Talk:Cass Review/Archive 3

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Cal Horton

Why is so much guff from Cal Horton still in this article. The several paragraphs of text beginning "A 2024 article in the International Journal of Transgender Health..." needs entirely removed. It is the opinions of someone who is employed by the business school of Oxford Brooks University (a former polytechnic, not to be confused with Oxford University) who's qualifications wrt criticising the Cass Review appear to be "mother of a trans child" who did a phd on that.[1] Sure, they've done some research on trans issues that may well be valuable and could well be a source of information to the Cass Review itself. But our article is presenting their personal opinions, many of which are false and highly contested, as though we consider them a counterbalance to this review. Dozens of people were interviewed and gave their opinions to the Cass Review, and here we give space to one who feels ignored perhaps?

For a start, I think we need to realise that criticisms about how systematic reviews reject low quality evidence that are based on views about the infeasibility or ethics of RCTs, and guff about blinding, are themselves a striking example of misinformation. And Wikipedia needs to avoid being a source of misinformation. Anyone serious about evidence based medicine rolls their eyes when reading such nonsense. It demonstrates deep ignorance of how evidence based medicine really works, and is what you get when you start quoting people who work in a business school rather who's day job is conducting systematic reviews for NICE or Cochrane or whatever. If you don't believe me, please go read some NICE reviews or Cochrane reports on random other bits of medicine like epilepsy or breast cancer or depression or diabetes, and you will find the systematic reviews commissioned and cited by the Cass review are entirely typical and the ethical issues they face not that unusual.

If the approach of these systematic reviews was as outrageous as some trans activists are suggesting it to be, do you really think the BMJ would have published it, or that Cass and their Clinical Expert Group (who assessed the evidence) would not have gone "Hold on a sec, this is demanding the infeasible and is totally unethical"? These are Trumpian-level arguments that sound great to the activist base but should ring alarm bells. -- Colin°^Talk 12:37, 13 April 2024 (UTC)

Firstly it is important to remember that the Cal Horton part is criticism to the interim report specifically. I agree that I think citing criticism of the solely medical aspects of this is probably undue but Horton has done a PhD on trans kids wellbeing and works advising about that so should be credible for the top 3 points. I also think that crediting criticism of the systematic reviews was by transgender activists and not professional health organisations is intriguing. I would also point that some of the criticisms are saying that members of the clinical expert group was inherintly biased and influenced the decision. This idea that the reviews are infallible when health organisations have criticised them is an idea that should not be entertained. LunaHasArrived (talk) 13:12, 13 April 2024 (UTC)

This review also contained peer-reviewed analysis of those self-same organisations and levelled criticism at the weak evidence base and circularity of their standards of care.

Devoting 5 paragraphs to the opinions of a parent advocate of a trans child is way, way overkill. Void if removed (talk) 13:39, 13 April 2024 (UTC)

I agree that the space taken up was overkill Snokalok (talk) 13:50, 13 April 2024 (UTC)

Please remember this is the interim report. I agree with the change that has been made on the page and that the criticism made from the international orgs is far better. LunaHasArrived (talk) 13:52, 13 April 2024 (UTC)

Boldly deleted Horton as recovering the link to the joint statement revealed the low levels of interesting original thought in that paper. Flounder fillet (talk) 13:52, 13 April 2024 (UTC)

The Horton paper is the best peer reviewed scholarly source we have on the Cass Review. It's an entire paper devoted to thematic analyses of multiple documents produced by the Cass Review and was published in the International Journal of Transgender Health, which has been going for almost 3 decades and is a leading journal in the field[2]. Cal Horton has published quite a bit of peer reviewed papers on trans healthcare herself[3] It is not just opinions.

Now, here's the removed text[4]:

A 2024 article in the International Journal of Transgender Health reviewed the publications produced by the Cass Review including their initial Terms of Reference, the NICE reviews into puberty blockers and hormones, an online panel, a survey of healthcare professionals, and the interim report. The paper found four areas of concern:

• Prejudice: Healthcare professional views that demonstrated ignorance, dismissiveness or hostility to transgender youth were presented as valuable inputs and quoted, without discussion of potential anti-trans prejudice among professionals.
• Cisnormative bias: By design, the Cass Review prioritized cisgender professionals without experience in transgender healthcare. Transgender children are consistently misgendered in reports, with the interim report consistently conflating transgender youth sure of their identity with those exploring it.
• Pathologization: The Review frames transgender identity as a "clinical condition" and uses language indicative of disease such as "epidemiology", and states a research priority should be the etiology of transgender identity without justification. This approach is counter to the global trend of depathologization of trans identities as supported by the World Health Organization, WPATH, and the American Psychiatric Association, among others.
• Inconsistent standards of evidence: The two 2020 NICE reviews considered only "high-quality" research as designated by the GRADE approach, which defines it as randomized control trials (RCTs). However, GRADE encourages the consideration of other evidence. Additionally, RCTs are considered unethical and infeasible when applied to puberty blockers and hormones, due to requiring a control group to be subjected to what some consider conversion therapy; while non-affirming treatments were not held to the same standard of evidence. The interim report framed non-affirmative and affirmative approaches as equally valid, despite the former lacking any evidence of effectiveness.

While the paragraph should be collaboratively trimmed, it should not be removed or ignored entirely. We don't pick and choose what peer-reviewed academic analyses of the Cass Review we like - we include all of them. This paper identified these 4 concerns with the Cass Reviews - how should we include them?

I'm open to something like A 2024 article in the International Journal of Transgender Health thematically analyzed the publications produced by the Cass Review including their initial Terms of Reference, the NICE reviews into puberty blockers and hormones, an online panel, a survey of healthcare professionals, and the interim report. The paper found four areas of concern: platforming of anti-trans prejudice, cisnormative bias in the Review's design, pathologization of transgender identities, and inconsistent standards of evidence between non-affirming and affirming approaches. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:04, 13 April 2024 (UTC)

On your new paragraph, I'd recommend saying which side of the affirming and non-affirming care is getting benefitted from the inconsistent standards of evidence. Just as at the moment it is not explicitly obvious. LunaHasArrived (talk) 17:20, 13 April 2024 (UTC)

Good note thank you! In that case it should be ... and inconsistent standards of evidence between non-affirming and affirming approaches as the former lacks any evidence of efficacy but was not held to the same scrutiny. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:33, 13 April 2024 (UTC)

I believe I have sufficiently justified the removal in my edit summary. To elaborate on that: Horton's criticisms minus the explicit accusation of cisnormativity are a subset of the criticisms in the joint statement. Flounder fillet (talk) 19:49, 13 April 2024 (UTC)

The statement in question as it appears in the article: In November 2022, WPATH, ASIAPATH, EPATH, PATHA, and USPATH issued a statement criticizing the NHS England interim service specifications based on the interim report. It stated several points of contention with the report, including the pathologization of gender diversity, the making of "outdated" assumptions regarding the nature of transgender individuals, that it "ignores" newer evidence regarding such matters, and that it calls for an "unconscionable degree of medical and state intrusion" into everyday matters such as pronouns and clothing choice, as well as into access to gender affirming care. It also stated that "the denial of gender-affirming treatment under the guise of 'exploratory therapy' is tantamount to 'conversion' or 'reparative' therapy under another name"

Addressing your two points in the summary

1) Horton being much lower profile than any of these medical organisations - a peer reviewed paper on the topic is still a peer reviewed paper on the topic. We can have both the positions of the medical orgs as well as a summary of the paper.

2) Horton's criticisms minus the explicit accusation of cisnormativity are a subset of the criticisms in the joint statement.

2.1) the explicit accusation of cisnormativity is a central theme of this paper - this paper said XYZ but someone more prominent said XY is not a reason to remove paper said XYZ or paper said Z

2.2) Horton's criticisms are nearly identical to the criticisms in the joint statement mentioned above

2.2.1) Horton's point 1 was the reports included examples anti-trans prejudice but did not adequately frame them (like recording that many psychiatrists did not believe transgender children exist, without pointing out this is 1) ridiculous 2) dangerous to trans kids). This is not mentioned in the statement.

2.2.2) Horton's point 2 was the reports expressly sidelined transgender voices and researchers from the start. Also not mentioned in the statement.

2.2.3) Horton's point 3 was pathologization of trans identities - this was mentioned in the statement

2.2.4) Horton's point 4 was there is no evidence denying transition is helpful but it was equated with the "low quality" evidence allowing transition is helpful. This was not mentioned in the statement.

In short, of Horton's 4 points, only the 3rd is nearly identical to the criticisms in the joint statement mentioned above, the other 3 are peer reviewed criticisms that were not covered by the WPATH statement. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:24, 13 April 2024 (UTC)

Given that afaik this is the only peer reviewed study on any part of the Cass report has to be considered when deciding to include it. In fact if any claims are shared between this study and international response it should probably be stated in the international response that this is backed up by a study (i.e not just the organisations opinion) LunaHasArrived (talk) 20:31, 13 April 2024 (UTC)

If the approach of these systematic reviews was as outrageous as some trans activists are suggesting it to be, do you really think the BMJ would have published it, or that Cass and their Clinical Expert Group (who assessed the evidence) would not have gone "Hold on a sec, this is demanding the infeasible and is totally unethical"? These are Trumpian-level arguments that sound great to the activist base but should ring alarm bells

Colin, can you please stop pushing your openly anti-trans POV on this talk page. It just continues to showcase that you shouldn't be anywhere near this topic area. Silverseren^C 16:43, 13 April 2024 (UTC)

Having been on the wrong side of a disagreement with Colin more times than I care to remember on GENSEX matters, he is always scrupulously even-handed IMO, and I strongly suggest you strike that comment. Void if removed (talk) 17:00, 13 April 2024 (UTC)

No thank you. And I really don't think you should be anywhere near this topic area either, considering how and why you first started editing on Wikipedia and how it nearly got you banned. Silverseren^C 17:28, 13 April 2024 (UTC)

Silver seren, seriously, you need to strike that right now. I'm in camp evidence-based-medicine, which one might have guessed from the fact I created WP:MEDRS. Anyone with a problem with that shouldn't be editing medical articles on Wikipedia. The personal attack you just made, is the sort of thing that will curtail your editing in this area. Please strike it now. I won't ask a second time. -- Colin°^Talk 17:38, 13 April 2024 (UTC)

Then why do you keep making commentary across two separate talk pages where criticism of the Cass Review is being made by "trans activists"? You're the one making those comments. And pointing out those comments as being POV is not a personal attack. It is a comment on your editing, ie your own comments being made on these talk pages. Silverseren^C 17:40, 13 April 2024 (UTC)

Silver seren you really should strike that comment. Leaving aside that it's uncivil, and that talk pages are a place to comment on content not the contributor, your reading of Colin and his contributions are wrong. While I have disagreements with some of what he's said, he has not said them because of an anti-trans POV. Sideswipe9th (talk) 17:50, 13 April 2024 (UTC)

Fine, I'll do it because you asked. But the repeated commentary from Colin on criticism being trans activists and comparing said criticism to homeopathy and fringe topics on the other talk page is not helpful and is not just statements on evidence-based medicine. Silverseren^C 17:54, 13 April 2024 (UTC)

I also think your original statement was too strong and striking it was the right thing to do. Which is not to say I don't agree with the comment I'm directly responding to: I agree that many of Colin's statements in this topic area have also not been great, and I wish that he would stick to just the evidence-based medicine stuff rather than, for example, getting into long disputes about whether or not the UK as a country is more anti-trans than other countries. Loki (talk) 18:34, 13 April 2024 (UTC)

Thanks for striking that, Silver seren.

If there's a correct shorthand way of referring to activists in camp-trans (vs camp-gender-critical or camp-wingnut or camp-religious) I'm all ears. I am not referring to the gender identity of these activists, which should be obvious for example from the fact that Horton is an advocate/parent. There are people who say dim things in all these camps, and right now, there's a lot of dim stuff being said about these systematic reviews by people who clearly haven't the first clue about how systematic reviews work, and are spreading disinformation. We must not pick up that disinformation and repeat it here.

And yes, the kind of arguments we are seeing are the kind of arguments made by proponents of homeopathy and fringe topics. Does that mean I think affirmative trans healthcare is like those fields. No. But it does mean that we should be sceptical of sources that stoop to that level of naivety and confusion.

I mean, who here is comfortable with this talk page claiming that "the report choses to ignore 100 of the 102 studies into puberty blockers and hormones". I don't see anyone else calling out that bs misinformation. Or the continued confusion of randomised controlled trials with blinded randomised controlled trials. Misinformation. Or above the continued pushing to include paragraphs of the opinion of one random person who did not review the actual Cass Review, but only the tiny bits of it they could see and that were published months if not years ago. This person's opinions on the cis-normativity and pathologization of trans healthcare doesn't magically become notable on Wikipedia because they included the words "Cass Review" in their article title.

Loki, I'm not the one who keeps bringing up the Terf Island trope on these pages. If there's criticism to be waged on that front, please address it towards the few editors who seem to think nationality is a basis by which to discredit first-class evidence based research published in the BMJ. Colin°^Talk 18:57, 13 April 2024 (UTC)

if there's a correct shorthand way of referring to activists in camp-trans (vs camp-gender-critical or camp-wingnut or camp-religious) presumes there is a camp-trans - framing the debate as camp-minority vs camp-people-who-don't-think-the-minority-exists-because-"feminism" / camp-undefined-radical / camp-people-who-don't-think-the-minority-exists-because-religion is part of the issue. There is no "camp-trans" apart from a nebulous bogeyman lumping together any and all criticism of the review as "activists".

Or above the continued pushing to include paragraphs of the opinion of one random person who did not review the actual Cass Review, but only the tiny bits of it they could see and that were published months if not years ago. This person's opinions on the cis-normativity and pathologization of trans healthcare doesn't magically become notable on Wikipedia because they included the words "Cass Review" in their article title.

- Are you by any chance referring to the short proposed paragraph above by a scholar on transgender healthcare who wrote a peer reviewed thematic analysis of multiple publications from the Cass Review in a famous transgender healthcare journal? Because framing that as "opinion" and speaking like we shouldn't include it at all is not how RS works. We don't ignore reliable sources we don't like. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:22, 13 April 2024 (UTC)

YFNS, I'm not going to take the bait. You say "thematic analysis" I say "opinion piece". What it isn't is science. Or medicine. Many if not all of the authors making these claims self describe as "activists".

Silver seren, Loki, Sideswipe9th, et al, have a look at what User:WhatamIdoing, wrote here. Maybe you prefer their style, but they make the same points. Just because some sources we can find are on Our Side, doesn't mean those writers aren't being spectacularly dim, or enthusiastically not letting the facts get in the way of their argument. I firmly believe Wikipedia articles are stronger and better when we trim out the shit stuff. There's hateful shit stuff on the gender-critical side (just glance at The Telegraph) but there's also well meaning shit stuff on the pro-trans side. Throwing shit on the page and seeing what sticks is not how to write a great article. Let's rise above that. Colin°^Talk 19:28, 13 April 2024 (UTC)

I realised I hadn't said what exactly I disagreed with in the quoted text, and that maybe has given the wrong impression. Specifically I disagree with do you really think the BMJ would have published it and or that Cass and their Clinical Expert Group (who assessed the evidence) would not have gone....

On the BMJ, there are right now a sizeable number of academics I follow on social media, all of whom have published in this or an adjacent medical topic, who are incredibly dissatisfied with comments made by the BMJ's editor in chief since the publication of Cass' review. There is at least one group of academics who are currently writing an article about the severe flaws in the systematic reviews published in the BMJ, with the implication that it will in part be questioning how those papers passed muster.

On the ethics question, we know from Appendices 4, 11, and 12 that six of the seven trusts within NHSE that host adult gender clinics refused to cooperate and hand over patient data for adult patients who had transferred from GIDS to their respective clinics, to Cass for use in a study on the follow-on outcomes of patients. Included in the reasons why those clinics refused to hand over the patient data were that the study had severe ethical concerns (appendix 4, page 8, PDF page 302), and that the study's design may not have been fully independent and may suffer from interference by NHS England, the Cass Review Team and government ministers whose interests do not align with those of providers and users of gender identity services (appendix 4, page 9, PDF page 303). Now yes, Cass and her team did dispute those concerns, however that they disputed them does not automatically mean they are incorrect any more than the fact that the issues were raised automatically make them correct.

Now I don't have an opinion on article content with regards to the above, I don't know who is right and who is wrong, and there are no reliable sources as of yet either way. However the concerns by both the academics about the BMJ's editor in chief, and the clinicians within the NSHE trusts do not exist in a vacuum. The only opinion I have right now is that we should be treating all content relating to the review, whether it's from the review report itself, the papers published in the BMJ, or the criticisms and praise of the review and related content, with a large degree of caution. We need to let the academics and reliable sources sort themselves out with regards to this review, and decide whether it is reputable or not, and whether it is good science or not. Sideswipe9th (talk) 20:02, 13 April 2024 (UTC)

I very much agree with the point about holding off and waiting for responses. Whilst waiting for study's of equal medrs Is of course unreasonable due to the time taken of these studies. I think at least waiting for international medical organisations to comment and being conservative with what to editis worth doing (probably could do with more talking on the talk page before making contributions, I get the feeling you'll get a sort of speedy response). (Also I'm majorly aware I could probably do with more of this myself.) LunaHasArrived (talk) 20:22, 13 April 2024 (UTC)

Sideswipe9th, can you find the bit in MEDRS where it says "A peer reviewed systematic review published in the very top tier of medical journal should be treated "with a large degree of caution" or "holding of" because, let me get this right, an editor's social media feed says so. If this was really as bad as some activists are making out, you can all tell me you told me so when the BMJ sacks its editor and retracts the paper and WPATH rush out a systematic review showing the evidence was all high quality after all, published in the New England Journal of Medicine because clearly Old England is run by terfs. But until them, there's not a single policy or guideline to support your position. And wrt holding off, let's be clear what I'm talking about.. I'm talking about things like what Wikipedia should say at puberty blocker wrt evidence. I'm not talking about how NHS England should care for trans adolescents. That's something reasonable people can come to radically different ideas on and mired in politics and funding and the basic problems of recruiting people into a toxic subject when the NHS pays shit. -- Colin°^Talk 20:35, 13 April 2024 (UTC)

Well, the issue is, large WP:MEDORGs have already said that the Cass Review ignores the consensus of major medical bodies around the world. I agree it's not normal to wait on secondary opinions for a big systematic review, but that's because most big systematic reviews aren't this controversial within their field. Loki (talk) 20:42, 13 April 2024 (UTC)

This did also include a systematic review of the guidelines produced by those MEDORGS and found them mostly inadequate. So when this review is explicitly critical of this international consensus controversy is to be expected. Void if removed (talk) 21:32, 13 April 2024 (UTC)

I mean, sure they did. It doesn't make it not the consensus in the field, though.

Otherwise, any crank could post a "systematic review" of the guidelines on regular vaccination, find them to be "mostly inadequate", and on that basis say that vaccines are bad and you should take his special protein supplements. The scientific consensus in a field has special weight in Wikipedia policy for a very good reason, and one paper cannot override that no matter how strong it is. If the consensus changes as a result of this paper, that's fine, but we would need a significant amount of time to assess that. Loki (talk) 01:36, 14 April 2024 (UTC)

It's not true at all that the Cass Review "ignores" the positions of major medical and scientific organizations around the world. It evaluates their positions and rejects them (except for national bodies in Finland and Sweden). And the review explains why. That's not ignoring 86.21.75.203 (talk) 21:30, 21 April 2024 (UTC)

In fact, it's the opposite of ignoring: reviewing, considering, evaluating, finding them wanting, explaining why then rejecting. Zeno27 (talk) 21:37, 21 April 2024 (UTC)

From the point of view of the Wikipedia sourcing guidelines, the fact that a study has said it's aware of the consensus and is rejecting it is not relevant for our judgement of how to cite it relative to the rest of the consensus.

Otherwise anyone who wants to push, say, anti-vax BS could simply say they have evaluated the existing consensus on vaccines and found it wanting. And they do, frequently. What matters isn't really how the Cass Review treats the consensus, but how the consensus treats the Cass Review. Loki (talk) 00:51, 22 April 2024 (UTC)

Loki, the word you are failing to pick up on is "ignores" which is patently wrong and misleading. I don't know if "ignores" comes from your own paraphrasing or is literally what they said, but if the latter then that still doesn't mean we can say that. I mean, the Cass review literally commissioned a systematic review to examine the existing guidelines. Ignore is the wrong word. The difference with "anti-vax BS" is they don't write systematic reviews that get published in the BMJ! -- Colin°^Talk 07:28, 22 April 2024 (UTC)

I'm talking about things like what Wikipedia should say at puberty blocker wrt evidence. So am I. While the specifics are of course a discussion for that article's talk page, while we can report on the findings of the review I would advise caution on using the review in a broader sense than that, for example using it as the basis of a substantive section on the use of puberty blockers for trans youth. There is at least one other major review and set of guidelines due for publishing within the next few weeks to a month; a joint German, Austrian, and Swiss guideline, and as I said on the puberty blocker talk page a couple of days ago, the early indications from a press briefing by the authors of the guideline is that they have assessed the same evidence and take a diametrically opposed stance to that of the Cass Review.

It's not out of the realm of possibility for top-tier journals to publish bad science. Though the specifics of the situations differ we've seen this sort of thing happen before with Wakefield and The Lancet. Now I'm not saying this is a Wakefield situation, it's possible that this is a storm in a teacup amplified by social media being social media, but it's also possible that the issues being raised by senior and well respected academics and clinicians on their respective profiles are valid. Whether we like it or not, or agree with it or not, both the Cass Review and the systematic reviews commissioned by it have been received highly controversially by other experts within this field, and that should give us pause while they and the sources they write figure everything out.

can you find the bit in MEDRS where it says Of course not, because MEDRS doesn't say anything like that or in that manner. However, WP:MEDSCI tells us that our articles must present whatever the prevailing medical consensus is. The problem is, as multiple MEDORGS have now stated, the Cass Review and the reviews commissioned by it have seemingly gone against the prevailing medical consensus. The PATHA statement even states this exact terms that mirrors MEDSCI: this review ignores the consensus of major medical bodies around the world. Now perhaps that is because the previously prevailing consensus was wrong, and Cass is right, or perhaps Cass is wrong and the previously prevailing consensus is right. Either way we don't know for certain. All we do know is, as I said in the previous paragraph, this review and its commissioned systematic reviews have been received highly controversially by other experts within the field, and that reception is why we should be cautious when including content from it. We need to let this controversy play out, because per non-negotiable policy we describe conflicts, and do not partake in them ourselves. Sideswipe9th (talk) 21:35, 13 April 2024 (UTC)

Indeed. I note there are still no responses to that bmj article. Zeno27 (talk) 09:07, 14 April 2024 (UTC)

I think we are continuing to confuse systematic reviews with guidelines and the sort of recommendations in the Cass Review. MEDORGS may well criticise the Cass Review but multiple systematic reviews (of which this latest is no revelation) report the same findings wrt evidence for certain things. These are academically uncontentious and I do not expect the BMJ reviews to receive any serious attack. Whereas I expect the Cass Review to maintain ongoing debate. Let's not confuse information-gathering exercises like what a systematic review does, with policy and possibly ideologically-based recommendations. One can look at a systematic review like in the BMJ and still decide that you think gender affirming care is the correct approach. And Wikipedia can still report on what the consensus is and any significant deviations from that. But what Wikipedia can't do is claim there is evidence there is not. These are the highest MEDRS sources for evidence and cannot be trumped by a MEDORG press release. If a MEDORG seriously disagrees about this evidence, then they should commission their own systematic review. MEDRS is quite clear about the hierarchy of evidence. But these systematic reviews in the BMJ are not clinical guidelines, which is what Cass is doing and what WPATH do. Do you see the separation? -- Colin°^Talk 10:44, 14 April 2024 (UTC)

You say "thematic analysis" I say "opinion piece" - but only one of is right, and the peer reviewed journal which accepted it said the former. They did not say it was a "letter to the editor" (which they do publish and would be an "opinion piece"), they put it in the same category as their qualitative health research. The paper had methods, findings, and discussion. It is not purely an opinion as you keep framing it.

• I also want to note the article currently contains multiple quotes from people speaking to lay publications about it. It is bad writing for us to assemble those opinions, but completely ignore an actual peer-reviewed paper and handwave it away as opinion.

What it isn't is science. - The Social Sciences are still science. Many if not all of the authors making these claims self describe as "activists". - where does Cal Horton do this? That is who we're discussing. If you refer to their commitment to trans emancipatory research, please explain why acknowledging that trans lives are equal to cis lives, and being attentive to cisnormativity or pathologization of gender diversity makes them a disqualified "activist".

I appreciated WhatamIdoing's statement when I saw it - but it has no relevance whatsoever to the Cal Horton paper: I'm also finding the idea that someone can "do a systematic review on one study" to be evidence that people (and the sources they're relying on) don't know what they're talking about. ... I would be surprised if we didn't see special pleading in social media about why low-quality studies with the Right™ results needed to be included anyway Horton's paper is a peer-reviewed paper, not social media. That is not their main critique of the Review, they found 4, whether or not you agree. They don't say "a systematic review of one study".

Apart from WP:IDLI - Why should a peer-reviewed thematic analysis of multiple Cass Review publications (the only peer reviewed analysis of multiple Cass Review documents we have) be completely ignored and excluded from an article about the Cass Review? WP:NPOV says All encyclopedic content on Wikipedia must be written from a neutral point of view (NPOV), which means representing fairly, proportionately, and, as far as possible, without editorial bias, all the significant views that have been published by reliable sources on a topic. Ignoring the most relevant peer reviewed paper on the topic is not that. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:04, 13 April 2024 (UTC)

Quick note, the article says Writing for The British Medical Journal, editor-in-chief Kamran Abbasi responded to criticism that the requested standard of evidence was infeasible, saying, "In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low".[5] - the editor of a journal wrote his own editorial in it supporting the review and is quoted in our article. The double standard that blatant opinion like that is fine, but peer reviewed independent analysis is not, is weird. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:10, 13 April 2024 (UTC)

YFNS, if you think "peer reviewed" means we must include it on Wikipedia, I've got a guideline to point you at called WP:MEDRS. Nearly all peer reviewed sources are unsuitable for use on Wikipedia. We include opinions, in quotes typically (vs paragraphs of unquoted text we had before), if those opinions are notable and have weight. Getting an opinion piece published in a minor journal doesn't automatically make it notable for Wikipedia, since, em, we don't write paragraphs of text, or even one sentence, quoting every single paper ever published in your "famous transgender healthcare journal". So there must be something else? I have never said being an activist disqualifies anyone's opinions. Writing stupid things disqualifies them (and activists on all sides are doing that) so you'll excuse me if I decide to respond increasingly less often to your posts, as arguing about things nobody ever said is a game for immortals, and life is too short. -- Colin°^Talk 20:47, 13 April 2024 (UTC)

Cal Horton works at All About Trans, an organization that describes itself as "a passionate team of professionals, advocates, and allies who are committed to promoting the well-being and empowerment of transgender individuals." I think it's fair to describe that as an activist organization 86.21.75.203 (talk) 21:38, 21 April 2024 (UTC)

Are you sure about that? That sounds like something that should be declared as a potential conflict of interest yet the paper says, "Disclosure statement No potential conflict of interest was reported by the author(s)."Zeno27 (talk) 21:50, 21 April 2024 (UTC)

I don't think this is the sort of thing "conflict of interest" is about. It's more about the fact that someone got a grant from the manufacturer of a drug they then claim is really effective, or in fact, works for them. Merely being an activist or biased isn't "conflict of interest". Their twitter and reddit work make their activism clear. Being an activist isn't a marker for exclusion on its own, but it makes their negative opinion entirely unremarkable. Like Polly Toynbee writing about how stupid the Tory party are and how wonderful Labour are. Their opinions may stack up from a certain POV if you share their sociopolitical beliefs but also there will be areas where Toynbee is speaking merely as someone paid to have an opinion rather than for their expert knowledge in e.g. healthcare. That Horton has opinions and that WPATH's journal wants to publish those opinions is no different from Toynbee having opinions and The Guardian publishing those opinions. Doesn't mean we have to give them space on Wikipedia. -- Colin°^Talk 07:57, 22 April 2024 (UTC)

Yes, you can google it to confirm. As Colin says below, involvement in politics or activism is not considered a conflict of interest when it comes to publishing research. Many academics are activists of one kind or another, and social science research is always informed by the writer's politics. A conflict of interest would be if the writer, or an organization they work for/receive funding from, stood to benefit financially from the research. 86.21.75.203 (talk) 18:52, 23 April 2024 (UTC)

Proposal

At the moment, this article does not include any reference to The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children, a peer-reviewed thematic analysis of Cass Review publications between January 2020 and May 2023 published in the International Journal of Transgender Health(impact factor) with the results Four concerns are presented and explored: (1) prejudice; (2) cisnormative bias; (3) pathologization; and (4) inconsistent standards of evidence. Each of these concerns impacts the Cass Review’s approach to trans children’s healthcare, with negative repercussions for trans children’s healthcare rights and well-being. The author is Dr. Cal Horton, who has written on transgender people's healthcare, family, and education.[6][7]

I believe the paper is due for inclusion, and propose the following text: A 2024 article in the International Journal of Transgender Health thematically analyzed the publications produced by the Cass Review up to the interim report and found four areas of concern: platforming of anti-trans prejudice, cisnormative bias in the Review's design, pathologization of transgender identities, and lower standards for evidence for non-affirming approaches compared to affirming ones.

I'd appreciate people's brief non-excessively threaded thoughts on whether the paper is due and whether the proposed text adequately captures it. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:27, 13 April 2024 (UTC)

WPATH is the partner organisation of the International Journal of Transgender Health, so it is not an independent source of critique. Zeno27 (talk) 22:42, 13 April 2024 (UTC)

I don’t think it’s particularly a bad source, but there are better, and I think the WPATH criticism is already fairly comprehensive as is. I could perhaps see adding the paper as an extra citation as Luna said, to show that there are studies that agree. Snokalok (talk) 00:30, 14 April 2024 (UTC)

I do think that a brief reference to this paper is WP:DUE. I don't think it's the strongest paper I've ever seen, but it is a peer-reviewed paper reacting to the Cass Report and we frankly could use more of those. A major question in this article is how the consensus of the field is going to change, if at all, in reaction to the Cass Report, and this paper does give some evidence of that. Loki (talk) 01:42, 14 April 2024 (UTC)

Im my experience, it's usual to see a declaration on each paper about the peer review it's been subjected to. There is none on the Horton paper and all I can find for the journal itself is where it says "All manuscripts published by IJTH, including those in special issues, have undergone rigorous, anonymous peer review, and editor screening." In contrast, the systematic reviews published in the bmj each say, "Provenance and peer review Commissioned; externally peer reviewed." Zeno27 (talk) 10:01, 14 April 2024 (UTC)

Yes, this article should be included. There is no good reason to exclude it, other than disagreeing with its findings and conclusions. Matters of ethics, prejudice, and bias are inherently important in medicine, and articles like this are needed for such a report. Especially when dealing with a small gender minority that has been historically marginalized. Hist9600 (talk) 00:55, 19 April 2024 (UTC)

Zeno, let's not confuse the BMJ with IJTM. For a start, Horton is not criticising the systematic reviews: they can't as they weren't finished never mind published when they wrote their critique. They are criticising Cass's approach, which is an ideological opinion, not some hard physical fact like "we studied 23 people and 1 died of suicide". Things like Horton's opinion piece (thematic analysis if you prefer) are assessed on quite different grounds to the BMJ systematic reviews, and simply saying it was "peer reviewed" doesn't mean anyone necessarily agrees with Horton, just that they didn't find it deranged and full of obvious mistakes. There will be people who reasonably disagree with Horton's opinions, likely on ideological grounds, but there aren't people who can reasonably say that if a systematic review looked at 50 studies and selected 34 then in my opinion they only selected 1.

If there is consensus that Horton's opinions are DUE (for the interim report sub-section) then we cannot present them the way YFNS has. This isn't how medical articles should be written. The style of "In 2022 Big Famous Journal found that XYZ" is what we get in the cruft sections of contentious medical topics and the more dubious wellbeing websites. It isn't encyclopaedic. For example, for all the systematic reviews that Cass commissioned, would you find it acceptable to name drop the British Medical Journal for each? We aren't to play pissing contests in front of our readers about who has the biggest journal. In the end, this is the opinion of Cal Horton, a pseudonymous researcher and parent of a trans child. It isn't the opinion of International Journal of Transgender Health (that would be expressed in an editorial). Replacing the views of an obscure author with the name of a journal is not done on Wikipedia, as Cal Horton is not the editor.

We can't say they "found four areas of concern" in Wikivoice. It would be like citing someone from the Labour party looking at the latest Tory immigration policies and saying, in Wikivoice, they "found four areas of concern". We need to somehow indicate that these are Horton's concerns. -- Colin°^Talk 10:37, 14 April 2024 (UTC)

I agree with @Colin that we should mention that this analysis was produced by Cal Horton. So, taking @Your Friendly Neighborhood Sociologist's text as a basis, we could change the first sentence so it reads: "Horton (2024) thematically analyzed the publications produced by the Cass Review up to the interim report and found four areas of concern". Cixous (talk) 17:52, 14 April 2024 (UTC)

@Cixous travelling today so typing from my phone, no issues with that change. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:47, 14 April 2024 (UTC)

Great! I think it's settled then: we include YFNS's proposal with this small amendment :). Cixous (talk) 08:05, 15 April 2024 (UTC)

If Horton is to be mentioned (and I don't think it adds anything) then the link with WPATH must be mentioned. Zeno27 (talk) 18:05, 14 April 2024 (UTC)

Why would WPATH need to be mentioned if we decide to use Horton's name? I don't really why one necessitates the other. Besides, the main reason why I argue in favour of the inclusion of Horton's name is because it is more in line with APA citation guidelines (i.e., the study is more verifiable and the text more concise). Cixous (talk) 18:42, 14 April 2024 (UTC)

It's WPATH partnership with the journal Horton's paper is published in: this is a potential for bias that readers should be made aware of. Zeno27 (talk) 18:47, 14 April 2024 (UTC)

Isn't that remedied by the fact that the paper was anonymously peer-reviewed? I think that already solves the main issue. Anyways, how would you suggest rewriting the sentence (or do you simply want to keep it as it is)? Cixous (talk) 18:53, 14 April 2024 (UTC)

I fail to see why the journal being the official journal of WPATH is an issue here. Horton's work was peer reviewed per the journal's usual process, and neither she nor her work are connected to nor funded by WPATH in any way beyond this being the journal it was published in. Unless you're implying that WPATH are exercising improper and undue editorial influence over the journal's content and publishing process, in which case the Sagan standard applies. Sideswipe9th (talk) 01:30, 15 April 2024 (UTC)

Sideswipe9th is correct. There is no reason to think that this journal isn't independent. Editors who are intuitively feeling like something's "off" will probably find it helpful to contrast independence (which affects whether a source is reliable) with WP:RSBIAS (which does not). The journal might be biased (though if so, that's not obvious to me), but a publication doesn't become non-independent just because the author and the owner happen to hold the same viewpoint.

YFNS, I have no strong views whether to include this, but you might copyedit your proposal in light of WP:MEDSAY. In particular, naming journals sometimes comes across as WP:PUFFERY. We usually want to see something closer to "Alice Expert said..." than "The Famous Journal of Important Things published...". WhatamIdoing (talk) 05:58, 15 April 2024 (UTC)

Whether the journal or Horton are biased isn't our concern, particularly when we are explicitly attributing opinions to them. We include viewpoints that have weight for inclusion, it isn't like anyone else being included in the "response" section is without a bias. And it isn't really our job to try to credit (puff) or discredit (diss) individuals in front of the reader. But again, we can't say, in Wikivoice, that Horton actually found four areas of concern, as though Horton climbed a mountain and found four new species of moss. Horton had four areas that they were concerned about. Clearly other people don't share those concerns. It is just a viewpoint. -- Colin°^Talk 09:30, 15 April 2024 (UTC)

I would prefer we didn't do the "Horton (2024)" style as we shouldn't really mix citation styles in an article. It isn't really important to date in front of the reader, the point we should make clear (by its position in the article, say, or explicitly) is that their critique was at the interim stage. Something like Cal Horton analysed the Cass Review at interim report stage and criticised it for platforming anti-trans prejudice, having cisnormative bias in its design and pathologising transgender identities. Horton also felt that the standards for evidence for non-affirming approaches were lower than for affirming ones. Something like that. Perhaps WhatamIdoing can finesse it.

But I still don't feel that Horton's opinion has weight to be due for inclusion. It repeats some of what we already document in detail about what WPATH said. So it is a bit like: here's a whole paragraph about what the international clinical guideline authority thinks and here's a short paragraph about what some parent thinks. We seem to be including it because some want those opinions repeated on this page, rather than that Horton is an authority worthy of note. -- Colin°^Talk 09:54, 15 April 2024 (UTC)

I feel that Horton's inclusion does matter. Of date, Horton is the only academic source on the Cass Review that analyses the Cass Review's study design. It goes to show that there are academic responses next to medical organisations that take issue with the Cass Review. Besides, if "Horton (2024)" feels off, we could change it into sth like "Cal Horton, researcher at Oxford Brookes University," (though I'd say that "Horton, 2024" is preferable). Lastly, if we take YFNS's text and simply change the subject into Horton, the reader will surely understand that this is her analysis (and, by extension, that she thinks there are four areas of concern, regardless of whether or not the reader agrees). Cixous (talk) 10:45, 15 April 2024 (UTC)

As I noted elsewhere, if we take these arguments, that the source is "peer reviewed" (wooo) and "academic" and "the only" and consider them sufficient for inclusion... would you guys would be so keen for Hal Corton (Cal Horton's evil nemesis, and parent of a non-binary ROGD child) who had recently completed a phd in gender-critical-feminism. Hal has just published their gender-critical thematic analysis at some similarly low ranking journal, claiming the Cass Review was epoc making and surely spelled the end of trans ideology, mutilation of vulnerable children and a long needed good-riddence towards wokeness in modern healthcare. For such opinions very very much exist and that they can be coherently made (whether one agrees with them or not) is all that is required to publish such in a social science journal. You are setting a low bar, imo, just because you like the opinion. -- Colin°^Talk 12:31, 15 April 2024 (UTC)

To be fair, I'm not very interested in what Horton says, as I haven't read her paper in depth, The main point I'm arguing for is the fact that her article analyses the processes behind the Cass Review and should therefore be included. I'm not claiming to be an arbiter scientiae in any sorts here, nor that I believe that Horton's analysis is or is not convincing. My main point is that not including it doesn't make much sense here. It is an academic response to the Cass Review and it adds to overall topic without being off the f*cking rails (if it indulged into any kind of conspiracy theory about a plot to deliberately destroy trans healthcare, that'd be a different story; then your ROGD example would be more applicable). It simply goes to show that not only international organisation take issue with Cass's methods. In an article about a medical review, criticism of the processes behind that review are relevant. Cixous (talk) 13:30, 15 April 2024 (UTC)

Oh, you mean it is Wikipedia's job to say that not only international organisations take issue with it, but someone's mum also? This isn't how we measure WP:DUE. The fact that someone writes up their opinions of the Cass Report and gets a social science piece published in a minor journal does not itself make that notable, as my example of the opposite should make clear. How is Horton's personal views notable to our readers? For example, many orders of magnitude more people will have read opinions in The Telegraph and The Times and there's a section below asking for those sources to be excluded for their anti-trans bias. But bias is not a reason to exclude, otherwise we'd be excluding WPATH's journal here.

My point is that any old criticism (or any opinion) of the Cass Review is not automatically relevant for this page, and it doesn't automatically become due because it was peer reviewed. WPATH's views, as a major organisation, are clearly due. Someone's mum? -- Colin°^Talk 13:58, 15 April 2024 (UTC)

That' not what I'm saying, though I have to say it's a hilarious way of putting it (I gotta admit I chuckled while reading your reaction). I don't care whether Horton's mother, father or non-binary parent. I don't care whether she's got no children, one child or fifteen children and a pet giraffe. I simply care about her inclusion, because she's currently one of the only independent academics to produce relatively decent criticism of a high-profile review. I see where you're coming from, and if better sources pop up in, say, two months, I'll be more than happy to remove her analysis. For now, I'm in favour of inclusion, you're not, and that's fine. Let's just see what the broad consensus about this is. Cixous (talk) 14:30, 15 April 2024 (UTC)

FWIW, I have read it and I don't think it is especially good, and it was a response to the interim review, not the review.

For example, Horton says on the point of the unethical nature of randomised-controlled trials:

RCTs are widely recognized as inappropriate for trans children’s healthcare, with a wide range of experienced healthcare researchers, ethicists and clinicians recognizing RCTs as both infeasible and unethical in this field

Widely recognised is a strong claim. This strong and definitive statement has 3 citations.

The first, Brik et al. says:

many would consider a trial where the control group is withheld treatment unethical, as the treatment has been used since the nineties and outcome studies although limited have been positive

So, not that definitive actually, just that some say it is, because they are already convinced of the benefits.

The second, Giordano et al says :

If we look at the licensing of GnRHa for puberty suppression in children with central precocious puberty that use has been licensed in Europe and the US based on relatively short open-label studies with small groups of patients (MHRA), because it is impossible and unethical to perform a Randomized Controlled Trial (RCT) for this indication. The same would apply to puberty delay in adolescents (see below).

This is just an assertion, but if you do see below they say:

it might be unethical

So again, not definitive, just "might".

The third citation is Horton themselves, saying in an earlier publication that denying anyone puberty blockers is like conversion therapy.

So we have two cites that don't really support the claim (some say, it might), and the author's personal opinion squared.

I'd say just because you can get your opinions in a journal doesn't make them due. So a) not due, and b) if people think it is, it can't possibly be due for anything other than the interim review. Void if removed (talk) 15:01, 15 April 2024 (UTC)

I've no interest in whether to include it at all. If we do, I suggest that the reason should be that we think it's the best source that is presently available, rather than the best source that could be imagined, and that we keep an eye out for better sources in the future (e.g., one that covers the final report, or one that talks about whether Horton's criticisms were taken into account).

I'm more interested in compliance with MEDSAY. Omit the (puffy) journal name and the (superfluous) year and the (hype-y) institution name. Nobody cares whether this was published in 2023 or 2024. The date is irrelevant because the material is not time-sensitive. Nobody will look back from some future date and say "actually, the interim report has changed during the last few years, so this one criticism no longer applies..." If we need to add some context (probably?), then the normal thing to do would be to provide a brief indication of the person's job, which in this case appears to be "postdoctoral researcher Cal Horton". WhatamIdoing (talk) 17:40, 15 April 2024 (UTC)

I agree with this with two caveats:

1) I do specifically want to include this source.

2) I think the year is more relevant than you do. The report isn't going to change in the intervening time, but the scientific consensus on the report might, and it's relevant in that context that this was one of the first papers to comment on it. That's actually a big part of why I think it's important to include: we currently don't have many other academic sources on the report, and if we had lots of those I don't know I'd be so strongly for inclusion of this particular one. Loki (talk) 18:49, 15 April 2024 (UTC)

It really wasn't the first paper to comment on the Cass Review. It commented on some material that was publicly available after the interim report was published. It's a bit like a review of a movie trailer, where you are sure that because Tom Cruise was in it and Christopher McQuarrie directed it, it will suck bigtime if you perform your thematic analysis from a feminist/pacifist/intellectualist pov. The mere fact that they were commenting at the interim report stage meant the clock was ticking on the relevance of their paper even before this wiki article got created. And we have literally zero sources suggesting Horton's opinion represents scientific consensus today, never mind in future. We aren't selecting it because Horton's opinion represents scientific consensus, and that's not why it got published in WPATH's journal. I don't think the same editors would be going on about this if the only academic publication they had was gender critical.

Sometimes less is more. The more points an article makes the more opportunity there is that those points have huge weak points. Making a statement about the Cass Review coming from WPATH has big importance. Making a statement about the Cass Review coming from some unknown researcher makes it look like you are scraping the barrel. It actually weakens the case. -- Colin°^Talk 21:09, 15 April 2024 (UTC)

Mostly news articles?

This article currently relies way too much on news articles covering it for a medical topic. Is there a reason why this published paper isn't in use in the article? Silverseren^C 20:43, 10 April 2024 (UTC)

No, and I agree - I think the sections should be citing the report directly, following the structure and wording of the review and recommendations, and news articles reserved for commentary/reaction. Void if removed (talk) 20:55, 10 April 2024 (UTC)

I agree: it's a long and detailed report and there needs to be a summary of the different focuses of the report, the recommendations noted and then, in the separate criticism section, commentary and reactions from others. Zeno27 (talk) 22:07, 10 April 2024 (UTC)

I disagree. I think it's probably a good idea to use the report itself and various statements as primary sources sparingly.

If points in the report haven't been covered elsewhere, they aren't notable enough to be included. Points covered in widely recognised reliable sources which have had time to digest, analyse, and summarise the report should be sufficient in detail for this article, which is a summary of the most notable aspects of a ~400-page report.

If a group has put out a statement that hasn't been covered in a reliable news source, it isn't notable enough to warrant its inclusion. Such a statement probably isn't a reliable source in and of itself anyway. 13tez (talk) 17:00, 17 April 2024 (UTC)

I think it is fair for us to summarise the reports main points just as we summarise a book. The published paper the OP mentions has been well discussed and refers to some draft text and out of date as it complains about the NICE reviews from 2020 rather than the BMJ reviews from 2024.

Wrt news articles, this is a report with health service implications and political implications and those are likely to be covered by the news rather than MEDRS sources. Were the article needs to discuss WP:BIOMEDICAL aspects, this report is often itself a first class secondary source (as are the systematic reviews it refers to). -- Colin°^Talk 16:14, 18 April 2024 (UTC)

Hi @Colin, thanks for your reply.

The paper is fine - it's a secondary source of the type I've been advocating for (along with news articles).

Per WP:PSTS, "Wikipedia articles should be based on reliable, published secondary sources, and to a lesser extent, on tertiary sources and primary sources." Therefore, this article should be based on secondary sources rather than the report itself, as I've been saying.

We have listed multiple statements about or responses to the report here from various groups and individuals, many of which without any references to substantiate them from reliable secondary sources. This is original reporting, violating Wikipedia:Wikipedia is not a newspaper and Wikipedia:No original research. Furthermore, as there hasn't been any coverage of these statements, none of them are notable enough for inclusion either.

I agree that the report would be a first-class secondary source for use in articles on transgender medicine. However, the subject of this article is the report itself, so it is a WP:PRIMARY source here. 13tez (talk) 18:03, 21 April 2024 (UTC)

If the choice is between secondary non-MEDRS sources and the report itself, we should cite the report itself. Draken Bowser (talk) 18:37, 21 April 2024 (UTC)

Hi @Draken Bowser,

Per WP:MEDRS: "Biomedical information must be based on reliable, third-party published secondary sources" and "A primary source is one in which the authors directly participated in the research". If you are using MEDRS to define which sources to use, the report itself is not suitable because it is a primary source because it is the subject of the article and the research being discussed. 13tez (talk) 19:37, 21 April 2024 (UTC)

As soon as we get reliable reviews citing Cass we can start transferring footnotes to them, in the meantime we'll use Cass. Draken Bowser (talk) 20:20, 21 April 2024 (UTC)

When we make a biomedical claim, like whether people who socially transition are "more likely to" medically transition, that needs MEDRS and this review qualifies. As I noted elsewhere, the review doesn't make that claim. When we make a statement about what the review recommends, it is a primary source for Cass's opinions. That may be fine and secondary sources are only a help if they are high quality (so newspapers fail that test). -- Colin°^Talk 20:28, 21 April 2024 (UTC)

Hi @Colin,

With non-MEDRS topics like the recommendations of the report, we should be basing the article on secondary sources rather than the report itself. As I mentioned earlier, per WP:PSTS, "Wikipedia articles should be based on reliable, published secondary sources, and to a lesser extent, on tertiary sources and primary sources."

I agree with your point on biomedical points generally, however the subject of this article is the report itself, so it remains a WP:PRIMARY source. I agree that it would be fine to use the report as a reference for biomedical claims in other articles.

Please could you explain for me what defines the quality of a source? I've seen source quality mentioned before, and that newspapers are of "lower quality" than other sources and that they should be excluded in some circumstances, but I have never seen anything in WP:P&G to support this idea. 13tez (talk) 09:36, 23 April 2024 (UTC)

Hey @Draken Bowser

There are plenty of news articles from reliable sources discussing the report that we can use now and should be using now. I think you now agree the article should be based on secondary sources, so clearly it can't be left as it currently is. If long parts of content can't be supported by references to secondary sources, they need to be removed. 13tez (talk) 09:27, 23 April 2024 (UTC)

No! And the cass report is a review i.e. a secondary source. Draken Bowser (talk) 10:17, 23 April 2024 (UTC)

Hi @Draken Bowser,

The Cass Report is a primary source when discussing the Cass Report. From WP:PRIMARY, "Primary sources are original materials that are close to an event, and are often accounts written by people who are directly involved." 13tez (talk) 10:24, 23 April 2024 (UTC)

No we will not use non-MEDRS-RS to report on facts covered by MEDRS, it is not a point of contention. This topic is exactly the reason for why we're allowed to make that exception. Draken Bowser (talk) 10:26, 23 April 2024 (UTC)

For the sake of clarity, which points in the article do you see as being WP:BMI and requiring WP:MEDRS references? And do you agree that in an article on the Cass Report, the report itself is a WP:PRIMARY source on the report, even though it's a secondary WP:MEDRS for WP:BMI elsewhere? 13tez (talk) 10:33, 23 April 2024 (UTC)

Anything under the headings "findings" and "recommendation" is MEDRS-territory, for "background" it depends, and for "reception" we can use standard RS with the caveat that we shouldn't overplay them (se Colin's comments). Yes, I agree that the report is primary with respect to its own findings under the general understanding of primary. It is simultaneously considered a secondary source under MEDRS. Since it is the best source currently available we can and should use it to report on its own findings, pending discussion in yet-to-be published secondary MEDRS-sources. Draken Bowser (talk) 10:42, 23 April 2024 (UTC)

Thanks for clarifying. Then we agree that the background to and reception of the report etc should come from secondary sources, which is progress.

I agree that the report's findings and recommendations are MEDRS territory. I don't think, however, the recommendations of the review are WP:BMI. From the examples it gives, they aren't related to the attributes of a drug or disease, nor are statements about how medical decisions are made. Some of them are recommendations about how decisions should be made in the future, which is a loose link at best - it's at least one step removed from current practice. Some of them aren't BMI at all, for example over the toxicity of debate and medical professionals avoiding gender services. Findings related to the treatment patients receive (and outcomes) probably is BMI. 13tez (talk) 11:05, 23 April 2024 (UTC)

Ok, maybe there's a misunderstanding here based on what's supposedly BMI or not. Let's make it simpler: it is a scientific report on a medical condition, we will report on it using appropriate academic sources, which does not include newspapers, but certainly includes the report itself, if need be. Draken Bowser (talk) 12:03, 23 April 2024 (UTC)

Where do you disagree as to what is and isn't BMI? Why are newspapers not appropriate for use in this article? Thanks again! 13tez (talk) 12:26, 23 April 2024 (UTC)

See WP:BIOMEDICAL for what is in scope for MEDRS. This includes "Medical decisions".

The actual studies that the systematic review looked at are the primary sources for the studies (like, we selected a cohort of 30 adolescents and gave them X and looked at what happened). The systematic review is a secondary source for the research field. It looks at all the studies and comments on them individually and as a group and does synthesis on it if it can. It is a primary source for itself (e.g. the review selected 30 studies and found 10 high quality...). The Cass Review document is technically a tertiary source when it is commenting on the research the York reviews looked at, and a secondary source for summarising what they concluded. Cass didn't do those systematic reviews. But the Cass Review is a primary source for what Cass herself recommends to NHS England. Anyone still following.. there will be a test at the end :-)

That doesn't forbid us from summarising what the review says (we summarise the plot of a novel all the time). If we had top quality sources summarising aspects of the report then great, but newspapers and press releases and letter to the editor and so on are not top quality. And we need to be wary of biased sources summarising aspects and either misrepresenting or putting their own spin on it.

The Cass Review was written to be accessible to a lay audience, even though primarily written for professionals. So we should be able to summarise it without concern for OR and such. But if there are areas where editors think the text is ambiguous then we need to be careful. That is true for summarising what any source text says.

So we need to move away from using newspapers, if we are, for summarising the review itself, and use them more for what Sunak said and the like. Similarly, press releases, even from reputable organisations, are not high quality sources and we need to be careful about saying much more than a summary of what aspects they support or reject. Once we start putting detailed WP:BIO statements from press releases or news into quotes it would be abusing the quotation system to make biomedical claims. For example, we don't fill our covid articles with details on why horse medicines are extremely safe and effective and why vaccines will kill everyone, by putting these crank ideas in quotes. -- Colin°^Talk 07:36, 24 April 2024 (UTC)

My main reason for using news articles when writing the sections this morning was that for a 400 page report, I wasn't certain what would qualify as WP:OR, so I wanted to rely on secondary coverage. Snokalok (talk) 22:32, 10 April 2024 (UTC)

The article OP linked should count as a secondary source. Flounder fillet (talk) 03:16, 11 April 2024 (UTC)

I agree Snokalok (talk) 07:09, 11 April 2024 (UTC)

Yes I think that's fair to flesh it out initially, I think we should aim to reference the review and the 9 accompanying MEDRS in the body in preference now: https://adc.bmj.com/pages/gender-identity-service-series Void if removed (talk) 07:52, 11 April 2024 (UTC)

That article was published almost a month before the Cass Review itself was. The authors cannot have read the final Cass Review. I don't think it's a suitable secondary source now that the review itself is available 86.21.75.203 (talk) 21:08, 21 April 2024 (UTC)

We should remove several responses to the report

I think several of the responses to and statements on the full and interim reports should be removed from the article. They aren't notable enough to have been covered in the news, so they use the statements and responses themselves (primary sources) as references instead. Per WP:PSTS, "Wikipedia articles should be based on reliable, published secondary sources, and to a lesser extent, on tertiary sources and primary sources." However, these statements and responses make up a large part of Cass_Review#Reception. Per WP:UNDUE, they are being given undue weight as they have no coverage in reliable sources. The points I have now added re the claims that 98% of studies being removed and those that weren't double-blind experiments being removed are the most notable and covered related claims I can find in the news that can be substantiated from reliable secondary sources. Therefore, they should be included instead.

Please let me know if you have any thoughts; thank you! 13tez (talk) 18:48, 23 April 2024 (UTC)

It should perhaps be understood that something does not need to be reported on by CNN to be worth including in the encyclopedia - and certainly not the statements in response to the report by countless national and international medorgs Snokalok (talk) 22:12, 23 April 2024 (UTC)

I think you need to be specific about which responses you think should go (and which stay). -- Colin°^Talk 08:08, 24 April 2024 (UTC)

GenderGP Response

GenderGP, the only private-sector provider of transgender youth healthcare in the UK, has issued a response to the Cass Review. It's pretty critical. Loki (talk) 22:33, 20 April 2024 (UTC)

I only got 3 paragraphs in and it felt like a "Cass Review Disinformation Greatest Hits Album" of everything that has been discussed on this page. We've got dismisses a very large number of studies - false, extensively discussed. omits studies from the past two years - also false (did they even read the report?). The reason for dismissing this evidence is that it did not come from randomised controlled trials - also false, also discussed above.

Pretty much what you'd expect from a source that doesn't pass the the Upton Sinclair test though. Barnards.tar.gz (talk) 11:22, 21 April 2024 (UTC)

Agree, this is an outfit based in Singapore prescribing online in the UK, one of whose founders has been struck off. They are not a reliable or neutral source, and one who Hilary Cass has specifically criticised for inadequate care. Void if removed (talk) 08:28, 22 April 2024 (UTC)

If they’re one of the ones Cass criticized, then shouldn’t they have their say? Snokalok (talk) 10:05, 24 April 2024 (UTC)

Yeah, if anything Cass having criticized them is the strongest argument for inclusion so far. Loki (talk) 15:55, 24 April 2024 (UTC)

Cass criticised them for inadequate assessment in her recent interview, not the report. They aren't responding to that, and that detail of Cass' interview isn't in this article so doesn't need offsetting anyway. Void if removed (talk) 22:16, 24 April 2024 (UTC)

Agree. I don't think criticism of GenderGP appeared in the CR and, if one steps outsides ones opinions on this medical culture war, this GP practice sets off so many red flags. -- Colin°^Talk 09:34, 25 April 2024 (UTC)

I oppose including their response. Per WP:VERIFY, information "must have been previously published in a reliable source before you can add it" and articles should be based on "reliable, WP:INDEPENDENT, published sources". Per WP:PSTS, articles should be based upon secondary sources. WP:UNDUE tells us we should only cover topics in proportion to their coverage in reliable sources.

I had a look online, and the only news coverage of this response I could see was in this article by the Daily Mail (please correct me if I'm wrong there). Therefore, there are no reliable secondary sources covering their response. This means, for the reasons discussed above, we should not include their response. 13tez (talk) 19:06, 25 April 2024 (UTC)

NPOV, MOS:CLAIM, and BLP oh my!

@Barnards.tar.gz

Okay since this is too much to say in an edit summary, I’ll say it here.

”identified disinformation” is both MOS:CLAIM by use of the term ‘identified’, and NPOV by the use of the term “disinformation” given that we have countless major medorgs in the responses saying the same thing. Conversely, “said that disinformation had been spread” is perfectly reasonable, because that properly attributes it to the opinion of one person.

As for BLP and NPOV, citing conservative sources to name a specific labour MP in article not about her has so many BLP and NPOV concerns I don’t even know where to begin, not to mention using those sources to say that she definitely spread disinformation as opposed to, the opinions of every major medorg listed above; and this alone merits immediate deletion pending talk on its own, but then there’s also the question of how much WEIGHT it’s owed relative to just “repeated by labour MP’s”. Naming her specifically reads as almost punitive, which is a terrible thing for a wikipedia article to read as.

You’re at three reverts, which means this thread is your next stop. Snokalok (talk) 10:39, 21 April 2024 (UTC)

1. MOS:CLAIM is a warning to take care, not a prohibition. In this case, the claim is objectively false and so there's little value in soft-pedalling it as just an opinion. If a major medorg is also spreading the same false claims, we should not be treating them as a reliable source for this article. Are you referring to PATHA? The one that also published misleading statements about haircuts? It's clear what such press releases are: hastily cobbled-together knee-jerk responses from PR teams in order to stake a position during the current news cycle. They carry very little MEDRS (or even RS) weight and do not represent a considered viewpoint. I'm sure we will see more substantial and measured responses in due course.

2. I didn't just add the text back in, I upgraded it with additional citations including to a non-conservative source (The Independent). Additionally, the actual source of this naming is Cass herself, not the editorial voice of The Times or The Independent. She was the one that called Dawn Butler out, and Cass's views are eminently relevant. Barnards.tar.gz (talk) 11:17, 21 April 2024 (UTC)

I agree with Snokalok here. You can't keep calling things that are said by the majority of reliable sources "misinformation".

Cass's views are relevant but she doesn't overrule all other sources. She is perfectly capable of misrepresenting what other people said (or even her own report) as well, and if she contradicts someone else the only thing we can say for sure is that one of them has to be wrong, not which one. See WP:WSAW. Loki (talk) 14:20, 21 April 2024 (UTC)

I’m in alignment with Loki and little bit Colin here, I think that attributing “disinformation” in quotes and neutral wording (“said”) to Cass is fairly important, although I still think that naming Dawn Butler specifically in this piece feels undue and unbecoming for a wiki article. Snokalok (talk) 09:28, 22 April 2024 (UTC)

All the very many newspapers who published this story named Butler. They are an outspoken MP who chose to speak out on an issue outside of their job remit. Not quite seeing why we should censor their gaff. -- Colin°^Talk 11:53, 22 April 2024 (UTC)

Maybe this is just my personal reading, but it feels like a digression almost. Instead of saying “including by labour MP’s in parliament”, saying “INCLUDING BY LABOUR MP DAWN BUTLER” reads like the article going out of its way to name her. It appears I’m in the minority on this point though. Snokalok (talk) 12:27, 22 April 2024 (UTC)

We name the MP who says things all the time. I can't recall a situation where someone made a gaff or announced a policy or whatever, and we relegated it to "someone in parliament said" level of vagueness. The closest that comes to that is if it becomes known that an MP has been told not to come to parliament because they are being investigated for a sex offence, and the MP is not named (until it all comes out of course). -- Colin°^Talk 15:02, 22 April 2024 (UTC)

Alright, I’ll defer to your 20 years of experience here. Snokalok (talk) 23:27, 22 April 2024 (UTC)

The word "disinformation" should really be in quotes as it is an implication that wrong information is spread deliberately. Cass themselves use a mix of disinformation and misinformation in the interview in the Times (not sure why were sourcing to Sky News). As for the 100 reports. Well the Time article says "In the days after the Cass review was published, activists claimed on social media that only two out of 100 studies were included in the report". They quote Cass saying "an influencer put up a picture of a list of papers that were apparently rejected for not being randomised control trials." What Dawn Butler said in parliament is a matter of public record. Hansard has her saying "Around 100 studies have not been included in the Cass report, and we need to know why". Ironically, Butler goes on to say "Misrepresenting the report, and the high-and-mighty attitude from the Secretary of State, helps no one." Way to go Butler. Snokalok, this is not a BLP concern, though labelling it disinformation in Wikivoice would be.

The BBC reported when Cass appears on "More or Less: Behind the Stats podcast" and breaks down the incorrect information that editors like me have been banging on about on these pages. Snokalok and Loki and others: this is not WPATH against Cass. This is basic maths and facts against lies. You cannot read the systematic reviews and come away with alternatives facts when they say explicitly that the majority of papers were of moderate and high quality and included in the synthesis and that none of these papers nor Cass's review nor Cass herself believes double blind RCTs are required evidence. Anyone spinning that story is engaging in disinformation. Our article should include both the 100 papers lie and the double-blind RCT lie as examples of disinformation that Cass has now twice (Times and BBC) complained about and widely reported. In both cases, Cass has the facts on their side. This isn't one of these different-people-have-different-opinions. This is Trumpian level falsehoods and distressingly so because, you know, we expect the dark side to do that. All that is in any way contentious is whether this is disinformation or misinformation but even with the latter, one would expect less naivety and someone with integrity to openly correct themselves, and I'd be interested to know if any of those peddling this crap have done so. Pink News, right now, are not doing themselves any favours should another RS review come about.

Snokalok, you ask about weight. Butler's gaff is covered by the Times interview itself, The Independent, Sky News, Daily Mail, Evening Standard, ITV news. Goodness, even the esteemed Whitchurch Herald, the Oxford Mail and the Rhyl Journal and Shropshire Star and Suffolk News pick up on it. And even Pink News covers it, but naively from the angle that Butler has a good point (null points for Pink News). -- Colin°^Talk 16:57, 21 April 2024 (UTC)

You call it a "lie" and I'm not sure what exactly you're referring to. There's a variety of related things people have said regarding RCTs and the Cass Report, some of which are just true based on the full report. (And note, not the studies, the report, a.k.a the actual thing people are responding to.)

So for instance, it's certainly not true that Cass believes that double-blinded RCTs are required evidence. But it certainly is true that she believes that the ‘gold standard’ trial is a randomised controlled trial (RCT) because that is a direct quote from the report.

I agree the "two out of 100 studies weren't included" thing is false, but it's very similar to "only two out of 100 studies were considered high quality", which is true.

In short, we can't really say that broad categories of statements are even false, much less misinformation. We need to judge every statement individually, since small details in two very similar statements may make the difference between a clearly true statement and a clearly false one. Loki (talk) 17:21, 21 April 2024 (UTC)

If one's angle is that only "high quality" studies were permitted to be included then stating "only two out of 100 studies were considered high quality" is deliberately misleading. Do you have any high quality sources making that claim?

Similarly if one says "Blinded RCTs are the gold standard" as an explanation of what got excluded from the report, that is also deliberately misleading and a strawman. I don't think there is a medical professional on planet Earth would would disagree that "the ‘gold standard’ trial is a randomised controlled trial (RCT)"

Loki, it doesn't have to be the case that what they said is true. Sometimes leaving out facts when making a case is deceptive. When Starmer was accused by Sunak of "failing to prosecute Jimmy Savile", when he was head of the Crown Prosecution Service, the sentence was "true" by your standards, but entirely misleading by everyone else's standards (including many on Sunak's side) because it wasn't Starmer's job or remit to do that. If the standard for inclusion in the synthesis is that the study must be of moderate or high quality, and one criticises the report for finding so few high quality studies (as if that's its fault) then one is being deliberately misleading.

These are not matters of opinion, Loki, and you need to strike, per BLP, your claim about Cass. -- Colin°^Talk 17:37, 21 April 2024 (UTC)

If one's angle is that only "high quality" studies were permitted to be included then stating "only two out of 100 studies were considered high quality" is deliberately misleading. Do you have any high quality sources making that claim?

Indeed, if that was one's angle, it would be so. But not if not.

Similarly if one says "Blinded RCTs are the gold standard" as an explanation of what got excluded from the report, that is also deliberately misleading and a strawman. I don't think there is a medical professional on planet Earth would would disagree that "the ‘gold standard’ trial is a randomised controlled trial (RCT)"

This is true.

But, I also view it as misleading, and the ultimate source of this misconception, for the report to spend all the time it does on RCTs when the underlying reviews did not actually disqualify or even discount studies for not being RCTs. I invite you to read the report itself, it goes into huge amounts of detail about RCTs specifically despite that not actually being relevant to the report.

Loki, it doesn't have to be the case that what they said is true. Sometimes leaving out facts when making a case is deceptive.

It can be. So can leaving out facts about what the people saying these things were actually concretely arguing. You're assuming that they were making the particular misleading arguments you think they were, when that's not necessarily the case.

you need to strike, per BLP, your claim about Cass.

Cass is a human being who is capable of making mistakes. I specifically am not accusing her of actually lying about anything, to be clear: to the extent she may or may not be misrepresenting people I don't think she's doing it deliberately. But I also think that saying her critics "deliberately spread misinformation" is very strong language, and likely false.

(And I know for a fact she said at least one false thing in the BBC article, not that it's relevant. She uses acupuncture as an example of a treatment that blinded RCTs couldn't be conducted on, but blinded RCTs absolutely have been conducted on acupuncture. This is probably a misremembering of a thing the report says about RCTs, using an example of a theoretical study comparing acupuncture to physiotherapy. People make mistakes like this all the time, even Cass in this very article, and this exact sort of very detail-sensitive mistake is why I think your accusations of "Trumpian"ness are so distasteful.) Loki (talk) 18:08, 21 April 2024 (UTC)

I agree with you about acupuncture. But also, I'm absolutely certain that Cass is the sort of person who if you said "You know, sham acupuncture RCTs are a thing" they would facepalm and want to correct themselves. You haven't accused them of making mistakes. You have accused them of misrepresenting sources, in a discussion explicitly about Butler, where they didn't. And accused them of writing a dodgy report. And really Cass Review does not spend a lot of time on RCTs. The word appears 7 times, and 6 of those are in an explanatory box for the benefit of a lay audience. Loki, arguing, as you are doing, that it isn't really misinformation, without citing any sources but just being hypothetical, isn't helpful. There are sourcable examples of misinformation and several sources now calling it out. Please back away from this dead horse. -- Colin°^Talk 18:20, 21 April 2024 (UTC)

First of all, now you're misrepresenting me. I specifically did not say that Cass wrote "a dodgy report". I said on my talk page to you 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". The whole report is not dodgy in the sense of poor quality and I never said that it is.

I also wasn't talking about Butler there and disagree that that discussion was "specifically about Butler". I agree that what Butler said there was severely misleading and think that it very likely means that Butler is incorrect about the content of the report. (It's technically not false because significantly more than 100 studies were excluded at earlier stages of the process but that's a nitpick.)

I agree that the specific claims Cass calls out as false in the BBC article are actually false. I don't agree that they are deliberately spread misinformation, and I think that saying that needs sources about the source of the false claims and cannot be sourced to Cass herself. Loki (talk) 19:02, 21 April 2024 (UTC)

Em. This section is about Snokalok three times reverting Barnards [8][9][10] about what Butler said and raising BLP concerns about a statement Bulter made that is on public record. Your tendentious claims about what is and isn't "technically true" are not helping your case. You explicitly said, about Cass, "She is perfectly capable of misrepresenting what other people said (or even her own report) as well" in your argument that "I agree with Snokalok here". I don't know which part of BLP violation you don't understand about that. -- Colin°^Talk 20:33, 21 April 2024 (UTC)

I agree that Cass is not a suitable source for information about Butler specifically, especially accusations that she is deliberately spreading misinformation, because of the BLP issues involved.

But my main complaint is not limited to this specific case. I'm worried about a general trend in several discussions on this talk page (and, apparently, by Cass herself) to assume that because someone was wrong about a fact, that means they are deliberately lying. (And often not just lying but that they are "Trumpian" or "in moon landing conspiracy territory" or other such vastly overblown claims.) No, people can make mistakes. Butler probably just made a mistake. Cass definitely made a factual mistake when responding to Butler in this very article and we're not claiming she's deliberately spreading misinformation about acupuncture, are we?

My point about the technicality wasn't meant to be tendentious or to defend Butler. It's to further make the point that we're in an area where small details matter and the difference between a true statement and a false statement can be very small. Loki (talk) 00:40, 22 April 2024 (UTC)

Firstly I think there's a huge amount of weight behind disinformation that probably shouldn't be even an attributed quote, rather a mention of the lots of misinformation stuff going on. As well as this I think this is another area where it is highly important to distinguish between the Cass report itself and the systematic reviews commissioned. For example there are lots of conclusions in the Cass report that people are calling misinformation and such. As for people saying the Cass report threw out 100 studies, this is a massively bold assumption to make (one has to assume Cass doesn't follow the synthesis of studies and conclusions from the systematic reviews), but it's a very different claim to saying the systematic reviews threw out 100 studies on trans healthcare (just factually incorrect). I don't doubt people have said the later (because on the internet people will have said anything, and newspapers do say stupid things on occasion) but I think it's an important distinction to make. I should say as well It is a massively bold claim to assume Cass didn't follow the reviews and not one I would ever make. LunaHasArrived (talk) 20:50, 21 April 2024 (UTC)

We can and should mention Cass's complaint about disinformation but in a way that attributes that to Cass, not Wikivoice. It is so widely covered by a variety of sources that I lose count enumerating them. There is no BLP issue whatsoever with repeating what Cass said about Butler. What Butler said is on public record and their no suggestion that the Times misreported what Cass said (they made similar complaints to the BBC). I have little doubt that the 100 excluded papers and the banging on about double-blind RCTs will be cited as case study textbook examples of disinformation when culture wars clash with science, just as in global warming.

As a general point, there's a range between outright disinformation, where one knows the facts aren't true but repeats them anyway, and misinformation, where one makes a mistake. Very often disinformation gets repeated and amplified by people whose intention is not malign but the story fits with their bias/beliefs and they either lack the incentive to do some basic checks to see if it is true or utterly lack the education/experience/knowledge to know that what they are saying is ripe BS. Genuine mistakes happen at random. When one keeps making mistakes that form the basis of one's argument, one is either incompetent or corrupt (see Hanlon's razor). One test is whether the person or organisation is open to correcting themselves. -- Colin°^Talk 08:53, 22 April 2024 (UTC)

On my last sentence, I am very pleased to read that Butler has admitted their mistake. They talked to Cass over the weekend and Hansard now contains a link to a correction here where they say "I may have inadvertently misled the House".

It takes guts to stand up in parliament and admit you got something important wrong and want the record corrected, something very very few MPs do. That's rare enough I think to deserve brief mention, and leaving the current text hanging with "She further criticized MP Dawn Butler MP for repeating such statements." is unfair. Something like "After talking with Cass, Butler subsequently used a point of order to admit their mistake in parliament, and correct the record." Stonewall is blamed as a source and I understand they have corrected their press statements too.

I think leaving both the criticism and correction in is better than removing because this is something that happened, featured in many news articles, and is an example of misinformation being spread () and corrected. -- Colin°^Talk 08:23, 24 April 2024 (UTC)

I am fine with saying that Butler corrected herself, but I oppose citing anything remotely related to trans issues to the Telegraph. I would rather cite the transcript directly, even though it's WP:PRIMARY. Loki (talk) 14:23, 24 April 2024 (UTC)

We really need a secondary source to indicate it is relevant to report here. I've changed it to Pink News but tbh I'm disappointed with Pink News repeating some of the same misinformation in other articles. It is interesting that far fewer outlets are interested in reporting that "MP admits mistake" vs "MP makes horrendous gaff". -- Colin°^Talk 09:40, 25 April 2024 (UTC)

So, am I misunderstanding this, or were the 60% used in the evidentiary synthesis, but the 98% was still cut from making the conclusions? Snokalok (talk) 15:18, 25 April 2024 (UTC)

I think the "98% cut from making the conclusions" relies heavily on which conclusions you are talking about (especially if it's the systematic reviews or Cass's report) and is at best a matter of opinion from those conclusions to which it applies LunaHasArrived (talk) 17:15, 25 April 2024 (UTC)

Actually if it's about a specific conclusion in the systematic review the 98% thing wouldn't apply. Because there's only a few studies that would apply. LunaHasArrived (talk) 17:23, 25 April 2024 (UTC)

Let me put it this way: I'm not currently aware of any place where Cass only used specifically high quality studies. If you have evidence that happened, feel free to provide it, it's very possible everyone else here has missed something.

I'm also not sure how she weighted high quality vs medium quality studies. I assume that she weighted the high quality studies more highly but as there wasn't any systematic weighting procedure inside the study, it's hard to tell. Each individual conclusion was based on only a handful of studies, and many categories had only medium quality studies, so she would have had to have relied on medium quality studies to make many of her conclusions. Loki (talk) 17:27, 25 April 2024 (UTC)

The 98% cut is horseshit. The systematic reviews make it clear that moderate-quality studies were included in the synthesis and results. Cass review builds on those two reviews. People are taking the fact that there were so few high quality studies and the complaint there not more and reading into it. Cass didn't do the systematic review, so words like "she weighted" aren't accurate. The York team did the systematic review and applied the Newcastle-Ottawa Scale to judge them. -- Colin°^Talk 08:45, 26 April 2024 (UTC)

Methodology

Hey @LunaHasArrived, yes other tools were also used to assess study quality. They are discussed on page 271: "Where appropriate, the quality of studies included in the individual reviews were appraised using the most appropriate method. The tools used included the Mixed Methods Appraisal Tool (MMAT), modified versions of the Newcastle Ottawa Scale, and the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument." 13tez (talk) 14:52, 26 April 2024 (UTC)

added. Flounder fillet (talk) 14:56, 26 April 2024 (UTC)

Why are we adding every single tool used? We don't need an exhaustive list and the N-O scale is the most notable 13tez (talk) 14:59, 26 April 2024 (UTC)

It's just three and the section is about methodology. Flounder fillet (talk) 15:05, 26 April 2024 (UTC)

I think giving one tool used as an example is fine to portray the general principle and in adherence to WP:SUMMARY 13tez (talk) 15:08, 26 April 2024 (UTC)

100% agree, I just didn't want the article to be vague if only one was used. LunaHasArrived (talk) 15:13, 26 April 2024 (UTC)

Just to be clear @LunaHasArrived, who is it you agree with here? Thanks 13tez (talk) 15:15, 26 April 2024 (UTC)

I think the most notable tool used should be the one mentioned (I think anyone who would be interested in the exact tools used should probably just read the systematic reviews.) LunaHasArrived (talk) 15:19, 26 April 2024 (UTC)

@LunaHasArrived I agree. Saying "the report used tools such as modified versions of the NO scale" makes it clear other tools were used too, but we don't need to list them all. 13tez (talk) 15:23, 26 April 2024 (UTC)

Removed AGREE II, kept MMAT because it's the less wordy one, already mentioned further down, and it's inclusion makes it clear to readers that there was more than just N-O. Flounder fillet (talk) 15:19, 26 April 2024 (UTC)

@Flounder fillet, thanks for your help before. I wasn't, however, trying to simply add EBM as a "see also" link. I was trying to explain why the systematic reviews were created and why they were essential to informing the reviews findings: systematic reviews are the highest level of evidence in medical research (see page 56), and it is essential that medical treatments are offered based on the best evidence possible (see page 47). I did this inelegantly in my first edit, but I think it's an important point to cover. 13tez (talk) 15:06, 26 April 2024 (UTC)

I think, based on what I said above, we should change the first paragraph to the following. Please let me know if you have any thoughts.

The Cass Review commissioned four independent, peer-reviewed systematic reviews, considered the highest level of evidence in medical research, into different areas of healthcare for children and young people with gender identity issues such as gender dysphoria. This was done to enable evidence-based medicine, an essential component of clinical medicine, in these areas. The reviews were carried out by academics at the University of York's Centre for Reviews and Dissemination, one of three bodies funded by the National Institute for Health and Care Research (NIHR) to provide a systematic review service to the NHS. 13tez (talk) 16:10, 26 April 2024 (UTC)

I would remove the part about, evidence based medicine. It has no bearing on the method and more on why it was done (a far more subjective area). LunaHasArrived (talk) 16:18, 26 April 2024 (UTC)

Do you think it might be better to explain that point in the background section instead? It might make more sense 13tez (talk) 16:35, 26 April 2024 (UTC)

The problem is that we generally don't make that kind of didactic clarifications when writing encyclopedic text. Draken Bowser (talk) 19:07, 26 April 2024 (UTC)

References