The Times - Gender clinics face scrutiny of science at last
Gender clinics face scrutiny of science at last
Hilary Cass’s report vindicates the many whistleblowers who for years had raised concerns about the Tavistock Centre
Dr Hilary Cass prefaced her statement on the future of child gender services with a quote from the American statistician W Edwards Deming: “Without data, you’re just another person with an opinion.” To anyone who has followed the grim practices of the Tavistock clinic, now thankfully to be closed down, this marks a quiet, careful but profoundly radical shift.
Writing on this topic, I’ve often encountered facts so dangerous and beliefs so bizarre, so beyond science or reason, it’s been hard to convey their existence.
Listen, you say, British doctors are prescribing a drug used to chemically castrate rapists to halt puberty in children as young as 11. The drug isn’t even approved for child gender dysphoria. It reduces growth and bone density, sterilises and kills future libido. And, get this, we don’t know what it does to teenagers’ developing brains, or even if it works and they become happy, fulfilled trans adults. Because there’s no data, no long-term research.
Now, thanks to Cass, such institutional incuriosity and medical negligence will end. Every child put on puberty blockers will now be tracked into adulthood, while 9,000 patients lost in the system — after transition they receive new NHS numbers — will be contacted. The findings have potential to end a grotesque craze for paediatric medical transition across the world.
This week has revealed the power of sunlight when shone into dark places. There would be no Cass report if Keira Bell, who regretted her hasty transition when the gender identity development service (GIDS) at the Tavistock put her on blockers at 16 after just three appointments, hadn’t launched a judicial review. In the High Court, I heard incredulity in judges’ voices.
How could a 12-year-old consent to a drug which would prevent her bearing children? Why were patients’ other troubling issues — autism, depression, homophobic bullying, childhood trauma — not considered first? Why couldn’t the court see results of the Tavistock’s long-promised study of 44 patients on blockers? (It was slipped out a day after the High Court ruling, but since it followed children for just three years with no control group, it’s almost worthless.)
That Bell eventually lost on appeal didn’t matter. Because she had succeeded, at great personal cost, in bringing legal and public scrutiny to bear on a corrupted NHS service. She pushed the scandal of medicine driven not by evidence but by adult activist demands into newspapers and MPs’ in-trays. (Even then Kemi Badenoch, as equalities minister, had to battle cowardly colleagues and obstructive civil servants to launch the Cass inquiry.)
I still struggle to grasp why GIDS abhors research. If it cared about dysphoric children wouldn’t it want the best outcomes? If it had faith in its medical pathway, surely it wouldn’t mind testing its efficacy? Isn’t free and open discussion among fellow professionals the best way to improve treatment?
Yet GIDS clinicians who worried that hormones were prescribed too quickly, or to kids who’d simply turn out gay, were vilified, accused of transphobia, forced to conduct any thoughtful, gently questioning therapy in secret. Whistleblowers such as Marcus and Susan Evans were discredited, internal reports such as Dr David Bell’s were suppressed, while staff were blocked from contacting Sonia Appleby, the GIDS head of safeguarding, about their concerns for vulnerable patients.
But there is only so long you can shut down questions, silence debate. Someone with true courage, who cannot live with their conscience if they fail to act, will eventually risk all.
The barrister Allison Bailey was aghast when her Garden Court Chambers (GCC) joined the Stonewall diversity champions scheme. She opposed its policies, which seek to erase biological sex in policy and law. As a lesbian, she was angry Stonewall had hired Morgan Page, a trans woman who’d run a notorious course, Overcoming the Cotton Ceiling, which, she tweeted, had the “sole aim of coaching heterosexual men who identify as lesbians on how they can ‘coerce’ young lesbians into having sex with them”.
After this and other tweets, Kirrin Medcalf, Stonewall head of trans inclusion, contacted GCC to warn that Bailey’s views threatened their working relationship. GCC put Bailey under investigation. Most people in a tight-knit profession would back down, but Bailey sued her chambers and Stonewall. After three stressful years her case was finally heard, and the charity whose motto is “No Debate” was held to account.
You might think the charge that lesbians are bigots for refusing to date people with penises hard to credit. But Medcalf said he doesn’t believe sexed bodies even exist and Cathryn McGahey QC, vice-chairwoman of the Bar Council’s ethics committee, compared urging lesbians to embrace “lady dick” to racial integration in post-apartheid South Africa. Yes, really.
Bailey won £22,000 in aggravated damages from GCC but while she did not prove that Stonewall compelled her chambers to act, she exposed its secret modus operandi: keep your staff in line or you’ll get chiding emails; pay for our diversity advice which violates the Equality Act but if you are sued, you’re on your own. The message to other Stonewall diversity champion members is caveat emptor.
Now gender services will move to regional children’s hospitals, including Great Ormond Street, and Alder Hey in Liverpool. Treatment, Cass says, will be holistic, taking into account autism traits, mental health and life experience. Yet already we learn GIDS staff will assist with the creation of these units. Activist groups such as Mermaids remain quiet, perhaps hoping they can assert influence. It will take generous funding, well-trained therapists and strict treatment protocols if we are to avoid the creation of more dark places, where opinion trumps data, and sunlight cannot reach.
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