the BMA does a U-turn over Cass
Dr Hilary Cass (now Baroness Cass) was commissioned by NHS England in September 2020 to conduct an independent review of gender identity services for children in the light of the significant increases in referrals, particularly of young girls. The service at the Tavistock Clinic in London was at the centre of considerable controversy at the time since the prescribing of puberty blockers appeared to be the outcome for the majority of young patients attending its Gender Identity Service. Several staff members had criticised the treatment pathway being adopted there, the most notable of whom was Dr David Bell, a consultant psychiatrist and psychotherapist who had worked at the Tavistock and subsequently authored a damning report on the treatment being given to children seen in the clinic.
The Cass Review published an Interim Report in 2022, which provided some initial advice, followed by the Final Report, published in April 2024. Among many other findings, the Review expressed concerns about ‘diagnostic overshadowing’, where there is a single focus on gender-related distress, which can lead to other complex needs or healthcare issues being sometimes overlooked [see item 1.6 in the Interim Report]. The report included a wide range of recommendations to improve NHS Gender Identity Services. One of the more widely discussed outcomes was the advice that puberty blockers should only be offered as part of a research protocol [see paragraph 16.38, p196, Cass Review] due to the lack of evidence of both their safety and long-term benefit.
Unsurprisingly, the Review was heavily attacked by activists advocating for puberty blocker use. It was, however, also critiqued by some academics both in the UK and beyond. One publication by McNamara et al claimed that the Cass review contained ‘serious methodological flaws’ and ‘misrepresents its own data’ (though that publication was not peer-reviewed).
Perhaps more surprisingly, the BMA expressed concerns about the reliability of Cass’ findings. A July 2024 BM council motion described the Review’s recommendations as ‘unsubstantiated’ and ‘driven by unexplained study protocol deviations, ambiguous eligibility criteria, and exclusion of trans-affirming evidence’, while committing the Association to ‘lobby and work with other relevant organisations and stakeholders to oppose the implementation of the recommendations made by the Cass review’. It also called for lifting the ban on prescribing puberty blockers. They called for the BMA to ‘publicly critique’ the Review – a move that elicited much criticism from its own grassroots members at the time. Following this pressure, in September 2024, BMA Council adopted ‘a position of neutrality’ on the Cass Review whilst the BMA undertook an evaluation of it.
Now, after almost two years, this BMA review conducted by an internal ‘task and finish’ group, unnamed because of security concerns, has concluded. The report’s lead author told The Times, ‘The baroness has been vindicated in the way she approached the data’. When asked to name a single one of Hilary Cass’s 32 recommendations that the BMA opposed, he said, ‘I can’t’ adding ‘she approached an area of significant uncertainty with that prime rule of medicine, of “first, do no harm”’.
It is worth noting, however, that the group failed to reach a conclusion on whether patients under 18 should have restricted access to puberty blockers. This disagreement aside, the BMA has now conceded that the evidence base for puberty suppression and gender affirming hormones is ‘limited and uncertain’.
Whenever ideology prevails over evidence, people must eventually face up to reality. Proverbs 24:28 cautions, ‘Do not testify against your neighbour without cause’. It’s very sad that now the BMA’s efforts to discredit Cass’ findings have turned out to broadly vindicate them, they still seek to criticise the necessary actions subsequently taken.
