Nothing in Critically Appraising the Cass Report is surprising, but a lot of it exactly confirms what has been widely suspected and reported less formally up until this point.
They essentially looked at it and found it wanting and against best practices
Noone, C., Southgate, A., Ashman, A., Quinn, É., Comer, D., Shrewsbury, D., … McLamore, Q. (2024, June 11). CRITICALLY APPRAISING THE CASS REPORT: METHODOLOGICAL FLAWS AND UNSUPPORTED CLAIMS. https://doi.org/10.31219/osf.io/uhndk
Rather than analyzing the Cass Review directly, this paper starts off by tackling something that is in the inference chain for the foundations of the Cass Review: the systematic reviews and research that went into it.
It claims methodological biases, breaks down each of the reviews in turn, and is a good overall answer to the "this is the best report ever, citation: the cass report" thing you 've seen a lot of.
I won't go into it more for now, but it's well worth your time.
So long as we are on the topic, in the same vein some other citations that are worth your time:
Horton, C. (2024). The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children. International Journal of Transgender Health, 1–25. https://doi.org/10.1080/26895269.2024.2328249
Grijseels, D. M. (2024). Biological and psychosocial evidence in the Cass Review: a critical commentary. International Journal of Transgender Health, 1–11. https://doi.org/10.1080/26895269.2024.2362304
I continue to circle back to something that seems glaringly obvious when you read the #CassReview and when we talk methodological criticisms.
The selection of studies for the review could be considered reasonable! The grading could be considered reasonable! There are reasons to dispute both of these, but we could even make an argument for that. In that sense they didn't "discard the evidence."
But then in their conclusions they definitely discarded it.
@hrefna@LiquidParasyte the grading as "low quality" is ok - but discarding low quality evidence in absence of enough "high quality" evidence is not best practice in evidence based medicine. They were cherry-picking parts of evidence based evaluation frameworks.
Also it seems the moniker "low quality" was deliberately used in communications without clarifying that it means something different in a scientific medical context than what people would infer from the wording.
And still - their idea of the "high quality" research which they would request to be satisfied is unfeasible and unethical.
So I don't think it can be considered reasonable in this case.
I agree that even if it was reasonable they are completely dismantling their conclusion by suggesting alternatives which in no way are held to the same standards. (Often suggesting interventions which are based on no evidence at all, except hearsay.)
Another problem that I have with the #CassReview: its attempt to draw a line between puberty blocking and GAHT.
One would not expect that puberty blocking would reduce dysphoria and, in fact, it would be kind of weird if it turned out that it did: that doesn't fit with how any of this works.
Puberty blocking is about giving time to make a choice.
If all of the kids who are going on puberty blockers are then going on GAHT, a clear alternate hypothesis would be they should just start GAHT.
Puberty blockers are the compromise solution because we know that this is an area that requires moving cautiously. We want to make damned sure, within our ability to do so, before forcing the kid to go through puberty if they have expressed dysphoria. Any puberty.
It's tempting in a triple blind sense to say "well these are two treatments"—and the review attempts this—but if your concern is PHS you know you could just… jump straight to GAHT or prioritize it very early.
They talk about "returning to normal best practices" but in a real way that would be more accepting and more progressive than the previous status quo.
Because ordinarily when you have a situation in pediatric care where there is nothing "on label" there should be a conversation between the kid, the parent, and the doctor.
This is done very commonly, because most drugs aren't authorized for the age group they get used with (like 70–80% of prescriptions?)
The review disagreed with the idea of puberty blockers providing youth patients with "time to think", due to the finding that nearly all patients who went on blockers later decided to proceed on to hormone therapy.
Gee, it's almost as if when you give adolescents room to find their full expression of self, they will then pursue a true expression of self.
That Cass Report is big dumb and actively harmful.
Responses to the #CassReview from supporters are all like:
"This document written by people at the top of their field, commissioned by the majority party, supported by the minority government, supported by the head of one of the largest medical journals in the world, is SPEAKING TRUTH TO POWER! GO GET THEM!"
Like… do you need any more evidence that these people are either fascists or leaning toward fascism at the very least?
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For those following the #CassReview: I highly recommend looking into the specific studies they judged as "poor quality overall" as well as anything labeled "high risk of bias."
It's interesting to pull out those results and scan through them and also see what kind of peer review they had to go through.
So if we treat the analysis at face value then the obvious questions are "high risk of bias about what?" and "what would pass muster and an IRB?" https://hachyderm.io/@hrefna/112266396098594639
I want to highlight this in particular because it shows the duplicitous, misleading dance that the proponents of the #CassReview are doing.
It is true that in a review, generally, judging something as "low quality" does not mean that it is "thrown out." It is a term of art, and if it were just that in isolation it could even be okay.
But.
They did, very clearly, throw out and discount those results and then manipulate the public on what "low quality" means.
But this is not what they are doing. They are talking about how "we are treating people without high quality results! This is dangerous!"
This clearly implies that they are discarding the evidence they have labeled as "low quality."
You always have to ask "what would be the study design that would satisfy you for this?" The answer here is not ethical, which leads to the conclusion that no evidence will satisfy them.
Again. I have to assume that they know all of this, because IIRC this was talked about in my 5xx biostatistics course when we were going over experiment design.
So either these preeminent clinicians and researchers, including editors of major medical journals, have a massive gap in their education covered by a low-level grad class in a mid-tier university in the US.
Or they are deliberately misleading people, possibly including themselves.
Most emergency surgical interventions are not aligned with science because trauma surgeons aren't letting patients die to establish appropriate control group
It's worth noting, Re: #CassReview, that off-label prescription is incredibly common in pediatrics. A 2019 study by Yackey et al found that around 1 in four prescriptions given to children in their database was off label with respect to age
No one is running around talking about the "Pulmonologist Ideologues," however.
@hrefna Ooh, about that. There's a synergy between that line of argument in anti-trans "science", on the one hand, and, on the other hand, other social forces that are beginning to veeeeery gently probe whether they can get away with starting a moral panic about off label prescribing.
The insurance industry would love to start a moral panic about off-label prescribing. They could extinguish a vast amount of medical care if they could just convince everyone that off label prescribing is illegitimate medical practice. It would save them a fortune.
It's almost impressive how bad #x née #twitter has gotten. I ended up on there briefly earlier while looking into the #CassReview and between the functionality and the people who crowd mentions it has gotten so, so much worse.
@Jackiemauro I genuinely think this is an interesting and important question, partly so that we can figure out how to fix things here to make it more inviting, in part to understand why people might end up on here vs. bluesky vs. threads vs. facebook etc just in general (regardless of if this would even be a good fit).
Why do people bounce off of other experiences? Why do they stick with the ones they have? What can we do to make that easier, do we want to make that easier?
@hrefna I totally agree. And I have a bit of the evangelist’s zeal on this because I have seen an actually marked improvement in my mental health from having migrated here.
One thing I’ve been considering is setting up a small instance just for people I know personally and sort of treating it as a group chat. But idk if I have the bandwidth (or know how).
I wish for all the people who believe #trans kids should be subjected to double-blind studies of the effectiveness of hormone treatments to themselves subjected to the first double-blind studies of the effectiveness of parachutes.
I am incredibly disappointed in both British and Dutch media, because they write without any criticism about a new anti-trans report by Hilary Cass, who was appointed to review #transgender health care by the NHS in the UK.
Cass calls herself "independent", but she's following the blueprint of the "Florida Review" closely, another politically motivated report by TERF quacks which had banning trans health care as their purpose. In the #CassReview which was released last Wednesday, trans kids are the victim. Cass leaves away 100+ studies which mention overwhelmingly positive effects of gender-affirming healthcare, because those do not use "double blind" testing. (Yeah, because you can't do that. Not easy or ethical to test e.g. puberty blockers like that - kids WILL notice.)