it as though that’s necessarily an authoritative rebuttal when, really it’s someone with less experience in the field of medicine in general - much less transgender health - being given excess weight vs those with extensive experience in both medicine and trans health. And while there is an argument that his inclusion is notable, I don’t dispute that for a second, what I’m disputing is him being weighted more heavily than the criticisms to which he is responding, from far more qualified names in the field Snokalok (talk) 13:19, 16 April 2024 (UTC)

The quote from Kamran Abbasi is useful as it demonstrates one argument, agreeing with the Cass report that there is a lack of evidence on the treatments. I'm not sure how that could have made it unbalanced. Before it was removed, there was the quote from Abbasi and an earlier one to the contrary, from the Canadian Paediatric Society. One could argue that Abbasi was getting the last word, but equally, one could argue that he was missing out on the first word.

Even if Abbasi isn't a specialist in that field, that doesn't mean he isn't qualified to speak on it. Ultimately, the article should explain the roles of any medical figures cited for quotes and leave the reader to decide how qualified they are to speak on the matter. Anywikiuser (talk) 15:52, 16 April 2024 (UTC)

You ultimately miss the point and context. We had several relevant medical personnel with each about two lines dedicates to their comments. We had the editor of the BMJ, a neuropsychology professor from UCL who (I’m told) wrote papers on the subject, the head of trans health research at the university of melbourne, and the vice president of AusPATH. They were all condensed as above into a single paragraph due to space concerns. So why then, is Kamran so exceptional in this regard as to warrant his own standout lines? Canada we put because it’s a medical organization, and thus it bears its own piece. An individual medical professional with an involvement in the field or - worse, one without - may still be notable, but not enough to privilege his view over and the other (more qualified) individuals also condensed into the paragraph. Snokalok (talk) 21:38, 16 April 2024 (UTC)

I agree with Snokalok, and would suggest if we want to break out Kamran we should break out everyone and just make the condensed version a bit longer.

Something like:

The report was praised by some academics and professionals in the UK, including the editor of the BMJ[Kamran] and a professor of neuropsychology[Sallie], who agreed with its findings stating a lack of evidence. Others in the UK, including the director of an independent gender service[Aiden] and a postdoctoral researcher[Cal], and in the the international community, including the head of trans healthcare research at the University of Melbourne[Ada] and the vice president of APATH [Portia], criticized the report, saying that it ignored high quality evidence already available [Cal, Ada] and that its required standard of evidence for the studies it did evaluate would be "infeasible and unethical" to achieve[Cal, Portia].

Personally, I think I prefer Snokalok's version because this version feels like it has a lot of WP:PUFFERY. But I don't think we should be privileging Kamran Abassi's response just because he's loosely associated with the papers themselves. Loki (talk) 22:29, 16 April 2024 (UTC)

++ to not privileging Kamran. I lean towards expanding/elaborating the condensed paragraph slightly but would also be ok condensing his.

Wrt Horton, I think their criticism should be slightly expanded but put in the section on the interim report as opposed to the final one. As a well sourced academic criticism of certain methodologies in the Cass Review from the outset as reviewed midway through it deserves some more elaboration, but we should make it clear to readers it was not a response to the final report. While it's a peer reviewed sociological critique of how the Review was organized, communicated, and carried out (presenting prejudice without noting it's prejudice, exclusion of trans expertise, pathologization in language and framing, etc), the others are high-profile medical professional's critiques of Cass's take on the evidence base, so I think it's also good to group them by field/expertise rather than lumping them by praise/criticism. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:15, 16 April 2024 (UTC)

Your last sentence in green makes no sense. How could "it did evaluate" studies that 'would be "infeasible and unethical" to achieve'. Both systematic reviews on the evidence base for drug treatments actually performed a narrative synthesis on the majority of the relevant studies (they included the moderate quality and the couple of high quality studies, while ignoring the low quality, which is what every systematic review ever conducted in history does).

I think we need to be really careful with this "infeasible and unethical" line as it as pure misinformation. Not a single line in the systematic reviews or Cass report insists on RCTs never mind blinded RCTs. Where the Cass Review mentions RCTs is because, while it was aimed for healthcare professionals, Cass realised the report had to be accessible to the public. So they spent a few pages giving a really good background on the strengths and weaknesses of various trial designs, and which kinds of trials we have in the literature on trans therapy for children and adolescents. These issues are simply facts, like the sky is blue. It is simply a fact that a control group strengthens the evidence and simply a fact that without one, all sorts of other reasons could explain one's "results". These reasons why the evidence base in this field is mostly low and moderate with only one or two high quality are all just facts of life.

Since in fact the majority of studies were included in the synthesis and those mostly moderate with one or two high quality studies actually really do exist and really didn't fail the ethics board when they were proposed, it is in fact a lie that the evidence base for the Cass Review needs "infeasible and unethical" evidence. It is entirely possible that these mostly moderate with one or two high quality studies could have produce convincing positive results, but they didn't. Why do you think activists don't like to mention that fact, but instead deflect the reader onto thinking Cass is both ignorant and evil.

Repeating the line '"infeasible and unethical" to achieve' is pure misinformation wrt the Cass Review. They actually reviewed the majority of relevant studies, not the "1 out of 100" that some on this page earlier claimed. How does anyone here square that fact with the claim. It would be a bit like saying that expecting women's football to attract large crowds and get headlines in the newspapers and on TV news is infeasible. Em, it already happened. There are studies that were good enough to be included as evidence. Those studies didn't produce the results some wanted to hear. We need more research for sure, and better research, but this guff about infeasible and unethical blinded RCTs wrt the Cass Review needs to be put in the "5G causes Covid" bin. -- Colin°^Talk 08:53, 17 April 2024 (UTC)

here is a good example of misinformation. The article says

It is notable, then, that one of the evidence reviews (in this case a review of the efficacy and safety of gender-affirming hormone therapy) commissioned to support the Cass Review questions the quality of many of the studies that demonstrate the clinical effectiveness of treatment with gender-affirming hormones based on a ‘lack of blinding’ (as can be found from page 109 onwards of the evidence review).

For a blind trial to be run, a patient/assessor must be unaware of what medication is being administered. The problem here is that running a blind trial with gender-affirming hormones or puberty blockers is highly challenging: when receiving gender-affirming hormone therapy or puberty blockers, obvious changes occur which alert the patient/assessor to that fact.

Put simply, the review sets an unreasonable standard for the kind of evidence it will accept — one which, given the nature of the research being done, cannot be met — then uses the resulting lack of evidence to suggest that existing medical interventions have no evidential basis. This undergirds many of the recommendations the review makes regarding changes to internationally established medical practice.

Additionally, the evidence review was prepared in October 2020 based on searches made in July 2020. This is not an inherent problem, but should be taken into account: it represents a moment in time, like any other review, and the speed of progress for research in this area is extremely quick.

But it becomes clear that what they are talking about are the NICE reviews from 2020 (here and here) and not the more recent reviews published alongside the Cass Review in the BMJ, which explicitly take into account any relevant research up to January 2024. It is clear then the author wishes to misinform the reader that the Cass Review is dependent on research from 2020. This is a lie.

But they also setup the strawman that the Cass Review ignores any evidence that didn't come from a blinded RCT. If you read the Cass Review or the two 2024 systematic reviews, they don't mention blinded RCTs at all and in fact include the majority of relevant studies in their evidence base. The older NICE reviews do mention blinding but only in the same way anyone following a standard checklist of good/bad points in a systematic review does. The older NICE review is particularly harsh but also entirely typical of this style of assessment. One cannot magically make a statistically weak study into a good quality one by good wishes and intentions.

This is the sort of shit that MEDRS prevents, where solid MEDRS compliant sources are juxtaposed in the press and other websites with the opinions of people with no knowledge of how systematic reviews typically work and who have found a hook (here the unreasonable/unethical claim) that sounds convincing to the uneducated but is eye-rollingly dim to any experts in the room. In practice the Cass Review included the majority of studies published and looked at studies right up to January 2024. -- Colin°^Talk 11:25, 17 April 2024 (UTC)

I expect we will eventually have a section of the article covering the misinformation put out by various individuals and organisations, but for now the very least we can do is to decline to amplify it by including it in the article here. Barnards.tar.gz (talk) 12:07, 17 April 2024 (UTC)

Kamran Abbasi may not be a specialist in this particular field, but an editor of a major medical journal does have expertise on medical research and evidence gathering. For example, Wikipedia has on multiple occasions cited comments from Richard Horton, the longtime editor of The Lancet, on medical research unrelated to his original specialty (liver medicine). A search for "Richard Horton editor" reveals some examples. Anywikiuser (talk) 11:40, 18 April 2024 (UTC)

Report used AI generated images of children

I'm not sure where to include this

• https://www.404media.co/uk-gender-affirming-care-ai-generated-children/

John Cummings (talk) 13:18, 17 April 2024 (UTC)

I mean, "report uses licensed stock images" is surely WP:NOTEVERYTHING. Void if removed (talk) 13:48, 17 April 2024 (UTC)

I think that that description is not accurate, I think its a reasonable thing to include since they have used fake images of children to illustrate a scientific paper. John Cummings (talk) 16:58, 17 April 2024 (UTC)

No part of the scientific content of the report depends on the illustrations, no part of the report claims that the images are of real children, and nobody has put forward any reason why it should be necessary to use images of real children in such a report.

The primary purpose of the source seems to be to introduce the word “fake” into a headline about the report. As a gotcha, it’s desperately weak. Barnards.tar.gz (talk) 16:08, 18 April 2024 (UTC)

Agree per WP:NOTEVERYTHING. I mean, we're nearly at the point were it will be hard to find a publication that doesn't used AI generated stock photos. -- Colin°^Talk 16:24, 18 April 2024 (UTC)

I don't really see the relevance to including this here, it has little to do with the content of the report. GnocchiFan (talk) 16:57, 18 April 2024 (UTC)

It's maybe worth a short mention if it gets more coverage. But probably nothing off just the one article. Loki (talk) 17:41, 18 April 2024 (UTC)

We'd need something stronger than 404media to say that it's DUE to include. If other news media reports on this aspect, then a sentence inclusion would be relevant. Silverseren^C 17:43, 18 April 2024 (UTC)

Even if other "news media" reports on this, it still would fail WP:NOTNEWS. Do you really think that an encyclopaedia article on a "major review into a health matter in England that significantly changes health policy in several countries" should trouble the readers with "slow news day" / "gotta meet my 300 word target" cruft in newspapers. A sentence here would never "be relevant". It's at the level of Daily Mail Catherine, Princess of Wales was once photographed in a way that showed some cellulite on her thighs. Not something that would ever appear in the wiki article. Let's be focused on the review. -- Colin°^Talk 07:43, 19 April 2024 (UTC)

This isn't a big rat dissilced situation, these images weren't used to convey any information. If someone were to criticise the report for typos, that wouldn't be included, and this shouldn't be either. Flounder fillet (talk) 10:00, 19 April 2024 (UTC)

I mean, I’d agree it’s sort of the cherry on top to the wide array of criticisms, but much like the cherry on top, there’s little of actual substance here. Not worth including without strong secondary coverage imo Snokalok (talk) 13:17, 19 April 2024 (UTC)

Recommendations

I have cut down the "recommendations" for continuity of care which was previously a mix of quotes from the report assembled largely by the Telegraph. I've added a citation to the relevant pages in the review. Can we expand from there please, without the Telegraph editorialisation as to "why" or "on the basis of" that aren't necessarily stated in the report? Void if removed (talk) 10:46, 17 April 2024 (UTC)

The Telegraph article is behind a paywall, so I can't access it myself and assess whether the summation that has been appearing in this article sums The Telegraph article accurately. That summation has significant differences to both the BBC article on the Cass Report and to the report itself, which is available to read here.

If the Cass Report actually had suggested stopping medical transitioning for 18-24 year olds, that would have been quite a headline-grabbing bombshell. But there is a good reason why the BBC article does not mention such a suggestion, because that isn't any of the report's 32 recommendations. Cass is more concerned with the organisation of services and only a few recommendation discuss when treatments can and can't be used (recs. 3, 7 and 8). A few do have implications for adult care and clinics (recs. 5, 23 and 24) but it does not propose stopping any adult treatments. Cass recommends a follow-up service (rec. 23) but does not propose they offer any different treatments to what is available now. Nor does the report address what to do with adults who first consult on gender aged 18-24, rather than before 18, as that wasn't within its scope. Anywikiuser (talk) 13:09, 17 April 2024 (UTC)

@Anywikiuser, the extension "Bypass Paywalls Clean" can be used to read Telegraph articles. But I wouldn't trust them to accurately report which recommendations came from where and which were true and which were fantasy. -- Colin°^Talk 16:20, 18 April 2024 (UTC)

Right, I read back over the review, this more than anything comes down to a difference in interpretation of the word “recommendation”. If you go strictly by the words listed in the 32 glowing RECOMMENDATION boxes, then you’re right, but if you go by what is said in the rest of the paper in a recommendatory manner that anyone would reasonably read as recommending something, then everything the Telegraph wrote is there.

So suggested compromise, we both - citing page numbers - restore our respective content, yours in the rec section, mine in the findings section.

Also - how in the year of our lady 2024 do you not know how to get around a paywall? That is honestly not a solid reason to discount a citation, the info is still easily verifiable. Snokalok (talk) 11:20, 19 April 2024 (UTC)

Sorry, that was meant for @Anywikiuser Snokalok (talk) 11:21, 19 April 2024 (UTC)

I still stand by my comment that I don't trust the Telegraph to report trans health issues accurately. And no newspapers meet MEDRS so if the recommendation contains a reason (e.g., insufficient evidence of benefit) then that's a WP:BIOMEDICAL claim that needs a MEDRS source.

If we are citing the 400-page Cass Review directly, and for the lengthier journal papers also perhaps, we need to use page numbers. One technique is the {{sfn}}. I used this in Vaccine ingredients which is a short enough article that it should be easy to see how it works if anyone here hasn't done that before. I recommend we do that for the Cass Review. It's only really needed for long journal papers if the specific fact one is citing it for is on a very specific page rather than in the conclusions. So if one is merely citing a 40 page systematic review for its concluding remarks, there's no need to give a page number for one sentence. -- Colin°^Talk 13:35, 19 April 2024 (UTC)

I agree with prioritizing page numbers over news when available, I STRONGLY disagree with sfn. I understand it’s the style of citation in vogue with a specific sect of editors, however all it does imo is make editing and citing 1000x more inaccessible for all involved. It undemocratizes the encyclopedia Snokalok (talk) 14:02, 19 April 2024 (UTC)

I just added my first sfn ever and it was quite simple. Now anyone can add more sfns to the review by simply pasting {{sfn|Cass review final report|2024|p=[page number]}}. Flounder fillet (talk) 15:25, 19 April 2024 (UTC)

Don't use sources by The Telegraph and The Times

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

They are extremely inappropriate in the context of this article about transgender issues. LilianaUwU ^{(talk / contributions)} 05:52, 15 April 2024 (UTC)

I think it'd be fair only to cite the documents relevant to the Cass Review in the 'Findings' and 'Recommendation' sections (including page numbers). Citing newpapers in tandem that got their information from the Cass Review is pretty dull and redundant. For other purposes, I agree that The Telegraph and The Times, and British media in the broad sense, tend to be generally biased when it comes to trans issues ("We're being pressured into sex by some trans women" comes to mind). Media sources are important when we want to know about their editorial stance on the Cass Review, but for other purposes we should approach and use them with caution. Cixous (talk) 09:25, 15 April 2024 (UTC)

I don't mind The Guardian and even the BBC (despite the fact the latter had "We're being pressured into sex by some trans women") because their nonsense is mostly a byproduct of British media being like that as a whole. The Telegraph and The Times are the very papers that give British media their transphobic reputation. I'm almost tempted to simply strip the Times and Telegraph references from the article, which seems to keep the article pretty much intact for the most part, (un)surprisingly enough. LilianaUwU ^{(talk / contributions)} 11:25, 15 April 2024 (UTC)

I agree that removing The Telegraph and The Times references (and all other references on the findings of the Cass Review that aren't actually referencing the Cass Review) should be removed. It's more logical to cite the Cass Review for what's in the Cass Review instead of a newspaper regurgitating the Cass Review.

Slightly off-topic, but BBC is really hit or miss. Their publicising on a study that 'saw a mental health change in participants on puberty blockers' without the study even being peer-reviewed, let alone of decent quality, was so so silly. Cixous (talk) 12:22, 15 April 2024 (UTC)

If the article text is WP:BIOMEDICAL the WP:MEDRS applies and no newspaper cuts it. If the text is mundane stuff like when it got published or political stuff like how there's now going to be a review for adults, then newspapers are acceptable. Personally I'd prefer that the Telegraph and Times were excluded from all trans topics, as they have completely lost the plot on this matter, but I recall previous RS requests were met with people bleating about them being newspapers of record. Clearly if we have multiple sources for uncontensible facts then we can cull the weak ones. -- Colin°^Talk 14:04, 15 April 2024 (UTC)

Of course attempts to change the reliability of those rags haven't been successful. Unless you give WP:RSN 30 reliable sources about how using this normally reliable source for an issue might be bad actually, they won't budge. LilianaUwU ^{(talk / contributions)} 15:15, 15 April 2024 (UTC)

I'm reasonably confident the previous RFCs went that way exactly because the filer wanted them to go that way, and therefore presented no evidence of unreliability nor gave anyone else time to gather such evidence. Loki (talk) 17:04, 15 April 2024 (UTC)

Yes there was a bit of that but it is still a hopeless case. -- Colin°^Talk 18:22, 15 April 2024 (UTC)

... I think we might actually be able to put together 30 sources for this. Anyone wanna collaborate to compile an RSN request? Snokalok (talk) 19:15, 15 April 2024 (UTC)

Wait no I misread. Snokalok (talk) 19:26, 15 April 2024 (UTC)

I mean, regardless of the intent, this has inspired me to collect sources for a future RSN RFC. So yes, I'd want to collaborate. Loki (talk) 19:29, 15 April 2024 (UTC)

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"

For the latter, PinkNews is probably our best place to start. They covered the two outlets' coverage back when it was more sporadic, and I remember a statistic somewhere saying how many pieces The Times wrote on trans people per month.:::::Snokalok (talk) 20:01, 15 April 2024 (UTC)

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 Snokalok (talk) 20:04, 15 April 2024 (UTC)

Hell, "We're being pressured into sex by some trans women" is so egregious it's notable enough for its own article. That ought to be something. LilianaUwU ^{(talk / contributions)} 21:24, 15 April 2024 (UTC)

Should we take this to draftspace, or... Snokalok (talk) 22:01, 15 April 2024 (UTC)

What, the sources against those rags? Sure, if you want to. LilianaUwU ^{(talk / contributions)} 22:02, 15 April 2024 (UTC)

Right now I'm looking for two things:

1. Cases where the Times or Telegraph said something that is either clearly false or very dubious.

Example A: This article calls trans women "men" in the article voice. Our article on trans women says explicitly that "a trans woman is a woman" and this is based off loads of reliable sources.

Example B: This article is about a really dubious poll (of all scientists rather than of biologists, explicitly carving out intersex people, and not publishing the actual poll itself) commissioned by the Telegraph itself.

Example C: This is an opinion piece, so it's not subject to the same factual standards as the others, but even so "Joseph Mengele tried to transition children" is a real chonker of a lie.

Note here that I'm not just looking for articles that are biased, but specifically articles that make false or clearly dubious claims.

2. Overviews, especially scholarly overviews, of problems with Times or Telegraph coverage in general.

Example A: this article about British media coverage of Mermaids.

Example B: this article is about British media bias about trans people in general.

Loki (talk) 22:05, 15 April 2024 (UTC)

I'll start digging for the BBC meanwhile. Snokalok (talk) 22:17, 15 April 2024 (UTC)

I don't think we should bother with the BBC yet. They're not good, but they're nowhere near as bad as the Times and Telegraph and I feel like including them will instantly shut the minds of some editors that would be open to unWP:GRELing the other two. Loki (talk) 22:46, 15 April 2024 (UTC)

I think it's time to take this somewhere else and finish this discussion of with a link to there. :) Draken Bowser (talk) 23:04, 15 April 2024 (UTC)

@LilianaUwU @Snokalok I've made a page for collaboration at User:LokiTheLiar/Times and Telegraph RFC prep. Loki (talk) 04:58, 16 April 2024 (UTC)

Hi all, please take a moment and consider the principle of neutrality. Please read: WP:NPOV.

As you well know, there are different points of view here, and the use of "men" to refer to adult human males is long established. So Example A is accurate reporting from that perspective. Its at odds with the point of view that trans women are women. To be neutral, we need to navigate these two perspectives and present them in a balanced way. See WP:DUE.

On the larger point, as you know, in the UK press PinkNews and to some degree The Guardian tend to support the side of trans rights activists, in terms of what they choose to report, and similarly, the Times and Telegraph tend to report more on the side of gender critical feminists, roughly speaking. I think there are few factual inaccuracies, but terms themselves are contested and so they report the same events in different ways. Our job as neutral editors is to synthesise balanced summaries. Anyone, self included, should consider whether our own allegiances may ever cloud our judgments of what's best for Wikipedia. AndyGordon (talk) 09:01, 16 April 2024 (UTC)

“ As you well know, there are different points of view here, and the use of "men" to refer to adult human males is long established. So Example A is accurate reporting from that perspective. Its at odds with the point of view that trans women are women. To be neutral, we need to navigate these two perspectives and present them in a balanced way. “

I really, cannot overstress how many editors have been sanctioned for choosing this exact hill. Snokalok (talk) 09:46, 16 April 2024 (UTC)

There is "whether discussion and language on talk pages and articles adheres to the norms and rules of Wikipedia" and there is "whether a source - which is not governed by those norms - not adhering to those norms makes that source de facto unreliable".

The former is how we can function and disagree (sometimes strenuously!) and build consensus in good faith. The latter is a swift route to insular groupthink and something to be very, very careful of. I can see it being a valid argument in WP:COMMONNAME disputes (ie, just because an inflammatory rag voluminously refers to someone in offensive terms, doesn't mean we should follow that example), but when talking about whether something is valid for facts, what matters is factual accuracy. Void if removed (talk) 10:03, 16 April 2024 (UTC)

I agree with User:Colin. There is no reason to set special rules on sources here; Wikipedia's existing rules and policies should be sufficient. That means that the popular press should not be cited for medical information, because WP:MEDRS applies to them. The Times and The Telegraph are the sort of popular press outlets that are accepted as reliable sources for current affairs, by virtue of not being tabloid trash. So they can be cited for covering political reactions to the Cass Report. Note that 'reliable' does not mean 'unbiased' or 'suitable for a naïve reader'; The Telegraph especially has a conservative angle, so when covering controversial issues, I recommend checking The Guardian especially for alternative angles. Anywikiuser (talk) 11:08, 16 April 2024 (UTC)

Agreed. Zeno27 (talk) 11:14, 16 April 2024 (UTC)

Can I suggest discussion on this matter ends on this page. If someone agrees, lets mark it closed. It's gone way off topic and there's now a user space for folk to continue dreaming they'll get The Telegraph cancelled. Let's keep this talk page focused on the Cass Review. -- Colin°^Talk 09:06, 16 April 2024 (UTC)

By all means Snokalok (talk) 09:47, 16 April 2024 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.