Misplaced Pages

Talk:Cass Review: Difference between revisions

Article snapshot taken from Wikipedia with creative commons attribution-sharealike license. Give it a read and then ask your questions in the chat. We can research this topic together.
Browse history interactively← Previous editNext edit →Content deleted Content addedVisualWikitext
Revision as of 14:03, 1 October 2024 editVoid if removed (talk | contribs)Extended confirmed users2,261 edits →Japanese Society of Psychiatry and Neurology: ReplyTag: Reply← Previous edit Revision as of 14:24, 1 October 2024 edit undoButterscotch Beluga (talk | contribs)Extended confirmed users1,121 edits →Japanese Society of Psychiatry and Neurology: ReplyTag: ReplyNext edit →
Line 936: Line 936:
:::::Have you compared these to the ? By my reading the 4th edition doesn't mention any concerns about infertility or confounding factors like autism, but these are present in the 5th edition - is this a result of the Cass Review highlighting these issues? We can't possibly know, and the document doesn't tell us. Does any of this come across in the text currently in use? No, because the sort of selective interpretation on display at the moment is not a good or comprehensive summary of the changes, turning some disconnected sentences into a "response to the Cass Review". But this source offers absolutely no comment of its own on the Cass Review, nor does it give any indication of the specific ways the guidelines were influenced by it. :::::Have you compared these to the ? By my reading the 4th edition doesn't mention any concerns about infertility or confounding factors like autism, but these are present in the 5th edition - is this a result of the Cass Review highlighting these issues? We can't possibly know, and the document doesn't tell us. Does any of this come across in the text currently in use? No, because the sort of selective interpretation on display at the moment is not a good or comprehensive summary of the changes, turning some disconnected sentences into a "response to the Cass Review". But this source offers absolutely no comment of its own on the Cass Review, nor does it give any indication of the specific ways the guidelines were influenced by it.
:::::The current paragraph gives the impression "we looked at the Cass Review and ignored it and WPATH criticised it, so we're carrying on with blockers". From actually reading, it seems far deeper than that, with significantly more caution on display, highlighting concerns of comorbidities, diagnostic overshadowing and desistance that weren't present before. I think this is the sort of thing that requires a HQ secondary source specifically analysing the impact of Cass on such guidelines, and until then this is just assembling fragments which create entirely the wrong impression, and all in a part of this article where I don't think it belongs. ] (]) 14:03, 1 October 2024 (UTC) :::::The current paragraph gives the impression "we looked at the Cass Review and ignored it and WPATH criticised it, so we're carrying on with blockers". From actually reading, it seems far deeper than that, with significantly more caution on display, highlighting concerns of comorbidities, diagnostic overshadowing and desistance that weren't present before. I think this is the sort of thing that requires a HQ secondary source specifically analysing the impact of Cass on such guidelines, and until then this is just assembling fragments which create entirely the wrong impression, and all in a part of this article where I don't think it belongs. ] (]) 14:03, 1 October 2024 (UTC)
::::::The announcement is a ''summary'' of their updated guidelines, the full document however, as @] pointed out earlier, directly refers to the Cass Review. I'm not quite sure why you are quoting the summary as, by its very nature, it is meant to briefly describe their results, interpretations, & changes, not give in-depth explanations on how they came to those conclusions, hence them linking the document in full as well. I think you are applying too strict an interpretation of what constitutes a "response", as by all means, this directly responds to the Cass Review's findings. ] (]) 14:24, 1 October 2024 (UTC)

Revision as of 14:24, 1 October 2024

This is the talk page for discussing improvements to the Cass Review article.
This is not a forum for general discussion of the article's subject.
Article policies
Find medical sources: Source guidelines · PubMed · Cochrane · DOAJ · Gale · OpenMD · ScienceDirect · Springer · Trip · Wiley · TWL
Archives: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10Auto-archiving period: 30 days 
The contentious topics procedure applies to this page. This page is related to gender-related disputes or controversies or people associated with them, which has been designated as a contentious topic.

Editors who repeatedly or seriously fail to adhere to the purpose of Misplaced Pages, any expected standards of behaviour, or any normal editorial process may be blocked or restricted by an administrator. Editors are advised to familiarise themselves with the contentious topics procedures before editing this page.

This article is rated C-class on Misplaced Pages's content assessment scale.
It is of interest to the following WikiProjects:
WikiProject iconGender studies Low‑importance
WikiProject iconThis article is part of WikiProject Gender studies. This WikiProject aims to improve the quality of articles dealing with gender studies and to remove systematic gender bias from Misplaced Pages. If you would like to participate in the project, you can choose to edit this article, or visit the project page for more information.Gender studiesWikipedia:WikiProject Gender studiesTemplate:WikiProject Gender studiesGender studies
LowThis article has been rated as Low-importance on the project's importance scale.
To-do list:

 Here are some tasks awaiting attention:
WikiProject iconLGBTQ+ studies
WikiProject iconThis article is of interest to WikiProject LGBTQ+ studies, which tries to ensure comprehensive and factual coverage of all LGBTQ-related issues on Misplaced Pages. For more information, or to get involved, please visit the project page or contribute to the discussion.LGBTQ+ studiesWikipedia:WikiProject LGBTQ+ studiesTemplate:WikiProject LGBTQ+ studiesLGBTQ+ studies
WikiProject iconMedicine Low‑importance
WikiProject iconThis article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Misplaced Pages talk:WikiProject Medicine.MedicineWikipedia:WikiProject MedicineTemplate:WikiProject Medicinemedicine
LowThis article has been rated as Low-importance on the project's importance scale.
WikiProject iconScience Policy Low‑importance
WikiProject iconThis article is within the scope of WikiProject Science Policy, a collaborative effort to improve the coverage of Science policy on Misplaced Pages. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.Science PolicyWikipedia:WikiProject Science PolicyTemplate:WikiProject Science PolicyScience Policy
LowThis article has been rated as Low-importance on the project's importance scale.
WikiProject iconEngland Low‑importance
WikiProject iconThis article is within the scope of WikiProject England, a collaborative effort to improve the coverage of England on Misplaced Pages. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.EnglandWikipedia:WikiProject EnglandTemplate:WikiProject EnglandEngland-related
LowThis article has been rated as Low-importance on the project's importance scale.
The following references may be useful when improving this article in the future:
Section sizes
Section size for Cass Review (36 sections)
Section name Byte
count		 Section
total
(Top) 7,824 7,824
Background 1,868 1,868
Methodology 10,553 10,553
Interim report 7,606 7,606
Final report 411 24,282
Findings 16 12,816
Lack of research 642 642
Increase in referrals 1,471 1,471
Social transition 2,170 2,170
Puberty blockers 2,415 2,415
Hormone therapy 1,523 1,523
Psychosocial intervention 748 748
Clinical pathways 1,566 1,566
International guidelines 888 888
Conflicting clinical views 1,377 1,377
Recommendations 5,717 5,717
Implementation 5,338 5,338
Reception 16 50,076
Response from UK political parties and public bodies 5,974 5,974
Response from devolved governments 3,382 3,382
Response from health bodies in the United Kingdom 10,694 10,694
Response from other health bodies globally 5,187 5,187
Response from transgender specialist medical bodies 4,867 4,867
Other academic responses 7,601 7,601
Reception by charities and human rights organisations 2,143 2,143
Reception by gender-critical organisations 1,256 1,256
Hilary Cass's response 8,956 8,956
Subsequent government actions in the UK 45 15,073
Ban on puberty blockers outside clinical trials 5,739 5,739
Adult clinics 6,856 6,856
NHS Scotland 1,780 1,780
Other government bodies’ actions 653 653
See also 335 335
References 30 942
Works cited 912 912
External links 557 557
Total 119,116 119,116

sources for consideration

BMA (percentage)

@Raladic I don't know if others will agree, but IMO I don't think combining different parts of the source to calculate a percentage like this when the source doesn't straightforwardly put the numbers together like that is quite simple enough for WP:CALC but I could be wrong! All the examples for percentages in WP:AVRC are trivial, this doesn't look exactly the same. It states The numerical data from the source is copied directly with an added conversion near to it. and the example is "were 120 of 200", but that isn't how it is formatted in this source.

I also think it overcomplicates a section where fewer numbers would be better, as this is the third time the numbers have changed in reported sources I believe (indeed, I already took one out with my edit as it kept rising, but was vague and didn't add much). I'd also add that based on this source we can fairly describe the original BMA Council motion as having been passed by a group comprising 0.035% of members. I don't think this is a road anyone wants to go down.

Rather than edit warring, maybe take it to talk. Void if removed (talk) 16:41, 27 August 2024 (UTC)

agree it is WP:OR to state the percentage until there is a source stating the relative percentages.
Though, the small percentage does seem to lead to question if the survey is WP:UNDUE on this article. Bluethricecreamman (talk) 16:45, 27 August 2024 (UTC)
IMO the inclusion of the BMA Council's original statement and the subsequent widespread coverage of this response is what determines WP:DUE. Void if removed (talk) 16:50, 27 August 2024 (UTC)
The simply calculation is important and allowed per WP:CALC/WP:AVRC and is absolutely not OR as CALC says - Routine calculations do not count as original research and the cited source itself lists the 195,000 member count. Most people don't typically do partial fraction calculations to less than a percent in their head, which is why it was relevant to add the 0.5% calculation here.
And the inclusion of the membership number and the showing that it is such a miniscule amount of members who have shown opposition is important exactly as that, as otherwise the "over xxxx" appears to be a WP:SCAREQUOTE to appear like there's a massive opposition, when it's really very-very small. So either the numbers are properly contextualized as I have now, or the whole paragraph may actually be WP:UNDUE entirely as Bluethricecreamman pointed out since it look like there really isn't much opposition to it. Raladic (talk) 16:49, 27 August 2024 (UTC)
If the purpose of the calculation is to undermine the statement by making the number look smaller, then it’s OR unless the sources also engage in that type of undermining.
The DUEness/UNDUEness of a viewpoint is by weight of source coverage, not by number of participants in the viewpoint. Barnards.tar.gz (talk) 17:22, 27 August 2024 (UTC)
There is no viewpoint in objective neutral reporting of the facts as stated in the source.
In August 2024, over 1400 doctors; 900 (0.5%) of which were members of the 195,000 that the BMA represents.. is a simple summary of the numbers from the article, nothing more, nothing less. Raladic (talk) 17:44, 27 August 2024 (UTC)
Could we do, In August 2024, over 1400 doctors of the 195,000 that the BMA represents...? Bluethricecreamman (talk) 17:50, 27 August 2024 (UTC)
No, because as the article points out, only 900 of the 1400 are BMA members, so we would have to say In August 2024, 900 doctors of the 195,000 that the BMA represents.. and that's again, why I used our WP:CALC policy as most readers don't do fractional percentage calculations in their head and added the (0.5%) there, as permitted by policy. Raladic (talk) 18:00, 27 August 2024 (UTC)
It is not. If the source said "900 of which were members of the 195000" you could possibly argue adding the percentage is a trivial calculation, maybe. But that's not the case, it's combining numbers from non adjacent paragraphs to make a point about relative size the source explicitly doesn't. In fact the source brings up the mental numbers in reference to the size of the BMA Council, ie that the original statement was made by a small group in private without polling the membership. Void if removed (talk) 17:53, 27 August 2024 (UTC)
And most governments of the world have elected council/house/senate leaders that make decision on behalf of their members that elected them to represent them, so your point being? Raladic (talk) 18:02, 27 August 2024 (UTC)
The BMA is a Union, and ordinarily members vote on policy at the ARM. Void if removed (talk) 18:10, 27 August 2024 (UTC)
Actually the article itself points out that the council is the policy forming elected body of representatives of all Union members - The union’s council, an elected policy-forming body of 69 members, was asked to vote on a motion .... The motion passed, making it formal BMA policy..
So, this seems quite normal order of business. Raladic (talk) 18:26, 27 August 2024 (UTC)
The viewpoint is “this is a really very-very small number”, as you stated. To understand whether this is truly a very small number we would have to know how many people typically sign similar complaint/protest letters. Maybe 0.5% is actually really high compared to the response that BMA motions normally get. The source doesn’t say, so we can’t say it or imply it. Barnards.tar.gz (talk) 18:08, 27 August 2024 (UTC)
Which is why there is no mention of "very small" or any such words with implications in the text (as that could be a point of view). Just simply the full statement of the facts of the numbers from the article, with one WP:CALC added to simplify the summary for the readers of this article, as outlined by our policies. Raladic (talk) 18:30, 27 August 2024 (UTC)
What you said was And the inclusion of the membership number and the showing that it is such a miniscule amount of members who have shown opposition is important exactly as that, as otherwise the "over xxxx" appears to be a WP:SCAREQUOTE to appear like there's a massive opposition, when it's really very-very small. so your reasoning is not a simplification but an WP:OR "contextualisation" that isn't given in the source in that way at all (and which, as Barnards rightly points out, is incomplete and misleading because without the information about how many usually respond like this in this sort of situation, you have absolutely no idea if this is a large or small percentage).
What you've done is add multiple, more confusing, duplicative numbers, and made this section harder to read, in a way that isn't in line with WP:CALC, is potentially misleading, and right now there are multiple editors disagreeing with you, yet you've persisted with this change and further changes, rather than follow WP:BRD. Void if removed (talk) 09:05, 28 August 2024 (UTC)
No, you yourself probably accidentally omitted the 900 doctors that are BMA members when you added the new source and changed the number itself. I added the 900 as the source article said so in the very sentence from the source: More than 1,400 doctors, 900 of whom are BMA members,... and so because the article itself added the important note that only some are members to fix your omission and also added the actual member number from the very article you added and added a simple WP:CALC, since the article mentioned the members specifically, so the adding of the member numbers was relevant and sourced from the very same article that introduced them for that same purpose.
Fixing your omission is what I did with the contextualization, that is not OR. It is a simple stating of the facts of the article and helps us accurately summarize here for the reader.
Also your strange accusation that I've made "further changes" that just help summarize the new article ref you added is unfounded, I don't think you'll find anyone disagreeing that adding what the ref said - The union’s council, an elected policy-forming body of 69 members, was asked to vote on a motion...the BMA’s membership base of 195,000 doctors... that the council members are elected to create policy for the BMA to represent them is in any way not useful to the reader for the purpose of WP:SUMMARIZE in the article here.
And as you know yourself, commentary of WP:OR does not apply to talk pages - This policy does not apply to talk pages, so the fact that I mentioned that the number is small in words here on the talk page is irrelevant for the policy, I did not mention any such thing in the article to maintain perfectly neutral of any such point of views and just simply summarized what the article said, including fixing your accidental omission of the member numbers. Raladic (talk) 14:52, 28 August 2024 (UTC)
When you said showing that it is such a miniscule amount of members, presumably you intended some part of your edit to show that? And whether you intended it or not, displaying a small number like 0.5% has the actual effect of downplaying the preceding number, which is not something that the source does. Barnards.tar.gz (talk) 16:05, 28 August 2024 (UTC)
And as outlined by WP:CALC, a routine calculation like this is perfectly ordinary and allowed and is not OR per our policy, so I don't know how else to say it for you to stop calling it OR. Raladic (talk) 16:40, 28 August 2024 (UTC)
The percentage is WP:OR, because you've gone beyond the allowable simplicity of WP:CALC and created a novel contextualisation of the information expressly for the purpose of making the scale of the open letter response seem comparatively small even though that is a) not how the source presents it and b) incomplete because you haven't properly contextualised it against the percentage of typical scale of such responses, creating a wholly misleading impression, which is why editors should not do this sort of thing off their own back.
To accuse other editors of WP:IDHT at this point is interesting. Void if removed (talk) 16:58, 28 August 2024 (UTC)
The very first sentence of the policy section that CALC links to says …provided there is consensus among editors that the results of the calculations are correct, and a meaningful reflection of the sources.. This conversation is about whether the calculation is a meaningful reflection of the sources, and I don’t think there is consensus that it is. Barnards.tar.gz (talk) 17:03, 28 August 2024 (UTC)
If you disagree that 900 divided by 195,000 is not 0.5%, then that would not be consensus, note that the next sentence of CALC says Mathematical literacy may be necessary to follow a "routine" calculation.
Of course we could keep it precise at 0.461%, but I took the liberty to round it up to 0.5%.
As to the meaningful reflection of the source, yes of course it is a reflection of the source, the source has the 900 members that signed the letter and the total membercount of 195,000. Raladic (talk) 17:14, 28 August 2024 (UTC)
I do think it is and I don't think that section means what you think it means. The agreement that needs to be had is that 900 is 0.5% of 195000 (it is) and that 900 and 195000 are sourcable numbers that can be meaningfully divided by each other (they are). That clause is intended to prevent stuff like adding statistics gathered by different methods, not simple math on simple numbers.
Per WP:CALC, 0.5% is just another phrasing of 900/195000. The policy I think you're looking for is WP:DUE. Loki (talk) 17:15, 28 August 2024 (UTC)
Can you point to the line in the source that says something like "900 of 195000" Which would make this sort of thing appropriate? Because by my reading, that's when routine calculations are appropriate, but combining different parts of the same source to state a conclusion that the source itself doesn't is SYNTH. Void if removed (talk) 17:39, 28 August 2024 (UTC)
WP:CALC is explicitly an exception to the overall WP:OR policy, which WP:SYNTH is part of. So, no: doing math with two numbers in the same source is not WP:SYNTH as long as the calculation is reasonable, even if the source did not explicitly make the calculation itself. Loki (talk) 04:43, 29 August 2024 (UTC)
The test for WP:CALC is not that it is possible to do some basic math with numbers that happen to be in the source. CALC says obvious, correct, and meaningful reflection of the sources. Raladic has stated in this thread that the clear intent is to demonstrate this particular percentage is miniscule. That's not a neutral, obvious CALC, that's combining different aspects of the source in a novel way to advance a specific POV, completely inverting the tenor of the source itself which strongly implies the opposite (ie, the BMA council's actions are unrepresentative of the membership, and the dissent in response is significant). Why can't we do what you're suggesting with many of the other numbers here? Do you think we really should say that the BMA council is 0.035% of members, which I offered as an absurd argument above? After all, at least in that case the numbers are in the same paragraph, rather than opposite ends of the source. Should we say that 2% of signatories are "former or current presidents of medical royal colleges"? That 1.4% of the BMA council described the motion as "a waste of time and resources"? That Emma Runswick who backed the motion is 0.0005% of the membership and that some members had resigned after she had served for 4% of their membership duration?
This is an enormous waste of time. Void if removed (talk) 11:13, 29 August 2024 (UTC)
I mean, no, 1400 out of nearly 200k isn’t significant dissent, flat out, and it is a tiny percentage, and if the goal of the source is to try and make it seem significant then that only seems like more reason for the sake of npov to clarify the percentage. Snokalok (talk) 11:43, 29 August 2024 (UTC)
if the goal of the source is to try and make it seem significant then that only seems like more reason
And this is where it is veering into WP:OR and not straightforward WP:CALC, because this is an additional analysis not clearly made by the source, with the intention to reframe the material in the source to advance a different POV than that in the source, which is instead based on your own personal and unsubstantiated opinion that this is insignificant. Void if removed (talk) 12:11, 29 August 2024 (UTC)
Seems like a pretty straightforward CALC inclusion that gives better understand for readers of what the information represents. Some editors here seem against such proper neutral representation of what the numbers represent. I wonder why. Silverseren 17:22, 28 August 2024 (UTC)
The reasons why are laid out extensively above. Barbs like “I wonder why” are not helpful. Barnards.tar.gz (talk) 20:34, 28 August 2024 (UTC)
I’m in favor of stating the percentage. This is elementary school math Snokalok (talk) 19:29, 28 August 2024 (UTC)
The mathematics of it is not in dispute. Barnards.tar.gz (talk) 20:34, 28 August 2024 (UTC)
Right, so then you surely agree it falls under CALC, since it’s simple enough math as to remain obvious Snokalok (talk) 10:48, 29 August 2024 (UTC)
I'm indifferent about whether to include the percentage, but it would be permissible as per WP:CALC. Anywikiuser (talk) 20:31, 28 August 2024 (UTC)
WP:CALC says obvious, correct, and meaningful reflection of the sources
These two numbers are 8 paragraphs apart in the source and not presented this way at all. This is not an obvious or meaningful reflection of the source. If the source had not happened to mention in passing the size of the BMA in a completely different context earlier in the piece, this conversation would not be happening.
And WP:SYNTH says do not combine different parts of one source to state or imply a conclusion not explicitly stated by the source.
The source does not explicitly compare these numbers, at all, and I think 8 paragraphs separation counts as different parts of one source. Void if removed (talk) 21:39, 28 August 2024 (UTC)
Both these compare and contrast exercises read like editorializing to me. The membership numbers of the BMA is listed on the other side of a wikilink. I'd rather we didn't do this. Draken Bowser (talk) 21:45, 28 August 2024 (UTC)
Emphasis on the ...to state or imply a conclusion not explicitly stated by the source. - there is no conclusion whatsoever in stating the membership numbers, they are simple fact from the source to help summarize. Raladic (talk) 21:48, 28 August 2024 (UTC)
It's not a CALC violation, but it sure smells like POV pushing.
To give an example closer to home, elections for the board of directors of the Wikimedia Foundation are coming up. We expect a couple thousand editors to vote. Let's say that if things go like they have the last couple of times, we would expect 2,000 editors to vote.
Now let's imagine that we are unhappy about the election results, and that 2,500 editors voted. Do we say:
  • only 2,500 (2.5%) of the 100,000 eligible editors voted?
  • only 2,500 (0.25%) of the 1,000,000 registered editors who contributed during the last year voted?
  • only 2,500 (0.01%) of the 30 million ever-contributed editors voted?
  • more editors voted than usual?
All of these are true, but they advance different narratives, and the choice of which (if any) numbers to include reveals the POV of the person making the choice.
What we know about the BMA situation appears to be:
  • A few dozen committee members voted to do something.
  • A thousand non-committee members publicly disagreed.
  • Twenty times as many members said nothing in public.
What I don't know is:
  • What's typical? Is this a big number or a small number for them? Have there ever been any similar petitions circulated?
Misplaced Pages will look biased if we say "Only 0.5% of current members signed this" and the facts turn out to be (I am making up this example) "This is the first public petition against a council decision ever, more members signed this petition than voted in the last election of the council, and shortly after the council reversed their decision, the petition writers banded together to promote a vociferously pro-science slate during the council's next election cycle." WhatamIdoing (talk) 06:07, 29 August 2024 (UTC)
Perhaps I'm being pedantic, "obvious, correct and meaningful reflection of the sources" is my issue here and why I think it goes beyond CALC into SYNTH.
The source says in paragraph 6:
The union’s council, an elected policy-forming body of 69 members, was asked to vote on a motion rejecting the Cass review at a meeting described by critics as “secretive and opaque”. The motion passed, making it formal BMA policy, although the breakdown of votes has not been made available and the BMA’s membership base of 195,000 doctors was not consulted.
The clear comparison here is between the size of the council, and the size of the membership. The inference is that this is a decision by a tiny minority, taken without consulting the huge majority (which, despite Raladic's claims, is unusual as the BMA sets policy democratically at the annual meeting, with the council only rarely setting policy in between annual meetings, and largely being responsible for steering and implementing the policy decided by the members). The acrimony over this action continues in further coverage today in The Guardian, but I digress.
The source then says, 8 paragraphs later, in paragraph 14:
More than 1,400 doctors, 900 of whom are BMA members, have signed an open letter calling for the BMA to drop its opposition to Cass.
I think it is improper to pull the number from earlier, and use it later in a different context, even if it is correct, as it is neither obvious to do so nor a meaningful reflection of the way the information is presented in the sources. And I think that if it is legitimate to do it for this number, it is arguably more legitimate to do it for the size of the council, where this size comparison is actually made more directly - but of course that would be absurd, and this whole thing is needless clutter. The comments in talk clearly reveal the intention is to make the response look miniscule, and that is not a reflection of this source at all, or any other covering this controversy. Maybe I'm reading WP:CALC too narrowly, but I don't think this is at all in the spirit of that policy.
As for correctness, as a further aside, despite the Times saying in passing it has a membership of 195,000 doctors, 20,000 are actually medical students, which is why we shouldn't take such passing numbers added as colour in news reporting as gospel to focmulate our own novel statistics. If 900 BMA doctors have signed an open letter, what's the proper comparison? The BMA membership, or the BMA membership who are doctors? This is all a completely needless can of POV worms and exactly why WP:CALC is limited in scope, not just free rein for any old calculation that you can happen to construct from numbers in a single source, and I'm exhausted by the amount of time spent defending something so trivial and WP:UNDUE that should have been discussed per BRD after it was removed, not reverted back in. Void if removed (talk) 09:09, 29 August 2024 (UTC)
I think it'd be clear to most readers and uninvolved editors that noting the fraction and percentage is making an implied claim—that the petition signers constitute a small portion of the BMA membershiup. At least one participant here has made it clear that assertion of such a claim was intentional. I think the opposers of this content have it right. If the source were making the claim, or linking those numbers, we could calculate the percentage. Since the source does not, we should not present the numbers next to each other, let alone calculate a percentage. One useful test for assessing whether an inappropriate SYNTH claim is being made is to consider whether the two parts of an implied claim could instead be separated. In this case, we already mention the overall membership of the BMA in the first paragraph of §British Medical Association. If we remove the later mention of 195k and the percentage, will all participants be content that all the relevant knowledge has been shared? If not, it's a sign that there is a claim you're trying to make, and it is (at least according to the sources presented so far) not one made explicitly by the sources. Firefangledfeathers (talk / contribs) 12:44, 29 August 2024 (UTC)
Snokalok, even including the total BMA membership (sans percentage) alongside the 900 is making an implied claim. Do any sources connect the two figures? Why should we? Firefangledfeathers (talk / contribs) 18:42, 30 August 2024 (UTC)
I agree with FFF. I add that it's not just a claim that it's a small percentage; it's an implied claim that the small percentage is meaningful.
For example, if you run an ordinary survey, and the sample size is small, you should call out the smallness as a reason why your survey results could be inaccurate. But in this case, we don't have sources (that I've seen) suggesting that a vote of the full membership would produce a different response. There is no reason, either in the sources or according to common sense, to believe that this is unrepresentative. In fact, as painful as it may be to consider, given the way transphobia is baked into society, including medicine, any suggestion that most healthcare providers understand the Cass Review and support the "pro-trans" criticisms against it would likely fall under the rule that Misplaced Pages:Extraordinary claims require extraordinary evidence. The default assumption should be that most physicians don't pay attention to anything outside their own specialty. WhatamIdoing (talk) 18:45, 30 August 2024 (UTC)
Per my original edit here (which was solely to update the numbers on existing consensus wording) it didn't even reference the size of the BMA or how many BMA members had signed. As others said above, the BMA membership is one click away, there's no point in it here and it will be swiftly outdated. I favour reverting to this earlier wording with fewer numbers. Void if removed (talk) 20:54, 30 August 2024 (UTC)
I mean, the Times source does say both the 900 and the 195k number, so, it’s not as though it’s synth or anything, it’s just repeating material from the same source. Snokalok (talk) 05:01, 31 August 2024 (UTC)
I’d also like to add that on its own, 1400 doctors protesting makes it sound to the lay reader like the entire UK medical community is in an uproar, which is misleading. Adding the BMA membership number puts the actual scale of the protest in accurate perspective. Snokalok (talk) 06:03, 31 August 2024 (UTC)
The actual scale could be unprecedentedly large, if BMA members don’t normally write protest letters about the actions of their own union. But sources don’t engage in this analysis, so neither should our article. Barnards.tar.gz (talk) 08:32, 31 August 2024 (UTC)
Presenting information from different parts of the same source in a way the source doesn't is WP:SYNTH.
do not combine different parts of one source to state or imply a conclusion not explicitly stated by the source. Void if removed (talk) 09:03, 31 August 2024 (UTC)
Again, WP:CALC is a specific exception to the entire WP:OR policy including WP:SYNTH. Loki (talk) 20:16, 31 August 2024 (UTC)
True, but CALC requires that the result be a "meaningful reflection of the sources", which is specifically disputed in this instance. WhatamIdoing (talk) 01:17, 1 September 2024 (UTC)
Exactly my point - CALC is not carte blanche to combine any numbers in any source to produce a percentage to make a specific point not made in the source (which does seem to have been the intent, based on comments here). If it isn't a meaningful reflection of the source, then (no matter how simple and arithmetically correct the calculation) it is SYNTH. Void if removed (talk) 09:20, 1 September 2024 (UTC)
But... it is though. One common use of WP:CALC is dividing population by area to make population density. Now, population density can be used to make comparisons and rhetorical points that neither population nor area can be used to make on their own... but it's still fine and not WP:SYNTH as long as both those numbers are sourcable.
This thread to me is, IMO, a bunch of people trying to make WP:CALC say stuff it doesn't say to avoid the obvious implication that this percentage is sourced. Loki (talk) 23:15, 1 September 2024 (UTC)
The article currently says "900 of which are members of the BMA’s 195,000", which needs some help. That makes it sound like there's a program at the BMA called "the 195,000", and not all BMA members are part of it. WhatamIdoing (talk) 23:12, 30 August 2024 (UTC)
I agree with WhatamIdoing and Firefangledfeathers that this "sure smells like POV pushing". Juxtaposing membership size or calculating percentages in an attempt at downplaying the importance or relevance of the complaint, in direct contradiction of the point made by our sources, is POV pushing. Seriously, why so much arguing about something high quality sources don't mention? Our reliable sources note this is a significant complaint both in size and also that many presidents of royal colleges have contributed. We absolutely cannot push numbers to give the opposite POV. What next? Add that the BMA membership is only 0.003% of the UK population so, you know, why should anyone care what they think? -- Colin° 17:58, 3 September 2024 (UTC)
So, there's really two questions here - first is whether it complies with OR/CALC to take a count of some of X that meet Y criteria from one source (or one part of one source) and calculate the percentage of X that count is based on another source/part of the source. I don't think anyone is questioning that is permissible in the vast majority of cases. The other question is whether the calculation being performed is actually warranted to be performed in the first place, and if so, whether the information is due for the article at all. Quite frankly, it's not. The source does not state a percentage or compare the number of doctors signing the letter precicely because that is an attempt to push the POV that their views should be diminished. The notable thing being reported on is that 1200 doctors signed the open letter. In other words, they are two distinct portions of the reporting. The source is not reporting the number in the background information to compare the later number to the total membership - it's reporting it as background information. The sentence should thus be reduced to state only the total number (over 1200) and can break that down into 900 of which are members of the BMA. But to include the total number of BMA members there is an inappropriate SYNTH violation. Even if sourcing was found that attempted to minimize the impact of this open letter by directly comparing the number of member-signatories to total membership... that would still be inappropriate here as it would be editorializing.To see how inappropriate this is, just rewrite it to read instead: An open letter was signed by 1200 doctors, 900 of whom were members of the BMA, but that is only 0.5% of their total membership or the same but the total membership has 195,000 members total. Those two sentences would be blatantly inappropriate attempts to impart a POV on the fact being reported. It is no different just because most of the words have been cut out or it's worded differently. The information about the open letter cannot, per NPOV, be presented in a way to lead the reader to the conclusion that it's irrelevant/a "small" portion of the population. The reader themselves may very well make that conclusion after looking into how many BMA members there are. But the reader may also understand that there are a plethora of reasons someone chose not to sign the letter (not aware of it, didn't want the publicity, disagreement of wording but agreement with principle, etc). -bɜ:ʳkənhɪmez | me | talk to me! 11:22, 4 September 2024 (UTC)
Note: I've gone through and affected a plethora of MOS:LISTGAP issues by removing whitespace in between comments and changing bullets to colons as that is what the start of this discussion was using. This is an accessibility issue for screen readers and also causes issues with reply tools when people reply to a comment and it uses a mixture of * and : characters. The indentation character changes here consisted solely of swapping initial *s to :s, keeping the same indent level as the comment had before. -bɜ:ʳkənhɪmez | me | talk to me! 11:22, 4 September 2024 (UTC)

I have restored the text per Raladic's edit here which had edit summary Per FFF on talk, I don't think this is making it easier for the reader per WP:FALSEBALANCE, but since we now have the membership number a few paragraphs above, as cited from the ref, the reader can do the math themself. It seems that would be a suitable compromise. I should warn that if editors continue to juxtapose the letter-writers size with the membership size, which no source does and which has the obvious POV of suggesting to the reader a small unrepresentative number, in direct contradiction to all reliable sources, I shall likely take this to ANI. Several editors have now warned this appears to be POV pushing, so I think that's fair enough warning that this should stop.

We currently juxtapose the 69 council members with the 195,000 BMA members. Our source does this too, in a paragraph suggesting the vote may be unrepresentative as the members were not asked. While this is a sourcable comparison, The Times is a biased source, so one could argue that this comparison is still not neutral or fair. After all, many bodies have elected councils of size that is infinitesimal compared to the main body (think ministers of government vs population, or board of a large corporation or charity). I would not be opposed to moving this 195,000 figure to a more neutral position. How about at the end of "which is both a trade union and professional body representing 195,000 members".

As aside, the council is voted for a 4-year term, and the current council members were voted for by just 11,312 members, which is 7.1% of the 159,632 eligible voters. In comparison, the last UK General Election had 60% turnout. One can offer up no end of comparisons of sizes, if one wants to make a point. But the point has to be sourcable and overall we are required to be neutral. -- Colin° 16:47, 5 September 2024 (UTC)

I like that change. I would also be fine with removing the 69 and not mentioning the 195,000 anywhere. None of the numbers are surprising or interesting. Firefangledfeathers (talk / contribs) 17:20, 5 September 2024 (UTC)
Agree on both numbers.
@Firefangledfeathers, wrt this edit. A problem with moving the RCPCH text is that although you wrote "their statement does not mention the BMA and shouldn't be in that section" they really were responding to the BMA "calling for a pause in implementation of the new Gender Identity Services until further reviews have taken place". The consequence of having the BMA response (and the ongoing response to that) in its own sub-section is it now appears after the RCPCH text and so readers at this point are unaware of anyone calling for a "pause" and planning their own "further reviews". Their announcement cannot possibly be referring to any other call to pause or further reviews, as there aren't any bodies making such in the UK. I appreciate they don't name them, presumably out of some gentlemanly weirdness about not dissing your colleagues by name. What to do?
If nobody seriously contests that the RCPCH (5th August) were responding to the BMA (31st July) then I think it may be chronologically and meaningfully more sensible to the reader to move the text back, as one of the many responses to the BMA. If you'd rather not, then another option is to move the BMA section up one, between the NHS England and other UK bodies sections. -- Colin° 18:40, 5 September 2024 (UTC)
Their statement doesn't mention that the calls came from "bodies" in the UK specifically, and at that point there were indeed many such calls. They also refer to "academic criticism". I don't think the reader needs to know the specifics of the calls for a pause. I have no real opinion on moving up the BMA section. Firefangledfeathers (talk / contribs) 18:48, 5 September 2024 (UTC)
I don't agree there were "many such calls". There were other non-UK bodies who disagreed, but they did so fundamentally, not with the "pause" language. Nor has any other body suggested a pause until further review, as those non-UK bodies simply reject it. Clearly if there isn't an editor consensus that the RCPCH were responding to BMA alone, and we can't find sources linking them, then it is difficult to do here. I thought it was as obvious as someone saying "I climbed the highest mountain on earth" and us writing "They climbed Everest" but this sort of thing needs agreement. Let's then move the section, because otherwise I do think our readers will be confused about what on earth the RCPCH are referring to. -- Colin° 20:19, 5 September 2024 (UTC)

Rephrasing BMA's initial paragraph

I rephrased the BMA's initial paragraph as follows (main changes underlined), trying to keep things as simple as possible:

"On 31 July 2024, the British Medical Association, representing the greater part of the UK’s medical practitioners, published a statement calling for a pause on the Cass Review's implementation while it conducted an evaluation, to be completed by January 2025. In anticipation of this, a motion was passed by the BMA's council to publicly critique the Cass Review, lobby the Government and the National Health Service for unhampered trans healthcare, and condemn what it called "political transphobia." Criticism was also levelled against the Review's allegedly "unsubstantiated recommendations driven by unexplained study protocol deviations, ambiguous eligibility criteria , and exclusion of trans-affirming evidence".

No numerology here. Instead, I took the trouble to inspect the connection between text and sources referred to in the notes, and removed notes not clearly supporting the text. I could not trace the statement in the published version, "arguing that is was not a decision for politicians to make", back to the sources to which the two adjacent notes refer, and therefore removed it. Instead, I added two important points in the BMA council's motion. Would anybody care to comment? Retal (talk) 20:38, 31 August 2024 (UTC)

representing the greater part of the UK’s medical practitioners
This is IMO leading wording, as it carries the implication that the BMA's statement was representing the greater part of the UK's medical establishment. It is also needless, as - again - anyone can click the link to the BMA page and we have no need to repeat this information here.
to be completed by January 2025
I'd leave this out, because the aspirations of the BMA council are something we shouldn't have to keep updating here if it slips.
In anticipation of this, a motion was passed by the BMA's council to publicly critique the Cass Review
This divorces the statement from the motion (indeed, reversing causality almost with this wording), when the two are the same. This is all needlessly convoluted and the prior wording lays it out quite straightforwardly.
lobby the Government and the National Health Service for unhampered trans healthcare, and condemn what it called "political transphobia."
This is a page about the Cass Review, not the BMA's motion, we don't need every single detail.
,
I see no reason for this inline explanation.
The wording before editors started adding percentages was pretty much fine IMO and I don't see the need for this when frankly the continued story is about the hostile response to the BMA council's statement and how they seem to have gone well outside their remit in this matter.
Responsibility for making BMA policy lies with the union’s representative body — a group of 560 members representing different medical disciplines and geographical areas — not the council. Policy is generally agreed at the annual representative meeting. Outside of this, the council can “formulate and implement policies” as long as it is not “inconsistent with any policy already laid down by the representative body”.
Void if removed (talk) 09:30, 1 September 2024 (UTC)

* Comment I reverted a reply by User:Retal here, because it was left inside of Void's comment above. This reply can now be found here in the version history. I've also, of course, notified the user in question of this change so they can recompose their comment.--Licks-rocks (talk) 15:06, 1 September 2024 (UTC)

I don’t mind this change, I think it’s fairly balanced Snokalok (talk) 14:59, 1 September 2024 (UTC)
The suggested text fails verification to the sources and is over editorial and joins too many dots. Also we don't write things like "allegedly". That this claim is in quotes is sufficient for us to be not making it ourselves. Wrt the "arguing that is was not a decision for politicians to make" you say is not in the source. Our text:
The BMA criticised the related ban on puberty blockers, arguing this wasn't a decision for politicians to make, while calling for more research."
Source text:
The BMA has been critical of proposals to ban the prescribing of puberty blockers to children and young people with gender dysphoria, calling instead for more research to help form a solid evidence base for children’s care – not just in gender dysphoria but more widely in paediatric treatments. The Association believes clinicians, patients and families should make decisions about treatment on the best available evidence, not politicians.
I think we have a fair summary of that with the current text. -- Colin° 17:08, 5 September 2024 (UTC)
I took into account some of your objections above. I also conceded your last point of critique and restored the sentence quoted above, putting back its two notes. In addition I use "methodological shortcomings" rather than the present opaque technical jargon ("unsubstantiated recommendations driven by unexplained study protocol deviations, ambiguous eligibility criteria, and exclusion of trans-affirming evidence"). Since I still believe the published summary lacks important points, I now suggest the following text: On 31 July 2024, the British Medical Association, representing the greater part of the UK’s medical practitioners, published a statement calling for a pause on the Cass Review's implementation while it conducted an evaluation. Criticism was levelled against the Review’s purported methodological shortcomings, and a motion was passed by the BMA's Council to lobby the Government and the National Health Service for unhampered trans healthcare (including “treatment at all ages”) and to condemn what it called "political transphobia." The BMA particularly opposed the temporary ban on puberty blockers, arguing this was not a decision for politicians to make. Can we agree on this? Retal (talk) 23:37, 7 September 2024 (UTC)
I think this proposed paragraph adds text more focused on UK trans politics than about the Cass review and the direct fallout of that (the puberty blocker ban). We aren't writing an article about BMA's views on trans politics in general (the "political transphobia" comment), but specifically about their rection to the Cass Review. There are still several aspects that are unsourced, such as the "unhampered trans healthcare". I'm uncomfortable with the description of this published statement as "representing the greater part of the UK’s medical practitioners" because that's clearly a point of contention, with multiple sources saying BMA members don't agree this represents their views, never mind "the greater part of the UK's medical practitioners". So I think we should stay away from suggesting "representing". While the council do have the power to make statements in BMA's name, our article text makes it clear this is a motion coming from a council vote, not a membership consultation.
I wonder whether other editors are happy with your suggested replacing the long direct quote "unsubstantiated..." with "methodological shortcomings". It's a blander description and I agree the list of issues is likely to be meaningless to many readers and every one of them is contentious. It does however give a flavour that the BMA council have credulously repeated some of the nuttier ideas in the Yale PDF. -- Colin° 11:07, 8 September 2024 (UTC)
I disagree with some of your assertions here. While the 195k has already been shot down, and “the greater part” is largely saying a similar thing; saying “BMA members disagree” as a general direction for how to steer our edits makes it sound as though the entire base or a large portion does when that’s just not supported by sources, and we shouldn’t be basing out edits off of such a sentiment.
Beyond that, the point about political transphobia is relevant because the Cass Review has been actively criticized in the past as exactly that, and we have several medorgs in this very article making assertions of a similar nature; so if the BMA is saying that in their response to the Cass Review, that’s a relevant detail.
As for “unsubstantiated”, I think the “allegedly” in the original already softens it enough. Changing the direct quote of unsubstantiated to a summarization as “methodological shortcomings” weakens it in a way that I feel is too extreme and goes out of its way to downplay the criticism. Snokalok (talk) 17:05, 8 September 2024 (UTC)
Yeah no looking back over it again, it softens it way too much. I’d much rather cut “greater part”, add “political transphobia”, and not remove the “unsubstantiated” quote than this new proposal. Tagging @Retal so they see. Snokalok (talk) 17:09, 8 September 2024 (UTC)
Would "methodological shortcomings and unsubstantiated recommendations" solve the problem for you? The original quote has the disadvantage that, as Colin observed, the list of issues is likely to be meaningless to many readers. Retal (talk) 18:49, 8 September 2024 (UTC)
I really like the current quote the most, as “methodological shortcomings” really downplays what they’re saying. A lay reader can absolutely understand what “unexplained deviations from study protocol and exclusion of trans affirming evidence” means, we really don’t need to change that. Methodological shortcomings makes it sound to the lay reader like a technicality, like oops they forgot to check a few boxes as a formality. Snokalok (talk) 10:48, 9 September 2024 (UTC)
Agree with Colin's assessment here. This section is already massive, please keep it on topic, ie what they say about the Cass Review, which is this page (WP:NOTEVERYTHING).
And the problem with the proposed construction:
the British Medical Association published a statement , and a motion was passed by the BMA's Council
Is it reverses the order. The BMA council passed a motion, and then released a statement about it. The proposed text reads like the BMA made a statement, and afterwards the council passed a motion.
I would suggest revising the existing text to make this clearer, something like.
On 31 July 2024 the British Medical Association council passed a motion committing the organisation to lobbying against the Cass Review. In a statement, the BMA criticised the review for "methodological shortcomings", and called for a pause on implementation while it conducted its own evaluation, intended for completion by January 2025. Void if removed (talk) 18:00, 8 September 2024 (UTC)
(1) Divorcing the BMA’s reaction to the Cass Review from UK trans politics seems somewhat artificial. The BMA Council’s “political transphobia” accusation, for example, directly concerns the reaction of UK Government and NHS to the Cass Review.
(2) The "unhampered trans healthcare" aspect is not, as you assume, unsourced, but condenses the Council’s motion V: “prompt access to gender identity services and treatment at all ages” and motion VI: “condemn….blocking their (the transgender people’s] access to healthcare.”
(3) Then, the British Medical Association “representing” the greater part of the UK’s medical practitioners. Since the problem appears to reside in the ambiguity of “representing”, a simple change can save us a lot of unnecessary discussion: the BMA, “whose membership comprises” the greater part, etc.
(4) The reversal of temporal order: considering the BMA proclamation, it is not clear to me that all BMA comments on the Cass Review - not only those contained in the Council's motion - stem from that Council. This uncertainty made me distinguish the two.
(5) Calling the section "massive" is a judgement I cannot share. The BMA reaction is one of the most influential ones; it deserves an adequate treatment. Retal (talk) 19:22, 8 September 2024‎ (UTC)
@Retal, I think the part I'm most confused by is the stuff in your suggestions. Do you mean "add an Misplaced Pages:Explanatory footnote here"? Or "One of those little blue clicky numbers goes here"? Or something else? WhatamIdoing (talk) 01:53, 9 September 2024 (UTC)
means one of the notes in the section as published. What else causes you confusion? Retal (talk) 16:48, 9 September 2024 (UTC)
On the points:
  1. This looks like something that reasonable people could disagree over. It's relevant, but is it relevant enough? OTOH, it's relevant, but is it only the BMA's response that is relevant, or should we be adding context that says all of these orgs – UK and non-UK; supportive and critical – are responding within the context of their political millieu?
  2. Forgive me for the WP:FORUM-ish comment, but do we really want to push the idea that of all the people served by NHS England, all of whom find their health care is restricted in various ways (e.g., scientific evidence, cost effectiveness, waiting lists), it's only trans folks that the BMA thinks deserving of "unhampered" healthcare?
  3. We might need to have a discussion about who counts as a "medical practitioner" before saying that the BMA represents "the greater part" of them, but I suggest to you that simpler language, like "most doctors" would be much more appropriate.
  4. The thing about corporate life is that even if all the "BMA comments" actually "stem from" something other than the Council vote, the organization itself didn't take an action until the Council took their vote. Before then (and since then), various individuals doubtless said stuff, but only official resolutions and official statements are from the BMA per se. The Western world draws a distinction between "The org said..." and "Bob, speaking in his personal capacity, said..."
  5. It's about three times as long as the space given to other British organizations. Whether that's "massive" or just "larger" is not IMO important.
WhatamIdoing (talk) 02:10, 9 September 2024 (UTC)
On your point 5 about the section being larger, actually only 97 words are currently given to explain the BMA's opposition, while 203 words are given to discredit the BMA's resolution in that section of a total of 300 words. This does look a little bit like a WP:PROPORTION issue in favor of the people opposing it if more than 2/3 of the section are trying to discredit it instead of actually giving it at least a decent amount of space explaining the BMAs position.
I've tagged the section with a WP:BALANCE tag to fix the POV proportions of the section. Raladic (talk) 02:28, 9 September 2024 (UTC)
The BMA's position gets just as much space as medorgs. It then gets a direct response from the review for balance, and then a third paragraph with further coverage because it has sparked lots of dissent and criticism which has been newsworthy as the story has developed. I see no reason for a balance tag. At some point the way things are going this might even become a "BMA Controversy" section one day. Void if removed (talk) 06:19, 9 September 2024 (UTC)
We might be more likely to end up with a ==BMA Controversy== section in British Medical Association than here, and I doubt that we will know that until their next internal council election (in 2026). WhatamIdoing (talk) 08:05, 9 September 2024 (UTC)
I was just thinking about that - wondering if it would be better to expand this back and forth and coverage over there, because it is now turning into accusations of entryism and more coverage etc that aren't really directly relevant to the response to the Cass Review, more about internal politics, for which the Cass response was the flashpoint. Perhaps worth considering that approach, with a summary/main section link here? Void if removed (talk) 08:16, 9 September 2024 (UTC)
I’d be in favor of “most doctors” Snokalok (talk) 10:09, 9 September 2024 (UTC)
Technically, the BMA represents all UK doctors: "The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK." Presumably they view this "represents" as what they aim to do even if you aren't a member. But their membership figures are similar to counts of the number of doctors employed on the NHS but I'm not sure how many doctors are members but perhaps work abroad or are retired. I can't find a recent source commenting on the relative membership size vs NHS doctors, likely because it simply isn't interesting to note. But "medical practitioners" is totally wrong, as there are well over 400,000 nurses and midwives.
The whole "represents" term is problematic wrt this council vote and motion. When Donald Trump "represented" the US on the international stage, no journalist would say "Donald Trump, who represents all citizens of the United States, said...". That would suggest that in this particular statement we know for sure he really is accurately representing them. And we know that is not the case. There's a clear separation that although the president is supposed to represent their citizens, what they actually say and do reflects the fact they are their own person. The proposed text here wrongly associates this council statement with the membership through the idea of "represents". And that's even before we get into the problematic idea that many democratic elections allow people to be elected on a minority of voters or that the BMA council were elected on only 7% of membership voting. So one can argue their position on the council represents the wishes of only a tiny percentage of BMA members.
This is just editorialising to try to enlarge the importance of this BMA motion, which currently is a big fat zero in terms of UK healthcare. -- 13:22, 9 September 2024 (UTC) Colin° 13:22, 9 September 2024 (UTC)

I'm not seeing how this discussion is going anywhere useful. We have a paragraph that is reliable sourced and neutral. The proposal adds unsourced wording and deviates into trans politics generally. While some editors are joining dots between the Cass Review and political transphobia, the BMA council do not. Their target there is far more likely to be the previous government who enacted the PB ban and routinely played the trans culture war game, but they don't say so neither can we. I see someone has added a "balanced" request that somehow we are to expand on the BMA's very brief statement and reduce the overwhelming criticism that it has provoked both from their own membership and wider in the UK among related medical bodies. But hold on a second. This is an article on the Cass Review, not BMA council activism, not puberty blockers, and perhaps the balance is that we should better describe the review and its implementation, and not focus so much of our time an energy on a small set of complaints which, in the UK at least, are entirely impotent: the BMA council is being absolutely ignored. -- Colin° 08:48, 9 September 2024 (UTC)

Just a wee reminder. The Cass Review did not recommend a ban on puberty blockers. Indeed it recognised that they were useful for some patients. It called for research into which patients benefited, and the BMA council also call for more research. The bits of the BMA motion that directly refer to the Cass Review are relevant. The confusion between both entirely blocking implementation and also wanting trans healthcare is relevant. But the rest is about the puberty blocker ban and the anti-trans culture war that so dominated the previous government and continues to be a focus of the right wing press. That is not "Cass Review". These things likely belong in articles on puberty blockers, on UK trans politics, on Tory/Labour politics, on the BMA itself, and so on. See WP:COATRACK. -- Colin° 09:34, 9 September 2024 (UTC)

Btw, I propose the edit notice about "balancing" the BMA motion's detail with critical concerns be removed. We don't "balance" things to be how editors might wish the balance was. Nor to we give weight to minor aspects of an article. The BMA's motion is itself just a few bullet points (vs 400 page Cass Review) and the reception it got was overwhelmingly negative and has been entirely rejected by anyone who matters (NHS England, NHS Scotland, current governments of both nations, the medical bodies that set clinical standards or govern the relevant medical specialities). That's the hard reality and the balance we need to represent. -- Colin° 09:34, 9 September 2024 (UTC)

Scotland

Although the Cass Review was commissioned by and for NHS England, there has been an expectation that Scotland (which has its own separate NHS) would consider its findings. This led to a report Cass Review – implications for Scotland: findings report, Full PDF here. And it seems the Scottish government has accepted that report in full. (Be clear: they accepted their own "implications for Scotland" report, not the whole Cass report, which has findings and recommendations that are England specific).

I think our current text on this probably now needs condensed wrt various ministers saying they will consider things. And then something written about Scotland's response. I'm happy to work on that this weekend, just posting this here in advance. If anyone has useful sources to add to this please post here. Thanks. -- Colin° 07:41, 6 September 2024 (UTC)

I have found these news sources:
I have also found several versions of https://news.stv.tv/scotland/scottish-government-accepts-findings-of-cass-report-on-gender-identity-healthcare-in-scotland, with various rephrasings or omissions. WhatamIdoing (talk) 02:24, 7 September 2024 (UTC)

Reflections from Hilary Cass

A new source has been published with a summary and reflections on the Cass Review by Hilary Cass.

https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/gender-identity-services-for-children-and-young-people-navigating-uncertainty-through-communication-collaboration-and-care/D0F6B23F37C3D82B38C2470DF65854C9

I am not yet sure if or how it can be used yet, but it is is concise and worth a read to get a sense of what she considered the main points. I thought it that might help guide any focus or emphasis in this article on the key takeaways of what is a wide-ranging and at times hard-to-summarize review. Void if removed (talk) 13:29, 7 September 2024 (UTC)

Third paragraph change

"The review has been criticised by several transgender-related medical organisations, and a number of international medical organisations have expressed disagreement with some of its conclusions."


It is true that the report has been criticised by several transgender-related medical organisations and non transgender-related medical organisations. It is also true that several medical organisations have rejected some all of its conclusions, its methodology, and its origins. It is also true that non-international medical organisations (BMA) have criticised the report. The sentence in its current form gives the impression that only transgender related organisations (with the implication here being they're biased) criticised (combative language) the report whilst non biased medical organisations merely disagreed (less combative) with only some (minimizing) of its findings.


Proposing it be changed to


"The review has been criticised by several medical organisations who have, variously, found fault with its methodologies and/or its findings." LDRnfr (talk) 22:44, 8 September 2024 (UTC)

@LDRnfr, are there any medical organizations (i.e., not individuals or publications, but official entities such as corporations and NGOs) that disagree with its methodologies and either agree with all of the findings or do not take any position at all on any of the findings? If not, then I don't think that methodological disagreements are important to call out.
It's a bit like giving directions to someone. You might disagree with their decision to take surface streets instead of the highway, but as long as they end up in the right place, the methodological disagreement is not very important. And if they don't end up in the right place, then the methodological disagreement is less important than the fact that they ended up in the wrong place. WhatamIdoing (talk) 01:34, 9 September 2024 (UTC)

Downplaying facts

We seem to have a disagreement about whether the sentence that says:

  • Children with comorbidities did not receive adequate psychological support, endocrinologists administering puberty blockers did not attend multidisciplinary meetings, and the frequency of those meetings did not increase when adolescents received puberty blockers, all of which the Dutch Approach recommends.

should be taken as a fact, or if we should use language like "The report claimed that..." to imply that NHS England is probably doing a good job, or at least an adequate job, of providing psychological support for kids with autism, anxiety, and depression, and it's really just the Cass Review's unimportant opinion that it's not good enough.

Here's some sources that say that children on the NHS are not receiving adequate psychological support, including trans kids.

Content warning: Anyone who searches for this is going to find not only stories that sound like "We've been waiting two years for an autism assessment", but also stories that sound like "At the time of her suicide, she had been waiting two years for an autism assessment and two and a half years for her first appointment with NHS gender services". IMO that's not what stories of "adequate psychological support" sound like. Adding search terms like "children" seems to reduce the number of results focusing on suicide deaths, and I doubleplus-recommend doing that.

On the list of sources claiming that all's well and the kids are getting everything they need, I find: Nothing. Not even the Tories are claiming that the CAMHS is sitting around all day with nothing to do because kids are already so well supported, so we should urgently cut their budget and my taxes.

So with all of this in mind, could we please take out the WP:WEASELly language that's implying that "Children with comorbidities did not receive adequate psychological support" isn't a universally acecpted fact?

WhatamIdoing (talk) 02:57, 10 September 2024 (UTC)

I'm of a few views here that I'm not sure how to reconcile. On one hand, I think it's important when making claims that they are cited to their source if that source isn't "final". On the other hand, the Cass Review is such that it's a large scale review that, while some people dissent to it, should be able to have its findings taken without the attribution. Yet still, this statement in question is being cited to the interim report, which should be attributed if it's being discussed as something the interim report said (which it is here).I'm not sure why this is only in background to begin with though - with barely any (if any) information in the actual discussion of the final Review. If there isn't going to be a section about the psychological support that is/should be provided in discussing the final results of the Review, then I'm not sure how it's relevant background information in the first place. If a section can be added discussing the findings of the final Review on this matter, then the background should continue to state that the interim report made that claim, since that's what the background paragraph in question is discussing. -bɜ:ʳkənhɪmez | me | talk to me! 03:11, 10 September 2024 (UTC)
I mean the Cass Review is not an undisputed report in the medical field by any stretch, and simply saying “According to the Cass Review, XYZ” goes a long way towards maintaining an NPOV on the topic. I think presenting the full report’s findings as undisputed fact without attribution, when we have countless medorgs across the globe including in the UK disputing it and accusing it of political machinations, misleads the reader at best and at worst is just pov. Snokalok (talk) 11:14, 10 September 2024 (UTC)
But we don't "have countless medorgs across the globe including in the UK disputing it". Where "it" means all of it. Nor are they "countless" vs "handful". The US ones have a common origin and united around a right-wing conservative domestic problem and are, sadly, playing at legal politics, not evidence based medicine.
There are two aspects to the review. One is the evidence both in terms of medical studies and the facts about the state of NHS England in this area. The other is in what should be done as a result. There is some criticism of the evidence, nearly all at an embarrassing level of competence by people with conflict of interest or no training at all in this field. Mostly that's about puberty blockers. And there's some criticism about what to do about it. Mostly that's about puberty blockers. And some of the criticism is of the puberty blocker ban, which isn't even recommended by the review.
But for the rest of it, as WAID points out, this is an NHS England commissioned report into the state of NHS England, which NHS England has accepted and vowed to fix. There isn't any need for any "According to the Cass Review" attribute any more than if National Highways published a report that said how long the A1 was and the condition of the road surface. None of these supposed "countless medorgs" dispute any of that. For our purposes, is the Cass Review a reliable source on the state of NHS England's trans healthcare? Absolutely. We can state these things as facts with a little numbered box after.
I've just finished reading Cass Review: Implications for Scotland. This is a 57-page NHS Scotland commissioned report written by a multidisciplinary team of experts and by the looks of it took weeks if not months to write. I wonder how many editors here have read it vs the Yale PDF or half-page BMA Council bullet-point statement.
The NHS Scotland report not only agrees with the Cass Review about the evidence and consequences, but goes through each of the 30+ recommendations working out how they apply to NHS Scotland. The differences, where they exist, are mostly because NHS Scotland is organised differently or has different programmes for improvement to occur within. They entirely accept Cass's analysis of the state of NHS England trans healthcare and agree NHS Scotland shares many of the same crises and solutions. What is interesting to me is that the NHS Scotland report will actually shape the future of trans healthcare in Scotland (much as the Cass Review will shape it for England). Unlike the other "publications" we have invested so much energy on, which will be forgotten about.
Snokalok, I really do encourage you to read the NHS Scotland report. Skim it at least. I know you won't agree with the puberty blocker bits but I think you will come away with a feeling that this is actually only a very very tiny part of the Cass Review. That most of it is about a health service that really is universally agreed as entirely failing its patients and for which radical change and investment is needed. I think you may also get a feeling that when the BMA council recommended to pause the implementation of the Cass Review and work to block it, why so many NHS doctors were aghast. -- Colin° 12:27, 10 September 2024 (UTC)
IMO if you can't state a fact from a source like the Cass Review without attribution, I have no idea what level of source you ever could. Void if removed (talk) 12:29, 10 September 2024 (UTC)
Wrt Snokalok's "misleads the reader at best and at worst is just pov", we actually do that when we attribute something that really is considered a fact and for which our source is reliable. It really is pov-pushing to stick weasel words around hard facts. As an editor with experience outside of this particular medical topic, I'm astonished at the degree to which mainstream first class evidence based medicine is being attacked on this topic, citing random lawschool PDFs and trade union councils, to try to discredit what is the largest, most thorough, independent and professionally conducted review of this field ever conducted.
It is a bit like we are writing about British Doctors Study and editors are filling this pages with stories about their gran living to 85 and smoking 40 a day, and linking to PDFs written by tobacco firms, and where Richard Doll reports he's scared to take public transport because of the abuse he gets. -- Colin° 13:15, 10 September 2024 (UTC)
My question is much narrower than this. We are saying that it's purely the POV of the Cass Review that "Children with comorbidities did not receive adequate psychological support".
@Snokalok, can you find any medorg that says that NHS England really has been providing trans kids with adequate psychological support? Just one medorg, anywhere in the world. If not, then this statement is not one that should have WP:INTEXT attribution. Probably lots of the others should, but I'm specifically talking about whether this exact claim should begin with that disclaimer-ish wording. WhatamIdoing (talk) 16:26, 10 September 2024 (UTC)
I think it’s important to ask what psychological support means here. In parlance on the topic in a UK context, it often means gender exploratory therapy and requiring the involvement of a mental health professional in perpetuity; which is of course, a highly controversial idea in the context of GAC, it’s considered conversion therapy to practice GET, etc. Thus, the statement requires attribution, because it makes the implication that they didn’t receive proper support *as the people doing the Cass Review considered it to be*. In other parts of the world meanwhile, it’s considered an intrusion to require continual therapy sessions in exchange for GAC - and we’ve even seen this opinion expressed several times by WPATH in a UK context. Thus, I’m not saying that the NHS or didn’t provide adequate support, I’m saying they didn’t provide adequate support as the Cass Review considered it, which is not necessarily a neutral position on the topic, and that’s why the attribution of “According to the Cass Review” is important. Snokalok (talk) 16:34, 10 September 2024 (UTC)
Here are two quotations about the absence of adequate support from the cited report (emphasis added):
  • "Additionally, children and young people with gender-related distress have been inadvertently disadvantaged because local services have not felt adequately equipped to see them. It is essential that they can access the same level of psychological and social support as any other child or young person..."
  • "The Dutch criteria for treating children with early puberty blockers were: (i) a presence of gender dysphoria from early childhood; (ii) an increase of the gender dysphoria after the first pubertal changes; (iii) an absence of psychiatric comorbidity that interferes with the diagnostic work-up or treatment; (iv) adequate psychological and social support during treatment; and (v) a demonstration of knowledge and understanding of the effects of gonadotropin-releasing hormones (puberty blockers), feminising/masculinising hormones, surgery, and the social consequences of sex reassignment"
Do you see anything in here that sounds like "Let's engage in conversion therapy"? I don't. I see "Local services are scared to provide ordinary treatment for autism in gender diverse kids because they worry that they might screw up" and "We actually need to support kids while they're on puberty blockers".
This sentence actually includes three claims:
  • NHS England is not providing adequate psychological support for the subset of trans kids who have autism, anxiety, depression, eating disorders, etc. while they're on puberty blockers. Note: The claim isn't about all trans kids. It's specifically about trans kids with comorbidities.
  • Endocrinologists administering puberty blockers did not attend multidisciplinary meetings.
  • The frequency of those meetings did not increase when adolescents received puberty blockers.
I think that all three of these are uncontested claims of fact. Your reply above, for example, does not even attempt to claim that anyone in the NHS with autism and anxiety has been well-served by the current system. It looks to me like you've swerved right away from "Children with comorbidities need adequate psychological support" to "Everyone agrees that conversion therapy is evil". Fine: Let's just stipulate here that every editor on this page agrees that conversion therapy is evil. But it's also evil to have one branch of the NHS wash their hands of a kid's crippling anxiety by saying that GIDS will deal with the anxiety, and after an education- and life-destroying multi-year delay, GIDS saying that they only do gender and CAMHS will deal with the anxiety ...after another year-long delay. This is not a case of "continual therapy is the price for GAC"; this is a case of "patients are allowed to have more than one health problem, and being trans should not disqualify you from the ordinary treatment for autism". WhatamIdoing (talk) 17:04, 10 September 2024 (UTC)
@WhatamIdoing the first claim is cited to page 18 which says Within the Dutch Approach, children and young people with neurodiversity and/or complex mental health problems are routinely given therapeutic support in advance of, or when considered appropriate, instead of early hormone intervention. Whereas criteria to have accessed therapeutic support prior to starting hormone blocking treatment do not appear to be integral to the current NHS process.
p32, right after your second quote, says However, the Dutch Approach differs from the GIDS approach in having stricter requirements about provision of psychological interventions. For example, under the Dutch Approach, if young people have gender confusion, aversion towards their sexed body parts, psychiatric comorbidities or Autism Spectrum Disorder (ASD) related diagnostic difficulties, they may receive psychological interventions only, or before, or in combination with medical intervention
Your first quote applies to all trans kids, it never specified those with comorbidities - it's a critique of local clinics turning away trans kids saying "idk what to do with them"
The second is just a summary of the Dutch protocol.
The article currently states The report stated that children with comorbidities did not receive adequate psychological support ... which the Dutch Approach recommends
That doesn't appear to be cited properly, as the section it's citing is talking about how the Dutch approach mandated trans kids with comorbidities have those addressed before or instead of receiving trans healthcare.
What the cited source supports is The report stated children were not required to undergo therapy prior to puberty blockers ... which the Dutch approach recommends Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:15, 10 September 2024 (UTC)
YFNS, the Cass Review does not refer to the patient cohort as "trans kids". I'm reminded of the comment Cass made, linked a few sections above: "During the course of the Review, we observed a change in attitudes, from an initial narrative among many trans advocates that only a minority of the young people presenting would have a longstanding trans identity and would benefit from a medical pathway to a belief in some quarters that all the young people on the waiting list for services were ‘trans kids’."
It would be helpful if you would stop doing using that language for this group. As Cass indicates, this is a recent and fringe activist-language, not something accepted by reliable sources. It makes discussing the treatment of children referred to CAMHS or GIDS-equivalent centres difficult. Only a minority of child and adolescent patients in the UK were referred for hormone therapy and this has been true for many years. The Cass Review refers to the patient cohort as "gender-questioning children and young people" which is a neutral term that does not prejudge diagnosis. This is aligned with WPATH. WPATH states for adolescents: "Given the emerging nature of knowledge regarding adolescent gender identity development, an individualized approach to clinical care is considered both ethical and necessary" and "We recommend health care professionals working with gender diverse adolescents undertake a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns and seek medical/surgical transition-related care, and that this be accomplished in a collaborative and supportive manner" and "We recommend health care professionals assessing transgender and gender diverse adolescents only recommend gender-affirming medical or surgical treatments requested by the patient when:...The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed." and "Professionals working with adolescents should understand what is and is not known regarding adolescent gender identity development, and how this knowledge base differs from what applies to adults and prepubertal children." I could go on quoting. And as for children: "This chapter employs the term “gender diverse” given that gender trajectories in prepubescent children cannot be predicted and may evolve over time". This is not the page to dig deep into that stuff, but the gist is WPATH make no diagnostic assumptions about the referral cohort and neither should we in our language. It is a bit like calling anyone who goes to the doctor with a lump in their breast a "cancer patient".
There are two aspects to "psychological support". The first is that a large chunk of the current cohort have psychological and neurodevelopmental conditions that are not being addressed at all, never mind before any medical treatment starts as recommended by both WPATH and the Dutch Protocol. The second is support during such medical treatment.
It is already well documented that CAMHS thought a referral to GIDS meant they didn't have to deal with that child as they thought the experts there would, and GIDS thought they didn't have to deal with anything other than gender dysphoria as they assumed CAMHS would deal with that. Both services were and continue to be massively overloaded, understaffed and with huge waiting lists. Which is part of what led to perhaps wishful thinking that someone else was dealing with it. That's a UK health service issue that is uncontested. This is the feature of "holistic" treatment that Cass recommends and is being addressed by NHS England and Scotland.
I think the issue that although these children's comorbid conditions were being neglected by all services in the UK, and especially so if they were gender questioning with a GIDS referral, it is being combined by some with the current activist battle that is uncomfortable with the fact that all international guidelines for children and adolescents have a psychosocial/neurodevelopmental gatekeeping component in them. It would be easier to fight the US battle against affirmative care bans if there was no question that every single referral was a "trans kid" who needed puberty blockers cross sex hormones. And so we get the claim that this psychosocial gatekeeping and now even any holistic psychosocial therapy at all is "conversion therapy" despite the fact that WPATH's definition of such is in the same pages as their recommendations that one must deal with these other things in order to have, as they put it, "diagnostic clarity" or "standards of care"
So, could we please stick to the sources on this one. Cass is not talking about conversion therapy but about stuff that is even in the WPATH guideline and the Dutch Protocols. It is basic "standards of care", as the WPATH guideline calls itself, that the UK health services fell well well short of. -- Colin° 08:31, 11 September 2024 (UTC)
I introduced the language of trans kids into this discussion, and I will attempt to remember your advice in the future. WhatamIdoing (talk) 18:29, 11 September 2024 (UTC)
@Colin "trans kids" is not "recent and fringe activist language" - that is complete and utter nonsense at best, ridiculously insulting at worst, and I will not stop referring to trans kids as trans kids.
Cass referring to kids sure of their gender as "gender questioning" is in fact one of the peer reviewed criticisms of the report btw
It is not a "neutral term that does not prejudge diagnosis" because being trans isn't a bloody diagnosis. And nobody has ever argued trans kids shouldn't get any mental healthcare or the NHS is doing a good job, that's a strawman, everyone agrees.
Besides which, I am sticking to what Cass said, that's why I quoted her specifically talking about how the NHS differed from the Dutch Approach. We already talk about diagnostic overshadowing earlier in the section, I am talking about a fragment of a sentence not supported by the cited source which could be changed to match the source. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:09, 11 September 2024 (UTC)
I'm sorry, are you seriously suggesting that colloquially referring to children as "kids" is fringe and activist language? --Licks-rocks (talk) 19:12, 11 September 2024 (UTC)
I believe the main point is that we shouldn't conflate "kids who have been referred to NHS gender services" with "kids who are sure they are trans".
YFNS cites a paper that says this:
"Trans children are instead reduced to definition as “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of trans children."
But it seems to me that an opposite and parallel statement would be equally true, viz.:
"When WhatamIdoing said 'trans kids' to refer to 'kids who have been referred to NHS gender services', she excluded “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of gender-questioning children."
I don't know what your experience is, and I don't want to bother looking it up, but I remember in the 1980s when the "Q" in LGBTQ was "questioning", and the definition seemed to be "I'm gay but I don't want to admit it". IMO Colin is correct that we shouldn't get in the habit of assuming that every single kid referred for gender services is actually trans. WhatamIdoing (talk) 20:07, 11 September 2024 (UTC)
@WhatamIdoing one term correctly refers to the majority of the cohort, the other incorrectly refers to them. If Cass said "youth seeking GAC" or something it would be another issue, but describing trans kids as "gender questioning" is not neutral. Imagine a report into LGB healthcare for youth which said "sexuality questioning youth" throughout and never once referred to "LGB youth" - it would be an immediate red flag. Per p 160 of the final report, the majority of kids turning up already socially transitioned.
I'd appreciate a response to my main point, which is what specifically did the Cass Review say about how the NHS differed from the Dutch protocol. I quoted 2 excerpts from the Cass review comparing the NHS and Dutch approach, which say the latter was stricter about mandating therapy as a prerequisite/corequisite/alternative to GAC. The paraphrase we have in the article misrepresents that. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:55, 12 September 2024 (UTC)
Imagine a report into LGB healthcare
The problem with analogies like this is they beg the question. Is that the same thing or not? Pick a different analogy and you can argue the reverse.
"Gender questioning" is the language of the review and I see no reason to avoid it.
In a clinical setting we're invariably talking about kids distressed at the development of secondary sex characteristics (prospective or actual), there's all kinds of reasons for that, strong opinions in different sources, and not much in the way of neutral language available. Void if removed (talk) 21:24, 12 September 2024 (UTC)
@Void if removed 1) this completely ignores the issue with the citation I'm discussing in favor of quibbling over language not in the article.
2) There is no situation on Misplaced Pages where somebody says "I am trans" and we refer to them as "gender questioning" just because somebody else did. MOS:GID and all that. Cass explicitly notes the majority of kids she's referring to as "gender questioning" have socially transitioned. Calling them all questioning is flatly inaccurate and not neutral at all. If you have a room full of 99 kids who say "I'm 100 sure I'm gay", and 1 person who says "I might be", saying you have a room full of "sexuality questioning kids" is nonsense. Insisting that some are questioning doesn't make it true for all people described. Colin and WAID have cited WPATH using terminology like "gender diverse" and "adolescents who present with gender identity related concerns" - those, unlike "gender questioning", accurately describe the cohort. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:08, 12 September 2024 (UTC)
Just to be clear, I'm not saying the term "trans kids" is activist language when used anywhere. And I'm aware of an anti-trans idea that there is no so such thing as a "trans kid", so I should have been clearer about that. There absolutely are trans kids. But I stand by the quote I made of Cass. WPATH above describe the referrals as "adolescents who present with gender identity-related concerns" and otherwise the shorthand "gender diverse" for both adolescents and children, repeatedly stating that each is an individual who's path is unknown. WPATH themselves recognise not all referrals will go down the path of gender-affirming medical treatments. WPATH themselves use the term "diagnostic clarity" to refer to a physician deciding to prescribe a medical treatment. I completely get the discomfort those words have wrt an identity but please take those concerns to WPATH and remember this is a medical treatment being prescribed.
YFNS cites an activist complaining that Cass using neutral non-activist terminology is a problem. And yet YFNS doesn't describe this activist opinion piece as such, but as a "peer reviewed criticism", as though that elevates it to the truth. And as though the peer review process for such opinion pieces exists to elevate opinion to truth. As WAID notes, Horton's criticism is logically nonsense. This friends, is the problem we have here. Cal Horton's opinions are Cal Horton's opinions, not "peer reviewed criticism", as though some kind of science or fact-based research is going on here. -- Colin° 07:52, 12 September 2024 (UTC)
I appreciate the clarification in the first part. As for the second. Cal Horton's "opinion piece" has in fact gone through peer review and what's more it has not been published as a letter or opinion article, it has been published as a proper stand-alone article. So yes, "peer reviewed criticism" is a correct characterization. --Licks-rocks (talk) 08:30, 12 September 2024 (UTC)
I wish I knew the exact technical term for this piece of academic writing. I wonder how you'd view it if written by a gender critical activist criticising the WPATH standards of care. They'd have their own POV and conceptual framework around which to build their case. What do you think "peer review" exists for in this kind of work? Do you think it exists to agree that every single sentence in this polemic is The Truth? Or more that this isn't the work of a crazed individual divorced from all reality unable to make any kind of cohesive argument.
On the one hand we have a review that took four years to write and was explicitly asked to be independent and selected a most senior and respected doctor to perform. Such a review has to find a balance of terminology and careful wording that is likely to upset those on the extremes in either side. But the point of the review is not to appease activists by using the Correct Words (on either side) but to determine the correct healthcare for an area of NHS England.
On the other hand we have an activist who's body of research is in interviewing their social media circle and who has written this polemic to advance their opinion that the Cass Review is inherently transphobic and thus can be dismissed before its findings are even known. Which, you know, as a piece, is not any different to someone writing a polemic that socialised healthcare is the fairest system and advancing their arguments in support of that. Such an piece could be peer reviewed as a valid argument, but not as The Truth. Someone could equally write a piece that says the capitalist model of insurance and pay-as-you-go for healthcare is the fairest and best system and make their arguments in support of that. Both could be peer reviewed and published. But both can't be correct, and peer review does not exist to determine that for this kind of work.
So it is a problem, frankly, when the language used by both Cass and WPATH, both MEDRS sources, is being attacked by an article that is really just some activists opinion, and referred to in a way that suggest "peer reviewed criticism" is in any way special at discovering who is Right. -- Colin° 09:56, 12 September 2024 (UTC)
What do you think "peer review" exists for in this kind of work? Do you think it exists to agree that every single sentence in this polemic is The Truth? I will, for the umpteenth time, note that that is not what anybody in this discussion has ever argued, least of all me. Neither have I or YFNS ever suggested that the sentence you're quoting is the only, or even the best, example of what YFNS pointed out the paper criticized in that paper. The reason that paper got through peer revieuw, though, is because it seeks to describe patterns of behaviour within the cass revieuw and its underlying research. Looking through the paper more closely, I don't get the impression that either you or whatamidoing (but especially you!) have made any real attempt to understand those arguments or represent them here in earnest.
I wish I knew the exact technical term for this piece of academic writing It's called a peer reviewed literary analysis. --Licks-rocks (talk) 11:08, 12 September 2024 (UTC)
I was responding to YFNS, who referred to Cal Horton's opinion as "peer reviewed criticism". Their overall paper, of 25 pages and about 16 thousand words, was "peer reviewed" in as much as that is worth something for a "literary analysis". But their specific criticism of Cass's use of the term "gender questioning", was not "peer reviewed" in the sense that Horton's peers examined that criticism and all enthusiastically agreed with it. That's what calling it "peer reviewed criticism" implies. I've lost count of the number of times YFNS has cited Horton as though this was definitive and widely accepted evidence, rather than one person's opinion, containing numerous factual misunderstandings, of the interim report. It is frustrating when two NICE systematic reviews and seven York systematic reviews and a four year independent review are repeatedly dismissed by citing a "literary analysis" written by an activist with no clinical background or experience conducting or reviewing clinical research of this kind. Is is though the very top of the MEDRS source hierarchy pyramid is "activist criticism". -- Colin° 12:00, 12 September 2024 (UTC)
YFNS didn't quote that paper, she mentioned it. As far as I can tell, the quoting was done by whatamidoing. Just like YFNS didn't use the term Trans kids in any formal way, she used it as a colloquialism, with the actual text she suggested right next to it. just like whatamidoing did prior to her. Look, I already said this on AE, but I want you to stop taking the worst interpretation of what we are saying and running with it, because a lot of the time it isn't even what we said. --Licks-rocks (talk) 12:15, 12 September 2024 (UTC)
I don't understand your first sentence at all. Maybe read WAID's defence of the trans kids issue at AE, and consider if you are taking the worst interpretation of what I said. -- Colin° 13:14, 12 September 2024 (UTC)
my first sentence is pointing out that the quote you and whatif are agitating against was not placed on this talk page by YFNS or me, and is not representative for the argument being made in the paper. I think it is a strawman of the argument YFNS is actually making, which is that the language used in the cass review and its underlying literature has been criticised for being non-inclusive, and for casting doubt on kids' ability to have a well-developed gender identity. The cited quote is one of several examples given.
Actually, I think the sentence whatamidoing did not include is very telling here. Let me introduce a more complete quote, including the sentence whatamidoing's quote is referencing:,the interim report does not include even one reference to a trans child, adolescent or young person. Trans children are instead reduced to definition as “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of trans children. Yeah, if the report didn't make a single reference to gender questioning people, I would still consider that a problem, to paraphrase whatamidoing's argument above. I'm sorry, but this practice has a name, and it is called cherrypicking.
Also, before you get up in arms about this being about the interim report again: A, nobody said otherwise, B, YFNS did not introduce this quote as being about the main report, she didn't introduce this quote at all, and C: the same people that wrote the interim report also wrote the main one. and D. there are similar issues with the main review, as evidenced by several MEDRS having published statements about this by now.--Licks-rocks (talk) 14:15, 12 September 2024 (UTC)
I'm afraid you lost me at "quote". No idea what you are talking about. But to be honest, I've got bigger problems to deal with today, as you well know. -- Colin° 14:24, 12 September 2024 (UTC)
For my money, Attribution is not just for when you want to draw a source's claims into question, you can also use it when you are describing what a source is saying. To me, it makes sense to point out that the cass review is saying this, because we're trying to describe what the cass review is saying. How about we follow MOS:CLAIM here and change it to say "the Cass review stated that...". That's how we usually avoid making a value statement in attributing something, and I think that makes a lot of sense here. --Licks-rocks (talk) 19:22, 11 September 2024 (UTC)
From WP:INTEXT:
When using in-text attribution, make sure it doesn't lead to an inadvertent neutrality violation. For example, the following implies parity between the sources, without making clear that the position of Darwin is the majority view:

☒N Charles Darwin says that human beings evolved through natural selection, but John Smith writes that we arrived here in pods from Mars.

checkY Humans evolved through natural selection, as first explained in Charles Darwin's The Descent of Man, and Selection in Relation to Sex.

Neutrality issues apart, there are other ways in-text attribution can mislead. The sentence below suggests The New York Times has alone made this important discovery:

☒N According to The New York Times, the sun will set in the west this evening.

checkY The sun sets in the west each evening.

When we say that the Cass Review stated that the NHS is failing pediatric mental health patients, are we implying that others disagree? Or that Cass alone has made this important discovery?
We might want to specify that the Cass Review says that the NHS has failed the kids referred to gender services even worse than they've failed all the other kids (that is the meaning of "Additionally, children and young people with gender-related distress have been inadvertently disadvantaged..."), as that might be their own discovery, but I suspect that even this is not original to the Cass Review. There are probably sources from the so-called trans activists complaining about exactly this problem that predate the Cass Review. WhatamIdoing (talk) 20:40, 11 September 2024 (UTC)
We're saying the cass revieuw stated that this was the case, which it sure did. I guess you could read implications into that, but then, it's a single sentence. Unless the next sentence is that some other source disagreed with that part I personally simply wouldn't get that implication out of it. --Licks-rocks (talk) 21:12, 11 September 2024 (UTC)
But INTEXT says that other people might, so if we don't think there are any other sources disagreeing with it, then we shouldn't use INTEXT attribution. WhatamIdoing (talk) 21:19, 11 September 2024 (UTC)
INTEXT also says In-text attribution may need to be used with direct speech (a source's words between quotation marks or as a block quotation); indirect speech (a source's words modified without quotation marks); and close paraphrasing. It may also be used when loosely summarizing a source's position in your own words. Which in my opinion is what we're doing here. I'll notice that the Darwin example still includes attribution, so clearly it's not quite as black and white as that. --Licks-rocks (talk) 08:21, 12 September 2024 (UTC)
The responses here exemplify so many of the problems in this area. The Cass Review is a high quality source and we should be able to use it to source facts like "Children with comorbidities did not receive adequate psychological support" without attribution. We can.
Instead of this being a minor point on which everyone can simply agree because the answer is so obvious, we have a massive thread full of comments recycling arguments about how using the language of the review "erases the existence of trans children". That's one opinion, others are available.
Relitigating this wastes time and space and stalls meaningful progress. There is an unresolved conflict in MEDRS, which is that some cleave to the US-based affirmative model, and some want to stick to psychotherapy as a first line treatment, and the language you choose to discuss the patient group affects how you think about the appropriateness of either of those approaches, and we can't simply attribute every claim in the Cass Review because that's implicitly picking a "side".
So, returning to the original question, I think that it absolutely can be stated without attribution, and I've not seen a good reason it cannot, especially since it is talking about comorbidities. Void if removed (talk) 14:50, 12 September 2024 (UTC)
I am also trying to understand his "US-based affirmative model" that appears to disagree with the US-dominated WPATH guidelines I quote 08:31, 11 September, which have "a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns" as a first-line step, and explicitly state that "gender-affirming medical or surgical treatments" be only recommended after "The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed."
Which MEDRS guidelines "cleave to the US-based affirmative model" for children and adolescents? Or is this describing current widespread practice that has yet to be updated into WPATH SoC? -- Colin° 15:52, 12 September 2024 (UTC)
Well there's what WPATH say in SOC8 in September 2022, and there's what WPATH say about the Interim Cass Review in November 2022, and they don't exactly gel:
At several points in the document, there is an emphasis on “careful exploration” of a child or young person’s co-existing mental health, neuro-developmental and/or family or social complexities. There is also a suggestion that a “care plan should be tailored to the specific needs of the individual following careful therapeutic exploration…” WPATH, ASIAPATH, EPATH, PATHA, and USPATH are concerned that this appears to imply that young people who have coexisting autism, other developmental differences, or mental health problems may be disqualified, or have unnecessary delay, in their access to genderaffirming treatment. This would be inequitable, discriminatory, and misguided (Coleman et al., 2022). WPATH, ASIAPATH, EPATH, PATHA, and USPATH recommend that puberty suppression, where urgently indicated, can be commenced promptly, and proceed alongside and at the same time as any necessary diagnostic clarification of other conditions, or treatment of other conditions
I think the distinction really is: what do these different models mean by "assessment"?
The York review of the different standards says:
All guidelines recommend multidisciplinary assessment. Three types were identified: (1) comprehensive psychosocial assessment, (2) medical or ‘readiness’ assessment for adolescents seeking hormonal treatments and (3) diagnostic assessment for gender dysphoria/incongruence. Some guidelines integrate these, while others present them separately. In most guidelines, there is no distinct assessment section or recommendations. There is limited clarity about assessment purpose. Most cited reasons are to inform a care plan, or assess eligibility for hormone treatment. Although most guidelines describe different pathways for children and adolescents, only three provide separate guidance. Five recent guidelines propose that prepubertal children only require assessment if gender-related psychosocial care is needed but provide limited detail about this. Others propose all children be assessed. There is little consideration of how a psychosocial assessment might be different for children and adolescents.
Detailed guidance regarding assessment is lacking with no consensus about the aim or clinical approach, nor the necessity for assessment in prepubertal children. Although most guidance recommends assessing gender, mental health, psychosocial and family functioning, other domains vary. Few guidelines recommend exploring sexual orientation or assessing body image, despite these being identified as important factors. Few recommend specific assessment tools, and those suggested have not been developed and/or validated for this population.
Cass says that we need to understand why youth are distressed before any medical interventions because we might be misinterpreting comorbid conditions or other factors. I could be wrong, but my impression of the "affirmative" model is that the assessment does not really question "why". Void if removed (talk) 20:32, 12 September 2024 (UTC)
I think this from Turban, Thornton and Ehrensaft gives a flavour of the distinction. This is supposed to lay out general guidelines for the biopsychosocial assessments WPATH recommends. But there are a few notable areas where "exploration" is off-limits:
Discuss unvalidated theories of TGD identities being related to trauma or internalized misogyny, emphasizing that there are no data to establish these etiologies but wanting patients to be exposed to these ideas in a safe and supportive environment, given the likelihood of encountering them on social or legacy media.
Although no evidence exists that trauma or internalized misogyny are the etiological cause of one’s trans identity, adolescents may hear these ideas in the media; addressing these unvalidated theories can prevent psychological distress related to encountering these ideas for the first time after starting gender-affirming medical interventions and open the discussion with patients to understand how they may have been affected by previous trauma or misogyny.
So where open and undirected psychotherapy might uncover and address address underlying causal factors for an individual's gender distress, here affirmative clinicians are concerned with ensuring the individual is not unduly affected by media reports that trauma or internalised misogyny might be an underlying cause, framing them in advance as "unvalidated theories".
Similarly, when it comes to comorbid conditions, the assessment focuses not on whether such conditions may be in part contributing to "gender questioning", but rather how to ensure they are not a barrier to consent for medical transition:
Identify and address any co-existing mental health concerns, particularly as they may relate to ability to engage in appropriate medical monitoring and ability to provide informed assent.
It is also important to conduct a comprehensive mental health evaluation to determine whether any co-existing mental health conditions (eg, anxiety, depression, autism spectrum disorder, eating disorders, etc) require support and/or may have an impact on decision making capacity or unique needs.
While both exploratory and affirmative models may talk of "assessment", the exact nature and focus of that assessment is ultimately the key cause of conflict. Void if removed (talk) 08:28, 19 September 2024 (UTC)

Who stripped away the BMA content?

I went to grab a citation to put in the lede, and it was all gone Snokalok (talk) 14:02, 17 September 2024 (UTC)

Bon courage, someone's asking about you. Firefangledfeathers (talk / contribs) 14:06, 17 September 2024 (UTC)
Sorry I was out for a bike ride (nice to catch the autumn sunshine). I left an edit-summary didn't I? Quite why we had this bloated attention on the BMA was a puzzle! (Add: Oh I see it's snuck back in. Seems undue to be; as if Misplaced Pages needs to surface the 'bad things' the BMA said. They're really not a reliable body for this stuff). Bon courage (talk) 14:19, 17 September 2024 (UTC)
While the section was a tad heavy for its weight, I don’t think we can really say what to me read as one sentence of ‘The BMA criticized the Cass Report,’ followed by two paragraphs of ‘but then everyone else told them that that was dumb because XYZ’ without including what those criticisms were Snokalok (talk) 14:37, 17 September 2024 (UTC)
I disagree, particularly since the BMA is only a trade union. I mean who cares, particularly when we have several more apt bodies making comments. More particularly this material should not be restored without consensus. Note WP:ONUS: "The responsibility for achieving consensus for inclusion is on those seeking to include disputed content" (my emphasis). By over-focussing on this body's pronouncements the article risks drifting into POV. Bon courage (talk) 14:48, 17 September 2024 (UTC)
I still stand by my earlier suggestion of expanding it as necessary over on BMA and summarize/link it here. The coverage since has been more about the resulting controversy within the BMA itself than the Cass Review, so it seems more DUE there than here. Void if removed (talk) 14:50, 17 September 2024 (UTC)
That sounds good; this is really more about the internal politics of the BMA than anything of real biomedical relevance to the Cass Review. Bon courage (talk) 14:52, 17 September 2024 (UTC)
Sorry, perhaps I’m misreading, but are you saying that the BMA’s specific criticisms of the Cass Review belong more on the BMA page than the Cass Review page? Snokalok (talk) 15:22, 17 September 2024 (UTC)
I'm saying that given the coverage in RS as the story has developed over time into one that centres on the BMA itself I think it is due for a fuller explanation over there, and a link and condensed summary with the most relevant parts here. Void if removed (talk) 16:40, 17 September 2024 (UTC)
Yes. For biomedical science, the BMA is not really a relevant body in the UK (we cite plenty that are). A sentence or two at most is due here. Otherwise it looks like Misplaced Pages is over-focussing on a bit-player in order to showcase the harsh words™ they put out. Bon courage (talk) 16:46, 17 September 2024 (UTC)
Right, and there was a longstanding consensus for inclusion before you changed it. Another relevant guideline is NPOV - because having two paragraphs on why critiquing the Cass review is dumb and all the people who are against doing so, needs to be balanced by what those critiques actually are. Otherwise it’s not neutral Snokalok (talk) 15:20, 17 September 2024 (UTC)
I don't think there was any consensus; you may of course try an establish it. After my edit the BMA content was:

The British Medical Association (BMA) has called for a pause on the review's implementation while it conducted a critique due to be completed by January 2025. The call has prompted some opposition from doctors, 1,400 of whom signed an open letter to the BMA characterising their planned critique as a "pointless exercise".

How is that "two paragraphs on why critiquing the Cass review is dumb"? Bon courage (talk) 16:10, 17 September 2024 (UTC)
You forgot the Academy of Royal Medical Colleges after that, but also look through the previous threads that even yet remain on this page - where several debates were had as to the content and where it was finally decided to keep it as it was before you changed it. That’s a consensus. A new editor coming in, while certainly welcome, does not break that consensus. Citing another guideline, we have BRD. You boldly shortened, I reverted as much as I could manually on mobile (hate the new html system, makes it impossible to manually revert things), and now we’re discussing. Snokalok (talk) 16:31, 17 September 2024 (UTC)
Nowhere was it "finally decided". Rather I see concerns about excessive quotation and smells of POV-pushing, and the section was tagged when I arrived here. BRD is not a "guideline", but an essay. WP:ONUS, on the other hand, is part of WP:V (i.e. core policy). Bon courage (talk) 16:36, 17 September 2024 (UTC)
Right, I forgot it was tagged.
Regardless, it was tagged as giving disproportionate weight to the criticisms of the BMA, not to the BMA’s original critiques. I’m not opposed to succinctness, but we can’t detail the counter-arguments of others if we’re not listing the original argument posed in the first place. Do you disagree? Snokalok (talk) 10:00, 18 September 2024 (UTC)
I agree with my own edit (i.e. we should have neither). The BMA is not a good source, especially compared to what we have, for biomedical science, and so their pronouncements are undue. Bon courage (talk) 10:56, 18 September 2024 (UTC)
They are a respected professional body though, representing a very significant number of doctors. If the spirit of your edit is to have neither criticism nor countercriticism, I don’t necessarily disagree, but I feel that your edit as you made it, read as being decidedly weighted in favor of the countercriticism. Reading through it from the perspective of the unknowing reader, my first thought was “What was said that provoked such documented backlash?” and inevitably a reader after asking that question, will fill in the blanks according to their own preconceptions.
Personally, I think that however little notability the BMA critique might have, the response to it holds decidedly less, and so I’m confused as to why you saw it as worth giving more space than the BMA themselves. Snokalok (talk) 12:48, 18 September 2024 (UTC)
Huh? what "countercriticism" are you referring to as being weighted? You you please show me which of my edits you are referring to with a diff. Bon courage (talk) 12:52, 18 September 2024 (UTC)
So I was looking at this diff,, and I realized that you didn’t actually edit in the AoMRC. Fair point to you there then.
Regardless, it does then become “here’s half a paragraph of the BMA saying they’re going to criticize” when they already criticized it, as the quotes I added show; followed by (with the AoMRC) 1.5 paragraphs including direct quotes of what I believe to be less notable backlash, on how such criticism is bad and the review will be implemented regardless.
Again, with direct quotes, the BMA Part balances these out in my view. Without direct quotes, it feels decidedly weighted in favor of those rebuffing either the criticism already given (per the quotes) or the idea of criticizing the Cass Review.
The current state of things, at this point is fine with me. BMA w/ quotes, half a paragraph about the letter, and then the AoMRC, that’s something that reads as relatively balanced to me. Snokalok (talk) 11:48, 19 September 2024 (UTC)
From this discussion it is apparent there is no consensus to give this much weight to the BMA so I have re-shrunk the section. Editors may try to establish a consensus for a more maximal treatment or pursue the option to hive the detail to the BMA article. Bon courage (talk) 12:00, 19 September 2024 (UTC)
Shrinking it to your original edit, while not my first choice, is acceptable on my end. Snokalok (talk) 12:32, 19 September 2024 (UTC)
The BMA story is obviously important and not mentioning it would be strange, but it's also the only UK medical organisation not to accept the review, despite being the least qualified and relevant to do so. It makes sense to keep coverage of it lean to ensure the article appropriately balances coverage against the unanimous acceptance by the organisations that actually oversee clinical practice. I think Void's right that it should be covered as a BMA topic rather than a Cass Review one. 212.36.63.7 (talk) 16:51, 17 September 2024 (UTC)
Yes, I think lean is the right approach. Others apparent want more. Let's see if they can be more persuasive about why Misplaced Pages needs to clear the WP:VNOT hurdle for extensive detail on this particular body alone. Bon courage (talk) 12:03, 19 September 2024 (UTC)
I also think that keeping this to a single paragraph is best. That treats the UK organizations equally and also respects the notion of an encyclopedia article (which should be a summary, not a detailed list of who said what). If the BMA says something useful or interesting (according to reliable sources) next year, then we can update it then. WhatamIdoing (talk) 01:22, 21 September 2024 (UTC)

Just to note, I have re-added the response from the AoMRC which was removed in the last edit, but without reference to the BMA. The AoMRC are a significant organisation, with responsibility for standards and training, whose response is at least as worthy of note as that of the BMA, of not more. Daff22 (talk) 12:27, 19 September 2024 (UTC)

The AoMRC’s response to the Cass Review would be worthy of such note. The AoMRC’s response to the BMA critique, an event already given incredibly little weight in this article, bears little to no weight by extension. Snokalok (talk) 12:34, 19 September 2024 (UTC)
Wait I didn’t see that you took out the BMA, okay fair Snokalok (talk) 12:37, 19 September 2024 (UTC)

International

The lead says: "However, it has been criticised by a number of international medical organisations and academic groups for its methodology and findings." I wonder whether "international" is the right word here.

First of all, does the word international apply to the academic groups, or only to the medical organizations? I'm not sure who the "academic groups" are. There the Integrity Project at Yale Law School, but I don't see any others (i.e., that aren't medical organizations).

Secondly, does the word international mean "organizations that actively/directly work in multiple countries" or is this meant to communicate "medical organizations outside the UK"? As an example, Médecins Sans Frontières is an international medical organization and PATHA of New Zealand is a non-international, non-UK national organization. WhatamIdoing (talk) 01:29, 21 September 2024 (UTC)

The answer is both, to both questions.
You have international global groups both medical, such as WPATH which is a global international medical organization, as well as groups such as Amnesty International as a global international non-medical human rights group or the Yale report group that was international, but not both medical and non medical.
As for the second question, it's both international in the "non-UK" (aka "foreign" (4) per wikt:en:international#Adjective) sense but of other national bodies, such as the Australian and New Zealand, American Association of Pediatrics, Canadian, as well as again, global (aka "of having to do with more than one nation" (1) per wikt:en:international#Adjective), such as WPATH and the Endocrine society or Amnesty.
What is missing is actually that beyond the international criticism, it has also received national criticism, such as from the BMA, which is now missing after a recent change by another user, so we should fix that in the lead and add "national and international" in that second sentence. I just made a follow up edit in the article to address this and also added the word "human rights organization" in recognition of Amnesty not falling in either a strictly medical, nor strictly academic group definition of the existing lead summary. Raladic (talk) 02:12, 21 September 2024 (UTC)
Do you know which "academic groups" are supposed to be included here? Amnesty International is neither medical nor academic. (Also, did they actually criticize the review, or did they instead criticize the media coverage and political weaponization of the review? I was under the impression that their response was exclusively the latter.)
At the moment, I'm wondering whether "However, it has been criticised by a number of organizations outside the UK..." would be more appropriate (e.g., includes international and non-international, medical and non-medical, academic and non-academic). WhatamIdoing (talk) 02:28, 21 September 2024 (UTC)
You can check out my change I made prompted by your initial question, I think especially the added wording of "human rights organizations" makes the question of which other academic groups beyond the Yale report group makes it moot, since we have Amnesty, as well as say Equality Australia, just to pull from the named organizations cited in the article for this. I don't think using the word "outside the UK" improves this and it is accurate to use the term international since there is a mix of global and non-global organizations (in use of the noun of international as I outlined above) that have levied criticism on it, so if we only added "outside the UK" it could be interpreted that it was just some small local other country organizations, so instead then we'd have to preface it with something like "it has been criticized by a number of global and non-global organizations outside the UK", which I think just makes it more convoluted. Raladic (talk) 02:55, 21 September 2024 (UTC)
I don't think that "widely welcomed by several UK medical organizations" is entirely idiomatic. If it's widely welcomed, then more than just several welcome it (though not all, as that would be universally welcomed).
I think we could shorten the second sentence to "it has been criticized by a number of organizations outside the UK". Then it wouldn't matter exactly how anyone chooses to classify the organizations. WhatamIdoing (talk) 03:23, 21 September 2024 (UTC)
The new phrasing is very awkward. I think we might just need more than one line to convey the full meaning here. Loki (talk) 03:28, 21 September 2024 (UTC)
I don't think a shortening of the sentence is needed and the lead should summarize the article. The lead as it stands is pretty short as-is and given that the reception section is almost half of the article as can be seen from the section sizes (I just added it to the headers of the talk page), if anything it should be expanded to accurately summarize the article and discuss core parts of it. The article presents a mix of medical and other organizations, so the lead calling it out is quite normal for someone who only has time to read the lead to get a picture of where criticism has come from instead of just having an abstract "organizations" without classifying what the array of them are. Raladic (talk) 03:30, 21 September 2024 (UTC)
The WP:LEADLENGTH (click that; it changed recently) as it stands is just over 250 words, which is a common length for FAs. For comparison, the old recommendation for an article of this length (just under 5K words) was two or three paragraphs (it's currently three) with 200 to 300 words (it's currently in the middle). WhatamIdoing (talk) 04:10, 21 September 2024 (UTC)
Right, but my point is that the lead is currently giving a lot more of its content to sections of the article that are much smaller, so it’s not quite summarizing the core contents of the article in appropriately similarly weighted amounts per MOS:LEADREL to summarize the entirety of the article as such. So if you want to trim the lead, then instead, we could for example remove the WP:FLUFF at the first sentence on the credentials of Cass, which are word puffery since this article is about the review, not the former credential of who led it. Raladic (talk) 04:19, 21 September 2024 (UTC)
The ==Reception== section contains 7 subsections about reception of the final report. I've lined up the sections with quotations from the lead. Let me know if you see anything else missing:
  • political parties – and it was endorsed by both the Conservative and Labour parties
  • NHS England and NHS Scotland – In September, the Scottish government accepted the findings of a multidisciplinary team that NHS Scotland had set up to consider how the Cass Review's recommendations could best apply there.
  • UK health bodies – The review's recommendations have been widely welcomed by UK medical organizations.
  • other health bodies, trans medical groups, "assorted responses" – However, it has been criticised by a number of national and international medical organisations, academic groups and human rights organizations for its methodology and findings.
  • and, finally, Cass's own response to the responses – ???
At a glance, the lead contains information about all of these sections except the last. I did notice that it omits all mention of support for the report by other health bodies and appears to categorize the non-judgmental response ("Dear Mass Media, Please note that disinformation is bad") from Amnesty International as being a criticism of the Cass Review.
I'm not sure how to classify this part of the lead:
The review led to a UK ban on prescribing puberty blockers to those under 18 experiencing gender dysphoria (with the exception of existing patients or those in a clinical trial). The Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust closed in March 2024 and was replaced in April with two new services, which are intended to be the first of eight regional centres. In August, the pathway by which patients are referred to gender clinics was revised and a review of adult services commissioned. In England a clinical trial into puberty blockers is planned for early 2025
On the one hand, this is a description of NHS England's reception of the report, namely a list of the changes it has made/is making as a result of the report. On the other hand, it's not presented in the form of "NHS England expressed support/opposition". That choice is probably appropriate (AIUI whether the agency agrees or disagrees is not very relevant, because they are going to have to implement most of the recommendations anyway) but it makes it difficult to decide whether these ~100 words should be 'counted' as representing the ==Recommendations==, ==Implementation==, or ==Reception== sections.  It's sort of all three at the same time. WhatamIdoing (talk) 17:52, 21 September 2024 (UTC)
If you'd like to do this 'by the numbers', then the ==Reception== section is around 40% of the article, and the quotations in the bullet points (i.e., excluding the part that I'm not sure how to classify) is around 30% of the lead. Since those two numbers are fairly close, that suggests that we're probably getting it approximately right. WhatamIdoing (talk) 17:55, 21 September 2024 (UTC)
I’m not in favor of this new phrasing, it unbalances it in favor of the UK medorgs.
It’d make it read like “The UK medical community welcomed it, but some other miscellaneous people didn’t like it.” Snokalok (talk) 09:50, 22 September 2024 (UTC)
Are you thinking that the UK political parties should also be mentioned in that sentence, too? It's inaccurate to say or even imply that only the UK medical community welcomed it.
We should probably remove "human rights organizations", because I only see two in the article, and neither of them criticize the report. Amnesty criticizes the misinformation about the report, and the British Equality and Human Rights Commission supports it. I'll go do that now. WhatamIdoing (talk) 17:29, 22 September 2024 (UTC)
Also, there aren't any non-international multinational groups mentioned in this article. "Multinational" does not mean "from outside the UK". It means "operating simultaneously in multiple countries". Facebook Inc is a multinational corporation. The Integrity Project at Yale isn't even a "national organization". (Technically, it's not even an organization at all; it's a project in a larger organization.) WhatamIdoing (talk) 17:33, 22 September 2024 (UTC)
I'm wrong; the Royal Australian and New Zealand College of Psychiatrists is multinational (or binational), since it operates in Australia and New Zealand. However, they don't seem to actually criticize the Cass Review, and they refer to a prior 2023 statement that says "There are methodological limitations in studies which assess the effectiveness of all models of treatment on the mental health of children and adolescents with Gender Dysphoria...There is limited high quality evidence to inform the provision or the withholding of medical interventions for gender affirmation of children and adolescents....The benefits and potential harms of both medical and psychosocial interventions for TGD children and young people have limited evidence" – which sounds pretty consistent with the Cass Review's complaints, as does their statement that standard recommendations include caution on the use of hormonal and surgical treatment, screening for potential coexisting conditions (e.g., ASD and ADHD), arranging appropriate service provision for these conditions, and offering psychosocial support to explore gender identity during the diagnostic assessment.
I really don't think we should name "multinational organizations" in the lead as opposing or disagreeing with the Cass Review; there's only one in the article, and it's not really opposed to anything in the Cass Review. The only thing they oppose is their own governments creating a copycat inquiry. WhatamIdoing (talk) 20:19, 22 September 2024 (UTC)
The Endocrine Society is multinational. Generally my intent was that international be used to mean, outside the UK, and multinational be used to mean operating in more than one country. Snokalok (talk) 20:35, 22 September 2024 (UTC)
Also WPATH is multinational Snokalok (talk) 20:38, 22 September 2024 (UTC)
Then the word you are looking for is foreign, not international. WhatamIdoing (talk) 21:27, 22 September 2024 (UTC)
“International employees”
”International collaborators”
”International students”
”International cultures”
“International films”
International is commonly used to replace the word foreign, because foreign carries with it a very specific connotation of ‘us vs the unknown and the strange’ which is not at all helpful. Snokalok (talk) 21:30, 22 September 2024 (UTC)
But also you didn’t answer my point about the endocrine society and WPATH Snokalok (talk) 21:30, 22 September 2024 (UTC)
Is there any question to be answered? You would like to downgrade WPATH and Endocrine Society from international (which implies they have something to say to everyone) to merely multinational (which implies that they are operating in specific countries and not in others). You would like to do this so that you can use the word international to mean "in a single country that isn't the UK". I think these are both bad ideas. WhatamIdoing (talk) 21:36, 22 September 2024 (UTC)
… You know what, that’s actually a fair point. Snokalok (talk) 21:39, 22 September 2024 (UTC)
When international is used that way (e.g., "international employees"), it is referring to groups of people/things from a wide variety of countries. The individuals are not themselves "international". For example, the Venice International Film Festival this year awarded its Golden Lion to The Room Next Door, which is a Spanish film, rather than an "international" one.
By contrast, an organization or an idea can actually be an international thing, e.g., the World Health Organization, the International Red Cross and Red Crescent Movement, or the International System of Units ("metric system"). WhatamIdoing (talk) 21:44, 22 September 2024 (UTC)

I have removed the word several from the sentence regarding UK medical organisations for two reasons. Firstly, it didn't make sense. Secondly, according to the article the only UK medical body to criticise the review is the BMA. That is not several, that is near universal approval. That fact should not be watered down in the lede. Daff22 (talk) 09:00, 21 September 2024 (UTC)

Please ignore the autocorrect typo in my edit summary on the article! Shouldn't edit on mobile. Daff22 (talk) 09:27, 21 September 2024 (UTC)

Here's my attempt at classifying the responses to the Cass Review's final report:

Groups reacting to the Cass Review
Org Type Where Location View Notes
NHS England Health UK National Support They don't have much choice.
NHS Scotland Health UK National Support
Conservative Party (UK) Political UK National Support
Labour Party (UK) Political UK National Support
Scottish Government Political UK National Support
British Psychological Society Health UK National Support
Royal College of Psychiatrists Health UK National Support
Royal College of Paediatrics and Child Health (RCPCH) Health UK National Support
Royal College of General Practitioners Health UK National Support
Academy of Medical Royal Colleges (AoMRC) Health UK National Support
British Medical Association (BMA) Health UK National Oppose
American Academy of Pediatrics Health USA National Oppose
Endocrine Society Health USA International Oppose
Canadian Pediatric Society Health Canada National Oppose? They are not updating their recommendations right now. They think PBs are safe and can be appropriate.
Amsterdam University Medical Center Health Netherlands National Mixed They think the evidence base for PBs is fine.
Royal Australian and New Zealand College of Psychiatrists Health Au + NZ Multinational? Mixed They oppose politicians creating a similar government inquiry.
World Professional Association for Transgender Health Health USA International Oppose
Professional Association for Transgender Health Aotearoa (PATHA) Health New Zealand National Oppose
Equality Australia Human rights Australia National Oppose
Australian Professional Association for Trans Health (AusPATH) Health Australia National Oppose
Amnesty International Human rights UK International No opinion Opposes misinformation about the report
Mermaids Human rights UK National Mixed
Stonewall Human rights UK National Mixed
Sex Matters Political? UK National Support
Genspect Political? UK International Support
British Equality and Human Rights Commission Human rights UK National Support
some unnamed individual academics Academic UK Support
Academic UK Oppose
Academic non-UK Oppose
Integrity Project at Yale Law School Academic USA Oppose

Overall, I'd say that the biggest difference between the content of the body and the lead is that the lead makes no mention of mixed responses. There seem to be several organizations that support parts of the report and oppose others, including only opposing very specific or narrow things (e.g., 99% of it is all good and/or none of our business, but we think the evidence base for puberty blockers is good enough). Another thing I've noticed is that the bigger and more UK-based the organization, the less likely they are to fully oppose it.

I've set the table to be sortable because I think that comparing similar groups might be interesting. The default order is the order in the ==Reception== section. If anyone thinks I've misclassified a group, please reply. WhatamIdoing (talk) 18:24, 22 September 2024 (UTC)

This is pretty great BUT I do have some quibbles:
The first one is that, while their HQs are both in the US, WPATH and the Endocrine Society are both international organizations with global membership.
The second one is that I'd split the political category into left and right or trans-supportive vs. trans-exclusionary. It's notable that Labour is supporting the Cass Review from the left(ish), for instance, and it's also not surprising where Sex Matters, Genspect, Mermaids, and Stonewall all fell out.
And the third is that there's a few cases, most notably WPATH/PATHA/AUSPATH but also the various Royal Colleges where we're including a parent organization and its independent child organizations, and I feel like we should note that. Loki (talk) 18:52, 22 September 2024 (UTC)
I changed Endocrine to list it as international. Amnesty is a UK-based international organization. International organizations have to have their legal existence somewhere. WhatamIdoing (talk) 19:04, 22 September 2024 (UTC)
That's fair! Loki (talk) 20:19, 22 September 2024 (UTC)
If you're using "international" to only mean "outside the UK" and "multinational" to mean it operates in globally, then Amnesty is multinational, as is the Endocrine society and WPATH. Though personally I think most people use "international" in place of global, rather than use multinational. Raladic (talk) 21:08, 22 September 2024 (UTC)
Also I'd say the Amnesty response is not entirely "no opinion", they strongly call out that "This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people. and “The negative rhetoric by the Government about the dangers of so-called gender ideology, healthcare for young trans people, as well as the push against LGBT-inclusive sex and relationship education is harmful and extremely damaging. It is no different from the ultra-conservative and evangelical groups pushing for discriminatory laws targeting trans people in the United States." - whether this critique is on the NHS/British Government or the report itself, it definitely reads as criticism. Raladic (talk) 21:21, 22 September 2024 (UTC)
Yes, they say that people who are not the Cass Review are behaving badly. Do you see anything that specifically sounds like they have "criticised ...for its methodology and findings"? WhatamIdoing (talk) 21:26, 22 September 2024 (UTC)
The second quote of "The negative rhetoric by the Government" is criticism - the Cass Review was commissioned by the Government/NHS, and AI is criticizing it. The article is not just about the review, but also the resulting use by the British government of it (as the second paragraph of the lead summarizes with the resulting use of the review by the government, which means that the reception should also extend to it). So we can fix the reception sentence in the lead for this to expand it to something along the lines of "However, the review and its use by the British government has been criticised by a number of international and multinational medical organisations, academic groups and human rights organizations for its methodology and findings and the resulting restrictions on healthcare for transgender youth. Raladic (talk) 21:36, 22 September 2024 (UTC)
Your proposed sentence says that the review has been criticized for:
  • its methodology,
  • its findings, and
  • the resulting restrictions on healthcare.
I do not see any words in the Amnesty International source that sound like criticizing any of those three things. Do you? If not, then we can't really put them down as having said that.
As for "The negative rhetoric by the Government" being criticism, I completely agree with you, but I believe that when they say "the Government" they specifically mean "the Conservative politicians who currently make up the majority in Parliament" rather than "the 388-page-long report itself". WhatamIdoing (talk) 01:21, 23 September 2024 (UTC)
The sentence is a summary sentence that summarizes the core criticisms by the different organizations, it doesn't mean that every of the either 'medical organizations', 'academic groups' or 'human rights organizations' had the same of the summarized criticisms, just that collectively between those 3, those are some of the main criticisms levied. We can replace the word "restrictions" with "damage" or "harm" instead into "resulting damage on healthcare for transgender youth", which is the word used by AI. Raladic (talk) 01:30, 23 September 2024 (UTC)
It's fair to say that not every org has all of the criticisms, but as far as I can see, Amnesty International expresses none of those criticisms. They don't directly criticize the Cass Review at all. WhatamIdoing (talk) 01:43, 23 September 2024 (UTC)
They criticized the government's resulting use of the review affecting trans healthcare. Raladic (talk) 02:04, 23 September 2024 (UTC)
Which is not criticism of the review itself. WhatamIdoing (talk) 02:23, 23 September 2024 (UTC)
And as I already said, this article is also not just about the review, but also the resulting use of the government. Which in turn means criticism of the resulting use of the review it also relevant to this article here and I proposed the wording above to reflect that accurately. Raladic (talk) 02:29, 23 September 2024 (UTC)
Negative rhetoric from politicians isn't the "use by the British government" of the report. The British government used the report to justify a prohibition on prescribing puberty blockers; they did not use the report just to engage in "negative rhetoric" (which, after all, they were saying before, during, and after the report's creation and publication).
I think it would be fair and a straightforward reading of that source to say that Amnesty criticized the government's anti-trans rhetoric. WhatamIdoing (talk) 03:26, 23 September 2024 (UTC)
Phenomenal, thank you. Perhaps notable that the BMA response was a controversial one. Maybe also note which international medorgs the Cass Review was critical of (Endocrine Society, APA and WPATH) as I think the tit-for-tat nature of these criticisms is noteworthy. Void if removed (talk) 19:09, 22 September 2024 (UTC)
I think the UK/non-UK divide is looking pretty stark. In the UK, only the BMA Council and the unnamed individual academics have expressed total opposition; even Mermaids supports parts of it. Every group based in the US is reacted with polarized total opposition.
Are you thinking about adding a phrase along the lines of The World Professional Association for Transgender Health, whose guidelines were heavily criticized in the final report released an email statement saying that the report "is rooted in the false premise...? WhatamIdoing (talk) 19:12, 22 September 2024 (UTC)
If you want a rundown of all reception of the Cass Review, Dr. Ruth Pearce has collected most of the reception with commentary - What’s wrong with the Cass Review? A round-up of commentary and evidence – Dr Ruth Pearce including many academic responses that are not currently covered in the article. Organizationally in the UK, there is the British Association of Gender Identity Specialists (statement, national, UK) and the Feminist Gender Equality Network (statement, international, UK).
So I think beyond maybe adding those those organizations/academic groups to the current receptions, the other thing standing out is some of that other criticism being entirely missing . There has been broad opposition from some editors here about the inclusion of individual academic critiques, as you noted in your table in the "unnamed individual academics", so arguably given that looking at the quite long list that Dr. Pearce (herself a gender studies scholar) has compiled on the issue, I think it might warrant at least a sentence in our assorted reception list along the lines of a summary sentence like "Several academic experts have also raised individual criticism of the Cass Review in statements, published papers and magazine articles." instead of being entirely left out of the article.
One notable interesting recent article from Australia from 20 August 2024 in has some interesting commentary on the evidence used in Queensland which looked at similar things to the Cass Review, but with very different results as summarized in their recently published Queensland Children’s Gender Service report. Raladic (talk) 21:04, 22 September 2024 (UTC)
The blog post says: This post provides a round-up of links to written commentary and evidence regarding problems with the Cass Review... which suggests that it excludes sources that support the Cass Review. It therefore seems to me that it's not "a rundown of all reception of the Cass Review", but instead "a rundown of all the negative reception of the Cass Review". WhatamIdoing (talk) 21:53, 22 September 2024 (UTC)
I think the article already contains most/all the organizations that support the review, which as summarized is mainly localized to the UK, but it is missing several criticisms of it.
My point of linking to the list was to help you expand your table with the reception that is currently missing from the article. Raladic (talk) 22:02, 22 September 2024 (UTC)
I'm looking at the list with my WP:RS glasses on. Here's what I see:
  • BMA – already in the article
  • Integrity Project at Yale – already in the article
  • A Google Doc written by two former gender care specialists – probably doesn't even count as WP:Published
  • Press release from WPATH and USPATH – already in the article
  • Press release from EPATH – already in the article
  • British Association of Gender Identity Specialists (BAGIS) – press release that says they want to read the report "before offering a comprehensive response"
  • PATHA – already in the article
  • AusPATH – already in the article
  • Therapists Against Conversion Therapy and Transphobia (TACTT) – another press release saying they'll get back to us after they've finished reading it
  • Endocrine Society – already in the article
  • American Academy of Pediatrics – already in the article
  • The National – an article in a daily newspaper that is generally supportive, and out of which is highlighted a quotation from an unnamed expert who thinks that the government should have appointed some trans people to lead the inquiry instead of only cis people (fair enough, but doesn't tell us much about the results).
  • The Medical Republic – self-described as a "paper" (rather than a newspaper) from "a group of like minded doctors, journos and ‘old world’ publishers who would like to jazz up communication more for doctors as we move into a mobile social universe" that says that the Queensland review shows the Cass Review was basically right on the facts, and what's really wrong is the funding for gender healthcare. (I put "doctors paid by funding for healthcare think that there isn't enough funding for healthcare" in the "completely unsurprising" category.) The highlighted quote is the claim from an AusPATH member that "There have been multiple expert academic treatises written on what was wrong with the Cass Review". If those really do exist, then why aren't we citing them? A quick trip to PubMed with the usual MEDRS filters (review+systematic review+meta analysis) finds nothing from this calendar year. I suspect that the speaker's personal definition of "expert academic treatise" includes "someone put a PDF or Google doc on their university website".
That's the first section. Either we've already got it, or it doesn't meet WP:RS, or it says they'll get back to us later. WhatamIdoing (talk) 02:22, 23 September 2024 (UTC)
IIRC the Queensland report was published in February and the evidence cutoff was September 2023, so misses all the recent systematic reviews on blockers, eg. Zepf et al. Void if removed (talk) 22:50, 22 September 2024 (UTC)
Nope, this is a brand new independent report that was published in July 2024 (Independent report into Queensland Children's Gender Service finds no evidence patients were 'hurried' into decisions - ABC News) and looked at new data - It was conducted by a panel of professionals external to CHQ from across Australia with expertise and experience in child and adolescent health care and diverse gender experiences between December 2023 and June 2024. (page 5) - including referencing the final Cass review itself. Raladic (talk) 23:00, 22 September 2024 (UTC)
Ah right, I mixed it up with the Sax Institute report. Void if removed (talk) 06:17, 23 September 2024 (UTC)

Queensland Children's Gender Service report

Splitting this off from the above, since it's a separate topic, but worth bringing up as it references the Cass Review.

The Australians Queensland government recently published a new independent review report on gender services in Queensland. The Independent evaluation finds Queensland paediatric gender services safe and evidence-based (full report) was published in July 2024.

As this article - Why Queensland didn’t copy the UK approach to transgender care from the Australian Medical Republic highlights, the independent review looked at similar data as the Cass Review, and had some recommendations similar to Cass, but largely led to some very different outcomes than the Cass Review and the results of the Queensland report were adopted by their government and led to a doubling of the funding to expand services. Independent report into Queensland Children's Gender Service finds no evidence patients were 'hurried' into decisions - ABC News, Queensland gender service should be expanded, review finds.

One thing that was highlighted in the Medical Republic article on it was the statement from the past president from AusPATH calling out that the different outcomes likely are connected due to the Cass Review not including transgender experts (According to Brisbane GP Dr Fiona Bisshop, immediate past president of the Australian Professional Association for Trans Health, the Cass Review largely ignored doctors who were providing gender-affirming care. “There have been multiple expert academic treatises written on what was wrong with the Cass Review … they intentionally sidelined people who worked in the field. Practitioners who worked with trans patients and trans people themselves were excluded from that whole review, and that didn’t happen . They talked to the right people who were using the service and they also included some people in the review panel who were experts.” she told The Medical Republic), which I know has been previously ignored on this talk page when it was brought up in The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children, but I think with yet another voice in a whole different continent drawing this same parallel I don't think we can just ignore it and it warrants inclusion in the article. Raladic (talk) 23:39, 22 September 2024 (UTC)

I think it’s worth noting that this is a source of significantly higher quality giving this criticism. The BMA also said that the “exclusion of trans affirming evidence” was a reason for their vote, so in light of these two sources I would support inclusion. Snokalok (talk) 00:55, 23 September 2024 (UTC)
Perhaps something like “Many in the medical field have accused the Cass Review of deliberately excluding evidence and people which favored gender affirming care as a mode of treatment.” Snokalok (talk) 00:57, 23 September 2024 (UTC)
Perhaps “some” instead of “many” would be more neutral Snokalok (talk) 01:00, 23 September 2024 (UTC)
What is your source for the incredibly strong claim of "deliberately excluding evidence"? Void if removed (talk) 09:39, 23 September 2024 (UTC)
I just looked for those "multiple expert academic treatises" in PubMed and didn't find them. Perhaps they're still stuck in the peer-review process? Or perhaps the speaker doesn't mean the same kind of source that I (and MEDRS) would mean with such a statement?
A handful of high-quality academic journal articles would be incredibly valuable. A soundbite from an AusPATH past president that asserts WP:SOURCESEXIST without identifying any of them is not so helpful. WhatamIdoing (talk) 02:28, 23 September 2024 (UTC)
I literally linked one of the peer-reviewed journal articles above that did point this out, so your search may have missed it, or overlooked it. Similarly, as much as people opposed to transgender care here tried to diminish the Yale Report because the academics (several of which are transgender studies experts) that authored it published it as a white paper, rather than a journal article, it also levied that relevant studies were excluded. Similar was levied in this pre-print paper. And as Snokalok pointed out, the point was also raised by the BMA as one of the reasons for them starting their own investigation of the Cass Review.
So again, this now has been levied by multiple fronts, they are not just making things up for the fun of it.
Criticism doesn't have to be exclusively published in academic journals to be relevant, the final Cass review itself is similarly self-published on its own website, not in an academic journal (only the underlying studies it is based on are in the BMJ). Raladic (talk) 02:44, 23 September 2024 (UTC)
That preprint claims evidence was excluded that wasn't. And the Yale report cited the preprint.
And the BMA Council just cited Yale and this preprint, they haven't done an "investigation". This isn't being levied on "multiple fronts". It's the same front. Void if removed (talk) 06:28, 23 September 2024 (UTC)
"A handful of high-quality academic journal articles would be incredibly valuable" ← this. Undercutting science with weak sources is a no-no. Bon courage (talk) 04:40, 23 September 2024 (UTC)
The QCGS report includes in its summary the conclusion that The process of making decisions about medical intervention is thoughtful, considered and evidence based. However, it does not cite the evidence on which that process is based.
The evaluation did not set out to conduct an extensive literature review on the care and treatment of children and adolescents with diverse gender experiences as this was outside the Terms of Reference. (page 5)
The evaluation did not attempt to resolve public debates or subjective opinions on the ethical considerations of children and adolescents accessing gender services, nor was an extensive literature review undertaken. (page 19)
Possibly the conclusion of "evidence based" was based on this statement on page 28: Once consumers are accessing the QCGS, the community organisations reported the care is extremely comprehensive, considered, safe, and evidence based., which seems to be reporting the opinion of "community organisations (NGOs)", who seem to be neither doctors nor scientists.
I am not seeing any substantial scientific content in this report. Certainly nothing that would challenge the conclusions of the systematic reviews that underpin Cass.
The QCGS report says it was conducted by a panel of professionals external to CHQ from across Australia with expertise and experience in child and adolescent health care and diverse gender experiences. In other words, people who practice within this field. They investigated their field and found no wrongdoing. This is exactly why the Cass Review was done by independent experts. The claim that Cass intentionally sidelined people who worked in the field would actually be a reason for its strength - and therefore it would be inappropriate for this article to use non-independent non-scientific statements to undermine independent, scientific conclusions. Barnards.tar.gz (talk) 10:18, 23 September 2024 (UTC)
Whether including gender care specialists and/or trans people on the committee itself is overall a strength or weakness is really something for the reliable sources to determine, rather than for Misplaced Pages editors to opine about.
Given that the cis-controlled Cass Review and the trans-inclusive QCGS report came to nearly all the same conclusions (e.g., there are more kids accessing gender services than there used to be, the evidence base is less than ideal, etc.), it might be worth looking for a reliable source commenting on whether involving specialists/people with lived experience actually changes the answers. WhatamIdoing (talk) 16:59, 23 September 2024 (UTC)
I think it’s well within the remit of editors to assess the degree to which a source is independent of its subject matter. That’s why we have extensive guidance on how to do it: WP:INDEPENDENT. When writing about climate change, we would question the independence of a source written by people who make a living in the fossil fuel industry. The QCGS report doesn’t identify its authors (which is a separate issue) but does position them as professionals working in the field, whose livelihoods might be at risk if their paper delivered the “wrong” answer. Barnards.tar.gz (talk) 19:30, 23 September 2024 (UTC)
I mean, the Cass Review doesn't list its full author team either but we have had individuals associated with Genspect and SEGM claiming that they worked on it, soooo Snokalok (talk) 19:52, 23 September 2024 (UTC)
And so you think we should trust their self-serving, self-aggrandizing self-reports? Personally I'd need some evidence that they understand the difference between "worked on" and "submitted a public comment to". WhatamIdoing (talk) 00:14, 24 September 2024 (UTC)

BMA update

Just in case anyone's curious: The Lancet is available in Misplaced Pages:The Misplaced Pages Library, and this recent news article in it reports "more than 1500 doctors", says the campaign is called "Not In Our Name BMA", and links to the BMA's response on the petition's website.

It also says that the Council's motion passed with 21 votes in favor and 24 abstentions+votes against (assuming the most popular set of rules, that means there must have been at least four abstentions). One person present at the meeting indicated that the vote was skewed by age (younger members more likely to support it) and that a significant proportion had not read the report before voting. Another person said the people who created the motion have been subjected to harassment and abuse online.

I've updated the number of signatories in this article, but I don't think that this article needs any further detail. I post this because I know some of you were curious about some of the details, and in case it would be useful at the British Medical Association article. WhatamIdoing (talk) 02:37, 23 September 2024 (UTC)

Policy is debated and voted on openly by the Representative Body at the Annual Representative Meeting (ARM) every June. The Council can formulate policy between ARM events where none exists, but it is unheard of for it to do so on contentious topics.
This is a key point. What the council have done is quite extraordinary, and that (and the mounting opposition) has become the story, rather than any substantive criticism of the Cass Review, which is really just "we read the Yale white paper and that iffy preprint". Void if removed (talk) 08:30, 23 September 2024 (UTC)
But it's probably the key point for a different article. :-) WhatamIdoing (talk) 16:34, 23 September 2024 (UTC)

Japanese Society of Psychiatry and Neurology

This content was added here, but the wording suggests a secondary source is being invoked which hasn't (yet?) been cited, in particular for the text

While taking the Cass Review into consideration, the guidelines ultimately continued ...

Is that right? Or is this interesting bit of analysis WP:verified by the source? (I'll need some extra help with the Japanese to see for myself). More particularly, why is this relevant to the Cass Review? Bon courage (talk) 06:14, 29 September 2024 (UTC)

Seems to me relevant for Puberty blockers but not this page. Void if removed (talk) 08:02, 29 September 2024 (UTC)
After reading the entire section in the new Japanese Society of Psychiatry and Neurology guideline, it does appear relevant as it is a reception to the Cass Review as it specifically dedicates a section to discuss the Cass Review - Page 16 & 17. The document notes the unique situation of the UK healthcare system and Cass, The Cass Review was commissioned by the NHS in response to the unique situation in the UK, where gender care for children and adolescents was limited to two NHS-approved centres, with secondary sex suppression therapy being given to a large number of people annually in 2,000 cases without adequate psychological follow-up, under the pretext of a shortage of physicians and even access to general care. (translated from Japanese).
The review continues with critique of review due to the country specific context: In addition, the Cass Review has also raised concerns about the fact that there are cases in which children and young people who have progressed from secondary sex characteristic suppression therapy to physical treatment such as sex hormones and surgery later regret it, but this is also because the UK guidelines require a long time to adapt to hormone therapy, so secondary sex characteristic suppression therapy is extended to young people who are older than the age that is considered suitable for secondary sex suppression therapy. (translated from Japanese).
Which then leads them to their conclusion of On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed that the issues pointed out by Cass Review are old acquaintances, and that secondary sexual characteristic suppression therapy has been used for many years. It is a treatment that has been established for many years, and the efficacy and safety of secondary sex characteristic suppression therapy are well known. It is expressed that it is a judgment based on scientific knowledge. ....... In addition, it is medically self-evident that the undesirable physical characteristics of the sex will be irreversible if secondary sexual characteristic suppression therapy is not provided in necessary cases, and although it is difficult to conduct studies that provide high-quality evidence in such cases, there are concerns that it will have a negative impact on the subsequent mental state. (translated from Japanese).
So based on this reading, this result from this are very relevant to Cass as another international independent evaluation of the Cass Review, its findings and the resulting effects on puberty blockers being stopped in the UK. The Guidelines address Cass and puts it into context that the Cass Review guidelines were in the specific UK country context and are not otherwise necessarily applicable and also did come to its own conclusion that the administration of puberty blockers are warranted for use in Japan, given the scientific basis of them and the otherwise irreversible effects to transgender youth and the mental health effects. Raladic (talk) 17:00, 29 September 2024 (UTC)
Seems a bit coat-racky from that; their decision is about well, their decision - and doesn't really tell us anything about the Cass Review. Bon courage (talk) 17:34, 29 September 2024 (UTC)
How is it coat-racky? It directly addresses multiple points and conclusions of the Cass Review (and determines that they're wrong). Silverseren 17:42, 29 September 2024 (UTC)
"determines that they're wrong" ← where is that in the source? Bon courage (talk) 17:46, 29 September 2024 (UTC)
From the quotes Raladic gave above. They determine multiple conclusions of the Cass Review aren't based in scientific evidence, but because of how bad, long, and underfunded trans care is in the UK. The last bit then has them conclude that puberty blockers have been effective in multiple other countries, as noted by multiple other scientific organizations. And they note the negative mental effects of not giving blockers at the very end. Silverseren 17:54, 29 September 2024 (UTC)
That seems like a rather odd interpretation of what seems like rather a more nuanced response. There is nothing there about "aren't based in scientific evidence", and in any case we wouldn't be using weak sources to undercut strong ones if that means this document is questioning the systematic reviews underlying the review (which are, in Misplaced Pages terms, "science" of the utmost quality). I think if this is to be included we should limit it to what is said about the Cass Review itself directly, rather then trying to tease out implications, especially with WP:NOTED decorations. Bon courage (talk) 18:03, 29 September 2024 (UTC)
Please do explain the nuanced response in the quotes above. Especially since it concluded that the support of puberty blockers was what was based in scientific evidence. Oh, and is one of the major Japanese scientific organizations (journal and all) that explicitly deals with this sort of subject matter a "weak" source now? Funny, that. The quotes above are about the Cass Review and what it said and what the organization claims are incorrect. Which is why they specifically refer to the Cass Review in every single paragraph quoted. There is no "teasing" out implications. Unless they're just conclusions you don't like? Silverseren 18:18, 29 September 2024 (UTC)
Well, for example saying (and I'm leaning heavily on Google translate because of my poor Japanese):

points out that there is a lack of evidence to reliably deny the possibility that secondary sexual characteristic suppression therapy may become an environmental factor that disrupts gender identity as a long-term effect, and that there is no evidence to reliably deny its adverse effects on mental and physical development. Following the publication of the Cass Review, discussions on secondary sexual characteristic suppression therapy have arisen not only in the UK but also internationally, and therefore the contents of the Cass Review and related discussions were considered when revising this guideline.

or their subsequent statement that they are strengthening reporting guidelines. The words "aren't based in scientific evidence" do not appear.Your disappointing attempt to descend to ad hominem is noted; do it again and you will find yourself at WP:AE, as this is a WP:CTOP. Bon courage (talk) 18:26, 29 September 2024 (UTC)
The part you're quoting is not a section making any statement or conclusion by the Japanese organization, but summarizing one of the claims of the Cass Review. Unless you're claiming that Raladic's translation above is incorrect, it clearly directly addresses such claims, It is a treatment that has been established for many years, and the efficacy and safety of secondary sex characteristic suppression therapy are well known. It is expressed that it is a judgment based on scientific knowledge, among other things in the quotes above. Again, are those quotes accurate or not? Because those quotes are the actual conclusions of the guideline revisions, not the paragraph you quoted just now. Silverseren 18:30, 29 September 2024 (UTC)
The point is we should be relayed (if anything) what this group says about the Cass Review, not what they say about themselves. And what we say should be WP:Verified. Bon courage (talk) 18:44, 29 September 2024 (UTC)
The paragraphs Raladic quoted are what the group is saying about the Cass Review. Again, that's why they say "Cass Review" in every single paragraph. And Raladic included the link to the guidelines source, so it's already verified. Silverseren 18:49, 29 September 2024 (UTC)
But the 'medically self-evident' comment is not in paragraph about the Cass Review it it? The big elision in the quote above mask a paragraph break (at least in my rendition). Bon courage (talk) 19:02, 29 September 2024 (UTC)
The paragraph is prefaced with "In addition", building on the criticisms from international orgs noted in the preceding paragraph. It is followed by a paragraph summing up the debate and what they're choosing to do. The last part of the line is the most opposed to Cass, instead of "we don't have enough high quality evidence to prescribe PBs", they agree with most medical organizations that "it obviously blocks puberty, which is irreversible and not good for trans kids mental health, and it's difficult to conduct 'high-quality' research" Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:24, 29 September 2024 (UTC)
Seems like a lot of editorial interpretation there. Bon courage (talk) 19:41, 29 September 2024 (UTC)
Seems explicitly what the text says, with little to no interpretation required. Silverseren 19:47, 29 September 2024 (UTC)
Well no, because when text states "In addition" that is what is wikt:explicit (words have meaning), Interpeting that to mean "building on the criticisms from international orgs noted" is not explicit, although an editor might argue it is implicit, It might just mean "here is something else we considered in addition" and indeed that would be a plainer reading. I'd prefer it if Misplaced Pages just stuck to summarizing the plain meaning of the source rather than an intepretation of it. Bon courage (talk) 20:04, 29 September 2024 (UTC)
It’s in the Cass Review section, and is stated as their direct rationale for continuing blockers in spite of the review. Snokalok (talk) 03:38, 30 September 2024 (UTC)
Okay, so we're now clear it not in the same "paragraph". The Japanese organisation are it seems choosing to favour additional considerations to the Cass Review's findings in making their decision. But that tells us about their decision, it doesn't tell us about the Cass Review (except through "interpretation" or what you might call WP:SYNTH). Bon courage (talk) 03:50, 30 September 2024 (UTC)
The previous sentence talks extensively and explicitly about the reasons for trusting WPATH over the Cass Review, and then says “In addition” to preface its statement about permanent sexual characteristics. That’s not synth, that’s a direct reasoning in regards to the Cass Review from the source. Not every sentence needs to repeat the exact words “Cass Review” to be clearly part of its rationale and findings regarding the Cass Review, amazingly enough. Snokalok (talk) 04:07, 30 September 2024 (UTC)
That’s not synth, that’s a direct reasoning ← this is a contradiction. The "reasoning" of Misplaced Pages editors is not the basis for content. Although elided in the extract above, this paragraph shifts attention to other considerations "In addition, the AMAB states ...". How is this then about the Cass Review in any WP:Verifiable way? Bon courage (talk) 04:14, 30 September 2024 (UTC)
“On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed the view that the issues raised in the Cass Review are old knowledge, that secondary sexual characteristic suppression therapy is a treatment that has been established over many years, and that the efficacy and safety of secondary sexual characteristic suppression therapy should be judged based on scientific knowledge. The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) 8th Edition (2022)10) also describes the usefulness, limitations and side effects based on more systematic reviews than the Cass Review.
In addition, it is medically self-evident in AMAB cases that failure to perform secondary sexual characteristic suppression therapy in necessary cases will lead to irreversible physical characteristics of the undesired sex”
Because this is very clearly
their reasoning given for not going along with the Cass Review and instead continuing to adhere more closely to WPATH? Your points honestly just read as being a matter of WP:IDONTLIKEIT, this text is pretty indisputable. Snokalok (talk) 04:30, 30 September 2024 (UTC)
The goalposts keep moving, and now include an attempt to personalize the discussion with your mention of IDONTLIKEIT. Be aware this is a WP:CTOP so such tactics will result in you being reported to WP:AE. You seem to be correct that the Japanese are generally "not going along with the Cass Review and instead continuing to adhere more closely to WPATH". But this is the point, it tells us about the stances taken in their decision-making process and not about the Cass Review. That they choose to base decision on what is "medically self-evident" tells us nothing about the Cass Review except by the mechanism of WP:SYNTH. Bon courage (talk) 04:40, 30 September 2024 (UTC)
WPATH SOC7, not 8. Void if removed (talk) 06:41, 30 September 2024 (UTC)
“WPATH (The World Professional Association for Transgender Health)のStandards of Care (SOC) 第8版 (2022)10)でも、Cass Reviewよりも多くのsystematic reviewをもとに 有用性、限界や副作用について記述している”
You don’t need to know Japanese to be able to read that this clearly says SOC8, 2022 Snokalok (talk) 06:44, 30 September 2024 (UTC)
You're talking about the passing mentions in background/introduction. The actual updates to the 5th edition Japanese guidelines continued using the 7th edition of the SOC as a reference. Void if removed (talk) 06:50, 30 September 2024 (UTC)
No but what I mean is, in the translated quote above it said SOC 8, you corrected to say SOC 7, and now I’m posting the original Japanese to show that it indeed said SOC 8. Snokalok (talk) 06:52, 30 September 2024 (UTC)
What you said is instead continuing to adhere more closely to WPATH and it is relevant that that is SOC7. Void if removed (talk) 07:33, 30 September 2024 (UTC)
I can't see anything to support this claim in the text. Void if removed (talk) 20:00, 29 September 2024 (UTC)
I'm relying on google translate but from what I can tell the JSPN also said the WPATH SOC 8 "The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) 8th Edition (2022) 10) also describes the usefulness, limitations and side effects based on more systematic reviews than the Cass Review.", which could be mentioned in the article.
I would suggest we slightly alter the language to better capture the gist of the report: The Japanese Society of Psychiatry and Neurology published its updated guidelines in August 2024 on the treatment of gender dysphoria. While taking The guideline took the Cass Review into consideration, the guidelines ultimately continued to recommend puberty suppression in trans patients described it as specific to a UK context, noted it's criticisms by other international organizations, stated the WPATH SOC 8 considered more reviews, and noting that stated it "is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it". However, they did ask doctors administering such treatment to report more detailed information on it going forward. They stated they would continue to record prescriptions of puberty blockers to minors but expand to recording discontinuations and switches to hormone therapy.
Change explanatins (apart from minor style things)
  • "the guidelines ultimately continued to recommend puberty suppression in trans patients" is covered by the last sentence
  • "described it as specific to a UK context, noted it's criticisms by other international organizations, stated the WPATH SOC 8 considered more reviews" - I think this cuts to the heart of the criticisms better
  • "However, they did ask doctors administering such treatment to report more detailed information on it going forward." - the however doesn't match the tone of the source, and I think it's good to note what they were already recording/pledged to start recording.
Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:08, 29 September 2024 (UTC)
Again, none of this is really due for this article. It isn't a "response". It is subsequent guidelines that considered Cass, WPATH, APA etc as background. It is due for Puberty blockers but coatracky here.
And the quotations on offer are highly selective. By my reading they seem to consider Cass not overly relevant because they currently have a large multidisciplinary team and psychological gatekeeping in place to manage individual cases that is far more in line with Cass' recommendations than GIDS practice (ie, the "UK context"). The "medically self-evident" quote is random and irrelevant. Selecting a few lines from a lengthy set of guidelines like this to create some sort of response to Cass is veering into WP:SYNTH. Void if removed (talk) 19:59, 29 September 2024 (UTC)
Of course it is due for the article. The paper spends two whole pages dissecting the Cass Review and which of the recommendations of the Cass Review it disagrees on the point of science, as I quoted above that secondary sexual characteristic suppression therapy has been used for many years. It is a treatment that has been established for many years, and the efficacy and safety of secondary sex characteristic suppression therapy are well known.
The other point of why it relevant for inclusion here is that it is one of the first more independent reviews of Cass that are not WPATH or other "involved" organizations that has put specific critique on the Cass Review to say that many of the recommendations from Cass should not be seen as universally applicable recommendations, but only in the context of the UK healthcare system that has been specfically lacking in transgender care.
The quotations above are not very selective, I copied several of the most relevant translated paragraphs of these two pages that discuss the Cass Review, this isn't a selecting picking of quotes. You are welcome to read the entirety of the two pages if you run them through Bing or Google translate, we just can't reproduce them in their entirety here due to copyright rules.
The fact that restriction of puberty blockers directly leads to negative mental outcomes as the above new critique called out, and more specifically to the death of transgender youth has also just a few days been backed by a newly published multi-year study published in Nature Magazine (NPR article), which found that laws restricting access to transgender care, such as restricting access to gender affirming puberty blockers directly led to an increase of 7-72% of suicide attempts of transgender youth. So here is hoping that the restrictions in the UK will be lifted, or else, the results of this study that followed similar such laws that were put in place in several states in the US over the past few years will sadly likely repeat itself in the UK, leading to unnecessary loss of life, given that the science on it now appears even more clear. The study has already been widely covered worldwide, but I haven't seen any mention of it in UK media yet, as it will probably ruffle some feathers in light of the UK government having recently enacted the ban. Raladic (talk) 22:35, 29 September 2024 (UTC)
The paper spends two whole pages dissecting the Cass Review
It spends a few sentences describing some parts of it as background, that's really not the same thing. Non-Japanese speakers are relying on auto translations of varying quality. Here's what I'm reading:
The Cass Review was commissioned by the NHS against the backdrop of a unique situation in the UK, where gender medicine for children and young people was limited to two NHS-approved institutions, and puberty blocker treatment was administered to as many as 2,000 individuals annually without adequate psychological follow-up, despite a shortage of doctors making general healthcare access difficult. The Cass Review also highlighted cases where children and young people who had progressed from puberty blockers to hormone treatment and surgery later regretted their decisions. However, the UK guidelines required a long period before eligibility for hormone therapy, meaning puberty blockers were applied to older youths than would typically be expected (the average starting age for puberty blockers in the UK is 15), with insufficient psychological assessment before moving on to hormone treatment and surgery. Following the Cass Review, the old specialist institutions in the UK were closed, new services were launched, and hormone therapy for young people continued within this new system. Puberty blocker treatment in the UK has been suspended in its previous medical form and is now continuing as part of clinical trials.
That's it. It is describing what happened, and why. There is no dissection, no critique. It goes on to add things about WPATH's response but that's not adding anything. This section then concludes:
In light of these points, the revision this time highlights cautionary points regarding puberty blocker treatment.
And:
In revising the guidelines to the 5th edition this time, as with the previous guidelines, the WPATH SOC 7th edition was used as a reference. Additionally, the guidelines of the Endocrine Society (2017) from the U.S. and the Amsterdam Free University Gender Clinic's guidelines were also referenced.
So this isn't a response or a critique, it is explaining the global backdrop against which they emphasise caution, and stick to SOC7, not SOC8. WP:NOTEVERYTHING that happens to mention Cass is due, and the way this is currently presented is selective.
Here's another way of describing this:
The Japanese Society of Psychiatry and Neurology referenced the Cass Review as part of the context for the creation of its 5th edition guidelines for the diagnosis and treatment of gender dysphoria. These guidelines continued to use WPATH SOC7 as a basis, and highlighted points of caution for the use of puberty blockers, while retaining requirements for multidisciplinary involvement and psychological assessment prior to any medical intervention.
All of which is I think a better summary of this document, and still none of it due for this page. Void if removed (talk) 11:59, 30 September 2024 (UTC)
@Raladic in this reversion you have claimed, again, that these guidelines spend an entire two pages dissecting and addressing the Cass Review. By my reading, that isn't the case. Merely describing the Cass Review is not two pages dissecting or addressing it.
The current wording creates a picture of a critical "response" from guidelines that are anything but, while eliding that Cass' recommendations are already not a million miles from the Japanese standards (multidisciplinary panels, psychotherapy as a first line treatment, assessment and gatekeeping, concerns with diagnostic issues with comorbid issues like autism, and with intervening too early on children who may not persist after adolescence).
I would sum this up as: we don't think Cass is that relevant to us since we're already taking great care in the way recommended, but in light of increased concerns we're going to reiterate the uncertainties and make sure we track desistance and discontinuation too.
As I said below, it may be due for a section on, say, "impact on international guidelines" or something. But this is not a "response", in the way the other content of this section is. Void if removed (talk) 10:26, 1 October 2024 (UTC)
Thanks for the suggestions @YFNS - I just used them to amend the paragraph with a few more wording changes for ease of reading and used the quote from the paper as-is on the effect of not administering puberty blockers, please take a look at the new change. Raladic (talk) 23:02, 29 September 2024 (UTC)
Taking this one sentence at a time:
The Japanese Society of Psychiatry and Neurology published its updated guidelines in August 2024 on the treatment of gender dysphoria.
So not immediately obvious how this is WP:DUE - it isn't stated up front or announced as a response to the Cass Review.
The guideline took the Cass Review into consideration and described that the Cass Review was specific to the unique situation in the UK, where gender care for children and adolescents was limited to two NHS-approved centres.
This makes a tenuous connection to the Cass Review, which is noted as part of the background picture. This is not a response, or an assessment, or a dissection or anything. It also gives a selective interpretation of what is said, which goes beyond the number of centres and into the lack of adequate psychotherapeutic assessment prior to physical intervention. They are largely noting that the criticism of GIDS that Cass produced are not applicable to Japan, where multidisciplinary assessment teams and psychotherapeutic gatekeeping are still the norm.
The paper noted criticism of the Cass Review by other international organizations, and stated the WPATH SOC 8 considered more reviews.
This is irrelevant, because the Cass Review is a specific review of services for children and young people, while SOC covers a far wider range of subjects. Also, WRT children and young people, I don't believe it is actually true. All this section is doing is noting such disagreement, not endorsing it, so this adds nothing.
The paper further stated that "it is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it".
This is an irrelevant quote that has no bearing on Cass, and doesn't contradict anything in the York reviews which were clear that - on a physical level - blockers certainly work to prevent physical development of secondary sex characteristics. The whole point is that the reasons for doing so were inconsistent, and the evidence of improved mental health was poor.
They stated they would continue to record prescriptions of puberty blockers in Japan to minors but expand to recording discontinuations and switches to hormone therapy.
Again, not relevant, and an incomplete picture since the Japanese guidelines are to involve a multidisciplinary team for assessment and gatekeeping that is far more in line with the direction of travel in the NHS. These guidelines are based on 2012's SOC7, which is again not mentioned.
Frankly, this feels like taking something that has no bearing on Cass, taking some isolated sentences, and turning it into a "rebuttal". This is all WP:DUE for other articles but tenuous here and any attempt to present a full and accurate picture would take up enormous space. Void if removed (talk) 09:09, 30 September 2024 (UTC)
@Void if removed - Is it necessary for the source to exclusively be about their thoughts on the Cass Review? Otherwise the source seems plenty DUE as it is directly commenting on the subject & explains what they find potentially lacking/non-applicable to them. Their inclusion would help establish a more diverse range of perspectives in regards to the review's findings & what their potential value may be in a global setting. Butterscotch Beluga (talk) 01:35, 1 October 2024 (UTC)
This section is "responses" - and if you compare the other entries, that's what they are, direct responses, press releases etc.
This is more like "updated international guidelines that happen to mention the Cass Review" - it isn't really a response so much as a description, and the way it's been framed in text (and described in this discussion, as if it's an analysis or critique) seems wrong to me.
Perhaps this would work in a different section on impact on guidelines internationally, but I think it's too soon to really justify that, and I don't think this merits a section of its own. Void if removed (talk) 08:26, 1 October 2024 (UTC)
The Cass Review was published, Japan’s response was to take it into consideration for their guidelines and determine to continue prescribing puberty blockers. That’s a response. Snokalok (talk) 12:06, 1 October 2024 (UTC)
This is a response to the Cass Review.
So is this.
These are the sorts of direct responses to the Cass Review currently outlined in that section.
Which is why I say an argument could be made for a new section, eg. "Impact on guidelines", and if that were the case, a better job would have to be done actually summarising how and why the guidelines were or weren't updated as a result of Cass, because right now this is a lot of selective interpretation of a WP:PRIMARY source.
The announcement of the 5th edition doesn't mention Cass as a reason, but says things like (by my translation):
Since that revision, the number of young patients has continued to increase, and there has been growing momentum to also address not only physical interventions but also psychosocial support.
And the summary of the key revisions:
Key Revisions in the 5th Edition:
* Updates in response to revised diagnostic criteria (DSM-5, ICD-11)
* Evaluation and treatment of discomfort with assigned gender during childhood
* Revisions related to psychiatric care involvement
* Additions regarding medications, dosages, and administration methods for hormone therapy and puberty suppression therapy
* Revisions regarding puberty suppression therapy
Reports:
* When starting puberty suppression therapy or hormone therapy for individuals aged 15 to under 18.
* When discontinuing puberty suppression therapy.
Have you compared these to the 4th edition guidelines? By my reading the 4th edition doesn't mention any concerns about infertility or confounding factors like autism, but these are present in the 5th edition - is this a result of the Cass Review highlighting these issues? We can't possibly know, and the document doesn't tell us. Does any of this come across in the text currently in use? No, because the sort of selective interpretation on display at the moment is not a good or comprehensive summary of the changes, turning some disconnected sentences into a "response to the Cass Review". But this source offers absolutely no comment of its own on the Cass Review, nor does it give any indication of the specific ways the guidelines were influenced by it.
The current paragraph gives the impression "we looked at the Cass Review and ignored it and WPATH criticised it, so we're carrying on with blockers". From actually reading, it seems far deeper than that, with significantly more caution on display, highlighting concerns of comorbidities, diagnostic overshadowing and desistance that weren't present before. I think this is the sort of thing that requires a HQ secondary source specifically analysing the impact of Cass on such guidelines, and until then this is just assembling fragments which create entirely the wrong impression, and all in a part of this article where I don't think it belongs. Void if removed (talk) 14:03, 1 October 2024 (UTC)
The announcement is a summary of their updated guidelines, the full document however, as @Raladic pointed out earlier, directly refers to the Cass Review. I'm not quite sure why you are quoting the summary as, by its very nature, it is meant to briefly describe their results, interpretations, & changes, not give in-depth explanations on how they came to those conclusions, hence them linking the document in full as well. I think you are applying too strict an interpretation of what constitutes a "response", as by all means, this directly responds to the Cass Review's findings. Butterscotch Beluga (talk) 14:24, 1 October 2024 (UTC)
Categories: