Talk:Cass Review/Archive 8

Archive 5

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Archive 7

Archive 8

Due weight

Why exactly do we use 231 characters to report the opinion of a single person affiliated with an SPLC-designated hate group (Genspect), while the paragraph on a report by eight Yale scholars – essentially the counter-report from a mainstream academic perspective – has been shortened to just 130 characters? --Amanda A. Brant (talk) 13:33, 5 July 2024 (UTC)

I reverted that change. Yale’s opinion is obviously more notable than that, and it’s peculiar to me that breadth of coverage was never the bar for previous statements by relevant orgs, but it somehow is here Snokalok (talk) 14:02, 5 July 2024 (UTC)

It is not the opinion of "Yale".

It is a self-published document by a small political project at Yale Legal School that has received little coverage.

We give due weight to notable organisations, which this isn't. Void if removed (talk) 15:33, 5 July 2024 (UTC)

the counter-report from a mainstream academic perspective

This is overblown, can you please stop inflating the importance of this opinion. Void if removed (talk) 15:34, 5 July 2024 (UTC)

This is not how academia works. Universities don't have "opinions". Scholars do. In this case a group of eight prominent scholars and scientists working on the intersection of law and medicine/health policy who are affiliated with a very prominent university. The expert opinion carries weight. The report is essentially the most comprehensive (for now) counter-report from a mainstream academic perspective and should be treated as such. What they do is summarizing peer-reviewed scientific knowledge for a legal audience[1] and the report reflects mainstream scholarship and science in this area. Your absurd claim that this is a "political project" really says it all. --Amanda A. Brant (talk) 16:10, 5 July 2024 (UTC)

If the expert opinion carries weight in academia, where are the other academic publications citing this? WhatamIdoing (talk) 16:14, 5 July 2024 (UTC)

Again, this comment fundamentally misunderstands how this field works. Academic publications don't cite a report released days ago because academic publications don't appear within days, but years, months at best. Plus, the report isn't really intended as an academic publication, but aimed at a broader legal audience, per the goals of the project[2]. It's not a report that advances any new scientific claims, but that engages with another report (also not peer-reviewed or anything) by summarizing existing scholarship and knowledge. --Amanda A. Brant (talk) 16:19, 5 July 2024 (UTC)

So it is an unreviewed, self-published document by some US-based legal academics and members of WPATH that for some inexplicable reason has (so far) been reported in a tiny Scottish Nationalist paper, and Teen Vogue.

And as such it should be given very little weight because this is not a MEDORG statement or a statement from a notable organisation, nor is it a peer-reviewed MEDRS response, nor is it some comparable "counter-report", and it should definitely not sit in its own whole section.

Its also, as an aside, really, really poor. Void if removed (talk) 16:28, 5 July 2024 (UTC)

This is a matter of law and human rights, just as it is a matter of medicine. MEDORG and MEDRS have no relevance. The legal field has quite different traditions than medicine, and works quite differently. If you are going to push this point, the Cass report is an "unreviewed, self-published document" too – a really poor one, to boot, judging by its reception from many academics and recognized organizations in the field. --Amanda A. Brant (talk) 16:39, 5 July 2024 (UTC)

If this document is to be treated as a legal document rather than a medical one, then it’s essentially a case of WP:MANDY: a group of people who are responding to the threat of a (likely) incoming president who wants to put them out of business, or even in jail, and whose sympathetic lawyers have already used the Cass review as a pretext to argue for this. They’re not publishing reliable medical information, they’re raising a shield in a legal fight for their survival. Cass has implicitly levied an accusation, and this is them denying it. Well, they would, wouldn’t they? Barnards.tar.gz (talk) 08:07, 6 July 2024 (UTC)

What? 24.63.3.107 (talk) 21:55, 13 July 2024 (UTC)

I have a general concern, which includes but is by no means limited to, the Yale Integrity Project, that we are choosing sources that have the Right™ POV, even though they are self-published and do not seem to get much attention outside of this article.

For example, the first sentence has two inline citations, and I'm pretty sure that both of them could be replaced by proper Wikipedia:Independent sources, such as a BBC article. In fact, I wouldn't be surprised if they could be replaced by one of the news articles that is already cited in the article.

I think it would be desirable to get some agreement on the characteristics of sources that we would like to be relying on, and see if we can match that. WhatamIdoing (talk) 16:13, 5 July 2024 (UTC)

It's not "self-published" any more than the Cass report is. The Cass report is a "report" too, just published by the authors, not in a peer-reviewed journal or anything. Badenoch has openly admitted it was meant to promote a gender-critical (i.e. fringe and pseudoscientific) narrative, a narrative recently described as extremist by UN Women[3]. The insistence that the counter-report (that engages with the Cass report based on mainstream scholarship) should meet a completely different standard is just weird. It's an expert report by eight reputable scholars, published by Yale. --Amanda A. Brant (talk) 16:21, 5 July 2024 (UTC)

AIUI the Cass Report was technically published by the UK government, rather than by the authors themselves.

The Yale Integrity Project, on the other hand, is published by the authors themselves, as are the various press releases and open letters that we're citing. Some of these self-published documents have received significant attention from independent media outlets, which I think argues in favor of those being important for us to include. Others have been largely ignored by news, which suggests to me that we should probably not include them. Obviously, as things change over time (e.g., if a previously ignored statement gets attention, or if attention to an early statement turns out to be a very brief flash in the pan, and others are preferred afterwards), then the article would change, too.

This would be a typical approach for other subject areas and consistent with both our usual practice and the relevant policies and guidelines. Does that sound reasonable to you? WhatamIdoing (talk) 17:01, 5 July 2024 (UTC)

It was technically published by Yale University, as part of their work as experts in this area[4]. But all this is hairsplitting. From such a perspective the Cass report is also self-published, by a government that has been internationally condemned for its attacks on LGBT+ rights. So that is hardly an argument in its favor. It's not published by an academic journal, it's not peer-reviewed. It's a "report" that advances the opinions of the UK Government, and Badenoch said the aim was to promote a gender-critical narrative, i.e. a fringe anti-trans ideology and pseudoscience. So it's comparable to a report self-published by the Government on Russia on LGBT+ issues; we would certainly treat such a report with a fair amount of skepticism as a source too. If eight distinguished Yale scholars released a similar report critiquing the Russian anti-LGBT+ report, published by Yale, from a mainstream perspective, that would be regarded as a very solid source too. --Amanda A. Brant (talk) 20:56, 5 July 2024 (UTC)

It's a "report" that advances the opinions of the UK Government, and Badenoch said the aim was to promote a gender-critical narrative, i.e. a fringe anti-trans ideology and pseudoscience

None of this is true. Void if removed (talk) 22:30, 5 July 2024 (UTC)

Amanda, it's not published by the university, even though the PR team put out a press release about it. If it were published by the university, the authors would have no chance of getting it into a peer-reviewed journal (which I'm confident is their plan).

As for the Cass Review being self-published: If the report had come out as a strongly pro-trans stance, do you think it would have been published, or do you think the government (i.e., the Tories) would have suppressed it? If the latter, then you have to admit that the publication was not entirely under the control of its authors, and therefore it is not self-published. WhatamIdoing (talk) 16:49, 6 July 2024 (UTC)

Why are you using such conspiratorial language, and disconnected logic? That the Cass Review was published "by" the UK government, "advanc[ing] the opinions" of it -> the UK gov't. has often been "internationally condemned" for its attacks on LGBT+ rights -> Cass is unreliable. That is absolute SYNTH to the extreme.

The Cass Review is substantially peer reviewed itself, regardless of self-publishing or not. Seriously, consider stopping it with the inflammatory language. Zilch-nada (talk) 22:33, 17 July 2024 (UTC)

The context of the report matters. The Cass Review was not a review study done in a peer-reviewed journal without any clear purpose and goals. It was a review that was commissioned by NHS England, for the purpose of providing recommendations for the NHS, which had already failed to keep up with demands for trans healthcare. As such, it's inseparable from the larger context of a healthcare system run by the UK government. And of course, the UK government has gone to significant lengths in recent years to align itself with gender-critical positions. Hist9600 (talk) 00:22, 18 July 2024 (UTC)

Criticisms of the Cass Review - which are mentioned - relate to its methodology and, in the most fundamentally sense, science. What the above user is doing is not only employing original research to prove unreliablity, but also detracting from such criticisms. Cass has itself been the subject of significant reviews; those sources matter, not absurd personal synthesis. Zilch-nada (talk) 00:30, 18 July 2024 (UTC)

For instance, citing Kemi Badenoch - a polemical politician in this case - and not the substance of the report itself (or even meta-analyses of such "intentions") - to make supposed claims about the report's intentions - is immensely dishonest from a Wikipedia editor. Zilch-nada (talk) 00:32, 18 July 2024 (UTC)

It's Wikipedia editing policy to assume good faith on the part of other Wikipedia editors, and to remain civil on the talk pages. That may mean not accusing other editors of being "immensely dishonest" about what amounts to a different point of view, or a different way of thinking about a situation. Would you be willing to strike through that comment? Hist9600 (talk) 01:35, 18 July 2024 (UTC)

Are you accusing me of bad faith? I'm calling the argument dishonest, not the user themselves. Can you please explain how such aforesaid original research is justified? Zilch-nada (talk) 01:46, 18 July 2024 (UTC)

I'm reminding you to assume good faith. When you give an example of something that another editor has written here, and then say that it's "immensely dishonest" to say such a thing, that doesn't seem like a positive and constructive way to engage with other editors on an article talk page. Hist9600 (talk) 03:18, 18 July 2024 (UTC)

I am not assuming bad faith. Can you answer my question above? Zilch-nada (talk) 11:48, 18 July 2024 (UTC)

@Hist9600, could you think of just letting this go. Reading what someone else wrote in the worse possible light, because one disagrees with what they are saying, in a contentious topic area, is not a good look. Similarly, @Zilch-nada, perhaps be quicker to strike and rephrase something that upsets another. Digging your heals in is also not a good look.

I think we've already established that the argument that "Badenoch therefore Cass Review bad" is logically incoherent. I wish some editors would stop repeating nonsense they read elsewhere in this talk page.

I've already outlined above how the scientific studies used for much of the Cass Reivew's systematic reviews (which were indeed published in a scholarly journal and peer reviewed) are international, as are the previous systematic reviews which produced similar results. There are dozens of recommendations and hundreds of evidence points in this 300 page review. Merely saying "it" is likely to be unhelpful when raising a criticism like "not a review study done in a peer-reviewed journal" because it really looks like an attempt to cherry pick without actually stating what on earth it is cherry picking and is neither a convincing argument or useful argument for anyone to agree or disagree with.

I think it is long past time that this page stopes being WP:NOTFORUM abused for editor's xenophobic content about British healthcare and academic professionals. This prejudice because they happen to share the same birthplace as some windbag politicians (many of which are now ex politicians and all of which are now ex government) is not acceptable on Wikipedia. It is no more sensible an approach than to dismiss US healthcare and academic professionals because you had Trump and are going to get Trump again.

Let's end this section. The "due weight" of a PDF that has been almost entirely ignored by the world's press is very very low. -- Colin°^Talk 14:17, 18 July 2024 (UTC)

Background

Creating this topic so @WhatamIdoing's interesting tangent/proposal doesn't get buried beneath the never-ending discussion about medical organisations: what do editors think of dedicating the 'background' section to agreements both Cass and critics have (e.g., trans kids should receive some form of treatment). It would clarify what the Cass Review is actually about and could provide us with a more constructive discussion rather than the same old 'Cass is wrong/right because A/B/C'. I personally propose to add a small history section as well delving into the British context why the Cass Review was commissioned in the first place. While the systematic reviews will most likely shape research and clinical practice internationally, I think we could dedicate more space of the article what led the NHS to such a review in the first place. Any thoughts and/or remarks? Cixous (talk) 13:17, 11 July 2024 (UTC)

I think it's a good idea if well sourced but it might be difficult to establish due. For the parts about where critics and Cass agrees this article (a summary of the Yale integrity project report) Includes part of where they agree and could be useful (I can't think of another source that has both support and criticism). LunaHasArrived (talk) 13:47, 11 July 2024 (UTC)

It is potentially interesting and useful for the reader. But it is also a topic fraught with disagreement.

I would say yes as long as this is sourced principally to the background laid out in the review and interim review themselves, ie:

• The adoption of the Dutch Protocol at GIDS in 2011 under a research protocol
• The shift to general usage in 2014, even though the outcomes of the research were not published until 2021
• The sharp increase in referrals from around that time, along with a sex ratio shift
• The Governer's report in 2018
• The Trust's review of the service in 2019
• The 2019 Keira Bell judicial review of the service
• The negative CQC report on GIDS in 2020

(All from chapter 3 of the Interim Cass Review)

Outside the Cass Review, the definitive source for the background is IMO Time to Think (book). If we can neutrally present something like this as the background then fine. Void if removed (talk) 14:10, 11 July 2024 (UTC)

I agree with referring to the background sections in the (interim) review and your layout seems to include all the major events (though I would like to note that GIDS practice diverted from the Dutch protocol in various important aspects, most likely due to the steep increase in referrals). As for Time to Think: I haven't read it so I can't stand in for its neutrality, but it's been ubiquitously praised in the UK media Cixous (talk) 15:10, 11 July 2024 (UTC)

GIDS practice diverted from the Dutch protocol in various important aspects, most likely due to the steep increase in referrals

This is where it starts to get contentious. How and why GIDS made the decision to deviate from the Dutch Protocol in around 2014, and lower the age for administering puberty blockers, is quite murky, and when pressed the Trust could offer no real justification other than that they made a clinical practice decision based on "international findings and careful consideration of our own experience". Void if removed (talk) 21:57, 11 July 2024 (UTC)

I see. It probably suffices to say that they started to divert from the protocol. On page 18 of the Interim Report they mention that "GIDS staff would recommend more frequent contact during this period, but the fall-off in appointments reflects a lack of service capacity, with the aspiration being for more staff time to remedy this situation". So CR recognises that staff shortage has had a hand in this situation, but, as you say, it does not unambiguously claim so. Cixous (talk) 12:40, 12 July 2024 (UTC)

The thing is, GIDS weren't novel in deviating from the Dutch Protocol. As Cass says:

Based on a single Dutch study, which suggested that puberty blockers may improve psychological wellbeing for a narrowly defined group of children with gender incongruence, the practice spread at pace to other countries. This was closely followed by a greater readiness to start masculinising/feminising hormones in mid-teens, and the extension of this approach to a wider group of adolescents who would not have met the inclusion criteria for the original Dutch study. Some practitioners abandoned normal clinical approaches to holistic assessment, which has meant that this group of young people have been exceptionalised compared to other young people with similarly complex presentations.

Cass is not referring to GIDS here - she is talking about clinicians worldwide. GIDS was comparatively unusual in its cautious approach. The Dutch Protocol published in 2006 had a minimum age of 12, but when adopted by Norman Spack at Boston Children's Hospital moved to a "stage, not age" approach, ie no age limits, but from Tanner 2.

In 2007 Norman Spack established a clinic in Boston, USA modelled on the Dutch protocol and began prescribing puberty blockers from early puberty (Tanner stage 2).

Practice in the USA began to diverge from the models of care in Canada and the Netherlands, following instead a gender affirmative model advocated by Diane Ehrensaft (Eherensaft, 2017).

Where it gets contentious is that (according to sources like Time to Think) in this period parents from England took their children overseas for treatment at Boston, and then parent advocacy groups lobbied GIDS to adopt this new model as "international best practice". With a change in leadership in 2011, GIDS adopted something similar to the Dutch Protocol approach under a research framework.

The ‘watchful waiting’ approach continued in the UK until 2011, when puberty blockers were trialled under a research protocol; the ‘early intervention study’. This was an uncontrolled study with inclusion criteria in line with the original Dutch protocol, and similar outcome measures.

However they did not publish any results (and when eventually published after the Keira Bell review, failed to replicate the Dutch results, and by some measures found some worsening). Despite that, they declared the intervention a success 3 years after starting and relaxed the inclusion criteria, more in line with the emerging "affirmative" US model:

From 2014, puberty blockers moved from a research-only protocol to being available through routine clinical practice. In light of the above findings, the rationale for this is unclear.

In addition, the strict inclusion criteria of the Dutch protocol were no longer followed, and puberty blockers were given to a wider range of adolescents than would have met the inclusion criteria in either the Dutch or UK studies. These included patients with no history of gender incongruence prior to puberty, as well as those with neurodiversity and complex mental health presentations.

Then as the caseload increased and clinical opinion within GIDS became divided on how to treat this cohort (ie, exploratory psychotherapy to address underlying causes vs an affirmative model) we got a series of safeguarding whistleblowers, internal reports, a Newsnight investigation, a judicial review, a CQC inspection, and the Cass Review. But - aside from the overloaded case backlog - the actual practice was by no means unique to GIDS, and was actually theoretically in line with what was happening worldwide by this point, erring towards the conservative end. Nobody seems to be following the Dutch Protocol as originally specified.

And it is against that backdrop that we have to understand the polarised reaction to the Cass Review, where a call for more holistic, evidence-based model of care with proper multidisciplinary assessment is widely decried as a return to "gatekeeping" by international bodies who have moved beyond even the assessment criteria of the Dutch Protocol in favour of "informed consent". Void if removed (talk) 15:08, 15 July 2024 (UTC)

Hmmm, I see. How would you frame the diverging practice in the text? Cixous (talk) 17:14, 23 July 2024 (UTC)

My biggest concern is that, background implies before the review, when many of these topics weren’t agreed upon until after.

Wait times, for example. Now both Cass and her critics agree with reducing wait times. But we didn’t know that before, and indeed the prevailing narrative in the wider environment was one of trans kids “being rushed” into treatment (thank you BBC) Snokalok (talk) 15:50, 11 July 2024 (UTC)

I just noticed Snokalok's comments about waiting times and "being rushed" or blaming the BBC for that narrative. Firstly you are confusing where the speed is. It was known for years that the waiting list for GIDS was growing exponentially and they were not getting through their patients quicker than they were being added to the list. The GIDS website had a notice on it telling readers how long ago the people they are seeing today were added to the list to give some idea of how long anyone being referred today might wait (i.e. not any less). This was very much agreed on before and one of the reasons for commissioning the review. The BBC reported a statement by a former governor of GIDS, who had resigned the previous week, who they quote as saying they thought the team were looking for "quick solutions" under pressure for various directions. This is standard reporting and quoting a person who was important enough to be quoted. Let's not blame the BBC for doing its job in that department please. -- Colin°^Talk 18:29, 14 July 2024 (UTC)

I'm a bit nervous about history based on recent posts on this talk page, but if we can source this to the review itself, or quality sources that do proper journalism/research like interviewing people at GIDS and going through reams of boring meeting minutes, rather than blogging from their bedroom in some random US state, then we might get somewhere.

I'm not sure that areas of agreement are "background" and think this is more something to ensure we cover rather than having some section listing things people agree on (which suggests everything else is one huge Controversy section). Agreement is difficult to source because the professionals this is aimed at just read it and get on with their job implementing things. We have had a few responses from NHS England about what they have done and intend to do, which is in the article. And people don't tend to write articles about how great a systematic review was. They just use it and cite it when making their own recommendations, which might drip out over the coming years.

I agree that the systematic reviews (the York and NICE ones) are of international focus whereas the Cass Review publication itself is NHS England focused and is concerned with things like GIDS and child mental health services in our NHS.

I've read Time To Think back when it was published. My feelings were that it is over-long and over-detailed. I think in terms of a history of GIDS, it is fine, but not sure how much of that we would include here. I don't recall the book mentioning the Cass Review but if it did it probably only could say that it had been initiated. -- Colin°^Talk 17:38, 11 July 2024 (UTC)

In line with Wikipedia:Criticism#Integrated throughout the article, it might not all be in the ==Background== section.

For example, the article currently says that one group "agrees with the goals of reducing wait times and improving research". AFAICT nobody loves the NHS wait times, except maybe the private providers who are making money off of patients who have already waited too long. So perhaps there should be something in the ==Recommendations== section that says the wait times are appalling and they recommend early contact with the medical system, and everyone else agrees that the wait times are appalling. Instead of putting this in the ====Response from other health bodies==== subsection, the fact of their agreement should go wherever in the article we are mentioning wait times. WhatamIdoing (talk) 18:09, 11 July 2024 (UTC)

As a minor detail, perhaps the lead should end with "organisations have expressed disagreement with some of its conclusions." WhatamIdoing (talk) 18:10, 11 July 2024 (UTC)

I agree and just changed it into your suggestion. If the change is objected by a majority of editors, I'll self-revert. It seems to me, though, that we can all see eye to eye on this one. Cixous (talk) 18:41, 11 July 2024 (UTC)

You're probably right about the fact that it can (and will) remain a contentious section regardless of its content. I do believe that this article could benefit from more scientific context (e.g., what was the basis/rationale behind puberty blockers, when did they become routine, what do earlier meta-analyses/policy documents say etc.), with a redirect to puberty blockers and Dutch protocol (really hope that will get its own separate article sometime soon). That way readers will hopefully have a better understanding of the kind of environment in which the systematic reviews saw the light of day. Cixous (talk) 18:39, 11 July 2024 (UTC)

The Cass Review is far more than just puberty blockers. The Terms of Reference mentions the shift "from a psychosocial and psychotherapeutic model to one that also prescribes medical interventions by way of hormone drugs" but also the "significant increase in the number of referrals to the Gender Identity Development Service". Pedantic arguments about whether that increase was literally "exponential" or not miss the point that it is a huge increase, accompanied by a shift in several characteristics of patients, and one that simply overloaded what had been a small clinic. It reached the level where children referred to GIDS aged out before they reached the head of the queue. Child and adolescent mental health services are all currently hugely overloaded, not just this aspect, but this was perhaps the worst and certainly most visible example. Even without the controversy about medical pathways, this was a service in need of a review. Many of the recommendations are uncontroversial and even those that are are in the end a matter of emphasis. There are AFAIK no child psychiatric clinics anywhere that put 100% of referrals onto puberty blockers or hormones or surgery, even if that seems to be the impression given by various sides. Everyone agrees these matters need to be evidence based and everyone agrees more research is needed. -- Colin°^Talk 07:51, 12 July 2024 (UTC)

Yeah, you're completely right about that. Perhaps a 'scientific context' section is WP:UNDUE here, but a more proper focus on the background of the review and why it was commissioned in the first place could probably help the reader understand why the Cass Review derived at some conclusions in the first place. Cixous (talk) 12:34, 12 July 2024 (UTC)

Yale integrity project

@Void if removed For the record, the integrity project is described on their website as a collaboration between Yale law school and several different departments from the school of medicine, and one of the two leads on the project is from the school of medicine as well. --Licks-rocks (talk) 11:40, 8 July 2024 (UTC)

Yes, I linked to it - it is not described as a project from Yale Law School and Yale School of Medicine. It is a Yale Law School project, that works collaboratively with some smaller departments elsewhere.

faculty members from the Yale Law School, Child Study Center, Department of Psychiatry, and Department of Pediatrics came together to synthesize and disseminate scientific and legal knowledge in support of LGBTQ+ youth and their families.

None of this says Yale School of Medicine. The project is part of Yale Law School, and sits on their website, and works with academics nationwide. And what you've done with your latest change actually misrepresents the document by implying that it is by academics solely from Yale Law School and Yale School of Medicine, when the majority of authors are not.

Your change is not an improvement, can you please self-revert, there really is no need to go to these lengths to try and shoehorn the Yale School of Medicine into this source's credentials. Void if removed (talk) 11:51, 8 July 2024 (UTC)

Yale law school is a department of Yale university, just like the other three mentioned. They do not themselves have a department of psychiatry. Yale university on the other hand, does. And when you click on it in their list of departments, you are redirected to the website of the Yale school of medicine's psychiatry department.

In conclusion, I won't be self-reverting, and I ask you to strike your comment about shoehorning. If anything, I'm being too accommodating in that edit. --Licks-rocks (talk) 12:30, 8 July 2024 (UTC)

And when you click on it in their list of departments, you are redirected to the website of the Yale school of medicine's psychiatry department.

This is all your own WP:OR. Neither the cited source, nor the WP:PRIMARY source here say that the Yale Integrity Project is from the Yale School of Medicine.

In fact, the currently cited source doesn't even mention the "Yale Integrity Project".

Then there is this, which only refers to it as "the Yale report".

Then there is this press release from Yale which says, explicitly:

The Integrity Project at Yale Law School

I'm asking you once again to self-revert. Void if removed (talk) 13:59, 8 July 2024 (UTC)

In case you missed it, my request to strike was my way of informing you that I think you've crossed over into unwarranted belligerence when you claimed I was going to "lenghts" to "shoehorn" something in. The version of the article present at that time did not mention the yale integrity project, and was intended as a compromise, however, based on my looking at the page where the integrity project describes themselves your claim that the medical school has nothing to do with it is obviously mistaken, it's a collaboration between four different departments at Yale university, which is (indeed, if you want to call that a victory) hosted at Yale Law School's website. The other three departments all belong to the Yale school of Medicine.

You cited the source for that claim yourself, it's the web page for the integrity project, which falls under WP:ABOUTSELF, by the way, so no need for the shouty link to WP:PRIMARY. Anyway, if you want to argue that Yale's law school somehow has a pediatrics department, be my guest, but personally I have no reason to think it counts as WP:OR to not (mis)interpret that sentence the way you did. --Licks-rocks (talk) 16:16, 8 July 2024 (UTC)

Taps source

The Integrity Project at Yale Law School

You are engaging in WP:OR by creating a claim that the source you're relying on does not explicitly say.

It says:

faculty members from the Yale Law School, Child Study Center, Department of Psychiatry, and Department of Pediatrics came together

I don't care if the last three are part of the School of Medicine, you are engaging in WP:SYNTH. The source does not say that the "Integrity Project" is part of the Yale Law School and the School of Medicine. I know it is founded by two people, one from each, that still doesn't mean it is part of both. As they describe themselves, per WP:ABOUTSELF, they say only that the Integrity Project is at Yale Law School. Both founders consistently say this.

We're now multiple replies and reverts into a thoroughly pointless debate over something plainly unsupportable. You're expending a lot of effort adding and now defending something that isn't explicitly stated in any source.

I ask a third time, self-revert. Void if removed (talk) 16:35, 8 July 2024 (UTC)

I see. Thanks for clearing that up. I'll grant you that it is indeed described by them as a collaboration that happens "at" Yale law school. Now if you could please strike your accusations of bad faith above, that'd be golden. I've implemented an alternative wording I suggested in my first edit summary, which describes it in a similar way to the source quoted for the sentence, which I hope will satisfies you better. Another solution would be to just take the way that they've worded it in the lead there and leave out the mention of the integrity project entirely, as I did in my first version. Whichever you prefer. --Licks-rocks (talk) 12:55, 9 July 2024 (UTC)

Here ABC describes it as by Yale law school and Yale school of medicine. LunaHasArrived (talk) 19:15, 10 July 2024 (UTC)

That says "a report by". It doesn't say "the integrity project".

Pick a wording. You can either have "a report by Yale law school and Yale school of medicine", per this source, or you can have "the integrity project at Yale law school" per the others. You can't combine them to say what the original edit said. Void if removed (talk) 19:48, 10 July 2024 (UTC)

@LunaHasArrived, that's a much better source than The National we are currently using. Maybe we can get another to help resolve this naming dispute. There are some responses from Cass's team in this article too which need to be included otherwise we give the wrong impression that this critical report is accepted. The challenge for us, as writers of an Encyclopaedia, rather than activists pushing "Bad things about a topic I hate" onto the page, is we are required to (per all our key policies) summarise what our secondary sources say in our own words. So can someone have a go at summarising this source rather than cherry picking quotes, which is not at all encouraged and considered a last resort.

I'm confused about the detransition section. It clearly says we can't know the detransition rate as followup details are unknown (they were withheld from the team). So I'm not sure how this critical report can possibly state the rate is 0.3%. Maybe someone can explain to me how Yale know the follow up details when adult services withheld them? -- Colin°^Talk 19:57, 10 July 2024 (UTC)

It's covered by 13.9-13.12 in the Cass review, effectively one adult GIC did give over information and out of the ~3400 patients audited <10 detransitioned. I'm pretty sure that's where the numbers come from

I'll admit part of this was just adding a better secondary source on this review (I'll add also of note is probably the analysis of where the Cass review agrees with international consensus) LunaHasArrived (talk) 20:06, 10 July 2024 (UTC)

I've read the Cass Review pages 168/169 and Appendix 8 again. The thing about the audit is it is a snapshot of a period in time at this clinic for children. There wasn't any intention to follow up patients for X years to determine the detransition rate. Of the 3400 patients, only 892 were referred to endocrinology for hormone treatment. The rest were effectively still working through their treatment decisions with GIDS and two thirds went on to adult services where their status is unknown. All we can do with that detransition figure, is say there were some. Anyone claiming the "This is a “detransition” rate of 0.3%" is displaying statistical incompetence of the very highest order. It is like if 500 people went to a concert. Only 50 went to an after party. Of those that went to the after party, 5 told you they didn't like the concert. And concluding that only 1% of concert goers didn't like it. We have no idea of the opinions of the 450 who didn't attend the party. Just as we have no idea about those who were still waiting or contemplating the medical pathway when they aged out of GIDS. These are people who perhaps had a couple of talking meetings before moving into the unknown. This is not a detransition study. -- Colin°^Talk 20:22, 10 July 2024 (UTC)

The Yale report, as it is referred to by the media, is now cited by the British Medical Association as one of their main sources as they announced that the "BMA [is] to undertake an evaluation of the Cass Review"[5]. It's essentially the counter report, at least so far, and it should have its own heading. --Amanda A. Brant (talk) 00:52, 3 August 2024 (UTC)

A citation doesn't elevate a non-notable "project" consisting of two people into an organisation bigger than a dozen other organisations we list and don't have headings. Are you really claiming a citation makes this Word document, saved as PDF and stuck on a web site because nobody would publish it, into something bigger than a position statement from any of the professional bodies who have supported or criticised? The BMA thing isn't about the Yale report, Amanda, it is about a doctors trade union being upset that therapeutic decisions were made by politicians. -- Colin°^Talk 12:40, 3 August 2024 (UTC)

BMA Council response

Snokalok removed text that included responses to the BMA Council motion. These are cited to the British Medical Journal which is not only a leading medical journal but contains news and current affairs reporting for UK doctors. It is an important and reliable source. You can read the full article if you have a Wikipedia Library membership. Snokalok said "This feels undue" and I strongly disagree. This wiki article is weighted way too much already on random criticism often with weak sources. The text removed was

Not all members of the BMA Council agreed with the motion. Consultant radiologist Jacky Davis questioned whether it was representative of the opinion of the wider membership, who were not consulted. The editor of Archives of Disease in Childhood, which published the seven systematic reviews produced by York University for the Cass Review, said he was confident in the reviews and that the criticisms they had received "hold no water", and were made by "those still struggling to come to terms with the findings.

This is important information for our readers: the vote was not unanimous and BMA members were not consulted. The systematic reviews have come under a lot of activist criticism in this Wikipedia article nearly all of which has come from authors who haven't ever done systematic reviews or even clinical research. The article currently is way way too unbalanced into giving the readers the impression that there really is something wrong with these York systematic reviews. So the voice of the editor of Archives of Disease in Childhood is a necessary one to hear. That in their opinion, the criticism is baseless and activist led rather than evidence led. Far from being "undue", this article needs far more content from professionals who understand evidence based medicine and respect findings even if they may have wished were different. The text Snokalok removed should go back. -- Colin°^Talk 12:54, 3 August 2024 (UTC)

I don’t deny that it’s sufficiently sourced, I just don’t think that in a section full of MEDORG responses, we should be giving half a paragraph to a few lone, individual voices. We’ve gone over this like four times now and always with the same result.

One can find a doctor that agrees with anything they want, that doesn’t mean that we need every article on MEDORG opinions to say “Dr. Harper in Manitoba, however, says drinking red paint is actually good for you!” But if we bring in those individual voices, then we have to bring back all the other individual voices we decided not to give precious space to. And on that note, nor do I think the BMA situation requires more than one paragraph in all truth. Snokalok (talk) 13:03, 3 August 2024 (UTC)

To refresh your memory, when the review first came out, a number of individual doctors and medical researchers in positions of significant relevance (such as the head of gender care research at U of Melbourne) openly criticized it, and at first when we were still scrambling for new info this was fine, but as we got more and more MEDORG criticism, we decided to scrap the opinions of individual medical professionals - influential as they might be - as largely a waste of space in comparison. Snokalok (talk) 13:12, 3 August 2024 (UTC)

Yeah, it's silly, and very much not WP:DUE, to single out one person or another, and go out of our way to say that it was not unanimous. Nothing about controversial topics like this is ever unanimous. Hist9600 (talk) 16:30, 3 August 2024 (UTC)

I think Snokalok's point re the singling out of Jacky Davis is valid. It seems a minor point of detail that the vote was not unanimous. However, the final paragraph is directly relevant, as the BMA's criticisms are as-yet-unsubstantiated. The systematic reviews remain high quality MEDRS sources, and we must not give the impression that they have been substantially challenged when they haven't (yet). An announcement of an intent to challenge is not (yet) a result that should be used to undermine or detract from the weight assigned to the systematic reviews. We shall see whether the BMA's evaluation eventually becomes a rigorous piece of scholarship, but the fact that they have pre-announced the conclusions doesn't bode well. Barnards.tar.gz (talk) 16:07, 3 August 2024 (UTC)

I'm fine for the first two sentences to be condensed to "Not all members of the BMA Council agreed with the motion and the BMA membership were not consulted". These are important facts when it is being reported widely that this is actually representative of BMA's 190,000 members. And we need to bear in mind that the BMA is a campaigning trade union (in this case, picking a fight with politicians overreaching into the medical domain) not a professional body for a medical speciality. In their decision to have their own review of the review, they have somewhat stepped on the toes of other professional bodies here.

Wrt the views of the editor of Archives of Disease in Childhood let's all remember that this article is on the "Cass Review" not wider "transgender medical care in the UK". As such, a core component of this review is the set of systematic reviews commissioned, including the initial NICE and the later seven York reviews. These reviews have come under criticism and we leave that criticism hanging if we don't supply the response from the authors/editors/publishers. As editor of the journal that published the seven systematic reviews, it is plainly DUE that their defence and criticism of his attackers is relevant to this article. Put it this way, if as editor he admitted they had failings and was retracting them, you'd be quoting him for sure. That he isn't is relevant and due. -- Colin°^Talk 17:39, 3 August 2024 (UTC)

Also I disagree with merging the Academy of Medical Royal Colleges comments into the BMA one. They are only in part responding to the BMA but also issuing their own position statement, which deserves a paragraph just like all the other professional bodies. -- Colin°^Talk 12:57, 3 August 2024 (UTC)

Snokalok, I'm not seeing your claim that Consensus on the talk page was firmly against this. There was consensus on mentioning Jacky Davis. I don't think you've made any convincing evidence or got any support in denying the editor journal that published the seven systematic reviews a response on this page. This isn't a random doctor; he's the editor who has to stand by the work he published, which has been criticised. I ask you to self revert that, as it seems to be made solely on the grounds of not liking it, rather than that it isn't relevant or due. -- Colin°^Talk 17:40, 8 August 2024 (UTC)

I agree, previous consensus against inclusion concerned the dissenting council member, not the defence by the journal editor of these reviews, which is WP:DUE. Void if removed (talk) 18:10, 8 August 2024 (UTC)

His opinion is certainly more relevant than Philip Banfield, obstetrician and gynaecologist, puffing the air full of guff about old adages. Colin°^Talk 19:11, 8 August 2024 (UTC)

Alright then by this logic we should bring back Melbourne and everyone else. We only have Banfield because he’s acting more or less as a spokesperson on this development. But the consensus was against individual doctors in general. And honestly if you want to take out Banfield’s mention, I wouldn’t challenge it. Snokalok (talk) 19:49, 8 August 2024 (UTC)

I thought there was a talk page consensus against mentioning the opinions of individual doctors regardless of who they are. Loki (talk) 19:48, 8 August 2024 (UTC)

There's a talk page consensus against accumulating and listing all the individual opinions of doctors that flooded popular media after the release of the Cass Review.

This isn't just padding the article with extensive, duplicative and largely inconsequential quotes from non-notable individuals saying the Cass Review is the best thing since sliced bread/a load of old tosh. Events have moved on. There's now been some far more concerted criticism of the systematic reviews themselves, and in that light the fact that the journal editor has stood by the reviews and is disparaging of that criticism is relevant and WP:DUE, and this is a different category of response in what is an ongoing and developing disagreement. Void if removed (talk) 15:47, 9 August 2024 (UTC)

I wonder if the US audience needs some help in understanding the difference between the BMA and the Royal Colleges. For example, are any of these mandatory, like lawyers in some places need to be a member of the Bar association#Mandatory, integrated, or unified bar associations to practice law? Which group would normally make a decision about, say, whether children need to have a vaccine to attend school, or whether teens should be allowed to take Prozac? WhatamIdoing (talk) 03:01, 9 August 2024 (UTC)

There isn’t really one. The American healthcare system is decentralized, it’s the whole reason why you don’t see moments like in Finland and the UK where a couple doctors with central authority make the entire country’s decision on GAC vs GET. It’s why bans on such here are done by politicians, because only they have such central authority.

Generally, the way it works stateside is reputable orgs develop recommendations for best practice, and they’re generally listened to, but every doctor or hospital makes their own final decision, and usually the decision on treatment will be more case by case or doctor by doctor according to the practice’s relevant experience and their keeping up on primary research; with the guidelines more serving as just that - guidelines. The only central medical authority they have to answer to is in regards to their medical licenses, which are a state matter, and indeed a lot of politicians enact bans on GAC this way, by automatically revoking the licenses of those who practice it - but again, that’s a political domain, not a medical one.

At the end of the day, total final authority over medical treatment just, doesn’t exist here the way it does overseas. The decisions over trans care in countries with centralized care are often a matter of a single digit number of fallible humans, often with very limited experience treating trans people and almost always their own preconceived biases over such, deciding how to wield their absolute authority over the matter. Whereas in the US you’d very much have to convince every single doctor individually, which is a much more Herculean task.

Hope that helps. Snokalok (talk) 03:28, 9 August 2024 (UTC)

To elaborate, we do have the Department of Health and Human Services, but its authority is virtually nonexistent and its recommendations when it does make them are generally not taken with any determinative degree of seriousness because at the end of the day it is a political organization staffed by political appointees in a country that’s always five minutes away from Balkanizing, and it’s fully treated as such. It’s why abortion doesn’t become completely legal or illegal every time one party or the other wins the election. Snokalok (talk) 03:38, 9 August 2024 (UTC)

As our article on the British Medical Association says, it is a trade union, and as such doctors are not required to be members, and some have announced the have given up their membership over this issue. Many see their role as one to negotiate pay and conditions, not to play at being NICE or entering culture war territory. They could justifiably argue their role could be to voice concern about politicians making medical decisions but it isn't seen as their job to conduct their own evidence reviews or to vet clinical guidance. I can't think of any other circumstance where they did that. The 50 odd people on that council were elected (by a tiny portion of the membership who bothered to vote) on the basis of their union campaigning, and not on any grounds of being a world authority on a medical topic. It is rather baffling and I suspect won't lead anywhere useful.

The body that regulates doctors is the General Medical Council. Many doctors are members of one or more royal college where specialisms like general practice or psychiatry or paediatrics are dealt with. One has to take exams to be admitted, so this is part of one's career development and essentially a necessary part of rising up to be a consultant. It is rather more expected that a royal college would choose to disagree on medical matters, and would be able to offer an expert on the matter of disagreement, unlike here where we have someone who is an obstetrician and gynaecologist weighing in on a matter quite outside his practice.

I think it would help the article if we clarified in text that the BMA is a trade union. -- Colin°^Talk 08:01, 9 August 2024 (UTC)

@Colin Regards the Trade Union status,I have added explanatory text. Peckedagain (talk) 19:51, 9 August 2024 (UTC)

We've got some text now, though I suspect the inclusion of "and professional body" has probably confused things. It is in the source so not really removable, but all it means is a body that a group of professionals might belong to. Here I think readers might assume such a body has regulatory role, which the BMA doesn't or a medical authority role, which the BMA doesn't. It is possible we will get a good source that explains better that this sort of action is generally considered outside of its remit as a trade union to represent doctors, but we'll need to wait for that. Colin°^Talk 10:19, 10 August 2024 (UTC)

Is the BMA talk of ‘no decision about me without me’ an empty statement given that the Cass Review did include gender disphoric young people? It's FAQ:

• "Did the Review speak to any gender-questioning and trans people when developing its recommendations?"
• "Yes,... over 1000 individuals and organisations across the breadth of opinion.. prioritised (A) People with relevant lived experience (direct or as a parent/carer) and organisations working with LGBTQ+ children and young people generally. (B) Clinicians and other relevant professionals with experience of and/ or responsibility for providing care and support to children and young people within specialist gender services and beyond. — Preceding unsigned comment added by Peckedagain (talk • contribs) 21:16, 9 August 2024 (UTC)

See below. I've removed it and it isn't "BMA talk" as the statement from BMA clearly calls this out as a personal statement by Banfield. It isn't "empty". It is misinformation, much like the misinformation that Cass excluded expert from the review. -- Colin°^Talk 10:31, 10 August 2024 (UTC)