Matthew Best
Penultimate Amazing
I had a feeling I would see Quinnehtukqut Mclamore’s name in there somewhere. And that it would also say there are no conflicts of interest.
Cass Report
- Thread starter d4m10n
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I had a feeling I would see Quinnehtukqut Mclamore’s name in there somewhere. And that it would also say there are no conflicts of interest.
Whistleblowers say Cass Report omitted spike in trans youth suicides.
https://www.erininthemorning.com/p/trans-youth-suicides-covered-up-by
https://www.erininthemorning.com/p/trans-youth-suicides-covered-up-by
angrysoba
Philosophile
I would like to see if independent researchers have issues with the Cass Report. I have no idea whether or not the Cass Report followed standard procedures for deciding what evidence there was.
BUT....
... if the only people who seem to be saying that the Cass Report missed important evidence are themselves clearly biased then it does look like the Cass Report is supported in the dog-that-didn't-bark evidence.
That said, instead of just posting links to articles and pre-prints, we need to see what the specific claims are and how they conflict with the Cass Report.
The Cass report is underpinned by a series of systematic evidence reviews which were commissioned from the University of York (which houses the centre for systematic evidence reviews and maintains PROSPERO, an international data base for pre-registration of evidence reviews). I summarised a bit about the method used to grade study quality earlier in the thread. All the systematic reviews conducted for Cass were peer-reviewed and published in BMJ.
Gender Identity Service Series
hecd2
Master Poster
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Of course we should assess the methodology and claims in that paper on their merits if we are competent to do so, but superficially I don't find the affiliations of the authors very relevant to paediatric medicine, and the conclusion seems to be along these lines to my uneducated eye:
"We don't like objective evidence based medicine being applied in this case, and to determine whether we should medicate children, we should ask the children."
hecd2
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Agreed. I didn't go through them all, but a random sample of the authors' bios seem to indicate the majority are trans, trans-activist, or otherwise biased. And as I commented before, their expertise seems to be in disciplines other than paediatric medicine. However, we should treat their claims on their merits.
Several of the authors of that paper signed their name to a letter from academics attacking the Cass report. The letter contained a demonstrable falsehood (that studies were rejected from systematic reviews for not being double-blinded) that remained for weeks after the review was published and long after it could be attributed to any genuine misunderstanding. I think the signatories are no longer visible. Those individuals have already made it clear that they don't care about the truth of what they say if it supports what they see as a politically desirable conclusion.
I agree that any substantive criticisms of methodology should be addressed on their merits regardless of who made them. It is also fairly obvious that none of the authors would be criticising the review if they liked the conclusions, even if the review methodology was appalling.
I haven't had time to read the paper in detail yet, but from a quick run through it seems to be largely picking at departures in methodology from the PROSPERO registration and suggesting something sinister about these. They claim to be using ROBIS to objectively evaluate risk of bias, but their application of this seems to be highly subjective.
There was one PROSPERO registration covering all nine publications arising from the UoY research, which covered a range of topics including outcomes of puberty blockers and cross-sex hormones, quality of international guidelines and guideline recommendations, and characteristics of clients using gender clinics. The fact that only one registration was made suggests that it was undecided how many publications would arise from the research programme and what specifically would be covered in each separate publication. This is not unusual for systematic reviews, and by their nature it is unclear what will be found until the search starts so minor deviations from protocol are not uncommon.
Looking at the first domain for risk of bias, study eligibility criteria, the authors claim high risk of bias due to 'unacceptably ambiguous' eligibility criteria and 'significant deviations' from protocol registered in PROSPERO.
As an example, I looked in more detail at two objections; exclusion of grey literature and literature not in English. In neither case have they pointed to any specific literature that was excluded which they think would alter the conclusions of the review. It is worth nothing that previous systematic reviews including the Swedish review also looked only at research published in English, despite being conducted in Sweden.
With regard to excluding grey literature, the PROSPERO registration states that a search will be made of standard databases and "In addition, the reference lists of eligible studies, including systematic reviews that are identified, will be searched in order to identify any relevant studies. A grey literature search will also be undertaken with a focus on key organisational websites and strategic policy documents with an aim to identify unpublished research". In the systematic reviews of treatment outcomes, the search strategy matches that recorded on PROSPERO, apart from no mention of searching for grey literature. However, the two reviews examining guideline quality would necessarily have included grey literature. So the extent of the criticism seems to be that there is no mention of searching for unpublished grey literature specifically on treatment outcomes. However, it is very unlikely that published grey literature contains such evidence and the authors have not pointed to any.
So looking at these criticisms as examples, I would say the assessment of these as significant problems is highly questionable.
angrysoba
Philosophile
Jesse Singal writes in the Economist about the way in which WPATH, a transgender advocacy group, has been leaning on Johns Hopkins University to fudge the evidence in transgender healthcare.
Gulliver Foyle
Philosopher
Another article from Erin in the Morning, detailing Ms. Cass' walking back of the entire "scientific basis" for the conclusions of her report: https://www.erininthemorning.com/p/dr-cass-backpedals-from-review-hrt. Not surprising that nobody in any major UK media outlet picked this massive Wakefield sized problem up.
One thing not mentioned in the article is that the two articles accepted by Cass were to a much lower standard than the 100 she rejected for not being "of a sufficiently high scientific standard". The more one digs the more one has to conclude that Ms. Cass started with her conclusion and worked backwards.
hecd2
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That opinion piece is even more biased than the paper d4m10n cited - it's typical of the response to the Cass review made by trans activists at the time and soon after the review was published. Some of the claims in the opinion piece have since been debunked, including the claim that poor quality research was improperly disregarded. The suggestion that the review included only two pieces of research and rejected 100 has been shown to be false and seemingly originated with Stonewall - a position from which they have had to backpedal. The assessment of research quality was made independently by academics at York and published after peer review.
Cass did not reject 100 articles. Out of 103, 60 were accepted for the final review (these rated high and moderate quality).
Cass herself did not reject any studies. The quality ratings were done by researchers at the University of York for the peer-reviewed systematic reviews published in BMJ.
Cass has not walked back on anything. The review has been misrepresented since it came out and some of the misinformation has been corrected. The interview linked to by 'Erin in the morning' is simply a propaganda piece written by an activist organisation who are clearly not quoting Cass as they write about her views in the third person.
The one article on puberty blockers that was rated high quality (just) is one where the authors claimed to find support for benefits of puberty blockers albeit with cautious conclusions. It is interesting that you think this paper is of a very low standard. I assume you think that the researchers were being overly generous to the gender affirmation approach?
Here are the ratings awarded on each criterion to each of the studies for puberty blockers. Perhaps you could indicate which ratings you think were made incorrectly? Especially for the one rated high quality (below) which you say is one of the worst pieces of research?
Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers
angrysoba
Philosophile
d4m10n
Penultimate Amazing
Hard to take these people seriously if they aren't going to say which studies showed that the consistently affirmative approach has proven superior to the earlier psychotherapeutic modalities.
It's hard to take anyone seriously if they profess to be concerned about 'serious methodological problems' in the Cass review without being able to explain how their concerns may have affected the conclusions, while being apparently unconcerned about the fact that WPATH hasn't published most of the evidence reviews that they claim underpin their guidelines, so the methods and conclusions are not even available for examination.
An independent review of data conducted by Prof. Louis Appleby shows no support for the claim of a large increase in suicides among Tavistock patients.
The report is critical of the way these claims have been made and promoted in the media. Suggesting to vulnerable people that they are at risk of suicide if a specific condition is not met is highly irresponsible.
'Erin in the morning' is a chronic purveyor of misinformation.
Matthew Best
Penultimate Amazing
Here's a rebuttal of the BMA's criticism of the Cass Review.
https://www.voidifremoved.co.uk/p/the-bma-council-shames-itself
https://www.voidifremoved.co.uk/p/the-bma-council-shames-itself
Singal has also written a good critique of the so-called 'Yale paper' (although very long), which is mentioned in this piece. Singal also acknowledges that some criticisms of the Cass review are valid (although they don't threaten the overall conclusions).
This won't make any difference to true believers. Anyone criticising their narrative is branded a transphobe for doing so, and their criticisms can therefore be rejected because they are known to be a transphobe.
d4m10n
Penultimate Amazing
Puberty blockers a 'safe, effective and reversible' form of gender-affirming care, finds review triggered by Westmead Hospital investigation
https://www.abc.net.au/news/2024-09...afe-effective-and-reversible-review/104322428
https://www.abc.net.au/news/2024-09...afe-effective-and-reversible-review/104322428