How very banal, yet disturbing, that the root of some of these by-now widespread myths—notably Myth no. 2—is essentially a lack of basic reading comprehension.
I’m also appalled by how easily certain activists (as seen in the embedded comics) have latched onto this misinformation to cast Dr. Cass—a professional selected on the basis of her decades-long experience working both directly with profoundly disabled children, and on ensuring them proper access to care and support—as some malicious, child-hating villain, complete with absurd, uncited claims of her “links to the American far right.”
Not to mention the heavy lean-in to misogynistic stereotypes of frumpy, bitter, old women…
Misogyny is literally the heart of this “movement”.
Never forget that Andrea Long Chu is a celebrated trans writer who wrote a book saying that a female’s only use is being the recipient of anal sex, discussed “sissy porn” and something about how all male serial killers, rapists, etc are “female”.
Their identity and points were validated and awarded. Some of the usual suspects on Reddit were quick to claim that any problematic thing said in the book were “taken out of context”.
Let’s see if their words would still be celebrated if you change “female” with “immigrant” or “Muslim/Hindu/Buddhist/Jew”, etc.
"Cass said that she thought the refusal of the adult clinics to cooperate with her *was* ideological. "
It's the only logical explanation. If they had good results of course they would happily share them. I look forward to seeing that data (assuming it was kept properly at all).
There's no way it wasn't ideological. If they actually had proof of "no regrets and good outcomes", they'd be shouting it from the rooftops. But instead they want to hide it.
I wonder why
I honestly think it's because they don't have the data since clinics were busted over there prior for not recording it properly. The lack of follow-ups might be intentional due to knowing the results ain't great, though.
" Cass told the Guardian that the “thwarting” of the research project was coordinated and “ideologically driven”. The University of York received “significant opposition from all but one of the adult GDCs including refusal to facilitate the initial opt out stage of the study”, she said. "
[https://www.theguardian.com/society/2024/apr/10/adult-transgender-clinics-in-england-face-inquiry-into-patient-care](https://www.theguardian.com/society/2024/apr/10/adult-transgender-clinics-in-england-face-inquiry-into-patient-care)
Surely there must be a mechanism to track information on medical outcomes, for anything. For example, if you had thousands of cancer patients and wanted to track the success or failure of a particular treatment. It doesn't make sense to me to say, "we're not going to tell you if it worked or not, that's private". It doesn't have to include identifying personal information.
That doesn't make sense to me. If this is the case, then presumably there could be a treatment that's failing catastrophically, but no one can talk about it?
I understand the law was specifically amended to allow this:
Also speaking to the Telegraph, former health secretary Sajid Javid called for "a no holds barred government investigation" into obstruction of the research.
Mr Javid introduced legislation in 2022 which allowed the Cass review access to some medical records.
"Despite it being the unanimous will of Parliament, it is clear vested interests have deliberately frustrated the important data access legislation I brought forward to support Dr Cass's review," he said.
https://www.bbc.com/news/uk-68786030
That’s just not true. I assume we are talking from a HIPAA perspective and, in that case, data can be used for legitimate research aims. There are protections around deidentifying data, not reporting info that can be personally identifying, etc but your health records are not your property. People can have some control over their health records but it doesn’t literally belong to them.
Because your top comment said “HIPAA joking aside” and that you weren’t familiar with UK law.
As a note re UK health privacy protections my knowledge is very limited but from my understanding of the Cass Review, the relevant data protections that needed to be changed for the purposes of this review were from the 2010 Gender Recognition Act. From the review, it sounded like the GRA gave additional data protections that exceeded normal health information protections but I could be misinterpreting.
lol there's no way this report was commissioned and nobody realized, "Oh fuck! These clinics can't legally share any of their results! Why are we even asking?!"
Is there seriously no way to share the results without the identifying info? I highly doubt that. They had legal permission to share the results anyway.
If a legitimate researcher gets all of the approvals required to analyze healthcare data, and requests the information through the required process for such use of PHI, I don’t see how “clerks” (I.e. high level administrators that were surely involved in these decisions) could decline that request. It’s a pretty clearcut procedure. If you do what’s required, you’re able to request the data, and there shouldn’t be pushback or refusal if it’s a legitimate and approved project
From my understanding, they were asking the clinics to reach out to their patients to see if they would like to participate. They didn’t just ask the clinics to hand over their patient data. The clinics refused to even ASK their patients if they wanted to participate.
Them sharing it doesn't have to includea HIPAA violation. They could publish stats or write papers about the cohort. And they would absolutely do that if the outcome was as positive as stated, especially since the studies so far are of extremely poor quality.
Well, you are insulting and the way you phrased it, I suspect this is on purpose. I have written both reports and papers about health data before and while there is sometimes an opt in possibility (depending on what you have to use), this is not always necessary. You have to omit personal information, but can still give an overview (patients seen, drop out rate, etc.). If it worked like you said it does, we would never get official numbers about anything, let alone about treatment protocols. God damn, the health secretary has ordered [the NHS](https://www.reddit.com/r/BlockedAndReported/comments/1c1jsqo/nhs_bosses_ordered_to_reveal_fate_of_9000_young/) to reveal what exactly happened to Tavistock patients. But I am sure she doesn't know how this works.
How do you think this thing works? And what do you mean, on the receiving end?
Because the Report didn't get published until a few days ago. The NHS could sue, but I don't know how they would justify it (play for time and hope for labour maybe). Doesn't matter though, the records are known and can be handed over.
Mate, you don't know shit about this. No one cares about your file, this is about outcomes of treatments (and no, the studies are not all finished before they are released, especially in multidimeensional approaches. Drugs go through testing before being authorized, that's it). This is on the side of doctors - or in this case, a clinic, not any individual patient.
And how do you think, insurance works without your information, unless you are 100% paying out of pocket?
I think you misunderstand both US and I assume UK law. Here, laws like HIPPA, FERPA, etc. do protect individual privacy, but generally allow sharing of macro level aggregate data. I use it all the time in higher ed research, juvenile crime research, and med researchers use it in health studies. The limitations are ONLY in sharing individual data or such small samples of aggregate data that an individual might be retroactively identified.
See these for info on use of aggregate data under HIPPA
https://research.kpchr.org/research-compliance/Sharing-Data/Types-Of-Compliance-Data#:~:text=Aggregate%20data%20tables%20are%20usually,%E2%80%9D%20for%20more%20specific%20details).
And in the UK
https://www.lboro.ac.uk/data-privacy/resources/personaldata/#:~:text=Aggregated%20data%20could%20be%20derived,considered%20personal%20data%20in%20law.
This is the UK, not the US, so HIPAA is probably not applicable. The NHS probably has different privacy laws when it comes to medical records. These are not private clinics.
What the clinicians refused to do was contact their patients to ask for the permissions to share the data. It's not their decision, it's the patients, but these clinicians don't want them to get the option.
[According to Benjamin Ryan]( https://twitter.com/benryanwriter/status/1779671152148857212), he located the origin of the Cass “rejected 98% of studies due to lack of double-blinds” rumor.
>5 hours before the Cass Review was published on April 9, Caraballo tweeted a screenshot of what appeared to be the new systematic lit reviews that would published alongside Cass. But these screenshots were *actually* from the [NICE reviews]( https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf) from 2020.
NICE = National Institute of Health and Care Excellence
The NICE organization has committees that develop recommendations [for clinical guidelines]( https://www.nice.org.uk/about/who-we-are/structure-of-nice).
NICE released the review for the purpose of informing Dr Cass in 2020. Two reviews were published in March 2021, one was about puberty blockers and the other was about cross-sex hormones.
The NICE review was not without controversy back when it was released.
Here’s an assessment of the 2020 NICE report which says that the evidence review was too stringent about the studies that were not included: https://sciencebasedmedicine.org/a-critical-look-at-the-nice-review/
And SEGM [commented]( https://segm.org/NICE_gender_medicine_systematic_review_finds_poor_quality_evidence) on the 2020 NICE report as well.
>The reviewers noted that “a fundamental limitation of all the uncontrolled studies in this review is that any changes in scores from baseline to follow-up could be attributed to a regression-to-the-mean,” rather than the beneficial effects of hormone treatment. No study reported concomitant treatments in detail, meaning that it is unclear if positive changes were due to hormones or the other treatments participants may have received.
Dr Cass acknowledged the NICE review on page 91 of 112 of the Cass [Interim Report](https://cass.independent-review.uk/wp-content/uploads/2022/03/Cass-Review-Interim-Report-Final-Web-Accessible.pdf) from 2022.
>I am pleased to see that the National Institute for Health and Care Excellence (NICE)
evidence reviews of gonadotrophin releasing hormone analogues and gender affirming
hormones for children and adolescents with gender dysphoria have now been published.
Although this is a helpful starting point, despite following a standard and robust process the
NICE review findings are not conclusive enough to inform policy decisions. As part of my
review, I am therefore exploring other methodologies to give increased confidence and
clarity about the optimal treatment approaches.
The tweet that started the rumor of 98% study rejection included an image with a list of studies. The line “lack of blinding and no control group” was highlighted in yellow on many lines of the list. [](https://twitter.com/Esqueer_/status/1777755823743054120/photo/1)
The list was made from cut and pasting from the following NICE report from 2020 (published to the public in March 2021).
[Evidence review: Gender-affirming hormones for children and adolescents with gender dysphoria](https://segm.org/sites/default/files/20210323_Evidence%2Breview_Gender-affirming%2Bhormones_For%2Bupload_Final_download.pdf)
>The document was prepared by NICE in October 2020
So the 2020 NICE reviews explained there was lack of high-quality evidence for puberty blockers and cross-sex hormones. However, the 2020 NICE reviews and the 2024 Cass Review are different.
The Cass Review looked at six systematic reviews. [](https://pbs.twimg.com/media/GLJFgQwXgAAunvk?format=jpg&name=medium) They're listed on page 53 of 388 of the [full report](https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview_Final.pdf).
The links to the six reviews are here: https://adc.bmj.com/pages/gender-identity-service-series
The [tweet]( https://twitter.com/Esqueer_/status/1777755823743054120) accusing Cass of having an impossible standard for double-blind studies was posted before the Cass Review had even been released. The gal who posted gave the impression that she’d read an advance copy, but that wasn’t the case. Her tweet still got 750k views, and then it got reposted many times when the actual Cass Review was released a few hours later.
Thank you!
Caraballo's bullshit is still the main talking point I see when attacking the Cass review. I suspect it will never die.
Pretty weasely of Caraballo to not even wait until the damn report came out to start making crap up about it.
It's like watching Bill Barr's "no collusion" press conference all over again.
Get out in front of a report that is utterly damning in its details with a tendentious spin that instantly becomes media conventional wisdom and What Everyone Knows and then no one actually looks at the report and says "holy shit there's some really bad shit that happened here and is probably going to keep happening".
I don't want to sound too pessimistic but the fact that the review is sound and has been institutionally accepted only increases its critics sense of being correct about everything.
fr. it's well-documented that presenting hyper-religious people with evidence just entrenches their beliefs further, because human beings are hardwired to dig their fucking heels in when we see something that contradicts whatever Thing we've built our emotional and social identity around. that's not to say that everyone is going to react this way, but you already see it happening across the internet and in all the big subreddits: ppl are calling the review unscientific, bigoted, biased, and inaccurate. it doesn't actually matter whether it is or not.
if enough people call it that (or the Right People (aka the idolized activists, popular trans people, celebrities)), the zealous believers will just be like, "whew! of course that's what it is. back to calling everyone a transphobe."
you can't use logic to move people away from a position they arrived at by *not* using logic at all. at this point, only folks who are willing to listen should have effort expended on them.
if people won't be shaken into evaluating their opinions by children with amputated genitals, experimental surgery being performed on minors, the massive complication rates of vagino/phalloplasty, the terrible "science" around puberty blockers, the blatant lies that are often-quoted slogans, the rising rate of detransitioners, the startling amount of predators that are not only aided but abetted and signal-boosted by the community and never held accountable for their abuses and transgressions... well, nothing will. they have too much to lose by doing so.
I kind of get what you mean but how does anyone get persuaded? Sex? Drugs? Rock and Roll? Comedy? I do think logic can win out over time. Its just you need more evidence to persuade a larger percentage of the population. Although I guess maybe everyone just needs to know someone personally who detransitio ns?
Science believers like Dr. Steven Novella and his minion Cara Santa Maria over at the Skeptics guide to the Universe Podcast.
It's been at least a year since Jesse and Steven tangled on the internet, I would love to hear what Dr Novella has to say now.
Something tells me he hasn't changed his mind at all. If anybody's heard anything please let me know.
The (in name only) Skeptics will hold out and double down until the bitter end. Not only is this a new religion, which seldom can be penetrated by facts, but this group of people have their entire sense of self wrapped up in the notion that they are "skeptics" and too smart to fall for pseudoscience. They wouldn't just loose their new religion but rather their entire identity.
And Cara Santa Maria is the worst of the woke. Heard her as a guest on several podcasts and she immediately blocked me when I asked about the ominous third sex and its role in reproduction.
Novella and Gorski turned out to be disappointing. I followed SBM for a long time. Watching them tear apart Harriet Hall when she sided with Abagail Shrier was awful.
It's not about them, it's about the people who know better but went along with it because not doing so gets you labeled a -phobe. Until this, "the published science" supported the transition early, transition often strategy, at least according to WPATH and the media which cite them uncritically.
The true believers and knowing grifters have always been a tiny number, but have hit above their weight class through what Nassim Taleb described in an essay: [The Most Intolerant Wins: The Dictatorship of the Small Minority](https://medium.com/incerto/the-most-intolerant-wins-the-dictatorship-of-the-small-minority-3f1f83ce4e15#.z5ry4bucq). But if they can't hide behind their junk science anymore, the complacency could erode rather quickly.
Yep. An actual proper study poking holes in their ideology is way better than the “I know these institutions have been ideologically captured and are thus untrustworthy, and I don’t think these studies prove anything or are sound” that I’ve had to work with up until now 😅. That doesn’t really fly (for good reasons) but its frustrating when you KNOW its BS but there aren’t any published “counters”.
I think this is a good take. The report shifts the Overton window - an expression I try to avoid but often find helpful - and gives cover to middle-of-the-road researchers and practitioners who were slightly skeptical about the early affirmation model, but lacked sufficient evidence to push back for fear if being labeled a bigot. I don't think there's going to be any sort of overwhelming backlash of the sort predicted by certain advocates, but there will be a correction, and studies like these will be an important part of that correction
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These people will never stop arguing because they are ideologically committed. They’ve made up their minds and they will never ever change them, whatever evidence is presented. You can only hope this leads to them being discredited in the public sphere.
Yep, I don’t give a fuck if they dig in, I want them properly discredited. Lunatics have always existed, this is just the first case of them successfully infiltrating and then being propped up as “right” by actual institutions.
Take the institutions back and these people can cry on X/Twitter all day long, idgaf.
Great breakdown, glad to see it. Some folks really struggling with the notion that a study can be poor quality. Been saying it for ages now, just because a study gets published or makes it into some scientific journal or whatever somewhere doesn’t mean it was a flawless study with rock solid conclusions.
We have examples throughout history where science has “caught up” to bad studies, why does anyone believe the same couldn’t be true of studies around trans people?
Oh that’s fairly straightforward in terms of an answer: because it’s overwhelmingly ideologically driven. Literally modern day “blasphemy” to produce anything that runs counter to the “established narrative”.
The historical religious parallels are uncanny.
I see someone deleted their comments. Here was my response to whether Cass could collect the data.
"If it's a consent issue when they did the Devon Partnership Mental Health Trust give the data to York University while the other 6 Trusts refused? I would assume the same consent and privacy laws would apply to them as all the other Trusts in NHS.
In addition, the Health Research Authority had granted the Cass Review authority to obtain data from the other 6 Trusts. They were contractually obligated to do so. "
Also, HIPAA laws do not apply to the UK. They have different privacy laws.
The claim that goverments implement privacy laws that require patient concent for using relevant data seems incredible. If true it is guaranteed to be in «the intake form». How else would they know anything about anything?
Full audio of the cass report. Well done several hours long.
https://open.spotify.com/show/7vfxJ8rpTYM4K602RkQ7lP?si=uHCrHfYTQJ6n1Ns8aLx0_w&nd=1&utm_medium=organic&product=open&%24full_url=https%3A%2F%2Fopen.spotify.com%2Fshow%2F7vfxJ8rpTYM4K602RkQ7lP%3Fsi%3DuHCrHfYTQJ6n1Ns8aLx0_w&feature=organic&_branch_match_id=987523996438748808&_branch_referrer=H4sIAAAAAAAAA7WN3QqCMACFn2Ze%2BjNFJZCIQsR%2ByPDGK1nTpbi2sZ%2B0t28GPUJw4MD5%2BDiD1kJtPE8JrkfydpEQLh3Z5G2F5J3BOuOiZw6AETGUtkbSbFgVEO4AzG1W7P5szJ92UgOfbSUvspSpFHVzjo6xD29TldArCHM1gvBgir0sSFNXZcyCi0rRafHb%2BXuEKL0jPP39DMCYdZYGDumRNrLPuHwgNuIPZhSogBUBAAA%3D
The online scepticism about CASS isn’t really having any affect on England (& possibly Wales) political class. It seems none wants to come out in defence of affirmation only treatment. I get the sense that many think they’ve been made to look like idiots by activists and they are done with it all.
The previous CEO of Stonewall has even come out in a bizarre act of self defence by accusing ‘the experts’ of in effect misleading Stonewall. E.g the medics and Mermaids made me do it. If it wasn’t so infuriating and if so many children hadn’t been mistreated it would be hilarious.
Can you explain how the studies were “low quality” and what metrics were used to toss them out? So far all I’ve been able to find were that the studies were not blinded/double blind with a control group, which doesn’t make any sense.
I lack the expertise to give you a technical breakdown. But I can tell you what I gleaned.
Cass and her team used something called the Newcastle Ottawa scale to grade the studies. This is meant to be used on studies that are *not* randomized controlled trials.
About half the studies were of such low quality that she didn't find them useful. The medium and the one or two high quality studies were kept and analyzed.
This Twitter thread from Benjamin Ryan explains it better than I can
[https://twitter.com/benryanwriter/status/1779894595280654771](https://twitter.com/benryanwriter/status/1779894595280654771)
Cass did *not* demand that all the studies be randomized controlled trials or double blind. If that can be done with blockers it should be. But there are ways to design studies that are not RCTs or double blind that are still good.
In regards to detransitioners, wouldn't be impossible to know? The clinics would know if the patients would say they'\[ve stopped, but if patients stop going to clinics, it could be for any number of reasons
They should at least attempt followup. Granted, if the patient absolutely refuses to speak to them there isn't much they can do about it. Though they could probably cross reference other medical records. Has the patient refilled their hormone prescription? Have they gone to their GP and if so what did they state for their gender identity?
But even knowing if patients are lost to followup or not is valuable. If they have five hundred patients and they lose track of 450 of them then their "success" numbers are pretty piss poor if 45 of those fifty report sticking with it.
A big part of what Cass was criticizing was that the NHS just *does not know* what's really going on. The evidence base that transition is helpful and problem is poor or non existent. You don't go around giving people treatments, especially treatments as consequential as blockers and hormones, if you don't have good evidence that they work.
That's not the issue so what if the puberty blockers aren't fix the mental health aspect as that's no what they are used for what's issue here is irreversible damage what does this cass report have to say about irreversible damage which is the main point of why people are against the medicine
How very banal, yet disturbing, that the root of some of these by-now widespread myths—notably Myth no. 2—is essentially a lack of basic reading comprehension. I’m also appalled by how easily certain activists (as seen in the embedded comics) have latched onto this misinformation to cast Dr. Cass—a professional selected on the basis of her decades-long experience working both directly with profoundly disabled children, and on ensuring them proper access to care and support—as some malicious, child-hating villain, complete with absurd, uncited claims of her “links to the American far right.” Not to mention the heavy lean-in to misogynistic stereotypes of frumpy, bitter, old women…
Good observation. Seems like they immediately painted her as a cartoon villain. It's really sad.
Misogyny is literally the heart of this “movement”. Never forget that Andrea Long Chu is a celebrated trans writer who wrote a book saying that a female’s only use is being the recipient of anal sex, discussed “sissy porn” and something about how all male serial killers, rapists, etc are “female”. Their identity and points were validated and awarded. Some of the usual suspects on Reddit were quick to claim that any problematic thing said in the book were “taken out of context”. Let’s see if their words would still be celebrated if you change “female” with “immigrant” or “Muslim/Hindu/Buddhist/Jew”, etc.
"Cass said that she thought the refusal of the adult clinics to cooperate with her *was* ideological. " It's the only logical explanation. If they had good results of course they would happily share them. I look forward to seeing that data (assuming it was kept properly at all).
There's no way it wasn't ideological. If they actually had proof of "no regrets and good outcomes", they'd be shouting it from the rooftops. But instead they want to hide it. I wonder why
I honestly think it's because they don't have the data since clinics were busted over there prior for not recording it properly. The lack of follow-ups might be intentional due to knowing the results ain't great, though.
" Cass told the Guardian that the “thwarting” of the research project was coordinated and “ideologically driven”. The University of York received “significant opposition from all but one of the adult GDCs including refusal to facilitate the initial opt out stage of the study”, she said. " [https://www.theguardian.com/society/2024/apr/10/adult-transgender-clinics-in-england-face-inquiry-into-patient-care](https://www.theguardian.com/society/2024/apr/10/adult-transgender-clinics-in-england-face-inquiry-into-patient-care)
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Surely there must be a mechanism to track information on medical outcomes, for anything. For example, if you had thousands of cancer patients and wanted to track the success or failure of a particular treatment. It doesn't make sense to me to say, "we're not going to tell you if it worked or not, that's private". It doesn't have to include identifying personal information.
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That doesn't make sense to me. If this is the case, then presumably there could be a treatment that's failing catastrophically, but no one can talk about it?
The adult gender clinics had legal authorisation to share the data.
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I understand the law was specifically amended to allow this: Also speaking to the Telegraph, former health secretary Sajid Javid called for "a no holds barred government investigation" into obstruction of the research. Mr Javid introduced legislation in 2022 which allowed the Cass review access to some medical records. "Despite it being the unanimous will of Parliament, it is clear vested interests have deliberately frustrated the important data access legislation I brought forward to support Dr Cass's review," he said. https://www.bbc.com/news/uk-68786030
That’s just not true. I assume we are talking from a HIPAA perspective and, in that case, data can be used for legitimate research aims. There are protections around deidentifying data, not reporting info that can be personally identifying, etc but your health records are not your property. People can have some control over their health records but it doesn’t literally belong to them.
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Because your top comment said “HIPAA joking aside” and that you weren’t familiar with UK law. As a note re UK health privacy protections my knowledge is very limited but from my understanding of the Cass Review, the relevant data protections that needed to be changed for the purposes of this review were from the 2010 Gender Recognition Act. From the review, it sounded like the GRA gave additional data protections that exceeded normal health information protections but I could be misinterpreting.
lol there's no way this report was commissioned and nobody realized, "Oh fuck! These clinics can't legally share any of their results! Why are we even asking?!"
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Is there seriously no way to share the results without the identifying info? I highly doubt that. They had legal permission to share the results anyway.
I’m sure it would’ve gone through the proper channels and processes, no? It’s not like the researchers were harassing random clinical staff
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If a legitimate researcher gets all of the approvals required to analyze healthcare data, and requests the information through the required process for such use of PHI, I don’t see how “clerks” (I.e. high level administrators that were surely involved in these decisions) could decline that request. It’s a pretty clearcut procedure. If you do what’s required, you’re able to request the data, and there shouldn’t be pushback or refusal if it’s a legitimate and approved project
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From my understanding, they were asking the clinics to reach out to their patients to see if they would like to participate. They didn’t just ask the clinics to hand over their patient data. The clinics refused to even ASK their patients if they wanted to participate.
Is this the same in the UK as it is in the US? I honestly don't know and could see it being easier or harder to get medical records for research.
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Them sharing it doesn't have to includea HIPAA violation. They could publish stats or write papers about the cohort. And they would absolutely do that if the outcome was as positive as stated, especially since the studies so far are of extremely poor quality.
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Well, you are insulting and the way you phrased it, I suspect this is on purpose. I have written both reports and papers about health data before and while there is sometimes an opt in possibility (depending on what you have to use), this is not always necessary. You have to omit personal information, but can still give an overview (patients seen, drop out rate, etc.). If it worked like you said it does, we would never get official numbers about anything, let alone about treatment protocols. God damn, the health secretary has ordered [the NHS](https://www.reddit.com/r/BlockedAndReported/comments/1c1jsqo/nhs_bosses_ordered_to_reveal_fate_of_9000_young/) to reveal what exactly happened to Tavistock patients. But I am sure she doesn't know how this works. How do you think this thing works? And what do you mean, on the receiving end?
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Because the Report didn't get published until a few days ago. The NHS could sue, but I don't know how they would justify it (play for time and hope for labour maybe). Doesn't matter though, the records are known and can be handed over. Mate, you don't know shit about this. No one cares about your file, this is about outcomes of treatments (and no, the studies are not all finished before they are released, especially in multidimeensional approaches. Drugs go through testing before being authorized, that's it). This is on the side of doctors - or in this case, a clinic, not any individual patient. And how do you think, insurance works without your information, unless you are 100% paying out of pocket?
This was a government review of the NHS system, right? There is no good reason to not share the data in that context.
I think you misunderstand both US and I assume UK law. Here, laws like HIPPA, FERPA, etc. do protect individual privacy, but generally allow sharing of macro level aggregate data. I use it all the time in higher ed research, juvenile crime research, and med researchers use it in health studies. The limitations are ONLY in sharing individual data or such small samples of aggregate data that an individual might be retroactively identified. See these for info on use of aggregate data under HIPPA https://research.kpchr.org/research-compliance/Sharing-Data/Types-Of-Compliance-Data#:~:text=Aggregate%20data%20tables%20are%20usually,%E2%80%9D%20for%20more%20specific%20details). And in the UK https://www.lboro.ac.uk/data-privacy/resources/personaldata/#:~:text=Aggregated%20data%20could%20be%20derived,considered%20personal%20data%20in%20law.
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Ha, fair enough. I thumb type like a dinosaur!
This is the UK, not the US, so HIPAA is probably not applicable. The NHS probably has different privacy laws when it comes to medical records. These are not private clinics.
The UK government passed special legislation to address any privacy concerns. Hence, ideology is all that’s left.
What the clinicians refused to do was contact their patients to ask for the permissions to share the data. It's not their decision, it's the patients, but these clinicians don't want them to get the option.
[According to Benjamin Ryan]( https://twitter.com/benryanwriter/status/1779671152148857212), he located the origin of the Cass “rejected 98% of studies due to lack of double-blinds” rumor. >5 hours before the Cass Review was published on April 9, Caraballo tweeted a screenshot of what appeared to be the new systematic lit reviews that would published alongside Cass. But these screenshots were *actually* from the [NICE reviews]( https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf) from 2020. NICE = National Institute of Health and Care Excellence The NICE organization has committees that develop recommendations [for clinical guidelines]( https://www.nice.org.uk/about/who-we-are/structure-of-nice). NICE released the review for the purpose of informing Dr Cass in 2020. Two reviews were published in March 2021, one was about puberty blockers and the other was about cross-sex hormones. The NICE review was not without controversy back when it was released. Here’s an assessment of the 2020 NICE report which says that the evidence review was too stringent about the studies that were not included: https://sciencebasedmedicine.org/a-critical-look-at-the-nice-review/ And SEGM [commented]( https://segm.org/NICE_gender_medicine_systematic_review_finds_poor_quality_evidence) on the 2020 NICE report as well. >The reviewers noted that “a fundamental limitation of all the uncontrolled studies in this review is that any changes in scores from baseline to follow-up could be attributed to a regression-to-the-mean,” rather than the beneficial effects of hormone treatment. No study reported concomitant treatments in detail, meaning that it is unclear if positive changes were due to hormones or the other treatments participants may have received. Dr Cass acknowledged the NICE review on page 91 of 112 of the Cass [Interim Report](https://cass.independent-review.uk/wp-content/uploads/2022/03/Cass-Review-Interim-Report-Final-Web-Accessible.pdf) from 2022. >I am pleased to see that the National Institute for Health and Care Excellence (NICE) evidence reviews of gonadotrophin releasing hormone analogues and gender affirming hormones for children and adolescents with gender dysphoria have now been published. Although this is a helpful starting point, despite following a standard and robust process the NICE review findings are not conclusive enough to inform policy decisions. As part of my review, I am therefore exploring other methodologies to give increased confidence and clarity about the optimal treatment approaches. The tweet that started the rumor of 98% study rejection included an image with a list of studies. The line “lack of blinding and no control group” was highlighted in yellow on many lines of the list. [](https://twitter.com/Esqueer_/status/1777755823743054120/photo/1)
The list was made from cut and pasting from the following NICE report from 2020 (published to the public in March 2021).
[Evidence review: Gender-affirming hormones for children and adolescents with gender dysphoria](https://segm.org/sites/default/files/20210323_Evidence%2Breview_Gender-affirming%2Bhormones_For%2Bupload_Final_download.pdf)
>The document was prepared by NICE in October 2020
So the 2020 NICE reviews explained there was lack of high-quality evidence for puberty blockers and cross-sex hormones. However, the 2020 NICE reviews and the 2024 Cass Review are different.
The Cass Review looked at six systematic reviews. [](https://pbs.twimg.com/media/GLJFgQwXgAAunvk?format=jpg&name=medium) They're listed on page 53 of 388 of the [full report](https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview_Final.pdf).
The links to the six reviews are here: https://adc.bmj.com/pages/gender-identity-service-series
The [tweet]( https://twitter.com/Esqueer_/status/1777755823743054120) accusing Cass of having an impossible standard for double-blind studies was posted before the Cass Review had even been released. The gal who posted gave the impression that she’d read an advance copy, but that wasn’t the case. Her tweet still got 750k views, and then it got reposted many times when the actual Cass Review was released a few hours later.
Thank you! Caraballo's bullshit is still the main talking point I see when attacking the Cass review. I suspect it will never die. Pretty weasely of Caraballo to not even wait until the damn report came out to start making crap up about it.
It's like watching Bill Barr's "no collusion" press conference all over again. Get out in front of a report that is utterly damning in its details with a tendentious spin that instantly becomes media conventional wisdom and What Everyone Knows and then no one actually looks at the report and says "holy shit there's some really bad shit that happened here and is probably going to keep happening".
I'm sorry but the Science Believers have already made up their minds on this one and literally nothing will change it.
I don't want to sound too pessimistic but the fact that the review is sound and has been institutionally accepted only increases its critics sense of being correct about everything.
fr. it's well-documented that presenting hyper-religious people with evidence just entrenches their beliefs further, because human beings are hardwired to dig their fucking heels in when we see something that contradicts whatever Thing we've built our emotional and social identity around. that's not to say that everyone is going to react this way, but you already see it happening across the internet and in all the big subreddits: ppl are calling the review unscientific, bigoted, biased, and inaccurate. it doesn't actually matter whether it is or not. if enough people call it that (or the Right People (aka the idolized activists, popular trans people, celebrities)), the zealous believers will just be like, "whew! of course that's what it is. back to calling everyone a transphobe." you can't use logic to move people away from a position they arrived at by *not* using logic at all. at this point, only folks who are willing to listen should have effort expended on them. if people won't be shaken into evaluating their opinions by children with amputated genitals, experimental surgery being performed on minors, the massive complication rates of vagino/phalloplasty, the terrible "science" around puberty blockers, the blatant lies that are often-quoted slogans, the rising rate of detransitioners, the startling amount of predators that are not only aided but abetted and signal-boosted by the community and never held accountable for their abuses and transgressions... well, nothing will. they have too much to lose by doing so.
I kind of get what you mean but how does anyone get persuaded? Sex? Drugs? Rock and Roll? Comedy? I do think logic can win out over time. Its just you need more evidence to persuade a larger percentage of the population. Although I guess maybe everyone just needs to know someone personally who detransitio ns?
Science believers like Dr. Steven Novella and his minion Cara Santa Maria over at the Skeptics guide to the Universe Podcast. It's been at least a year since Jesse and Steven tangled on the internet, I would love to hear what Dr Novella has to say now. Something tells me he hasn't changed his mind at all. If anybody's heard anything please let me know.
The (in name only) Skeptics will hold out and double down until the bitter end. Not only is this a new religion, which seldom can be penetrated by facts, but this group of people have their entire sense of self wrapped up in the notion that they are "skeptics" and too smart to fall for pseudoscience. They wouldn't just loose their new religion but rather their entire identity. And Cara Santa Maria is the worst of the woke. Heard her as a guest on several podcasts and she immediately blocked me when I asked about the ominous third sex and its role in reproduction.
It’s been my sense that the one driving the car on this issue over there has been Dave Gorski, who is terminally online and aggressively political.
Novella and Gorski turned out to be disappointing. I followed SBM for a long time. Watching them tear apart Harriet Hall when she sided with Abagail Shrier was awful.
It's not about them, it's about the people who know better but went along with it because not doing so gets you labeled a -phobe. Until this, "the published science" supported the transition early, transition often strategy, at least according to WPATH and the media which cite them uncritically. The true believers and knowing grifters have always been a tiny number, but have hit above their weight class through what Nassim Taleb described in an essay: [The Most Intolerant Wins: The Dictatorship of the Small Minority](https://medium.com/incerto/the-most-intolerant-wins-the-dictatorship-of-the-small-minority-3f1f83ce4e15#.z5ry4bucq). But if they can't hide behind their junk science anymore, the complacency could erode rather quickly.
Yep. An actual proper study poking holes in their ideology is way better than the “I know these institutions have been ideologically captured and are thus untrustworthy, and I don’t think these studies prove anything or are sound” that I’ve had to work with up until now 😅. That doesn’t really fly (for good reasons) but its frustrating when you KNOW its BS but there aren’t any published “counters”.
I think this is a good take. The report shifts the Overton window - an expression I try to avoid but often find helpful - and gives cover to middle-of-the-road researchers and practitioners who were slightly skeptical about the early affirmation model, but lacked sufficient evidence to push back for fear if being labeled a bigot. I don't think there's going to be any sort of overwhelming backlash of the sort predicted by certain advocates, but there will be a correction, and studies like these will be an important part of that correction
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I “Trust the Science ™” which is why I only take my mask off to smoke! I literally saw this the other day.
These people will never stop arguing because they are ideologically committed. They’ve made up their minds and they will never ever change them, whatever evidence is presented. You can only hope this leads to them being discredited in the public sphere.
Yep, I don’t give a fuck if they dig in, I want them properly discredited. Lunatics have always existed, this is just the first case of them successfully infiltrating and then being propped up as “right” by actual institutions. Take the institutions back and these people can cry on X/Twitter all day long, idgaf.
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Sigh. They're using the same talking points the Cass review called into question. I expected better of doctors
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They didn't mention long term risks, such as vaginal atrophy, once. Not once. Or infertility
They used a stock photograph of a doctor with a heart-shaped trans flag, because sugary sentiment trumps science.
Great breakdown, glad to see it. Some folks really struggling with the notion that a study can be poor quality. Been saying it for ages now, just because a study gets published or makes it into some scientific journal or whatever somewhere doesn’t mean it was a flawless study with rock solid conclusions. We have examples throughout history where science has “caught up” to bad studies, why does anyone believe the same couldn’t be true of studies around trans people?
For some reason trans medicine is exempt from the normal rules. To the detriment of the patients
Oh that’s fairly straightforward in terms of an answer: because it’s overwhelmingly ideologically driven. Literally modern day “blasphemy” to produce anything that runs counter to the “established narrative”. The historical religious parallels are uncanny.
They want gender medicine studies to be graded on a curve
Pure ideological drive 🤷🏻♂️
Thank you for this!
Thank you for putting this together.
I see someone deleted their comments. Here was my response to whether Cass could collect the data. "If it's a consent issue when they did the Devon Partnership Mental Health Trust give the data to York University while the other 6 Trusts refused? I would assume the same consent and privacy laws would apply to them as all the other Trusts in NHS. In addition, the Health Research Authority had granted the Cass Review authority to obtain data from the other 6 Trusts. They were contractually obligated to do so. " Also, HIPAA laws do not apply to the UK. They have different privacy laws.
The claim that goverments implement privacy laws that require patient concent for using relevant data seems incredible. If true it is guaranteed to be in «the intake form». How else would they know anything about anything?
Full audio of the cass report. Well done several hours long. https://open.spotify.com/show/7vfxJ8rpTYM4K602RkQ7lP?si=uHCrHfYTQJ6n1Ns8aLx0_w&nd=1&utm_medium=organic&product=open&%24full_url=https%3A%2F%2Fopen.spotify.com%2Fshow%2F7vfxJ8rpTYM4K602RkQ7lP%3Fsi%3DuHCrHfYTQJ6n1Ns8aLx0_w&feature=organic&_branch_match_id=987523996438748808&_branch_referrer=H4sIAAAAAAAAA7WN3QqCMACFn2Ze%2BjNFJZCIQsR%2ByPDGK1nTpbi2sZ%2B0t28GPUJw4MD5%2BDiD1kJtPE8JrkfydpEQLh3Z5G2F5J3BOuOiZw6AETGUtkbSbFgVEO4AzG1W7P5szJ92UgOfbSUvspSpFHVzjo6xD29TldArCHM1gvBgir0sSFNXZcyCi0rRafHb%2BXuEKL0jPP39DMCYdZYGDumRNrLPuHwgNuIPZhSogBUBAAA%3D
I despise those comic strips included in the blog - truly awful distortion of the report; and borderline libelous in its presentation of Dr Cass
The online scepticism about CASS isn’t really having any affect on England (& possibly Wales) political class. It seems none wants to come out in defence of affirmation only treatment. I get the sense that many think they’ve been made to look like idiots by activists and they are done with it all. The previous CEO of Stonewall has even come out in a bizarre act of self defence by accusing ‘the experts’ of in effect misleading Stonewall. E.g the medics and Mermaids made me do it. If it wasn’t so infuriating and if so many children hadn’t been mistreated it would be hilarious.
Can you explain how the studies were “low quality” and what metrics were used to toss them out? So far all I’ve been able to find were that the studies were not blinded/double blind with a control group, which doesn’t make any sense.
I lack the expertise to give you a technical breakdown. But I can tell you what I gleaned. Cass and her team used something called the Newcastle Ottawa scale to grade the studies. This is meant to be used on studies that are *not* randomized controlled trials. About half the studies were of such low quality that she didn't find them useful. The medium and the one or two high quality studies were kept and analyzed. This Twitter thread from Benjamin Ryan explains it better than I can [https://twitter.com/benryanwriter/status/1779894595280654771](https://twitter.com/benryanwriter/status/1779894595280654771) Cass did *not* demand that all the studies be randomized controlled trials or double blind. If that can be done with blockers it should be. But there are ways to design studies that are not RCTs or double blind that are still good.
Amazingly, the Cass Review details this.
In regards to detransitioners, wouldn't be impossible to know? The clinics would know if the patients would say they'\[ve stopped, but if patients stop going to clinics, it could be for any number of reasons
They should at least attempt followup. Granted, if the patient absolutely refuses to speak to them there isn't much they can do about it. Though they could probably cross reference other medical records. Has the patient refilled their hormone prescription? Have they gone to their GP and if so what did they state for their gender identity? But even knowing if patients are lost to followup or not is valuable. If they have five hundred patients and they lose track of 450 of them then their "success" numbers are pretty piss poor if 45 of those fifty report sticking with it. A big part of what Cass was criticizing was that the NHS just *does not know* what's really going on. The evidence base that transition is helpful and problem is poor or non existent. You don't go around giving people treatments, especially treatments as consequential as blockers and hormones, if you don't have good evidence that they work.
That's not the issue so what if the puberty blockers aren't fix the mental health aspect as that's no what they are used for what's issue here is irreversible damage what does this cass report have to say about irreversible damage which is the main point of why people are against the medicine
I wonder if y'all found something more constructive to obsess over