Nearly 900 doctors have written to the British Medical Association (BMA), expressing “dismay” and disappointment” at the stance taken by the doctors’ union on puberty blockers and the Cass Review on gender identity services, and suggesting its focus should rather be on pay and working conditions.
The New Statesman reports that in a statement last week, the BMA criticised the ban on new prescriptions of puberty blocker medication – restrictions introduced by the government from June after Dr Hilary Cass’ four-year review of gender identity services for children and young people.
Cass’ final report was published on 10 April this year.
In response, the BMA has now called for a pause in the implementation of recommendations made by the Cass Review, having branded them “unsubstantiated”.
The letter, which is addressed to Philip Banfield, chair of the BMA’s UK Council, said the signatories were “extremely disappointed that the BMA Council has passed a motion to conduct a ‘critique’ of the Cass Review and to lobby to oppose its recommendations”.
It is signed by 57 professors and 22 former or current presidents of royal medical colleges and other clinical leaders, among others. Of the 870 signatories, more than two-thirds are BMA members.
“The number of signatories to this letter speaks to the level of concern among doctors about the BMA Council motion against the Cass Review,” said Dr Camilla Kingdon, a past president of the Royal College of Paediatrics and Child Health (and a signatory of the letter).
On 16 July, the New Statesman revealed a motion tabled by the BMA calling for its members to “lobby and work with other relevant organisations and stakeholders to oppose the implementation of recommendations made by the Cass Review”.
The BMA’s policy-forming body, the UK Council, voted the next day on a slightly amended motion: instead of voting to “disavow” the Cass Review, it voted to “publicly critique” it.
The motion also described Cass’ recommendations as having been “driven by unexplained study protocol deviations, ambiguous eligibility criteria, and exclusion of trans-affirming evidence”.
The doctors’ letter to the BMA criticises the process that led to the organisation’s position on the Cass Review as “opaque and secretive” and “not reflecting the views of the wider membership, whose opinion you did not seek”.
It is not known how many of the BMA’s 69 council members voted in favour of the motion.
BMA members who signed the letter say the refusal to provide details of the vote amount to “a failure of accountability to members”, and is “simply not acceptable”.
After the vote, the BMA issued a press release criticising the government’s ban on the private prescription of puberty blockers to under-18s (for the purpose of treating gender-related distress).
In March, NHS England confirmed that puberty blockers would no longer be prescribed on the NHS for the treatment of gender-related distress, as there was “not enough evidence to support the safety or clinical effectiveness …to make the treatment routinely available.”
Instead, they would only be prescribed as part of clinical research. This ban was judged lawful by the High Court last month.
In her review, Cass found that gender medicine was built on “shaky foundations”: “This is an area of remarkably weak evidence.”
The reality, she wrote in her report, is that there is “no good evidence on the long-term outcomes of [hormonal] interventions to manage gender-related distress”.
Speaking to the New Statesman, Cass expressed “disappointment” that the BMA’s UK Council had not made contact with her to discuss their concerns in the four months since the review was released.
“The review (team) spoke to BMA representatives during … its work, and the recommendations in the final report reflect the issues they raised; specifically, anxieties about lack of adequate training in this area, and the pressures on GPs by private providers to prescribe in an area many feel is outside their competence.”
The letter, which strongly supports Cass, has accused the union of failing to follow an evidence-based approach to medicine.
It says: “The Cass Review has got it right when it says that because there is so little evidence about (puberty blockers’) safety and efficacy, they should only be prescribed under research conditions.”
The letter also notes: “By lobbying against the best evidence we have, the BMA is going against the principles of evidence-based medicine and against ethical practice.”
After the BMA’s announcement, NHS England said: “Dr Cass spent four years gathering evidence for the most comprehensive report of its kind, and her expertise and advice has been invaluable in supporting the NHS to create a fundamentally better and safer service for children and young people.”
Both Kingdon and Dame Clare Gerada (a former president of the Royal College of General Practitioners, and another signatory) echoed the letter, insisting the Cass Review is “the most comprehensive review of its type ever conducted”.
“Patients – and that includes children, have a right to receive treatment based on best evidence,” Gerada added. “This is especially important when that treatment is a life-altering intervention.”
Scores of signatories to the letter added further comment below the main text. They didn’t hold back: “appalled”, “horrified”, “shocked”, “reprehensible”, “irresponsible” and “wrong”.
Some claim that the move will cause direct harm to children, while one signatory claims it shows “an abysmal failure of leadership”.
A number are perplexed as to why the BMA, a trade union for doctors, is getting involved at all, suggesting that its focus should be on pay and working conditions, rather than “challenging an evidenced based document which took four years of painstaking research to produce”.
Several signatories say they have resigned their membership as a result of the union’s announcement. Many said they are deeply concerned about the thousands of distressed children in need of help – the most recent figures suggest that more than 5 700 are on the waiting list for youth gender services.
The BMA now plans to embark on its own review of the Cass Review, which it hopes to have completed by the end of the year.
The letter to Banfield express its signatories’ “dismay” that the BMA has chosen to critique Cass.
It concludes: “We call on the BMA to abandon this pointless exercise and to welcome and follow the Cass Review as the Royal College of Psychiatrists, the Royal College of General Practitioners, the Royal College of Paediatrics and Child Health and the Academy of Medical Royal Colleges have done.”
See more from MedicalBrief archives:
Cass Review slammed by transgender associations
Puberty blockers ban lawful, rules UK High Court
NHS drafts new guidelines for treating transgender youth