The Journal’s editors clearly care more about ideology and politics than actual scientific debate when it comes to this highly contentious cultural issue.
The American medical establishment remains radically committed to the misnamed “gender-affirming care” model, refusing to even consider following the examples of the U.K., Sweden, Denmark, Finland, New Zealand, France, Norway, and others whose health ministries have hit the brakes hard on providing puberty blockers, hormones, and surgeries to gender dysphoric children.
Example: The current New England Journal of Medicine published a “Perspectives” screed attacking the Cass Review — widely respected for its thorough investigation of the lack of significant scientific data supporting puberty blocking of gender dysphoric children. From “The Future of Gender Affirming Care:”
Our concern here is that the Review transgresses medical law, policy, and practice, which puts it at odds with all mainstream U.S. expert guidelines. The report deviates from pharmaceutical regulatory standards in the United Kingdom. And if it had been published in the United States, where it has been invoked frequently, it would have violated federal law because the authors failed to adhere to legal requirements protecting the integrity of the scientific process.
Actually, I suspect the authors’ real concern is that the transgender juggernaut involving children has been substantially impeded.
But what about the substance of the Cass Review’s findings? Where specifically was the report in error?
The Review calls for evidentiary standards for GAC that are not applied elsewhere in pediatric medicine. Embracing RCTs as the standard, it finds only 2 of 51 puberty-blocker and 1 of 53 hormone studies to be high-quality. But more than half of medicines used in pediatrics have historically been prescribed off-label on the basis of limited evidence.
But again, what about the substance?
Similar calls for higher standards are not applied to cisgender young people receiving gender-affirming care. Cisgender girls sometimes seek hormone therapy for hirsutism; cisgender adolescents receive hormone-replacement therapy for delayed puberty; and young people experiencing precocious puberty can receive puberty blockers to enable them to reach a greater height — without the hurdles that the Review recommends be instituted for transgender young people.
That’s a rank deflection. Those listed conditions are physical ailments. Gender dysphoria is an emotional condition — one might say, an obsession.
So, what about the substance?
There is evidence of antitransgender bias in invitations to oversee and participate in the report. At the outset, the Cass Review’s terms of reference for its assurance group (advisory body) stated that it “deliberately does not contain subject matter experts or people with lived experience of gender services.” In other words, GAC experts and GAC patients were generally excluded from roles in overseeing the report.
Again. What about the substance of the Cass Report?
Although these process issues may not fully undermine the findings of the report, they raise questions about their trustworthiness and reliability. Commentators also point out that the Review (and associated studies) misrepresented the data behind its conclusions, had both a high risk of bias according to the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) and a “substandard level of scientific rigor,”
This is getting tiresome. What about the substance of the Cass Report?
The Review’s departure from the evidentiary and procedural standards of medical law, policy, and practice can be understood best in the context of the history of leveraging medicine to police gender norms. Recent efforts to increase the presence of women in medicine, improve access to reproductive services, and offer GAC seek to break from that history, but the Cass Review represents a return to the past.
Please! What about the substance of the Cass Report?
Medicine has long been deployed by people seeking to enforce gender norms. For example, in the United States, “it was the medical profession that led the nineteenth century campaign to criminalize abortion,” in order to “ensure women’s performance of marital and maternal obligations.” A resolution by the American Medical Association in 1859 called abortion an “unwarranted destruction of human life”; doctors invoked women’s reproductive physiology to support claims that abortion would harm both women themselves and society at large.
1859? Objection, irrelevant! What about the substance of the Cass Report?
Mainstream medical views have shifted on both abortion access and care of intersex people. But the Cass Review suggests that some actors continue to focus on policing gender in the context of transgender rights. Indeed, U.S. GAC bans exempt intersex surgeries — which suggests that such laws are designed not to protect children, but to enforce the gender binary.
But what about the substance of the Cass Report? Never addressed.
The NEJM editors should be ashamed. A true science journal worthy of the designation would require criticisms based on the substance of the Cass findings not just process complaints, charges of discriminatory motives, and references to long-past injustices. And more importantly, it would also publish a supporter of the Cass Review defending its content.
That would be true scientific discourse. But the Journal’s editors clearly care more about ideology and politics than actual scientific debate when it comes to this highly contentious cultural issue.