[Tubby Isaacs]

Nothing's settled, but Streeting's ban was based on a report from the Commission of Human Medicine. As I understand it, this is a separate process from the Cass Review.

I take your point that it wasn't just the one side that wouldn't compromise.

The criticism of Corbyn in there may have been unfair. He got a bit of stick for stating very clearly his support for single sex spaces in accordance with the Equality Act. Obviously, he was keen to be seen to be on the right side, but one thing I think he'd have been good at is listening patiently to both sides.

[Crabcakes]

Nothing's settled, but Streeting's ban was based on a report from the Commission of Human Medicine. As I understand it, this is a separate process from the Cass Review.

Fair point. The report was separate, but came after the Cass review publication. So given the timing I suspect it factored into Streeting’s decision (in fact, given the context it would be bizarre if it didn’t), but as you say wasn’t a direct cause.

[Tubby Isaacs]

Quite possibly, but has anybody even resigned from the CMH (I don't want to sound like I know much about them, I'm looking all this up now)? That's a lot of very senior doctors across lots of disciplines. Wouldn't we expect at least one of them to walk out if the report was a load of bollocks just based on a rogue report by Cass?

https://www.gov.uk/government/organisat ... membership

What we might call the medical "establishment" doesn't exactly seem to be unhappy to be rid of puberty blocker prescription. I'm wary of calling out the "medical establishment" for obvious reasons.

[Crabcakes]

I wouldn’t expect anyone to resign, to be honest. The Cass report does a lot of people a lot of favours - it sets out a route to be followed and can be used to justify decisions on that route. Having worked in healthcare for 30-odd years now, and the last decade in evidence-based guidance, I know first hand it can take a long while for consensus to shift even if (increasing) evidence is against it. When it solves problems for people without being outright “wrong”, that shift can be even slower - look how long it took to reverse the stance on treating ME as a primarily psychological condition. And similarly, this lack of progress came about in part because the affected population were largely excluded from being involved with policy decisions about their own care for far too long a time.

That said, I’m not expecting anything explosive like vaccines and autism with Wakefield - there is no suggestion of outright fraud. What I do think will happen is that there will be a continuing questioning of some of the findings and recommendations, other reports that include more direct input from the affected communities and better methodologies will come to contradictory conclusions, and eventually it’ll be superseded. It’s just not good enough - it’s not rigorous enough in places (for example, one section warning about impaired brain development from gender-affirming medical treatment comes from a single speculative study involving female mice), and it’s also been assessed independently as being at risk of bias in many domains: https://bmcmedresmethodol.biomedcentral ... 25-02581-7

Ultimately, trans people and trans youth deserve better, and they’re being let down by people in positions of authority who don’t want to make difficult decisions and media who just want one word answers to “define a woman” type questions.

[Tubby Isaacs]

Even if it were purely about convenience, I think we could expect to see a lot more senior doctor opposition to the ban, both inside and outside this committee. The choice of Cass could certainly be seen as a fix, but it's not like Victoria Atkins or Streeting chucked a load of people off the committee and put a load of placemen on it. I'm happy to take the advice as good faith. I don't think even Streeting is saying the science is settled, though as you say, that Private Eye article talks like it is.

[The Weeping Angel]

I remember when Cass was published and straight away trans activists responded with personal attacks and insinuations.

[Crabcakes]

I remember when Cass was published and straight away trans activists responded with personal attacks and insinuations.

In the circumstances, in this really surprising? It more or less set out exactly what they feared it would as a worst case scenario (from their point of view), and many people directly affected by it now can’t access gender affirming healthcare (one of the most universal responses against the report is that it ignores or downgrades significant amounts of evidence showing gender affirming healthcare can have a number of positive effects - not least of which being reduction in depression and suicide rates).

You might not agree with them, but anger in the circumstances and the moment is hardly an unusual response.

[Crabcakes]

I'm happy to take the advice as good faith. I don't think even Streeting is saying the science is settled, though as you say, that Private Eye article talks like it is.

The problem is there is good faith, and I don’t think it was done with malice in mind, and good quality. And it does not stand up on the latter. See, for example:

https://law.yale.edu/sites/default/file ... sponse.pdf

Streeting has at least left open clinical trials and a review of the current indefinite ban in 2 years time.

[The Weeping Angel]

So accusing Hilary Cass of committing genocide is a reasonable response is it?

[Tubby Isaacs]

I'm happy to take the advice as good faith. I don't think even Streeting is saying the science is settled, though as you say, that Private Eye article talks like it is.

The problem is there is good faith, and I don’t think it was done with malice in mind, and good quality. And it does not stand up on the latter. See, for example:

https://law.yale.edu/sites/default/file ... sponse.pdf

Streeting has at least left open clinical trials and a review of the current indefinite ban in 2 years time.

It's above my pay grade to know how good that paper is. Are we saying none of those people have read it? I don't know how likely that is.

[Tubby Isaacs]

So accusing Hilary Cass of committing genocide is a reasonable response is it?

Of course, not but "entitled to be angry" covers a rather larger range of responses than that.

[Crabcakes]

It's above my pay grade to know how good that paper is. Are we saying none of those people have read it? I don't know how likely that is.

As I say, you would be genuinely surprised how long it takes for things to change in medical circles, and how many people will simply say “well the evidence has changed” and move on without ever contemplating resignation. But, we’ll see.

[Tubby Isaacs]

I take your point. I probably have naive views about this.

[Crabcakes]

So accusing Hilary Cass of committing genocide is a reasonable response is it?

Consider the person in question has effectively been told their reality is wrong, they cannot be who they wish to be, the medication they were taking that was helping them live the life they feel is right for them is to be stopped, and instead they must live every day as a lie in a body that feels alien to them.

I cannot begin to comprehend how utterly hopeless and crushed that would make someone feel, and I suspect you can’t either. But I would wager I’d not feel like being particularly objective on such an occasion.

[Crabcakes]

I take your point. I probably have naive views about this.

Not at all. I’d say your views were entirely optimistic - and it may be people do if not stand down then at least distance themselves from where they are now. Sometimes that’s about as good as it gets in medical academia!

[The Weeping Angel]

So accusing Hilary Cass of committing genocide is a reasonable response is it?

Consider the person in question has effectively been told their reality is wrong, they cannot be who they wish to be, the medication they were taking that was helping them live the life they feel is right for them is to be stopped, and instead they must live every day as a lie in a body that feels alien to them.

I cannot begin to comprehend how utterly hopeless and crushed that would make someone feel, and I suspect you can’t either. But I would wager I’d not feel like being particularly objective on such an occasion.

The person who said this wasn't trans.

[Crabcakes]

Maybe the person has a trans person in their life they are close to? Maybe they’re particularly empathetic and emotional around causes where people’s rights are being eroded? Maybe they’ve seen some sort of abuse first-hand and have sympathy that this will lead to more abuse for some populations? Maybe Hilary Cass ran over their cat that morning?

The point is, I don’t know. And nor do you.

But I do know the Cass review handed a huge win to gender critical supporters, causes and organisations. Irrespective of whether you or I think it was right or wrong, the other side is clearly going to be devastated because of the fundamental, life-changing shifts they know are now coming. As such, I can appreciate there are many reasons why they might be angry at that point in time. That’s not an endorsement of an extreme response or online abuse, or even an excuse for it. It is an understanding though that it didn’t just come from nowhere, and people are human and sometimes lash out.

[The Weeping Angel]

Try sanctimonious, self righteous arsehole instead

[Crabcakes]

Well as I say, people are human and sometimes lash out. I didn’t expect quite that example given what it represents in context of your argument, but thanks for it all the same.