Talk:Cass Review

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sources for consideration[edit]

Cass q&a[edit]

I don't think this is worth a mention just on this source (there might be more coverage later or more similar things.) but I wanted to give notice that the kite trust (Scroll down past the response) met with Cass and her team and had this q&a with common questions. LunaHasArrived (talk) 18:51, 19 April 2024 (UTC)[reply]

I agree that this source is very, very primary, but I think the content itself bears weight because it potentially reframes a lot of the Cass Review’s findings and recommendations Snokalok (talk) 20:50, 19 April 2024 (UTC)[reply]
Hopefully other sources will cover it, but given the way the UK media is, I don’t have high hopes Snokalok (talk) 20:50, 19 April 2024 (UTC)[reply]
IMO, while we cannot use the source directly, we can use it to guide our coverage. In particular in cutting down on nonsense. For example, any suggestion that the Cass Review recommended against medical transition for 18-24 (or whatever) years old is at best a misunderstanding. I don't think there's a reason to think it a misunderstanding significant enough to be mentioned in the article so it's something which we should just exclude. Nil Einne (talk) 17:36, 20 April 2024 (UTC)[reply]
As mentioned, in it's current form with this source it shouldn't be included. I think it was done with multiple other charities though. Although I think this kind of source could prove very useful (an opinion from Cass on common criticisms.) LunaHasArrived (talk) 18:07, 20 April 2024 (UTC)[reply]
I don’t think we can do that though, for the reason that what’s said in the interview reads as directly contradictory to a lot of what’s said in the report.
If we had weightier sourcing then we could perhaps add in the kite trust interview and say “In a followup interview, XYZ contradictory thing was said”, but right now, it bears neither weight nor reliable sourcing - certainly not to the level needed to make BLP claims about Dr. Cass herself. Snokalok (talk) 00:58, 21 April 2024 (UTC)[reply]
At the very least, we need very strong source to repeat claims which Cass herself has said is a misunderstanding of what her review recommended. I don't know what such sourcing may be, but perhaps criticism coming from WPATH may be it. But some random expert IMO is clearly not that. To put it a different way, I'm not sure why it's productive for us to get into some fuss just because some people failed to recognise that the word transition can have multiple meanings and so when someone says "Taking account of all the above issues, a follow-through service continuing up to age 25 would remove the need for transition at this vulnerable time and benefit both this younger population and the adult population" they are not saying this would remove the need for "social transition" or "medical transition" but instead referring to remove the need for a "Transfer to adult gender services" which is what the section is titled and when read in context with the rest of the paragraph seems to clearly be what the read transition was referring to in this entire section. I mean it earlier says "surrounding transition from children and young people’s gender services to an adult Gender Dysphoria Clinic (GDC)" and I don't see how in any context that can be understood as referring to a social or medical transition. It also quotes the NHS Long Term Plan 2019, which I think we can assume for many reasons is referring to providing services to young people in general which says "“Failure to achieve a safe transition can lead to disengagement, failure to take responsibility for their condition and ultimately poorer health outcomes.". So I'm even more confused why until we get better sources, we should take this as a contradiction between her report and what she later said instead of people just not properly understanding the report. (I mean I strongly suspect whoever wrote the Long Term Plan thing didn't even think the word might be misunderstood in this way since it wasn't at all relevant to what they were talking about.) Nil Einne (talk) 01:47, 21 April 2024 (UTC)[reply]
As the Amsterdam UMC response pointed out, even reading it as transition to adult services it carries implications of restricting medical transition in young adults, because the report already advocated for restricting medical transition in teenagers, so if it says that young adults should be treated by the same places as teenagers, that implies that it would at least become more difficult for young adults to transition. Loki (talk) 02:39, 21 April 2024 (UTC)[reply]
The Cass review didn't look at adults and Cass themselves are not doing the adult review. Any commentary on that aspect is likely speculation/misinformation. I agree that "transition" is the word the NHS use to describe moving into adult care it is a fraught time for any longterm medical issue, not just trans medicine. There is often a gap where one hospital refuse to take you (as you are leaving anyway) and another refuse to take you (as you aren't old enough) and so on. -- Colin°Talk 12:29, 21 April 2024 (UTC)[reply]
For everyone interested: I found The BMJ podcast episode where Abassi interviews Cass very helpful at dispelling some other myths too (https://thebmjpodcast.podbean.com/e/improving-nhs-gender-identity-services-hilary-cass/). Just like Luna mentions, it is not a proper secondary source, but it can help making more sense of what Cass is actually on to. For instance, Cass mentions somewhere that the psychological interventions are (obviously) not meant to get rid of gender incongruence, but of comorbidities that may obfuscate a proper diagnosis. (This is actually the standard in some other guidelines. The Amsterdam response also commended them for this recommendation, though they also noted that they fear the NHS won't receive enough funding to meaningfully implement this change). Cixous (talk) 18:11, 21 April 2024 (UTC)[reply]
You're probably right, but I'm always frustrated when important information is in podcasts or videos without transcripts. It makes it harder to verify the citation later.
That's my own gripe though. More relevant to this article is that anything Cass says is still a primary source, and has WP:ABOUTSELF problems to boot. So we should be careful when citing it, especially if/when Cass makes claims about third parties (like what they're saying about her study). Loki (talk) 00:55, 22 April 2024 (UTC)[reply]
I get that. Podcasts or videos are not great sources, especially not for Wikipedia. And you are completely right about WP:ABOUTSELF. We should watch out for that Cixous (talk) 16:01, 22 April 2024 (UTC)[reply]
That the BMJ interview with Cass was on a "podcast" doesn't fundamentally change its reliability status or PSTS status than if the BMJ had written it down and published it on their website. If anything, it is better than the snippets of her interview that the Times published, which doesn't give an accurate view of her response/reaction to questions. WP:ABOUTSELF is about questionable sources like Twitter, not about interviews in the BMJ website, even if in audio form. So the claim that "anything Cass says is still a primary source, and has WP:ABOUTSELF problems" is ripe nonsense and I don't understand the "not a proper secondary source" (see Wikipedia:Secondary does not mean independent).
There is no difference, for example, about what Cass says about third parties vs what third parties says about Cass. If one is critical of the other, it may or may not be worth noting here, with attribution and quotes as required, but there's no asymmetry. If Cass clarifies something in the review and we find that helpful as a source when writing our summary of the review, we can cite that along with the review citation no problem. -- Colin°Talk 08:05, 24 April 2024 (UTC)[reply]
The whole Cass Review is a primary source on this page. Anything Cass says about the Cass Review (in any medium, to be clear: a New York Times interview would have the exact same problems) is also a primary source here. I would have assumed that this is obvious, and that the WP:INDEPENDENCE problems with citing a source in the article about that source would also be obvious. Loki (talk) 15:55, 24 April 2024 (UTC)[reply]
"The whole Cass Review is a primary source on this page." this is oversimplistic and makes me very concerned. @WhatamIdoing: who is our expert on such matters.
See my earlier comments about the mix of PSTS that the Cass Review is. Let's look at an example of article text and assume it is all sourced to the Cass Review:
  1. The report stated that the evidence base and rationale for early puberty suppression remains unclear, with unknown effects on cognitive and psychosexual development.
  2. A systematic review examined 50 studies on the use of puberty blockers using a modified version of the Newcastle–Ottawa scale and considered only one to be of high quality, along with a further 25 being of moderate quality, and the remaining 24 being of low quality.
  3. The review concluded that the lack of evidence means no conclusions can be made regarding the impact on gender dysphoria and mental health, but did find evidence of bone health being compromised during treatment.
  4. The review disagreed with the idea of puberty blockers providing youth patients with "time to think", due to the finding that nearly all patients who went on blockers later decided to proceed on to hormone therapy.
For #1, the CR is a primary source for whether or not it stated these things. But it is tertiary source for commenting on the evidence base and the "unknown effects on cognitive and psychosexual development" is a WP:BMI fact we can state in wikivoice per WP:MEDRS. For #2, the CR is a secondary source for what the York reviews studied and selected and graded. For #3 I think "review" is meaning the York systematic review, not the Cass review. Here the CR is a secondary source for whether or not the York review found these things and that it offered a conclusion, but it is again a fine tertiary source for the medical facts for what there is and isn't evidence for wrt various issues, which we can state in wikivoice. For #4 I think we are back to discussing what the Cass Review said about the "time to think" idea (could be wrong, but don't think that was what the York reviews commented on). For the first clause, the CR is a primary source that it disagreed with this idea, but a tertiary source for the medical fact that nearly all patients who go on such blockers (in studies at least) later went down the hormone pathway, which we can state as a fact in Wikivoice.
I think, Loki, you need to be specific about what claim you wish to comment on wrt PSTS and independence/third-party and so on, because you are waving crude generalisations about in a discussion where, once again, I don't think you are actually specifically addressing the debate. Wrt your claim "Anything Cass says about the Cass Review .... is also a primary source here" doesn't appear to undestand PSTS at all. For example, if Cass said in an interview in the times "Well in fact, the York reviews selected 60 papers out of 103" she is actually commenting on the York reviews, not her own report document, so she's a third-party secondary source on what they selected. If Cass said "My recommendations in the report on puberty blockers were..." then her interview is still a secondary source on what the report said but not independent of the report. These things are important because when we get newspapers interviewing some random Canadian GP who says there is good evidence of psychosocial and mental health benefit from puberty blockers, that claim fails every one of our MEDRS requirements and is in no way improved (from a "can we repeat their claim" pov) by being not-Cass. I just get the feeling you are trying to put Cass and their review into some untouchable twitter-trash level of sourcing and the absolute opposite is true. -- Colin°Talk 09:11, 25 April 2024 (UTC)[reply]
I haven't read the report, but it's probably not a tertiary source for anything, unless it has a glossary or similar non-analytical summary of basic information.
All sources are primary for something. As with any (vaguely) similar government report, it will be secondary in the parts that analyze, evaluate, criticize, draw conclusions from, etc. previously published sources ("Seventeen papers met the pre-determined criteria for inclusion, and frankly, we think all of them stink"), and primary for any previously unpublished information it presents ("We interviewed a bunch of patients ourselves, and they said that everything was moderately bad and getting worse") as well as for the fact of its own recommendations ("The Cass report recommended that funding for this area be significantly increased").
NB that conclusions ("There is no good evidence, so this is not actually based in decent science") are not the same as recommendations ("In our view, it's stupid to have teens go to one provider to talk about gender identity and a completely different clinic, with a completely separate waitlist, to talk about anxiety, so everything should be one-stop shopping"). WhatamIdoing (talk) 00:26, 26 April 2024 (UTC)[reply]
I agree with this with the caveat that, because this whole article is about what the Cass Review says, even parts of it that would be secondary on other pages are primary here.
To be clear, I'm not saying that the review is a bad source on other pages. Even though the criticisms make me more skeptical of it than I would be of most other systematic reviews, it's clearly a reliable source for Wikipedia's purposes.
I'm saying that on this page where the whole point of any statement is what the Cass Review says, using the review itself to source those statements is clearly using it as a primary source on itself. When we say "The Cass Review says there isn't a lot of evidence for puberty blockers" on other pages, we're citing it for a fact about puberty blockers, but when we say that on this page, we're citing it for a fact about the Cass Review. Loki (talk) 02:57, 26 April 2024 (UTC)[reply]
You can use any source as a primary source. To the extent that editors use the Cass Report in this article like one might use a novel to write the ==Plot== section in an article about that novel, then that would be using the Cass Report as a primary source. The article's subject isn't really a determining factor; if you use a statement from WPATH to describe WPATH's statement, then that would be using the WPATH statement as a primary source, too.
It will be important to remember that primary is not a fancy way to spell 'bad'. (In particular, for direct quotations, primary sources are often best. Original documents can't misquote their own contents. ;-) ) WhatamIdoing (talk) 06:51, 26 April 2024 (UTC)[reply]
Yes, I agree with all of that. I am mostly just frustrated at the strange insistence that Cass or the Cass Review aren't primary sources on themselves. Loki (talk) 14:18, 26 April 2024 (UTC)[reply]
Loki, I don't see how you can say "I agree" and then dig further in on your insistence it be considered only primary on this page. At a superficial level, as WAID says, one can look at statements like we are summarising a plot of a book and using it as a primary source for such. But that would only let us quote or write about what the report said in language that very much distanced ourselves from the facts it claimed. It would be like if we used Wakefield's autobiography and he claimed he found MMR caused autism. For the medical facts we can state them as though Cass is a fine secondary source that meets MEDRS. For the recommendations and advice to NHS England about what clinics to setup and so on, the report is a primary source for Cass's proposals. I suggest you stop banging this drum because it isn't going anywhere helpful. You aren't going to get anyone going "oh, since Cass is a primary source on this page, we have to put everything in quotes and consider their statements as unreliable as some random Canadian GP that the Pink News dredged up. -- Colin°Talk 08:36, 26 April 2024 (UTC)[reply]
You are making some assumptions about my motivations that are not in evidence. I don't think that Cass is a bad source for the things we can use primary sources for. We can definitely source the content of the report to the report. When Cass makes uncontroversial claims about something the report says, we can cite her too, just like any author.
My skepticism here is coming from the fact that you appear to want to ignore ordinary sourcing guidelines in favor of MEDRS when that's not appropriate here. A strong MEDRS source is not exempt from the general guidelines on sourcing. Wakefield is in fact a great example of that; I would have used him as an example before if I wasn't worried that you would think I was equivocating between a quack and a real medical doctor who can nonetheless still make mistakes. Loki (talk) 14:33, 26 April 2024 (UTC)[reply]
Loki, stop digging. The PSTS concept is not simplistic or determined at article level as you keep making out. The fact we are discussing the Cass report on this article page doesn't magically stop it being a first class MEDRS compliant secondary source on biomedical facts and claims. If you can agree with me (and WAID) that the Cass review can be BOTH a primary source for certain things on this page AND a MEDRS compliant secondary source for other things on this page, we can all move on. Otherwise, please go post a request at WT:MED for clarification, and I'm sure someone will be along shortly to put you right. I mention Wakefield because his autobiography is entirely unlike this Cass review, whereas you seem to be saying the two are similar in that they are both doctors to not be trusted one bit. Hmm. -- Colin°Talk 11:25, 27 April 2024 (UTC)[reply]
It's very much a secondary source for biomedical facts on other articles. But we wouldn't be citing it for biomedical facts in this article, we would be citing it for what the Cass Review says.
You keep on saying things about PSTS that I don't dispute and have never disputed. What I am claiming is not a fact about the policy but a fact about this article and the claims that are being made in it, and I feel like it is actually a fairly obvious claim: that this is not an article about the underlying biomedical facts but an article about a particular study.
If you disagree with me, I invite you to find any place in this article where the Cass Review is being cited in order to prove a biomedical fact and not in order to prove what the Cass Review says. Loki (talk) 17:01, 27 April 2024 (UTC)[reply]
Oh also, please again do not impute my motives and do not accuse me of saying that Cass is exactly like Wakefield because I think the sourcing guidelines that apply to both of them are similar or because I think that the pitfalls of your argument are well documented by the case of Wakefield. Loki (talk) 17:04, 27 April 2024 (UTC)[reply]
You're almost at Australia now. Please send us a postcard. Have a look at the language at Lancet MMR autism fraud and the section "1998 The Lancet paper" and compare it with the language in this article. In one case we are describing a doctor who supposedly "found" links between MMR and autism and the reader is left in no doubt whatsoever that the findings were not just unreal but fraudulent. Now compare with this article. We can be comfortable that when the systematic reviews "found" or "stated" things, we can write that in a style that believes they did find them, that there really is insufficient evidence for this and moderate evidence for that.
Have a look at Timeline of tuberous sclerosis. It describes various doctors finding and discovering things over the years. Nowhere is the suggestion that those doctors didn't find and discover those things. We attribute their discoveries just as we attribute the findings of this Cass Review. We simply would not take that approach with a publication from e.g. Sex Matters or Mermaids, for example. We'd need be highly cautious with either organisation's claims and not present them to the reader at face value.
Citing AGF isn't a defence in being suspected of being wrong and then removing all doubt about it by comparing Cass with Wakefield. Can you stop doing that please Loki. I do believe you are here in good faith. You can be wrong in good faith. Can you permit me disagree with you without being hassled by AGF allegations please.
Wakefield's fraudulent paper on a dozen children was primary research that MEDRS would reject and there aren't high quality secondary reviews of Wakefield's work that we could cite because it was recognised as flawed research on publication. All the safeguards we have with MEDRS exist to prevent random research primary papers being used to make medical claims on Wikipedia. Contrast that with this. The BMJ lists seven systematic reviews commissioned by the Cass Review from which the CR draws many of its findings. Those reviews in turn examined hundreds of primary research studies and in turn hundreds if not thousands of patients. The review itself took four years. I can't think of another healthcare review that endeavoured to gather as much information and systematically review it in an evidence based approach, considering all the other guidelines across the world while formulating its own. Can you? I contrasted this review with Wakefield's autobiography as examples of polar opposites. You have now repeatedly said Wakefield is a great example of how cautious we should be and somehow continuing to push your novel concept that this review cannot be a fine secondary source for medical claims on this page. Colin°Talk 17:51, 27 April 2024 (UTC)[reply]
I note that you still have not given me a single example of a claim on this page the review would be a secondary source for.
Instead you continue to grandstand about claims I've never made: I have never once disputed that the Cass Review is a WP:MEDRS-quality source or that it would be a high-quality source on other articles. (I do dispute that "high-quality source" means that it would be incontrovertible or a great bastion of objective truth, to quote Snokalok below, but that's neither here nor there in this particular argument.) I'm not even claiming that the Cass Review is a bad source on this article, just that it is a primary source.
Can you please for once actually listen to the words I am saying and not the phantom that you have made up in your head? Loki (talk) 18:10, 27 April 2024 (UTC)[reply]
Loki, I feel like I'm getting mixed signals for you. Up above, you say More relevant to this article is that anything Cass says is still a primary source. Down here, you seem to be saying that the Cass Review is actually a secondary source (at least sometimes). Perhaps a few examples would help?
The review is a primary source if you want to write a sentence like "The final review is 388 pages long and contains 12 appendices" or "The report recommends that families of pre-pubertal trans or gender-questioning kids get at least one appointment with a qualified practitioner right away, without first spending years on a waitlist".
The review is a secondary source if you want to write a sentence like "Based on moderate-quality evidence, puberty blockers neither change nor worsen either gender dysphoria or body satisfaction" or "Post-pubertal autistic teenagers are more likely to discontinue puberty blockers than pre-pubertal kids".
Note the absence of any wording about "in this article" on "in other articles" in my examples. Whether it's being used as a primary or a secondary source has to do with the content of the sentence it's supporting. It has nothing to do with the article that the sentence is placed in. For example: if the Cass report is cited in support of the sentence "Based on moderate-quality evidence, puberty blockers neither change nor worsen either gender dysphoria or body satisfaction", then the Cass report is:
  • secondary if it's in this article,
  • secondary if it's in another article, and
  • secondary if it's on another website entirely.
Does that make sense? WhatamIdoing (talk) 03:00, 28 April 2024 (UTC)[reply]
It does but I have a quibble.
I agree that if you wanted to cite "Based on moderate-quality evidence, puberty blockers neither change nor worsen either gender dysphoria or body satisfaction" you could use the Cass Review as a high-quality secondary source, and that in principle it doesn't matter what article you say it in.
But in this article, I don't think that's the sort of fact we care about. Instead we want the similar but distinct "one of the findings of the Cass Review was that puberty blockers neither change nor worsen either gender dysphoria or body satisfaction". Since this is a statement about what the Cass Review says cited to the Cass Review, I believe it's primary for this purpose.
(Now, I don't think it really matters because the Cass Review is obviously a reliable source on its own findings. Which is a big part of why I'm frustrated by this argument: I don't think it has any practical effect on this article. This argument was originally about Cass's statements in interviews about the review, where it might actually matter, not the review itself.) Loki (talk) 04:28, 28 April 2024 (UTC)[reply]
What's your point, Loki? Why, argue that Cass's review (and by extension presumably the seven systematic reviews commissioned by it), are to be considered merely primary sources on this page. It can't be merely pedantry. You must have a reason for wanting these documents to be WP:PRIMARY on this page and mysteriously on this page fail WP:MEDRS despite the primary topic of this page falling under WP:BIOMEDICAL. Please can you tell us where in our policies and guidelines we have a sourcing distinction that applies at article level, rather than "What the article text says and the point the article text is making". Please do tell us.
When our readers read the texts on lack of research or increase in referrals or that there are conflicting clinical views and a mixed picture wrt the role evidence has played in forming existing clinical guidelines, we can say all these things because the review and its supporting documents are first class WP:MEDRS. We wouldn't even attempt to spell out anything like this much information, let alone include it outside scare quotes, if it had come from some Sex Matters publication or interview with a LGBA spokesperson in the Telegraph. If that publication or interview was notable enough to have an article, we'd be writing it in entirely a different style even though we could use it as a primary source just like Cass is a primary source for whether or not the report made certain statements and claims. Is this clear?
The primary-source role Cass's report is making on this page is where or not the report actually made those claims and statements and whether our text is a fair summary. That role is insufficient for us to write sections and paragraphs on their "findings" and "conclusions" if they were in fact the findings of a hate group, fringe medicine, political or cultural ideology and so on. What is it that let's us write about their findings as though they really did find them? Well, that's because the document and supporting documents are WP:MEDRS compliant sources for these. -- Colin°Talk 11:03, 28 April 2024 (UTC)[reply]

It can't be merely pedantry.

Oh, it's pedantry. Well, more annoyance that you keep on misrepresenting what I'm saying over and over, so I feel the need to correct you, so you then try to incorrectly guess my motivations again and we go round and round forever.
The original point was about Cass's statements in interviews. I brought up the Cass Review being primary here mainly as evidence that Cass's statements in interviews were also primary. That has led us to this quagmire of an argument where you seem to think I brought up the Cass Review being primary to say it was a questionable source for this page, and I am ripping my hair out to insist that you are blatantly failing to both WP:AGF and even to literally read the words I am writing. No, I think Cass's statements are the questionable source, not the review itself.
I am fine with tabooing the Cass Review in this discussion. It's a fine source for this page and it doesn't matter why it is.

You must have a reason for wanting these documents to be WP:PRIMARY on this page and mysteriously on this page fail WP:MEDRS

They don't fail WP:MEDRS on this page and I've never said that. (They don't even reach the point at which WP:MEDRS matters; we could cite something for its text on a WP:MEDRS page without it being a WP:MEDRS source.) Stop putting words in my mouth and stop assuming the worst of my motives.

We wouldn't even attempt to spell out anything like this much information, let alone include it outside scare quotes, if it had come from some Sex Matters publication or interview with a LGBA spokesperson in the Telegraph. If that publication or interview was notable enough to have an article, we'd be writing it in entirely a different style even though we could use it as a primary source just like Cass is a primary source for whether or not the report made certain statements and claims. Is this clear?

I agree with the conclusion but disagree with the reasoning.
If we had a notable article on a famous work of non-fiction, it'd be written in a similar style to this article. (Compare Das Kapital, as an example of a work whose claims are very controversial in modern economics and yet which is still written about similarly.) The reason a very controversial work would be written about in a different style would be because of the abundance of sources challenging the publication's claims. Again, doesn't even reach WP:MEDRS.

The primary-source role Cass's report is making on this page is where or not the report actually made those claims and statements and whether our text is a fair summary. That role is insufficient for us to write sections and paragraphs on their "findings" and "conclusions" if they were in fact the findings of a hate group, fringe medicine, political or cultural ideology and so on.

See above: we document the factual claims made by all sorts of non-fiction books that wouldn't normally be considered reliable sources for facts. Das Kapital, On the Origin of Species (great work in its time but out of date now), Outliers (book), etc etc.
This is again not to say that the Cass Review is not a reliable source for facts, only that it doesn't matter either way. Loki (talk) 14:41, 28 April 2024 (UTC)[reply]
Loki, fiction is one of those things where we assume our readers know it is fiction and Jedi Knights aren't real. We really wouldn't describe the findings of this report in this style if it wasn't also MEDRS. You don't seem to believe me but I've given you an example, Wakefield. And you literally on this page then compared a Wakefield source as being like Cass, and now you are saying "I think Cass's statements are the questionable source". Please stop. And please stop citing AGF as though I haven't been here 20 years. I'm not questioning your motives at all. I'm questioning the words you keep writing, which are wrong. Honestly, turning a "You are wrong and here's why" argument into a "Would you stop questioning my motives argument" is itself a bad faith move. Quit it now. Anyway, you've admitted this is pedantry on your part which is, you know, WP:NOTHERE. So I think it best we end this discussion and go find something actually productive to do. -- 15:31, 28 April 2024 (UTC) Colin°Talk 15:31, 28 April 2024 (UTC)[reply]
I did give you three examples of non-fiction books where we do this. As in, they are not fiction.
Besides that, yes I agree it's best we end this discussion. Loki (talk) 17:38, 28 April 2024 (UTC)[reply]
Just wanted to add two cents to the discussion I unintendingly started: a podcast is not an ideal source, but in this case it can add interesting details about the report currently not found elsewhere. From the top of my head, these were:
  • The team behind the Cass Review actually reached out to the Dutch team at VUmc to extensively discuss their approach (pretty logical considering they came up with this in the first place)
  • Gender exploratory therapy is not meant to get rid of gender incongruence/dysphoria, but to make comorbidities more manageable. Cass claims that GD may resolve, but that is not the actual goal (gotta admit, very contentious claim)
  • Cass claims that the psychological interventions she proposes do not have a strong-evidence base either (for which you are obviously allowed to criticise her)
  • Lastly, she claims that a consensus-baded guideline like WPATH's is actually not bad at all, as she said that such things happen all the time. She does take issue with the fact that the evidence is sometimes presented as stronger than ot really is
PS: I agree with @Colin here that the meta-analysis can be used as a decent medical source. Having read quite some systematic reviews in different fields, I have to say there's nothing off the rails here. Besides, we should not overlook the fact that the meta-analysis has not found anything shockingly new. The Endocrine Society, for instance, has always stated that their recommendations regarding puberty suppression are of low or very low certainty. The question here is whether that warrants a change in practice, about which you can meaningfully disagree. Claiming that this could be a situation like Wakefield's, however, seems to me to absolutely miss the point of all of this. There's really nothing extraordinary about this study in any way, as much as people with different perspective may want to think Cixous (talk) 11:25, 7 May 2024 (UTC)[reply]
@Cixous I mostly agree. Wrt the evidence examination, I see no surprises (as you note, previous reviews have also reported low evidence quality). I think one of the problems is the temptation to think even weak evidence is still evidence, and thus fool oneself into thinking it is telling you what you want to hear.
I think Cass was specifically calling out WPATH for being unclear and not open that their guidelines were not in fact based on good evidence but merely a consensus of experts. That they claimed there was evidence but really when examined that claim turns out to be unfounded and in any other field would not be regarded as safe. As you say, there's nothing wrong with openly declared expert consensus and in many fields that's all we have. And I agree that different rational sensible people could meaningfully disagree about what to do in the absence of good evidence. -- Colin°Talk 12:48, 7 May 2024 (UTC)[reply]
@Colin
> (WPATH) guidelines were not in fact based on good evidence but merely a consensus of experts.
Exactly. The WPATH 8 FAQ reveals explicitly how one significant recommendation was changed like that:
  • A previous version of the WPATH Standards included specific ages for medical procedures. Why were those pages removed in the SOC-8?<
  • Minimum ages for providing gender-affirming medical care were removed from the SOC-8 … (after) a public open comment period … (which) allowed input and feedback from professionals … who were concerned that the listing of ages would lead to further limitations to care… After comments were reviewed … it was determined that the specific ages would be removed to ensure greater access to care for more people.
  • ==== end of quotation from the WPATH 8 FAQ ======
In the same FAQ WPATH, are bold in their claims about evidence
  • represent the most expert, in-depth, and evidence-based and consensus-based guidelines internationally.
  • the most comprehensive set of guidelines ever produced.
  • represent gold standard, best practices for global health care
  • clinical guidelines meant to provide the gold standard on how to deliver care
  • By defining the gold standard of care providers and institutions are now primed
  • obtaining medically necessary, life-saving gender-affirming care.
  • Puberty-delay medications are safe and effective and can be stopped at any time, at which point puberty starts back up after being temporarily paused.
  • Regret in any aspect of TGD healthcare is uncommon and statistically lower than for other medical or surgical interventions and recent studies
  • One of the primary forms of gender-affirming medical care for TGD adolescents is to introduce medications that delay puberty
  • Why are the needs of eunuch-identified people included in the SOC-8 for the first time?
  • SOC-8 provides guidelines based upon the best available research and clinical expertise to provide the safest gender-affirming care to all TGD people.
  • based on the best available science and expert professional consensus
Peckedagain (talk) 14:37, 7 May 2024 (UTC)[reply]
Thanks for your quotes, but we shouldn't extrapolate things too easily. The SOC 8 has been criticised for its guidelines for the treatment of adolescents. That doesn't mean that other parts of the guideline can be regarded the same (or criticised accordingly).
As for the age limit for puberty suppression: the discussion about that has been going on for over a decade. The original minimum age of 12 was chosen because from that age onwards Dutch adolescents were allowed to make medical decision with permission of their parents (I'm not sure whether I read this in a source from the 1990s or in de Vries & Cohen-Kettenis, 2012). The 16-year mark was chosen likewise (i.e., Dutch adolescents are allowed to make medical decision on their own from that age). In some countries this is eighteen years (e.g., in Italy).
In their discussion, de Vries et al. (2014) already pointed out that the ages of twelve and sixteen years may change, because of the nature of puberty onset and the effects of puberty suppression. As a result, the Dutch guidelines from 2017 do not include a minimum age for puberty suppression anymore (but continue to include one for gender-affirming hormone therapy). So, with regards to this specific discussion, the minimum ages were always somewhat arbitrary Cixous (talk) 12:41, 8 May 2024 (UTC)[reply]
The point was not about the history of age limits which as you say goes back decades. The point was that in 2022 WPATH decided to remove the limits - with no new research. No new science. The papers you mention were not new data. The change was made simply by asking their members. Peckedagain (talk) 21:37, 9 May 2024 (UTC)[reply]
Yeah, you're right about that :) Cixous (talk) 12:44, 10 May 2024 (UTC)[reply]

Refactoring the Reception -> Final report subsection[edit]

I think the Reception -> Final report subsection is in dire need of changes; it's very disorganised, there are lots of non-reliable sources being used as references, and we're including statements from fringe patient advocacy groups who don't have the credibility to warrant their inclusion under WP:WEIGHT.

It's currently a long, messy list of statements. To improve its organisation, I think it'd be helpful to further split up "Final report" into several subsections of its own. For example, we could split it up into: responses from politics; responses from medicine; and other responses. The second subsection can contain responses from "reputable major medical and scientific bodies" (per WP:MEDORG). The third can contain responses from those who are involved neither in politics nor medicine, but whose reactions are still notable enough to warrant inclusion.

When I brought up removing responses to the report not referenced by reliable news sources (and therefore lacking coverage) before, people said it would be inappropriate because it falls under WP:BMI. Per WP:MEDORG, "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources...major medical and scientific organizations sometimes clash with one another...which should be resolved in accordance with WP:WEIGHT." Some of these statements and responses are critical and contradict the Cass Review, which is the most credible and authoritative source on the topics it covers. It is the most credible and authoritative source on the topics it covers because it is based upon systematic reviews, per WP:MEDASSESS, and was commissioned by the NHS, one of the "reputable major medical and scientific bodies" explicitly named in WP:MEDORG. We currently include dissenting opinions from groups like PATHA and AusPATH which are so niche they don't even have a Wikipedia page. They are patient advocacy groups. They are not, as WP:MEDORG sets out, "reputable major medical and scientific bodies". Therefore, per WP:MEDORG and WP:WEIGHT, we shouldn't be including their contradictions to the best evidence there is on this subject. WP:MEDORG also tells us "to avoid WP:original research by only using the best possible sources". Clearly, statements from these fringe groups that contradict the findings of the report are not the best possible sources. We're also including, for example, the EHRC, which is not a WP:MEDORG, and doing so with a reference from its own website rather than a secondary source (seeing as it isn't a medical organisation).

Non-reliable sources we're using as references in this section include WP:DAILYDOT; the Evening Standard; and them.us. If we are going to use secondary news articles as references, surely we can (and should) use better sources than these. 13tez (talk) 22:47, 3 May 2024 (UTC)[reply]

If your agenda was any more transparent, birds would kill themselves flying into it. 2601:1C0:717E:4C0:7CC7:E299:DF59:A01E (talk) 23:44, 3 May 2024 (UTC)[reply]
You should note I oppose the use of the sources being used to reference Sex Matters and Genspect supporting the report and, therefore, the inclusion of their stances in the article until better, reliable sources (that also show they're notable) are found. 13tez (talk) 00:59, 4 May 2024 (UTC)[reply]
I support the aim to tidy up the Reception: Final Report section.
Another section that is poor: is the Findings section. It's phrased in complex sentences that are not clear. It would benefit from using more direct text from the report: as other editors have suggested. Eg maybe the entire FAQ sections of the Review could be included.
Here in the UK, all political sides have supported the Cass Review and most mainstream health organisations have too - and YET the article here is phrased in ways to hint at discrediting the report, and that it is not well founded in science.
Those of us who have tried to edit to bring the article in line: have been on the receiving end of some over-zealous reversion and on the Talk page even personal comments about our 'editing style'. Hopefully now that partisan period is over here on wikipedia: which is appropriate as the partisan views on under-18's puberty-blockers are now pretty much over in the wider world. Even staunch proponents of them have moderated their views: and MPs in parliament have apologised for their earlier criticisms of Cass. Peckedagain (talk) 00:12, 4 May 2024 (UTC)[reply]
Thanks for your thoughts. Would you support the ideas to remove the PATHA and AusPATH statements and to improve the reliability of the news sources used or else remove the content they currently support? I see you support the idea of the sub-headings I mentioned before. 13tez (talk) 00:56, 4 May 2024 (UTC)[reply]
"Here in the UK, all political sides have supported the Cass Review and most mainstream health organisations have too - and YET the article here is phrased in ways to hint at discrediting the report, and that it is not well founded in science."
A. The UK is not the only country in the world.
B. MEDORG criticism, even if it's from outside the UK, bears weight.
C. The findings section was written to be remarkably neutral in its statements of the report, using directly cited findings with page numbers in SFN and neutral wording in accordance with MOS:CLAIM. If you're reading it as discrediting, then what does that say about the findings themselves? Snokalok (talk) 12:42, 4 May 2024 (UTC)[reply]
A) straw-man. The UK has a good reputation for science and healthcare; and a four year research project by the state health system the NHS.
In the Parliament, an MP publically apologised for wrongly criticising the report.
C) - it says nothing!
@Snokalok - what will it take for you to accept that the report is scientifically robust, as other editors have eg @Colin argued that criticism of it is unscientific. Peckedagain (talk) 14:28, 4 May 2024 (UTC)[reply]
You’re approaching from entirely the wrong angle. It’s not about whether the UK is a good country for science and medicine or whether the report even is a good one, science is not a set of doctrinal ideas from a designated authority wielder on high that are not allowed to be controverted. Even if the report was 100%, indisputably accurate (which it’s not but whatever), the fact is that criticism from contemporary scientific organizations is relevant and bears including. It doesn’t matter if the report is right or wrong, it matters that the criticism bears weight regardless. It is not our job as editors to determine one set of ideas to be inherently right (let alone just because the British govt said so) and then censor anything to the contrary, our job is to write an article which fully and fairly encapsulates the topic - and if numerous medorgs are criticizing the report, then it’s not fair nor accurate to exclude those simply because we believe the report to be right. Snokalok (talk) 14:49, 4 May 2024 (UTC)[reply]
@Snokalok - a strawman - it is not being suggested that criticism be excluded.
It's about weight. Much of the criticism is fundamentally unscientific, because the very FAQs in the Cass report disprove them!
Would you object to the FAQ's being copied directly here?
  • Did the Review set a higher bar for evidence than would normally be expected? No
  • Did the Review reject studies that were not double blind randomised control trials No
  • Did the Review reject 98% of papers demonstrating the benefits of affirmative care? No
  • Has the Review recommended that no one should transition before the age of 25 and that Gillick competence should be overturned. No
  • Is the Review recommending that puberty blockers should be banned? No
  • Has the Review recommended that social transition should only be undertaken under medical guidance? (The Review has advised that a more cautious approach)
  • Did the Review speak to any gender-questioning and trans people when developing its recommendations? Yes
Peckedagain (talk) 15:02, 4 May 2024 (UTC)[reply]
The authors of the Cass Review say these things about their own review, and the hundred medorgs and academic voices we have cited in the article resoundingly disagree. We don’t censor criticism because the people being criticized say “Nuh uh” Snokalok (talk) 15:13, 4 May 2024 (UTC)[reply]
At least some of these points are objective truth, e.g. that they didn't reject 98% of papers. We can't include criticism based upon claims that simply aren't true. Please remember the systematic reviews that informed the report were peer-reviewed. Therefore, the authors can't just lie about them. 13tez (talk) 16:14, 4 May 2024 (UTC)[reply]
Perhaps the page could a have a table, one column per FAQ: with one row per body that is critical: so that an X marks which FAQs each body have questioned - for visual clarity and reduce repetition: as the same points are raised by several bodies. Peckedagain (talk) 18:36, 4 May 2024 (UTC)[reply]
I think adding the FAQs from the Cass Review website in a manner like you've described is a good idea. If we're following MEDRS sourcing (so not using news articles), we should probably be taking the key findings and recommendations from it too. 13tez (talk) 19:59, 4 May 2024 (UTC)[reply]
I wonder if that wouldn't take up a disproportionate amount of space. Additionally, a number of these answers are far less concrete than a simple factual yes or no. For example, there are strong arguments to be made of a higher bar indeed being expected, given that somewhere around half of all medical care only has low quality evidence supporting it, and that the majority of children's medicine is prescribed off-label. Furthermore, the report directly says that the evidence for psychosocial intervention is as weak as that for hormonal treatments, but recommends psychosocial as the default and against hormonal treatment in the majority of cases. That itself is a higher bar required for hormones vs therapy. Snokalok (talk) 20:25, 4 May 2024 (UTC)[reply]
Ultimately, this is a primary source and can only really be taken as the review responding to criticism, that is - it can be taken as one side in the debate, not as objective fact. If you want to implement the contents of this FAQ in the Cass Response section or somewhere similar, that's one thing, but in and of itself this FAQ is not a reliable source to censor criticism with because it's effectively somewhere between "Nuh uh" and "We've investigated ourselves and found no wrongdoing" Snokalok (talk) 20:27, 4 May 2024 (UTC)[reply]
And this is exactly the thing I was getting at when I was kvetching about primary sources above, or about Cass herself not necessarily being a reliable source for even the contents of the report. The sourcing guidelines on Wikipedia are there for good reasons and those reasons don't stop applying in MEDRS cases no matter how strong the evidence is within the context of MEDRS. Loki (talk) 20:37, 4 May 2024 (UTC)[reply]
Hey, thanks again for your further thoughts.
I wonder if that wouldn't take up a disproportionate amount of space.
I was thinking of replacing our own summaries of findings and recommendations with those from the review website itself. There are only 8 FAQs which we can summarise.
For example, there are strong arguments to be made of a higher bar indeed being expected, given that somewhere around half of all medical care only has low quality evidence supporting it, and that the majority of children's medicine is prescribed off-label. Furthermore, the report directly says that the evidence for psychosocial intervention is as weak as that for hormonal treatments, but recommends psychosocial as the default and against hormonal treatment in the majority of cases.
I think the authors of a NHS-commissioned report better understand the quality, nature, and quantity of evidence to support medical practice and how that evidence should shape practice than any of us here, so we should go with what they say.
Ultimately, this is a primary source and can only really be taken as the review responding to criticism, that is - it can be taken as one side in the debate, not as objective fact... in and of itself this FAQ is not a reliable source
It's a follow-up by a report commissioned by the NHS, a reputable major and national medical organisation that defines the guidelines for and carries out almost all medicine in the UK. If we're using MEDRS sources here - as is the consensus - we're not delving into normal practice of requiring mostly secondary sources etc set out at WP:PSTS.
it's effectively somewhere between "Nuh uh" and "We've investigated ourselves and found no wrongdoing"
A lot of the claims the FAQs address are objectively and obviously not true, which is well-documented at this point. They don't deserve serious consideration. Apart from anything else, it's sad they've felt the need to refute them. The misinformation helps nobody, least of all trans people. 13tez (talk) 20:49, 4 May 2024 (UTC)[reply]
"I was thinking of replacing our own summaries of findings and recommendations with those from the review website itself. There are only 8 FAQs which we can summarise."
I remember that was done early on, and eventually it was decided that the summary page was vague and open to misinterpretation from all sides, and that using direct pieces from the report was better.
"I think the authors of a NHS-commissioned report better understand the quality, nature, and quantity of evidence to support medical practice and how that evidence should shape practice than any of us here, so we should go with what they say."
The international medical community disagrees. They can't investigate themselves and find no wrongdoing, that's a blatant conflict of interest. Even someone with no scientific or medical expertise could see that.
"It's a follow-up by a report commissioned by the NHS, a reputable major and national medical organisation"
Again, conflict of interest here. They can't say "We've investigated the criticism leveled against us by other medical orgs and decided nuh uh"
"A lot of the claims the FAQs address are objectively and obviously not true, which is well-documented at this point."
Well since we are using MEDRS sources, again, the entire international medical community is in apparent disagreement right now. Only UK sources have been speaking in favor of the Cass Review, and while they're not invalid sources, they do not hold supremacy over consensus. Snokalok (talk) 21:23, 4 May 2024 (UTC)[reply]
It doesn't matter how reliable you consider the NHS for medical info, the fact is the NHS is always a primary source when talking about the NHS. Snokalok (talk) 21:25, 4 May 2024 (UTC)[reply]
The international medical community disagrees.
The international medical community - the WHO, the National Institutes of Health, Health Canada, etc - haven't rejected the Cass Review. A similar Swedish systematic review also found that there's a severe lack of evidence for current practice. There isn't some great disagreement here.
They can't investigate themselves and find no wrongdoing, that's a blatant conflict of interest.
They aren't investigating themselves for alleged wrongdoing. They're explaining why common misconceptions and misinformation are incorrect. Again, a lot of the claims still circulating are clearly just objectively false at this point.
the entire international medical community is in apparent disagreement right now. Only UK sources have been speaking in favor of the Cass Review
This isn't true. See Sweden and their aforementioned review, Ireland, Norway, and Finland, Denmark, the Netherlands, and the European Academy of Paediatrics. You're making an assertion here that the rest of the world is against the findings of this review or of different opinions, but it's simply not the case.
It doesn't matter how reliable you consider the NHS for medical info, the fact is the NHS is always a primary source when talking about the NHS.
As discussed, the consensus is that the report falls under BMI, so MEDRS sources are needed. The NHS and the report qualify as MEDRS sources. 13tez (talk) 23:08, 4 May 2024 (UTC)[reply]
Afaik the consensus was that it's complicated in regards to BMI and primary and therefore depends on what one is commenting on. I think the larger problem with the FAQs is that we're trusting Cass with that those are in fact the FAQs (definitely not BMI) and that the questions aren't being misrepresented in any way. As well as this as far as I can tell I have no way to verify who the FAQs page was written by and what process went into writing it, feel free to show me where but this also seems to pose a problem. LunaHasArrived (talk) 23:54, 4 May 2024 (UTC)[reply]
As well as this I think if somebody says "the Cass review ignored 98% of evidence" and someone else says "the systematic reviews actually considered more evidence than that". These 2 people are arguing past eachother, I think one can claim that in Cass's findings and recommendations they only wanted high quality evidence for this kind of care. Not to say the first statement is correct by any means just that saying "the systematic reviews considered that evidence" isn't really enough to refute it by itself. LunaHasArrived (talk) 00:06, 5 May 2024 (UTC)[reply]
@LunaHasArrived
Are you not simply re-stating, in different words, again and again, that you view that the Cass report is not a top-quality reliable report?
> I think the larger problem with the FAQs is that we're trusting Cass ... I have no way to verify who the FAQs page was written by and what process went into writing it,
The FAQs are on the official Cass Review website! What more is needed for us to 'trust' the FAQs?!
Looking at your view of Cass: in your own words:
> I think a very important thing to say that Cass's report whilst based on systematic reviews is not top tier medical evidence.
> Oh yes, I'm not saying at all that the Cass review itself should be discredited. It's just...
> this isn't to say Cass isn't Medrs or unreliable. It's just to say ... Peckedagain (talk) 00:28, 5 May 2024 (UTC)[reply]
Hey @LunaHasArrived, thanks for your thoughts.
I have no way to verify who the FAQs page was written by
I understand that concern, however it is published on the official Cass Review website. To me, this gives it credibility in the same way as something published on the NHS website.
As well as this I think if somebody says "the Cass review ignored 98% of evidence" and someone else says "the systematic reviews actually considered more evidence than that". These 2 people are arguing past eachother
One side of such arguments is objectively wrong and undermines the credibility of the report, though. You can see this in the peer-reviewed systematic reviews that informed the report, regardless of any reservations you might have about the report itself or the website. Furthermore, reliable sources reject these claims too; The Guardian has said: "To understand the broader effects of puberty blockers, researchers at the University of York identified 50 papers that reported on the effects of the drugs in adolescents with gender dysphoria or incongruence. According to their systematic review, only one of these studies was high quality, with a further 25 papers regarded as moderate quality. The remaining 24 were deemed too weak to be included in the analysis." Seeing as there were ~100 papers considered in total, if 26 were considered just in the systematic review on puberty blockers, it's clear that 98% weren't rejected. 13tez (talk) 00:55, 5 May 2024 (UTC)[reply]
I admit I could have phrased my bit better, I 100% agree that the systematic reviews covered and considered all the evidence. I think one can argue that Cass's recommendations do not. Saying to this later argument that the systematic reviews considered the evidence isn't refuting the argument. It's a matter of the recommendations which aren't more than peer reviewed medical expert opinion. LunaHasArrived (talk) 00:59, 5 May 2024 (UTC)[reply]
> I think one can argue that Cass's recommendations do not.
This is still going in circles, you've moved on from not trusting the Cass FAQs: and now you don't trust the Cass recommendations. Really?
After dropping that, will you go back to the 98% thing again?
There is no logic to regurgitating the same, un-true allegations endlessly. If Colin (the science and stats guy')'s arguments has not helped to clarify for you that the Cass resort is quite simply sound: and the patient time invested by @13tez and me and others too.
Question: what would you need to happen, to decide that the Cass resort is quite simply sound?
eg -would a discussion with Colin or someone on their home page be helpful for you? Peckedagain (talk) 01:24, 5 May 2024 (UTC)[reply]
I 100% agree that the systematic reviews covered and considered all the evidence. I think one can argue that Cass's recommendations do not.
IIRC the systematic reviews considered around 60% of the papers they had in their syntheses, the remainder being of too low quality to use. Cass's recommendations were informed by the systematic reviews (which the report commissioned) and their meta-analyses. It makes references to them and their findings and explains them throughout. They're contained within a review that was commissioned and later endorsed by the NHS and written by medical professionals. They know much better than anyone here how to interpret the systematic reviews and, consequently, what the review should come to in its findings and recommendations. This is why large parts of the final report are purely explanatory. 13tez (talk) 01:36, 5 May 2024 (UTC)[reply]
And where on the MEDRS pyramid does an FAQ on the website fall? Snokalok (talk) 12:32, 5 May 2024 (UTC)[reply]
@Snokalok
> Additionally, a number of these answers are far less concrete than a simple factual yes or no.
Not true -the Cass FAQs nearly all start with a Yes or a No ! Peckedagain (talk) 23:39, 4 May 2024 (UTC)[reply]
@Snokalok
This is just going round in circles - it's been raised here before, @Colin already shot it down, as Cass already explicitly addressed this exact issue:
> For example, there are strong arguments to be made of a higher bar indeed being expected,... and that the majority of children's medicine is prescribed off-label.
Yet when editors suggest including exact quotes from cass that cover false criticisms like this, you write: "I wonder if that wouldn't take up a disproportionate amount of space."
You can't have it both ways - if coverage of bodies that basically lie about Cass is desirable in the page: then the text from Cass that proves their claims are lies is vital.
Snokalek - the page history says
> Found 154 edits by Snokalok (30.02% of the total edits made to the page)
I don't know what the wiki rules are on over-coming a log-jam. Peckedagain (talk) 23:55, 4 May 2024 (UTC)[reply]
I mean I think this is probably the best example of why we can't always use Cass about itself. We have medorgs saying the Cass review has a higher bar of evidence for some care over others, then we have Cass saying no it is the same bar. We have 2 distinct opinions here about what the findings and recommendations said and I think saying it's a false criticism is unhelpful. This is not a case of WP:Bluesky and the Cass side of it seems a little like a school saying it has an anti-bullying policy so it doesn't have bullying. (I.e we said we were equal to different care, therefore we were). This is not to say either side is correct just that it's not clearly so. LunaHasArrived (talk) 00:22, 5 May 2024 (UTC)[reply]
@LunaHasArrived
Have you gone back and read @Colin's earlier comments here.? It would reduce the repetition here if you would.
This 'higher bar of evidence' thing has ALREADY been shot down in this talk page. Already explained that the issue the medorgs raise is explicitly covered by Cass, head on.
QED: the medorgs you mention are IGNORING Cass itself and proving themselves to be unreliable sources, and not applying the normal logic of scientific debate.
The Cass FAQ
Did the Review set a higher bar for evidence than would normally be expected?
No.
No, the approach to the assessment of study quality was the same as would be applied to other areas of clinical practice – the bar was not set higher for this Review.
Clarification:
The same level of rigour should be expected when looking at the best treatment approaches for this population as for any other population so as not to perpetuate the disadvantaged position this group have been placed in when looking for information on treatment options.
The systematic reviews undertaken by the University of York as part of the Review’s independent research programme are the largest and most comprehensive to date. They looked at 237 papers from 18 countries, providing information on a total of 113,269 children and adolescents.
All of the University of York’s systematic review research papers were subject to peer review, a cornerstone of academic rigour and integrity to ensure that the methods, findings, and interpretation of the findings met the highest standards of quality, validity and impartiality.
end--of--cass--faq-snippet Peckedagain (talk) 00:43, 5 May 2024 (UTC)[reply]
This is arguing directly past me and strawmanning, one can easily say that Cass's recommendations required higher quality of evidence for one thing than another, this is a comment about interpretation of the systematic reviews. That Cass says this didn't happen isn't an answer to this. That the systematic reviews considered all qualities of evidence isn't an answer to this. The fact that you think any medorg criticising this is ignoring the entirety of the report and unreliable because of it would lead to the conclusion of the Cass report being infallible just because it is LunaHasArrived (talk) 00:50, 5 May 2024 (UTC)[reply]
Your entire argument keeps centering on the idea of “The Cass Report is infallible. If a MEDORG makes a criticism of it that the Review team says is not true, then that criticism is automatically not true and the org is an unreliable source” which is, not at all how any of this works. Snokalok (talk) 12:29, 5 May 2024 (UTC)[reply]
I'd support that.
It would reduce alot of the Talk here - people would not raise 'criticisms' of Cass that Cass itself disproves alreadY Peckedagain (talk) 23:38, 4 May 2024 (UTC)[reply]
I'd support the sub-headings you propose ( responses from politics; responses from medicine; and other responses.) Peckedagain (talk) 00:14, 4 May 2024 (UTC)[reply]
A point of order… PATHA and AusPATH are not patient advocacy groups, they are professional associations. However, I think their statement is only in the article because it was one of the first to be released. Now that we have a statement from the far more relevant and notable WPATH, the views of the non-notable other PATHs are less important.
We shouldn’t be presenting any views in a way that serves to offset, undermine or contradict the findings of the systematic reviews unless those views are based on equivalently weighty research.
We should also make clear that some of these responding organisations were directly criticised in the report (most notably WPATH). That makes their views more relevant but also more WP:MANDY. Barnards.tar.gz (talk) 06:39, 4 May 2024 (UTC)[reply]
I agree, especially since as time passes the significant responses will be those that have lasting impact and significant coverage. It is hard to see why PATHA especially receive so much space - especially when their response is, frankly, ill-informed gibberish. Adding subdivisions is, I think, just going to provide extra WP:COATRACK space, and better to keep this devoted to actually pertinent response and not a blow by blow of any old partisan commentary. Plus the political and medical are deeply intertwined here and clear separation is not going to be so straightforward I fear.
Though I have to say, WPATH still don't seem to have actually published a statement, and all we have, still, is second-hand reporting of an email statement? Void if removed (talk) 08:34, 4 May 2024 (UTC)[reply]
"their response is, frankly, ill-informed gibberish"
Plenty of people say the same about the Cass Report. MEDORGs have weight. Just because they favor allowing trans people to transition over what has widely been criticized as conversion therapy, doesn't make them partisan. Snokalok (talk) 12:44, 4 May 2024 (UTC)[reply]
Plenty of people say the same about the Cass Report
That doesn't matter. PATHA, AusPATH, etc, aren't "reputable major medical and scientific bodies" like WP:MEDORG sets out, and in fact they're dissenting from the NHS, which is one of the examples explicitly given there. Per WP:MEDASSESS, "editors should rely on high-level evidence, such as systematic reviews. Low-level evidence (such as case reports or series) or non-evidence (such as anecdotes or conventional wisdom) are avoided." This is pretty much what we're weighing up here: the findings from systematic reviews carried out by an actual MEDORG vs conventional wisdom from professional associations. 13tez (talk) 13:08, 4 May 2024 (UTC)[reply]
That's the thing though, they are reputable major medical and scientific bodies, they're the medical orgs for Australia and New Zealand regarding gender medicine. You're the only one calling them "fringe patient advocacy groups", which is a novel and wildly in an of itself fringe take to say the least. Snokalok (talk) 13:12, 4 May 2024 (UTC)[reply]
they are reputable major medical and scientific bodies
From WP:MEDORG: "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the National Academy of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization." PATHA and AusPATH clearly don't meet the standard set out here. They shouldn't be overriding the findings of systematic reviews carried out by the NHS, one of the examples explicitly given. 13tez (talk) 13:57, 4 May 2024 (UTC)[reply]
@Snokalok Anybody that describes CASS as 'frankly, ill-informed gibberish"' is plainly not a reliable source.
You are right that plenty of people say that - but by definition, the fact that they say that is proof that they are unscientific. Peckedagain (talk) 14:49, 4 May 2024 (UTC)[reply]
You keep using that word, “unscientific”. I do not think it means what you think it means.
Just because someone has a badge saying “designated authority wielder” does not make their ideas automatically correct and all others heretical, this is not the Vatican. And again, even if they were correct, the fact that they’re being criticized by their contemporaries bears including regardless of all else. Snokalok (talk) 15:17, 4 May 2024 (UTC)[reply]
That is again a strawman - no one is suggesting that a badge : "makes their ideas automatically correct and all others heretical,".
You said that "Plenty of people " say that the Cass Report is "ill-informed gibberish" - but you didn't answer my point, that any such person 'is plainly not a reliable source." Peckedagain (talk) 17:18, 4 May 2024 (UTC)[reply]
I think the idea that one view immediately makes someone unreliable is heavily pov and unproductive on Wikipedia. This is especially the case in controversial topics such as this. It can certainly question a sources reliability, but this statement means that, for example if the BMJ said this in 2 years time, the BMJ would be unreliable. LunaHasArrived (talk) 19:45, 4 May 2024 (UTC)[reply]
They're not professional associations, they're medical associations. They fully fall under MEDORG. Snokalok (talk) 11:34, 4 May 2024 (UTC)[reply]
@Barnards.tar.gz @Void if removed thanks for your thoughts. I take your points that they are professional associations and that WPATH's response still isn't covered much anywhere.
We shouldn’t be presenting any views in a way that serves to offset, undermine or contradict the findings of the systematic reviews unless those views are based on equivalently weighty research.
This was my main point. WP:MEDORG tells us "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources." Clearly, PATHA, AusPATH, etc, are not "major medical and scientific bodies" and so we shouldn't be listing their oppositions from the most credible body of research available from the NHS, which does meet the aforementioned definition set out by WP:MEDORG and is explicitly listed as an example there. 13tez (talk) 13:01, 4 May 2024 (UTC)[reply]
Okay well they are medical and scientific, this is undisputed, and they are national level for two Commonwealth countries, so they are fairly major. Just like how the NHS is a national level medical body from a Commonwealth country. I notice the issue you're taking is, per your own statement, that they're criticizing the Cass Report. That just makes this entire thing an issue of NPOV. Snokalok (talk) 13:06, 4 May 2024 (UTC)[reply]
PATHA and AusPATH are in no way equivalent to the NHS. It's the national health service for the whole of the UK vs niche professional organisations in Australia and New Zealand that don't even have Wikipedia articles.
the issue you're taking
My issue is the undue weight they're being given as dissenting opinions from two niche groups against the most credible source on the topic from a major MEDORG. From WP:MEDORG: "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the National Academy of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization." PATHA and AusPATH clearly don't meet the standard set out here. 13tez (talk) 13:16, 4 May 2024 (UTC)[reply]
"that don't even have Wikipedia articles."
Right, and most orgs for various fields of medicine (heart health for instance) in France, Germany, the NL, etc don't have their own pages. That doesn't make them irrelevant, it means the project still has more work to do.
"My issue is the undue weight they're being given"
PATHA got three lines, Auspath got two. That's not a ton of weight. And I disagree that PATHA and AusPATH do not meet the standard there. The names listed are all very recognizable for ease of understanding, but if the American Society of Nephrology criticized a report on kidney health, their criticism would still bear indisputable weight. This is no different. Snokalok (talk) 13:46, 4 May 2024 (UTC)[reply]
Right, and most orgs for various fields of medicine (heart health for instance) in France, Germany, the NL, etc don't have their own pages. That doesn't make them irrelevant, it means the project still has more work to do.
This is English Wikipedia, so organisations in countries that don't speak English as a first language are unlikely to have articles; let's discount them. Using your example of heart health, the British Cardiovascular Society (BCS) is (positively) mentioned on the NHS website, the RCP website, and in the BMJ. Since it's mentioned positively in these credible organisations, it's reasonable for us to assume the BCS is itself credible. WP:MEDORG essentially tells us statements from credible and major medical organisations (examples are national and international organisations such as the NHS and WHO) can be used as references, though we have to give due weight, especially in case of disagreements.
If you think the BCS counts as a major medical organisation, then it makes sense that you can use its statements as references, since it's also credible. However, it doesn't fit the examples or definition of major organisations given in WP:MEDORG: national and international organisations that present recommendations and opinions that many caregivers rely upon (or may even be legally obliged to follow). It would be better to take information on cardiology from the NHS or WHO, major medical organisations which meet these criteria and have a broader view of the topic than any one association of cardiologists.
Furthermore, per WP:MEDORG, even if you were to use their statement as a reference, it would still have to be within what's due weight, especially when it is in disagreement with other strong evidence. This means that the outcomes of strong scientific evidence (e.g. NHS-run systematic reviews) would have precedence over a BCS statement based on conventional wisdom, per WP:MEDASSESS. The questions we need to answer are: can we establish PATHA is credible in the same way I described above? Do we think it's a major medical organisation such as the examples given at WP:MEDORG? Given the strength of the evidence it's in disagreement with per WP:MEDASSESS, is it within due weight to include its dissenting response?
ATHA got three lines, Auspath got two.
The due weight point is regarding the following from WP:MEDORG, not the amount of text in WP:WEIGHT: "Guidelines by major medical and scientific organizations sometimes clash with one another (for example, the World Health Organization and American Heart Association on salt intake), which should be resolved in accordance with WP:WEIGHT." 13tez (talk) 15:20, 4 May 2024 (UTC)[reply]
“national and international organisations that present recommendations and opinions that many caregivers rely upon (or may even be legally obliged to follow)”
And both PATHA and AusPATH took part in helping to write the WPATH standards of care, and even outside of that they are the bodies providing these opinions and standards for Australia and New Zealand. Therefore yes, they do apply.
“The due weight point is regarding the following from WP:MEDORG, not the amount of text in WP:WEIGHT”
The issue is here that we’re not writing a page on puberty blockers, we’re not writing a page on HRT, we’re not writing a page on any secondary topic. We’re writing a page on the Cass Report itself. The Cass Report’s role in this page is as the subject, the same way a War and Peace’s role in the War and Peace page is as the subject. I’m not saying every citation to the Cass Report in secondary topic articles needs to have “PATHA criticized this” underneath it, I’m saying that for an article about a report put out by the British government, the responses to that report by relevant medorgs hold weight in the article responses section. Rishi Sunak is not an MEDRS source yet we certainly include his opinion on the matter. Snokalok (talk) 15:29, 4 May 2024 (UTC)[reply]
And both PATHA and AusPATH took part in helping to write the WPATH standards of care, and even outside of that they are the bodies providing these opinions and standards for Australia and New Zealand. Therefore yes, they do apply.
Do they "present recommendations and opinions that many caregivers rely upon (or may even be legally obliged to follow)"? You mentioned their contribution to the WPATH SOC. Can we establish how many or what proportion of caregivers rely upon them, especially after criticism from the Cass Review? Do they form the primary guidance caregivers in gender-related healthcare follow in New Zealand or internationally? What was the extent of their contribution? Does it really count to lump them in as part of WPATH's SOC when the other organisations listed in WP:MEDORG disseminate their own? There are lots of factors to consider here. It's a lot easier to establish with NICE, for example, publishing guidance on behalf of the NHS.
relevant medorgs hold weight in the article responses section
Sure, if we decide they're credible organisations, major, and not outweighing higher-level evidence. 13tez (talk) 15:47, 4 May 2024 (UTC)[reply]
AusPATH:
Standards of care, including primary guidance composed by them specifically independent of other orgs:
https://auspath.org.au/standards-of-care/
Royal Children's Hospital Melbourne outlining their treatment protocol and citing AusPATH for endorsement of said protocol:
https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf
South Australian govt citing AusPATH standards of care and saying that AusPATH should be used as the primary guiding point for GAC in South Australia:
https://www.sahealth.sa.gov.au/wps/wcm/connect/d70c3a24-a054-4f6a-b56c-17152faa9d5c/Model+of+care_Gender+Diversity_Jul2023_FINAL_FOR+PUBLICATION+%281%29.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-d70c3a24-a054-4f6a-b56c-17152faa9d5c-oJF0hpN
The Australian govt's health information page lists them as a valuable resource for info on GAC:
https://www.healthdirect.gov.au/gender-affirming-surgery
So that's AusPATH sorted.
PATHA:
Their own primary guidance composed specifically by them independent of other orgs:
https://patha.nz/Guidelines
NZ Ministry of Health meeting with PATHA to help improve their trans healthcare system:
https://www.pharmacytoday.co.nz/article/unfiltered/unfiltered/patha-vision-transgender-healthcare-under-2022-health-reforms
Royal New Zealand College of General Practitioners Guidelines on GAC directly citing PATHA as having played a major role in writing them:
https://blogs.otago.ac.nz/rainbow/files/2023/03/Primary-Care-GAHT-Guidelines_Web_29-Mar.pdf
So yeah, I think they're sorted as well. They're MEDORGs Snokalok (talk) 16:15, 4 May 2024 (UTC)[reply]
If we're starting up discussion on this again, we should tag those previously involved. @Colin @WhatamIdoing @Anywikiuser @Nil Einne @LokiTheLiar @Your Friendly Neighborhood Sociologist @LunaHasArrived @Sideswipe9th @Licks-rocks @Draken Bowser @Cixous Snokalok (talk) 11:28, 4 May 2024 (UTC)[reply]
If WPATH ever gets around to issuing an actual full response, then we can remove PATHA and AusPATH. But we shouldn't before then. I agree with Snokalok that they're clearly WP:MEDORGs, and that the reasoning for removing their response would be that they're included in WPATH rather than that they're not reliable. Loki (talk) 11:35, 4 May 2024 (UTC)[reply]
I see we're starting this one off strong by calling AusPath and PATHA "fringe patient advocacy groups". grumbling aside, I'm with Loki in that we might want to wait for a more official response. I think I said that in the last discussion, and not much seems to have changed, so it also seems a bit soon to be restarting this discussion in full. And who spilled all this spaghetti on the floor? --Licks-rocks (talk) 12:18, 4 May 2024 (UTC)[reply]
Yeah, it wasn't my most neutral or objective language. My issue is that we're overriding the best evidence we have on this topic from a legitimately major medical organisation with dissent from much, much smaller groups because they (sincerely, I'm sure) believe its implementation will prevent what they see as being the best care for trans people. However, medicine is based on evidence, not on anecdotes or conventional wisdom. Therefore, the findings of this report (the best evidence available, based on peer-reviewed systematic reviews carried out by the NHS) take priority over the various statements (from small, relatively unknown professional associations and based upon their conventional wisdom). There's a vast difference between the report and these statements, per WP:MEDASSESS. The best thing to do for everybody in need of medical treatment is to stay within what the evidence supports (except when gathering evidence on new treatments). In this sense, it's the best thing for those trans people in need of help, too. 13tez (talk) 14:40, 4 May 2024 (UTC)[reply]
You keep claiming that this is "the best evidence available" or earlier "the most credible and authoritative source on the topics it covers", seemingly with the implication that there is no better evidence available. I think it's neccesary to push back on that. It is not the most credible and important source out there. WPATH for example publishes similar reports, which are read and used worldwide, and released at regular intervals to keep up with the state of the science. --Licks-rocks (talk) 14:50, 4 May 2024 (UTC)[reply]
Hi @Licks-rocks, thanks for your thoughts.
It is not the most credible and important source out there. WPATH for example publishes similar reports, which are read and used worldwide, and released at regular intervals to keep up with the state of the science.
I disagree, I think it is. It was created by the NHS, which is a "major medical and scientific organization...[that] present[s] recommendations and opinions that many caregivers rely upon (or may even be legally obliged to follow)", per WP:MEDORG, as well as one of the explicit examples it lists of suitable organisations. The report is based upon peer-reviewed systematic reviews, which are the highest level of evidence in medical research, per WP:MEDASSESS. The NHS and the Centre for Reviews and Dissemination are more reputable than WPATH in medical research. Systematic reviews take precedence over the conventional wisdom presented in the Standards of Care for the Health of Transgender and Gender Diverse People. 13tez (talk) 15:29, 4 May 2024 (UTC)[reply]
Just because something's a good source does not mean other good sources are automatically worse. The standards of care are an internationally recognised clinical practice guideline, which stands at the very top at least in the proctor & gamble version of the medical source quality pyramid, so at worst they are equals. Calling the information contained within "conventional wisdom" also seems a touch demeaning. --Licks-rocks (talk) 16:30, 4 May 2024 (UTC)[reply]
Thanks for your further thoughts.
Just because something's a good source does not mean other good sources are automatically worse.
If you agree that the Cass Review is a reliable source and credible, you should know that one of the peer-reviewed systematic reviews that informed the Cass Review found that: "The WPATH and Endocrine Society international guidelines, which like other guidance lack developmental rigour and transparency have, until recently, dominated the development of other guidelines. Healthcare professionals should consider the lack of quality and independence of available guidance when utilising this for practice. Future guidelines should adhere to standards for guideline development and provide greater transparency about how recommendations are developed and links between evidence and recommendations." Here, they're saying (among other things) the WPATH guidelines fail to adhere to evidence-based medicine, which is essential and foundational to modern medicine. Since this is being said in part of the body of work you consider to be a reliable source published by the NHS, a major and reputable national medical organisation, and in a peer-reviewed systematic review (the highest level of evidence in medical research), you should believe it. Therefore, we can say that the WPATH guidelines aren't as credible as the Cass Review.
The standards of care are an internationally recognised clinical practice guideline, which stands at the very top at least in the proctor & gamble version of the medical source quality pyramid, so at worst they are equals.
The Procter & Gamble builds up in the same way as other pyramids; each level informs the one above it. In it, clinical practice guidelines are informed by systematic reviews (in other words, the best evidence available) which are, in turn, informed by the lower levels. As we discussed before, however, this isn't the case with these guidelines: they were not adequately based upon scientific evidence.
Calling the information contained within "conventional wisdom" also seems a touch demeaning.
Conventional wisdom is a widely used phrase, but maybe not the most polite one available, given the contention. Maybe "popular belief" or "current practice" would be better in that regard?
Thanks again. 13tez (talk) 17:20, 4 May 2024 (UTC)[reply]
I feel like you're doing some mental gymnastics here to support your position. Each rung on the source quality pyramid is supported by those below it, and is therefore based on multiple publications from the rungs below it. This upward accumulation of evidence and cross-comparison is what makes the sources further up on the ladder so reliable. Going back down this informational ladder in order to use something you find there to discredit a better source further up is not how this works. In short, you appear to be cherrypicking here. --Licks-rocks (talk) 18:13, 4 May 2024 (UTC)[reply]
I feel like you're doing some mental gymnastics here to support your position. Each rung on the source quality pyramid is supported by those below it, and is therefore based on multiple publications from the rungs below it. This upward accumulation of evidence and cross-comparison is what makes the sources further up on the ladder so reliable.
I agree. The WPATH guidance fails to do this, hence its lack of credibility.
Going back down this informational ladder in order to use something you find there to discredit a better source further up is not how this works.
As discussed, the clinical guidance from WPATH is not based on the evidence in the levels below it. This fact is supported by a systematic review peer-reviewed and published in the BMJ. Therefore, it shouldn't be considered valid at all, let alone of higher quality than the Cass Review or its peer-reviewed systematic reviews. 13tez (talk) 18:33, 4 May 2024 (UTC)[reply]
You can't cite the thing I've just disagreed with as the reason I should agree with you. I could theoretically just take my previous comment and copy it here, but I don't think there's much point, so this is where I take my leave. (Okay, one more point: you should be wary of when a paper says stuff it can't really back up. If just one review study came to that conclusion, it's highly possible that this claim reflects the opinions of the authors, rather than necessarily being based in fact. It happens.) --Licks-rocks (talk) 18:37, 4 May 2024 (UTC)[reply]
Okay, sorry we couldn't see eye-to-eye. Thanks for talking it out anyway. It's worth saying that methods of ranking the quality of different types of evidence like WP:MEDASSESS and the levels of evidence in medical research are based upon the assumption that each piece of evidence is itself scientifically scrupulous (peer-reviewed etc). Even if a piece of evidence is of a type relatively high in these hierarchies, if it's not scientifically valid, it isn't good evidence.
If just one review study came to that conclusion
Firstly, it's a study of extremely high quality, so we shouldn't be questioning its credibility or findings. Secondly, another paper published in Social Science & Medicine says "TGNC people and clinicians have criticized the [WPATH] SOC for relying too heavily on expert opinion and called for updates that incorporate stronger evidence (Berli et al., 2017; Riggs et al., 2019)." 13tez (talk) 18:47, 4 May 2024 (UTC)[reply]
I think a very important thing to say that Cass's report whilst based on systematic reviews is not top tier medical evidence. I also think that proper criticism to the systematic reviews will take much longer than a month and that I'm sure there's a lot of people researching why these reviews found different results to other systematic reviews. Some people are claiming that this is just because the other reviews accepted lower quality evidence but anybody saying that at this point just probably hasn't done the full research necessary to produce that response. Because of this I think it's important to consider, whats the strongest possible condemnation to this report possible at this moment in time when weighing up what to put in this article. Not saying we should weigh medorg statements equally with a systematic review, but consider that if there are proper problems with the systematic reviews, all a medorg could have done by this time is put out a statement. LunaHasArrived (talk) 16:58, 4 May 2024 (UTC)[reply]
@LunaHasArrived
> I think a very important thing to say that Cass's report whilst based on systematic reviews is not top tier medical evidence.
Not true. This has been argued at length above: @colin is perhaps the most science/statistics savvy editor here and has backed Cass: "the evidence about e.g. puberty blockers really doesn't make the grade".
That was 3 weeks ago: and yet editors are stilling making unsupported claims to the opposite.
I'd recommend anyone confused about the calibre off Cass, take time to read Colin's comments here. Peckedagain (talk) 18:00, 4 May 2024 (UTC)[reply]
I should have been more specific. The idea that anybody critiquing Cass is critiquing systematic reviews is just plain wrong. This isn't to say Cass isn't Medrs or unreliable. It's just to say Cass is not the systematic reviews Cass made her report on and us editors need to be very specific about what people are referring to and that people can rightly critique Cass's report without going against the top of the Medrs pyramid. Especially on the less BMI and more opinionated parts of the report. LunaHasArrived (talk) 20:02, 4 May 2024 (UTC)[reply]
Cass's report whilst based on systematic reviews is not top tier medical evidence
At the risk of people jumping on this to discredit the review, yes there's some nuance there; it isn't itself a peer-reviewed systematic review, but it is informed by several it specifically commissioned, it was written by qualified medical researchers, and it was itself commissioned by the NHS.
I also think that proper criticism to the systematic reviews will take much longer than a month
I agree. If criticism gets past peer-review in a credible medical journal, it'll be reasonably scrupulous, even if not as high a level of evidence.
whats the strongest possible condemnation to this report possible at this moment in time...all a medorg could have done by this time is put out a statement
That's a good point. 13tez (talk) 18:04, 4 May 2024 (UTC)[reply]
it is informed by several [systematic reviews] it specifically commissioned
When I say this, what I mean is that the review is a discussion and almost an explanation of what the systematic reviews are showing and making findings and recommendations from them. And it's qualified people doing it who were commissioned to do so by the NHS. 13tez (talk) 18:06, 4 May 2024 (UTC)[reply]
Oh yes, I'm not saying at all that the Cass review itself should be discredited. It's just medorgs criticising it can do so without criticising systematic reviews, they're criticising Cass's recommendations and findings. LunaHasArrived (talk) 18:18, 4 May 2024 (UTC)[reply]
Ah right, forgot @LilianaUwU. Anyone else I'm missing? Snokalok (talk) 12:56, 4 May 2024 (UTC)[reply]
This may be a bit of a late response (life be like that sometimes), but I agree with Loki. I think what LunaHasArrived just above hits the nail on its head: the medical organisations are not necessarily criticising the meta-analysis, but the recommendations. An official response would be fantastic, but we sadly don't have one yet Cixous (talk) 11:04, 7 May 2024 (UTC)[reply]
Okay except, they are widely reputed MEDORG's. Just because their findings are in favor of GAC does not make them fringe nor advocacy groups, and it's pretty blatant POV to try and frame them as otherwise. Snokalok (talk) 11:32, 4 May 2024 (UTC)[reply]
Yeah, we don't disqualify opinions. The receptions section is about the public debate following the review. To the extent that opinions by relevant orgs and pundits were repeated by reliable sources, we're liable to include them. Draken Bowser (talk) 22:43, 4 May 2024 (UTC)[reply]

I took a break and catching up have skimmed the above. I'm seeing an awful lot of wikilawyering going on, with MEDORG and PRIMARY being used as weapons. One of the problems with wikilawyering is that two editors with opposite POVs they want to push can end up arguing past each other endlessly. It is frankly tedious to keep seeing the words "primary" being invoked against Cass and the NHS, and the Cass final report FAQ being dismissed as though the plain objective facts it states must suddenly be regarded as unreliable, and yet all the BS that came out from people-who-should-know-better was somehow reliable. I imagine that those who say "Anything Cass says about the report is primary and can be dismissed as unreliable" will later forget to argue "Anything WPATH say in their defence (of the criticism that their guidelines are not evidence based and built on shaky foundations) is primary and can be dismissed as unreliable". This sort of wikilawyering is getting us nowhere useful.

I repeat the comment I made earlier that the each layer in the MEDRS pyramid depends on the layers below. One can only point to clinical guidelines as top-tier evidence sources when they are themselves based on top-tier evidence sources, such as systematic reviews, randomised controlled trials and so on. Currently the WPATH guidelines have been explicitly called out, by a systematic review in a top tier journal, as not being evidence based. That leaves them in an uncertain position, and one that isn't typical.

My name has been mentioned a few times and generally to argue a simplistic point. I'm not saying the Cass Review and the systematic reviews are perfect and that any possible criticism of them is scientifically unsound. I am saying that currently these systematic reviews represent the best MEDRS sources for Wikipedia's voice on whether certain therapies work and are safe. If those claiming "there is evidence" and "these reviews are flawed" are right, then I look forward to them publishing a better systematic review in the NEJM. Merely saying "there is evidence" isn't enough and we can't RIGHTGREATWRONGS by choosing who we want to believe and giving them a voice in our article. And I'm saying that most of the criticism published so far is easily dismissed as flat out wrong, not merely matter-of-opinion wrong. But that may change. I also separate criticism of the scientific evidence gathering and criticism of "well what should we do in the absence of evidence", which is far more something that reasonable people might disagree about.

Lastly, the myth that the systematic reviews dismissed 98% of the evidence was easily shown false because the reviews themselves spell out what evidence they used. This myth seems to have been replaced now with a social media myth that OK, the systematic reviews looked at most of studies, but Cass herself didn't. This is a made up story with nothing to support it. Wanting something to be true seems to make people spread all sorts of nonsense. -- Colin°Talk 12:36, 5 May 2024 (UTC)[reply]

Regarding primary, the simple fact is that while the Cass Report may be considered an MEDRS for secondary topics (puberty blockers, HRT, etc) it is a primary source on the Cass report. A text is inherently a primary source on its own contents, that’s simply a fact. Beyond that, while no one is saying that the Review’s FAQ response is inherently invalid, it cannot be taken as reason to exclude other criticisms. Excluding criticisms from reliable and weighty sources simply because the one being criticized said “Nuh uh” and “We’ve investigated ourselves and found no wrongdoing” is such a wild conflict of interest and places so much more privilege on the source being criticized than the one criticizing. Not to mention, the FAQ is not a systematic review. At best it’s a MEDORG statement.
Regarding the quote “Anything WPATH say in their defence (of the criticism that their guidelines are not evidence based and built on shaky foundations) is primary and can be dismissed as unreliable" if WPATH answered criticisms, their answer would be notable as an answer to criticisms, but it would not be a reason to exclude those criticisms entirely as some are arguing for.
” Lastly, the myth that the systematic reviews dismissed 98% of the evidence was easily shown false because the reviews themselves spell out what evidence they used.”
Right but that’s only one topic the FAQ addressed. There are others where its answers are of more variable factuality, such as their claim that they didn’t use an uneven standard of evidence when in the report they directly say that the evidence for psychosocial intervention is as weak as that for hormonal, and yet they then recommend psychosocial as the default and for excluding medical interventions in the majority of patients. Snokalok (talk) 12:58, 5 May 2024 (UTC)[reply]
Snokalok, I've been over this "primary for itself" wikilawyering tediousness before. Yes, it is primary for "did the Cass review actually say those words or not" and primary for "Cass herself now recommends X" but it is secondary for most of the words we write on this page, which are medical facts about evidence and therapies and patient population trends and whether other guidelines are evidence based and so on and so on. While we do attribute those words in many cases, we simply wouldn't be writing them out in any detail if they were fringe conspiracy theory level beliefs, which some people here seem to be claiming. If people want to argue about which criticisms to include or not, please do it properly, and not by waving PRIMARY in a way that just confirms a lack of understanding.
Describing the FAQ as "We’ve investigated ourselves and found no wrongdoing" is frankly a twitter-level incoherent description of the FAQ. It wasn't an "investigation" and the criticisms that it address are mostly basic reading comprehension and maths ability issues. Please don't frame this like we need some independent commission to look at the review and agree about the points currently at Final FAQ. A FAQ which also mysteriously doesn't mention the "uneven standard of evidence" claim. So you appear to be arguing about something that doesn't exist. -- Colin°Talk 10:04, 7 May 2024 (UTC)[reply]
Whilst not directly the question, I do think the first faq is trying to argue about the standard of evidence. One point of note is that it says "interpretation of the findings met the highest standards of impartiality ", which is only notable as members of SEGM claim they worked on the report. I do agree that the vast majority of the bits in the Faq probably meet WP: BLUESKY, and are trying to give nuance to ideas that had been exaggerated due to the nature of media. LunaHasArrived (talk) 10:46, 7 May 2024 (UTC)[reply]

These 12 lines seem undue: Interim report, the ACP-UK section[edit]

Firstly, these comments are about the 2022 interim report, which are now moot given that the final 2024 report is out. Secondly, despite conversation here in Talk, no editor has brought up evidence that ACP-UK is a meaningful organisation: it has no Wiki page and no one here has found out how large it's membership is.

So 12 lines about it's views, and some of it's members disagreeing, seems undue.Peckedagain (talk) 14:21, 4 May 2024 (UTC)[reply]

The ACP-UK seems to have no independent significant coverage (a grand total of 4 (four) news articles on the internet mention them, and they provide next to no information on what ACP-UK is) so 1. no wiki page should be created for this organisation per WP:NORG 2. I agree this is undue.
The two articles about the ACP-UK not already used as sources in this article are:
https://www.theguardian.com/uk-news/2023/nov/12/psychology-body-says-costs-ruling-unfair-in-appeal-on-use-of-unregulated-experts-in-england-and-wales
https://www.lawgazette.co.uk/news/intervenor-hit-with-20000-costs-for-acting-unreasonably/5117811.article Flounder fillet (talk) 13:52, 6 May 2024 (UTC)[reply]

The collapse of the Scottish Government is caused partly by unwillingness to accept the Cass review - is it time here on Wiki to accept the report too?[edit]

Scottish newspaper the Herald:" Just last week, the First Minister admitted that Patrick Harvie's unwillingness to accept the findings of Dr Cass’s review had played a part in the collapse of the coalition government, which ultimately led to his downfall." [1]Peckedagain (talk) 14:48, 4 May 2024 (UTC)[reply]

… What? Snokalok (talk) 14:55, 4 May 2024 (UTC)[reply]
The full text continues:
"Last month, during an interview with the BBC’s Sunday Show, Mr Harvie - who was a minister at the time - was asked if he accepted that the Cass report was a valid scientific document. He replied: "I've seen far too many criticisms of it to be able to say that.” The next day, during an interview with the BBC’s Today programme, he was asked if he accepted the findings of the Cass Review. He said it had been “politicised and weaponised” against trans people. The comments triggered a motion of no confidence from Alba MSP, Ash Regan.
While the SNP's chief whip claimed publicly that none of her members would back the vote, reports have suggested that a number were likely to rebel.
In his first interviews since announcing his intention to resign, Mr Yousaf said the comments had caused problems. Mr Yousaf told the BBC: “I made it very clear my position and the government’s position was on the Cass review, but it is fair to say that of course those comments that were made by Patrick Harvie on the Sunday Show did upset a lot in my group. Peckedagain (talk) 15:38, 4 May 2024 (UTC)[reply]
What is the point you're trying to make here? Snokalok (talk) 15:40, 4 May 2024 (UTC)[reply]
That the consensus of reliable sources is that the Cass Review:
  • is a valid scientific document
  • it's findings are essentially sound.
After all - we have 2 governments, 2 National Health System in alignment: and a quick google shows many commentators agreeing - here in the UK whether in the left-leaning Guardian or the right-leaning Telegraph.
This is in contrast to you saying here that Cass is: "Is not the most credible and important source out there." And that WPATH publishes 'similar reports' - a claim that is laughable in it's lack of support. Peckedagain (talk) 15:52, 4 May 2024 (UTC)[reply]
And none of this changes the mountains of international medical orgs criticizing them.
So no, the consensus of the reliable sources is not that the Cass Review is valid or sound. The consensus in the United Kingdom alone might be that, but as I said previously, the UK is not the only country in the world.Snokalok (talk) 16:28, 4 May 2024 (UTC)[reply]
So if you believe that WPATH has published 'similar reports': please do show the exact URLs here. And 'similar report' does NOT mean 1 or 2 bits of research already reviewed by Cass which reviewed over 100 such!
No one in this page has so far pointed to anything close to Cass in it's scope and thoroughness and credibility. But if you have something up your sleeve, do share.
Don't link to anything at the BBC, because you've argued at length here to ban them, and other RSs from this page! You wrote: "Oh. Yay! Then let's do so! Right, do we just need sources from the telegraph and times themselves demonstrating their unsuitability, or do we need other outlet to directly say "The Times and The Telegraph write anti trans propaganda" ... I'd argue we could also perhaps get the BBC to yellow on trans issues. There's a ton of info on the trans rights in the UK page as to why" Peckedagain (talk) 17:40, 4 May 2024 (UTC)[reply]
As far as I'm aware, the Cass Review was only prepared for NHS England, and is mainly relevant for the NHS, and not for other countries. Can you provide more information on what changes you are proposing to make, and what sources support those changes? Hist9600 (talk) 17:57, 4 May 2024 (UTC)[reply]
@Hist9600 - your points have been covered several times already - have you read the long discussions on this page? Or the Cass report?
It pulled in international evidence and current practise:
Eg Cass report "An appraisal of international guidelines ...", "Only five guidelines described using a systematic approach to searching for and/or selecting evidence (AACAP 2012, Endocrine Society 2017, Finland 2020, Sweden 2022 and WPATH 2022).", "... Only the Swedish and Finnish guidelines linked the lack of robust evidence about medical treatments to ... they are also the only guidelines that have been informed by an ethical review conducted ... " . And three times: "...in the UK and internationally..."."the practice of pausing puberty at Tanner Stage 2 was initiated in the Netherlands, and subsequently adopted in the UK and nternationally."
And yes you're right, it was commissioned for NHS England and that is only one country - but Scotland have followed suite already. No other country has done such a comprehensive, 4 year study: so it is highly likely that the report will influence worldwide health practise. Peckedagain (talk) 18:20, 4 May 2024 (UTC)[reply]
I think you have quickly veered off-topic from a collapse of the Scottish government, to a general defense of the Cass Review (WP:OR). The posts here are barely coherent, and I haven't seen any clear indication of what you are proposing or why independent reliable sources could be said to support those changes. Hist9600 (talk) 19:33, 4 May 2024 (UTC)[reply]
Hi @Hist9600
So you read the Cass Review and the FAQs - and then asked above: " the Cass Review was only prepared for NHS England, and is mainly relevant for the NHS, and not for other countries"
Wasn't that question already answered by Cass:
> ... looked at 237 papers from 18 countries, providing information on a total of 113,269 children and adolescents.
Can you find any review, from anywhere in the world, by an equivalent national health service, that gets close to that breadth? Peckedagain (talk) 00:48, 5 May 2024 (UTC)[reply]
While the breadth of the studies considered is important, it is only one factor, and the review is only one review. It was also endorsed universally by gender-critical organizations, and international medical organizations in the field have criticized its methodology and findings. We should take care when covering this review and be sure to use independent reliable sources.
Again, wasn't this section about the collapse of the Scottish government? Why are you now changing the topic to a general defense of the Cass review? I don't think that is necessary, since we follow reliable sources on the matter. Determining whether the Cass Review as a whole is "correct" is not our role as Wikipedia editors. Hist9600 (talk) 14:50, 5 May 2024 (UTC)[reply]
The Cass review is afaik the most thorough review of the subject matter since the SBU review of 2022. Saying the Cass review is only important with respect to the NHS is like saying the SBU 2022 was only important to the Swedish healthcare system. Sure, the recommendations are with respect to the NHS, but the ramifications of an in-depth review considering the international body of research are more far reaching. Draken Bowser (talk) 22:39, 4 May 2024 (UTC)[reply]
The Cass Review was prepared for NHS England, and its purpose was to provide recommendations. The NHS had failed previously to provide adequate timely services for transgender people. If the Cass Review has implications beyond that, then we can follow independent reliable sources about those events, and we don't need to speculate about them. Hist9600 (talk) 14:53, 5 May 2024 (UTC)[reply]
"So if you believe that WPATH has published 'similar reports': please do show the exact URLs here."
Why, I can't find anywhere that I said such a thing. That's not to say that I don't believe it or that I do, simply that I never made this claim. If you have otherwise, please by all means provide a diff.
As for the BBC, my sole comment on that has been "I'd argue we could also perhaps get the BBC to yellow on trans issues". Hardly the grand litigation, the verbose, impassioned diatribes that would constitute an argument at length. Again, not that I don't believe it, nor that I do. Simply that it's an inaccurate characterization. Snokalok (talk) 18:20, 4 May 2024 (UTC)[reply]
Actually it was not you but @Licks-rocks, an edit sandwiched between yours, apologies.
> That's not to say that I don't believe it or that I do.
Do share a URL, if you do believe it, it'll help the page. Peckedagain (talk) 18:26, 4 May 2024 (UTC)[reply]
You mention the BBC - has your view on these RS's changed, or not?
> The Times and The Telegraph write anti trans propaganda Peckedagain (talk) 18:30, 4 May 2024 (UTC)[reply]
I think the Bute House Agreement ultimately collapsed over disagreements on net zero targets. The Cass Review currently isn't mentioned in Bute_House_Agreement#Dissent_over_continuation. If it did contribute, it might make more sense to develop this information in that article first? 13tez (talk) 15:56, 4 May 2024 (UTC)[reply]
I'd say that you're not wrong - Harvie's comments on Cass were merely 1 factor Peckedagain (talk) 17:42, 4 May 2024 (UTC)[reply]
I think you might be right. It's definitely worth adding to the article on the Bute House Agreement. 13tez (talk) 18:39, 4 May 2024 (UTC)[reply]
@13tez - I've now done that. Peckedagain (talk) 01:03, 5 May 2024 (UTC)[reply]

References

  1. ^ https://www.heraldscotland.com/news/24297566.cass-review-author-appear-holyrood-health-committee/

The page has been protected- but I can't find out why?[edit]

Sorry if my ignorance is showing: The page says: "This article is currently protected from editing until May 7, 2024 at 18:22 UTC, or until editing disputes have been resolved."

Apparently: "For more information on who protected the page and for what reason, see: The talk page of the protected page"

But there is no explanation here? Peckedagain (talk) 19:00, 4 May 2024 (UTC)[reply]

https://en.wikipedia.org/w/index.php?title=Wikipedia:Requests_for_page_protection/Increase&oldid=1221582638
The relevant page protection request is near the bottom. Flounder fillet (talk) 22:21, 4 May 2024 (UTC)[reply]
Thanks @Flounder fillet, that was well hidden!
> Reason: IP Editor making persistent disruptive edits to the lede three times now despite being reverted by multiple editors. Requesting Semi-Confirmed Protection Snokalok (talk) 17:41, 30 April 2024 (UTC)[reply]
Ive searched for 'IP Editor' but can't find out what that means?
And how do folks find out which specific edits those were. Apologies if these are questions you all know well: I've spent time trying to find this stuff, and somehow the wiki UI does not make it easy.(why wasn't Flounders link in the page where it says protected? Or am I missing something obvious and making a fool of myself? Peckedagain (talk) 00:00, 5 May 2024 (UTC)[reply]
IP editors are editors who are not logged in, whose "usernames" are their IP addresses. If you ever see an edit by someone whose username is a bunch of numbers with dots or a really long sequence of letters and numbers, that's an IP editor. As for the edits that led to page protection, they are currently near the top of the edit history of the article. Also, the link I posted wasn't accessible in any straightforward way, I had to manually retrieve it from the page history of Wikipedia:Requests for page protection/Increase. Flounder fillet (talk) 00:17, 5 May 2024 (UTC)[reply]
@Flounder fillet -many thx for helping my understanding. I only see two IP articles at the top, both by '147.219.171.237' and both just 1 word changes. So 'Edit warring' can be so small? Peckedagain (talk) 12:55, 5 May 2024 (UTC)[reply]
There’s also the new account with one edit and that one edit was re-implementing the IP’s reverted edit, that can thus be reasonably taken as the same editor. Snokalok (talk) 13:03, 5 May 2024 (UTC)[reply]
@Snokalok thanks. Why doesn't Wiki put that kind of detail in the Protection message at the top of the page? It seems like the wiki software has an error or something, that those facts are obfuscated down in the depths? Peckedagain (talk) 13:52, 5 May 2024 (UTC)[reply]
They probably have their reasons Snokalok (talk) 14:06, 5 May 2024 (UTC)[reply]
@Snokalok - you raised the Protection. Where can the text be viewed that you wrote at the time to support that action? Peckedagain (talk) 14:14, 5 May 2024 (UTC)[reply]
It’s literally just the message you copied and pasted above requesting semi-confirmed protection. No other text was given. Snokalok (talk) 14:16, 5 May 2024 (UTC)[reply]
  • You may want to read WP:PROTECT. In this case the article is fully-protected, such that only administrators can edit it; this is relatively uncommon, compared to extended-confirmed protection or semiprotection, but does happen every once in a while. It implies that some more-obnoxious-than-usual shenanigans are going on (usually that the edit war involves extended-confirmed users). I haven't really been paying attention to this article, so I couldn't say what the deal was (I just came here to read it to figure out what the heck a "Cass Review" was, noticed it was fully protected, and came to the talk page to see what was going on). A page getting fully-protected for a few days is typically a way for the protecting admin to tell everybody to calm the hell down and I really mean it this time I will turn this encyclopedia article around if you don't stop hitting each other back there. El C has been around for quite some time so he knows what he is doing and I am inclined to assume he had some smart reason for doing this. jp×g🗯️ 17:13, 5 May 2024 (UTC)[reply]

If the problem involved an IP and an account with 1 edit, why was it fully protected? Skyshiftertalk 23:16, 5 May 2024 (UTC)[reply]

Well he's right there we can just ask him. @El C: jp×g🗯️ 06:12, 6 May 2024 (UTC)[reply]
The protection was in response to a request at RfPP (diff). I saw edit warring by various parties over the last couple of weeks. I'm not obliged to confine the scope to a couple of days. Anyway, a couple of days till the protection expires. Hopefully, the break from the all the edit warring proved productive. El_C 07:47, 6 May 2024 (UTC)[reply]

The WPATH is silent on the criticisms by Cass - will active editors here help improve it?[edit]

There are several editors on this Cass page who are arguing consistently for the approach that valid criticisms should get coverage: Snokalok (talk), LunaHasArrived (talk), Loki (talk)

The WPATH page has no mention of the Cass report's comments/criticisms of it; nor anything in the Talk page about it - despite the fact that the Cass report mentions WPATH 394 times, so would benefit from the approach that you three advocate. I see that Snokalok and LunaHasArrived have already been active there in the Talk page.

The aim would be to follow the exact approach that you three have argued for in this page: that criticisms are important to have in a page.

A side note, the WPATH talk page is very quiet - less than 100 edits, versus this pge with ~ 1000 - so a little more TLC there wouldn't hurt Peckedagain (talk) 11:59, 5 May 2024 (UTC)[reply]

Wikipedia:Be bold
LunaHasArrived (talk) 13:45, 5 May 2024 (UTC)[reply]
@LunaHasArrived Thanks. Would you agree that the WPATH page should have comments and criticisms from Cass? And @Snokalok - you too?
Because... your comment to 'being Bold' - my experience here in Cass, is that I was immediately reverted by @Snokalok: (despite much of the text I added being direct quotations from Cass and RS sources like the BMJ) - and later even had my personal motives criticised by him: "It’s very telling about your editing perspective that you try and make false claims..." Peckedagain (talk) 14:34, 5 May 2024 (UTC)[reply]
I suggest reading WP:BRD. Being bold and being reverted are part of the natural process. Snokalok (talk) 14:37, 5 May 2024 (UTC)[reply]
I was more focusing on, if you think stuff on the WPATH page needs fixing, fix it. People might disagree but this is heavily Wikipedia:NOTFORUM territory. Also please remember good faith LunaHasArrived (talk) 14:49, 5 May 2024 (UTC)[reply]
The main reason for that is that WPATH isn't the right target for it, as the Cass Review is about the Standards of Care (SOC) published by WPATH, in particular primarily the older SOC7 as the underlying systemic review for the most part concerned itself with the older standard as the newer SOC8 came out around the same time that the systemic review that the Cass Review is based on concluded with looking at data prior to 2022 (and the newer SOC was published in 2022).
And thusly, we do have a mention of the Cass Review on the more appropriate target of Standards of Care for the Health of Transgender and Gender Diverse People#Version 7 already after it was discussed on the Talk page. Note that the SOC article is a medical article, so WP:MEDRS and WP:MEDDEF apply, which is why there is limited commentary, other than mentioning that the systemic review that is the actual medical paper was used to inform the Cass Review, but we did not include direct Opinion commentary from Cass as they are primary. So if you want to discuss this further, you should head to Talk:Standards of Care for the Health of Transgender and Gender Diverse People#Systematic review by University of York as that is the appropriate venue. Raladic (talk) 18:32, 5 May 2024 (UTC)[reply]
@Raladic- your statement that Cass primarily looked at Soc 7 and not Soc 8 is disproved by a cursory search of the Cass Review -
The word 'WPATH is used 35 times, of which 13 are 'WPATH 8'. 'WPATH 7' occurs 4 times, in most cases 'WPATH 8' is in the same sentence: ie Cass is contrasting 7 and 8.
A whole page is titled: "World Professional Association for Transgender Healthcare (WPATH) 8 guideline (2022). (page 131).
I have created a seperate section specifically for the mentions in Cass of WPATH, so that it is easy for all Editors to reference. — Preceding unsigned comment added by Peckedagain (talk • contribs)
It appears you misread what I said - I said the underlying systemic review did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did - it looked at guidance to 2022, just prior to the WPATH SOC8 being published and only cursory included reference to SOC8.
You have to differentiate between the peer-reviewed systemic review, that is Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1) | Archives of Disease in Childhood (bmj.com) and the Cass Review that drew from it and some other parts, but they are not interchangeable. The other important part is that the Cass Review is the guidance for gender-affirming care for one country, the UK. Whereas much parts of the rest of the world do still follow WPATH as worldwide guidance. So while the Cass Review provides criticism of much of the WPATH SOC standards, this isn't a universal or worldwide view, so we have to be careful to put not put too much undue WP:WEIGHT of it and rush to conclusions what it means for the rest of the world as we do not have a WP:CRYSTALBALL. We follow what the WP:RS, and in this case because we are concerning a medical topic, more specifically WP:MEDRS, which has a higher standard (in which case, the Cass Review itself, which is not peer reviewed, may fall short) on what inclusion is warranted or which is not. Raladic (talk) 22:05, 5 May 2024 (UTC)[reply]
@Raladic
You have edited your own earlier comments (to insert the 2 words "underlying systemic".
And then quoted the changed text saying:
  • "It appears you misread what I said - I said the underlying systemic review did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did review did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did."
A) Why try to mislead in this way?
B) Why are you simply ignoring the actual text from Cass that I provided here, and simply re-stating your opinion without providing any evidence to support it? Peckedagain (talk) 22:44, 5 May 2024 (UTC)[reply]
Part of working with other editors on Wikipedia is to assume good faith. Please be mindful of this when engaging with other editors here. Hist9600 (talk) 22:54, 5 May 2024 (UTC)[reply]
As you can clearly see from the edit history, I first replied to you to clarify what I had meant (since it appeared to have caused confusion) and then edited the prior comment to make it clearer to avoid any further confusion for other editors.
I did not try to mislead anyone as even my original comment did already say ...that the systemic review that the Cass Review is based on..., but that nuance was lost, which caused you to make your reply to begin with, which is why I first clarified it and then edited it.
I recommend you take a read of WP:ASPERSION before casting any further accusations of intentional misleading. Please assume good faith when interacting with other editors.
Also, I am not ignoring your text, I just pointed out that there is a difference between peer reviewed medical articles, and synthesis thereof, which the Cass Review is, which is why I pointed you to the relevant WP:MEDRS guidelines as a possible reason of why the WPATH page has no mention of the Cass Review and why we have a very brief mention of it on the SOC7 article after a talk page discussion happend there as WP:DUE was relevant on what, if any, is relevant. Raladic (talk) 22:57, 5 May 2024 (UTC)[reply]
@Raladic
I am not ignoring your text,
You are, and have ignored it again. The history is straightforward:
  • you stated of Cass that it "did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did review did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7, because it did."
  • I supplied a score of quotations form Cass itself that disproved that claim.
  • you reply yet did not say whether those facts had caused you to review your statement or not.
So either there is supporting evidence for your statement: or we agree that it is not founded on fact. Peckedagain (talk) 23:29, 5 May 2024 (UTC)[reply]
Raladic is 100% correct here. The studies that compose the actual review barely mentioned SoC 8. It's the report that mentioned it more, but the report is just the professional opinion of the authors, not a review, nor even a study at all. It's a government report. Loki (talk) 23:41, 5 May 2024 (UTC)[reply]
@LokiTheLiar
You are expressing a Wikipedia:Fringe theories when you caricature the Cass Review as merely 'a government report'
> just the professional opinion of the authors, not a review, nor even a study at all. It's a government report.
That has been debunked here in talk already. -eg read back to Colin's clear statements. Peckedagain (talk) 23:51, 5 May 2024 (UTC)[reply]
@LokiTheLiar
You are expressing a Wikipedia:Fringe theories when you say Cass is:
> just the professional opinion of the authors, not a review, nor even a study at all. It's a government report.
That has been debunked here in talk already. Peckedagain (talk) 23:59, 5 May 2024 (UTC)[reply]
What? No it's not. The reviews are high quality peer reviewed academic studies. The report isn't. It is compiled by a qualified group of people but it's not the reviews, it's a professional opinion about the reviews... and many other things, as you appear to have discovered.
Like, I am not saying this just to trash it. The DSM is also in this category: it's not a peer reviewed study either because it's not a study, it's a series of professional recommendations. WPATH's guidelines are in a similar boat. To the extent any of these things are evidence based they are high quality MEDRS sources. However, this is clearly a case where the report is getting ahead of the studies it's based on, right? The actual reviews could not have done any serious evaluation of SoC 8 either way, so when the report criticizes SoC 8 it is necessarily not based on peer reviewed studies. Loki (talk) 00:12, 6 May 2024 (UTC)[reply]
That's true, I think Peckedagain is confused on this point. There is a difference between a review study, like a systematic review and meta-analysis, published in a peer-reviewed academic journal, and a report prepared for a government medical service like the NHS. Hist9600 (talk) 04:24, 6 May 2024 (UTC)[reply]
@Hist9600 you write:
  • There is a difference between a review study... published in a peer-reviewed academic journal, and ... (one) for a medical service like the NHS.
True, by definition, in all cases.
Why is that relevant to Cass?
PS - I'd appreciate if you avoid personalising our conversation:
  • (your) posts here are barely coherent
  • (you) are confused on this point.
Peckedagain (talk) 11:40, 6 May 2024 (UTC)[reply]
This is relevant because the final report of the Cass Review is not a systematic review itself. The systematic reviews commissioned by the Cass Review and the report are not the same. The reviews can be found here. Flounder fillet (talk) 13:03, 6 May 2024 (UTC)[reply]
@LokiTheLiar
> ... when the report criticizes SoC 8 it is necessarily not based on on peer reviewed studies.
Why do you think it a criticism of Cass, If WPATH have not published any 'peer reviewed studies. under WPATH 8 -and therefore Cass can't mention them?
You DO already know about the wide extent of WPATH and WPATH 8 facts that Cass included - because you commented on 'List of Mentions of WPATH 8 in Cass' which I created to assist editors on both sides of this issue. See Talk:Cass Review#List of mentions of WPATH in Cass - dis-proving claims that WPATH 8 was not thoroughly reviewed there
Your comment seems a (weak) variant of the claim yesterday by @LunaHasArrived that Cass only included WPATH 7 and not WPATH 8. Which the list of Cass quotes above undermines. And to date, no editor here has produced a RS that says otherwise. Peckedagain (talk) 11:26, 6 May 2024 (UTC)[reply]
Several editors disagree:
  • "this isn't to say Cass isn't Medrs or unreliable" ( @LunaHasArrived)
  • "it is published on the official Cass Review website. To me, this gives it credibility in the same way as something published on the NHS website." @13tez
And anyway, you've already been round this loop before with Colin - at great length. Did you take up his suggestion you seek advice at WT:MED  ?
  • The fact we are discussing the Cass report on this article page doesn't magically stop it being a first class MEDRS compliant secondary source on biomedical facts and claims. If you can agree with me (and WAID) that the Cass review can be BOTH a primary source for certain things on this page AND a MEDRS compliant secondary source for other things on this page, we can all move on. Otherwise, please go post a request at WT:MED for clarification, and I'm sure someone will be along shortly to put you right.
Peckedagain (talk) 00:21, 6 May 2024 (UTC)[reply]
Last time I try it. I pointed out that the Cass review concerns itself with the Standards of Care published by WPATH and we do already have it mentioned there as I pointed out in my very first response to you further up- And thusly, we do have a mention of the Cass Review on the more appropriate target of Standards of Care for the Health of Transgender and Gender Diverse People#Version 7 already after it was discussed on the Talk page.
My side-note about SOC7 vs SOC8, was that, a side note.
You asked why the WPATH page doesn't have a mention and I provide an answer to it - that the more appropriate target for it was the SOC article, where we already have it referenced. The Cass Review, or from a medical sourcing view, the underlying systemic review, concerned itself with the SOC, not WPATH as an organization. Raladic (talk) 23:46, 5 May 2024 (UTC)[reply]
>My side-note about SOC7 vs SOC8, was that, a side note.
As you have not provided evidence that the Cass report "did primarily concern itself with the 2009 guidance from the Endocrine society and WPATH SOC7"
Then reading between the lines, you now agree that Cass did thoroughly include Wpath 8 in it's scope, Ie, that your are withdrawing your 'side note'. Peckedagain (talk) 23:55, 5 May 2024 (UTC)[reply]
Pecked, I think it's time for you to read WP:BLUDGEON and stop posting here for at least a bit, the sheer mass of your comments alone makes this and other discussions on this page almost unreadable. --Licks-rocks (talk) 13:13, 6 May 2024 (UTC)[reply]
@Licks-rocks
'Sheer mass', you think?
I did post alot yesterday (20) - partly uploading a useful resource that editors of all sides can refer to: 'List of mentions of WPATH in Cass'
But 20 in a day is less than Snokalok's 27 on the 4th May.
And Raladic did 13 yesterday - there was to-and-fro between us on her claim that Cass didn't include Wpath 8 just 7.
Comparing editors History shows:
  • Found 70 edits by Peckedagain on Talk:Cass Review (8.78% of the total edits made to the page)
  • Found 189 edits by Snokalok on Talk:Cass Review (23.71%
  • Found 47 edits by LunaHasArrived on Talk:Cass Review (5.9%
Peckedagain (talk) 14:03, 6 May 2024 (UTC)[reply]
Given that your first contribution to this page was the 28th of April and there's been 243 edits since the start of that day, your % is 28.80 over these past 8 days. LunaHasArrived (talk) 14:18, 6 May 2024 (UTC)[reply]
Right, well, looking it up, 32 of these my edits were to my own comments, 29 more were replies to myself [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] (to elaborate on my thought without having to dig through the source code).
This brings it down to 128 edits by Snokalok, which is still a fair bit, but far less so considering that I've been actively involved on this talk page since April 9. 128 edits out of 800 comes down to 16% of edits. Snokalok (talk) 15:19, 6 May 2024 (UTC)[reply]
To be fair If you're removing doubles you should remove them from total as well. So it would be 128 out of 740 so 17.3%. Now a lot of work would have to be done to remove other people's "doubles" from the total as well but even taken a generous estimate of 140 other doubles, 128 out of 600 is still 21%. LunaHasArrived (talk) 17:09, 6 May 2024 (UTC)[reply]
I, would be very surprised if other editors' doubles added up to such a high number. I'd be surprised if they came in above 50, for that matter. I've found that most people don't reply to themselves or edit their own comments nearly as frequently as I do.
Regardless, you're correct about subtracting from the total. 128/740 is 17.3% Snokalok (talk) 17:28, 6 May 2024 (UTC)[reply]

List of mentions of WPATH in Cass - dis-proving claims that WPATH 8 was not thoroughly reviewed there[edit]

This list is intended as a reference list. It's suggested that editors NOT comment inside this list, but leave it intact as useful archive available to all editors'. The list was created after it was argued here that Cass had not covered Wpath 8 but primarily Wpath 7: by editor @Ralidic, who wrote:

  • "as the Cass Review is about the Standards of Care (SOC) published by WPATH, in particular primarily the older SOC7 as the review for the most part concerned itself with the older standard as the newer SOC8 came out around the same time that the systemic review that the Cass Review is based on concluded with looking at data prior to 2022 (and the newer SOC was published in 2022).

Archive list of Wpath coverage in the Cass Review:

The word 'WPATH is used 35 times, of which 13 are 'WPATH 8'. 'WPATH 7' occurs 4 times, in most cases 'WPATH 8' is in the same sentence: ie Cass is contrasting 7 and 8.

A whole page is titled: "World Professional Association for Transgender Healthcare (WPATH) 8 guideline (2022). (page 131). In addition

  • (a) "however, none of the WPATH 8 statements in favour of social transition in childhood are supported by the findings of the University of York’s systematic review (Hall et al: Social Transition)." p163
  • (b) "There has been a shift in recommendations between WPATH 7 (2012), which was more cautious about social transition, and WPATH 8 (2022) which argues in favour of social transition in childhood." p 163 and
  • (c) " WPATH 8 cited many of the other national and regional guidelines to support some of its recommendations, despite these guidelines having been considerably influenced by WPATH 7. The links between the various guidelines are demonstrated in the graphics in the guideline appraisal aper (Hewitt et al., Guidelines 1: Appraisal). 9.22 The circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor"
  • (d) "Clinical consensus is a valid approach to guideline recommendations where the research evidence is inadequate. However, instead of stating that some of its recommendations are based on clinical consensus, WPATH 8 overstates the strength of the evidence in making these recommendations" p132
  • (e) "Swedish (2022) and Finnish (2020) guidelines 9.33 The Swedish guideline took a different stance to WPATH 8 based on three considerations:..." 132
  • (f) "International Practise ... WPATH 8 guidance has moved from a ‘watchful waiting’ approach for children to a position of advocating for social transition as a way to improve children’s mental health" p158
  • (g) "a shift in recommendations between WPATH 7 (2012), which was more cautious about social transition, and WPATH 8 (2022)... WPATH 8 justifies this change in stance on the basis that ... " p163
  • (h) .. the earlier requirement to wait for the patient to reach age 12 before they can access puberty blockers has been removed from some guidelines (for example, WPATH 8). T p174
  • (i) The University of York concluded that there is insufficient and/or inconsistent evidence about the effects of puberty suppression on psychological or psychosocial health. This is in line with the finding of the NICE review (2020) and other systematic reviews, apart from the systematic review commissioned by WPATH (Baker et al., 2021), which reported some benefit. However, in the latter systematic review, eight of the 12 studies reporting psychological outcomes were rated as low quality, which may explain the difference. p176
  • (j) The Swedish and WPATH guidelines mention the need to support those who discontinue treatment or detransition, but no detail is provided on how this should be managed p182
  • (k) The Swedish and Norwegian guidelines do not recommend hormone treatments in this group due to lack of evidence, whilst WPATH recommends providing tailored hormones treatments in a separate chapter on non-binary people, rather than in the adolescent chapter, so it is unclear if this applies to adults only or includes adolescents. p183 Peckedagain (talk) 21:38, 5 May 2024 (UTC)[reply]
"The Cass Review" in this context is confusing. Are you talking about these two studies or the final report?
If you're talking about the studies, then indeed they do not have much reference to WPATH SoC 8. A little bit, but since the majority of the research for those studies was compiled in April 2022 and WPATH SoC 8 was released in September 2022 it just can't have been given any significant scrutiny. The timeline doesn't add up.
On the other hand, if you're talking about the final report (and I believe this to be more likely because of the high page count in your references), criticism it makes of WPATH SoC 8 that was not part of the underlying reviews (and again, the underlying reviews make little mention of SoC 8 either way) is ultimately just the professional opinion of the authors. It's not systematic, it's not even a study. It's a government report. Loki (talk) 23:38, 5 May 2024 (UTC)[reply]
Can I suggest that if you want to edit the page for WPATH or Standards of Care for the Health of Transgender and Gender Diverse People you edit one of those pages? I don't disagree that the Cass Review is critical of WPATH's guidance but I think that's covered by the section "International guidelines". Void if removed (talk) 18:04, 6 May 2024 (UTC)[reply]

The view that "Cass is not a reliable RS on biomedical facts and claims": a snapshot of the For and Against from Talk so far[edit]

Licks-rocks (talk) said: "this and other discussions on this page are almost unreadable". Taking that lead, how to make the talk page more readable/useful, I spent a couple of hours collecting the widely spread comments on this issue where consensus seem not to be reached

  • that: "Cass is not a reliable RS on biomedical facts and claims.”

Your mileage may vary, but I hope at least editors will find this collection useful. All comments come this Cass’s Talk page. To make this list more useful, side-issues in paragraphs have been ‘…’ed out. I’ve double checked that no meanings have been changed, but apologies in advance if one slipped through.

It is only a snap-shot in time -as of now.

In full: View that: “Cass is not a 1st-class MEDRS compliant secondary source on biomedical facts and claims.”

Grouped under headings

  • A) “not top tier medical evidence”
  • B) Concerns over it being Primary

A) “not top tier medical evidence”

FOR

  • “It is not the most credible and important source out there. WPATH for example publishes similar reports, which are read and used worldwide, and released at regular intervals to keep up with the state of the science.” (Licks-rocks)
  • “ I think a very important thing to say that Cass's report whilst based on systematic reviews is not top tier medical evidence” (LunaHasArrived)
  • “The reviews are high quality peer reviewed academic studies. The report isn't. It is compiled by a qualified group of people but it's not the reviews, it's a professional opinion about the reviews” (Loki)
  • “I 100% agree that the systematic reviews covered and considered all the evidence. I think one can argue that Cass's recommendations do not… the recommendations which aren't more than peer reviewed medical expert opinion. ” (LunaHasArrived)
  • “About the final report, .. it is ultimately just the professional opinion of the authors. It's not systematic, it's not even a study. It's a government report” (Loki)
  • “While the breadth of the studies considered is important, it is only one factor, and the review is only one review. It was also endorsed universally by gender-critical organizations, and international medical organizations in the field have criticized its methodology and findings. We should take care when covering this review and be sure to use independent reliable sources… Determining whether the Cass Review as a whole is "correct" is not our role as Wikipedia editors. ” (Hist9600)
  • “Just because something's a good source does not mean other good sources are automatically worse.” (Licks-rocks)
  • “I said ..that “the Cass Report is kind of dodgy about what it's actually arguing”, specifically regarding whether or not it thinks that more RCTs should have been conducted. This is "dodgy" in the sense of "evasive", and not in the sense of "poor quality". (Loki)
  • “As far as I'm aware, the Cass Review was only prepared for NHS England, and is mainly relevant for the NHS, and not for other countries.” (Hist9600)

AGAINST

  • “The Cass review is afaik the most thorough review of the subject matter since the SBU review of 2022. Saying the Cass review is only important with respect to the NHS is like saying the SBU 2022 was only important to the Swedish healthcare system. Sure, the recommendations are with respect to the NHS, but the ramifications of an in-depth review considering the international body of research are more far reaching.” (Draken Bowser)
  • “What is it that let's us write about their (Cass) findings as though they really did find them? Well, that's because the document and supporting documents are WP:MEDRS compliant sources for these.” (colin)
  • “We shouldn’t be presenting any views in a way that serves to offset, undermine or contradict the findings of the systematic reviews unless those views are based on equivalently weighty research.(Barnards.tar.gz)
  • We should also make clear that some of these responding organisations were directly criticised in the report (most notably WPATH). That makes their views more relevant but also more WP:MANDY. (Barnards.tar.gz)
  • “I am saying that currently these systematic reviews represent the best MEDRS sources for Wikipedia's voice on whether certain therapies work and are safe. “ (colin)
  • “This is pretty much what we're weighing up here: the findings from systematic reviews carried out by an actual MEDORG vs conventional wisdom from professional associations.” (13tez)
  • “The whole report is not dodgy in the sense of poor quality and I never said that it is.” (Loki)

B) Concerns over it being Primary:

FOR

  • “The whole Cass Review is a primary source on this page. Anything (Helen) Cass says about the Cass Review (in any medium, to be clear: a New York Times interview would have the exact same problems) is also a primary source here. I would have assumed that this is obvious, and that the WP:INDEPENDENCE problems with citing a source in the article about that source would also be obvious”. (Loki)
  • “(Re FAQs)...Ultimately, this is a primary source and can only really be taken as the review responding to criticism, that is - it can be taken as one side in the debate, not as objective fact. “ (snokalok)
  • “I think this is probably the best example of why we can't always use Cass about itself. We have medorgs saying the Cass review has a higher bar of evidence for some care over others, then we have Cass saying no it is the same bar. We have 2 distinct opinions here about what the findings and recommendations said and I think saying it's a false criticism is unhelpful.” (LunaHasArrived)
  • “(Helen) Cass herself not necessarily being a reliable source for even the contents of the report. The sourcing guidelines on Wikipedia are there for good reasons and those reasons don't stop applying in MEDRS cases no matter how strong the evidence is within the context of MEDRS” (Loki)

AGAINST

  • “As discussed, the consensus is that the report falls under BMI, so MEDRS sources are needed. The NHS and the report qualify as MEDRS sources.” (13tez)
  • “What is it that let's us write about their (Cass) findings as though they really did find them? Well, that's because the document and supporting documents are WP:MEDRS compliant sources for these.” (colin)
  • “As with any (vaguely) similar government report, it will be secondary in the parts that analyze, evaluate, criticize, draw conclusions from, etc. previously published sources” (WhatamIdoing)
  • “It will be important to remember that primary is not a fancy way to spell 'bad'. (In particular, for direct quotations, primary sources are often best. Original documents can't misquote their own contents.” (WhatamIdoing)
  • “For example: if the Cass report is cited in support of the sentence "Based on moderate-quality evidence, puberty blockers neither change nor worsen either gender dysphoria or body satisfaction", then the Cass report is:
  • secondary if it's in this article,
  • secondary if it's in another article, and
  • secondary if it's on another website entirely. (colin)
  • “the Cass review can be BOTH a primary source for certain things on this page AND a MEDRS compliant secondary source for other things on this page. (colin)
  • … primary source if you want to write a sentence like ... "The report recommends that families of pre-pubertal trans or gender-questioning kids get at least one appointment with a ...
  • … secondary .. ... "Based on moderate-quality evidence, puberty blockers neither change nor worsen either gender dysphoria or body satisfaction"
  • “It's a follow-up by a report commissioned by the NHS, a reputable major and national medical organisation that defines the guidelines for and carries out almost all medicine in the UK. If we're using MEDRS sources here - as is the consensus - we're not delving into normal practice of requiring mostly secondary sources etc set out at WP:PSTS. (13tez)

================== end of quotes ========== Peckedagain (talk) 17:37, 6 May 2024 (UTC)[reply]

I don’t think these are the quotes that those in the FOR side would choose to represent or encapsulate their arguments, they feel specifically as the quotes that sound the weakest out of context.
If I were to choose my own quote cited here, for example, it’d be
“The FAQ is not a reliable source to censor criticism with because it's effectively somewhere between "Nuh uh" and "We've investigated ourselves and found no wrongdoing"”
And for the wider text
“A text is inherently a primary source on its own contents, that’s simply a fact”

While the use of direct quotes is ultimately better than not, this does to some degree still feel as though you’re speaking for your opposition without their input.Snokalok (talk) 19:04, 6 May 2024 (UTC)[reply]

I think that trying to decide which WP:LABELS to stick on the Cass Review is a misguided exercise. I think a list of what we agree on would be more useful to editors than trying to pigeonhole the report into various keywords. I dislike the model that you'll see at Talk:COVID-19 pandemic#Current consensus, but it does seem to have had the beneficial effect of not having editors re-re-re-discussing basic points.
For example, I suspect that editors from all sides would be willing to agree that if a source says that the Cass Review excluded 98% of the evidence and does not issue a correction, then that specific source (whether you define that as the author, the document, or the publisher) should be considered unreliable in Wikipedia's terms. Nobody wants to see misinformation in the article, and a source that gets such a basic factual point wrong can't be relied upon to get everything else right.
Similarly, it looks to me like there is at least the possibility of an agreement that the WPATH statement, if any ever appears, should replace the early statements from PATHA and AusPATH, rather than being added to them, but that until WPATH decides to issue its own statement, these two should be kept. An encyclopedic summary provides the most important points from the most salient groups, rather than a laundry list of everyone who ever wrote about it (regardless of whether they wrote in favor or against it). WhatamIdoing (talk) 23:38, 6 May 2024 (UTC)[reply]
I agree and what I've been saying all along is that using PSTS or MEDORG or any other labels about "the whole Cass Review" and "anything one might use it as a source for" is entirely wrongheaded and over simplistic. These things only make sense when one is examining actual words in a sentence on the page, the point we are trying to make there and the exact text from the source we are relying on. I see some comment above about it being a government report and just the opinion of its authors. Oh, well, I guess we'll need to bin all the NICE guidelines, because they are just the opinions of some non-departmental public body. These aren't helpful arguments.
The statement "The FAQ is not a reliable source to censor criticism with because it's effectively somewhere between "Nuh uh" and "We've investigated ourselves and found no wrongdoing"" has problems on so so many levels. Playing the censor card when we are talking about basic biomedical misinformation is the sort of diff one might cite in a topic ban. Can we try harder please. This isn't twitter or a forum to trash Cass. A random line one heard from activists isn't necessarily a good one to repeat on this talk page.
One useful trick to try is if one takes one's argument and tries to imagine using it in another situation or if people with opposing POV tried to use it. Can people see themselves arguing that a CDC FAQ responding to "Should I inject bleach to clean out the COVID from my body" or "Does 5G cause COVID" should be regarded as unreliable because "It's just some government document and the opinions of its author". Or if the government responded to "Did Bill Gates put microchips in the COVID vaccine?" with a "No, the vaccines contain no microchips" and editors here argued this was a case of "We've investigated ourselves and found no wrongdoing". Can you see how that kind of argument looks?
Or imagine that the Cass Review came out with recommendations that you really liked and got the gender critical people fuming mad. How would you feel then about how much room we give to criticism from random Canadian gender-critical doctors that the Telegraph found or some US republican politician. How would you feel if we gave room to misinformation from LGBA or some transphobic Tory MP? Would you instead be banging on about how the author is a highly respected paediatrician and took four years and is built on half a dozen systematic reviews, and that in your view the gender critical twitterati can all go take a running jump. -- Colin°Talk 10:50, 7 May 2024 (UTC)[reply]
The difference between this and the vaccine example is that, this is major MEDORGs criticizing the report. That is to say, the criticisms are credibly and bear weight, and excluding them simply because the FAQ that the source being criticized put out saying “no” is an incredibly conflict of interest on a basic level. Let’s pose another example: let’s say that the Saudi health ministry put out a report in which they said “It is our opinion that women lack the neurological capacity to drive a car”, and that report was thoroughly criticized by a number of reliable and relevant MEDORGs. I think we can all agree that the criticism there would bear weight. Now let’s say the Saudi health ministry put out an FAQ in response to the criticism saying “The criticism is fake and nonsensical because we never recommended that women not drive” and then you look at the report, and it has the above quote directly. Would we use this FAQ as reason to exclude MEDORG criticism, given that the authority that published it said “nuh uh”?
“How would you feel then about how much room we give to criticism from random Canadian gender-critical doctors that the Telegraph found or some US republican politician. How would you feel if we gave room to misinformation from LGBA or some transphobic Tory MP?” The difference here is that we’re not saying activist groups or politicians, we’re saying MEDORGs should not have their criticism excluded simply because the ones being criticized said no. There is very much a difference.
Like how we implemented the Cass Review’s criticism on the WPATH SoC page. That’s a medorg criticism that bears weight (the others are correct imo that while the sources cited in the report are systematic reviews, the report itself is an NHS report and thus a MEDORG source)
EDIT: To clarify, I also agree with the consensus point regarding excluding the 98% statistic and whatnot. Also I will likewise be limiting my interactions because I feel my involvement has been a tad disproportionate. Snokalok (talk) 11:44, 7 May 2024 (UTC)[reply]
@Snokalok, an argument that "major MEDORGs criticizing the report" is reasonable but only on that points where that is specifically the case. I think you are making an argument about the FAQ and should perhaps re-read the FAQ. Which specific things have a major MEDORG claimed that the FAQ counterclaimed and are in dispute? Rather than wikilawering about how the FAQ may or may not be regarded as reliable for our purposes, what on earth is it that anyone thinks the FAQ got wrong?
I think you are overstating the criticism with a claims that major MEDORGs criticise the report. The report specifically called out WPATH for criticism, to the point where "discredited" now appears in news headlines, so I would very much understand that they are unhappy, defensive and looking for points to score. The WPATH section in our article currently focuses on the recommendations, which they disagree with, not the evidence, which is an area they are weak on. Their comment on mental illness is somewhat disingenuous in that while being trans itself is not regarded as a mental illness by WHO, Cass's review and the supporting research, demonstrates the patient population group currently being referred to and on the waiting list for appointments at gender clinics overwhelmingly have multiple mental health issues, often of the most serious and disabling kind, along with neurodivergence and child-abuse/in-care factors. Cass was asked to examine how this group is being treated by the clinics and other services, and found huge failings that are undisputed. The idea this population group would benefit from a holistic approach rather than ignoring their mental health problems is widely regarded as a good thing (the story being that once referred to GIDS then CAHMS didn't want to know and no longer helped, and once the few eventually arrived at GIDS, who are psychiatrists, all anyone wanted was a referral to endocrinology). Do you see there might be some nuance in what is welcomed and what is disagreed with that is being lost in the social media witch burning.
I think reducing things down to "major MEDORDS criticise the report" is an over simplification. The FAQ is dealing with the nonsense that gets spread on social media and we need to take care not to repeat. That WPATH and NHS England might develop treatment guidelines that take different approaches is not really what that FAQ is looking at. Kneejerk press releases playing political games about mental illness aren't helpful either. Let's hope a full response is more considered than that. -- Colin°Talk 13:18, 7 May 2024 (UTC)[reply]
I don't think the FAQ is an unusuable source but I do think that, just like the 98% number is reason for strong skepticism because it's obvious BS, some of the things Snokalok has identified about the claims in the FAQ are very concerning and make it look like the FAQ is probably making claims that are either false or very easy to misinterpret into a false claim.
Specifically I'm thinking about the claim that they didn't use an uneven standard of evidence, but they recommend psychosocial intervention and not hormonal intervention despite coming to nearly identical conclusions about the evidence base for each being weak. This seems to me a claim in the FAQ that, if not definitely false, is at least questionable enough to call its reliability into question.
Also: the general RS guidelines still do apply in the case of COVID or vaccines or any other MEDRS area. Of course they do. If a FAQ of a high quality systematic review into COVID said something that directly contradicted the review we'd obviously exclude that. Loki (talk) 17:37, 7 May 2024 (UTC)[reply]
Apologies for not keeping up with this subject (my news feed, fortunately for me, is mostly filled with baked goods), but Loki, do we actually have a statement from WPATH or any similar MEDORG that says something like "The Cass Review set a higher bar for evidence than would normally be expected"? I don't remember anyone mentioning such a thing.
It sounds to me like we have one source (Cass' FAQ) saying one thing ("We did not use a higher standard for evidence than normal"), and other sources (e.g., various types of orgs) saying something quite different ("Yeah, you didn't use a high standard, but you also didn't use the same standard for everything. You used the normal standard of evidence for puberty blockers and a lower standard for psychological support. If weak evidence is good enough for talk therapy, then it should be good enough for drugs, too."). WhatamIdoing (talk) 20:17, 7 May 2024 (UTC)[reply]
I'm concerned you are saying "some of the things Snokalok has identified about the claims in the FAQ are very concerning" when I still haven't got a reply from Snokalok that the things they are concerned about are actually in the FAQ Could you both read it carefully and point me to the sentence that talks about "uneven standard of evidence", which WAID addresses. As I have said, what experts do in the absence of evidence is often going to vary from one perfectly reasonable person to another. Cass falls back on evidence for psychological therapies being useful in related areas (and needed, anyway, for this population group) and this isn't that dissimilar to the trope about puberty blockers having a safety record in precocious puberty so presumably safe for teenagers. Both arguments are open to criticism but also both have some reasoning to them that isn't completely stupid. These are areas where I hope we can have solid expert and carefully written sources to describe the difficult decisions being made, why they were made, and why some disagree with them. But please, read the FAQ, and I don't think there's anything there that will be disagreed with by any reasonable person.
Btw, Snokalok, your Saudi health ministry example demonstrates prejudice as your reasoning rather than offering a fact-based counter example to women's driving skills (pretty easy to find which sex has the most accidents and drives dangerously). If the UK or US had made a statement about the poor driving standards of men, and felt they had to defend that statement from complaints from some Top Gear presenter, nobody here would be going "oh, we can't trust that FAQ because it is a primary source from a government and just somebody's opinion". These arguments are bogus, if you shift them to a different example.
It is pretty clear a lot of talk on the internet is prejudiced against Cass (middle aged woman from the UK: obvious TERF) Let's have the FAQ criticised, if necessary, because of sourced evidence that what it says is clearly wrong, not because of editors wikilawyering about primary which continues to waste our time (hint: please stop). -- Colin°Talk 20:42, 7 May 2024 (UTC)[reply]
First question: "Did the Cass Review set a higher bar than would normally be expected"
Stated answer: "No, the approach to the assessment of study quality was the same as would be applied to other areas of clinical practice – the bar was not set higher for this Review. Clarification: The same level of rigour should be expected when looking at the best treatment approaches for this population as for any other population so as not to perpetuate the disadvantaged position this group have been placed in when looking for information on treatment options."
This is questionable for two reasons.
1. According to this systematic review, less than half of all medical treatments are backed by moderate quality evidence or above [30], meaning that requiring such for puberty blockers is a higher bar than would normally be expected.
2. The Cass Report itself says on page 196 "research on psychosocial interventions and longer-term outcomes of those who do not access endocrine pathways is as weak as research on endocrine treatment" And yet then elsewhere, it says "For the majority of young people, a medical pathway may not be the best way to achieve this. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems"[page 30] and "Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress and cooccurring conditions."[page 31] and "In addition to treating co-existing conditions, the focus on the use of puberty blockers for managing gender-related distress has overshadowed the possibility that other evidence-based treatments may be more effective. The intent of psychosocial intervention is not to change the person’s perception of who they are, but to work with them to explore their concerns and experiences and help alleviate their distress regardless of whether or not the young person subsequently proceeds on a medical pathway."[page 31] Very clearly stating hormone treatment as the undesirable option for the majority of patients while stating psychosocial intervention as the best for both those on hormones, and those not. This is all despite them having the same quality of evidence. That's a double standard.
Regarding your comparison to the puberty blockers for precocious puberty argument, this I feel misses a key point to that argument that biologically there is no difference between administering for precocious puberty or gender dysphoria. Your body doesn't know the difference. It blocks puberty the same regardless. Whereas psychological treatment for general anxiety and depression vs for gender dysphoria is inherently different because they're two fundamentally different psychological scenarios thus requiring two different treatments even if remaining strictly therapeutic. That is, your mind does know the difference and does respond differently.
"If the UK or US had made a statement about the poor driving standards of men, and felt they had to defend that statement from complaints from some Top Gear presenter, nobody here would be going "oh, we can't trust that FAQ because it is a primary source from a government and just somebody's opinion" Are you saying that a Top Gear presenter is equivalent to a MEDORG in this scenario? Because that's, a very bold take if so. Regardless, if we were to elevate a top gear presenter to the level of a MEDORG in that scenario, we would reasonably include the criticism in the article - and then if the US or UK govt said "nuh uh", we might include the nuh uh as well, but we would not use it to exclude the criticism itself.
Anyway regarding "when I still haven't got a reply from Snokalok " as I said, I'm trying to reply less frequently so that my voice doesn't inadvertently smother all others on this page.
EDIT: Regarding PRIMARY source concerns, how is that wikilawyering? I read over the essay and I, genuinely do not see it, I haven't been citing the exact wording of policies or technically misinterpreting them or anything, I wouldn't even know where to begin with that. Snokalok (talk) 02:02, 8 May 2024 (UTC)[reply]
@Snokalok, I've only read your #1 point ("According to this systematic review..."). What I'm not seeing here is a reliable source that says this about the Cass Review. PMID 32890636 (the review article you linked) is a very nice source, and I hope it's been used in Evidence-based medicine, but it was published in 2020, and it doesn't mention the Cass Report, or trans people, or anything else that's relevant.
Consequently, it looks like this point represents a Wikipedia editor engaging in WP:Original research, rather than a reliable source saying – I'm not sure what they'd be saying, actually. Maybe "The median medical intervention has moderate quality evidence behind it, and we think treatments for trans kids don't need to rise even to the average level"? I certainly hope not.
Do you have a reliable source that directly connects these two? WhatamIdoing (talk) 05:43, 8 May 2024 (UTC)[reply]
You’re allowed to engage in OR in talk pages, especially for evaluating sources.
See “ This policy does not apply to talk pages and other pages which evaluate article content and sources, such as deletion discussions or policy noticeboards” Snokalok (talk) 08:41, 8 May 2024 (UTC)[reply]
Snokalok, you were asked "Which specific things have a major MEDORG claimed that the FAQ counterclaimed and are in dispute?", not for some OR citing papers from 2020. -- Colin°Talk 13:00, 8 May 2024 (UTC)[reply]
“I still haven't got a reply from Snokalok that the things they are concerned about“
Well no actually, you asked what I’m concerned about in terms of evidentiary reasons and again, as the policy says, OR is perfectly valid and acceptable under WP:OR for analyzing the reliability of sources and info through the lens of a talk page, per the quoted text. It only becomes a problem if you add info to the article that is OR. You can’t accuse me of wikilawyering for disagreeing on a source’s reliability, and then turn around and directly misapply the OR policy against that disagreement.
And again, it doesn’t matter if a MEDORG is criticizing the FAQ or not, we’re fully allowed to evaluate sources as unreliable based on our own dissections - which is exactly what this talk page - including you yourself - did for any source saying 98% , even before the FAQ came out. Why is it suddenly now not acceptable to do that? Snokalok (talk) 15:32, 8 May 2024 (UTC)[reply]
Oh, sorry, I must have misunderstood. I thought the reason you posted that information was because you were trying to help us improve the article. WhatamIdoing (talk) 16:13, 8 May 2024 (UTC)[reply]
WP:AGF. Using an unreliable source to exclude relevant and well sourced content helps no one, that’s what I’m arguing against. Kindly strike your personalization. Snokalok (talk) 16:20, 8 May 2024 (UTC)[reply]
@WhatamIdoing Snokalok (talk) 17:35, 8 May 2024 (UTC)[reply]
@Snokalok, I think you are reading more into the report than it actually says. None of the recommendations actually recommend using psychosocial interventions instead of puberty blockers. There are three groups of treatment under consideration:
1. Psychosocial interventions
2. Standard evidence based psychological and psychopharmacological treatment [for mental health]
3. Puberty blockers
Cass notes that the evidence base for 1 and 3 is poor, but the evidence base for 2 is good. Therefore 2 should be leveraged to treat the comorbidities that occur in the majority of cases (Recommendation 3, on page 31). She notes that the focus on 3 has overshadowed the possibility of 1 being more effective. The purpose of the explanation of psychosocial intervention ("The intent..."), is to distinguish it from "conversion practices" and position it as an approach worthy of further investigation (she states elsewhere how harmful it is to equate the two). This leads to Recommendation 6 (page 35), that the "evidence base underpinning medical and non-medical interventions in this clinical area must be improved", and Recommendation 20 (page 40), that a "unified research strategy should be established". That is, she wants to see more research and better evidence for both medical and non-medical interventions.
At no point does she actively recommend psychosocial intervention. Therefore much of the noise here is being expended on a straw man. Barnards.tar.gz (talk) 11:16, 8 May 2024 (UTC)[reply]
The evidence base for 2 in the general population for normal anxiety and depression is good. The evidence base for using general anxiety and depression treatments for gender dysphoria, is non-existent, which is specifically why the report instead extrapolated from genpop treatment. That means that both group 1 and group 3 are being held to a higher standard for dysphoria than group 2.
And yes, the report can say that they want to see better evidence for both 1 and 3, but the fact is it still says group 3 shouldn’t be given to the majority of patients while group 1 should be given to all, despite them having the same level of evidence. That’s giving one a higher standard than the other. Snokalok (talk) 15:38, 8 May 2024 (UTC)[reply]
using general anxiety and depression treatments for gender dysphoria That's not what is being recommended. Cass does not state or imply that treating the cooccurring conditions will cure the dysphoria. One might believe that "anxiety in association with gender dysphoria" is a completely separate condition from "anxiety", and that the established methods of treating anxiety are not transferable to this new condition... but do any MEDRS sources make that criticism? I've not detected that this is a common line of argument.
group 1 should be given to all It really doesn't say that, but if you think it does, could you provide a citation / page ref? Barnards.tar.gz (talk) 16:06, 8 May 2024 (UTC)[reply]
According to this systematic review, less than half of all medical treatments are backed by moderate quality evidence or above, meaning that requiring such for puberty blockers is a higher bar than would normally be expected.
I think this is missing the point - Cass used an appropriate bar for evaluating quality. The conclusions were not based on the quality of the studies, but on their findings. The findings of moderate/high quality studies did not give clear indication of psychological benefits and some indication of negative physiological side effects.
The review does not say "the benefits are inconclusive because there aren't many MQ/HQ studies", it says "there aren't many MQ/HQ studies and the ones that do exist are inconclusive".
Critics plead to include the LQ studies because without them, the evidence base for the treatment vanishes. That's not a robust finding, and not a situation you can directly compare to the aforementioned systematic review.
This is why this meta review does not apply - they didn't just look at systematic reviews with favourable outcomes. Many of the reviews simply reached no conclusion. What this review is looking at is whether evidence quality is improving. This review is not saying that "medical treatments" are backed by low quality data, they are saying that the conclusions of most systematic reviews are based on low quality data - irrespective of if those conclusions are favourable or not - and there's not much improvement in quality over time. Void if removed (talk) 17:05, 8 May 2024 (UTC)[reply]

Specifically I'm thinking about the claim that they didn't use an uneven standard of evidence, but they recommend psychosocial intervention and not hormonal intervention despite coming to nearly identical conclusions about the evidence base for each being weak. This seems to me a claim in the FAQ that, if not definitely false, is at least questionable enough to call its reliability into question.

I cannot locate this claim within the FAQ. Flounder fillet (talk) 22:47, 7 May 2024 (UTC)[reply]
See Snokalok's reply, they answer it better than I would. Loki (talk) 03:25, 8 May 2024 (UTC)[reply]
No, the approach to the assessment of study quality was the same as would be applied to other areas of clinical practice – the bar was not set higher for this Review.
This does not imply that the standards of evidence for everything that was evaluated were equal within the review at all. That is, unless one were to assume standards are equal for everything in all other areas of clinical practice. Flounder fillet (talk) 04:11, 8 May 2024 (UTC)[reply]
Note the words "higher" in the FAQ question and the response specifically commenting on the York systematic reviews. Snokalok and others are claiming major MEDORGs disagree with the report in a way that the FAQ is controversially responding to. But no evidence of this has been given, just some OR citing old old papers. There's NOTHING in the FAQ about "uneven" standards of evidence. At the moment, it seems some editors are getting worked up about a misunderstanding of their own making. Could we drop this "FAQ is unreliable" attack front completely as a total waste of everyones time please. -- Colin°Talk 12:58, 8 May 2024 (UTC)[reply]
No, I never said major MEDORGs dispute the FAQ - which would be interesting to see given that the FAQ has been out for what, a week? Are they expected to put out a statement every time the Cass Review team opens their mouths? No, I’ve consistently said here is why I and other editors see the FAQ as not reliable to exclude content based off of. Please do not misrepresent me or my points. Snokalok (talk) 15:39, 8 May 2024 (UTC)[reply]
I think we've reached the stage in this discussion where it is now just a meta argument about people complaining they never said the things someone says they said even though those things are on this page. Life is too short for that. I'm not interested in any more wikilawyering about Cass, her interview on BMJ or the FAQ because those are not directly concerning improving this page (WAID's point above). I propose this section be abandoned as the waste of all our time it is. Let's have a normal discussion involving actual or proposed article text and actual or proposed sources, rather than folk arguing about what policy may or may not say about this or that source that may or may not even be used. -- Colin°Talk 08:45, 9 May 2024 (UTC)[reply]
… Fuck it, sold. Though if a certain editor is reading this, I’d still like them to strike what they said. Snokalok (talk) 10:20, 9 May 2024 (UTC)[reply]
I think your top point hits the nail on the head with this entire section. It depends on what we're citing the Cass review for on whether primary and Medrs applies. I would also like to apologise for previous comments that are probably part of some of the latter part. I am a new editor still and I think I'm going to limit myself to a maximum of 3 comments on the talk page whilst it's still in it's current popularity to help curb the problem. I would also argue that we do currently have quotes from MPs people find transphobic and lgba level Organisations. Also that a lot of comments are coming from medorgs not a US republican or Canadian gender critical doctors. LunaHasArrived (talk) 11:46, 7 May 2024 (UTC)[reply]

Bibliography[edit]

Flounder fillet posted a link to https://adc.bmj.com/pages/gender-identity-service-series above. I think it is usual, in the case of a report that has multiple separate pieces, to provide a ==Bibliography== or ==Further reading== section at the end that simply lists all of them.

Is there anything missing from that page? Personally, I'm inclined to skip the editorial and include only the externally peer reviewed papers. I suggest providing no commentary beyond perhaps labeling reviews in the citation (which means adding "Review." at the end). WhatamIdoing (talk) 23:47, 6 May 2024 (UTC)[reply]

widespread, false claims from critics of the report that it had dismissed 98% of the studies[edit]

There is more nuance to the claim that the report dismissed 98% of the studies it collected. For example, see footnote 14 here 

   Hilary Cass has contested this claim in reporting for the BBC. Her argument is that of the 103 studies analysed for the review, 60% were included in the synthesis of evidence. However, my argument here is specifically that the findings of these papers were broadly ignored in the writing of the report’s recommendations, while less robust material was instead prioritised. As Simon Whitten argues, “The majority of moderate certainty studies were included in the results section but then arbitrarily ignored in the conclusion entirely”.

It should be noted that the original source for the claim that 98% of studies were dismissed was Cass herself, in the press release announcing the final report's release: 

   Of the 50 studies included in the review looking at the effectiveness of puberty blockers for gender questioning teens, only one was of high quality, leading the authors to conclude that although most of the studies suggested that treatment might affect bone health and height: “No conclusions can be drawn about the impact on gender dysphoria, mental and psychosocial health or cognitive development.” 
   Similarly, of the 53 studies included in the review on the use of masculinising and feminising hormones, only 1 was of sufficiently high quality, with little or only inconsistent evidence on key outcomes, such as body satisfaction, psychosocial and cognitive outcomes, fertility, bone health and cardiometabolic effects.

I would say a reasonable interpretation of those two paragraphs is that the non-high-quality studies were dismissed - particularly the word 'sufficiently'. The claim is not solely about the systematic reviews that York undertook, but what the Cass Review took from those studies.

As a result, I think it's inaccurate to call the claim straightforwardly false. It would appear to be in the realm of opinion whether the review dismissed 98% of studies or not. I propose rewording to 'misleading', or change 'dismissed' to 'rejected', or including the additional context I mention here. Rattic (talk) 20:50, 8 May 2024 (UTC)[reply]

I agree that in our current version it's a bit unclear because the comment is, "the report dismissed 98% of studies", whilst Cass's response is, "the systematic reviews synthesised their evidence from far more studies". These comments don't actually disagree with each other. The problem is I think without a Medrs source saying "we believe the findings of the Cass report ignored the majority of the studies" it might be difficult to include explicitly. I'm also not 100% sure what has been said by various people because I'm certain there probably have been people who have falsely claimed that 98% of the studies where thrown out by the systematic reviews. I think the fix would have to be either making sure that the 98% claim is on the reviews and just is general being clear on what is from the systematic review or what is from Cass's report. LunaHasArrived (talk) 21:06, 8 May 2024 (UTC)[reply]
This is straightforwardly false. Whitten is wrong as anyone who can read the Cass Review instead of a press release can confirm, and Pearce is wrong to promote this. Void if removed (talk) 21:40, 8 May 2024 (UTC)[reply]
Frankly, a self-published (partisan) blogpost citing a (partisan) tweet is not even remotely close to a reliable source for valid criticism of a systematic review. Void if removed (talk) 09:11, 9 May 2024 (UTC)[reply]
Just so we're clear, here is Pearce's actual claim:
You can see, if you read the Cass report, that they looked at over 100 studies, most of which show that puberty blockers and hormone therapy can help young trans people. And they just ignored them.
This is a lie. There's no other word for it, it is flatly untrue. Seemingly aware this was overstating things, Pearce then caveats this in the footnotes as:
the findings of these papers were broadly ignored in the writing of the report’s recommendations
That is a lesser claim, and still false.
Then in the source tweet thread, you get this:
The review found 5 studies of moderate certainty relevant to psychological health. All 5 supported the conclusion that treatment of trans teens with CSH improved psychological health. [...] Our intrepid authors draw no conclusions from this whatsoever, instead declaring the evidence for every outcome for which there was no high certainty study “inconclusive.” [...] This is the sense in which the Cass Review absolutely did ignore almost all evidence on the efficacy & safety of PBs and CSH.
So again, further caveated, and still false. What the paper Whitten is referring to actually gives is extensive discussion of these studies, and in the conclusion says:
There is suggestive evidence from mainly pre–post studies that hormone treatment may improve psychological health although robust research with long-term follow-up is needed.
The original tweet thread is not talking about the cass review, it is making untrue and hyperbolic claims about an underlying systematic review.
And lest we think this can be applied to the Cass Review, instead of the systematic review, the Cass Review on page 184, talking about the systematic review Whitten is attacking here, says:
There was moderate quality evidence from mainly pre-post studies that hormone treatment may improve psychological health in the short-term
AND quotes the conclusions verbatim in para 15.25.
There is no nuance to be represented here, just garbage piled upon garbage. Void if removed (talk) 10:48, 9 May 2024 (UTC)[reply]
Yeah, I would agree that there is definitely some nuance involved in navigating this one in particular. I think the main question is what independent reliable sources can be relied upon for analyzing and interpreting such statements. The article should not rely on the WP:OR of individual Wikipedia editors for interpretation, analysis, etc. Hist9600 (talk) 00:29, 9 May 2024 (UTC)[reply]
The sentence is currently unsourced, precisely because it’s largely based on Twitter chatter. How widespread the claim is, and what, specifically, the claim is is unclear, and likely varies from person to person. If it belongs in the article, it’s only because Cass has responded to it, but what precisely is being responded to is not stated. 2406:5A00:DC9B:5000:60C3:F2CC:ED70:ABE (talk) 05:37, 10 May 2024 (UTC)[reply]
It is not true that Cass is "the original source for the claim that 98% of studies were dismissed". The claim arises from a misinterpretation of Cass's statements. The words "included in the review" are right there. If someone engages in motivated reasoning about the text, that's entirely on them, not on Cass. Barnards.tar.gz (talk) 08:48, 9 May 2024 (UTC)[reply]
I think it would be reasonable to say that the low quality studies were "ignored" in the review, iffy wording and lacking nuance but not outright wrong. These low quality studies are mentioned as being "in the review" above so I don't think it's unreasonable for someone to assume that just from the press release above, moderate quality and low quality studies were "in the review" in the same way. Now this person should have read the report and reviews but I think some blame could and should be put on the statement. Also in the 53 statement I can't see any way to read "one was of sufficiently high quality" as apart from only one was sufficient to be 'proper' evidence. LunaHasArrived (talk) 11:43, 9 May 2024 (UTC)[reply]
The claim arises from a misinterpretation of Cass's statements.
The idea that the review dismissed most studies did not come from misinterpretations of her statements, albeit maybe they mutated this idea into the "98%" claim on social media after the review was published. However, variants of this claim were going around before that. From this article:
Dr Hilary Cass, 66, told The Times last week that one activist had begun posting falsehoods about her landmark review of the treatment of trans children before it was even published. She was referring to Alejandra Caraballo, an American attorney, transgender woman and instructor at Harvard Law School’s Cyberlaw Clinic. On April 9 — the day before the Cass review was published — Caraballo claimed it had “disregarded nearly all studies” because they were not double-blind controlled ones. 13tez (talk) 12:57, 9 May 2024 (UTC)[reply]
I think ‘the claims of one activist are false’ is a far more specific and sourceable statement than ‘widespread claims were made and they are false’ 2406:5A00:DC9B:5000:60C3:F2CC:ED70:ABE (talk) 05:41, 10 May 2024 (UTC)[reply]
That wouldn't be true, though. The claims were widely spread and not said only by a single person. "But before the Cass Review was even published, an idea was spreading on Twitter that it was all based on biased information...This idea that 98% of the evidence was ignored or dismissed has been repeated again and again" - https://www.bbc.co.uk/sounds/play/p0hry4wj 13tez (talk) 15:41, 11 May 2024 (UTC)[reply]
Sorry if I am being an idiot but I can't seem to find the quotation you used in the press release you linked. Where exactly in the page was it used from. LunaHasArrived (talk) 11:45, 9 May 2024 (UTC)[reply]
The press release is here. Two things. Firstly, it is widely discussed online that the source for the misinformation we are discussing is indeed a twitter influencer noted above and actually published they day before when they were confused even about the documents someone was passing to her. Their twitter page doesn't seem accessible any more, but last time I looked it wasn't very nice, personally, about Cass, and the responses from their followers were an order of magnitude worse. The Labour MP got their information from Stonewall who admit they got their information wrong. Second thing, the press release is not written by Cass, so maybe we could strike & amend the above text to make that clear. Press releases are notorious for being misrepresentative of the science or whatever is behind them, and not considered a reliable source. The press release is indeed badly worded in a misleading way and I'm disappointed the BMJ hasn't amended it or issued a clarification/correction. Colin°Talk 15:28, 9 May 2024 (UTC)[reply]
Thank you for the link, It seems that the twitter account in particular has taken a break to improve mental health (something everyone should probably do every so often). I agree the above comment should be struck and let me know if there is anything I posted that you think should be. I do think it is perhaps notable that even the bmj has been misleading about this particular comment. LunaHasArrived (talk) 15:54, 9 May 2024 (UTC)[reply]
Wrt twitter breaks: I think someone should break twitter to improve everyone's mental health. -- Colin°Talk 07:26, 10 May 2024 (UTC)[reply]

Add comments from Cass she believes she has seen treatments work well?[edit]

Although the review found insufficient evidence to support making the treatments it examined standard practice, Cass has since said that although she thinks they have been applied inappropriately in some instances, she also has seen them have a positive effect on young people who have benefitted from them and believes they are the right option and helpful in some cases. Should we include this fact? The following sources can substantiate this:

13tez (talk) 13:19, 9 May 2024 (UTC)[reply]

In Cass Response possibly, I'd say, but not in findings. Snokalok (talk) 14:38, 9 May 2024 (UTC)[reply]
On that note, how do we feel about adding in the bit from the Holyrood interview about general anxiety and depression medications? We do also have "Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress and cooccurring conditions."[page 31] in the report itself. Snokalok (talk) 15:08, 9 May 2024 (UTC)[reply]
@13tez and others: The BMJ interview is available through Wikipedia:The Wikipedia Library. Login (click the button for OAuth) and then search for the BMJ's entry (use the sidebar, not the search box at the top). Once you've clicked through to the BMJ's website – the resulting URL will start with https://www-bmj-com.wikipedialibrary.idm.oclc.org/ – search for any paper you want in the BMJ.
Nature journals are also available through TWL. WhatamIdoing (talk) 21:41, 9 May 2024 (UTC)[reply]

When referring to pre-pubescent females - is 'women' better than 'females?[edit]

I changed [31]: TO:

  • For transgender females, blockers taken too early can make a later vaginoplasty more difficult, although blockers do prevent lower voice and facial hair [1]

FROM

  • "For transgender women, the report advised balancing the need to mitigate the effects of male puberty with the need to allow for a certain level of penile development in the event that the patient later wishes to pursue a vaginoplasty"

Raladic reverted, writing:

  • "not an improvement and we use the term transgender women on Wikipedia as per the linked article

I reverted it back, writing:

  • "this sentence is about pre-pubescent children so 'women' is not the right word, nor is it used by Cass near this point. In fact Cass uses it 9 times in total, vs 47 for 'female'. "

Raladic reverted again, writing:

  • "the usages of “females” as a noun to refer to humans is disparaging and dehumanizing, refer to Female#Etymology and usage - we don’t support using disparaging wording on Wikipedia, whether the report used it or not"

So we don't have consensus right now. Peckedagain (talk) 00:09, 10 May 2024 (UTC)[reply]

I went to the most 'safe' page possible for this issue: and choose Feminism. For over 3 years, the page has contained the word 'females'. And twice :
  • "Changes in female dress standards and acceptable physical activities for females have often been part of feminist movements."
  • "As women earned doctorates in psychology, females and their issues were introduced as legitimate topics of study."
Peckedagain (talk) 00:20, 10 May 2024 (UTC)[reply]
Thanks for pointing out that mistake on Feminism, that article does also use the word women 428 times. I've corrected the two mistaken occurrences you found per the same reasoning of why I reverted your change - we use the word Woman as a noun on Wikipedia - the word female is an adjective and its use as a noun should be avoided as it can been seen as dehumanizing/disparaging per the references on Female#Etymology and usage, and that page being the better page to look for the meaning behind the word Female and its uses, why it has a Etymology section to begin with. You can also check out wikt:en:female#Usage notes with the same.
You may find reading this article interesting on the problematic use of female as a noun. Raladic (talk) 01:15, 10 May 2024 (UTC)[reply]
Thanks for pointing out that section, which was based on weak sources. I've left in the Jezebel piece, which is basically an opinion piece agreeing with a BuzzFeed listicle, but I've added Fowler's Dictionary of Modern English Usage for the important points.
NB that this is a "some people believe" situation, not an "it universally is" situation. The dictionaries are not marking this as derogatory (except for one, which marked it derogatory if and only if it was used to describe an effeminate man). @SMcCandlish, you might be interested in looking at this, and maybe seeing whether parallel updates to Male need to be made. (Garner's, which is in WP:TWL under the Oxford Reference item, wasn't informative.) WhatamIdoing (talk) 05:08, 10 May 2024 (UTC)[reply]
I did also find that the APA style guide, as one of the foremost style guides for professional and scholarly writing, also similarly calls out the avoidance of “males” and “females” as a noun. Raladic (talk) 06:28, 10 May 2024 (UTC)[reply]
They don't say it's disparaging, though; it's just not their style, except in two circumstances, when it is their style: "Use “male” and “female” as nouns only when the age range is broad or ambiguous or to identify a transgender person’s sex assignment at birth (e.g., “person assigned female at birth” is correct, not “person assigned girl at birth”)."
I think it's interesting that anyone now would push the late-Victorian POV that female is derogatory because that word is also used for animals and humans are better than other animals. I suspect that it's fundamentally based in an anti-evolution, pro-Christian worldview, so it doesn't feel like it fits in the modern era. (I also wonder if the OED made the same claim about male in 1895.) WhatamIdoing (talk) 16:37, 10 May 2024 (UTC)[reply]
On the original question: woman is basically never appropriate for any pre-pubertal human, as it is defined as referring to adults (under any definition of adult, including legal, social, or biological status). Female is confusing because it is primarily, but not exclusively, used to refer to biological sex; consequently, transgender females will be read by some people as referring to transfeminine people and by others as referring to AFAB non-binary and trans people. You might consider trans girl or perhaps something like child who was assigned male at birth. WhatamIdoing (talk) 05:24, 10 May 2024 (UTC)[reply]
For pre-pubescents, the term is girls; and for male pre-pubescent, boys. This is just kinda basic English. As for female[s] being "disparaging and dehumanizing", that seems to be yet another activistic "language reform" position, and one of very recent origin. I'm not aware of any reliable sources on English usage that suggest this notion, though I suppose there could be some somewhere that have adopted this stance by now. I would predict AP Stylebook and other journalism style guides to make such a change first (because they bend over backwards to avoid offense to even a small portion of their target, mostly left-leaning, market, and will do so at the expense of clarity/precision and in defiance of everyday actual usage). However, the AP Stylebook 2022 ed. (the newest I have, but it changes very little from edition to edition) actually recommends using female: "female: Use female as an adjective, not woman or girl. 'She is the first female governor of North Carolina.'" It doesn't address the plural or singular noun forms at all. The term female is also entirely conventional, adjectivally, in anthropological, medical, and related writing to refer to women and girls, e.g. "female gender roles", "female social status", "heritability dependent on the female line (matrilineality)", "an exclusively female medical condition", etc. However, the plural noun form is also very, very common in such material, including when the search is constrained to papers published after 2020 [32]. So, what's really happening here is that "females" is academic/scientific/medical terminology, that is somewhat depersonalized, approaching women and girls as a subject of study (same with men and boys, as male[s]). This does not actually translate to "dehumanizing" much less "disparaging", though the usage would not be appropriate for all contexts. E.g., "the two females in the band" doesn't make much sense, since bands are not generally subjects of scientific inquiry, but more personal-warmth-infused biography. As with nearly everything about writing on Wikipedia, the wording to use in a particular context is going to be a judgement call, and WP:Use common sense applies. But we're not going to outright ban the word "females" in reference to humans. If anyone wants to push such an idea anyway, the proper venue for that is WT:MOSWTW. Anyway, in this case, the source material clearly prefers female[s] by a wide margin, and women doesn't make sense in a pre-pubescent context. But there may simply be a way to rewrite the material to avoid the question, e.g. by using female adjectivally.  — SMcCandlish ☏ ¢ 😼  20:33, 10 May 2024 (UTC)[reply]

References

  1. ^ Cass review final report 2024, p. 178.

Edit-warring the lede[edit]

@Fiona Weber @Moons of Io please take it to the talk instead of edit-warring the lede. Void if removed (talk) 11:56, 10 May 2024 (UTC)[reply]

While their revert might have been debatable, their first edit very clearly showed that the revert was just plain vandalism on IO’s part, so I reported it as such and User:ScottishFinnishRadish agreed clearly agreed with my assessment and handed out a week-long block. If you need more evidence, this was their response to the vandalism report.
I consider the matter resolved by that and will reinstate the extended version.
--Fiona Weber (talk) 17:56, 10 May 2024 (UTC)[reply]
The offensive comment was vandalism, the revert of your changes was not vandalism, you have edited the lede without consensus and are continually edit warring over it, I've asked you to discuss your bold changes here per WP:BRD now please self-revert and discuss. Void if removed (talk) 18:06, 10 May 2024 (UTC)[reply]

Well, so far the only argument that has been presented against the extension to the intro was a slanderous claim that organizations like WPATH make millions of abusing children. Which isn’t surprising considering that the only addition was about what the already previously mentioned heavy criticism was about and that Cass admitted that the standards of evidence she is asking for can indeed not be met by ethical research. All of these are indisputable facts and clearly critical context for the introduction, certainly more important than what some politicians have to say. So if someone wants to revert, they should present actual arguments, for why the fact that actual experts essentially classify the report as junk should be left out. --Fiona Weber (talk) 19:35, 10 May 2024 (UTC)[reply]

@Fiona Weber
  • There is little point in mentioning yet again the vandalism - it can have no bearing to a discussion around RS and evidence.
  • "previously mentioned heavy criticism" - has already been discussed at length here in Talk from all sides: and there is no consensus for the text you proposed. Two editors have now described your text as: AGF and editorialising.
Peckedagain (talk) 19:56, 10 May 2024 (UTC)[reply]

Mother Jones article[edit]

A new Mother Jones article has been published with comments from several critical experts. Loki (talk) 20:27, 10 May 2024 (UTC)[reply]

This is the same untrue arguments that have been shown to be incorrect in the talk here already, eg:
  • "The Cass Report’s bar for evaluating research is too high
In scientific research, the randomized control trial (RCT) is often considered the gold standard..." 92.40.215.34 (talk) 14:55, 11 May 2024 (UTC)[reply]
I think most importantly you've got various Drs, including the president of USPath (for some reason Turban feels very familiar and Turban et al comes up so it must be for some scientific paper), saying that in Cass's report the recommendations doesn't follow from the findings, Cass uses misleading language (like poor and weak quality studies) and that there are concerns about who helped Cass write the report. Also notable is that a mistake has possibly been identified in one of the systematic reviews. Now this doesn't necessarily mean that it completely merits inclusion for all of this but it does mean it is a lot more than untrue garbage. LunaHasArrived (talk) 15:15, 11 May 2024 (UTC)[reply]
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