BMA has no evidence to reject my trans review, says Hilary Cass

The original paywalled article is here.

Dr Hilary Cass has criticised the British Medical Association for its “puzzling” decision to oppose the findings of her review into NHS services for transgender children.

The paediatrician said that the doctors’ union had no evidence to back up its critique of her review, and that the BMA’s stance represented only a “small minority” of the medical profession.

The Cass review, published in April, recommended an end to the practice of prescribing puberty blockers to children outside clinical trials, and called for a more “holistic” model of care.

The NHS and government accepted the review but the BMA has since come out to raise concerns about “weaknesses in the methodologies” used by Cass and “unsubstantiated” recommendations.

Cass told Woman’s Hour on BBC Radio 4: “I found the BMA position puzzling because they haven’t actually said what it is they object to about my recommendations … Do they object to better training? Do they object to better research?”

Cass said the BMA’s critique was based on “online sources mainly from the US”, adding: “When thinking about evidence-based care, they haven’t produced any evidence that the review should be stopped.”

She said the leaders of the BMA who opposed the review were “in a relatively small minority within the medical profession”.

She added: “There will always be a spectrum of opinion in medicine: that’s the way of the world. But I think the difference between the BMA’s position and mine is that I’ve spoken to hundreds of doctors as well as other clinical staff, both during the course of the review and since the review.

“The vast majority of those people in national meetings and in one-to-ones and in work groups are really supportive of the approach. So I feel that those who take issue with it are in a relatively small minority within the medical profession.”

The review by Cass, a former president of the Royal College of Paediatrics and Child Health, was the biggest into the treatment of children struggling with their gender. It involved examining data from 113,000 children, and speaking to transgender children and their parents over a four-year period.

Cass said it was important that the BMA’s critique, which will be published in January, did not “cherry-pick a small part of the experience and the evidence”. She added that, unlike her own review, the BMA “have not got the four years to do it”.

Cass’s comments, on Wednesday, are the first time she has publicly spoken about the BMA and her review amid a mounting revolt over its leadership.

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. Some have resigned from the union after being members for up to 50 years, with others describing the BMA’s leadership as“abysmal”, “increasingly bonkers” and “ideologically captured”.

The BMA’s governing council voted to reject the Cass review in a private meeting in July but the union’s membership base of 195,000 doctors was not consulted.

Following the criticism, the BMA council held a further vote last month to say it would approach its critique of the review “neutrally”.

Professor Philip Banfield, chairman of the BMA council, said: “The BMA is not aiming to replicate the Cass review. The chair of our ‘task and finish’ group has set out to [the] council how we will listen to those with lived experience either as patients or as clinicians, consider the link between evidence and recommendation, and compare the recommendations with the actions or strategies that have arisen from them.

“According to the founding principles of the BMA, our evaluation will be evidence-led, starting from a position of neutrality. I cannot predict the outcome of our evaluation. However, I am clear that we will hear different perspectives, always prioritising the needs of transgender children and young people, who deserve the very best care.”

In a separate development, the Royal College of Psychiatrists has cut all ties with the Stonewall charity amid concerns about its stance on transgender issues.

Writing to members, Sonia Walter, the college’s chief executive, and Dr Lade Smith, the president, said: “Stonewall helped us to become a more inclusive organisation. However, we are acutely aware that there is a risk in being affiliated with an organisation that may speak on matters relating to the professional practice of our members, but over which the college has no direct control.”