I had words for the BMJ. I don’t know if they’ll stay up on the BMJ’s site, but they’re here if they don’t.
Dear Editor,
The BMJ’s editorial supportive of the findings of the Cass review will stand as one of the poorest decisions in this journal’s storied history. On final publication it has become incredibly clear that the review was deeply politicised. Dr Cass and her team’s decision to exclude the 98% of studies on transgender healthcare – with positive findings – for failing to be double blind studies, but then to include multiple non-double-blinded studies, which were supportive of her own position, is damning by itself.
It makes a mockery of the concept of a review. Had I handed this in as part of any of my degree studies I would have failed because it lacks even the most basic principles of scientific rigour.
Furthermore, the position adopted by Dr Cass, that — because a large proportion of people who start puberty blockers go on to require further gender affirming care we should not prescribe blockers — shows a fundamental misunderstanding of the situation. That is broadly the equivalent of complaining that patients who present to an emergency department having an ST elevation MI go on to have reperfusion therapy. The guidelines have successfully identified those requiring treatment, we gave it, and it worked. Puberty blockers were always a compromise because people were concerned about children making their minds up too fast. It turns out that children know who they are.
Indeed, that such a high percentage of people using puberty blockers go on to have further gender affirming care suggests they should be used more broadly, not less. And that the current guidelines are actually identifying people who should be placed on HRT so that they can go through an appropriate puberty with their peers. Instead she has used it to argue for an opposite, and completely unsupported by the evidence conclusion.
The evidence is very clear that gender affirming care is safe, as has been found by less biased reviews in multiple other countries. It is vividly clear that this government study is purely a basis for further politicisation of transgender healthcare, and provides a figleaf for the NHS’s appallingly inadequate service provision. That a journal that I respect has decided to editorialise positively on such a travesty is deeply disappointing and engenders deep concerns regarding the decision making at the BMJ’s editorial heart.
