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| * {{Cite journal |last=Budge |first=Stephanie L. |last2=Abreu |first2=Roberto L. |last3=Flinn |first3=Ryan E. |last4=Donahue |first4=Kelly L. |last5=Estevez |first5=Rebekah |last6=Olezeski |first6=Christy L. |last7=Bernacki |first7=Jessica M. |last8=Barr |first8=Sebastian |last9=Bettergarcia |first9=Jay |last10=Sprott |first10=Richard A. |last11=Allen |first11=Brittany J. |date=28 September 2024 |title=Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth |url=https://linkinghub.elsevier.com/retrieve/pii/S1054139X24004397 |journal=] |doi=10.1016/j.jadohealth.2024.09.009 |issn=1054-139X}} | * {{Cite journal |last=Budge |first=Stephanie L. |last2=Abreu |first2=Roberto L. |last3=Flinn |first3=Ryan E. |last4=Donahue |first4=Kelly L. |last5=Estevez |first5=Rebekah |last6=Olezeski |first6=Christy L. |last7=Bernacki |first7=Jessica M. |last8=Barr |first8=Sebastian |last9=Bettergarcia |first9=Jay |last10=Sprott |first10=Richard A. |last11=Allen |first11=Brittany J. |date=28 September 2024 |title=Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth |url=https://linkinghub.elsevier.com/retrieve/pii/S1054139X24004397 |journal=] |doi=10.1016/j.jadohealth.2024.09.009 |issn=1054-139X}} | ||
| == |
== Enforced BRD == | ||
| Just so nobody misses this: There's a thing called 'enforced BRD', and it now applies to this page. That means that the rules used to be: | |||
| We seem to have a disagreement about whether the sentence that says: | |||
| * Make your edit | |||
| * Children with comorbidities did not receive adequate psychological support, endocrinologists administering puberty blockers did not attend multidisciplinary meetings, and the frequency of those meetings did not increase when adolescents received puberty blockers, all of which the Dutch Approach recommends. | |||
| * Get reverted | |||
| * Maybe restore your edit (but never to the point of edit warring) | |||
| and they are now: | |||
| should be taken as a fact, or if we should use language like "The report claimed that..." to imply that NHS England is probably doing a good job, or at least an adequate job, of providing psychological support for kids with autism, anxiety, and depression, and it's really just the Cass Review's unimportant opinion that it's not good enough. | |||
| * Make your edit | |||
| Here's some sources that say that children on the NHS are not receiving adequate psychological support, including trans kids. | |||
| * Get reverted | |||
| * Start a discussion on the talk page (or just decide to never restore your edit) | |||
| * At least 24 hours after starting that discussion, you can maybe restore your edit (but never to the point of edit warring, nor if the discussion on the talk page has active opposition. Silence is not active opposition). | |||
| See ] and ] for more information. | |||
| * (2022) | |||
| * (2022) because of "Long-waiting times and high thresholds for treatment". | |||
| * (2023) | |||
| * "In some areas of England and Wales, for example, ] won’t see young people with autism and there is often no statutory support at all in this area". (2023) | |||
| * (2024) | |||
| * (2024) | |||
| * (2024) – "NHS is not equipped to treat record numbers of cases" with "unacceptably long waiting lists". | |||
| * "children and young people who had an appointment for suspected autism had waited on average nine months (295 days) after their initial referral. This is despite the National Institute for and Care Excellence recommending that people with suspected autism should be diagnosed within three months of a referral". (2024) | |||
| * "long waiting lists for mental health services or for autism/ADHD support... more than 40,000 children had been waiting over two years for treatment." (2024) | |||
| * (2024) | |||
| * (2024) | |||
| * "of the respondents who were waiting for an NHS ADHD assessment, 24% had been waiting between one and two years and 10% had been waiting between two and three years". (2024) | |||
| ] (]) 04:04, 11 December 2024 (UTC) | |||
| Content warning: Anyone who searches for this is going to find not only stories that sound like "We've been waiting two years for an autism assessment", but also stories that sound like "At the time of her suicide, she had been waiting two years for an autism assessment and two and a half years for her first appointment with NHS gender services". IMO that's not what stories of "adequate psychological support" sound like. Adding search terms like "children" seems to reduce the number of results focusing on suicide deaths, and I doubleplus-recommend doing that. | |||
| :Glad to see this - is it wrong that I think this should be mandatory on GENSEX? ] (]) 18:06, 11 December 2024 (UTC) | |||
| On the list of sources claiming that all's well and the kids are getting everything they need, I find: Nothing. Not even the Tories are claiming that the CAMHS is sitting around all day with nothing to do because kids are already so well supported, so we should urgently cut their budget and my taxes. | |||
| ::I think you would be surprised how cumbersome it can be, especially for problems like subtle vandalism. ] (]) 18:29, 11 December 2024 (UTC) | |||
| == Was the Cass Review peer reviewed? == | |||
| So with all of this in mind, could we please take out the ]<nowiki/>ly language that's implying that "Children with comorbidities did not receive adequate psychological support" isn't a universally acecpted fact? | |||
| ] (]) |
Nothing in the article seems to address this question unless I'm overlooking it. ] (]) 19:43, 22 December 2024 (UTC) | ||
| :I'm of a few views here that I'm not sure how to reconcile. On one hand, I think it's important when making claims that they are cited to their source if that source isn't "final". On the other hand, the Cass Review is such that it's a large scale review that, while some people dissent to it, should be able to have its findings taken without the attribution. Yet still, this statement in question is being cited to the ''interim report'', which ''should'' be attributed if it's being discussed as something the interim report said (which it is here).{{pb}}I'm not sure why this is only in background to begin with though - with barely any (if any) information in the actual discussion of the final Review. If there isn't going to be a section about the psychological support that is/should be provided in discussing the final results of the Review, then I'm not sure how it's relevant background information in the first place. If a section can be added discussing the findings of the final Review on this matter, then the background should continue to state that the interim report made that claim, since that's what the background paragraph in question is discussing. -bɜ:ʳkənhɪmez | ] | ] 03:11, 10 September 2024 (UTC) | |||
| ::I mean the Cass Review is not an undisputed report in the medical field by any stretch, and simply saying “According to the Cass Review, XYZ” goes a long way towards maintaining an NPOV on the topic. I think presenting the full report’s findings as undisputed fact without attribution, when we have countless medorgs across the globe including in the UK disputing it and accusing it of political machinations, misleads the reader at best and at worst is just pov. ] (]) 11:14, 10 September 2024 (UTC) | |||
| :::But we don't "have countless medorgs across the globe including in the UK disputing it". Where "it" means all of it. Nor are they "countless" vs "handful". The US ones have a common origin and united around a right-wing conservative domestic problem and are, sadly, playing at legal politics, not evidence based medicine. | |||
| :::There are two aspects to the review. One is the evidence both in terms of medical studies and the facts about the state of NHS England in this area. The other is in what should be done as a result. There is some criticism of the evidence, nearly all at an embarrassing level of competence by people with conflict of interest or no training at all in this field. Mostly that's about puberty blockers. And there's some criticism about what to do about it. Mostly that's about puberty blockers. And some of the criticism is of the puberty blocker ban, which isn't even recommended by the review. | |||
| :::But for the rest of it, as WAID points out, this is an NHS England commissioned report into the state of NHS England, which NHS England has accepted and vowed to fix. There isn't any need for any "According to the Cass Review" attribute any more than if ] published a report that said how long the A1 was and the condition of the road surface. None of these supposed "countless medorgs" dispute any of that. For our purposes, is the Cass Review a reliable source on the state of NHS England's trans healthcare? Absolutely. We can state these things as facts with a little numbered box after. | |||
| :::I've just finished reading . This is a 57-page NHS Scotland commissioned report written by a multidisciplinary team of experts and by the looks of it took weeks if not months to write. I wonder how many editors here have read it vs the Yale PDF or half-page BMA Council bullet-point statement. | |||
| :::The NHS Scotland report not only agrees with the Cass Review about the evidence and consequences, but goes through each of the 30+ recommendations working out how they apply to NHS Scotland. The differences, where they exist, are mostly because NHS Scotland is organised differently or has different programmes for improvement to occur within. They entirely accept Cass's analysis of the state of NHS England trans healthcare and agree NHS Scotland shares many of the same crises and solutions. What is interesting to me is that the NHS Scotland report will actually shape the future of trans healthcare in Scotland (much as the Cass Review will shape it for England). Unlike the other "publications" we have invested so much energy on, which will be forgotten about. | |||
| :::Snokalok, I really do encourage you to read the NHS Scotland report. Skim it at least. I know you won't agree with the puberty blocker bits but I think you will come away with a feeling that this is actually only a very very tiny part of the Cass Review. That most of it is about a health service that really is universally agreed as ''entirely failing its patients'' and for which radical change and investment is needed. I think you may also get a feeling that when the BMA council recommended to pause the implementation of the Cass Review and work to block it, why so many NHS doctors were aghast. -- ]°] 12:27, 10 September 2024 (UTC) | |||
| :IMO if you can't state a fact from a source like the Cass Review without attribution, I have no idea what level of source you ever could. ] (]) 12:29, 10 September 2024 (UTC) | |||
| ::Wrt Snokalok's "misleads the reader at best and at worst is just pov", we actually do that when we attribute something that really is considered a fact and for which our source is reliable. It really is pov-pushing to stick weasel words around hard facts. As an editor with experience outside of this particular medical topic, I'm astonished at the degree to which mainstream first class evidence based medicine is being attacked on this topic, citing random lawschool PDFs and trade union councils, to try to discredit what is the largest, most thorough, independent and professionally conducted review of this field ever conducted. | |||
| ::It is a bit like we are writing about ] and editors are filling this pages with stories about their gran living to 85 and smoking 40 a day, and linking to PDFs written by tobacco firms, and where ] reports he's scared to take public transport because of the abuse he gets. -- ]°] 13:15, 10 September 2024 (UTC) | |||
| :::My question is much narrower than this. We are saying that it's purely the POV of the Cass Review that "Children with comorbidities did not receive adequate psychological support". | |||
| :::@], can you find any medorg that says that NHS England really has been providing trans kids with adequate psychological support? Just one medorg, anywhere in the world. If not, then ''this statement'' is not one that should have ] attribution. Probably lots of the others should, but I'm specifically talking about whether ''this exact claim'' should begin with that disclaimer-ish wording. ] (]) 16:26, 10 September 2024 (UTC) | |||
| ::::I think it’s important to ask what psychological support means here. In parlance on the topic in a UK context, it often means gender exploratory therapy and requiring the involvement of a mental health professional in perpetuity; which is of course, a highly controversial idea in the context of GAC, it’s considered conversion therapy to practice GET, etc. Thus, the statement requires attribution, because it makes the implication that they didn’t receive proper support *as the people doing the Cass Review considered it to be*. In other parts of the world meanwhile, it’s considered an intrusion to require continual therapy sessions in exchange for GAC - and we’ve even seen this opinion expressed several times by WPATH in a UK context. Thus, I’m not saying that the NHS or didn’t provide adequate support, I’m saying they didn’t provide adequate support as the Cass Review considered it, which is not necessarily a neutral position on the topic, and that’s why the attribution of “According to the Cass Review” is important. ] (]) 16:34, 10 September 2024 (UTC) | |||
| :::::Here are two quotations about the absence of adequate support from the cited report (emphasis added): | |||
| :::::* "Additionally, children and young people with gender-related distress have been inadvertently disadvantaged because local services have '''not felt adequately equipped''' to see them. It is essential that they can access '''the same level of psychological and social support as any other child or young person'''..." | |||
| :::::* "The Dutch criteria for treating children with early puberty blockers were: (i) a presence of gender dysphoria from early childhood; (ii) an increase of the gender dysphoria after the first pubertal changes; (iii) an absence of psychiatric comorbidity that interferes with the diagnostic work-up or treatment; (iv) '''adequate psychological and social support during treatment'''; and (v) a demonstration of knowledge and understanding of the effects of gonadotropin-releasing hormones (puberty blockers), feminising/masculinising hormones, surgery, and the social consequences of sex reassignment" | |||
| :::::Do you see anything in here that sounds like "Let's engage in conversion therapy"? I don't. I see "Local services are scared to provide ordinary treatment for ] in gender diverse kids because they worry that they might screw up" and "We actually need to support kids while they're on puberty blockers". | |||
| :::::This sentence actually includes three claims: | |||
| :::::* NHS England is not providing adequate psychological support for the subset of trans kids who have autism, anxiety, depression, eating disorders, etc. while they're on puberty blockers. Note: The claim isn't about all trans kids. It's specifically about '''trans kids with comorbidities'''. | |||
| :::::* Endocrinologists administering puberty blockers did not attend multidisciplinary meetings. | |||
| :::::* The frequency of those meetings did not increase when adolescents received puberty blockers. | |||
| :::::I think that all three of these are uncontested claims of fact. Your reply above, for example, does not even attempt to claim that anyone in the NHS with autism and anxiety has been well-served by the current system. It looks to me like you've swerved right away from "Children with comorbidities need adequate psychological support" to "Everyone agrees that conversion therapy is evil". Fine: Let's just stipulate here that every editor on this page agrees that conversion therapy is evil. But it's ''also'' evil to have one branch of the NHS wash their hands of a kid's crippling anxiety by saying that GIDS will deal with the anxiety, and after an education- and life-destroying multi-year delay, GIDS saying that they only do gender and CAMHS will deal with the anxiety ...after another year-long delay. This is not a case of "continual therapy is the price for GAC"; this is a case of "patients are allowed to have more than one health problem, and being trans should not disqualify you from the ordinary treatment for autism". ] (]) 17:04, 10 September 2024 (UTC) | |||
| ::::::@] the first claim is cited to page 18 which says {{tq|Within the Dutch Approach, children and young people with neurodiversity and/or complex mental health problems are routinely given therapeutic support in advance of, or when considered appropriate, instead of early hormone intervention. Whereas criteria to have accessed therapeutic support prior to starting hormone blocking treatment do not appear to be integral to the current NHS process.}} | |||
| ::::::p32, right after your second quote, says {{tq|However, the Dutch Approach differs from the GIDS approach in having stricter requirements about provision of psychological interventions. For example, under the Dutch Approach, if young people have gender confusion, aversion towards their sexed body parts, psychiatric comorbidities or Autism Spectrum Disorder (ASD) related diagnostic difficulties, they may receive psychological interventions only, or before, or in combination with medical intervention}} | |||
| ::::::Your first quote applies to all trans kids, it never specified those with comorbidities - it's a critique of local clinics turning away trans kids saying "idk what to do with them" | |||
| ::::::The second is just a summary of the Dutch protocol. | |||
| ::::::The article currently states {{tq|The report stated that children with comorbidities did not receive adequate psychological support ... which the Dutch Approach recommends}} | |||
| ::::::That doesn't appear to be cited properly, as the section it's citing is talking about how the Dutch approach mandated trans kids with comorbidities have those addressed ''before or instead of'' receiving trans healthcare. | |||
| ::::::What the cited source supports is {{tq|The report stated children were not required to undergo therapy prior to puberty blockers ... which the Dutch approach recommends}} ] (]) 19:15, 10 September 2024 (UTC) | |||
| ::::::YFNS, the Cass Review does not refer to the patient cohort as "trans kids". I'm reminded of the , linked a few sections above: {{tq|"During the course of the Review, we observed a change in attitudes, from an initial narrative among many trans advocates that only a minority of the young people presenting would have a longstanding trans identity and would benefit from a medical pathway to a belief in some quarters that all the young people on the waiting list for services were ‘trans kids’."}} | |||
| ::::::It would be helpful if you would stop doing using that language for this group. As Cass indicates, this is a recent and fringe activist-language, not something accepted by reliable sources. It makes discussing the treatment of children referred to CAMHS or GIDS-equivalent centres difficult. Only a minority of child and adolescent patients in the UK were referred for hormone therapy and this has been true for many years. The Cass Review refers to the patient cohort as "gender-questioning children and young people" which is a neutral term that does not prejudge diagnosis. This is aligned with WPATH. WPATH states for adolescents: {{tq|"Given the emerging nature of knowledge regarding adolescent gender identity development, an individualized approach to clinical care is considered both ethical and necessary"}} and {{tq|"We recommend health care professionals working with gender diverse adolescents undertake a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns and seek medical/surgical transition-related care, and that this be accomplished in a collaborative and supportive manner"}} and {{tq|"We recommend health care professionals assessing transgender and gender diverse adolescents only recommend gender-affirming medical or surgical treatments requested by the patient when:...The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed."}} and {{tq|"Professionals working with adolescents should understand what is and is not known regarding adolescent gender identity development, and how this knowledge base differs from what applies to adults and prepubertal children."}} I could go on quoting. And as for children: {{tq|"This chapter employs the term “gender diverse” given that gender trajectories in prepubescent children cannot be predicted and may evolve over time"}}. This is not the page to dig deep into that stuff, but the gist is WPATH make no diagnostic assumptions about the referral cohort and neither should we in our language. It is a bit like calling anyone who goes to the doctor with a lump in their breast a "cancer patient". | |||
| ::::::There are two aspects to "psychological support". The first is that a large chunk of the current cohort have psychological and neurodevelopmental conditions that are not being addressed at all, never mind before any medical treatment starts as recommended by both WPATH and the Dutch Protocol. The second is support during such medical treatment. | |||
| ::::::It is already well documented that CAMHS thought a referral to GIDS meant they didn't have to deal with that child as they thought the experts there would, and GIDS thought they didn't have to deal with anything other than gender dysphoria as they assumed CAMHS would deal with that. Both services were and continue to be massively overloaded, understaffed and with huge waiting lists. Which is part of what led to perhaps wishful thinking that someone else was dealing with it. That's a UK health service issue that is uncontested. This is the feature of "holistic" treatment that Cass recommends and is being addressed by NHS England and Scotland. | |||
| ::::::I think the issue that although these children's comorbid conditions were being neglected by all services in the UK, and especially so if they were gender questioning with a GIDS referral, it is being combined by some with the current activist battle that is uncomfortable with the fact that all international guidelines for children and adolescents have a psychosocial/neurodevelopmental gatekeeping component in them. It would be easier to fight the US battle against affirmative care bans if there was no question that every single referral was a "trans kid" who needed puberty blockers cross sex hormones. And so we get the claim that this psychosocial gatekeeping and now even any holistic psychosocial therapy at all is "conversion therapy" despite the fact that WPATH's definition of such is in the same pages as their recommendations that one must deal with these other things in order to have, as they put it, "diagnostic clarity" or "standards of care" | |||
| ::::::So, could we please stick to the sources on this one. Cass is not talking about conversion therapy but about stuff that is even in the WPATH guideline and the Dutch Protocols. It is basic "standards of care", as the WPATH guideline calls itself, that the UK health services fell well well short of. -- ]°] 08:31, 11 September 2024 (UTC) | |||
| :::::::I introduced the language of ''trans kids'' into this discussion, and I will attempt to remember your advice in the future. ] (]) 18:29, 11 September 2024 (UTC) | |||
| :::::::@] "trans kids" is not "recent and fringe activist language" - that is complete and utter nonsense at best, ridiculously insulting at worst, and I will not stop referring to trans kids as trans kids. | |||
| :::::::Cass referring to kids sure of their gender as "gender questioning" is in fact one of the peer reviewed criticisms of the report btw | |||
| :::::::It is not a "neutral term that does not prejudge diagnosis" because being trans isn't a bloody diagnosis. And nobody has ever argued trans kids shouldn't get any mental healthcare or the NHS is doing a good job, that's a strawman, everyone agrees. | |||
| :::::::Besides which, I am sticking to what Cass said, that's why I quoted her specifically talking about how the NHS differed from the Dutch Approach. We already talk about diagnostic overshadowing earlier in the section, I am talking about a fragment of a sentence not supported by the cited source which could be changed to match the source. ] (]) 19:09, 11 September 2024 (UTC) | |||
| :::::::I'm sorry, are you seriously suggesting that colloquially referring to children as "kids" is fringe and activist language? --] (]) 19:12, 11 September 2024 (UTC) | |||
| ::::::::I believe the main point is that we shouldn't conflate "kids who have been referred to NHS gender services" with "kids who are sure they are trans". | |||
| ::::::::YFNS cites a paper that says this: | |||
| ::::::::"Trans children are instead reduced to definition as “''gender questioning children and young people''” (Report 5, p. 11) or “''children and young people needing support around their gender''” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of trans children." | |||
| ::::::::But it seems to me that an opposite and parallel statement would be equally true, viz.: | |||
| ::::::::"<u>When WhatamIdoing said 'trans kids' to refer to 'kids who have been referred to NHS gender services', she excluded</u> “''gender questioning children and young people''” (Report 5, p. 11) or “''children and young people needing support around their gender''” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of <u>gender-questioning children</u>." | |||
| ::::::::I don't know what your experience is, and I don't want to bother looking it up, but I remember in the 1980s when the "Q" in LGBTQ was "questioning", and the definition seemed to be "I'm gay but I don't want to admit it". IMO Colin is correct that we shouldn't get in the habit of assuming that every single kid referred for gender services is actually trans. ] (]) 20:07, 11 September 2024 (UTC) | |||
| :::::::::@] one term correctly refers to the majority of the cohort, the other incorrectly refers to them. If Cass said "youth seeking GAC" or something it would be another issue, but describing trans kids as "gender questioning" is not neutral. Imagine a report into LGB healthcare for youth which said "sexuality questioning youth" throughout and never once referred to "LGB youth" - it would be an immediate red flag. Per p 160 of the final report, the majority of kids turning up already socially transitioned. | |||
| :::::::::I'd appreciate a response to my main point, which is what specifically did the Cass Review say about how the NHS differed from the Dutch protocol. I quoted 2 excerpts from the Cass review comparing the NHS and Dutch approach, which say the latter was stricter about mandating therapy as a prerequisite/corequisite/alternative to GAC. The paraphrase we have in the article misrepresents that. ] (]) 18:55, 12 September 2024 (UTC) | |||
| ::::::::::{{ tq | Imagine a report into LGB healthcare }} | |||
| ::::::::::The problem with analogies like this is they beg the question. Is that the same thing or not? Pick a different analogy and you can argue the reverse. | |||
| ::::::::::"Gender questioning" is the language of the review and I see no reason to avoid it. | |||
| ::::::::::In a clinical setting we're invariably talking about kids distressed at the development of secondary sex characteristics (prospective or actual), there's all kinds of reasons for that, strong opinions in different sources, and not much in the way of neutral language available. ] (]) 21:24, 12 September 2024 (UTC) | |||
| :::::::::::@] 1) this completely ignores the issue with the citation I'm discussing in favor of quibbling over language not in the article. | |||
| :::::::::::2) There is no situation on Misplaced Pages where somebody says "I am trans" and we refer to them as "gender questioning" just because somebody else did. ] and all that. Cass explicitly notes the majority of kids she's referring to as "gender questioning" have socially transitioned. Calling them all questioning is flatly inaccurate and not neutral at all. If you have a room full of 99 kids who say "I'm 100 sure I'm gay", and 1 person who says "I might be", saying you have a room full of "sexuality questioning kids" is nonsense. Insisting that some are questioning doesn't make it true for all people described. Colin and WAID have cited WPATH using terminology like "gender diverse" and "adolescents who present with gender identity related concerns" - those, unlike "gender questioning", accurately describe the cohort. ] (]) 22:08, 12 September 2024 (UTC) | |||
| ::::::::Just to be clear, I'm not saying the term "trans kids" is activist language when used anywhere. And I'm aware of an anti-trans idea that there is no so such thing as a "trans kid", so I should have been clearer about that. There absolutely are trans kids. But I stand by the quote I made of Cass. WPATH above describe the referrals as {{tq|"adolescents who present with gender identity-related concerns"}} and otherwise the shorthand {{tq|"gender diverse"}} for both adolescents and children, repeatedly stating that each is an individual who's path is unknown. WPATH themselves recognise not all referrals will go down the path of gender-affirming medical treatments. WPATH themselves use the term {{tq|"diagnostic clarity"}} to refer to a physician deciding to prescribe a medical treatment. I completely get the discomfort those words have wrt an identity but please take those concerns to WPATH and remember this is a medical treatment being prescribed. | |||
| ::::::::YFNS cites an activist complaining that Cass using neutral non-activist terminology is a problem. And yet YFNS doesn't describe this activist opinion piece as such, but as a "peer reviewed criticism", as though that elevates it to the truth. And as though the peer review process for such opinion pieces exists to elevate opinion to truth. As WAID notes, Horton's criticism is logically nonsense. This friends, is the problem we have here. Cal Horton's opinions are Cal Horton's opinions, not "peer reviewed criticism", as though some kind of science or fact-based research is going on here. -- ]°] 07:52, 12 September 2024 (UTC) | |||
| :::::::::I appreciate the clarification in the first part. As for the second. Cal Horton's "opinion piece" has in fact gone through peer review and what's more it has not been published as a letter or opinion article, it has been published as a proper stand-alone article. So yes, "peer reviewed criticism" is a correct characterization. --] (]) 08:30, 12 September 2024 (UTC) | |||
| ::::::::::I wish I knew the exact technical term for this piece of academic writing. I wonder how you'd view it if written by a gender critical activist criticising the WPATH standards of care. They'd have their own POV and conceptual framework around which to build their case. What do you think "peer review" exists for in this kind of work? Do you think it exists to agree that every single sentence in this polemic is The Truth? Or more that this isn't the work of a crazed individual divorced from all reality unable to make any kind of cohesive argument. | |||
| ::::::::::On the one hand we have a review that took four years to write and was explicitly asked to be independent and selected a most senior and respected doctor to perform. Such a review has to find a balance of terminology and careful wording that is likely to upset those on the extremes in either side. But the point of the review is not to appease activists by using the Correct Words (on either side) but to determine the correct healthcare for an area of NHS England. | |||
| ::::::::::On the other hand we have an activist who's body of research is in interviewing their social media circle and who has written this polemic to advance their opinion that the Cass Review is inherently transphobic and thus can be dismissed before its findings are even known. Which, you know, as a piece, is not any different to someone writing a polemic that socialised healthcare is the fairest system and advancing their arguments in support of that. Such an piece could be peer reviewed as a valid argument, but not as The Truth. Someone could equally write a piece that says the capitalist model of insurance and pay-as-you-go for healthcare is the fairest and best system and make their arguments in support of that. Both could be peer reviewed and published. But both can't be correct, and peer review does not exist to determine that for this kind of work. | |||
| ::::::::::So it is a problem, frankly, when the language used by both Cass and WPATH, both MEDRS sources, is being attacked by an article that is really just some activists opinion, and referred to in a way that suggest "peer reviewed criticism" is in any way special at discovering who is Right. -- ]°] 09:56, 12 September 2024 (UTC) | |||
| :::::::::::{{tq|What do you think "peer review" exists for in this kind of work? Do you think it exists to agree that every single sentence in this polemic is The Truth?}} I will, ''for the umpteenth time'', note that that is not what anybody in this discussion has ''ever'' argued, least of all me. Neither have I or YFNS ever suggested that the sentence you're quoting is the only, or even the best, example of what YFNS pointed out the paper criticized ''in that paper''. The reason that paper got through peer revieuw, though, is because it seeks to describe ''patterns of behaviour'' within the cass revieuw and its underlying research. Looking through the paper more closely, I don't get the impression that either you or whatamidoing (but especially you!) have made any real attempt to understand those arguments or represent them here in earnest. | |||
| :::::::::::{{tq|I wish I knew the exact technical term for this piece of academic writing}} It's called a peer reviewed literary analysis. --] (]) 11:08, 12 September 2024 (UTC) | |||
| ::::::::::::I was responding to YFNS, who referred to Cal Horton's opinion as "peer reviewed criticism". Their overall paper, of 25 pages and about 16 thousand words, was "peer reviewed" in as much as that is worth something for a "literary analysis". But their specific criticism of Cass's use of the term "gender questioning", was not "peer reviewed" in the sense that Horton's peers examined that criticism and all enthusiastically agreed with it. That's what calling it "peer reviewed criticism" implies. I've lost count of the number of times YFNS has cited Horton as though this was definitive and widely accepted evidence, rather than one person's opinion, containing numerous factual misunderstandings, of the ''interim report''. It is frustrating when two NICE systematic reviews and seven York systematic reviews and a four year independent review are repeatedly dismissed by citing a "literary analysis" written by an activist with no clinical background or experience conducting or reviewing clinical research of this kind. Is is though the very top of the MEDRS source hierarchy pyramid is "activist criticism". -- ]°] 12:00, 12 September 2024 (UTC) | |||
| :::::::::::::YFNS didn't quote that paper, she ''mentioned'' it. As far as I can tell, the quoting was done by whatamidoing. Just like YFNS didn't use the term ''Trans kids'' in any formal way, she used it as a colloquialism, with the actual text she suggested right next to it. ''just like whatamidoing did prior to her''. Look, I already said this on AE, but I want you to stop taking the worst interpretation of what we are saying and running with it, because a lot of the time it isn't even what we said. --] (]) 12:15, 12 September 2024 (UTC) | |||
| ::::::::::::::I don't understand your first sentence at all. Maybe read WAID's defence of the trans kids issue at AE, and consider if you are taking the worst interpretation of what I said. -- ]°] 13:14, 12 September 2024 (UTC) | |||
| :::::::::::::::<s>my first sentence is pointing out that the quote you and whatif are agitating against was not placed on this talk page by YFNS or me, and is not representative for the argument being made in the paper. I think it is a strawman of the argument YFNS is actually making, which is that the language used in the cass review and its underlying literature has been criticised for being non-inclusive, and for casting doubt on kids' ability to have a well-developed gender identity. The cited quote is one of several examples given. </s> | |||
| :::::::::::::::<s>Actually, I think the sentence whatamidoing did not include is very telling here. Let me introduce a more complete quote, including the sentence whatamidoing's quote is referencing:,{{tq| '''the interim report does not include even one reference to a trans child, adolescent or young person.''' Trans children are instead reduced to definition as “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of trans children.}} Yeah, if the report didn't make a single reference to gender questioning people, I would still consider that a problem, to paraphrase whatamidoing's argument above. I'm sorry, but this practice has a name, and it is called cherrypicking. </s> | |||
| :::::::::::::::<s>Also, before you get up in arms about this being about the interim report again: A, nobody said otherwise, B, YFNS did not introduce this quote as being about the main report, she didn't introduce this quote at all, and C: the same people that wrote the interim report also wrote the main one. and D. there are similar issues with the main review, as evidenced by several MEDRS having published statements about this by now.</s>--] (]) 14:15, 12 September 2024 (UTC) | |||
| ::::::::::::::::I'm afraid you lost me at "quote". No idea what you are talking about. But to be honest, I've got bigger problems to deal with today, as you well know. -- ]°] 14:24, 12 September 2024 (UTC) | |||
| :For my money, Attribution is not just for when you want to draw a source's claims into question, you can also use it when you are describing what a source is saying. To me, it makes sense to point out that the cass review is saying this, because we're trying to describe what the cass review is saying. How about we follow MOS:CLAIM here and change it to say "the Cass review stated that...". That's how we usually avoid making a value statement in attributing something, and I think that makes a lot of sense here. --] (]) 19:22, 11 September 2024 (UTC) | |||
| ::From ]: | |||
| ::When using in-text attribution, make sure it doesn't lead to an inadvertent ] violation. For example, the following implies parity between the sources, without making clear that the position of Darwin is the ]: | |||
| ::{{quotation|{{cross}} ] says that human beings evolved through ], but John Smith writes that we arrived here in pods from Mars.}} | |||
| ::{{quotation|{{tick}} Humans evolved through ], as first explained in ]'s '']''.}} | |||
| ::Neutrality issues apart, there are other ways in-text attribution can mislead. The sentence below suggests ''The New York Times'' has alone made this important discovery: | |||
| ::{{quotation|{{cross}} According to ''The New York Times'', the sun will set in the west this evening.}} | |||
| ::{{quotation|{{tick}} The sun sets in the west each evening.}} | |||
| ::When we say that the Cass Review stated that the NHS is failing pediatric mental health patients, are we implying that others disagree? Or that Cass alone has made this important discovery? | |||
| ::We might want to specify that the Cass Review says that the NHS has failed the kids referred to gender services even worse than they've failed all the other kids (that is the meaning of "Additionally, children and young people with gender-related distress have been inadvertently disadvantaged..."), as that ''might'' be their own discovery, but I suspect that even this is not original to the Cass Review. There are probably sources from the so-called trans activists complaining about exactly this problem that predate the Cass Review. ] (]) 20:40, 11 September 2024 (UTC) | |||
| :::We're saying the cass revieuw stated that this was the case, which it sure did. I guess you could read implications into that, but then, it's a single sentence. Unless the next sentence is that some other source disagreed with that part I personally simply wouldn't get that implication out of it. --] (]) 21:12, 11 September 2024 (UTC) | |||
| ::::But INTEXT says that other people might, so if we don't think there are any other sources disagreeing with it, then we shouldn't use INTEXT attribution. ] (]) 21:19, 11 September 2024 (UTC) | |||
| :::::INTEXT also says {{tq|In-text attribution may need to be used with direct speech (a source's words between quotation marks or as a block quotation); indirect speech (a source's words modified without quotation marks); and close paraphrasing. It may also be used when loosely summarizing a source's position in your own words}}. Which in my opinion is what we're doing here. I'll notice that the Darwin example still includes attribution, so clearly it's not quite as black and white as that. --] (]) 08:21, 12 September 2024 (UTC) | |||
| :The responses here exemplify so many of the problems in this area. The Cass Review is a high quality source and we should be able to use it to source facts like "{{tq | Children with comorbidities did not receive adequate psychological support}}" without attribution. We can. | |||
| :Instead of this being a minor point on which everyone can simply agree because the answer is so obvious, we have a massive thread full of comments recycling arguments about how using the language of the review "erases the existence of trans children". That's one opinion, others are available. | |||
| :Relitigating this wastes time and space and stalls meaningful progress. There is an unresolved conflict in MEDRS, which is that some cleave to the US-based affirmative model, and some want to stick to psychotherapy as a first line treatment, and ''the language you choose to discuss the patient group affects how you think about the appropriateness of either of those approaches'', and we can't simply attribute every claim in the Cass Review because that's implicitly picking a "side". | |||
| :So, returning to the original question, I think that it absolutely can be stated without attribution, and I've not seen a good reason it cannot, especially since it is talking about comorbidities. ] (]) 14:50, 12 September 2024 (UTC) | |||
| ::I am also trying to understand his "US-based affirmative model" that appears to disagree with the US-dominated WPATH guidelines I quote 08:31, 11 September, which have "a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns" as a first-line step, and explicitly state that "gender-affirming medical or surgical treatments" be only recommended after "The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed." | |||
| ::Which MEDRS guidelines "cleave to the US-based affirmative model" for children and adolescents? Or is this describing current widespread practice that has yet to be updated into WPATH SoC? -- ]°] 15:52, 12 September 2024 (UTC) | |||
| :::Well there's what WPATH say in SOC8 in September 2022, and there's what WPATH say about the Interim Cass Review in November 2022, : | |||
| :::{{quote frame | At several points in the document, there is an emphasis on “careful exploration” of a child or young person’s co-existing mental health, neuro-developmental and/or family or social complexities. There is also a suggestion that a “care plan should be tailored to the specific needs of the individual following careful therapeutic exploration…” WPATH, ASIAPATH, EPATH, PATHA, and USPATH are concerned that this appears to imply that young people who have coexisting autism, other developmental differences, or mental health problems may be disqualified, or have unnecessary delay, in their access to genderaffirming treatment. This would be inequitable, discriminatory, and misguided (Coleman et al., 2022). WPATH, ASIAPATH, EPATH, PATHA, and USPATH recommend that puberty suppression, where urgently indicated, '''can be commenced promptly, and proceed alongside and at the same time as any necessary diagnostic clarification of other conditions, or treatment of other conditions''' }} | |||
| :::I think the distinction really is: what do these different models mean by "assessment"? | |||
| :::: | |||
| :::{{quote frame | All guidelines recommend multidisciplinary assessment. Three types were identified: (1) comprehensive psychosocial assessment, (2) medical or ‘readiness’ assessment for adolescents seeking hormonal treatments and (3) diagnostic assessment for gender dysphoria/incongruence. Some guidelines integrate these, while others present them separately. In most guidelines, there is no distinct assessment section or recommendations.''' There is limited clarity about assessment purpose.''' Most cited reasons are to inform a care plan, or assess eligibility for hormone treatment. Although most guidelines describe different pathways for children and adolescents, only three provide separate guidance. Five recent guidelines propose that prepubertal children only require assessment if gender-related psychosocial care is needed but provide limited detail about this. Others propose all children be assessed. There is little consideration of how a psychosocial assessment might be different for children and adolescents.}} | |||
| :::{{quote frame | Detailed guidance regarding assessment is lacking with no consensus about the aim or clinical approach, nor the necessity for assessment in prepubertal children. Although most guidance recommends assessing gender, mental health, psychosocial and family functioning, other domains vary. '''Few guidelines recommend exploring sexual orientation or assessing body image''', despite these being identified as important factors. Few recommend specific assessment tools, and those suggested have not been developed and/or validated for this population. }} | |||
| :::Cass says that we need to understand '''why''' youth are distressed before any medical interventions because we might be misinterpreting comorbid conditions or other factors. I could be wrong, but my impression of the "affirmative" model is that the assessment does not really question "why". ] (]) 20:32, 12 September 2024 (UTC) | |||
| ::::I think from Turban, Thornton and Ehrensaft gives a flavour of the distinction. This is supposed to lay out general guidelines for the biopsychosocial assessments WPATH recommends. But there are a few notable areas where "exploration" is off-limits: | |||
| ::::{{quote frame | Discuss unvalidated theories of TGD identities being related to trauma or internalized misogyny, emphasizing that there are no data to establish these etiologies but wanting patients to be exposed to these ideas in a safe and supportive environment, given the likelihood of encountering them on social or legacy media.}} | |||
| ::::{{quote frame | Although no evidence exists that trauma or internalized misogyny are the etiological cause of one’s trans identity, adolescents may hear these ideas in the media; addressing these unvalidated theories can prevent psychological distress related to encountering these ideas for the first time after starting gender-affirming medical interventions and open the discussion with patients to understand how they may have been affected by previous trauma or misogyny. }} | |||
| ::::So where open and undirected psychotherapy might uncover and address address underlying causal factors for an individual's gender distress, here affirmative clinicians are concerned with ensuring the individual is not unduly affected by media reports that trauma or internalised misogyny might be an underlying cause, framing them in advance as "unvalidated theories". | |||
| ::::Similarly, when it comes to comorbid conditions, the assessment focuses not on whether such conditions may be in part contributing to "gender questioning", but rather how to ensure they are not a barrier to consent for medical transition: | |||
| ::::{{quote frame | Identify and address any co-existing mental health concerns, particularly as they may relate to ability to engage in appropriate medical monitoring and ability to provide informed assent.}} | |||
| ::::{{quote frame | It is also important to conduct a comprehensive mental health evaluation to determine whether any co-existing mental health conditions (eg, anxiety, depression, autism spectrum disorder, eating disorders, etc) require support and/or may have an impact on decision making capacity or unique needs. }} | |||
| ::::While both exploratory and affirmative models may talk of "assessment", the exact nature and focus of that assessment is ultimately the key cause of conflict. ] (]) 08:28, 19 September 2024 (UTC) | |||
| :We are currently discussing this. Per Cass' own description of the process, she only mentions the systematic reviews being peer reviewed. The whole point of the independent review is that she gets to make her own conclusions based on that evidence. Because she hasn't documented that the review was peer reviewed, I think it's pretty clear that it isn't (and she doesn't pretend that it is). But I'm sure there are people who feel very strongly that we can't include that in the article unless it's explicitly written somewhere. I'm not sure that follows (she included the protocols, process, etc; if it's not in those, it didn't happen), but, well, it's still an ongoing discussion. ] (]) 19:55, 22 December 2024 (UTC) | |||
| == Who stripped away the BMA content? == | |||
| ::WP:V will say that we can't include that in the article unless we have a reliable source that ] such a statement. And if none exist, then one has to wonder whether such a statement would be ] anyway. | |||
| ::About the above comments on the "peer-reviewed journal": Although that is a common phrase, it is somewhat more accurate to describe individual articles as being peer reviewed, because not everything in a peer-reviewed journal always undergoes (external) peer review. ] (]) 07:06, 23 December 2024 (UTC) | |||
| :::I think you've got things reversed here. We can't describe the report itself as peer-reviewed if we can't verify that it was. What it appears to be is an administrative summary of peer-reviewed research. We should avoid using terms that imply that the report itself is peer-reviewed, as well: specifically, we should be very clear about what was in the reviews versus what was in the report summarizing those reviews. ] (]) 04:04, 25 December 2024 (UTC) | |||
| ::::I agree. We can neither describe the final report as a peer-reviewed report, nor describe it as non-peer-reviewed report, unless we have sources. | |||
| ::::My preference is to describe the systematic reviews as being peer-reviewed articles, and to describe nothing else (not the reports issued by Cass, not the journal in which the reviews appeared) in that language. ] (]) 17:28, 25 December 2024 (UTC) | |||
| :::::I'm fine with all of the above. I think we're in agreement. ] (]) 17:43, 26 December 2024 (UTC) | |||
| ::::::The "non peer reviewed" is inappropriate. Cass is an independent review, it isn't an academic publication. We don't call the ] "non peer reviewed" or any other wiki page about an independent review, because they are independent reviews, not academic papers. The source being used to make the claim this is a "narrative review" (which is quite wrong) is one line in a table in a non-peer reviewed document from a thinktank. This is inadequate. ] (]) 14:30, 1 January 2025 (UTC) | |||
| :::::::@] you've reverted this saying {{tq | If peer-reviewed systematic reviews are gold standard, they are gold standard here too }}- please point to me where the RAND document is peer-reviewed? It is not published in any academic journal. Here are their standards for their self-published reports: https://www.rand.org/about/standards.html | |||
| :::::::Please self-revert. And using this one source to falsely call an independent review a "narrative review" is a stretch. ] (]) 15:00, 1 January 2025 (UTC) | |||
| ::::::::Here is the relevant bit: | |||
| ::::::::{{tq|This work was supported by Indiana University Bloomington and the Medical College of Wisconsin and conducted by the Access and Delivery Program in RAND Health Care and the Social and Behavioral Policy Program in RAND Social and Economic Well-Being. This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. '''All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.'''}} | |||
| ::::::::Source: https://www.rand.org/pubs/research_reports/RRA3223-1.html | |||
| ::::::::So it ''is'' peer-reviewed. ] (]) 15:15, 1 January 2025 (UTC) | |||
| :::::::::That line (thank you for finding and posting it) would be more reassuring if they specified ''external'' peer review. "Internal" peer review is a thing, and "rigorous", like beauty, can be in the eye of the beholder. ] (]) 00:34, 2 January 2025 (UTC) | |||
| ::::::::::VIR found something elsewhere on their website which said they have at least two reviewers, with one in-house and at least one other/independent, IIRC. I currently find anything on this page as it's now a wall of text. Sorry about that. ] (]) 18:17, 2 January 2025 (UTC) | |||
| :@] why did you add a citation needed tag? The source explicitly says it's a narrative review and not peer reviewed on p 10, table 2.1 ] (]) 23:34, 30 December 2024 (UTC) | |||
| ::Ah, that's just because I'm not familiar with that source - hence why I put the CR and SRs into different sentences, so they can be referenced separately to avoid just this type of confusion. ] (]) 23:40, 30 December 2024 (UTC) | |||
| ::@] Just wanted to give you a heads up I think you slightly over-reverted here. I agree with the main removal of the bloated background, but want to check if you meant to also revert the additions to methodology clarifying the review was a non-peer reviewed narrative review and expanding on its methods - I'm assuming that was accidental collateral lol. Best, ] (]) 15:06, 31 December 2024 (UTC) | |||
| :::I thought about it, but I think if we add that in, then we also need to add in that the systematic reviews were peer reviewed. And the problem is, small additions can result in a bunch of other things being added too, so every small change is potentially a big one. This is the draft I have been working on: | |||
| ===Methodology=== | |||
| The Cass Review was an independent ] which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS. It was not ] but it commissioned a series of ] which were.{{efn|The review was a non-peer-reviewed narrative review, in which Cass synthesised multiple sources of evidence to form her conclusions and make recommendations. According to RAND: "The Cass Review was another highly comprehensive effort to summarize research evidence on interventions for gender dysphoria in TGE youth, informed in part by systematic reviews of evidence for social transition (Hall et al., 2024), other psychosocial interventions (Heathcote et al., 2024), and | |||
| I went to grab a citation to put in the lede, and it was all gone ] (]) 14:02, 17 September 2024 (UTC) | |||
| hormonal interventions (Taylor, Mitchell, Hall, Langton, et al., 2024; Taylor, Mitchell, Hall, Heathcote, et al., 2024). (The Cass Review also incorporated input from professionals, both in the United Kingdom and other | |||
| countries, as well as from youth and caregivers.) The systematic reviews conducted for the Cass Review used similar methods to our work, with some variations—for example, the reviews were restricted to studies with participants age 18 and younger, excluded case studies and non-English studies, used different risk-of-bias assessment tools, excluded studies meeting less than 50 percent of bias assessment criteria from syntheses in the hormonal intervention reviews, and did not provide certainty-of-evidence ratings for outcomes (Taylor, Mitchell, Hall, Langton, et al., 2024; Taylor, Mitchell, Hall, Heathcote, et al., 2024). Overall, it is important to recognize that the purpose and approach of the Cass Review report were guided by its mandate to make recommendations for UK National Health Service policy. Although policymakers elsewhere have begun considering how the Cass Review findings could inform their decisions, given its prominence and comprehensiveness, that mandate certainly affects | |||
| the applicability of those findings for decisionmaking in other contexts. As one example, the Cass Review did | |||
| not include evidence for gender-affirming surgery because the National Health Service had already restricted that intervention to individuals age 18 or older. In contrast, we sought to provide evidence summaries that practice and policy decisionmakers could more broadly consider across diverse contexts."<ref name="RAND-2024"/>}} In addition to the systematic reviews,<ref name="RAND-2024">{{Cite report |url=https://www.rand.org/content/dam/rand/pubs/research_reports/RRA3200/RRA3223-1/RAND_RRA3223-1.pdf |title=Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research - RAND_RRA3223-1.pdf |last=R. Dopp |first=Alex |last2=Peipert |first2=Allison |last3=Buss |first3=John |last4=De Jesús-Romero |first4=Robinson |last5=Palmer |first5=Keyton |last6=Lorenzo-Luaces |first6=Lorenzo |date=November 26, 2024 |publisher=] |access-date=2024-12-28 |orig-date=December 28, 2024}}</ref><ref name="Thornton2024">{{cite journal |last1=Thornton |first1=Jacqui |date=April 2024 |title=Cass Review calls for reformed gender identity services |journal=] |type=News |volume=403 |issue=10436 |pages=1529 |doi=10.1016/S0140-6736(24)00808-0 |pmid=38643770 |quote=Cass commissioned four systematic reviews of the evidence on key issues...}}</ref>{{sfn|Cass review final report|2024|p=28}} the review also commissioned ] and ] into young people with gender dysphoria and their health outcomes,{{sfn|Cass review final report|2024|pp=52–53}} conducted listening sessions and ]s with service users and parents, held meetings with advocacy groups, and gathered existing evidence and ] on the ] of patients.{{sfn|Cass review final report|2024|p=60}} The systematic reviews looked into different areas of healthcare for children and young people with distress related to ],<ref name="Thornton2024">{{cite journal |last1=Thornton |first1=Jacqui |date=April 2024 |title=Cass Review calls for reformed gender identity services |journal=] |type=News |volume=403 |issue=10436 |pages=1529 |doi=10.1016/S0140-6736(24)00808-0 |pmid=38643770 |quote=Cass commissioned four systematic reviews of the evidence on key issues...}}</ref>{{sfn|Cass review final report|2024|p=28}} which were carried out by the ]'s ] {{efn|The Centre for Reviews and Dissemination is one of three bodies funded by the ] (NIHR) to provide a systematic review service to the NHS.{{sfn|Cass review final report|2024|p=56}}}} and published in '']''.{{sfn|Cass review final report|2024|loc=Appendix 2|p=8}}<ref>{{cite web |title=Homepage {{pipe}} Archives of Disease in Childhood |url=https://adc.bmj.com/ |website=] |access-date=19 December 2024 |archive-url=https://archive.ph/S6tpr |archive-date=19 December 2024 |language=en |url-status=live}}</ref><ref name="implications-australian-minors-p3">{{cite journal |last1=Clayton |first1=Alison |last2=Amos |first2=Andrew James |last3=Spencer |first3=Jillian |last4=Clarke |first4=Patrick |title=Implications of the Cass Review for health policy governing gender medicine for Australian minors |journal=] |date=31 August 2024 |pages=3 |doi=10.1177/10398562241276335 |language=en}}</ref> The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes.<ref name="RAND-2024"/> The reviews covered:<ref name="GenderIdentityServiceSeries">{{cite web |title=Gender Identity Service Series |url=https://adc.bmj.com/pages/gender-identity-service-series |url-status=live |archive-url=https://web.archive.org/web/20240410082126/https://adc.bmj.com/pages/gender-identity-service-series |archive-date=10 April 2024 |access-date=10 April 2024 |website=] |type=Series of reviews commissioned to inform the Cass Review}}</ref> | |||
| *Characteristics of children and adolescents referred to specialist gender services<ref name="Taylor2024a">{{cite journal |last1=Taylor |first1=Jo |last2=Hall |first2=Ruth |last3=Langton |first3=Trilby |last4=Fraser |first4=Lorna |last5=Hewitt |first5=Catherine Elizabeth |date=9 April 2024 |title=Characteristics of children and adolescents referred to specialist gender services: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326681 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s3–s11 |type=Review |doi=10.1136/archdischild-2023-326681 |issn=0003-9888 |pmid=38594046 |archive-url=https://web.archive.org/web/20240410152521/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326681 |archive-date=10 April 2024 |access-date=11 April 2024|doi-access=free }}</ref> | |||
| *Impact of social transition in relation to gender for children and adolescents<ref name="Taylor2024b">{{cite journal |last1=Hall |first1=Ruth |last2=Mitchell |first2=Alex |last3=Taylor |first3=Jo |last4=Heathcote |first4=Claire |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |last7=Hewitt |first7=Catherine Elizabeth |date=9 April 2024 |title=Impact of social transition in relation to gender for children and adolescents: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326112 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s12–s18 |type=Review |doi=10.1136/archdischild-2023-326112 |pmid=38594055 |archive-url=https://web.archive.org/web/20240422134915/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326112 |archive-date=22 April 2024 |access-date=22 April 2024}}</ref> | |||
| *Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence<ref name="Taylor2024c">{{cite journal |last1=Heathcote |first1=Claire |last2=Mitchell |first2=Alex |last3=Taylor |first3=Jo |last4=Hall |first4=Ruth |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |last7=Hewitt |first7=Catherine Elizabeth |last8=Jarvis |first8=Stuart William |date=9 April 2024 |title=Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326347 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s19–s32 |type=Review |doi=10.1136/archdischild-2023-326347 |pmid=38594045 |archive-url=https://web.archive.org/web/20240423162758/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326347 |archive-date=23 April 2024 |access-date=23 April 2024 |ref=psychosocialreview}}</ref> | |||
| *Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (])<ref name="Taylor2024d">{{cite journal |last1=Taylor |first1=Jo |last2=Mitchell |first2=Alex |last3=Hall |first3=Ruth |last4=Heathcote |first4=Claire |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |last7=Hewitt |first7=Catherine Elizabeth |date=9 April 2024 |title=Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326669 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s33–s47 |type=Review |doi=10.1136/archdischild-2023-326669 |issn=0003-9888 |pmid=38594047 |archive-url=https://web.archive.org/web/20240410222540/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326669 |archive-date=10 April 2024 |access-date=11 April 2024}}</ref> | |||
| *Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (])<ref name="Taylor2024e">{{cite journal |last1=Taylor |first1=Jo |last2=Mitchell |first2=Alex |last3=Hall |first3=Ruth |last4=Langton |first4=Trilby |last5=Fraser |first5=Lorna |last6=Hewitt |first6=Catherine Elizabeth |date=9 April 2024 |title=Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326670 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s48–s56 |type=Review |doi=10.1136/archdischild-2023-326670 |issn=0003-9888 |pmid=38594053 |archive-url=https://web.archive.org/web/20240410222522/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326670 |archive-date=10 April 2024 |access-date=11 April 2024|doi-access=free }}</ref> | |||
| *Care pathways of children and adolescents referred to specialist gender services<ref name="Taylor2024f">{{cite journal |last1=Taylor |first1=Jo |last2=Hall |first2=Ruth |last3=Langton |first3=Trilby |last4=Fraser |first4=Lorna |last5=Hewitt |first5=Catherine Elizabeth |date=9 April 2024 |title=Care pathways of children and adolescents referred to specialist gender services: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326760 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s57–s64 |type=Review |doi=10.1136/archdischild-2023-326760 |pmid=38594052 |archive-url=https://web.archive.org/web/20240428170610/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326760 |archive-date=28 April 2024 |access-date=28 April 2024|doi-access=free }}</ref> | |||
| *Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence<ref name="Taylor2024g">{{cite journal |last1=Taylor |first1=J |last2=Hall |first2=R |last3=Heathcote |first3=C |last4=Hewitt |first4=CE |last5=Langton |first5=T |last6=Fraser |first6=L |date=9 April 2024 |title=Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1). |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326499.long |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s65–s72 |type=Review |doi=10.1136/archdischild-2023-326499 |pmid=38594049 |access-date=13 April 2024 |archive-date=2 August 2024 |archive-url=https://web.archive.org/web/20240802152411/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326499.long |url-status=live }}</ref><ref name="Taylor2024h">{{cite journal |last1=Taylor |first1=J |last2=Hall |first2=R |last3=Heathcote |first3=C |last4=Hewitt |first4=CE |last5=Langton |first5=T |last6=Fraser |first6=L |date=9 April 2024 |title=Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2). |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326500.long |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s73–s82 |type=Review |doi=10.1136/archdischild-2023-326500 |pmid=38594048 |archive-url=https://web.archive.org/web/20240629234058/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326500.long |archive-date=29 June 2024 |access-date=13 April 2024}}</ref> | |||
| The systematic reviews assessed the quality of the studies available{{efn|The reviews used tools such as the ] and modified versions of the ] to assess the quality of the studies available because no ] controlled studies – those usually thought of as having the highest quality – were available.{{sfn|Cass review final report|2024|p=161}}{{sfn|Cass review final report|2024|loc=Appendix 2|pp=2, 3}}<ref>{{cite web |last1=James |first1=Beal |date=26 April 2024 |title=Cass author condemns 'misinformation' spread by trans lawyer |url=https://www.thetimes.co.uk/article/cass-author-condemns-misinformation-spread-by-trans-lawyer-b5t9hd92m |url-status=live |archive-url=https://archive.today/20240422223249/https://www.thetimes.co.uk/article/cass-author-condemns-misinformation-spread-by-trans-lawyer-b5t9hd92m |archive-date=2024-04-22 |access-date=26 April 2024 |website=] |language=en |type=News |quote=During a systematic review, researchers looking at studies on transgender healthcare found no blind control ones — so used another system altogether to determine study quality.}}</ref>}} and used ] to combine the results of multiple studies. The results informed Cass' conclusions and recommendations, along with the results of the other forms of evidence collected.{{sfn|Cass review final report|2024|p=243}}<ref name="bbc-cass-misinfo"/> | |||
| :{{u|Bon courage}}, someone's asking about you. ] (] / ]) 14:06, 17 September 2024 (UTC) | |||
| ] (]) 17:40, 31 December 2024 (UTC) | |||
| ::Sorry I was out for a bike ride (nice to catch the autumn sunshine). I left an edit-summary didn't I? Quite why we had this bloated attention on the BMA was a puzzle! (Add: Oh I see it's snuck back in. Seems undue to be; as if Misplaced Pages needs to surface the 'bad things' the BMA said. They're really not a reliable body for this stuff). ] (]) 14:19, 17 September 2024 (UTC) | |||
| :::While the section was a tad heavy for its weight, I don’t think we can really say what to me read as one sentence of ‘The BMA criticized the Cass Report,’ followed by two paragraphs of ‘but then everyone else told them that that was dumb because XYZ’ without including what those criticisms were ] (]) 14:37, 17 September 2024 (UTC) | |||
| ::::I disagree, particularly since the BMA is only a trade union. I mean who cares, particularly when we have several more apt bodies making comments. More particularly this material should not be restored without consensus. Note ]: "The responsibility for achieving consensus for <u>inclusion</u> is on those seeking to include disputed content" (my emphasis). By over-focussing on this body's pronouncements the article risks drifting into POV. ] (]) 14:48, 17 September 2024 (UTC) | |||
| :::::I still stand by my earlier suggestion of expanding it as necessary over on ] and summarize/link it here. The coverage since has been more about the resulting controversy within the BMA itself than the Cass Review, so it seems more DUE there than here. ] (]) 14:50, 17 September 2024 (UTC) | |||
| ::::::That sounds good; this is really more about the internal politics of the BMA than anything of real biomedical relevance to the Cass Review. ] (]) 14:52, 17 September 2024 (UTC) | |||
| ::::::Sorry, perhaps I’m misreading, but are you saying that the BMA’s specific criticisms of the Cass Review belong more on the BMA page than the Cass Review page? ] (]) 15:22, 17 September 2024 (UTC) | |||
| :::::::I'm saying that given the coverage in RS as the story has developed over time into one that centres on the BMA itself I think it is due for a fuller explanation over there, and a link and condensed summary with the most relevant parts here. ] (]) 16:40, 17 September 2024 (UTC) | |||
| ::::::::Yes. For biomedical science, the BMA is not really a relevant body in the UK (we cite plenty that are). A sentence or two at most is due here. Otherwise it looks like Misplaced Pages is over-focussing on a bit-player in order to showcase the harsh words™ they put out. ] (]) 16:46, 17 September 2024 (UTC) | |||
| :::::Right, and there was a longstanding consensus for inclusion before you changed it. Another relevant guideline is NPOV - because having two paragraphs on why critiquing the Cass review is dumb and all the people who are against doing so, needs to be balanced by what those critiques actually are. Otherwise it’s not neutral ] (]) 15:20, 17 September 2024 (UTC) | |||
| ::::::I don't think there was any consensus; you may of course try an establish it. After my edit the BMA content was:{{tq2|The British Medical Association (BMA) has called for a pause on the review's implementation while it conducted a critique due to be completed by January 2025. The call has prompted some opposition from doctors, 1,400 of whom signed an open letter to the BMA characterising their planned critique as a "pointless exercise".}} How is that "two paragraphs on why critiquing the Cass review is dumb"? ] (]) 16:10, 17 September 2024 (UTC) | |||
| :::::::You forgot the Academy of Royal Medical Colleges after that, but also look through the previous threads that even yet remain on this page - where several debates were had as to the content and where it was finally decided to keep it as it was before you changed it. That’s a consensus. A new editor coming in, while certainly welcome, does not break that consensus. Citing another guideline, we have BRD. You boldly shortened, I reverted as much as I could manually on mobile (hate the new html system, makes it impossible to manually revert things), and now we’re discussing. ] (]) 16:31, 17 September 2024 (UTC) | |||
| ::::::::Nowhere was it "finally decided". Rather I see concerns about excessive quotation and smells of POV-pushing, and the section was tagged when I arrived here. BRD is not a "guideline", but an essay. ], on the other hand, is part of ] (i.e. core policy). ] (]) 16:36, 17 September 2024 (UTC) | |||
| :::::::::Right, I forgot it was tagged. | |||
| :::::::::Regardless, it was tagged as giving disproportionate weight to the criticisms of the BMA, not to the BMA’s original critiques. I’m not opposed to succinctness, but we can’t detail the counter-arguments of others if we’re not listing the original argument posed in the first place. Do you disagree? ] (]) 10:00, 18 September 2024 (UTC) | |||
| ::::::::::I agree with my own edit (i.e. we should have neither). The BMA is not a good source, especially compared to what we have, for biomedical science, and so their pronouncements are undue. ] (]) 10:56, 18 September 2024 (UTC) | |||
| :::::::::::They are a respected professional body though, representing a very significant number of doctors. If the spirit of your edit is to have neither criticism nor countercriticism, I don’t necessarily disagree, but I feel that your edit as you made it, read as being decidedly weighted in favor of the countercriticism. Reading through it from the perspective of the unknowing reader, my first thought was “What was said that provoked such documented backlash?” and inevitably a reader after asking that question, will fill in the blanks according to their own preconceptions. | |||
| :::::::::::Personally, I think that however little notability the BMA critique might have, the response to it holds decidedly less, and so I’m confused as to why you saw it as worth giving more space than the BMA themselves. ] (]) 12:48, 18 September 2024 (UTC) | |||
| ::::::::::::Huh? what "countercriticism" are you referring to as being weighted? You you please show me which of my edits you are referring to with a diff. ] (]) 12:52, 18 September 2024 (UTC) | |||
| :::::::::::::So I was looking at this diff,, and I realized that you didn’t actually edit in the AoMRC. Fair point to you there then. | |||
| :::::::::::::Regardless, it does then become “here’s half a paragraph of the BMA saying they’re going to criticize” when they already criticized it, as the quotes I added show; followed by (with the AoMRC) 1.5 paragraphs including direct quotes of what I believe to be less notable backlash, on how such criticism is bad and the review will be implemented regardless. | |||
| :::::::::::::Again, with direct quotes, the BMA Part balances these out in my view. Without direct quotes, it feels decidedly weighted in favor of those rebuffing either the criticism already given (per the quotes) or the idea of criticizing the Cass Review. | |||
| :::::::::::::The current state of things, at this point is fine with me. BMA w/ quotes, half a paragraph about the letter, and then the AoMRC, that’s something that reads as relatively balanced to me. ] (]) 11:48, 19 September 2024 (UTC) | |||
| ::::::::::::::From this discussion it is apparent there is no consensus to give this much weight to the BMA so I have re-shrunk the section. Editors may try to establish a consensus for a more maximal treatment or pursue the option to hive the detail to the BMA article. ] (]) 12:00, 19 September 2024 (UTC) | |||
| :::::::::::::::Shrinking it to your original edit, while not my first choice, is acceptable on my end. ] (]) 12:32, 19 September 2024 (UTC) | |||
| :The BMA story is obviously important and not mentioning it would be strange, but it's also the only UK medical organisation not to accept the review, despite being the least qualified and relevant to do so. It makes sense to keep coverage of it lean to ensure the article appropriately balances coverage against the ''unanimous'' acceptance by the organisations that actually oversee clinical practice. I think Void's right that it should be covered as a BMA topic rather than a Cass Review one. ] (]) 16:51, 17 September 2024 (UTC) | |||
| ::Yes, I think lean is the right approach. Others apparent want more. Let's see if they can be more persuasive about why Misplaced Pages needs to clear the ] hurdle for extensive detail on this particular body alone. ] (]) 12:03, 19 September 2024 (UTC) | |||
| :::I also think that keeping this to a single paragraph is best. That treats the UK organizations equally and also respects the notion of an encyclopedia article (which should be a summary, not a detailed list of who said what). If the BMA says something useful or interesting (according to reliable sources) next year, then we can update it then. ] (]) 01:22, 21 September 2024 (UTC) | |||
| :@] @] @] @] What do you think of this draft? ] (]) 17:51, 31 December 2024 (UTC) | |||
| Just to note, I have re-added the response from the AoMRC which was removed in the last edit, but without reference to the BMA. The AoMRC are a significant organisation, with responsibility for standards and training, whose response is at least as worthy of note as that of the BMA, of not more. ] (]) 12:27, 19 September 2024 (UTC) | |||
| ::Looks overall good to me! I only have the minor quibble that 2/3 sentences seem a little redundant, | |||
| ::* {{tq|The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity}} could probably be merged into {{tq| It was not peer-reviewed but it commissioned a series of systematic reviews which were}} or even removed considering the bullets. | |||
| ::* {{tq|The systematic reviews assessed the quality of the studies available and used meta-analysis to combine the results of multiple studies. The results informed Cass' conclusions and recommendations, along with the results of the other forms of evidence collected}} feels very redundant, explaining what systematic reviews are, and we already note Cass commissioned all these things | |||
| ::] (]) 18:58, 31 December 2024 (UTC) | |||
| :::I'll drop the first redundant line. For the second, I will drop both sentences. ] (]) 08:40, 1 January 2025 (UTC) | |||
| :::All done. Check out the latest version. I think it's much more balanced now. I also added the RAND systematic review to the "other academics" section for lack of a better home. That seems appropriate since it's also a systematic review, mentions Cass, and details some of the similarities/differences in their approaches and conclusions. ] (]) 09:52, 1 January 2025 (UTC) | |||
| ::::Hey @], | |||
| ::::The Background and Methodology sections were separate sections, which I think made sense. Why is the Methodology section (describing how the review was carried out) now a subsection of the Background section (describing why the review was carried out)? | |||
| ::::The new version of the Methodology section is still the version in place before my originally contested edits. Before them, the article said that the SRs were peer-reviewed and independent without having to state the CR itself wasn't peer-reviewed, which some people want to, citing ]. However, balance is not just weighing all viewpoints or sides of an argument equally, or even equally based on how much each are voiced, it's weighing their coverage in the article in proportion to their coverage in suitable/reliable sources. | |||
| ::::We've now removed all mention of the SRs' independence, while adding that the CR wasn't itself peer-reviewed and criticism of the SRs from ] ("The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes."). | |||
| ::::To me, this seems ] because there's consensus the (externally peer-reviewed and independent) SRs were fine, even among people who criticise the CR; I've seen no MEDRS source that criticises them; the SRs commissioned by the CR concurred with others, e.g. the Swedish and Finnish SRs; and the SRs commissioned by the CR are of higher quality than RAND's SR because they were commissioned for the ], carried out by the ], independent, and externally peer-reviewed by published in ], a high-quality and peer-reviewed medical journal associated with the ], while the RAND SR was created by and for a think tank and research organisation. Furthermore, I don't think the RAND review is a ] source because it wasn't published in a medical journal or created by a major medical or scientific organisation. | |||
| ::::We've also relegated the explanation of what the Centre for Reviews and Dissemination is to an endnote. While I'm okay with that change in and of itself, it's another dilution from the version in place before my original edits. Editors trying to maintain balance have pushed the ship back further the other way than my changes swayed it to begin with, and out of proportion with coverage in reliable and MEDRS sources. Therefore, there is now a ] issue. | |||
| ::::The types of evidence other than the SRs ("In addition to the systematic reviews, the review also commissioned...") should be put at the end of the section because the SRs made up most of the evidence base for the review (per the CR other pieces of evidence "supplemented" them) and it makes sense logically for readers to group information on the SRs together. | |||
| ::::Thanks! ] (]) 12:28, 1 January 2025 (UTC) | |||
| :::::The RAND corporation stuff is definitely UNDUE, this is a primary source from a policy thinktank, not any sort of MEDRS. ] (]) 14:43, 1 January 2025 (UTC) | |||
| ::::::It is a peer-reviewed systematic review, so definitely not a primary source. See here: https://www.rand.org/pubs/research_reports/RRA3223-1.html Download the report and read it for yourself. ] (]) 15:17, 1 January 2025 (UTC) | |||
| :::::@] Methodology was supposed to be a main header. I posted some text for workshopping upthread and had made the header there a subheader so it didn't start a new topic, but when I copied it over, I forgot to fix that. | |||
| :::::RAND is due, as it's another peer reviewed systematic review. They worked with two universities on the report. I have no problem with the SRs, and I don't think stating what they excluded is non-neutral in itself. It's true they only looked at people up to 18, whereas RAND also looked at those up to 25. That was an intentional decision and all of those things, except the bit about confidence of evidence ratings, are also said within the Cass Review itself, so it can have two sources backing it up if you'd like? | |||
| :::::@]'s edits have conflicted with mine, so the changes I made to methodology have been reverted, adding "non-peer reviewed" back in and a few other things. I had suggested the following wording for Methodology, which I think was a fair compromise: | |||
| :::::'''Methodology''' | |||
| :::::The Cass Review was an independent ] which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS.{{efn|The review was a non-peer-reviewed narrative review, in which Cass synthesised multiple sources of evidence to form her conclusions and make recommendations. According to the ]: "The Cass Review was another highly comprehensive effort to summarize research evidence on interventions for gender dysphoria in TGE youth, informed in part by systematic reviews of evidence for social transition (Hall et al., 2024), other psychosocial interventions (Heathcote et al., 2024), and hormonal interventions (Taylor, Mitchell, Hall, Langton, et al., 2024; Taylor, Mitchell, Hall, Heathcote, et al., 2024). (The Cass Review also incorporated input from professionals, both in the United Kingdom and other countries, as well as from youth and caregivers.) The systematic reviews conducted for the Cass Review used similar methods to our work, with some variations—for example, the reviews were restricted to studies with participants age 18 and younger, excluded case studies and non-English studies, used different risk-of-bias assessment tools, excluded studies meeting less than 50 percent of bias assessment criteria from syntheses in the hormonal intervention reviews, and did not provide certainty-of-evidence ratings for outcomes (Taylor, Mitchell, Hall, Langton, et al., 2024; Taylor, Mitchell, Hall, Heathcote, et al., 2024). Overall, it is important to recognize that the purpose and approach of the Cass Review report were guided by its mandate to make recommendations for UK National Health Service policy. Although policymakers elsewhere have begun considering how the Cass Review findings could inform their decisions, given its prominence and comprehensiveness, that mandate certainly affects the applicability of those findings for decisionmaking in other contexts. As one example, the Cass Review did not include evidence for gender-affirming surgery because the National Health Service had already restricted that intervention to individuals age 18 or older. In contrast, we sought to provide evidence summaries that practice and policy decisionmakers could more broadly consider across diverse contexts."<ref name="RAND-2024">{{Cite report |url=https://www.rand.org/content/dam/rand/pubs/research_reports/RRA3200/RRA3223-1/RAND_RRA3223-1.pdf |title=Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research - RAND_RRA3223-1.pdf |last=R. Dopp |first=Alex |last2=Peipert |first2=Allison |last3=Buss |first3=John |last4=De Jesús-Romero |first4=Robinson |last5=Palmer |first5=Keyton |last6=Lorenzo-Luaces |first6=Lorenzo |date=November 26, 2024 |publisher=] |access-date=2024-12-28 |orig-date=December 28, 2024}}</ref>}} According to Cass, "The bedrock of the Review was a series of seven ] commissioned from the University of York, as well as a survey of international practice and a ] study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians."<ref>{{Cite journal |last=Cass |first=Hilary |date=2024-09-06 |title=Gender identity services for children and young people: navigating uncertainty through communication, collaboration and care |url=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/gender-identity-services-for-children-and-young-people-navigating-uncertainty-through-communication-collaboration-and-care/D0F6B23F37C3D82B38C2470DF65854C9 |journal=The British Journal of Psychiatry |language=en |volume=225 |issue=2 |pages=302–304 |doi=10.1192/bjp.2024.162 |issn=0007-1250}}</ref> | |||
| :::::The systematic reviews looked into different areas of healthcare for children and young people with distress related to ],<ref name="Thornton2024">{{cite journal |last1=Thornton |first1=Jacqui |date=April 2024 |title=Cass Review calls for reformed gender identity services |journal=] |type=News |volume=403 |issue=10436 |pages=1529 |doi=10.1016/S0140-6736(24)00808-0 |pmid=38643770 |quote=Cass commissioned four systematic reviews of the evidence on key issues...}}</ref>{{sfn|Cass review final report|2024|p=28}} were carried out by the ]'s ],{{efn|The Centre for Reviews and Dissemination is one of three bodies funded by the ] (NIHR) to provide a systematic review service to the NHS.{{sfn|Cass review final report|2024|p=56}}}} and were published in '']''.{{sfn|Cass review final report|2024|loc=Appendix 2|p=8}}<ref>{{cite web |title=Homepage {{pipe}} Archives of Disease in Childhood |url=https://adc.bmj.com/ |website=] |access-date=19 December 2024 |archive-url=https://archive.today/20241219195107/https://adc.bmj.com/ |archive-date=19 December 2024 |language=en |url-status=live}}</ref><ref name="implications-australian-minors-p3">{{cite journal |last1=Clayton |first1=Alison |last2=Amos |first2=Andrew James |last3=Spencer |first3=Jillian |last4=Clarke |first4=Patrick |title=Implications of the Cass Review for health policy governing gender medicine for Australian minors |journal=] |date=31 August 2024 |pages=3 |doi=10.1177/10398562241276335 |language=en}}</ref> The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes.<ref name="RAND-2024" /> The reviews covered:<ref name="GenderIdentityServiceSeries">{{cite web |title=Gender Identity Service Series |url=https://adc.bmj.com/pages/gender-identity-service-series |url-status=live |archive-url=https://web.archive.org/web/20240410082126/https://adc.bmj.com/pages/gender-identity-service-series |archive-date=10 April 2024 |access-date=10 April 2024 |website=] |type=Series of reviews commissioned to inform the Cass Review}}</ref><ref name="bbc-cass-misinfo" /> | |||
| :::::*Characteristics of children and adolescents referred to specialist gender services<ref name="Taylor2024a">{{cite journal |last1=Taylor |first1=Jo |last2=Hall |first2=Ruth |last3=Langton |first3=Trilby |last4=Fraser |first4=Lorna |last5=Hewitt |first5=Catherine Elizabeth |date=9 April 2024 |title=Characteristics of children and adolescents referred to specialist gender services: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326681 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s3–s11 |type=Review |doi=10.1136/archdischild-2023-326681 |issn=0003-9888 |pmid=38594046 |archive-url=https://web.archive.org/web/20240410152521/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326681 |archive-date=10 April 2024 |access-date=11 April 2024|doi-access=free }}</ref> | |||
| :::::*Impact of social transition in relation to gender for children and adolescents<ref name="Taylor2024b">{{cite journal |last1=Hall |first1=Ruth |last2=Mitchell |first2=Alex |last3=Taylor |first3=Jo |last4=Heathcote |first4=Claire |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |last7=Hewitt |first7=Catherine Elizabeth |date=9 April 2024 |title=Impact of social transition in relation to gender for children and adolescents: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326112 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s12–s18 |type=Review |doi=10.1136/archdischild-2023-326112 |pmid=38594055 |archive-url=https://web.archive.org/web/20240422134915/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326112 |archive-date=22 April 2024 |access-date=22 April 2024}}</ref> | |||
| :::::*Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence<ref name="Taylor2024c">{{cite journal |last1=Heathcote |first1=Claire |last2=Mitchell |first2=Alex |last3=Taylor |first3=Jo |last4=Hall |first4=Ruth |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |last7=Hewitt |first7=Catherine Elizabeth |last8=Jarvis |first8=Stuart William |date=9 April 2024 |title=Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326347 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s19–s32 |type=Review |doi=10.1136/archdischild-2023-326347 |pmid=38594045 |archive-url=https://web.archive.org/web/20240423162758/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326347 |archive-date=23 April 2024 |access-date=23 April 2024 |ref=psychosocialreview}}</ref> | |||
| :::::*Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (])<ref name="Taylor2024d">{{cite journal |last1=Taylor |first1=Jo |last2=Mitchell |first2=Alex |last3=Hall |first3=Ruth |last4=Heathcote |first4=Claire |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |last7=Hewitt |first7=Catherine Elizabeth |date=9 April 2024 |title=Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326669 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s33–s47 |type=Review |doi=10.1136/archdischild-2023-326669 |issn=0003-9888 |pmid=38594047 |archive-url=https://web.archive.org/web/20240410222540/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326669 |archive-date=10 April 2024 |access-date=11 April 2024}}</ref> | |||
| :::::*Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (])<ref name="Taylor2024e">{{cite journal |last1=Taylor |first1=Jo |last2=Mitchell |first2=Alex |last3=Hall |first3=Ruth |last4=Langton |first4=Trilby |last5=Fraser |first5=Lorna |last6=Hewitt |first6=Catherine Elizabeth |date=9 April 2024 |title=Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326670 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s48–s56 |type=Review |doi=10.1136/archdischild-2023-326670 |issn=0003-9888 |pmid=38594053 |archive-url=https://web.archive.org/web/20240410222522/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326670 |archive-date=10 April 2024 |access-date=11 April 2024|doi-access=free }}</ref> | |||
| :::::*Care pathways of children and adolescents referred to specialist gender services<ref name="Taylor2024f">{{cite journal |last1=Taylor |first1=Jo |last2=Hall |first2=Ruth |last3=Langton |first3=Trilby |last4=Fraser |first4=Lorna |last5=Hewitt |first5=Catherine Elizabeth |date=9 April 2024 |title=Care pathways of children and adolescents referred to specialist gender services: a systematic review |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326760 |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s57–s64 |type=Review |doi=10.1136/archdischild-2023-326760 |pmid=38594052 |archive-url=https://web.archive.org/web/20240428170610/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326760 |archive-date=28 April 2024 |access-date=28 April 2024|doi-access=free }}</ref> | |||
| :::::*Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence<ref name="Taylor2024g">{{cite journal |last1=Taylor |first1=J |last2=Hall |first2=R |last3=Heathcote |first3=C |last4=Hewitt |first4=CE |last5=Langton |first5=T |last6=Fraser |first6=L |date=9 April 2024 |title=Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1). |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326499.long |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s65–s72 |type=Review |doi=10.1136/archdischild-2023-326499 |pmid=38594049 |access-date=13 April 2024 |archive-date=2 August 2024 |archive-url=https://web.archive.org/web/20240802152411/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326499.long |url-status=live }}</ref><ref name="Taylor2024h">{{cite journal |last1=Taylor |first1=J |last2=Hall |first2=R |last3=Heathcote |first3=C |last4=Hewitt |first4=CE |last5=Langton |first5=T |last6=Fraser |first6=L |date=9 April 2024 |title=Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2). |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326500.long |url-status=live |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s73–s82 |type=Review |doi=10.1136/archdischild-2023-326500 |pmid=38594048 |archive-url=https://web.archive.org/web/20240629234058/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326500.long |archive-date=29 June 2024 |access-date=13 April 2024}}</ref> | |||
| :::::The review also commissioned qualitative and ] into young people with gender dysphoria and their health outcomes,{{sfn|Cass review final report|2024|pp=52–53}} conducted listening sessions and ]s with service users and parents, met with advocacy groups, and gathered existing evidence and ] on the ] of patients.{{sfn|Cass review final report|2024|p=60}} ] (]) 15:26, 1 January 2025 (UTC) | |||
| ::::::Re: "supplemented", I did find this in the final report, but in this context {{tq|The Review has therefore had to base its recommendations on the currently available evidence, '''supplemented by its own extensive programme of engagement'''}} (p. 20). This means the engagement activities were supplements, but the qualitative and quantitative research that the Cass Review also commissioned can't reasonably be slotted into the "engagement" category over the "available evidence" category. The quantitative research, certainly, wouldn't fit that criteria. Specifically, she also refers to the SRs on the international GLs as "supplementing" the evidence (p. 53: {{tq|'''an appraisal of an international guidelines''' and international survey were undertaken to supplement this information}}). In the box underneath, the appraisal of int'l GLs is the two papers: ''Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)'' and ''Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)'', so I'm not sure we should draw a specific conclusion re: proportionality from the word ''supplement'' alone. Was it used more specifically anywhere else that you've found? ] (]) 15:54, 1 January 2025 (UTC) | |||
| :::::::Hey @], thanks for getting back to me. | |||
| :::::::''RAND is due, as it's another peer reviewed systematic review. They worked with two universities on the report. I have no problem with the SRs, and I don't think stating what they excluded is non-neutral in itself. It's true they only looked at people up to 18, whereas RAND also looked at those up to 25. That was an intentional decision and all of those things, except the bit about confidence of evidence ratings, are also said within the Cass Review itself, so it can have two sources backing it up if you'd like?'' | |||
| :::::::I don't necessarily doubt that it was peer-reviewed or that they worked with two univertisites to make it. However, it wasn't published by a major medical organisation or in a reputable medical journal. Therefore, I don't think we can count it as a MEDRS source, and I certainly don't think so to the extent that its criticism of the CR's SRs (which I view as higher quality sources for the reasons I gave before) should be afforded weight (especially when the quote comes from a paragraph explaining these were minor changes and the SRs mostly worked the same anyway). If you can find some other sources to back it up, that'd be better, both to have sources we all view as MEDRS/suitable stating these criticisms and to ensure there's enough coverage of them in MEDRS/suitable sources to warrant their inclusion (even if we view the RAND review as MEDRS, if these criticisms aren't made in other MEDRS sources, they won't have enough coverage to be included per weight). | |||
| :::::::''Re: "supplemented", I did....I'm not sure we should draw a specific conclusion re: proportionality from the word supplement alone. Was it used more specifically anywhere else that you've found?'' | |||
| :::::::I think there are one or other two sources I don't have to hand saying the SRs were the foundation of the evidence and the CR's findings. From page 47 of the final report though: "The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews on a range of issues from epidemiology through to treatment approaches, and international models of current practice." You've also seen: "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians." I think the "as well as" puts emphasis more on the SRs being the "bedrock" of the CR. In all, I think it's reasonable to say the SRs were the core of the evidence the CR used; what do you think now, with this all in mind? | |||
| :::::::Regarding the draft version of the Methodology section (and comparing to the section and ): | |||
| :::::::* "According to Cass..." We should try to write the text ourselves, rather than quoting, especially given how contentious this article is: people will see "according to Cass" and immediately overwrite it because they "disagree with the review". | |||
| :::::::* I appreciate you putting the non-SR stuff at the end, I think it works much better that way | |||
| :::::::* I'm fine with the explanation of the role of the Centre for Reviews and Dissemination moving to an endnote if it helps get a compromise | |||
| :::::::* Why did you remove the paragraph including the Mixed Methods Appraisal Tool and Newcastle–Ottawa scale? They were key to how the SRs worked and help the reader better understand the CR's overall methodology. | |||
| :::::::* We've still swayed further towards criticisms of the SRs than even before my edits. For example, the section used to say the SRs were independent and peer-reviewed. Now, it doesn't, and instead we have some (minor in context) criticism of them. The boat has still been pushed back further than it swayed to begin with. | |||
| :::::::I might make a revision of the methodology section based upon the version present before my originally contested edits, with some tweaks - maybe adding extra details people want as endnotes and adding more references. What would you think about that? | |||
| :::::::Thanks again! ] (]) 17:20, 1 January 2025 (UTC) | |||
| ::::::::Hi @], | |||
| ::::::::{{tq|"The Review has to be grounded in a thorough examination of the most robust existing evidence. '''To support this''', we commissioned systematic reviews on a range of issues from epidemiology through to treatment approaches, and international models of current practice." You've also seen: "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, '''as well as''' a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians." I think the "as well as" puts emphasis more on the SRs being the "bedrock" of the CR. In all, I think it's reasonable to say the SRs were the core of the evidence the CR used; what do you think now, with this all in mind?}} I really don't see it that way. In fact, with the "to support this" part in there, that shows me that there's no consistency in how she uses phrases like "support", "supplement", etc. How can the SRs be the most important thing if they only ''support'' the other evidence looked at? She's using these terms loosely throughout, and the only logical meaning, from my POV, is that the only consistent statement we can make is that ''she's using all this information to support her findings/recommendations'', not that some evidence is prioritised and the rest is secondary. Anything more than that is ]. Given the ambiguity, I think we either have to include her direct quotation or remove the claim of SR centrality altogether. | |||
| ::::::::{{tq|However, it wasn't published by a major medical organisation or in a reputable medical journal. Therefore, I don't think we can count it as a MEDRS source, and I certainly don't think so to the extent that its criticism of the CR's SRs (which I view as higher quality sources for the reasons I gave before) should be afforded weight (especially when the quote comes from a paragraph explaining these were minor changes and the SRs mostly worked the same anyway). If you can find some other sources to back it up, that'd be better, both to have sources we all view as MEDRS/suitable stating these criticisms and to ensure there's enough coverage of them in MEDRS/suitable sources to warrant their inclusion (even if we view the RAND review as MEDRS, if these criticisms aren't made in other MEDRS sources, they won't have enough coverage to be included per weight).}} As I said upthread, the Cass Review and its SRs already state ''what the remit of the review was'', and therefore its ''limitations''. So this is equally sourced by the Cass Review/SRs. The only part that isn't is the part about confidence ratings, and I'm happy for that particular part to be removed (although, the Cass Review doesn't include confidence ratings, so it's also not untrue). Besides which, we don't necessarily exclude RSes just because some sources are better. Only if the better source conflicts. But there isn't a conflict here, since Cass isn't contradicting RAND. Furthermore, RAND is peer reviewed (Cass isn't) and RAND's health research arm is well regarded and influential, having provided evidence for the US government among others. The SRs being published in peer reviewed journals is one-nil to the Cass Review, but the fact the overall RAND report is peer reviewed and Cass isn't makes it one-all. So there's not much in it. And again, Cass supports RAND's statement about limitations because those limitations were largely intentional. | |||
| ::::::::But I feel very strongly that we shouldn't exclude RAND just because some editors prefer Cass or think it's more reliable, since the fact Cass has been based on SRs has been repeatedly used to already exclude other sources that are critical of the review. We need to be consistent here. Moreover, we shouldn't be excluding all criticism here; at worst, we should be including stuff with caveats to reflect the uncertainty Cass herself says exists in the evidence base (and therefore in her own findings). The person who added RAND in the first place obviously agrees it's due and so do I. Minimising critique (or perceived critique, since I don't feel RAND is actually giving a critique rather than simply explaining limitations) introduces bias in itself. | |||
| ::::::::{{tq|"According to Cass..." We should try to write the text ourselves, rather than quoting, especially given how contentious this article is: people will see "according to Cass" and immediately overwrite it because they "disagree with the review".}} It's a direct quote. That's the whole point. The compromise is to include the direct quote so that others can make up their own mind. Going back to a statement in Wikivoice isn't a compromise, because one of us is going to disagree with how it's framed. The only Wikivoice statement I think is justified is something along the lines of "to draw her conclusions, Cass commissioned systematic reviews, qualitative and quantitative research, etc". | |||
| ::::::::{{tq|Why did you remove the paragraph including the Mixed Methods Appraisal Tool and Newcastle–Ottawa scale? They were key to how the SRs worked and help the reader better understand the CR's overall methodology.}} The final report section details the tools used for each outcome/finding, so it's redundant. Also, specific trumps the general here, so being able to say "this SR used x" is better than a generalised statement. | |||
| ::::::::If you want to propose some new text, please add a draft here and ping me. Then we can discuss it and workshop it without any intervening edit conflicts or reversions. However, I did make several compromises already and they have been repeatedly undone afterwards (I know there have been lots of editors making changes), so the draft I've proposed is far closer to your preferred wording than mine. I also suspect it's still a bit quiet here after Christmas, and we might want to give others a chance to chime in too, since there seems to be only 3 or 4 of us engaging regularly at the moment. ] (]) 18:24, 1 January 2025 (UTC) | |||
| :::::::::Hey @], thanks for sharing your thoughts again. | |||
| :::::::::''How can the SRs be the most important thing if they only support the other evidence looked at?'' | |||
| :::::::::She said: "The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews..." She's saying the SRs were commissioned to support the ability of the review to be "grounded in a thorough...". This ability ("to be grounded...") is the "this" in "support this", not the other types of evidence. After pointing that out, and considering the other references we've discussed so far ("supplemented" and "the bedrock"), is your mind changed at all? | |||
| :::::::::''As I said upthread, the Cass Review and its SRs already state what the remit of the review was, and therefore its limitations. So this is equally sourced by the Cass Review/SRs'' | |||
| :::::::::I'd be happy to include the scope/remit/limitations of the SRs or CR if they can be sourced from the CR or SRs themselves and are due etc. Do you think we could include something like that instead of the RAND stuff altogether to move forwards on this? | |||
| :::::::::''So there's not much in it.'' | |||
| :::::::::I don't want to debate the relative quality of the two sources much more, since it isn't really productive, but: the NHS is the type of medical organisation (and listed as an example) in ] and they commissioned the review (and the group who carried it out serve the NHS); and the SRs were published in a (highly) reputable medical journal. Neither of these points are true for the RAND review, so I consider it to be of lower quality and credibility. | |||
| :::::::::Again, I'm not assuming it's wrong - it doesn't even seek to criticise or "debunk" the SRs/CR anyway - just that I don't think we can assess its quality to be high enough under MEDRS to warrant the inclusion of its content in the article which is currently being presented in a manner that undermines the credibility of the SRs/CR. | |||
| :::::::::''I don't feel RAND is actually giving a critique rather than simply explaining limitations'' | |||
| :::::::::Yeah, I don't feel that way either. RAND never says "the Cass Review was wrong" and the limitations are discussed, in context, as small differences from their own approach and not as criticisms anyway. However, the whole basis of including some of their described limitations of the SRs seemed to be critical and included to form some kind of balance "against the systematic reviews". | |||
| :::::::::''It's a direct quote. That's the whole point. The compromise is to include the direct quote so that others can make up their own mind'' | |||
| :::::::::I was trying to say we don't need to make up our own minds on whether the CR commissioned "a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians". All of this is currently in the quote from Cass. However, this is all objectively true, not being contended here, and supported by MEDRS sources other than Cass. We can move that the CR commissioned that stuff out of the quote. I think it'd be beneficial because we should use direct quotes sparingly and, given how contentious this article is, people will see "according to Cass" and immediately overwrite it or add other text afterwards to "debunk" it because they "disagree with the review". Do you see what I mean about moving what we can out of the direct quote? | |||
| :::::::::''The final report section details the tools used for each outcome/finding, so it's redundant. Also, specific trumps the general here, so being able to say "this SR used x" is better than a generalised statement.'' | |||
| :::::::::Yeah, I take your point that the Newcastle–Ottawa scale is redundant when included in both the methodology and final report sections. I think it makes more sense to include in the methodology section than the final report sections. In other words, describe how the quality of research was assessed in the methodology section, then describe the outcome of these processes in the final report section. What would you think about that? Ditto for the Mixed Methods Appraisal Tool. | |||
| :::::::::However, we're now missing the explanation of why these tools were used ("because no blinded controlled studies – those usually thought of as having the highest quality – were available") and that meta-analyses were used to combine the results of different research in the SRs. I think this is important information, in part because "the CR excluded non-blinded studies which was unfair" is a widely covered and shared claim, and, in part, to explain the methodology underpinning the SRs and CR. Do you agree with me here? How do you think we could restore this information? I genuinely thought that paragraph had been removed accidentally, because I hadn't seen anyone objecting to it before. | |||
| :::::::::''If you want to propose some new text, please add a draft here and ping me. Then we can discuss it and workshop it without any intervening edit conflicts or reversions.'' | |||
| :::::::::Sure, thanks again for working in good faith to compromise. I might make one in my sandbox or something similar and ping you with it. | |||
| :::::::::Thanks! ] (]) 22:13, 1 January 2025 (UTC) | |||
| ::::::::::Again, though, "to support this" doesn't mean "we used the systematic reviews over everything else". There's no explicit statement to support "we used this more than anything else", so the rest is a matter of interpretation. If the meaning is as clear as you think it is, then it will be equally clear if we include an original, direct quote? We could remove {{tq|According to Cass}}, since the statement is sourced, while still using the direct quote. That will avoid the impulse for someone to try to counter it. We can also add invisible text to advise others not to do that in future. | |||
| :::::::::: | |||
| ::::::::::Re: RAND versus the Cass Review, R (it's still sourced)AND has existed since c.1948, was funded by NIH and others, and regularly contributed research to the CDC and other governmental departments in the U.S. While it wasn't published in a journal (it says all its publishing is "open publishing"), their review was written by multiple authors and peer reviewed. The only person who needed to be convinced in the Cass Review was Cass (a self-described non-expert), so she was free to interpret the evidence how she wanted to. Which is why, in places, she makes her own conclusions, and draws from disparate bits of evidence like sex-rearing in DSD. | |||
| ::::::::::My main concern at this stage is that if nothing is allowed in that isn't deemed to be equal to the Cass Review by a small group of editors, then we effectively minimise any critique, discussion or nuance. ] shouldn't be used to silence disagreement, especially when the medical consensus across multiple countries isn't as clear-cut. That's before we even get into the politics of this – Cass ''is'' a politician, and members of the last government were proud to announce their own support of the review, even after they had made non-neutral statements about this subject before. Indeed, similar claims have been made about Cass. | |||
| ::::::::::All of which is to say that no evidence is perfect, all sources are biased, and the Cass Review itself isn't perfect. The SRs are mostly fine, but the CR =/= the SRs alone. There's a significant amount of synthesis and interpretation occurring to create the conclusions and recommendations, and Cass herself doesn't deny that. | |||
| ::::::::::What I suggested to VIR elsewhere was that we could remove the part about certainty ratings and then cite the remainder to both RAND and the Cass Review. | |||
| ::::::::::As for the grading tools, some of those would have been used either way. That's what a systematic review does. RAND used GRADE, which is what NICE uses, whereas York used a mixed approach. It's different but not particularly unusual, and so not majorly notable. However, I have no problem with those more specific statements from the findings being replaced with a more generic statement – so long as you're aware that's what's happening. I also don't mind the statement about no blinded studies being in there. Though, blinded RCTs are usually the highest standard and there are particular circumstances that make blinded RCTs unlikely or difficult to obtain here – e.g., control will always be treatment x + treatment y versus treat ebt X or y alone, or treatment x versus treat ebt y. You'll never get treatment x versus placebo for blockers, for example, because it's obvious whether you're going through puberty or not (especially if you have dysphoria). So someone is likely to feel, at some point, that this clarification also needs to be made. Not mentioning the blinded part avoids that. We already explain most of the evidence was of insufficient quality, which does the same thing for those who are interested in knowing such details anyway. | |||
| ::::::::::If you post a draft in sandbox, I'll happily take a look. Thank you. I'm going to put a notice in the WikiProject so we can get more eyes on this anyway. There's a danger whatever we say here will get reverted again otherwise. ] (]) 08:59, 2 January 2025 (UTC) | |||
| :::::::::::About this sentence, which is what I believe you're talking about: {{xt|The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes}}. This is a selective statement of differences between the RAND report and the Cass report. (It leaves out "{{xt|used different risk-of-bias assessment tools, excluded studies meeting less than 50 percent of bias assessment criteria from syntheses in the hormonal intervention reviews}}".) | |||
| :::::::::::I don't think that the first even sounds like a "criticism" of Cass; it sounds like a simple, factual description. In order: | |||
| :::::::::::* The Cass Review looked at studies of the relevant population. This is a ''good'' thing, right? <small>(If the world never sees another study for children with cancer that relies on geriatric results, it will still be too soon.)</small> | |||
| :::::::::::* The Cass final report excluded weak evidence. The RAND report included weak evidence, and I guess that's their choice, but it's not actually ''bad'' to exclude weak evidence. | |||
| :::::::::::* The Cass final report also excluded studies that were not published in the international language of science. Not only is this usual, but nobody has since reported even a single study in any other language that could be used to seriously challenge any of Cass' recommendations. The RAND report says they didn't exclude non-English sources and still only found one non-English study that met their inclusion criteria (in Spanish; I believe it was {{PMID|36705053}}). This is therefore an unimportant difference between the RAND and Cass reports. | |||
| :::::::::::So what's left is: It {{xt|did not provide certainty-of-evidence ratings for outcomes}}. | |||
| :::::::::::My main concern is that this sentence will not be understood by some (probably most) readers. We have seen unfortunate misunderstandings happen before (e.g., in the "they rejected 98% of the scientific studies!" misinformation), and I would like us to do our part, small as our part may be in this instance, to avoid setting off another round of drama on antisocial media. If we dump this in the article, some people are going to believe that they have now, finally, after all these months, found the detail that proves the Cass Review is 100% bad, because they have no idea what this means, but it sounds all science-y and it must be some kind of stunning criticism, or else Misplaced Pages wouldn't have mentioned it. | |||
| :::::::::::What RAND's statement means is that they intend to spam {{xt|(low certainty)}} and {{xt|(very low certainty)}} at the end of certain sentences in their report, and they notice that the Cass final report did not do this. (With a quick search, RAND didn't label anything in their report as having a certainty rating higher than "low".) RAND writes, e.g., in their Summary (bottom of page V) that puberty blockers slow pubertal progression (low certainty), GAH is associated with cross-sex pubertal changes (low certainty), and both of these reduced gender dysphoria (very low certainty), where Cass would have said basically the same thing, except not spammed "(low certainty)" after the items. | |||
| :::::::::::Including this label is the standard form for ], but including or omitting that information doesn't actually change the recommendation/assessment, and both the interim and the final report already said that the evidence base sucks in general. See, e.g., this line in the Cass final report: | |||
| :::::::::::{{xt|This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.}} | |||
| :::::::::::That pretty much tells you that the certainty of evidence for "outcomes" is low (except when it's very low, or non-existent). | |||
| :::::::::::Additionally, quite a lot of the Cass final report isn't something that would have this sort of statement anyway. You can't have a certainty-of-evidence rating about whether ]. | |||
| :::::::::::My bottom line is that if we're going to mention this – and there's no clear reason why we should – we need to be precise in what we're saying and explain what that means and why it (doesn't) matter in practice. It might help to stop thinking of this as a criticism. RAND isn't complaining about Cass's choice. Also, they did a review of the evidence in a somewhat different way (e.g., including case studies), and still ended up in the same place, namely that the existing evidence base sucks (or is entirely non-existent for two of their categories). ] (]) 11:38, 2 January 2025 (UTC) | |||
| ::::::::::::I don't see it as criticism of Cass. I see it as describing limitations, which is also pretty neutral in this context. I've said as much elsewhere. My feeling, however, was that people are unduly anxious that it ''is'' a critique, which is why they don't want it in the article at all. I disagree with that stance and believe RAND is suitable to use. RAND isn't/wasn't just used in the article to cite the sentence above – it was also used to cite the limitations in terms of other countries. I.e., this is a review for the NHS and isn't necessarily applicable to other countries' health services. Which again, is blindly obvious to us, but a lot of people have spread misinformation about that part, such as that US politician who has tried to ban certain treatments citing Cass. That is relevant for the same reasons you cite: avoiding misinformation. So, broadly speaking, if we're in agreement that RAND is fair to use in the article, I'm happy. | |||
| ::::::::::::However, if we're also including lots of detail on the SRs, then mentioning the (intentional) limitations is also warranted. I wanted less explanation of the SRs in general, but as 13tez feels very strongly that we need more info on them, then we should balance that out by adequately setting expectations. ] (]) 18:30, 2 January 2025 (UTC) | |||
| :::::::::::::I don't feel like we're including "lots of detail on the SRs". | |||
| :::::::::::::The text currently says: | |||
| :::::::::::::{{tqb|1= | |||
| :::::::::::::It commissioned a series of several ], independent ] that looked into different areas of healthcare for children and young people with distress related to ], was carried out by the ]'s ], and was published in '']''. The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. The reviews covered: | |||
| :::::::::::::* Characteristics of children and adolescents referred to specialist gender services | |||
| :::::::::::::* Impact of social transition in relation to gender for children and adolescents | |||
| :::::::::::::* Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence | |||
| :::::::::::::* Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (]) | |||
| :::::::::::::* Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (]) | |||
| :::::::::::::* Care pathways of children and adolescents referred to specialist gender services | |||
| :::::::::::::* Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence}} | |||
| :::::::::::::Which is to say, it provides basic information about who-what-where and the main subjects of the seven reviews. | |||
| :::::::::::::The "restricted to studies focusing on minors" is redundant with "looked into different areas of healthcare for children and young people". Mentioning the "non-English studies" thing implies that this is a material restriction, which is known to be false. For that matter, "non-English studies" implies that there was more than one non-English study, which RAND says is false. I think we should remove both of those. | |||
| :::::::::::::Also, that first sentence is 50 words long. Maybe that could be split. ] (]) 22:40, 2 January 2025 (UTC) | |||
| ::::::::None of this is DUE - the RAND report could maybe go on ] or ] but its not a response to or critique of Cass, nor is it an authoritative source on Cass' methodology. It doesn't encompass the same evidence, and it isn't published in any reputable journal. ] (]) 21:10, 1 January 2025 (UTC) | |||
| :::::::::That's your opinion, and frankly this feels like ] at this point. You've vigorously fought every single source which critiques Cass in even the lightest terms possible. It risks becoming ]. ] (]) 08:37, 2 January 2025 (UTC) | |||
| ::::::::::I lean towards agreeing with Void's suggestion that RAND is more relevant to other articles. Also, I think you're wrong to interpret RAND as "critiquing" Cass at all. ] (]) 11:39, 2 January 2025 (UTC) | |||
| :::::::::::See above. I don't think it's critiquing Cass. But the objection to it seems motivated by keeping out criticism, whether it actually is or not. ] (]) 18:32, 2 January 2025 (UTC) | |||
| <references /> | |||
| :The AoMRC’s response to the Cass Review would be worthy of such note. The AoMRC’s response to the BMA critique, an event already given incredibly little weight in this article, bears little to no weight by extension. ] (]) 12:34, 19 September 2024 (UTC) | |||
| ::Wait I didn’t see that you took out the BMA, okay fair ] (]) 12:37, 19 September 2024 (UTC) | |||
| ==Updates and copyedits== | |||
| == International == | |||
| I have gone through the article to make some general copyedits for length and repetition, and to add page refs to some of the citations (see diffs – moving stuff up has made some edits look larger in markup). I have tried to keep the meaning the same. In a few instances, I have removed text that was either apparently unsourced or which didn't reflect the source material (see thread immediately above this one). Where I could, I simply reworded such text, and only removed it when it wasn't there at all in the sources or was unclear/misleading. I'm noting here a few of my own queries/things we might still want to consider: | |||
| * {{tq|There are conflicting views about the clinical approach, with expectation at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services.}} We previously said clinicians had expectations far from the norm based on this, but I think this is actually talking about the expectations of service users and their families. I.e., that the expectation among patients and their families that they will/should receive treatment x, and that clinicians who don't offer this worry they'll suffer sanctions or face a complaint. That was a strong theme in the York papers, and makes sense in the context. If I'm reading that wrong, I'm happy to restore that wording or an alternative, as needed. | |||
| * In-keeping with the general consensus for orgs over individuals in the Responses section (which is still really long), I have trimmed or removed statements by, e.g., the president or chair of an organisation if their comments were substantively the same as those of their org. E.g., if the org says "Yes!" and they say "Yay!" I've left quotes that add extra/different info ("Yay, but..." or "No"). | |||
| * On responses in general, the length is partly to due with lots of direct quotes. We could probably round up some of the Responses (in the format of {{tq|orgs x, y and z supported the review but x said "something else" as well}}). In the meantime, I have trimmed the direct quotes a bit, both for length and to avoid extensive reproduction of text from sources. I don't believe these have changed the meaning of any quotes, but please ping me if I've left something important out or misinterpreted anything. | |||
| * I think the Methodology section spends too much time on the independent systematic reviews, rather than the Cass Review process itself. This may need some workshopping. | |||
| * Do we need a terminology or "concepts" section? There are some concepts that are overlapping and the nuances may not immediately be clear to readers (e.g., gender dysphoria, gender incongruence, gender-related distress). We can outline how the systematic reviews and Cass Review use these terms, if there are differences. | |||
| * I added one sentence to summary Cass' response at the end of the lede: {{tq|Following high profile media coverage, Cass expressed concern that misinformation about the review had spread online and elsewhere, and that her review was being weaponised against trans people.}} It seems important to mention both of these things. This wording seems fairly neutral to me and hopefully conveys the points in broad strokes, without needing to go into too much detail here. Hopefully this isn't controversial, but as always, I am happy to self-revert if necessary. | |||
| Thoughts are always welcome. | |||
| The lead says: "However, it has been criticised by a number of international medical organisations and academic groups for its methodology and findings." I wonder whether "international" is the right word here. | |||
| ] (]) 10:44, 27 December 2024 (UTC) | |||
| :I agree with your idea of summarizing responses, and suggest that it should be {{xt|"orgs x, y and z supported the review, <u>and</u> x said "something else" as well"}}. One risk is that the supporters may be easy to summarize, which could result in "A, B, C, D, E, F, G, H, I, J, K, L, M, O, N, P, Q, R, S, T, U, V, W, and X all supported the review, but Y said <multiple sentences of disagreement> and Z said <long paragraph of disagreement>", which would amount to providing UNDUE weight to a minority of organizations. | |||
| First of all, does the word ''international'' apply to the academic groups, or only to the medical organizations? I'm not sure who the "academic groups" are. There the Integrity Project at ], but I don't see any others (i.e., that aren't medical organizations). | |||
| :Right now, we have a long list of subsections, to which I have added a quick guess at the overall 'feel' of the contents: | |||
| :* Response from UK political parties and public bodies: 90% support | |||
| :* Response from devolved governments: 80% support | |||
| :* Response from health bodies in the United Kingdom: 90% support | |||
| :* Response from other health bodies globally: 10% support | |||
| :* Response from transgender specialist medical bodies: 0% support | |||
| :* Other academic responses: 20% support | |||
| :* Reception by charities and human rights organisations: 40% support | |||
| :* Reception by gender-critical organisations: 100% support | |||
| :The thing about summarizing is that the high levels of support are fairly boring: A, B, C, D, etc., all basically support the review and its recommendations. The opponents, however, are all over the map: N disagrees about this specific thing. O disagrees about a different specific thing. P throws out an ''ad hominem'' attack on Cass herself. Q makes an (unsubstantiated?) claim that Bad People were involved. R thinks it's fine, as long as it doesn't get imported into R's country. And so forth. The net result for the reader is that a concise summary of (for example) 60% support could look like 90% opposition, merely because the opposition can't be summarized as simply. ] (]) 21:39, 27 December 2024 (UTC) | |||
| ::I hear you. But one way around that is to cluster them by the groupings we currently have. So "political parties x, y and z said this", "medical groups a, b and c said that", and so on. If we workshop the text here we might be able to pare it down fairly while making sure it doesn't feel unbalanced? We did something similar for ] and it worked quite well. That section was equally long and got pared right back. ] (]) 07:56, 28 December 2024 (UTC) | |||
| :::I'll take a stab at a draft tomorrow and post it here. I think we can do it without unbalancing things. I think we can keep it balanced through the space we give to each side. ] (]) 18:42, 28 December 2024 (UTC) | |||
| :Catching up now on the many changes over Xmas. So the "weaponisation" is not representative of the source given, which is clear that she's talking about the fear of weaponisation. I've clarified the body and removed from the lede, as I don't think its a significant enough statement in context. ] (]) 13:56, 1 January 2025 (UTC) | |||
| ::I have put the entire sentence because I don't think your reading is clear either. She's saying that she didn't say that trans people don't exist, not that there isn't weaponisation of the report. She's saying that there is fear, yes, but that doesn't mean that the fear isn't due to weaponisation. Arguably, the fear is caused by the weaponisation and that's what she's saying. ] (]) 14:15, 1 January 2025 (UTC) | |||
| :::No, it is not - she's concerned people are fearful. You had written that she was concerned it was being weaponised. These are different. If you have to put the full quote in to try and make sense of it, I think that's ] for such a trivial detail, and as written it is nowhere near ledeworthy. | |||
| :::The quote is | |||
| :::{{quote frame|I think there is an appreciation that we are not about closing down health care for children. But there is fearfulness — about health care being shut down, and also about the report being weaponized to suggest that trans people don’t exist. And that’s really disappointing to me that that happens, because that’s absolutely not what we’re saying.}} | |||
| :::The "disappointing" is ambiguous. Is it the fear or the weaponisation she's referencing? If it was the latter, and if it was significant, there'd be other sources, because she's been very vocal about attacking the misinformation about her review. This feels like making a lot out of a passing comment. There are other, better sources for Cass' reflections, including a whole peer-reviewed article by her. I'd focus on the totality of her reflections as a whole rather than taking a tiny ambiguous quote like this and making it the focus. ] (]) 14:26, 1 January 2025 (UTC) | |||
| ::::She says it's disappointing ''that that happens, because that's absolutely not what we're saying''. It doesn't make logical sense that she's saying "we're not saying that there is fearfulness", or "we're not saying that there's weaponisation", while also saying "fearfulness is happening". The only way that "happening" and "saying" makes sense is if she's saying "weaponisation is happening but we didn't say ". Moreover, you admit yourself it's ambiguous what "disappointing" is referring to, so a direct quote avoids having to make a definitive statement about something you say isn't clear. | |||
| ::::Incidentally, I think there was an edit conflict, so 13tez had inadvertently restored my text. I have edited the text again to address 13tez's edit conflict. The quote now isn't a blockquote, and it's shorter. I didn't re-add it to the lede after you removed it, but including it in the body isn't undue. ::::@] @] @] @] what do you think Cass is trying to say here? ] (]) 15:13, 1 January 2025 (UTC) | |||
| :::::If you have to parse the statement this much to get the meaning you want, then I think you should look for a better source, and if there isn't one, it doesn't belong. She just says its disappointing "that happens". What is the that? The fearfulness? The weaponisation? The whole messy situation where some peoeple are afraid and others draw the wrong conclusions from her work? I get the sense of her throwing her hands up at the whole mess. This is a brief statement in an interview, and seizing on one interpretation of these words and highlighting them to imply she was concerned about people weaponizing the report when she didn't outright say that is not NPOV. | |||
| :::::The best source for Cass' reflections on the review is . | |||
| :::::AFAICT, we still don't cite this, and I don't know why. I brought it up months ago, and it gives a lot of useful material about what Cass felt was the most important takeaways. Weaponisation isn't in there, but she does reiterate: | |||
| :::::{{quote frame | This Review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people's rights to healthcare}} | |||
| :::::I would revisit this source and expand from there the points she actually made and felt worth making, at length, in her own considered words, rather than over-interpreting an NY Times interview. ] (]) 18:06, 1 January 2025 (UTC) | |||
| ::::::{{tq|If you have to parse the statement this much to get the meaning you want, then I think you should look for a better source, and if there isn't one, it doesn't belong.}} That's your opinion, and my opinion is that your interpretation seems to be the unlikely one. I still don't see why you object so much to the direct quotation. If it does indeed mean what you think it does, what harm would it cause to include that wording, rather than making a claim in Wikivoice which one of us is going to dispute? It is a direct answer to someone asking her about the reaction to the report, which is relevant to the section it was in. I believe I am trying to compromise here. ] (]) 19:16, 1 January 2025 (UTC) | |||
| :::::::{{tq | you object so much to the direct quotation}} | |||
| :::::::I don't feel strongly about the direct quotation - I think its overlong but, if that's the compromise fine. | |||
| :::::::But ideally, I would like to go to her peer-reviewed editorial and build this section from that, rather than quotes in interviews. I think that's a much better source for her considered reflections. But that's for another discussion. ] (]) 10:46, 2 January 2025 (UTC) | |||
| == Background changes == | |||
| Hi @], hope you're doing well. | |||
| Secondly, does the word ''international'' mean "organizations that actively/directly work in multiple countries" or is this meant to communicate "medical organizations outside the UK"? As an example, ] is an international medical organization and PATHA of New Zealand is a non-international, non-UK national organization. ] (]) 01:29, 21 September 2024 (UTC) | |||
| After I made to expand the background section to give readers, you one of the paragraphs I added, citing ]. your edit removing my changes, explaining why I felt this paragraph didn't constitute SYNTH. Afterwards, you made in which you removed this paragraph again and warned me not to ] and that this article currently has a ] in place. | |||
| :The answer is both, to both questions. | |||
| :You have international global groups both medical, such as WPATH which is a global international medical organization, as well as groups such as Amnesty International as a global international non-medical human rights group or the Yale report group that was international, but not both medical and non medical. | |||
| :As for the second question, it's both international in the "non-UK" (aka "foreign" (4) per ]) sense but of other national bodies, such as the Australian and New Zealand, American Association of Pediatrics, Canadian, as well as again, global (aka "of having to do with more than one nation" (1) per ]), such as WPATH and the Endocrine society or Amnesty. | |||
| :What is missing is actually that beyond the international criticism, it has also received national criticism, such as from the BMA, which is now missing after , so we should fix that in the lead and add "national and international" in that second sentence. I just made a follow up edit in the article to address this and also added the word "human rights organization" in recognition of Amnesty not falling in either a strictly medical, nor strictly academic group definition of the existing lead summary. ] (]) 02:12, 21 September 2024 (UTC) | |||
| ::Do you know which "academic groups" are supposed to be included here? Amnesty International is neither medical nor academic. (Also, did they actually criticize the review, or did they instead criticize the media coverage and political weaponization of the review? I was under the impression that their response was exclusively the latter.) | |||
| ::At the moment, I'm wondering whether "However, it has been criticised by a number of <u>organizations outside the UK</u>..." would be more appropriate (e.g., includes international and non-international, medical and non-medical, academic and non-academic). ] (]) 02:28, 21 September 2024 (UTC) | |||
| :::You can I made prompted by your initial question, I think especially the added wording of "human rights organizations" makes the question of which other academic groups beyond the Yale report group makes it moot, since we have Amnesty, as well as say Equality Australia, just to pull from the named organizations cited in the article for this. I don't think using the word "outside the UK" improves this and it is accurate to use the term international since there is a mix of global and non-global organizations (in use of the noun of international as I outlined above) that have levied criticism on it, so if we only added "outside the UK" it could be interpreted that it was just some small local other country organizations, so instead then we'd have to preface it with something like "it has been criticized by a number of global and non-global organizations outside the UK", which I think just makes it more convoluted. ] (]) 02:55, 21 September 2024 (UTC) | |||
| ::::I don't think that "widely welcomed by several UK medical organizations" is entirely idiomatic. If it's ''widely'' welcomed, then more than just ''several'' welcome it (though not all, as that would be ''universally'' welcomed). | |||
| ::::I think we could shorten the second sentence to "it has been criticized by a number of organizations outside the UK". Then it wouldn't matter exactly how anyone chooses to classify the organizations. ] (]) 03:23, 21 September 2024 (UTC) | |||
| :::::The new phrasing is very awkward. I think we might just need more than one line to convey the full meaning here. ] (]) 03:28, 21 September 2024 (UTC) | |||
| :::::I don't think a shortening of the sentence is needed and the lead should summarize the article. The lead as it stands is pretty short as-is and given that the reception section is almost half of the article as can be seen from the section sizes (I just added it to the headers of the talk page), if anything it should be expanded to accurately summarize the article and discuss core parts of it. The article presents a mix of medical and other organizations, so the lead calling it out is quite normal for someone who only has time to read the lead to get a picture of where criticism has come from instead of just having an abstract "organizations" without classifying what the array of them are. ] (]) 03:30, 21 September 2024 (UTC) | |||
| ::::::The ] (click that; it changed recently) as it stands is just over 250 words, which is a common length for FAs. For comparison, the old recommendation for an article of this length (just under 5K words) was two or three paragraphs (it's currently three) with 200 to 300 words (it's currently in the middle). ] (]) 04:10, 21 September 2024 (UTC) | |||
| :::::::Right, but my point is that the lead is currently giving a lot more of its content to sections of the article that are much smaller, so it’s not quite summarizing the core contents of the article in appropriately similarly weighted amounts per ] to summarize the entirety of the article as such. So if you want to trim the lead, then instead, we could for example remove the ] at the first sentence on the credentials of Cass, which are word puffery since this article is about the review, not the former credential of who led it. ] (]) 04:19, 21 September 2024 (UTC) | |||
| ::::::::The ==Reception== section contains 7 subsections about reception of the final report. I've lined up the sections with quotations from the lead. Let me know if you see anything else missing: | |||
| ::::::::* political parties – {{xt|and it was endorsed by both the Conservative and Labour parties}} | |||
| ::::::::* NHS England and NHS Scotland – {{xt|In September, the Scottish government accepted the findings of a multidisciplinary team that NHS Scotland had set up to consider how the Cass Review's recommendations could best apply there.}} | |||
| ::::::::* UK health bodies – {{xt|The review's recommendations have been widely welcomed by UK medical organizations.}} | |||
| ::::::::* other health bodies, trans medical groups, "assorted responses" – {{xt|However, it has been criticised by a number of national and international medical organisations, academic groups and human rights organizations for its methodology and findings.}} | |||
| ::::::::* and, finally, Cass's own response to the responses – ??? | |||
| ::::::::At a glance, the lead contains information about all of these sections except the last. I did notice that it omits all mention of support for the report by other health bodies and appears to categorize the non-judgmental response ("Dear Mass Media, Please note that disinformation is bad") from Amnesty International as being a criticism of the Cass Review. | |||
| :::::::: I'm not sure how to classify this part of the lead: | |||
| ::::::::{{xt|The review led to a UK ban on prescribing puberty blockers to those under 18 experiencing gender dysphoria (with the exception of existing patients or those in a clinical trial). The Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust closed in March 2024 and was replaced in April with two new services, which are intended to be the first of eight regional centres. In August, the pathway by which patients are referred to gender clinics was revised and a review of adult services commissioned. In England a clinical trial into puberty blockers is planned for early 2025}} | |||
| ::::::::On the one hand, this is a description of NHS England's reception of the report, namely a list of the changes it has made/is making as a result of the report. On the other hand, it's not presented in the form of "NHS England expressed support/opposition". That choice is probably appropriate (AIUI whether the agency agrees or disagrees is not very relevant, because they are going to have to implement most of the recommendations anyway) but it makes it difficult to decide whether these ~100 words should be 'counted' as representing the ==Recommendations==, ==Implementation==, or ==Reception== sections. It's sort of all three at the same time. ] (]) 17:52, 21 September 2024 (UTC) | |||
| :::::::::If you'd like to do this 'by the numbers', then the ==Reception== section is around 40% of the article, and the quotations in the bullet points (i.e., excluding the part that I'm not sure how to classify) is around 30% of the lead. Since those two numbers are fairly close, that suggests that we're probably getting it approximately right. ] (]) 17:55, 21 September 2024 (UTC) | |||
| :::::I’m not in favor of this new phrasing, it unbalances it in favor of the UK medorgs. | |||
| :::::It’d make it read like “The UK medical community welcomed it, but some other miscellaneous people didn’t like it.” ] (]) 09:50, 22 September 2024 (UTC) | |||
| ::::::Are you thinking that the UK political parties should also be mentioned in that sentence, too? It's inaccurate to say or even imply that only the UK medical community welcomed it. | |||
| ::::::We should probably remove "human rights organizations", because I only see two in the article, and neither of them criticize the report. Amnesty criticizes the misinformation about the report, and the British ] supports it. I'll go do that now. ] (]) 17:29, 22 September 2024 (UTC) | |||
| :::::::Also, there aren't any non-international multinational groups mentioned in this article. "Multinational" does not mean "from outside the UK". It means "operating simultaneously in multiple countries". ] is a multinational corporation. The Integrity Project at Yale isn't even a "national organization". (Technically, it's not even an organization at all; it's a project in a larger organization.) ] (]) 17:33, 22 September 2024 (UTC) | |||
| ::::::::I'm wrong; the ] is multinational (or binational), since it operates in Australia and New Zealand. However, they don't seem to actually criticize the Cass Review, and they refer to a prior 2023 statement that says {{xt|"There are methodological limitations in studies which assess the effectiveness of all models of treatment on the mental health of children and adolescents with Gender Dysphoria...There is limited high quality evidence to inform the provision or the withholding of medical interventions for gender affirmation of children and adolescents....The benefits and potential harms of both medical and psychosocial interventions for TGD children and young people have limited evidence"}} – which sounds pretty consistent with the Cass Review's complaints, as does their statement that standard recommendations {{xt|include caution on the use of hormonal and surgical treatment, screening for potential coexisting conditions (e.g., ASD and ADHD), arranging appropriate service provision for these conditions, and offering psychosocial support to explore gender identity during the diagnostic assessment.}} | |||
| ::::::::I really don't think we should name "multinational organizations" in the lead as opposing or disagreeing with the Cass Review; there's only one in the article, and it's not really opposed to anything in the Cass Review. The only thing they oppose is their own governments creating a copycat inquiry. ] (]) 20:19, 22 September 2024 (UTC) | |||
| :::::::::The Endocrine Society is multinational. Generally my intent was that international be used to mean, outside the UK, and multinational be used to mean operating in more than one country. ] (]) 20:35, 22 September 2024 (UTC) | |||
| ::::::::::Also WPATH is multinational ] (]) 20:38, 22 September 2024 (UTC) | |||
| :::::::::::Then the word you are looking for is ''foreign'', not ''international''. ] (]) 21:27, 22 September 2024 (UTC) | |||
| ::::::::::::“International employees” | |||
| ::::::::::::”International collaborators” | |||
| ::::::::::::”International students” | |||
| ::::::::::::”International cultures” | |||
| ::::::::::::“International films” | |||
| ::::::::::::International is commonly used to replace the word foreign, because foreign carries with it a very specific connotation of ‘us vs the unknown and the strange’ which is not at all helpful. ] (]) 21:30, 22 September 2024 (UTC) | |||
| :::::::::::::But also you didn’t answer my point about the endocrine society and WPATH ] (]) 21:30, 22 September 2024 (UTC) | |||
| ::::::::::::::Is there any question to be answered? You would like to downgrade WPATH and Endocrine Society from ''international'' (which implies they have something to say to everyone) to merely ''multinational'' (which implies that they are operating in specific countries and not in others). You would like to do this so that you can use the word ''international'' to mean "in a single country that isn't the UK". I think these are both bad ideas. ] (]) 21:36, 22 September 2024 (UTC) | |||
| :::::::::::::::… You know what, that’s actually a fair point. ] (]) 21:39, 22 September 2024 (UTC) | |||
| :::::::::::::<small>When ''international'' is used that way (e.g., "international employees"), it is referring to groups of people/things from a wide variety of countries. The individuals are not themselves "international". For example, the ] this year awarded its ] to ], which is a Spanish film, rather than an "international" one.</small> | |||
| :::::::::::::<small>By contrast, an organization or an idea can actually be an international thing, e.g., the ], the ], or the ] ("metric system").</small> ] (]) 21:44, 22 September 2024 (UTC) | |||
| The 1RR rule states: "An editor must not perform more than one revert on a single page—whether involving the same or different material—within a 24-hour period. An edit or a series of consecutive edits that undoes or manually reverses other editors' actions—whether in whole or in part—counts as a revert." | |||
| I have removed the word several from the sentence regarding UK medical organisations for two reasons. Firstly, it didn't make sense. Secondly, according to the article the only UK medical body to criticise the review is the BMA. That is not several, that is near universal approval. That fact should not be watered down in the lede. ] (]) 09:00, 21 September 2024 (UTC) | |||
| As I've described, you have now made two edits which removed this paragraph I added, so you are actually in violation of this rule. Please could you explain why you think this paragraph constitutes SYNTH, regardless of the explanation I offered? Thank you. ] (]) 22:48, 30 December 2024 (UTC) | |||
| :Please ignore the autocorrect typo in my edit summary on the article! Shouldn't edit on mobile. ] (]) 09:27, 21 September 2024 (UTC) | |||
| :Ah, yes, regarding the 1RR, this page is actually under enforced BRD, not 1RR. That was my mistake for getting them mixed up. Regardless, the fact is that you made an addition, it was partially reverted, and under enforced BRD, you’re not to add it back in without consensus. | |||
| Here's my attempt at classifying the responses to the Cass Review's final report: | |||
| :As for synth, there’s no evidence that I saw in your citations that Sweden’s opinions had any bearing on the Cass Report. Otherwise we could just as easily add in all of the countries that said the opposite prior to the report’s publication. ] (]) 22:58, 30 December 2024 (UTC) | |||
| {| class="wikitable sortable" | |||
| ::Hey, thanks for getting back to me. | |||
| |+Groups reacting to the Cass Review | |||
| ::''As for synth, there’s no evidence that I saw in your citations that Sweden’s opinions had any bearing on the Cass Report'' | |||
| !Org | |||
| :: did not state or imply that the findings of the SR commissioned by Sweden did influence the Cass Review. If you are curious about this point, the Swedish guidelines are explicitly discussed in the final report (e.g. page 132) and the SR discussing guidelines. It is, however, part of the background context behind the review being commissioned, namely the debate over the strength of evidence for care like that provided at GIDS. | |||
| !Type | |||
| ::SYNTH refers to using two referenced pieces of information being used to argue for a third, without that third piece of information itself being supported by references. It is not text being irrelevant. | |||
| !Where | |||
| ::Please remove "which are meant to buy time without undergoing any permanent bodily changes for patients to assess their options" as this point is argumentative, discussed elsewhere, unsupported by sources, and not relevant to the concerns of the GIDS staff members. | |||
| !Location | |||
| ::Thanks!] (]) 23:09, 30 December 2024 (UTC) | |||
| !View | |||
| :::Okay starting with the buying time point, it’s in the latter two BBC sources attached to that sentence and since this is the background section and the sources mentioned it, it’s relevant to mention for a full and balanced picture. | |||
| !Notes | |||
| :::As for synth, adding the Sweden thing suggests that the Cass Review was influenced by Sweden’s decision, but no cited sources said that; if you have a citation in the Cass Review, by all means add it back in with citation and we’ll go from there. ] (]) 23:46, 30 December 2024 (UTC) | |||
| |- | |||
| ::::''Okay starting with the buying time point, it’s in the latter two BBC sources attached to that sentence.'' | |||
| |NHS England | |||
| ::::The closest thing I could see is: "These drugs stop a young person's body developing, with the aim of helping to relieve gender dysphoria - distress caused when a person's gender identity does not match their biological sex. The NHS now recognises, external that little is known about their long term side effects." Am I right in thinking this is the sentence you're basing it off? | |||
| |Health | |||
| ::::''since this is the background section and the sources mentioned it, it’s relevant to mention for a full and balanced picture'' | |||
| |UK | |||
| ::::Do you think describing the aim of the use of puberty blockers is relevant in a subsection discussing criticism of GIDS? Why not describe puberty blockers elsewhere, where they're discussed in more detail, so this point would be more relevant? | |||
| |National | |||
| ::::''As for synth, adding the Sweden thing suggests that the Cass Review was influenced by Sweden’s decision'' | |||
| |{{yes O|Support}} | |||
| ::::Well, the paragraph you removed doesn't say there's any link between Sweden's decision and the Cass Review. It was meant to describe the ongoing debate over the extent to which evidence supported the types of treatments given at GIDS and how several countries were also examining them at the time. Do you think we should instead make this point more clearly by describing how several other European countries were examining these treatments because of this ongoing debate (and came to similar conclusions) so this is more explicit? After all, the CR was commissioned by NHSE back in 2020, so the Swedish review couldn't have influenced it being created. | |||
| |They don't have much choice. | |||
| ::::Thanks! ] (]) 00:04, 31 December 2024 (UTC) | |||
| |- | |||
| :::::the recent research part is definitely synth and adds bulk to a background section. And why exactly Sweden specifically for a review article? ] (]) 00:07, 31 December 2024 (UTC) | |||
| |NHS Scotland | |||
| ::::::Maybe we should remake it to focus more on the debate over the extent to which evidence supported the types of treatments given at GIDS and how several countries were also examining them at the time. That was my intent - to illustrate that other countries were also undertaking similar investigations because of this debate. | |||
| |Health | |||
| ::::::We can cut out the unique findings of the Swedish systematic review. I just thought it should be included since it's significant in what it found and its impact - the changes in clinical practice in Sweden. ] (]) 00:30, 31 December 2024 (UTC) | |||
| |UK | |||
| :::::::If other countries are also looking at this evidence, that's something for the Responses section. At best, it requires a sentence in the Background section, but I think it definitely veers into ] territory. What's important to know is that there were concerns about GIDS and evidence, and that's what the Cass Review looked at. That's all well described in the Background section as it was before these additions, and is also discussed in the relevant parts of the Interim report, Final report and Responses sections. | |||
| |National | |||
| :::::::I have added some of the extra info you created over the last day or so as endnotes, but really, none of this is needed for the article at hand. It's already getting long. It may be that there's a changing attitude to things like the Dutch Protocol across Europe, and maybe even elsewhere, but that could be covered at the relevant article or could form a new article. I don't think it needs to be here. ] (]) 12:26, 31 December 2024 (UTC) | |||
| |{{yes O|Support}} | |||
| ::::::::I think we may have gotten a bit confused. There are four publications to consider: | |||
| | | |||
| ::::::::* the February 2022 guideline from the Swedish National Board of Health and Welfare (with a final update in December 2022; ) | |||
| |- | |||
| ::::::::* the March 2022 Cass interim report, | |||
| |] | |||
| ::::::::* the 2023 Swedish systematic review (, cited in ), and | |||
| |Political | |||
| ::::::::* the 2024 Cass final report. | |||
| |UK | |||
| ::::::::The 2023 Swedish systematic review does not actually mention Cass's work. It mentions some of NICE's work (linking to the NICE's documents on the Cass Review's website). <small>"Last, there have been studies in this field published after the date of our literature search (9 November 2021). These have not been added to this study in order to not depart from the systematic approach. We nevertheless wish to comment on some of the publications. First, the ] in England (NICE) conducted evidence reviews of GnRHa<sup></sup> as well as CSHT<sup></sup> for children with gender dysphoria, which were independent from our work. The conclusions generally align with our findings."</small> | |||
| |National | |||
| ::::::::NICE's work was (according to the Cass website) one of the things that led to the creation of the Cass Review, but the Cass Review itself is not mentioned in the 2023 Swedish systematic review. | |||
| |{{yes O|Support}} | |||
| ::::::::The Cass final report discusses the 2022 Swedish National Board of Health and Welfare guideline at some length (primarily pages 129–135). The Cass final report mentions the 2023 Swedish systematic review in a single sentence in 15.25, only as an example of other papers that agree with Cass's commissioned reviews: "This is in line with other systematic reviews published previously (Ludvigsson et al., 2023)." | |||
| | | |||
| ::::::::My first conclusion is that the 2023 Swedish systematic review is certainly not "a response" to Cass, since it doesn't mention Cass at all. It could be considered background information. | |||
| |- | |||
| ::::::::My second conclusion is that the Cass Review was influenced by the 2022 Swedish National Board of Health and Welfare guideline, since it spends quite a lot of time talking about it and agreeing with it. ] (]) 20:38, 31 December 2024 (UTC) | |||
| |] | |||
| ::::::::Hey @], | |||
| |Political | |||
| ::::::::I agree with WhatAmIdoing, both here ("I think we may have gotten a bit confused. There are four publications..") and below ("As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies."). | |||
| |UK | |||
| ::::::::I'm not talking about other countries reacting to the Cass Review with similar reviews of their own or debate over the evidence underpinning treatments given to TGGNC youth that took place after the CR. This happened before the CR, so is part of the situational context before and that led to it. Therefore, it belongs in the Background section, not the Responses section. | |||
| |National | |||
| ::::::::The controversy over GIDS, including the "whistleblowers", legal cases, etc, led, in part, to the review and has been given extensive coverage in the news and has some in the report too. Therefore, per ], so the reader can understand what led to the CR, and so the reader can understand the background on GIDS without having to go and read its article, its discussion is warranted in this article, albeit in a neutral tone, ] style, etc. For example, the Mermaids controversy got a lot of coverage, but after an investigation, there were found to be no inappropriate links between Mermaids and GIDS. Therefore, if we felt it was within due weight and included it here, we'd do so while giving that proviso. ] (]) 13:30, 1 January 2025 (UTC) | |||
| |{{yes O|Support}} | |||
| :::::::::Hi @] and @], | |||
| | | |||
| :::::::::Per the discussion here, a reduced and summarised version of the previous content I added to the background section. It doesn't go into the general history of GIDS and says explicitly what the issues and background were behind the CR. Please let me know what you think when you have time. Thanks! ] (]) 14:37, 1 January 2025 (UTC) | |||
| |- | |||
| ::::::::::As I said elsewhere, I had attempted to come to a compromise on the wording, but VIR's hasty edits have restored much of the objectionable text (for you and for me). Find a version I think is quite fair here: https://en.wikipedia.org/Special:Diff/1266638132/1266639348 Note that it still has the SRs first, but it uses Cass's direct wording (which could be read to mean "this is the bedrock, and these things are also the bedrock" as well as "this is the bedrock, and these are other things we did which aren't the bedrock"), which allows us to briefly mention the other things too. Then the part about the other bits of research are included at the end, but without "supplemented" (since we've used the "bedrock" quote instead). It removes "non-peer reviewed" and "peer-reviewed" but keeps in where it was published. I think that gives you most of what you feel should be included while also doing the same for what I think should be in there? ] (]) 15:37, 1 January 2025 (UTC) | |||
| |] | |||
| :::::::::::Hey @], thanks for trying to compromise again! | |||
| |Political | |||
| :::::::::::I basically just restored your version of the new paragraph (the only differences are: I added a sentence explaining what GIDS is since it hadn't yet been done, at least by that point in the article; I changed the see also link to point to the GIDS article, not its history subsection; I made the text "systematic reviews" link to their article, since they hadn't yet been mentioned in this article; I removed a parameter causing an error in a reference which wasn't needed anyway; and I corrected "the NHS England Policy Working Group" to "an NHS England Policy Working Group"). | |||
| |UK | |||
| :::::::::::@] @] Please can you let me know if we can agree to leave in order to create a compromise and prevent frequent article changes? | |||
| |National | |||
| :::::::::::I'm personally against in the new paragraph ("In the years leading up to the Cass Review, several GIDS staff...") because the references say "debate" rather than "concerns"; there were other (highly covered) legal cases apart from BvT; and the legal cases also examined the evidence base as well as the ability to gain informed consent. However, I'm happy to compromise on them to get the paragraph added because I think it leaves readers more informed, and it allows us to resolve at least that section. | |||
| |{{yes O|Support}} | |||
| :::::::::::Thanks! ] (]) 16:13, 1 January 2025 (UTC) | |||
| | | |||
| ::::::::::::Thank you. I do want to get this right. I know we're all reading things slightly differently here, and I find myself more frustrated than usual with the text of the report itself (which is often imprecise), but I think we're inching closer to getting this article to a good place. | |||
| |- | |||
| ::::::::::::I changed "debate" to "concerns" just because "debate" sounded like it was a formal debate, rather than an ongoing series of issues being raised. If anything, I think that would veer too much on the side of the negative side of the debate over the positive, but I think it is a fair reflection of where things were at. | |||
| |] | |||
| ::::::::::::What did you think of my Methodology wording linked above? I think it also addressed many of your issues while also addressing some of mine. Are you happy for that to be restored as well? ] (]) 16:19, 1 January 2025 (UTC) | |||
| |Health | |||
| :::::::::::::''Thank you. I do want to get this right. I know we're all reading things slightly differently here, and I find myself more frustrated than usual with the text of the report itself (which is often imprecise), but I think we're inching closer to getting this article to a good place.'' | |||
| |UK | |||
| :::::::::::::Thanks again for working in good faith! I agree. Like I said, I'm happy to agree to leave the Background section where it is now, but I wouldn't mind getting another version we all think is an improvement either. | |||
| |National | |||
| :::::::::::::''I changed "debate" to "concerns" just because "debate" sounded like it was a formal debate, rather than an ongoing series of issues being raised. If anything, I think that would veer too much on the side of the negative side of the debate over the positive, but I think it is a fair reflection of where things were at.'' | |||
| |{{yes O|Support}} | |||
| :::::::::::::"on the negative side" meaning the toxic culture war side of things? I see what you mean. We could quote the MEDRS source directly and say "professional disagreement"? You might prefer "disagreement" to "debate", and it focuses the debate/concerns/disagreement to those among medical scientists, rather than toxic discourse between pro-trans and anti-trans groups. | |||
| | | |||
| :::::::::::::''What did you think of my Methodology wording linked above?'' | |||
| |- | |||
| :::::::::::::I'll take a look and reply in the Methodology section here (of this talk page), just so everything stays separated. | |||
| |] | |||
| :::::::::::::Thanks again! ] (]) 16:30, 1 January 2025 (UTC) | |||
| |Health | |||
| ::::::::::::::This got lost in the wall of text. Professional disagreement would be ideal, in fact! ] (]) 13:11, 5 January 2025 (UTC) | |||
| |UK | |||
| :::::::::::@] I have no idea what you're talking about with {{tq|hasty edits}}, please be specific, with diffs. ] (]) 17:36, 1 January 2025 (UTC) | |||
| |National | |||
| ::::::::::::I meant the number of overlapping edits made in a short period of time, which meant that edits made by me and 13tez were reverted accidentally. I had realised all three of us were editing at the same time and tried to restore some of 13tez's text, but that got undone too. | |||
| |{{yes O|Support}} | |||
| ::::::::::::* Here, for example, you said you were reverting one part of the edit, but you also restore prior text from a previous edit at the same time: https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266631684 | |||
| | | |||
| ::::::::::::* Here you restored the "non-peer-reviewed" text you yourself had previously removed, as well as the blockquote I had previously added which you had also objected to: https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266637868 I had removed "non-peer-reviewed" in response to 13tez (I hadn't added it and RAND in the first place). | |||
| |- | |||
| ::::::::::::Those could have been intentional, of course, but since you specifically objected to my use of a direct quote over Wikivoice and felt the RAND sourcing was undue, it seemed unlikely. ] (]) 18:30, 1 January 2025 (UTC) | |||
| |] (RCPCH) | |||
| :::::::::::::{{tq | Here you restored the "non-peer-reviewed" }} | |||
| |Health | |||
| :::::::::::::Aha thank you! This is the problem edit on my part. Yes, that was only supposed to be a section header change, my bad, I blame visual editor/too many tabs etc. | |||
| |UK | |||
| :::::::::::::Hopefully a one off, but please, if I do anything like that again, ping me with the diff at the outset. ] (]) 21:45, 1 January 2025 (UTC) | |||
| |National | |||
| :::::::::I still think some of it is ] because it's drawing connections that Cass hasn't. It would be best to stick to things Cass specifically mentions as influences on the report. ] (]) 14:49, 1 January 2025 (UTC) | |||
| |{{yes O|Support}} | |||
| ::@], it's not quite right to say {{xt|under enforced BRD, you’re not to add it back in without consensus}}. That's the ]. Under enforced BRD, you're not to add something back in until you've posted a comment about it on the talk page and waited 24 hours. | |||
| | | |||
| ::Of course, if, during those 24 hours, a significant amount of opposition appears, then you shouldn't add it back in until the discussion gets settled, but that's due to the ordinary ] policy, not the enforced BRD rules specifically. ] (]) 20:41, 31 December 2024 (UTC) | |||
| |- | |||
| :The background section is significantly expanded by nearly 3x... is all of it necessary or could you just link to the GIDS article for a lot of this criticism? ] (]) 23:44, 30 December 2024 (UTC) | |||
| |] | |||
| ::Well, I expanded the section to allow readers to understand the current situation and history of transgender healthcare for young people in the UK at the time of the review and the concerns and events which led to it. This is important context describing the situation in which the review was commissioned and made. It's given coverage in the report itself because it aids the reader's understanding of the review: how can you understand its recommendations if you don't understand the prior situation they were meant to change. ] (]) 00:33, 31 December 2024 (UTC) | |||
| |Health | |||
| :::It's not at all necessary. This is a huge addition of text added without consensus. This should be a paragraph at most, since the article already lays out the complaints against GIDS well. I will revert and we can sort out a new paragraph. ] (]) 08:58, 31 December 2024 (UTC) | |||
| |UK | |||
| ::::I've posted what I think is a decent compromise on the Methodology section here: https://en.wikipedia.org/Talk:Cass_Review#c-Lewisguile-20241231174000-Methodology_2 As for the Background, I stuck in the "See also" link and added some of the extra detail as endnotes. I'm hoping this avoids bloat while retaining the details people wanted in there for those who want it. ] (]) 17:55, 31 December 2024 (UTC) | |||
| |National | |||
| ::As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies. ] (]) 20:46, 31 December 2024 (UTC) | |||
| |{{yes O|Support}} | |||
| :::The article does not the reasons why the Cass Review was commissioned. We could certainly add a sentence or two more, but we don't need the entire history. ] (]) 14:32, 1 January 2025 (UTC) | |||
| | | |||
| ::::I've taken a stab at compressing what @] just added. It seems better now, although it was simpler before either edit. ] (]) 14:46, 1 January 2025 (UTC) | |||
| |- | |||
| :::::TBH I'm not sure why any of this is here - we already "see also" to GIDS, which covers all this in more detail. ] (]) 15:51, 1 January 2025 (UTC) | |||
| |] (AoMRC) | |||
| ::::::I didn't think it was due anyway, but 13tez very clearly wanted more context there, which is why I trimmed the longer version to a shorter one as a compromise. ] (]) 18:34, 1 January 2025 (UTC) | |||
| |Health | |||
| :::::::Hey @], I gave my reasoning for including this stuff before as follows: "I expanded the section to allow readers to understand the current situation and history of transgender healthcare for young people in the UK at the time of the review and the concerns and events which led to it. This is important context describing the situation in which the review was commissioned and made. It's given coverage in the report itself because it aids the reader's understanding of the review: how can you understand its recommendations if you don't understand the prior situation they were meant to change." | |||
| |UK | |||
| :::::::I also agree with the broad strokes of what WhatamIdoing said was their reasoning for agreeing with the idea of including at least some of the information I added, at least in some form: "As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies." ] (]) 21:27, 1 January 2025 (UTC) | |||
| |National | |||
| ::::::::Ok, I take the point of having something in some form. ] (]) 22:05, 1 January 2025 (UTC) | |||
| |{{yes O|Support}} | |||
| :::::::::Thanks! Glad we can agree or at least compromise on it :) ] (]) 22:17, 1 January 2025 (UTC) | |||
| | | |||
| :Hey @] @] @] @] @], I hope you're all doing well! | |||
| |- | |||
| :Since nobody has changed the background section in a while (past some minor tweaks), I was wondering if you all think we can now agree to leave ? It is a compromise since it's not how any of us left it ourselves, but we've managed to stop the disruptive back-and-forth editing there at least, which is a big win. | |||
| |] (BMA) | |||
| :I was thinking of adding the following notice to the start of the section (which would only show when you go to edit it and doesn't change the article when being read). Please can you let me know if you'd support its addition (or something like it)? | |||
| |Health | |||
| :</!-- January 2025: The current content of this section of the article was formed as a compromise after lengthy discussion between editors (https://en.wikipedia.org/Talk:Cass_Review#Background_changes) who have agreed to leave it in its current state (as of https://en.wikipedia.org/search/?title=Cass_Review&oldid=1267517052#Background). Therefore, and since this article has proven to be contentious and led to frequent, disruptive, back-and-forth editing, if you think changes could improve this section, instead of making them outright, please consider proposing them in the talk page for this article. --> | |||
| |UK | |||
| :Thanks! :) ] (]) 14:27, 5 January 2025 (UTC) | |||
| |National | |||
| ::I generally think that such messages, no matter how heartfelt the sentiment, are ultimately not very helpful, and when they're either present or enforced for more than a few weeks, begin to contradict ] and ]. ] (]) 05:51, 6 January 2025 (UTC) | |||
| |{{no O|Oppose}} | |||
| ::I'm happy with the Background section as it is now. Per usual policy, if there are no further changes to text, consensus can be assumed anyway, but it's always good to have explicit consensus to point to. I don't object to the invisible text, per se, but I know some people interpret policies and suggestions more narrowly than I do, meaning some people might be more likely to avoid editing the text as a result. One alternative might be to take a middle road. E.g., add a much shorter statement like {{tq|<nowiki><!-- Consensus text agreed January 2025. See discussion for more info: https://en.wikipedia.org/Talk:Cass_Review#Background_changes for further info.--></nowiki>}} That doesn't tell people to edit/not edit, but it does flag this discussion for additional context. ] (]) 09:01, 6 January 2025 (UTC) | |||
| | | |||
| |- | |||
| |] | |||
| |Health | |||
| |USA | |||
| |National | |||
| |{{no O|Oppose}} | |||
| | | |||
| |- | |||
| |] | |||
| |Health | |||
| |USA | |||
| |International | |||
| |{{no O|Oppose}} | |||
| | | |||
| |- | |||
| |] | |||
| |Health | |||
| |Canada | |||
| |National | |||
| |{{no O|Oppose}}? | |||
| |They are not updating their recommendations right now. They think PBs are safe and can be appropriate. | |||
| |- | |||
| |] | |||
| |Health | |||
| |Netherlands | |||
| |National | |||
| |{{maybe|Mixed}} | |||
| |They think the evidence base for PBs is fine. | |||
| |- | |||
| |] | |||
| |Health | |||
| |Au + NZ | |||
| |Multinational? | |||
| |{{maybe|Mixed}} | |||
| |They oppose politicians creating a similar government inquiry. | |||
| |- | |||
| |] | |||
| |Health | |||
| |USA | |||
| |International | |||
| |{{no O|Oppose}} | |||
| | | |||
| |- | |||
| |Professional Association for Transgender Health ] (PATHA) | |||
| |Health | |||
| |New Zealand | |||
| |National | |||
| |{{no O|Oppose}} | |||
| | | |||
| |- | |||
| |] | |||
| |Human rights | |||
| |Australia | |||
| |National | |||
| |{{no O|Oppose}} | |||
| | | |||
| |- | |||
| |Australian Professional Association for Trans Health (AusPATH) | |||
| |Health | |||
| |Australia | |||
| |National | |||
| |{{no O|Oppose}} | |||
| | | |||
| |- | |||
| |] | |||
| |Human rights | |||
| |UK | |||
| |International | |||
| |{{operational|No opinion}} | |||
| |Opposes misinformation about the report | |||
| |- | |||
| |] | |||
| |Human rights | |||
| |UK | |||
| |National | |||
| |{{maybe|Mixed}} | |||
| | | |||
| |- | |||
| |] | |||
| |Human rights | |||
| |UK | |||
| |National | |||
| |{{maybe|Mixed}} | |||
| | | |||
| |- | |||
| |] | |||
| |Political? | |||
| |UK | |||
| |National | |||
| |{{yes O|Support}} | |||
| | | |||
| |- | |||
| |] | |||
| |Political? | |||
| |UK | |||
| |International | |||
| |{{yes O|Support}} | |||
| | | |||
| |- | |||
| |British ] | |||
| |Human rights | |||
| |UK | |||
| |National | |||
| |{{yes O|Support}} | |||
| | | |||
| |- | |||
| | rowspan="3" |some unnamed individual academics | |||
| |Academic | |||
| |UK | |||
| | | |||
| |{{yes O|Support}} | |||
| | | |||
| |- | |||
| |Academic | |||
| |UK | |||
| | | |||
| |{{no O|Oppose}} | |||
| | | |||
| |- | |||
| |Academic | |||
| |non-UK | |||
| | | |||
| |{{no O|Oppose}} | |||
| | | |||
| |- | |||
| |Integrity Project at ] | |||
| |Academic | |||
| |USA | |||
| | | |||
| |{{no O|Oppose}} | |||
| | | |||
| |} | |||
| == "Narrative review" == | |||
| Overall, I'd say that the biggest difference between the content of the body and the lead is that the lead makes no mention of mixed responses. There seem to be several organizations that support parts of the report and oppose others, including only opposing very specific or narrow things (e.g., 99% of it is all good and/or none of our business, but we think the evidence base for puberty blockers is good enough). Another thing I've noticed is that the bigger and more UK-based the organization, the less likely they are to fully oppose it. | |||
| The Cass Review is not a narrative review. A ] is an academic review of existing literature. The Cass Review is an independent service review with a wide remit, that commissioned new research and engaged with stakeholders. Relying on one primary source to falsely call it a "narrative review" is wrong, and actually speaks to the reliability of the original source. This was a new addition which I have taken out, but @] has reverted with an edit comment that by my reading wrongly refers to a document from a think tank as "peer-reviewed". I ask this be self-reverted and this badly-sourced misrepresentation actually be discussed before adding. ] (]) 15:13, 1 January 2025 (UTC) | |||
| I've set the table to be sortable because I think that comparing similar groups might be interesting. The default order is the order in the ==Reception== section. If anyone thinks I've misclassified a group, please reply. ] (]) 18:24, 22 September 2024 (UTC) | |||
| :I've told you twice now: it is peer-reviewed. You are frantically editing the page and adding talk page comments, and it's becoming a chaotic mess. You've actually restored text I had taken out because I agreed with 13tez that those things may not be needed, meaning the text is now more objectionable to more people as a result. Please take a breather and read your replies. ] (]) 15:33, 1 January 2025 (UTC) | |||
| :This is pretty great BUT I do have some quibbles: | |||
| ::Just so we're clear about that process: https://www.rand.org/pubs/periodicals/health-quarterly/peer-review.html | |||
| :The first one is that, while their HQs are both in the US, WPATH and the Endocrine Society are both international organizations with global membership. | |||
| ::{{quote frame | All RAND documents are peer reviewed by at least two qualified reviewers—usually a RAND staff member and an outside expert. Reviewers are chosen for technical expertise, policy experience, and ability to provide an objective review. Reviewers are selected by the senior staff member in each RAND division responsible for quality assurance.}} | |||
| :The second one is that I'd split the political category into left and right or trans-supportive vs. trans-exclusionary. It's notable that Labour is supporting the Cass Review from the left(ish), for instance, and it's also not surprising where Sex Matters, Genspect, Mermaids, and Stonewall all fell out. | |||
| ::So it is ''sort of'' peer reviewed, semi in-house, and selected in-house. Not really comparable to an academic journal. This isn't the "gold standard". | |||
| :And the third is that there's a few cases, most notably WPATH/PATHA/AUSPATH but also the various Royal Colleges where we're including a parent organization and its independent child organizations, and I feel like we should note that. ] (]) 18:52, 22 September 2024 (UTC) | |||
| ::Can you please take out the "narrative review" description - it is false. ] (]) 15:41, 1 January 2025 (UTC) | |||
| ::I changed Endocrine to . Amnesty is a UK-based international organization. International organizations have to have their legal existence somewhere. ] (]) 19:04, 22 September 2024 (UTC) | |||
| :::The Cass Review didn't have a peer review at all and you've argued that trumps almost everything else? I don't think we should have double standards here. It's a peer reviewed systematic review. NICE also publishes its own systematic reviews, but that doesn't invalidate them. | |||
| :::That's fair! ] (]) 20:19, 22 September 2024 (UTC) | |||
| ::: |
:::Either way, I didn't add that description, and you reverted my prior edit of that section when you made all your edits recently. It's probably best to go back and figure out who added it and ask them. ] (]) 16:41, 1 January 2025 (UTC) | ||
| ::::You're not comparing like with like. | |||
| ::::Also I'd say the Amnesty response is not entirely "no opinion", they that "{{tq|This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people.}} and {{tq|“The negative rhetoric by the Government about the dangers of so-called gender ideology, healthcare for young trans people, as well as the push against LGBT-inclusive sex and relationship education is harmful and extremely damaging. It is no different from the ultra-conservative and evangelical groups pushing for discriminatory laws targeting trans people in the United States.}}" - whether this critique is on the NHS/British Government or the report itself, it definitely reads as criticism. ] (]) 21:21, 22 September 2024 (UTC) | |||
| ::::The Cass Review is an independent review, and the final report is a culmination of a four-year process encompassing dozens and dozens of contributors and stakeholders, and multiple specifically commissioned systematic reviews. It is not a policy document or a peer-reviewed paper, and iti definitely isn't a "narrative review" - it is a service review, commissioned by a national health body. On this page, the cass review is an authoritative source about itself. | |||
| :::::Yes, they say that ''people who are not the Cass Review'' are behaving badly. Do you see anything that specifically sounds like they have "criticised ...for its methodology and findings"? ] (]) 21:26, 22 September 2024 (UTC) | |||
| ::::Other independent reviews that aren't peer-reviewed are things like the ] - these aren't peer-reviewed sources, they are a different thing entirely. | |||
| ::::::The second quote of "The negative rhetoric by the Government" is criticism - the Cass Review was commissioned by the Government/NHS, and AI is criticizing it. The article is not just about the review, but also the resulting use by the British government of it (as the second paragraph of the lead summarizes with the resulting use of the review by the government, which means that the reception should also extend to it). So we can fix the reception sentence in the lead for this to expand it to something along the lines of "{{tq|However, the review and its use by the British government has been criticised by a number of international and multinational medical organisations, academic groups and human rights organizations for its methodology and findings and the resulting restrictions on healthcare for transgender youth.}} ] (]) 21:36, 22 September 2024 (UTC) | |||
| ::::{{tq | NICE also publishes its own systematic reviews}} | |||
| :::::::Your proposed sentence says that the review has been criticized for: | |||
| ::::NICE is not a policy thinktank. | |||
| :::::::* its methodology, | |||
| ::::{{tq | I didn't add that description}} | |||
| :::::::* its findings, and | |||
| ::::So why did you revert to re-add it? If you aren't defending it, take it out again. | |||
| :::::::* the resulting restrictions on healthcare. | |||
| ::::Also, having now read it in more detail, that RAND source is even more questionable. | |||
| :::::::I do not see any words in the Amnesty International source that sound like criticizing any of those three things. Do you? If not, then we can't really put them down as having said that. | |||
| ::::It describes the 2022 Cass Review (so the Interim Report) as a narrative review, so it isn't applicable anyway. It also places, at the same level, two blogposts on SBM, which are also described as "narrative reviews". | |||
| :::::::As for {{xt|"The negative rhetoric by the Government"}} being criticism, I completely agree with you, but I believe that when they say "the Government" they specifically mean "the Conservative politicians who currently make up the majority in Parliament" rather than "the 388-page-long report itself". ] (]) 01:21, 23 September 2024 (UTC) | |||
| ::::https://sciencebasedmedicine.org/gender-affirming-care-is-not-experimental/ | |||
| ::::::::The sentence is a summary sentence that summarizes the core criticisms by the different organizations, it doesn't mean that every of the either 'medical organizations', 'academic groups' or 'human rights organizations' had the same of the summarized criticisms, just that collectively between those 3, those are some of the main criticisms levied. We can replace the word "restrictions" with "damage" or "harm" instead into "{{tq|resulting damage on healthcare for transgender youth}}", which is the word used by AI. ] (]) 01:30, 23 September 2024 (UTC) | |||
| ::::https://sciencebasedmedicine.org/gender-affirming-care-is-not-experimental-part-ii/ | |||
| :::::::::It's fair to say that not every org has all of the criticisms, but as far as I can see, Amnesty International expresses none of those criticisms. They don't directly criticize the Cass Review at all. ] (]) 01:43, 23 September 2024 (UTC) | |||
| ::::Likewise the "what we know project" which is little more than a group blog. This mixing of high quality sources like Cass with self-published stuff is pretty poor frankly. | |||
| ::::::::::They criticized the government's resulting use of the review affecting trans healthcare. ] (]) 02:04, 23 September 2024 (UTC) | |||
| ::::Also the literature cutoff of September 2023 manages to exclude all the major work like Zepf et al that came just after that date. This document is already out of date, frankly, and seeing as it doesn't actually reference the final Cass Review beyond noting it exists, is not terribly relevant for this page. ] (]) 17:30, 1 January 2025 (UTC) | |||
| :::::::::::Which is not criticism of the review itself. ] (]) 02:23, 23 September 2024 (UTC) | |||
| :::::{{tq|Also the literature cutoff of September 2023 manages to exclude all the major work like Zepf et al that came just after that date.}} All research has limitations. Of course they had a cutoff, because that's common practice. {{tq|This document is already out of date, frankly, and seeing as it doesn't actually reference the final Cass Review beyond noting it exists, is not terribly relevant for this page.}} But in this case, RAND specifically talks about the applicability of Cass to other contexts than the NHS, and talks about its limitations. So I disagree that it's not terribly relevant. | |||
| ::::::::::::And , this article is also not just about the review, but also the resulting use of the government. Which in turn means criticism of the resulting use of the review it also relevant to this article here and I proposed the wording above to reflect that accurately. ] (]) 02:29, 23 September 2024 (UTC) | |||
| :::::{{tq|iti definitely isn't a "narrative review" - it is a service review, commissioned by a national health body}} One isn't exclusive of the other. A service review can be a narrative review as well. According to RAND, its own "research is sponsored by U.S. government agencies; U.S. state and local governments; allied non-U.S. governments, agencies, and ministries; international organizations; colleges and universities; foundations; professional associations; other nonprofit organizations; and industry". | |||
| :::::::::::::Negative rhetoric from politicians isn't the "use by the British government" of the report. The British government used the report to justify a prohibition on prescribing puberty blockers; they did not use the report just to engage in "negative rhetoric" (which, after all, they were saying before, during, and after the report's creation and publication). | |||
| :::::In this case: "This work was supported by ''Indiana University Bloomington'' and the ''Medical College of Wisconsin''. In addition, RAND provided funding to support publication production, quality assurance, and supplemental research analyses. The research was carried out within the Access and Delivery Program in RAND Health Care and the Social and Behavioral Policy Program in RAND Social and Economic Well-Being. In addition, Lorenzo-Luaces was funded by grant numbers KL2TR002530 and UL1TR002529 (A. Shekhar, principal investigator ) from the ''National Institutes of Health'', National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award (NCATS); Peipert was funded by grant number TL1TR002531 (T. Hurley, PI) from NCATS; and Buss was funded by T32-MH103213-07 (W. Hetrick, PI) from the ''National Institutes of Mental Health''. RAND Health Care oversaw the quality assurance process for completing and publishing this report; otherwise, funders did not influence the conduct or reporting of this research. The authors declare that they have no competing interests." | |||
| :::::::::::::I think it would be fair and a straightforward reading of that source to say that Amnesty criticized the government's anti-trans rhetoric. ] (]) 03:26, 23 September 2024 (UTC) | |||
| :::::{{tq|NICE is not a policy thinktank.}} But RAND is not ''just'' a policy thinktank either. It has conducted high profile research for the US government. You can see its prior commissioners here: https://www.rand.org/health-care.html. It uses open publication. | |||
| :Phenomenal, thank you. Perhaps notable that the BMA response was a controversial one. Maybe also note which international medorgs the Cass Review was critical of (Endocrine Society, APA and WPATH) as I think the tit-for-tat nature of these criticisms is noteworthy. ] (]) 19:09, 22 September 2024 (UTC) | |||
| :::::{{tq|So why did you revert to re-add it? If you aren't defending it, take it out again.}} I reverted to the Methodology section that 13tez had edited and which I had re-edited afterwards. 13tez had left it in and I saw (and still see) no reason to take it out. It was about the entirety of that section, not one particular part, which you reverted, thereby reinstating the "non-peer-reviewed" text as well. (See the diffs I posted elsewhere on this page.) | |||
| ::I think the UK/non-UK divide is looking pretty stark. In the UK, only the BMA Council and the unnamed individual academics have expressed total opposition; even Mermaids supports parts of it. Every group based in the US is reacted with polarized total opposition. | |||
| :::::I'm trying to engage in good faith here, but it feels like you're unwilling to compromise on anything. Your responses seem consistently aggressive and ]-like. (not only your fault, but I was trying to fix that when I got reverted again, which made me give up). That makes it very difficult to form a consensus, and the article will just end up being resolved by who can shout the longest. Can we call it a day and come back to this with cooler heads? I'm sure there's a consensus to be had, but it will require all of us to engage with the ongoing attempts to agree wording on this talk page so we don't all keep reverting each other (whether accidentally or not). ] (]) 19:09, 1 January 2025 (UTC) | |||
| ::Are you thinking about adding a phrase along the lines of {{xt|The World Professional Association for Transgender Health, <u>whose guidelines were heavily criticized in the final report</u> released an email statement saying that the report "is rooted in the false premise...}}? ] (]) 19:12, 22 September 2024 (UTC) | |||
| ::::::The edit I'm currently concerned with is here: | |||
| :If you want a rundown of all reception of the Cass Review, ] has collected most of the reception with commentary - including many academic responses that are not currently covered in the article. Organizationally in the UK, there is the British Association of Gender Identity Specialists (, national, UK) and the Feminist Gender Equality Network (, international, UK). | |||
| ::::::https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266632416 | |||
| :So I think beyond maybe adding those those organizations/academic groups to the current receptions, the other thing standing out is some of that other criticism being entirely missing . There has been broad opposition from some editors here about the inclusion of individual academic critiques, as you noted in your table in the "unnamed individual academics", so arguably given that looking at the quite long list that Dr. Pearce (herself a gender studies scholar) has compiled on the issue, I think it might warrant at least a sentence in our assorted reception list along the lines of a summary sentence like "{{tq|Several academic experts have also raised individual criticism of the Cass Review in statements, published papers and magazine articles.}}" instead of being entirely left out of the article. | |||
| ::::::You undid this here along with other changes: | |||
| :One notable interesting in has some interesting commentary on the evidence used in Queensland which looked at similar things to the Cass Review, but with very different results as summarized in their recently published . ] (]) 21:04, 22 September 2024 (UTC) | |||
| ::::::https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266634667 | |||
| ::The blog post says: {{xt|This post provides a round-up of links to written commentary and evidence regarding problems with the Cass Review}}... which suggests that it excludes sources that support the Cass Review. It therefore seems to me that it's not "a rundown of all reception of the Cass Review", but instead "a rundown of all <u>the negative</u> reception of the Cass Review". ] (]) 21:53, 22 September 2024 (UTC) | |||
| ::::::Since then you've made accusations on my part of hasty editing, called for cooler heads, and cast aspersions, with accusations of aggression, while I'm simply trying to get you to engage in good faith on this edit. | |||
| :::I think the article already contains most/all the organizations that support the review, which as summarized is mainly localized to the UK, but it is missing several criticisms of it. | |||
| ::::::Ignore everything else about this source to save distractions and just on this one specific point: I removed a recently added and IMO redundant new sentence in this section that incorrectly calls it a "narrative review" based on a source that doesn't actually call the cass review a "narrative review", and would be wrong to do so if it did. | |||
| :::My point of linking to the list was to help you expand your table with the reception that is currently missing from the article. ] (]) 22:02, 22 September 2024 (UTC) | |||
| ::::::You've reverted my change amid a whole bunch of other issues, which AFAICT are nothing to do with this edit, and then when I asked you why, told me you don't actually want that text in but to to take it up with whoever added it. That isn't how mandatory BRD is supposed to work. If you don't want to defend "narrative review", take it out please. ] (]) 21:34, 1 January 2025 (UTC) | |||
| ::::I'm looking at the list with my WP:RS glasses on. Here's what I see: | |||
| :::::::{{tq|based on a source that doesn't actually call the cass review a "narrative review", and would be wrong to do so if it did.}} - p 10, table 2.1 of the RAND report does call it that... | |||
| ::::* BMA – ''already in the article'' | |||
| :::::::You keep saying the Cass Review is a "service review" rather than a "narrative review", but those are not in any sense mutually exclusive. ] (]) 22:55, 1 January 2025 (UTC) | |||
| ::::* Integrity Project at Yale – ''already in the article'' | |||
| ::::::::It refers to the interim report as that. It is incorrect to do so, and also wrong to apply it to the Cass Review as a whole, or the final report. ] (]) 10:08, 2 January 2025 (UTC) | |||
| ::::* A Google Doc written by two former gender care specialists – probably doesn't even count as ] | |||
| :::::::@], you realise , right? You left that part in but restored text from RAND, including the "non-peer-reviewed" statement I had removed ''and'' RAND's description of limitations which @13tez and I were discussing. I was restoring the text 13tez and I were quibbling over but broadly in agreement on and we were still discussing the nuances when you reverted it. You then and which were also, incidentally, in line with a statement made by the BMA (the same source says: {{tq|Many GPs are not trained to provide the specialist care these patients need and therefore fear risking patient safety.}}) to insert a statement which was less supported in said source, and now you keep demanding that I revert something you yourself have subsequently edited and left in. I'm not being difficult, but I'm well aware of the ], and unfortunately, some editors interpret it narrowly (i.e., including self-reverts as well). Also, if I removed the text I would be obligated to also re-edit the text you restored, since 13tez and I were working on getting it up to scratch and both disagreed with several parts of the restored text. | |||
| ::::* Press release from WPATH and USPATH – ''already in the article'' | |||
| :::::::As for the "narrative review" versus "service review" dichotomy, per ], which you're familiar with: {{tq|Reviews may be narrative or systematic (and sometimes both). Narrative reviews provide a general summary of a topic based on a survey of the literature, which can be useful when outlining a topic. A general narrative review of a subject by an expert in the field can make a good secondary source covering various aspects of a subject within a Misplaced Pages article. Such reviews typically do not contain primary research '''but can make interpretations and draw conclusions from primary sources''' that no Misplaced Pages editor would be allowed to do.}} This fits the definition of Cass to a tee. The primary sources are the York papers and the secondary review is Cass. The York papers also indicate they use narrative methods ''in addition to'' systematic reviews in in multiple places. (See Taylor J, Hall R, Langton T, et al. Arch Dis Child 2024;109:s3–s11 (s3).)] (]) 09:54, 2 January 2025 (UTC) | |||
| ::::* Press release from EPATH – ''already in the article'' | |||
| ::::* British Association of Gender Identity Specialists (BAGIS) – press release that says they want to read the report "before offering a comprehensive response" | |||
| ::::* PATHA – ''already in the article'' | |||
| ::::* AusPATH – ''already in the article'' | |||
| ::::* Therapists Against Conversion Therapy and Transphobia (TACTT) – another press release saying they'll get back to us after they've finished reading it | |||
| ::::* Endocrine Society – ''already in the article'' | |||
| ::::* American Academy of Pediatrics – ''already in the article'' | |||
| ::::* ] – an article in a daily newspaper that is generally supportive, and out of which is highlighted a quotation from an unnamed expert who thinks that the government should have appointed some trans people to lead the inquiry instead of only cis people (fair enough, but doesn't tell us much about the results). | |||
| ::::* ] – self-described as a "paper" (rather than a newspaper) from "a group of like minded doctors, journos and ‘old world’ publishers who would like to jazz up communication more for doctors as we move into a mobile social universe" that says that the Queensland review shows the Cass Review was basically right on the facts, and what's really wrong is the funding for gender healthcare. <small>(I put "doctors paid by funding for healthcare think that there isn't enough funding for healthcare" in the "completely unsurprising" category.)</small> {{pb}}The highlighted quote is the claim from an AusPATH member that "There have been multiple expert academic treatises written on what was wrong with the Cass Review". If those really do exist, then why aren't we citing them? A quick trip to ] with the usual MEDRS filters (review+systematic review+meta analysis) finds nothing from this calendar year. I suspect that the speaker's personal definition of "expert academic treatise" includes "someone put a PDF or Google doc on their university website". | |||
| ::::That's the first section. Either we've already got it, or it doesn't meet WP:RS, or it says they'll get back to us later. ] (]) 02:22, 23 September 2024 (UTC) | |||
| ::IIRC the Queensland report was published in February and the evidence cutoff was September 2023, so misses all the recent systematic reviews on blockers, eg. Zepf et al. ] (]) 22:50, 22 September 2024 (UTC) | |||
| :::Nope, this is a brand new independent report that was published in July 2024 () and looked at new data - {{tq|It was conducted by a panel of professionals external to CHQ from across Australia with expertise and experience in child and adolescent health care and diverse gender experiences between December 2023 and June 2024.}} () - including referencing the final Cass review itself. ] (]) 23:00, 22 September 2024 (UTC) | |||
| ::::Ah right, I mixed it up with the Sax Institute report. ] (]) 06:17, 23 September 2024 (UTC) | |||
| :The definition you are talking about applies to review articles. The Cass Review is not a review article - you're trying to apply terminology across different kinds of document, when "review" has multiple meanings, both broad and narrow. The Cass Review is an independent service review (in the broad sense) that, as part of its process, commissioned multiple systematic reviews (in the narrow sense) and produced an interim report and a final report. It isn't a "review article" published in an academic journal and isn't straightforwardly either a systematic or narrative review. Rather the "review" is a 4-year process, and its output was two reports giving a series of recommendations and guidelines to the NHS about how it structures its service, which the NHS then followed. Quite where the final report fits on the MEDRS pyramid isn't straightforward, but it is much more in line with something like, say, clinical practice guidelines than anything. ] (]) 10:20, 2 January 2025 (UTC) | |||
| == Queensland Children's Gender Service report == | |||
| :In the interests of moving on - I apologise unreservedly for , which mistakenly reinserted text, when the only intention was to change a section heading. | |||
| :Until you pointed to that diff last night, I did not realise that's what happened, as I was looking only at this specific diff relating to "narrative review" and its reversion. Had I realised, I would have reverted it myself. I'm not trying to get you to 3RR, or make demands, I'm just trying in the best possible faith not to fall afoul of enforced BRD. ] (]) 10:41, 2 January 2025 (UTC) | |||
| ::To avoid problems with enforced BRD, worried editors may find it useful to make no more than one edit to the article per 24 hours. ] (]) 11:55, 2 January 2025 (UTC) | |||
| ::Yes, I suspected you didn't mean to restore that text. That was what I was trying to say yesterday. I suspect all three of us were working on edits at the same time and merely pressed publish at different points. Which explains why stuff which was taken out got put back in again, and sometimes in unusual ways. I'm sorry if I implied bad faith on anyone's part – it's always hard to convey/read tone online. ] (]) 17:46, 2 January 2025 (UTC) | |||
| == Gender-Critical Responses == | |||
| Splitting this off from the above, since it's a separate topic, but worth bringing up as it references the Cass Review. | |||
| VIR, you've removed the entire section on gender-critical responses saying {{tq|Remove the "gender critical" organisations response, this seems like passing and non-notable coverage, and hardly deserved its own section, we have plenty of better responses now WP:NOTEVERYTHING}} | |||
| The Australians Queensland government recently published a new independent review report on gender services in Queensland. The () was published in July 2024. | |||
| We have the guardian saying {{tq|Parts of Cass’s review have been proclaimed as wholesale vindication by gender-critical feminists}} | |||
| We have Them and Mother Jones saying {{tq|The Cass Review won’t have an immediate impact on how gender medicine is practiced in the United States, but both Europe’s “gender critical” movement and the anti-trans movement here in the US cited the report as a win, claiming it is the proof they need to limit medical care for trans youth globally. Notable anti-trans group the Society for Evidence Based Gender Medicine called the report “a historic document the significance of which cannot be overstated,” and argued that “it now appears indisputable that the arc of history has bent in the direction of reversal of gender-affirming care worldwide.”}} | |||
| As this article - from the Australian Medical Republic highlights, the independent review looked at similar data as the Cass Review, and had some recommendations similar to Cass, but largely led to some very different outcomes than the Cass Review and the results of the Queensland report were adopted by their government and led to a doubling of the funding to expand services. , . | |||
| Right now we talk about how LGBT orgs have recieved the report, but don't mention gender-critical orgs once. Considering it's a fairly BLUESKY statement that the gender-critical movement in the UK is large and broadly opposed to youth transition, why remove mention of the fact they broadly supported Cass's review? It seems unbalanced to reference only LGBT orgs without any mention of gender-critical ones. | |||
| One thing that was highlighted in the Medical Republic article on it was the statement from the past president from AusPATH calling out that the different outcomes likely are connected due to the Cass Review not including transgender experts ({{tq|According to Brisbane GP Dr Fiona Bisshop, immediate past president of the Australian Professional Association for Trans Health, the Cass Review largely ignored doctors who were providing gender-affirming care. | |||
| “There have been multiple expert academic treatises written on what was wrong with the Cass Review … they intentionally sidelined people who worked in the field. Practitioners who worked with trans patients and trans people themselves were excluded from that whole review, and that didn’t happen . | |||
| They talked to the right people who were using the service and they also included some people in the review panel who were experts.” she told The Medical Republic}}), which I know has been previously ignored on this talk page when it was brought up in , but I think with yet another voice in a whole different continent drawing this same parallel I don't think we can just ignore it and it warrants inclusion in the article. ] (]) 23:39, 22 September 2024 (UTC) | |||
| I think the section should be put back in and expanded. ] (]) 23:11, 1 January 2025 (UTC) | |||
| :I think it’s worth noting that this is a source of significantly higher quality giving this criticism. The BMA also said that the “exclusion of trans affirming evidence” was a reason for their vote, so in light of these two sources I would support inclusion. ] (]) 00:55, 23 September 2024 (UTC) | |||
| ::Perhaps something like “Many in the medical field have accused the Cass Review of deliberately excluding evidence and people which favored gender affirming care as a mode of treatment.” ] (]) 00:57, 23 September 2024 (UTC) | |||
| :::Perhaps “some” instead of “many” would be more neutral ] (]) 01:00, 23 September 2024 (UTC) | |||
| :::What is your source for the incredibly strong claim of "deliberately excluding evidence"? ] (]) 09:39, 23 September 2024 (UTC) | |||
| :I just looked for those "multiple expert academic treatises" in PubMed and didn't find them. Perhaps they're still stuck in the peer-review process? Or perhaps the speaker doesn't mean the same kind of source that I (and MEDRS) would mean with such a statement? | |||
| :A handful of high-quality academic journal articles would be incredibly valuable. A soundbite from an AusPATH past president that asserts ] without identifying any of them is not so helpful. ] (]) 02:28, 23 September 2024 (UTC) | |||
| ::I literally linked one of the peer-reviewed journal articles above that did point this out, so your search may have missed it, or overlooked it. Similarly, as much as people opposed to transgender care here tried to diminish the Yale Report because the academics (several of which are transgender studies experts) that authored it published it as a white paper, rather than a journal article, it also levied that relevant studies were excluded. Similar was levied in this . And as Snokalok pointed out, the point was also raised by the BMA as one of the reasons for them starting their own investigation of the Cass Review. | |||
| ::So again, this now has been levied by multiple fronts, they are not just making things up for the fun of it. | |||
| ::Criticism doesn't have to be exclusively published in academic journals to be relevant, the final Cass review itself is similarly self-published on its own website, not in an academic journal (only the underlying studies it is based on are in the BMJ). ] (]) 02:44, 23 September 2024 (UTC) | |||
| :::That preprint claims evidence was excluded that wasn't. And the Yale report cited the preprint. | |||
| :::And the BMA Council just cited Yale and this preprint, they haven't done an "investigation". This isn't being levied on "multiple fronts". It's the same front. ] (]) 06:28, 23 September 2024 (UTC) | |||
| ::{{tq|"A handful of high-quality academic journal articles would be incredibly valuable"}} ← this. Undercutting science with weak sources is a no-no. ] (]) 04:40, 23 September 2024 (UTC) | |||
| :The QCGS report includes in its summary the conclusion that {{tq|The process of making decisions about medical intervention is thoughtful, considered and '''evidence based'''}}. However, it does not cite the evidence on which that process is based. | |||
| :{{tq| The evaluation '''did not''' '''set out to conduct an extensive literature review''' on the care and treatment of children and adolescents with diverse gender experiences as this was outside the Terms of Reference. }} (page 5) | |||
| :{{tq| The evaluation did not attempt to resolve public debates or subjective opinions on the ethical considerations of children and adolescents accessing gender services, '''nor was an extensive literature review undertaken'''.}} (page 19) | |||
| :Possibly the conclusion of "evidence based" was based on this statement on page 28: {{tq|Once consumers are accessing the QCGS, the community organisations reported the care is extremely comprehensive, considered, safe, and evidence based.}}, which seems to be reporting the opinion of "{{tq|community organisations (NGOs)}}", who seem to be neither doctors nor scientists. | |||
| :I am not seeing any substantial scientific content in this report. Certainly nothing that would challenge the conclusions of the systematic reviews that underpin Cass. | |||
| :The QCGS report says it was {{tq|conducted by a panel of professionals external to CHQ from across Australia with expertise and experience in child and adolescent health care and diverse gender experiences}}. In other words, people who practice within this field. They investigated their field and found no wrongdoing. This is exactly why the Cass Review was done by ] experts. The claim that Cass {{tq|intentionally sidelined people who worked in the field}} would actually be a reason for its strength - and therefore it would be inappropriate for this article to use non-independent non-scientific statements to undermine independent, scientific conclusions. ] (]) 10:18, 23 September 2024 (UTC) | |||
| ::Whether including gender care specialists and/or trans people on the committee itself is overall a strength or weakness is really something for the reliable sources to determine, rather than for Misplaced Pages editors to opine about. | |||
| ::Given that the cis-controlled Cass Review and the trans-inclusive QCGS report came to nearly all the same conclusions (e.g., there are more kids accessing gender services than there used to be, the evidence base is less than ideal, etc.), it might be worth looking for a reliable source commenting on whether involving specialists/people with lived experience actually changes the answers. ] (]) 16:59, 23 September 2024 (UTC) | |||
| :::I think it’s well within the remit of editors to assess the degree to which a source is independent of its subject matter. That’s why we have extensive guidance on how to do it: ]. When writing about climate change, we would question the independence of a source written by people who make a living in the fossil fuel industry. The QCGS report doesn’t identify its authors (which is a separate issue) but does position them as professionals working in the field, whose livelihoods might be at risk if their paper delivered the “wrong” answer. ] (]) 19:30, 23 September 2024 (UTC) | |||
| ::::I mean, the Cass Review doesn't list its full author team either but we have had individuals associated with Genspect and SEGM claiming that they worked on it, soooo ] (]) 19:52, 23 September 2024 (UTC) | |||
| :::::And so you think we should trust their self-serving, self-aggrandizing self-reports? Personally I'd need some evidence that they understand the difference between "worked on" and "submitted a public comment to". ] (]) 00:14, 24 September 2024 (UTC) | |||
| ::::@] According to responding to the guidelines in "Australasian Psychiatry", two of the seven member panel are members of AusPATH. One is actually the president of AusPATH. ] (]) 08:51, 16 October 2024 (UTC) | |||
| :Agreed. There is an issue with balance in the article overall, so this section should go back in. ] (]) 09:11, 2 January 2025 (UTC) | |||
| == BMA update == | |||
| ::What I would hope is that we can get away from the constant blow by blow responses, and start thinking about the wider context and aftermath and subsequent political flashpoints as more secondary and reflective pieces come out. One line in a guardian piece in april saying unnamed "feminists" claim "vindication" doesn't justify a whole section in "responses" | |||
| ::We have a wide variety of contemporaneous responses from major political parties and health bodies domestically and internationally that gives an accurate reflection of how it was received at the time. We have a ton of individual responses we've culled because frankly everyone and their dog has an opinion so we have to keep it to the most significant ones. It is already hard to prioritise. | |||
| :: | |||
| ::But what would be really good is to start working on what I suggested last year, which would be another section to expand on the wider response over time and larger political context in the aftermath. I think we should keep the immediate responses as focused as possible and start fleshing out everything after about August or so in a new section. | |||
| ::What was the immediate response? Domestic political parties and health bodies almost unanimously endorsed it, with a couple of notable exceptions like the BMA. Internationally the picture varied from cautious agreement on some points to outright condemnation. That is a picture we can present in the "responses" based on the best possible and most notable opinions. What was the wider context and aftermath? Maybe we can build a more useful picture of that from other sources but I don't think it is a good to keep expanding this section like this with every minor note of celebration or protest gathered from passing mentions in rolling news coverage at the time. ] (]) 09:59, 2 January 2025 (UTC) | |||
| :::And just so we're clear, the sourcing of this section was one passing mention right at the end of an Economist article that just happened to have a quote from Stella O'Malley, and a self-published statement by Sex Matters. Neither of these are DUE. We have avoided individual responses, and if there was decent secondary coverage dedicated to either of these organisations as a whole then fine, but this is not notable coverage. ] (]) 10:06, 2 January 2025 (UTC) | |||
| :::Again, it's your opinion that it's not notable. Our view is different. There isn't consensus for your removal. ] (]) 10:16, 2 January 2025 (UTC) | |||
| ::::My opinion is based on the dearth of coverage. If there were more coverage (ie an article about sex matters' response in a RS, or an article about Genspect's response), I would agree, but as it is this section is poorly sourced to one quote from one individual, and a self-published statement that I don't think is enough to establish notability. We wouldn't have covered Stonewall's response had it not received press attention in its own right, and Stonewall are vastly more notable, and similarly we wouldn't have framed a quote from an individual connected to Stonewall as Stonewall's official response either. I don't see coverage of a response from either Genspect or Sex Matters and unless there actually is any I don't think this is ]. ] (]) 10:26, 2 January 2025 (UTC) | |||
| :I don't think that it's necessary to expand this content, or to name any of those orgs. It's enough to say that gender-critical orgs praised it, citing ] for this fact. ] (]) 11:58, 2 January 2025 (UTC) | |||
| ::To be fair, though, the same could be said of the various politicians whose views don't diverge from their party's. (I think I've said this before, so apologies if I'm a stuck record.) Until then, we have got a blow by blow, so it should be representative of the key parties. ] (]) 17:39, 2 January 2025 (UTC) | |||
| :::Eventually, I think most of those soundbites will get removed. | |||
| :::The bit about the Green Party issuing and then retracting a statement, for example, is just unencyclopedic. Encyclopedias summarize, with a focus on facts that made a difference. The net effect of the response from the Green Party – one of the smallest political parties in the UK, holding 0.6% of seats in Parliament, by no means a "key party" – on the world, on the Cass Review, on the implementation, on anything except themselves was: nothing. IMO that whole paragraph should be removed. ] (]) 23:08, 2 January 2025 (UTC) | |||
| ::::They probably will get removed but there isn't consensus for that just yet. We'll get there, though. ] (]) 11:45, 3 January 2025 (UTC) | |||
| == Enforced BRD (again) == | |||
| Just in case anyone's curious: ''The Lancet'' is available in ], and reports "more than 1500 doctors", says the campaign is called "''Not In Our Name BMA''", and links to on the petition's website. | |||
| @] you have undone my reverts . | |||
| It also says that the Council's motion passed with 21 votes in favor and 24 abstentions+votes against (assuming the most popular set of rules, that means there must have been at least four abstentions). One person present at the meeting indicated that the vote was skewed by age (younger members more likely to support it) and that a significant proportion had not read the report before voting. Another person said the people who created the motion have been subjected to harassment and abuse online. | |||
| These are recent additions by @], which I have reverted. My understanding of enforced BRD is that these should then be brought here for discussion ''and then consensus established'' before being re-added. ] (]) 10:59, 2 January 2025 (UTC) | |||
| I've updated the number of signatories in this article, but I don't think that this article needs any further detail. I post this because I know some of you were curious about some of the details, and in case it would be useful at the ] article. ] (]) 02:37, 23 September 2024 (UTC) | |||
| :Hmmm. You raise a good point/grey area. My understanding is that @] can't reinstate their own edit for 24 hours, not that nobody can. The examples refer to Editor A and Editor B, where Editor A can't restore until they've discussed with Editor B. But Editor C isn't mentioned at all. | |||
| :{{tq | Policy is debated and voted on openly by the Representative Body at the Annual Representative Meeting (ARM) every June. The Council can formulate policy between ARM events where none exists, '''but it is unheard of for it to do so on contentious topics'''.}} | |||
| :Enforced BRD is also intended to have the advantage that Editor B can't use 1RR+"consensus needed" to stonewall new edits being added, and to prevent Editor A from reverting the revert of Editor B. | |||
| :This is a key point. What the council have done is quite extraordinary, and that (and the mounting opposition) has become the story, rather than any substantive criticism of the Cass Review, which is really just "we read the Yale white paper and that iffy preprint". ] (]) 08:30, 23 September 2024 (UTC) | |||
| :I think Editor C restoring text isn't falling afoul of enforced BRD, but I'm happy to self-revert if there's no consensus for this text. At the moment, the additions (with your restored correction of removing Badenoch) seems fair and balanced, since LGBTQ groups ''are'' relevant and have mostly been removed from this article. It's quite relevant that most LGBTQ+ and trans groups have criticised the review, for example, but that's somehow not in the lede and has been whittled to almost nothing in the Responses section. ] (]) 11:19, 2 January 2025 (UTC) | |||
| ::But it's probably the key point for a different article. <code>:-)</code> ] (]) 16:34, 23 September 2024 (UTC) | |||
| ::I've started a discussion either way: https://en.wikipedia.org/Talk:Cass_Review#c-Lewisguile-20250102113700-Responses_section_(picking_up_per_BRD) I noticed there wasn't one previously. ] (]) 11:38, 2 January 2025 (UTC) | |||
| ::I would disagree TBH, this was added because of a tendency for bold additions to be added, reverted, and then re-added without discussion, and attempts to discuss ignored. I would say that if it can by bypassed by essentially tag-teaming (not an accusation, merely saying that that would permit bypassing EBRD), then it is a worthless measure, and not really in the spirit of the restriction. ] (]) 11:41, 2 January 2025 (UTC) | |||
| :::Ok, so from the FAQ: | |||
| :::{{quote frame | You ''can'' reinstate the edit without violating this sanction, but if your revert gets reverted you must then discuss and wait 24 hours before re-reverting. That said, unless the revert was really bad it's a better idea to go to the talkpage before reverting. And if you stumble upon an active edit war between multiple editors you should definitely try to find a compromise/consensus on the talk page before participating in any reverting.}} | |||
| :::So basically, you aren't ''technically'' violating it, but it does seem to be not in the spirit of things to revert without discussion first. | |||
| :::I'd ask you in future to at least open a discussion first, or slow down and wait to see if the original editor takes it to talk, there's no rush. ] (]) 11:54, 2 January 2025 (UTC) | |||
| ::::Yes, this is unclear, too. I think whoever wrote the FAQ simply didn't consider that a third editor might come along and revert a revert, which is why it only talks about the second person reverting the revert of their revert. Hmmm. It seems @] has pinged someone for clarity, so that may help. | |||
| ::::In any case, BRD does require an attempt to engage in said discussion by the reverter as well, if it's to work. I didn't see a topic for those reversions, which is why I have created this one. I think, in general, I would agree to the "no reverts of reverts" principle for all parties so long as whoever makes the first revert also actually opens up said discussion first. Then it's clear when an enforced BRD process has begun for all parties and it means we can gauge whether there's consensus or not for the edits. ] (]) 17:35, 2 January 2025 (UTC) | |||
| :Pinging ], who may be able to tell us whether tag-team reverting is technically okay, and/or get the rules fixed to be clear about it. ] (]) 12:00, 2 January 2025 (UTC) | |||
| ::Editor C can revert Editor B's revert of Editor A's "bold edit" without first discussing or waiting 24 hours. But of course if editor D reverts Editor C's edit, then C must slow down and join the conversation as well before making any more reverts. Sometimes a disagreement is simple and can be resolved in a couple of edits/reverts without a ton of discussion, especially when a third party shows up. Sometimes it's not simple and there are many editors with different and nuanced viewpoints. That's where we want people to slow down and engage on the talk page instead of just having people "tag-team" up to their 3RR limit. If you want to think of "Enforced BRD" as one round of tag-teaming followed by discussion you can, but I prefer if people would treat it more like a true BRD rather than going through the motions of discussing just so they can revert again tomorrow. <span style="font-family:times; text-shadow: 0 0 .2em #7af">~] <small>(])</small></span> 00:37, 5 January 2025 (UTC) | |||
| :::Excellent. Thanks for the clarification. I think so far people have followed your intention, and the enforced BRD has pushed us to come up with wording that has consensus. Except over Christmas, when things slowed a little, this has also happened relatively quickly. ] (]) 11:53, 5 January 2025 (UTC) | |||
| == Responses section (picking up per BRD) == | |||
| == Japanese Society of Psychiatry and Neurology == | |||
| We have a discussion already about the GC responses in the Responses section. We don't currently have one for the additions of LGBTQ+ groups in that section – these were initially reverted by @] and then restored by me. Personally, I agreed with the original editor, @], that these are ], since the article otherwise includes very little of the LGBTQ+ response to the review (which has largely been mixed to critical, with some outright opposing it). | |||
| This content was added , but the wording suggests a secondary source is being invoked which hasn't (yet?) been cited, in particular for the text | |||
| {{tq2|While taking the Cass Review into consideration, the guidelines ultimately continued ...}} | |||
| Is that right? Or is this interesting bit of analysis ] by the source? (I'll need some extra help with the Japanese to see for myself). More particularly, why is this relevant to the Cass Review? ] (]) 06:14, 29 September 2024 (UTC) | |||
| As it's not entirely clear to me whether enforced BRD also applies to third party editors, I figured I should start the discussion anyway and I can revert the text again if there's not a consensus to keep it. ] (]) 11:37, 2 January 2025 (UTC) | |||
| :Seems to me relevant for ] but not this page. ] (]) 08:02, 29 September 2024 (UTC) | |||
| :After reading the entire section in the new guideline, it does appear relevant as it is a reception to the Cass Review as it specifically dedicates a section to discuss the Cass Review - Page 16 & 17. The document notes the unique situation of the UK healthcare system and Cass, {{tq|The Cass Review was commissioned by the NHS in response to the unique situation in the UK, where gender care for children and adolescents was limited to two NHS-approved centres, with secondary sex suppression therapy being given to a large number of people annually in 2,000 cases without adequate psychological follow-up, under the pretext of a shortage of physicians and even access to general care. (translated from Japanese)}}. | |||
| :The review continues with critique of review due to the country specific context: {{tq|In addition, the Cass Review has also raised concerns about the fact that there are cases in which children and young people who have progressed from secondary sex characteristic suppression therapy to physical treatment such as sex hormones and surgery later regret it, but this is also because the UK guidelines require a long time to adapt to hormone therapy, so secondary sex characteristic suppression therapy is extended to young people who are older than the age that is considered suitable for secondary sex suppression therapy. (translated from Japanese)}}. | |||
| :Which then leads them to their conclusion of {{tq|On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed that the issues pointed out by Cass Review are old acquaintances, and that secondary sexual characteristic suppression therapy has been used for many years. It is a treatment that has been established for many years, and the efficacy and safety of secondary sex characteristic suppression therapy are well known. It is expressed that it is a judgment based on scientific knowledge. ....... In addition, it is medically self-evident that the undesirable physical characteristics of the sex will be irreversible if secondary sexual characteristic suppression therapy is not provided in necessary cases, and although it is difficult to conduct studies that provide high-quality evidence in such cases, there are concerns that it will have a negative impact on the subsequent mental state. (translated from Japanese)}}. | |||
| :So based on this reading, this result from this are very relevant to Cass as another international independent evaluation of the Cass Review, its findings and the resulting effects on puberty blockers being stopped in the UK. The Guidelines address Cass and puts it into context that the Cass Review guidelines were in the specific UK country context and are not otherwise necessarily applicable and also did come to its own conclusion that the administration of puberty blockers are warranted for use in Japan, given the scientific basis of them and the otherwise irreversible effects to transgender youth and the mental health effects. ] (]) 17:00, 29 September 2024 (UTC) | |||
| ::Seems a bit coat-racky from that; their decision is about well, their decision - and doesn't really tell us anything about the Cass Review. ] (]) 17:34, 29 September 2024 (UTC) | |||
| :::How is it coat-racky? It directly addresses multiple points and conclusions of the Cass Review (and determines that they're wrong). ]]<sup>]</sup> 17:42, 29 September 2024 (UTC) | |||
| ::::{{tq|"determines that they're wrong"}} ← where is that in the source? ] (]) 17:46, 29 September 2024 (UTC) | |||
| :::::From the quotes Raladic gave above. They determine multiple conclusions of the Cass Review aren't based in scientific evidence, but because of how bad, long, and underfunded trans care is in the UK. The last bit then has them conclude that puberty blockers have been effective in multiple other countries, as noted by multiple other scientific organizations. And they note the negative mental effects of not giving blockers at the very end. ]]<sup>]</sup> 17:54, 29 September 2024 (UTC) | |||
| ::::::That seems like a rather odd interpretation of what seems like rather a more nuanced response. There is nothing there about "aren't based in scientific evidence", and in any case we wouldn't be using weak sources to undercut strong ones if that means this document is questioning the systematic reviews underlying the review (which are, in Misplaced Pages terms, "science" of the utmost quality). I think if this is to be included we should limit it to what is said about the Cass Review itself directly, rather then trying to tease out implications, especially with ] decorations. ] (]) 18:03, 29 September 2024 (UTC) | |||
| :::::::Please do explain the nuanced response in the quotes above. Especially since it concluded that the support of puberty blockers was what was based in scientific evidence. Oh, and is one of the major Japanese scientific organizations ( and all) that explicitly deals with this sort of subject matter a "weak" source now? Funny, that. The quotes above '''are''' about the Cass Review and what it said and what the organization claims are incorrect. Which is why they specifically refer to the Cass Review in every single paragraph quoted. There is no "teasing" out implications. Unless they're just conclusions you don't like? ]]<sup>]</sup> 18:18, 29 September 2024 (UTC) | |||
| ::::::::Well, for example saying (and I'm leaning heavily on Google translate because of my poor Japanese): {{tq2| points out that there is a lack of evidence to reliably deny the possibility that secondary sexual characteristic suppression therapy may become an environmental factor that disrupts gender identity as a long-term effect, and that there is no evidence to reliably deny its adverse effects on mental and physical development. Following the publication of the Cass Review, discussions on secondary sexual characteristic suppression therapy have arisen not only in the UK but also internationally, and therefore the contents of the Cass Review and related discussions were considered when revising this guideline.}} | |||
| ::::::::or their subsequent statement that they are strengthening reporting guidelines. The words "aren't based in scientific evidence" do not appear.{{pb}}Your disappointing attempt to descend to ''ad hominem'' is noted; do it again and you will find yourself at ], as this is a ]. ] (]) 18:26, 29 September 2024 (UTC) | |||
| :::::::::The part you're quoting is not a section making any statement or conclusion by the Japanese organization, but summarizing one of the claims of the Cass Review. Unless you're claiming that Raladic's translation above is incorrect, it clearly directly addresses such claims, {{tq|It is a treatment that has been established for many years, and the efficacy and safety of secondary sex characteristic suppression therapy are well known. It is expressed that it is a judgment based on scientific knowledge}}, among other things in the quotes above. Again, are those quotes accurate or not? Because those quotes are the actual conclusions of the guideline revisions, not the paragraph you quoted just now. ]]<sup>]</sup> 18:30, 29 September 2024 (UTC) | |||
| ::::::::::The point is we should be relayed (if anything) what this group says about the Cass Review, not what they say about themselves. And what we say should be ]. ] (]) 18:44, 29 September 2024 (UTC) | |||
| :::::::::::The paragraphs Raladic quoted are what the group is saying about the Cass Review. Again, that's why they say "Cass Review" in every single paragraph. And Raladic included the link to the guidelines source, so it's already verified. ]]<sup>]</sup> 18:49, 29 September 2024 (UTC) | |||
| ::::::::::::But the 'medically self-evident' comment is not in paragraph about the Cass Review it it? The big elision in the quote above mask a paragraph break (at least in my rendition). ] (]) 19:02, 29 September 2024 (UTC) | |||
| :::::::::::::The paragraph is prefaced with "In addition", building on the criticisms from international orgs noted in the preceding paragraph. It is followed by a paragraph summing up the debate and what they're choosing to do. The last part of the line is the most opposed to Cass, instead of "we don't have enough high quality evidence to prescribe PBs", they agree with most medical organizations that "it obviously blocks puberty, which is irreversible and not good for trans kids mental health, and it's difficult to conduct 'high-quality' research" ] (]) 19:24, 29 September 2024 (UTC) | |||
| ::::::::::::::Seems like a lot of editorial interpretation there. ] (]) 19:41, 29 September 2024 (UTC) | |||
| :::::::::::::::Seems explicitly what the text says, with little to no interpretation required. ]]<sup>]</sup> 19:47, 29 September 2024 (UTC) | |||
| ::::::::::::::::Well no, because when text states "In addition" that is what is '']'' (words have meaning), Interpeting that to mean "building on the criticisms from international orgs noted" is not explicit, although an editor might argue it is implicit, It might just mean "here is something else we considered in addition" and indeed that would be a plainer reading. I'd prefer it if Misplaced Pages just stuck to summarizing the plain meaning of the source rather than an intepretation of it. ] (]) 20:04, 29 September 2024 (UTC) | |||
| :::::::::::::It’s in the Cass Review section, and is stated as their direct rationale for continuing blockers in spite of the review. ] (]) 03:38, 30 September 2024 (UTC) | |||
| ::::::::::::::Okay, so we're now clear it not in the same "paragraph". The Japanese organisation are it seems choosing to favour additional considerations to the Cass Review's findings in making their decision. But that tells us about their decision, it doesn't tell us about the Cass Review (except through "interpretation" or what you might call ]). ] (]) 03:50, 30 September 2024 (UTC) | |||
| :::::::::::::::The previous sentence talks extensively and explicitly about the reasons for trusting WPATH over the Cass Review, and then says “In addition” to preface its statement about permanent sexual characteristics. That’s not synth, that’s a direct reasoning in regards to the Cass Review from the source. Not every sentence needs to repeat the exact words “Cass Review” to be clearly part of its rationale and findings regarding the Cass Review, amazingly enough. ] (]) 04:07, 30 September 2024 (UTC) | |||
| ::::::::::::::::{{tq|That’s not synth, that’s a direct reasoning}} ← this is a contradiction. The "reasoning" of Misplaced Pages editors is not the basis for content. Although elided in the extract above, this paragraph shifts attention to other considerations "In addition, <u>the AMAB states</u> ...". How is this then about the Cass Review in any ] way? ] (]) 04:14, 30 September 2024 (UTC) | |||
| :::::::::::::::::“On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed the view that the issues raised in the Cass Review are old knowledge, that secondary sexual characteristic suppression therapy is a treatment that has been established over many years, and that the efficacy and safety of secondary sexual characteristic suppression therapy should be judged based on scientific knowledge. The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) 8th Edition (2022)10) also describes the usefulness, limitations and side effects based on more systematic reviews than the Cass Review. | |||
| :::::::::::::::::In addition, it is medically self-evident in AMAB cases that failure to perform secondary sexual characteristic suppression therapy in necessary cases will lead to irreversible physical characteristics of the undesired sex” | |||
| :::::::::::::::::Because this is very clearly | |||
| :::::::::::::::::their reasoning given for not going along with the Cass Review and instead continuing to adhere more closely to WPATH? Your points honestly just read as being a matter of WP:IDONTLIKEIT, this text is pretty indisputable. ] (]) 04:30, 30 September 2024 (UTC) | |||
| ::::::::::::::::::The goalposts keep moving, and now include an attempt to personalize the discussion with your mention of IDONTLIKEIT. Be aware this is a ] so such tactics will result in you being reported to ]. You seem to be correct that the Japanese are generally "not going along with the Cass Review and instead continuing to adhere more closely to WPATH". But this is the point, it tells us about the stances taken in their decision-making process and not about the Cass Review. That they choose to base decision on what is "medically self-evident" tells us nothing about the Cass Review except by the mechanism of ]. ] (]) 04:40, 30 September 2024 (UTC) | |||
| ::::::::::::::::::WPATH SOC7, not 8. ] (]) 06:41, 30 September 2024 (UTC) | |||
| :::::::::::::::::::“WPATH (The World Professional Association for Transgender Health)のStandards of Care (SOC) 第8版 (2022)10)でも、Cass Reviewよりも多くのsystematic reviewをもとに 有用性、限界や副作用について記述している” | |||
| :::::::::::::::::::You don’t need to know Japanese to be able to read that this clearly says SOC8, 2022 ] (]) 06:44, 30 September 2024 (UTC) | |||
| ::::::::::::::::::::You're talking about the passing mentions in background/introduction. The actual updates to the 5th edition Japanese guidelines continued using the 7th edition of the SOC as a reference. ] (]) 06:50, 30 September 2024 (UTC) | |||
| :::::::::::::::::::::No but what I mean is, in the translated quote above it said SOC 8, you corrected to say SOC 7, and now I’m posting the original Japanese to show that it indeed said SOC 8. ] (]) 06:52, 30 September 2024 (UTC) | |||
| ::::::::::::::::::::::What you said is {{tq| instead continuing to adhere more closely to WPATH }} and it is relevant that that is SOC7. ] (]) 07:33, 30 September 2024 (UTC) | |||
| ::::::I can't see anything to support this claim in the text. ] (]) 20:00, 29 September 2024 (UTC) | |||
| ::I'm relying on google translate but from what I can tell the JSPN also said the WPATH SOC 8 "The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) 8th Edition (2022) 10) also describes the usefulness, limitations and side effects based on more systematic reviews than the Cass Review.", which could be mentioned in the article. | |||
| ::I would suggest we slightly alter the language to better capture the gist of the report: {{tq|The Japanese Society of Psychiatry and Neurology published its updated guidelines in August 2024 on the treatment of gender dysphoria. <s>While taking</s> <u>The guideline took</u> the Cass Review into consideration, <s>the guidelines ultimately continued to recommend puberty suppression in trans patients</s> <u>described it as specific to a UK context, noted it's criticisms by other international organizations, stated the WPATH SOC 8 considered more reviews, and</u> <s>noting that</s> stated it "is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it". <s>However, they did ask doctors administering such treatment to report more detailed information on it going forward.</s> <u>They stated they would continue to record prescriptions of puberty blockers to minors but expand to recording discontinuations and switches to hormone therapy.</u>}} | |||
| ::Change explanatins (apart from minor style things) | |||
| ::* "the guidelines ultimately continued to recommend puberty suppression in trans patients" is covered by the last sentence | |||
| ::* "described it as specific to a UK context, noted it's criticisms by other international organizations, stated the WPATH SOC 8 considered more reviews" - I think this cuts to the heart of the criticisms better | |||
| ::* "However, they did ask doctors administering such treatment to report more detailed information on it going forward." - the however doesn't match the tone of the source, and I think it's good to note what they were already recording/pledged to start recording. | |||
| ::] (]) 19:08, 29 September 2024 (UTC) | |||
| :::Again, none of this is really due for this article. It isn't a "response". It is subsequent guidelines that considered Cass, WPATH, APA etc as background. It is due for ] but coatracky here. | |||
| :::And the quotations on offer are highly selective. By my reading they seem to consider Cass not overly relevant because they currently have a large multidisciplinary team and psychological gatekeeping in place to manage individual cases that is far more in line with Cass' recommendations than GIDS practice (ie, the "UK context"). The "medically self-evident" quote is random and irrelevant. Selecting a few lines from a lengthy set of guidelines like this to create some sort of response to Cass is veering into ]. ] (]) 19:59, 29 September 2024 (UTC) | |||
| ::::Of course it is due for the article. The paper spends two whole pages dissecting the Cass Review and which of the recommendations of the Cass Review it disagrees on the point of science, as I quoted above {{tq|that secondary sexual characteristic suppression therapy has been used for many years. It is a treatment that has been established for many years, and the efficacy and safety of secondary sex characteristic suppression therapy are well known.}} | |||
| ::::The other point of why it relevant for inclusion here is that it is one of the first more independent reviews of Cass that are not WPATH or other "involved" organizations that has put specific critique on the Cass Review to say that many of the recommendations from Cass should not be seen as universally applicable recommendations, but only in the context of the UK healthcare system that has been specfically lacking in transgender care. | |||
| ::::The quotations above are not very selective, I copied several of the most relevant translated paragraphs of these two pages that discuss the Cass Review, this isn't a selecting picking of quotes. You are welcome to read the entirety of the two pages if you run them through Bing or Google translate, we just can't reproduce them in their entirety here due to copyright rules. | |||
| ::::The fact that restriction of puberty blockers directly leads to negative mental outcomes as the above new critique called out, and more specifically to the death of transgender youth has also just a few days been backed by a newly published multi-year (), which found that laws restricting access to transgender care, such as restricting access to gender affirming puberty blockers directly led to an increase of 7-72% of suicide attempts of transgender youth. So here is hoping that the restrictions in the UK will be lifted, or else, the results of this study that followed similar such laws that were put in place in several states in the US over the past few years will sadly likely repeat itself in the UK, leading to unnecessary loss of life, given that the science on it now appears even more clear. The study has already been widely covered worldwide, but I haven't seen any mention of it in UK media yet, as it will probably ruffle some feathers in light of the UK government having recently enacted the ban. ] (]) 22:35, 29 September 2024 (UTC) | |||
| :::::{{tq | The paper spends two whole pages dissecting the Cass Review}} | |||
| :::::It spends a few sentences describing some parts of it as background, that's really not the same thing. Non-Japanese speakers are relying on auto translations of varying quality. Here's what I'm reading: | |||
| :::::{{quote frame | The Cass Review was commissioned by the NHS against the backdrop of a unique situation in the UK, where gender medicine for children and young people was limited to two NHS-approved institutions, and puberty blocker treatment was administered to as many as 2,000 individuals annually without adequate psychological follow-up, despite a shortage of doctors making general healthcare access difficult. The Cass Review also highlighted cases where children and young people who had progressed from puberty blockers to hormone treatment and surgery later regretted their decisions. However, the UK guidelines required a long period before eligibility for hormone therapy, meaning puberty blockers were applied to older youths than would typically be expected (the average starting age for puberty blockers in the UK is 15), '''with insufficient psychological assessment before moving on to hormone treatment and surgery'''. Following the Cass Review, the old specialist institutions in the UK were closed, new services were launched, and hormone therapy for young people continued within this new system. Puberty blocker treatment in the UK has been suspended in its previous medical form and is now continuing as part of clinical trials.}} | |||
| :::::That's it. It is describing what happened, and why. There is no dissection, no critique. It goes on to add things about WPATH's response but that's not adding anything. This section then concludes: | |||
| :::::{{quote frame | In light of these points, the revision this time '''highlights cautionary points regarding puberty blocker treatment'''.}} | |||
| :::::And: | |||
| :::::{{quote frame | In revising the guidelines to the 5th edition this time,''' as with the previous guidelines, the WPATH SOC 7th edition was used as a reference'''. Additionally, the guidelines of the Endocrine Society (2017) from the U.S. and the Amsterdam Free University Gender Clinic's guidelines were also referenced. }} | |||
| :::::So this isn't a response or a critique, it is explaining the global backdrop against which they emphasise caution, and stick to SOC7, not SOC8. ] that happens to mention Cass is due, and the way this is currently presented is selective. | |||
| :::::Here's another way of describing this: | |||
| :::::{{tq | The Japanese Society of Psychiatry and Neurology referenced the Cass Review as part of the context for the creation of its 5th edition guidelines for the diagnosis and treatment of gender dysphoria. These guidelines continued to use WPATH SOC7 as a basis, and highlighted points of caution for the use of puberty blockers, while retaining requirements for multidisciplinary involvement and psychological assessment prior to any medical intervention.}} | |||
| :::::All of which is I think a better summary of this document, and still none of it due for this page. ] (]) 11:59, 30 September 2024 (UTC) | |||
| ::::::@] in this you have claimed, again, that these guidelines {{tq | spend an entire two pages dissecting and addressing the Cass Review}}. By my reading, that isn't the case. Merely describing the Cass Review is not two pages dissecting or addressing it. | |||
| ::::::The current wording creates a picture of a ''critical'' "response" from guidelines that are anything but, while eliding that Cass' recommendations are already not a million miles from the Japanese standards (multidisciplinary panels, psychotherapy as a first line treatment, assessment and gatekeeping, concerns with diagnostic issues with comorbid issues like autism, and with intervening too early on children who may not persist after adolescence). | |||
| ::::::I would sum this up as: we don't think Cass is that relevant to us since we're ''already'' taking great care in the way recommended, but in light of increased concerns we're going to reiterate the uncertainties and make sure we track desistance and discontinuation too. | |||
| ::::::As I said below, it ''may'' be due for a section on, say, "impact on international guidelines" or something. But this is not a "response", in the way the other content of this section is. ] (]) 10:26, 1 October 2024 (UTC) | |||
| :::Thanks for the suggestions @] - I just used them to amend the paragraph with a few more wording changes for ease of reading and used the quote from the paper as-is on the effect of not administering puberty blockers, . ] (]) 23:02, 29 September 2024 (UTC) | |||
| :Taking this one sentence at a time: | |||
| :{{tq | The Japanese Society of Psychiatry and Neurology published its updated guidelines in August 2024 on the treatment of gender dysphoria. }} | |||
| :So not immediately obvious how this is ] - it isn't stated up front or announced as a response to the Cass Review. | |||
| :{{tq | The guideline took the Cass Review into consideration and described that the Cass Review was specific to the unique situation in the UK, where gender care for children and adolescents was limited to two NHS-approved centres. }} | |||
| :This makes a tenuous connection to the Cass Review, which is noted as part of the background picture. This is not a response, or an assessment, or a dissection or anything. It also gives a selective interpretation of what is said, which goes beyond the number of centres and into the lack of adequate psychotherapeutic assessment prior to physical intervention. They are largely noting that the criticism of GIDS that Cass produced are not applicable to Japan, where multidisciplinary assessment teams and psychotherapeutic gatekeeping are still the norm. | |||
| :{{tq | The paper noted criticism of the Cass Review by other international organizations, and stated the WPATH SOC 8 considered more reviews. }} | |||
| :This is irrelevant, because the Cass Review is a specific review of services for children and young people, while SOC covers a far wider range of subjects. Also, WRT children and young people, I don't believe it is actually true. All this section is doing is noting such disagreement, not endorsing it, so this adds nothing. | |||
| :{{tq | The paper further stated that "it is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it". }} | |||
| :This is an irrelevant quote that has no bearing on Cass, and doesn't contradict anything in the York reviews which were clear that - on a physical level - blockers certainly work to prevent physical development of secondary sex characteristics. The whole point is that the reasons for doing so were inconsistent, and the evidence of improved mental health was poor. | |||
| :{{tq | They stated they would continue to record prescriptions of puberty blockers in Japan to minors but expand to recording discontinuations and switches to hormone therapy. }} | |||
| :Again, not relevant, and an incomplete picture since the Japanese guidelines are to involve a multidisciplinary team for assessment and gatekeeping that is far more in line with the direction of travel in the NHS. These guidelines are based on 2012's SOC7, which is again not mentioned. | |||
| :Frankly, this feels like taking something that has no bearing on Cass, taking some isolated sentences, and turning it into a "rebuttal". This is all ] for other articles but tenuous here and any attempt to present a full and accurate picture would take up enormous space. ] (]) 09:09, 30 September 2024 (UTC) | |||
| ::@] - Is it necessary for the source to ''exclusively'' be about their thoughts on the Cass Review? Otherwise the source seems plenty DUE as it is directly commenting on the subject & explains what they find potentially lacking/non-applicable to them. Their inclusion would help establish a more diverse range of perspectives in regards to the review's findings & what their potential value may be in a global setting. ] (]) 01:35, 1 October 2024 (UTC) | |||
| :::This section is "responses" - and if you compare the other entries, that's what they are, direct responses, press releases etc. | |||
| :::This is more like "updated international guidelines that happen to mention the Cass Review" - it isn't really a response so much as a description, and the way it's been framed in text (and described in this discussion, as if it's an analysis or critique) seems wrong to me. | |||
| :::Perhaps this would work in a different section on impact on guidelines internationally, but I think it's too soon to really justify that, and I don't think this merits a section of its own. ] (]) 08:26, 1 October 2024 (UTC) | |||
| ::::The Cass Review was published, Japan’s response was to take it into consideration for their guidelines and determine to continue prescribing puberty blockers. That’s a response. ] (]) 12:06, 1 October 2024 (UTC) | |||
| :::::. | |||
| :::::. | |||
| :::::These are the sorts of direct responses to the Cass Review currently outlined in that section. | |||
| :::::Which is why I say an argument could be made for a new section, eg. "Impact on guidelines", and if that were the case, a better job would have to be done actually summarising how and why the guidelines were or weren't updated as a result of Cass, because right now this is a lot of selective interpretation of a ] source. | |||
| ::::: doesn't mention Cass as a reason, but says things like (by my translation): | |||
| :::::{{tq | Since that revision, the number of young patients has continued to increase, and there has been growing momentum to also address not only physical interventions but also psychosocial support.}} | |||
| :::::And the summary of the key revisions: | |||
| :::::{{tq | Key Revisions in the 5th Edition:}} | |||
| :::::{{tq | * Updates in response to revised diagnostic criteria (DSM-5, ICD-11)}} | |||
| :::::{{tq | * Evaluation and treatment of discomfort with assigned gender during childhood}} | |||
| :::::{{tq | * Revisions related to psychiatric care involvement}} | |||
| :::::{{tq | * Additions regarding medications, dosages, and administration methods for hormone therapy and puberty suppression therapy}} | |||
| :::::{{tq | * Revisions regarding puberty suppression therapy}} | |||
| :::::{{tq | Reports:}} | |||
| :::::{{tq | * When starting puberty suppression therapy or hormone therapy for individuals aged 15 to under 18.}} | |||
| :::::{{tq | * When discontinuing puberty suppression therapy.}} | |||
| :::::Have you compared these to the ? By my reading the 4th edition doesn't mention any concerns about infertility or confounding factors like autism, but these are present in the 5th edition - is this a result of the Cass Review highlighting these issues? We can't possibly know, and the document doesn't tell us. Does any of this come across in the text currently in use? No, because the sort of selective interpretation on display at the moment is not a good or comprehensive summary of the changes, turning some disconnected sentences into a "response to the Cass Review". But this source offers absolutely no comment of its own on the Cass Review, nor does it give any indication of the specific ways the guidelines were influenced by it. | |||
| :::::The current paragraph gives the impression "we looked at the Cass Review and ignored it and WPATH criticised it, so we're carrying on with blockers". From actually reading, it seems far deeper than that, with significantly more caution on display, highlighting concerns of comorbidities, diagnostic overshadowing and desistance that weren't present before. I think this is the sort of thing that requires a HQ secondary source specifically analysing the impact of Cass on such guidelines, and until then this is just assembling fragments which create entirely the wrong impression, and all in a part of this article where I don't think it belongs. ] (]) 14:03, 1 October 2024 (UTC) | |||
| ::::::The announcement is a ''summary'' of their updated guidelines, the full document however, as @] pointed out earlier, directly refers to the Cass Review. I'm not quite sure why you are quoting the summary as, by its very nature, it is meant to briefly describe their results, interpretations, & changes, not give in-depth explanations on how they came to those conclusions, hence them linking the document in full as well. I think you are applying too strict an interpretation of what constitutes a "response", as by all means, this directly responds to the Cass Review's findings. ] (]) 14:24, 1 October 2024 (UTC) | |||
| :::::::"{{tq | refers to the Cass Review}}" is not what Raladic described as "{{tq | dissecting and discussing }}". Nor is it "{{tq | criticism}}" as described in . | |||
| :::::::What is their response to the Cass Review? I can't find one in the text. Or do you think that their response to the Cass Review is to ''produce'' the updated guidelines, despite this not being explicitly stated in the source? If so, what part of the guidelines is a response? The text doesn't make this clear, the announcement doesn't make this clear, and what's there now is selecting machine-translated lines from a primary source somewhat arbitrarily, without actually referencing the parts that the announcement says have been updated. ] (]) 08:48, 2 October 2024 (UTC) | |||
| :@] this IP editor added a quotation with no citation. | |||
| :It was replaced with a machine translation by Raladic . | |||
| :Which you arguing that this was, to you, more readable. | |||
| :The wording supplied seems to come verbatim from , which is not a ], is not cited here, and we have no way to ] the translation which is currently presented ''as a direct quote''. | |||
| :This quote is now being used verbatim across multiple pages, with no indication that this is the true source. | |||
| :IMO this quote adds nothing meaningful anyway, and should be removed. ] (]) 09:23, 4 October 2024 (UTC) | |||
| ::IMO the information in the quote is necessary to include. I don’t know if it’s an exact translation, but several translators have said virtually the same thing just in slightly different wording. Maybe we could replace the quote with something that’s not a direct quote such as: The paper noted that if AMAB individuals do not receive puberty suppression when necessary, it can result in irreversible characteristics of the undesired sex which could then negatively impact their mental state. ] (]) 01:21, 5 October 2024 (UTC) | |||
| :::{{tq | The paper noted that if AMAB individuals do not receive puberty suppression when necessary, it can result in irreversible characteristics of the undesired sex which could then negatively impact their mental state.}} | |||
| :::What does this have to do with the Cass Review? ] (]) 07:54, 5 October 2024 (UTC) | |||
| ::::I think it’s a good example of how the new guidelines differ from the Cass Review and ultimately came to some different conclusions despite taking it into consideration. The Cass Review didn’t think puberty suppression was necessary and didn’t think not receiving it could negatively impact mental health. I think it’s important to include contrasting opinions and examples of medical organizations that considered the Cass Review but ultimately disagreed with it on some points. ] (]) 22:59, 5 October 2024 (UTC) | |||
| :Lots of people have opinions, as do lots of activist groups. The student officer for a minor affiliated group in the Labour Party is not an opinion that is as notable as, say, WPATH's. So, we give lots of space to WPATH, and don't waste space on trivia with no significant secondary coverage. | |||
| === Well known === | |||
| :I have in the past said that the responses should be limited to the notable and immediate reaction and implementation, and that wider things (like what you're concerned about) should be used to flesh out a new section covering the wider sociopolitical response and aftermath. I'm fully prepared to believe such things could go in there, but I simply disagree that what a minor political activist thought about the review is of any consequence, compared to how the royal colleges responded straight away. I think this continual attempt to expand "responses" rather than accept a limit there and start expanding further down the article is to the detriment of the article as a whole. My impression of the discussion at the time was that editors perhaps didn't want to see criticism relegated to the bottom of the article, but that's not how I see it - I think there's plenty of space for all that, but it should be contextualised properly as something wider than simply "responses". The Cass Review fits into a large and complicated divide in opinion and perception and we can give that its due, but not by simply recounting responses one by one, and each attempt to bring something new in there simply brings about new conflict. | |||
| Can someone help me out here? The (translated) source is quoted as saying {{xt|the efficacy and safety...are well known}}. Does it actually say anything else? I'm asking this because the efficacy and safety of ] "are well known", too. Specifically, it's known to have one-tenth the efficacy of a sharp knife and to be far less safe. The fact that it's "well known" doesn't mean that it's ''good''. | |||
| :I think it would be more fruitful to discuss how to expand a new section with a broader remit than to continue to bloat the responses. ] (]) 11:43, 2 January 2025 (UTC) | |||
| ::To the extent that it's feasible, I think that most groups should be presented in summaries: Most UK politicians and doctors supported it, the gender-critical people danced in the streets, UK trans groups were appalled by the puberty blocker restrictions but liked the idea of having more than one clinic in the whole country, the parent groups distrusted anything that would require more funding, American trans groups were terrified that it would prompt even more restrictions in the US, etc. | |||
| ::I also think that, to the extent that it's feasible, we should be citing reliable sources that are both independent and secondary for these claims. This will probably get easier as time goes on (e.g., if we get a "one year ago today" kind of news story later this year). ] (]) 12:06, 2 January 2025 (UTC) | |||
| :::A one paragraph intro to the "Reception" section encompassing that sort of high level summary is probably a good idea? | |||
| :::] a new "Further Commentary" section or similar would be a good place to expand with some of the other stuff. ] (]) 12:53, 2 January 2025 (UTC) | |||
| ::::I certainly wouldn't object to an overview like that, either. I think it sorely needs it. I would also have a compressed version in the lede, since it more accurately reflects the pro/anti in broad strokes rather than the flat statement we have in the lede at present. But the former is probably a higher priority. One good outcome of that is that we may, in time, be able to remove or further condense these sections in Responses altogether. It's more important to show the broad support/opposition among groups rather than listing individual comments, but that applies to all support/opposition and needs to be done carefully. ] (]) 17:18, 2 January 2025 (UTC) | |||
| :I agree with Lewis and Friendly Sociologist. Trans people are the affected party, so we should include responses from groups established to protect their interests. ] (]) 14:07, 2 January 2025 (UTC) | |||
| ::Thanks, Henrik. ] (]) 17:19, 2 January 2025 (UTC) | |||
| :::The approach taken in Misplaced Pages policy is to ignore our (i.e., Misplaced Pages editors') beliefs about who "the affected party" is, and to rely on what the published reliable sources say, with special attention to sources that are ] and ]. If the independent, secondary reliable sources don't care what Organization A says, then editors should be cautious about assuming that this article should include information from groups that nobody else thought was worth discussing. ] (]) 07:31, 3 January 2025 (UTC) | |||
| ::::We don't need a source to say the sky is blue, but luckily, there are plenty of sources which discuss the Cass Review as affecting/pertaining to trans people or subsets of trans people (such as the review itself). I don't think anyone here needs to go over the basics of reliable sources, but thanks for offering your advice. ] (]) 11:41, 3 January 2025 (UTC) | |||
| :::::I don't think my earlier comment was clear. I believe that there are multiple affected parties, including, but not limited to: | |||
| :::::* Children and teens who would have been seen at GIDS, except that it's been closed; | |||
| :::::* Parents seeking gender care for their kids; | |||
| :::::* Healthcare providers, who have to learn new referral systems and standards; | |||
| :::::* Gender care providers, whose jobs have disappeared, been relocated, or changed; | |||
| :::::* People in the UK who would not have been seen at GIDS (e.g., because they're adults) but who are affected by subsequent decisions (e.g., schools that have to update their policies); and | |||
| :::::* Trans people outside the UK, especially in the US, who worry what the politicians will do. | |||
| :::::But the fact that a Misplaced Pages editor holds these beliefs is not important. What's important is what the reliable sources say. And for better or worse, the reliable sources don't seem to care much about what some of the small or marginal groups are saying. Therefore, the Misplaced Pages articles shouldn't care much either. | |||
| :::::I think this is a straightforward case of following the sources' lead. ] (]) 02:55, 4 January 2025 (UTC) | |||
| == ILGA, Transgender Europe, and IGLYO Joint Statement == | |||
| In this context, I suspect that "efficacy is well known" means "known to stop progression of puberty", but we seem to have a desire to imply that it means "known to prevent suicides" or "known to improve quality of life 10+ years later" or even "improves the quality of life in the short term, for Autistics who have already reached Tanner 5". While all of that's hoped for, I haven't seen anything that suggests any of that's actually proven. I'm sure the Cass Review never said that puberty blockers aren't effective for temporarily blocking puberty, either, so that would fall into the "not news" category. ] (]) 23:13, 4 October 2024 (UTC) | |||
| :I don't think that part is referring to suicides or anything like that. It says "efficacy and safety", so it's referring to the known effectiveness and safety for the use of puberty blockers, ie stating that the science is that there aren't meaningful health risks like the Cass Review is claiming. The part commenting on mental health effects is at the end of that section. ]]<sup>]</sup> 23:17, 4 October 2024 (UTC) | |||
| ::"Efficacy" has nothing to do with health risks. ] (]) 01:35, 5 October 2024 (UTC) | |||
| :::Whilst Cass did not dispute the efficacy of puberty blockers of blocking puberty, it did dispute the safety of puberty blockers for gender affirming care. In fact this statement of health risks led to the restriction of puberty blockers in the UK (one of very few actual actions so far). A different country saying it is well known these health risks aren't meaningful seem notable (at the very least in the context of the restriction on puberty blockers). ] (]) 13:22, 5 October 2024 (UTC) | |||
| ::::They didn't say they aren't meaningful, they said well-known. ] (]) 13:34, 5 October 2024 (UTC) | |||
| :::::They said their safety is well known. I was taking Silver Seren's comment "there aren't meaningful health risks like the Cass review claims", at face value. ] (]) 13:40, 5 October 2024 (UTC) | |||
| ::::::The passage is quoted in this comment ], which is based (I believe) on the following in the source: | |||
| ::::::{{quote frame | 一方、米国内分泌学会(Endocrine Society) を含む諸外国の複数の関連団体からは、Cass Reviewが指摘する事項は旧知のものであり、二次性徴抑制療法はこれまで長年に渡って築かれてきた治療法であるとともに、二次性徴抑制療法の効果や安全性については科学的知見に基づいて判断していくべきものであるという趣旨の見解が示されている。}} | |||
| ::::::But ]. When I translate it via multiple different methods, it a) reads like they're simply relaying the Endocrine Society's view, and b) don't actually state that the safety and efficacy is well known, rather that '''the concerns raised in the Cass Review''' are well known. | |||
| ::::::If we can't ] what a source says, we shouldn't be using it. Per ] {{tq | Editors should not rely upon machine translations of non-English sources in contentious articles}}. ] (]) 13:58, 5 October 2024 (UTC) | |||
| :::::::I have begged a favor from a friend (a native speaker of Japanese) and received translations for these three sentences: | |||
| :::::::* ja: <span lang="ja" dir="ltr">今回、ガイドラインを再改訂し第 5 版とするにあたって、これまでのガイドライン同様に、WPATHのSOC 第 7 版 <u>11)</u> を参考としている。また、前述の米国内分泌学会 (Endocrine Society 2017) のガイドライン<u>8)</u> 、アムステルダム自由大学ジェンダークリニックのガイドライン <u>9)</u> も参考とした。</span> | |||
| :::::::* en: As we revise the Guidelines to the 5th edition, just like we have done with the past editions, we take into consideration the 7th edition of the WPATH SOC <u>11)</u>. In addition, the Guidelines provided in the Endocrine Society 2017 <u>8)</u> as well as the Gender Clinic Guidelines at the Vrije Universiteit Amsterdam (Amsterdam Free University) <u>9)</u> were also referred to. | |||
| :::::::and | |||
| :::::::* ja: <span lang="ja" dir="ltr">一方、米国内分泌学会(Endocrine Society) を含む諸外国の複数の関連団体からは、Cass Reviewが指摘する事項は旧知のものであり、二次性徴抑制療法はこれまで長年に渡って築かれてきた治療法であるとともに、二次性徴抑制療法の効果や安全性については科学的知見に基づいて判断していくべきものであるという趣旨の見解が示されている。</span> | |||
| :::::::* en: On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed the view that the issues raised in the Cass Review are old knowledge, that puberty suppression therapy is a treatment that has been established over many years, and that the effectiveness and safety of that puberty suppression therapy should be judged based on scientific knowledge. | |||
| :::::::and: | |||
| :::::::* ja: <span lang="ja" dir="ltr">WPATH (The World Professional Association for Transgender Health)のStandards of Care (SOC) 第8版 (2022） <u>10)</u>でも、Cass Reviewよりも多くのsystematic reviewをもとに有用性、限界や副作用について記述している。</span> | |||
| :::::::* en: The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) 8th Edition (2022) <u>10)</u> also describes the usefulness, limitations, and side effects based on more systematic reviews than the Cass Review. | |||
| :::::::The middle one is the one you quote above. In the first and last, I underlined the bits referring to specific footnotes; think of those as just being our little blue clicky numbers/not directly content. ] (]) 23:40, 12 October 2024 (UTC) | |||
| ::::::@], my main concern about this point is that we seem to be interpreting "safety profile is well-known" as being the equivalent of "these are safe". The safety profile of substances like ] and ] are also "well-known", and their safety is very bad indeed. The opposite of "well-known" is "uncertain". If this text actually says that the safety profile is well-known, that doesn't mean the Japanese authors are saying {{!xt|"it is well known these health risks aren't meaningful"}}; they are only saying that whatever the health risks are (whether very significant or very minor or something in between), everyone knows what they are. ] (]) 23:38, 5 October 2024 (UTC) | |||
| :You can read the results of a new multi year study that was just published that ], which has now actually proven that the link - restriction on access to gender affirming care including restricting access to puberty blockers, has led to negative mental health outcomes and a rise in suicides. | |||
| :So since this study just came out and is the first one that actually tracked it, it obviously wasn’t available to consider while the Cass Review was written, or more importantly, the UK government action to now restrict them following the Cass Review, which will sadly likely result in a rise of suicides of trans youth in the UK, unless the UK government reverses course in light of the new data. | |||
| :But in any case, this is a discourse and isn’t specifically linked yet to the Cass Review, but more to reply to your question of {{tq| While all of that's hoped for, I haven't seen anything that suggests any of that's actually proven.}} ] (]) 23:38, 4 October 2024 (UTC) | |||
| ::Thanks for that. However, that doesn't prove that puberty blockers are effective at protecting mental health. It doesn't even show that dashing expectations about being able to receive puberty blockers has an effect. The paper mentions puberty blockers once, as an example of gender-affirming healthcare. The paper did "not differentiate the laws based on type or scope", so they handled the 7 states that restricted healthcare the same as the 12 states that enacted non-healthcare restrictions. If one state enacts restriction "A" only, and another enacts restrictions "A and B", and both see the same result, then that argues for the irrelevance of restriction "B". This paper does not analyze down to that level, so literally all we can say is their conclusion that enacting some anti-trans laws increases suicide attempts. We can't say that it has anything to do with access to puberty blockers. | |||
| ::I am hoping that the authors are taking the ] approach, and that we will therefore some day see a paper that lists which states enacted restrictions in which of their five waves and which categories of restrictions produced the worst effect. In the meantime, this isn't proof that puberty blockers protect mental health, and they don't even try to claim that it is. ] (]) 02:16, 5 October 2024 (UTC) | |||
| ::Please stop carelessly saying the Cass Review or the closure of GIDS or restriction of puberty blockers {{tq | will sadly likely result in a rise of suicides of trans youth in the UK}}. | |||
| ::The UK's leading authority on suicide prevention (and one of the most respected figures in this area worldwide) . | |||
| ::{{quote frame | There is a need to move away from the perception that puberty-blocking drugs are the main marker of non-judgemental acceptance in this area of health care.}} | |||
| ::This new paper based on US social media self-reporting adds nothing to this page. ] (]) 08:01, 5 October 2024 (UTC) | |||
| :::See the problem with this is that it believes that trans kids want puberty blockers because it’s a marker of being accepted and not, you know, so they don’t go through the wrong puberty and the permanent bodily changes that come with it. Any source that supposes the former, is flat out unreliable. ] (]) 08:22, 5 October 2024 (UTC) | |||
| ::::You've misunderstood. He's not saying kids want them as a marker of acceptance - he is talking about the general sociopolitical demand for their provision being treated as {{tq | the main marker of non-judgemental acceptance in this area of health care}}. ] (]) 08:29, 5 October 2024 (UTC) | |||
| :::This study wasn't tracking social media self-reporting, they said they recruited participants using social media and then had strict protocols that they've detailed on the tracking. | |||
| :::This study ran over several years and is newer than the examination you linked as it was just published, so the review you linked obviously didn't have this data that now unequivocally links advancing of restriction of gender affirming care to a rise in suicides. | |||
| :::The data available to science is always a point in time. The world was considered flat, until people found that it was actually spherical. So we now have new strong data that links them. Since the US study found that the rise was not linked merely to the announcement of such anti-trans laws, but only after the restrictions actually went into effect, if an effect may be observed in the UK, it wouldn't have been observable until the restrictions were passed now. ] (]) 15:10, 5 October 2024 (UTC) | |||
| ::::The study is based on self-reports, even though the self-reports aren't being posted on social media. Self-reports have advantages and disadvantages. Especially for mental health issues, selection bias can be significant. But: That's a problem for the peer reviewers. | |||
| ::::What we've got is a ] source that says something very general about passing any anti-trans law, and that says nothing specific about passing healthcare-related laws, much less about passing laws specifically about puberty blockers. Keep in mind that 65% of the states that this paper says saw a rise in self-reported suicide attempts ''did not'' pass any restrictions on healthcare at all, so those kids have every bit as much access to puberty blockers and all other forms of gender-affirming healthcare as they did before. | |||
| ::::I'm not saying this is bad research – not at all – but we've got to respect the research by not blowing it out of proportion. They've found that self-identified trans kids were more likely to self-report suicide attempts some time after ''any'' anti-trans laws went into effect in their area. That's it. They did not find that the common bathroom bills were better or worse or the same as anti-puberty blocker laws. They just found that anti-trans laws in general, taken as an indiscriminate whole, had an effect. ] (]) 23:54, 5 October 2024 (UTC) | |||
| :How you interpret that section depends on the translation, which is why I think the whole thing should be scrapped. | |||
| :For example, this translation (GPT4) implies that the issues raised in the Cass Review aren't new, but are actually well-known: | |||
| :{{quote frame | On the other hand, several related organizations from various countries, including the Endocrine Society in the United States, have expressed the view that the issues raised by the Cass Review are already well-known. Puberty suppression therapy is a treatment method that has been developed over many years, and its effectiveness and safety should be judged based on scientific knowledge.}} | |||
| :However, this translation (Google) implies something very different: | |||
| :{{quote frame | On the other hand, several related organizations in other countries, including the Endocrine Society, have expressed the view that the issues pointed out in the Cass Review are old knowledge, secondary sexual characteristic suppression therapy is a treatment that has been established over many years, and the effectiveness and safety of secondary sexual characteristic suppression therapy should be judged based on scientific knowledge.}} | |||
| :Here, the framing is plausibly not that Cass is old news, but ''outdated'' - and in that sense they are saying that WPATH and the Endocrine society are more up to date in saying its safe and effective. | |||
| :And this one (Bing) is incoherent, while saying the safety is '''not''' known. | |||
| :{{quote frame | On the other hand, several related organizations in other countries, including the American Endocrine Society, Cass The points made by the review are old acquaintances, and secondary sex characteristic suppression therapy has been around for many years. In addition to the treatment that has been built, the effect and safety of secondary sex characteristic suppression therapy are not known.}} | |||
| :I think there's too much contradictory cherry-picking possible without an official English translation, and none of this is ]. ] (]) 08:25, 5 October 2024 (UTC) | |||
| ::The first two say more or less the same thing. ‘The issues raised have been known for a long time, but puberty blockers have been around for a long time and their safety should be based on scientific knowledge.’ The Bing one doesn’t, but also Bing is probably the least reliable resource for, anything, in the history of the internet. Either way, AI hallucinates, and the response by the relevant Japanese org is as due as any other. ] (]) 08:35, 5 October 2024 (UTC) | |||
| :Sorry, what do autistics who have already been through puberty have to do with any of this? ] (]) 08:27, 5 October 2024 (UTC) | |||
| ::In the prior UK system, trans teens who have already completed puberty were put on puberty blockers (i.e., even though there was no more pubertal development to block) because they needed a year of puberty blockers before cross-sex hormones could be accessed. | |||
| ::Post-pubescent Autistic teens were the group that was most likely to voluntarily discontinue the use of puberty blockers before that year of puberty blockers was completed. ] (]) 23:43, 5 October 2024 (UTC) | |||
| :::I think the JSPN section on the Cass Review actually mentioned something to that effect, would you be at all opposed to including that as a useful piece of info (ie quote + context)? To date I don’t know of any article on the topic that has it. ] (]) 01:00, 6 October 2024 (UTC) | |||
| ::::I don't know if the Japanese source says anything about autism. They do say that the Cass Review reported the average age for the initiation of puberty blockers was 15 in the UK ("<span lang="ja" dir="ltr">これ も英国のガイドラインではホルモン療法の適応までに長い時間が必要とされたため、二次 性徴抑制療法に適するとされる年代よりも高めの年齢の若年者にまで二次性徴抑制療法が 適用され（英国における二次性徴抑制療法開始年齢の平均は15歳とされる）</span>"). | |||
| ::::I think it would be appropriate for the article to provide factual information such as "GIDS was seeing a lot of Autistic kids" and "Most kids weren't starting PBs until at least age 15", but I don't know that we gain much from saying that "The Japanese group says that the Cass Review says that most kids who got puberty blockers didn't get them until they were at least 15 years old". This is AFAICT an undisputed fact; we should just present it as an undisputed fact, and we should not present it as merely something someone says. ] (]) 21:51, 6 October 2024 (UTC) | |||
| ::::That info can be sourced to : | |||
| ::::{{quote frame | One study reported that six (8%) young people discontinued gonadotropin-releasing hormone analogues (GnRH-a) for puberty suppression following a median duration of 6months (range 6-18 months). Compared with those who continued with treatment, young people who discontinued had initiated treatment at an older age and included a higher proportion of those with mental health conditions and autism spectrum condition}} ] (]) 11:51, 10 October 2024 (UTC) | |||
| === Medically self-evident quote === | |||
| As I pointed out over on , following on from , the quote {{tq | it is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it}} is not derived from any known machine translation, and the actual verbatim source is a self-published activist website. I tagged this quote as failed verification. Can someone please provide a decent source for this actual translation? ] (]) 12:24, 9 October 2024 (UTC) | |||
| The largest and oldest international LGBT watchdog ], one of the largest and oldest international trans watchdogs ], and the largest LGBT student group ] released a joint statement criticizing UK government policy and said {{tq|The “Keeping Children Safe in Education 2024” guidance uses the Cass Review as an evidentiary basis for this policy change, despite its poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts. As stated by healthcare activist and feminist researcher Dr Ruth Pearce in an article titled “What’s wrong with the Cass Review? A round-up of commentary and evidence” (2024), the Cass Review “has been extensively criticised by trans community organisations, medical practitioners, plus scholars working in fields including transgender medicine, epidemiology, neuroscience, psychology, women’s studies, feminist theory, and gender studies”.}} | |||
| :Oh and I did not notice @] had removed it, I've added it again. The text is here: | |||
| :{{quote frame | また、AMABにおいては、必要な例に二次性徴抑制療法を実施しないことで望まない性 の身体の特徴が不可逆的になることは、医学的に自明であり、そのような例では、質の高 いエビデンスを示す研究をすることが困難なものの、その後の精神状態に悪影響を与える ことが懸念されている。}} | |||
| :Can anyone supply an actual verified source (not a self-published activist website) that this translates as: | |||
| :{{tq | it is medically self-evident that bodily features of the undesired sex will become permanent if AMAB individuals who would require puberty suppression do not receive it}} ] (]) 22:55, 12 October 2024 (UTC) | |||
| ::An alternative to fixating on this lengthy quote is to paraphrase. I think we can confirm that "self-evident" is part of the source. So eg. something like: | |||
| ::{{tq | The guidelines note it is "self-evident" that, unless puberty is suppressed, development of sex characteristics are irreversible in AMAB individuals. }} ] (]) 23:00, 12 October 2024 (UTC) | |||
| :::I think that’s a good compromise suggestion for the sentence. ] (]) 23:07, 12 October 2024 (UTC) | |||
| ::::That would be fine. Or we could go with the summary I previously suggested: {{tq | The paper noted that if AMAB individuals do not receive puberty suppression when necessary, it can result in irreversible characteristics of the undesired sex which could then negatively impact their mental state.}} ] (]) 08:06, 14 October 2024 (UTC) | |||
| ::I still think we should just paraphrase the sentence since all the translations virtually say the same thing just in slightly different wording. That way we can stop debating over the exact word for word translation. ] (]) 08:02, 14 October 2024 (UTC) | |||
| @] removed it saying {{tq|this is about a government action, and it happens to mention the Cass Review in passing. This is not due, and also citing a blog?}} | |||
| == New assorted response: Gender Affirming Care Is Evidence Based == | |||
| # This is about a government action explicitly justified by the Cass Review, which the statement spends a paragraph critiquing | |||
| # They explicitly reference the blog in their statement. We aren't citing it directly, we're providing a courtesy link to who ILGA et al cited. | |||
| Today alone, you removed the fact the UK's LGBT doctors org explicitly criticized it, that the labour party's LGBT chapter criticized it , and are now removing criticism from Europe's largest LGBT rights watchdog and trans rights watchdog by claiming, somehow, a paragraph criticizing the Cass review is not relevant to the section "Reception by charities and human rights organisations". That's today alone, there are dozens of diffs of you trying to remove criticism from LGBT rights orgs, hell you even tried to remove that PATHA criticized them for whitewashing a form of conversion therapy. | |||
| I've removed a section referencing , as this is turning into a ]. By my reading, the entirety of this response boils down to noting the existence of other responses (Horton's piece on the Interim Review, the Noone et al preprint, the Grisjeels commentary and the Yale white paper), which is hardly an improvement to this article. What, specifically, does this response add? | |||
| Please self-revert. This is painfully obviously due, and your continued removal of criticisms from LGBT orgs is getting tendentious to the extreme. ] (]) 20:54, 2 January 2025 (UTC) | |||
| It makes, as far as I can tell, one actual criticism of its own: | |||
| :ILGA are huge and influential. If ILGA release a statement about the Cass Review, and it gets coverage in a RS, it is arguably more due than the Stonewall and Mermaids statements. | |||
| {{quote frame | she also minimizes the robust data and the potential negative impact of increasing barriers for an already disenfranchised group.}} | |||
| :This, OTOH, is a self-published statement about a completely different matter, 9 months after the release of the final report. that happens to mention the Cass Review. It isn't a response and doesn't belong in "reception". | |||
| :Now, if we had a section for wider impacts, or further coverage about related sociopolitical events, there's a case for it there, but even so, I'd hope for a secondary source that directly links this statement to the Cass Review. For example, perhaps if we had coverage of the "Keeping Children Safe in Education 2024" guidance that RS explicitly linked to the Cass Review, and a section in "wider impacts" or something that mentioned it and explained what it was, then this response to that guidance would go there. | |||
| :And citing a blog is terrible sourcing. | |||
| :So I would say: if this statement gets reliable secondary coverage relating it to the guidance, and there's coverage of the guidance relating it to the cass review, and we build enough to make a section relating all three things together in some sort of "wider impacts" or "subsequent events" section of this article, then it would be due. ] (]) 21:56, 2 January 2025 (UTC) | |||
| ::I dont understand why we cannot use advocacy group statements in attributed voice on Misplaced Pages in a reception section, and you just admitted that they are a giant watchdog. I also do not understand, this is clearly a large portion of info about the Cass Review and its effect on government policy. It is like arguing that a report about lung cancer criticizing cigarettes as a cause for cancer in a single paragraph is not about cigarettes and cannot be used as evidence. | |||
| ::The statement isn't a blog either and is part of the IGLYO website. this seems like tendetious editing. ] (]) 22:13, 2 January 2025 (UTC) | |||
| :::{{tq | I dont understand why we cannot use advocacy group statements in attributed voice on Misplaced Pages in a reception section}} | |||
| :::If it were ILGA's statement upon the release of the Cass Review you'd have a point. That's not what this is, it is a statement about a different thing, months down the line. | |||
| :::The problem here is the longstanding resistance to expanding this article and instead turning "reception" into a coatrack, because it seems everyone wants their favourite response to be in "reception". | |||
| :::I would like to expand this article. I think you could make a better case for this statement as part of an expansion in a different section. It isn't "reception" because this is months down the line and a response to a completely unrelated political matter. | |||
| :::I think a better approach rather than continuing to bloat "reception" with ever more tenuous things is: make the case that the political matter itself is due, explain what it is and why, and then include ILGA's response to that. | |||
| :::The Cass Review is significant. It has had a significant impact. Now lots of subsequent matters rely on it. I think it is well past time to try to move past "reception" and into broader matters, and I would like to see the subsequent critical to and fro in that light, where they can be properly presented. | |||
| :::The guidance in question is and the sole reference to Cass is: | |||
| :::{{quote frame | However, the Cass review identified that caution is necessary for children questioning their gender as there remain many unknowns about the impact of social transition and children may well have wider vulnerabilities, including having complex mental health and psychosocial needs, and in some cases additional diagnoses of autism spectrum disorder and/or attention deficit hyperactivity disorder }} | |||
| :::That's literally it, and it is hardly contentious. Now if there's secondary coverage of this guidance, that makes the point it is directly the result of the Cass Review, then there's a case to be made for creating a section in "subsequent government actions" for this, and ''then'' arguably ILGA's response would be due ''as a response to that''. I couldn't find any but I didn't look hard so be my guest. The only ones I found on a cursory search making a big deal out of it is , but that's nowhere near enough, it needs secondary coverage to make it notable, not just advocacy orgs taking predictably polarised positions. | |||
| :::{{tq | The statement isn't a blog either }} | |||
| :::The edit included a citation to a blog. ] (]) 22:31, 2 January 2025 (UTC) | |||
| ::::To be clear: , by someone very invested in collecting every bad thing anyone said about the Cass Review all in one place. This is not a reliable source for anything, and there's no reason to cite it. Trying to justify citing it by calling it a "courtesy link" is no policy I've ever come across. As it stood, the edit inappropriately inflated the opinion of this individual blog. | |||
| ::::We have a longstanding consensus to avoid individual responses in the "reception" section because there are so very many of them, and if we start adding them, there are a dozen higher quality ones in the queue before this one. Trying to add one like this, attached to the ILGA statement, is reopening an old argument. | |||
| ::::So aside from the fact ILGA aren't even responding to the Cass Review I also strongly object to trying to get this extensive opinionated quote in: | |||
| ::::{{quote frame | They also quoted healthcare activist and feminist Dr Ruth Pearce, who collated criticisms of the review and said it "has been extensively criticised by trans community organisations, medical practitioners, plus scholars working in fields including transgender medicine, epidemiology, neuroscience, psychology, women’s studies, feminist theory, and gender studies"}} | |||
| ::::Attempting this simply because ILGA cite this blog is ridiculous when we've excluded far, far more weighty and significant contemporaneous individual responses from, say, the editor-in-chief of the BMJ and surely nobody wants to have the "individual response" argument all over again. ] (]) 22:57, 2 January 2025 (UTC) | |||
| :::::Bruh, ILGA cited them and quoted them. It was not cited for the statement, ILGA was cited quoting them. It would be silly to not provide a courtesy link. It is common practice on Misplaced Pages, when a source quotes and references another, to link the original. | |||
| :::::{{tq|We have a longstanding consensus to avoid individual responses in the "reception" section}} - Once again, it was ILGA et als response being quoted. The fact you don't like what they quoted doesn't mean they didn't quote it. If we have a source that says "BMJ editor-in-cheif said so and so", that would be different, but we don't. Apples and oranges. ] (]) 23:09, 2 January 2025 (UTC) | |||
| ::::::{{tq | that would be different}} | |||
| ::::::It is not - we have dozens of sources of individuals being quoted, and we took the decision not to include any of them because it was so contentious, and it was more important to focus on what, say, WPATH thought, than what, say, David Bell thought. Once we got past the immediate and significant political and medical figures directly responsible for policy and implementation, just adding endless quotes from Doctor X saying "I think its great" and Doctor Y saying "I think its terrible" wasn't adding a lot. ] (]) 23:16, 2 January 2025 (UTC) | |||
| :::::::And here we have ILGA saying according to this collection of criticism and commentary of the Cass Review, it is xyz. Those are individual responses, this is a collation of responses that ILGA thought important enough to name, quote, and reference. ] (]) 23:22, 2 January 2025 (UTC) | |||
| ::::::::Well, let's get some outside opinions. Would you like me to ask at ], since this seems to be a question closer to formatting than to whether her blog contains the quote? Or do you have a different policy/guideline/noticeboard that you think would be more relevant? ] (]) 23:34, 2 January 2025 (UTC) | |||
| :::::::::That might help actually! Though, I did just find ] saying {{tq|Per the verifiability policy, direct quotations ''must'' be accompanied an inline citation}} which seems straightforward. Formatting and policy wise, when have source A saying X and and as B said Y, it makes sense to cite it as {{tq|A said X. It cited B saying Y.}}Somebody should make ] for this lol ] (]) 23:55, 2 January 2025 (UTC) | |||
| ::::::::::WP:V only requires a single source. | |||
| ::::::::::I've posted it at ]. It took a while to figure out how to explain the situation for people who know nothing about the subject matter, but I think it will be clear enough. We'll probably get at least one response in the next 24 hours. ] (]) 04:37, 3 January 2025 (UTC) | |||
| :::::::::::Interested to see what other people say. ] is about alternative hosting for the '''same''' source. So, eg, a formal citation to a book, and a convenience link to an archived public domain copy. I can't see how that justifies adding a direct citation to a blog mentioned in a source. ] (]) 09:36, 3 January 2025 (UTC) | |||
| ::::::::::::First response: It's permitted but not required. | |||
| ::::::::::::Years ago, we did something similar for mass media explanations of medical sources, with the <code>|lay-source</code> parameter in {{tl|cite journal}}, but it wasn't used much, and eventually the community voted to remove the parameters, with the idea that any such secondary source should be presented with its own little blue clicky number (or a ]). ] (]) 23:29, 4 January 2025 (UTC) | |||
| ::::{{tq|a response to a completely unrelated political matter.}} - How exactly is UK government policy explicitly justified by the Cass Review "Completely unrelated"? | |||
| ::::We should expand on the anti-trans schools guidance, and note ILGA's criticisms, in the section on "Subsequent government actions in the UK". But also cover what they explicitly said about the Cass Review itself in the section on human rights orgs. | |||
| ::::WRT {{tq|That's literally it, and it is hardly contentious.}} - That is ''ridiculously'' contentious... | |||
| ::::* Almost every criticism of the Cass Review highlights the fearmongering about supposed dangers of social transition. It's a human right, not requiring any kind of "caution". | |||
| ::::* Almost every criticism of the Cass Review highlights referring to kids who ''explicitly identity as trans'' "gender questioning". | |||
| ::::* Right after the Cass quote, they recommend multiple things Cass called for, which were also heavily criticized such as 1) outing trans kids to their parents 2) telling parents to take their pre-pubertal (ie, in no need of any medical treatment) trans kids to a clinic | |||
| ::::* As ILGA noted, the guidance previously said trans kids should be affirmed. That was replaced with "LGB kids should be affirmed", followed immediately with {{tq| '''However''', the Cass review}}, which is then followed by saying Cass's recommendations about trans kids | |||
| ::::{{tq|The edit included a citation to a blog.}} which ILGA et al explicitly referenced and linked. ] (]) 23:00, 2 January 2025 (UTC) | |||
| :::::{{ tq | How exactly is UK government policy explicitly justified by the Cass Review}} | |||
| :::::Do you have some good secondary sourcing for that? If so, please, expand on this in "subsequent government actions", ideally under a heading like '''"Keeping children safe in education 2024 guidance"''' and add the ILGA response there. | |||
| :::::{{tq | which ILGA et al explicitly referenced and linked}} | |||
| :::::So? ] (]) 23:06, 2 January 2025 (UTC) | |||
| ::::::I said {{tq|How exactly is UK government policy explicitly justified by the Cass Review "Completely unrelated"?}}. You have no compelling arguments for why it isn't, we have a statement from multiple reliable watchdogs that it is. Also, the fact it's blindingly obvious and verifiable. The guidance changed from "affirm LGBT youth" to "affirm LGB youth, however the Cass Review said XYZ about trans kids, so do the things Cass said for trans kids", | |||
| ::::::Like I said, ILGA's response to the guidance can go into a section on education, but the response to the Cass Review should be in the normal place. | |||
| ::::::{{tq|So?}} If we mention what ILGA said, we mention the quote they gave, and there's no good reason not to provide a link and plenty of reasons too. ] (]) 23:20, 2 January 2025 (UTC) | |||
| :::::::You keep saying {{tq | How exactly is UK government policy '''explicitly justified by the Cass Review'''}}. | |||
| :::::::I'm asking you to provide secondary coverage that would justify this statement. | |||
| :::::::If it is indeed {{tq | explicitly justified by the Cass Review}}, I would very much like to see a dedicated section explaining how, ''and then'' the ILGA statement in response, because that is what ILGA are responding to and it demonstrates, for better or worse, the wide impact of Cass on policy, and the ongoing criticism of Cass by orgs like ILGA every time that policy comes up. This would benefit the article as a whole. ] (]) 23:29, 2 January 2025 (UTC) | |||
| ::::::::Page 55 of the DfE guidance says to consult the Cass Review in this area. ] (]) 13:06, 5 January 2025 (UTC) | |||
| :very clearly due and should be included. ] (]) 22:07, 2 January 2025 (UTC) | |||
| :Clearly due. The source is appropriate as per ] and ], since ILGA is a well-recognized expert group and because the statement concerns the source itself. | |||
| :The revert was unwarranted and the content should be reintroduced. ] (]) 23:12, 2 January 2025 (UTC) | |||
| ::@] I don't have the energy for this. Consensus is against you, you aren't convincing anybody, please self-revert so this can be dropped. Best, ] (]) 23:26, 2 January 2025 (UTC) | |||
| :::I've started wondering (not just due to this, but this is a fine example) if Misplaced Pages's whole notion of sourcing is rapidly becoming outdated. | |||
| :::Fifteen years ago, when our Official™ Rules started calcifying, we would have said that if ILGA/this joint statement was actually important, you would know that because someone other than the self-publishers would have picked up on it. There'd be a newspaper article, or a magazine story, or some independent source we could cite. If we were lucky (and we frequently were) that source would combine several, so that we had a single source telling us which of several press releases we needed to pay attention to. | |||
| :::But here we are, four months later, and it sounds like nobody's picked this up. Traditionally, we'd have said that was evidence that the joint statement was not important to get mentioned on Misplaced Pages, as it's too easy for editors to accidentally end up with NPOV failures if we get to cherry pick which sources we personally deem important. | |||
| :::That said, in this case (and some others), I wonder if the problem is that our old assumptions about journalism are now unrealistic. Why would the news media write a story about this statement, when the people who want to read about it have already heard all about it on social media? ] (]) 04:52, 3 January 2025 (UTC) | |||
| ::::Here's how I'd expect something like this to be covered: | |||
| ::::{{tq | In September 2024, the UK Government released new statutory guidance for schools and colleges, titled "Keeping children safe in education 2024". This provided guidance for safeguarding in education, covering a variety of topics from physical abuse to mental health, along with escalation pathways and statutory duties for educators. The guidance contained new measures '''explicitly justified by the Cass Review''', regarding social transition within the education environment, cautioning that schools and college should be aware of the Review's findings and guidance in this area. IGLYO, ILGA-Europe and TGEU released a statement strongly condemning the new guidance, expressly criticising its reliance on the Cass Review as an evidentiary basis. }} | |||
| ::::Or something similar, expand ILGA's effusive condemnation as appropriate etc. If that could be sourced I would support that at a minimum for starters, and as I suggested, it would fit nicely under "further government actions". | |||
| ::::The problem is that everything up until the mention of the ILGA statement has absolutely zero coverage that I can find. This guidance has been roundly ignored by the press since it came out 4 months ago, nobody has made any connection to the Cass Review outside of activist groups, and the mention of Cass in the actual document boils down to a single paragraph in a 180-page document, making the "explicitly justified" overstating things somewhat. Without the underlying guidance being notable, and without it having some relation to the Cass Review as established in a RS, there's no real grounds for incorporating ILGA's statement on this page, ''as if it were a direct response to the Cass Review'' when it is - very explicitly, from the title on down - a response to new statutory guidance and a criticism of that guidance's reliance on the Cass Review. | |||
| ::::So I would say you could make a case that ILGA etc are big and notable enough that their self-published statement doesn't need a secondary source to establish notability, but I think you need a secondary source to establish the notability of what they're actually responding to, and that connects that government guidance to the Cass Review, so you can hang the ILGA statement off it. Otherwise we're going to be mining every activist statement that responds to every policy downstream of the Cass Review, and chucking it in "reception" pretending they're responses to Cass, when they aren't - they're responses to further events the Cass Review precipitated, which individually should be included if they're notable. ] (]) 09:18, 3 January 2025 (UTC) | |||
| :::::I thought the source itself was fine (subject matter experts talking about themselves and not about a BLP), and it is notable. But it's probably too long where it was. I would support it going under "further govt action" as per @]. I'd suggest the following: | |||
| :::::{{tq|In September 2024, the UK Government released new statutory safeguarding guidance for schools and colleges, titled "Keeping children safe in education 2024". Among the topics covered by the guidance, it contained new measures regarding social transition within the education environment, saying that schools and colleges should follow the Cass Review in this area. ] (ILGA), international LGBTQ student organization ], and ] released a joint statement condemning the new guidance, and criticising its reliance on the Cass Review for its "poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts".<ref name="ILGA-TGEU-IGLYO">{{Cite web |date=September 2, 2024 |title=Joint statement: Trans children and young people in schools deserve safety and understanding |url=https://www.ilga-europe.org/news/trans-children-and-young-people-in-schools-deserve-safety-and-understanding/ |access-date=2025-01-02 |website=] Europe |language=en-GB}}</ref>}} ] (]) 11:19, 3 January 2025 (UTC) | |||
| ::::::Ok, now find a good secondary source for the first two sentences to establish notability and relevance of the topic to Cass so we're not just cobbling it together from ] and primary sources and I'll agree. | |||
| ::::::The best I found was: | |||
| ::::::https://www.tes.com/magazine/analysis/general/keeping-children-safe-in-education-kcsie-safeguarding-guidance | |||
| ::::::Which describes it as "only minor changes in language", stressing how inconsequential the update is, and no reference at all to Cass or social transition. Absent a better source, this seems to not be ]. ] (]) 15:41, 3 January 2025 (UTC) | |||
| :::::::A primary source is adequate for the first two sentences, since the interpretation is provided by the second source itself (the ILGA statement). As the DfE is an expert source on this area, there's no problem using it. Your source also helps. Secondary sources are needed for interpretation – but the IGLA statement is a secondary source for the purposes of discussing the DfE report. ] (]) 12:53, 5 January 2025 (UTC) | |||
| ::::::::I'm not entirely sure that your primary/secondary analysis holds up. I'd have to spend more time looking at what, exactly, the joint statement says. Something like "This report uses the Cass Review" could be a simple ] situation and therefore still primary. Also, the DfE document is not the Cass Review or either of the Cass Reports, so what the joint statement says about the DfE document is irrelevant. | |||
| ::::::::Even if we ] that the joint statement is secondary, it is also self-published, which is a reason to not use it at all. | |||
| ::::::::To look at our third usual point, although I don't think ] addresses advocacy groups specifically (at least, it didn't when I re-wrote it years ago), it is possible that the community would not judge them to be an independent source, either. It would depend on whether editors saw the organizations more as political rivals. Two candidates for the same political office, or two businesses producing rival products, would not usually be considered independent. If editors saw advocacy groups vs government agencies in a similar light, they'd consider it non-independent, which would be another reason not to use it at all. But they might see such orgs as completely independent. I really don't know what they would say if we asked, e.g., whether ] is independent of veganism, or of a law promoting meat-eating that they oppose. That would be something interesting (to me, anyway) to discuss elsewhere, unrelated to this joint statement. ] (]) 05:45, 6 January 2025 (UTC) | |||
| :::::::::The DfE guidance is relevant because it says "because of the Cass Review, we should do x", and then ILGA and others commented on that. Regardless of how one feels about the IGLA statement, the DfE guidance is a potentially relevant topic for the "other government responses" section. The DfE is generally considered notable and reliable, and few people would argue against its inclusion. A literal reading of policy does mean it's also "self-published", but that's the tension inherent to the policy and guidance we have in this area. | |||
| :::::::::If we do include the DfE guidance, the second question is whether the ILGA/IGLYO statement should also be mentioned with it, whether it should be mentioned separately in charity responses, or whether it shouldn't be mentioned at all. That's where consensus is needed. | |||
| :::::::::The DfE report is certainly notable. ILGA is generally considered notable and an expert in its area, as is IGLYO. They are writing within their areas of expertise, in this case. From at ], I see that many people did | |||
| :::::::::Given differences in how policy is interpreted, I think we can resolve this with consensus among ourselves. VIR suggested some wording upthread, which I have tweaked and offered some sources for, and I think that could be used (potentially with more sources if needed).. ] (]) 12:08, 6 January 2025 (UTC) | |||
| ::::::::::I agree that the ] is ], but I disagree that "The DfE report is certainly notable". Do you mean that the report is subjectively important to you? | |||
| ::::::::::The story here appears to be: | |||
| ::::::::::* A government agency issued a 185-page-long document. It mentions the subject of this article by name in exactly one (1) sentence. 99% of the document is ''not'' about trans students, gender-questioning students, or anything else related to the subject of this article. | |||
| ::::::::::* That one sentence is under the bold-faced subheading that says "'''N.B. This section remains under review, pending the outcome of the gender questioning children guidance consultation, and final gender questioning guidance documents being published.'''" | |||
| ::::::::::* Three advocacy organizations have self-published a joint statement objecting to the Cass Review's POV being mentioned. | |||
| ::::::::::* No independent media has mentioned the Cass Review in connection with the DfE's document. | |||
| ::::::::::* No independent media has mentioned the joint statement objecting to the DfE's document mentioning the Cass Review. | |||
| ::::::::::Are we agreed on these facts? ] (]) 20:42, 6 January 2025 (UTC) | |||
| :I think the statement should be mentioned in the article (as it is significant), but no more than a single sentence should be needed. Also, I agree with Void that the blog should not be cited, nor is it necessary to discuss the blog post specifically. ] (]) 07:00, 4 January 2025 (UTC) | |||
| ::Are you saying that it's "significant" that this trio of organizations issued a press release? How do we know that this is significant, since other reliable sources have apparently completely ignored it? | |||
| ::I think that both Void's ] and Lewisguile's might be vulnerable to a ] challenge precisely because all the sources have ignored it. ] (]) 23:38, 4 January 2025 (UTC) | |||
| :::@]' suggestion works for me. The ILGA statement is a primary source on itself but a secondary source on the DfE report. is a primary source on itself and a secondary source on the Cass Review (p. 55). The DfE is also an expert in this area (education policy). So, the ILGA statement comments on the DfE report which comments on the Cass Review. The ILGA statement and the DfE report can both therefore be cited for this statement.] (]) 13:02, 5 January 2025 (UTC) | |||
| :::Well quite, my example was how it could be written if sources existed to justify doing so. | |||
| :::I looked and they do not. There's no notable secondary coverage of this guidance, which has been ignored for four months, and what little there is makes no mention of Cass and describes it as a fairly trivial update. | |||
| :::I think we need a higher standard for statements to be added to the "reception" of the Cass Review, in that they are principally about the Cass Review, and not about tertiary events. I have no objection to including these in response to tertiary events elsewhere (and as I've made clear would actively encourage that approach), but unless that tertiary event becomes notable, this statement - no matter how notable the organisation issuing it - is also not notable. | |||
| :::Trying to assemble the wording I posited as a hypothetical from primary sources is SYNTH. ] (]) 14:48, 5 January 2025 (UTC) | |||
| ::::The guidance has been discussed by several legal organisations, who also note the impact of the Cass Review | |||
| ::::* Here: https://www.hcrlaw.com/news-and-insights/kcsie-2024-what-to-expect/ | |||
| ::::* And another: https://www.stoneking.co.uk/literature/e-bulletins/have-you-implemented-changes-keeping-children-safe-education-kcsie-2024 | |||
| ::::* And here: https://www.irwinmitchell.com/news-and-insights/expert-comment/post/102jhbf/keeping-children-safe-in-education-guidance-whats-changed | |||
| ::::* And here: https://wslaw.co.uk/insight/keeping-children-safe-in-education-2024-the-main-changes-and-action-required/ | |||
| ::::* And here: https://www.brownejacobson.com/insights/keeping-children-safe-in-education-kcsie-2024-the-main-changes-and-what-to-do-next | |||
| ::::* The draft DfE guidance was also mentioned here: https://www.irwinmitchell.com/news-and-insights/expert-comment/post/102j6jj/cass-review-implications-for-schools-and-colleges | |||
| ::::LifeLessons, an education website, published an article about it here: https://lifelessons.co.uk/resource/kcsie-updates-2024/ The Key, originally a government start-up, also wrote about the guidance here: https://schoolleaders.thekeysupport.com/pupils-and-parents/safeguarding/managing-safeguarding/keeping-children-in-safe-education-kcsie-changes-september-2024/?marker=content-body (both mention the Cass Review). ] (]) 12:43, 6 January 2025 (UTC) | |||
| :::::Thank you, I did find most of these when I was looking before but since they're all ] I didn't think this was notable coverage. I was hoping for a news report that the guidance had even been updated. | |||
| :::::Of them, the ones that I think make the most of the Cass Review are: | |||
| :::::https://www.hcrlaw.com/news-and-insights/kcsie-2024-what-to-expect/ | |||
| :::::{{quote frame | Another change made is in the ‘Children who are lesbian, gay, bisexual or gender questioning’ section. This has been adapted to comply with the gender questioning children guidance terminology. The guidance notes that schools should take a cautious approach as there remain many unknowns about the impact of social transition, and children may have wider vulnerabilities. When families and carers are making decision about support for gender questioning children, KCSIE 2024 '''notes the recommendation of the Cass review''' that they should be encouraged to seek clinical help and advice. Schools should consider the broad range of their individual needs, in partnership with the child’s parents when supporting a gender questioning child.}} | |||
| :::::https://www.stoneking.co.uk/literature/e-bulletins/have-you-implemented-changes-keeping-children-safe-education-kcsie-2024 | |||
| :::::{{quote frame | New wording has been inserted at paragraphs 205 – 209 '''following the publication of the Cass Review''', which, in summary, urges school to “take a cautious approach” and consider the “broad range of individual needs” when supporting a child who is gender questioning. }} | |||
| :::::https://wslaw.co.uk/insight/keeping-children-safe-in-education-2024-the-main-changes-and-action-required/ | |||
| :::::{{quote frame | this update found in paragraphs 205 – 209 '''was to be expected following the release of the Cass review report'''. The main thrust of these paragraphs is that schools exercise caution due to the many unknowns about the impact of social transitioning and need to consider the broad range of needs that the child may have, to include complex mental health and psychosocial needs, and in some cases additional diagnoses of autism spectrum disorder and/or attention deficit hyperactivity disorder. }} | |||
| :::::Several point out this section is still a work in progress and as the document itself states: | |||
| :::::{{quote frame | This section remains under review, pending the outcome of the gender questioning children guidance consultation, and final gender questioning guidance documents being published.}} | |||
| :::::Based on these, if it were to be used I'd phrase it something like: | |||
| :::::{{tq | In September 2024, the UK Government released new statutory safeguarding guidance for schools and colleges, titled "Keeping children safe in education 2024". Following the Cass Review, the guidance contained new draft measures recommending a cautious approach to social transition within the education environment due to the many unknowns, and to consider that gender-questioning children may have wider vulnerabilities. International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA), international LGBTQ student organization IGLYO, and Transgender Europe released a joint statement condemning the new guidance, and criticising its reliance on the Cass Review for its "poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts".}} | |||
| :::::I still don't think that, without some sort of notable coverage of the first event, this is due. Looking at the other events in the section on "subsequent government actions" they are based on widespread coverage on the BBC, CNN, the Times, The Independent, The Telegraph and The Guardian. If we're having to scrabble round with ], this isn't comparably notable. But if others disagree, this is how I'd suggest inclusion. I just get the impression this is work in progress guidance that hasn't become a significant event yet, but might once it is finalised. The outcome of the consultation is . | |||
| :::::(On notability - the glaring exception is the section on the charity commission/mermaids which IMO is UNDUE and should be removed.) ] (]) 13:40, 6 January 2025 (UTC) | |||
| ::::::Fair enough. I'd be fine with your wording (probably removing "due to the many unknowns" as redundant given that's already clear from the rest of the article), but on reflection, I don't think it's necessary to go in just now, either. As you say, the final guidance will probably be more notable and will get more coverage. At that point, the ILGA/IGLYO statement might be superceded anyway. | |||
| ::::::I've also just realised my browser scrambled my earlier post (sometimes happens when I hit publish). I've edited it to be legible. Sorry about that! ] (]) 14:44, 6 January 2025 (UTC) | |||
| :::::::I'm doubtful that this is ], since we only have self-published sources. | |||
| :::::::Law firm websites, in particular, use this kind of post for advertising purposes. It's not considered sufficiently dignified to do hard-sell advertisements, so they subscribe to content services to get blog posts. (AI must be a boon for these services; you can write it once, and then generate a dozen "unique" variations.) Accountants do the same. ] (]) 20:51, 6 January 2025 (UTC) | |||
| ==Methodology V3.0== | |||
| For which there is no citation, so this is the opinion of the authors, in an opinion piece. It is not a terribly weighty commentary, and the material on Cass is thin. | |||
| Hi @], | |||
| I've taken a stab at a new consensus version of Methodology, using your comments and some feedback from others. This is a new topic to avoid getting lost in a wall of text. Changes and reasons as follows: | |||
| I can't see what chucking this in adds, so ]. At best it could be an extra citation to the condensed individual responses. ] (]) 13:48, 7 October 2024 (UTC) | |||
| * Restored assessment tools but removed the ''Times'' source for why these were used per ], as it was conflating two different things (it's standard practice to assess studies in meta-analyses; that's how you know how to weight stuff). | |||
| * Per the discussion with @], I reworded the sentence about limitations/scope so it hopefully doesn't read as criticism (we all seemed agreed that it wasn't). Now it is more focused on what the review ''did do'', not on what it didn't. E.g., it says it "examined English-language studies of minors" rather than "it excluded non-English studies", etc. I have added an endnote after "minors" to clarify that the systematic reviews looked at ages <=18, while the qualitative review included people up to 30 to speak about their prior experiences. This is important, I think, because there has been some confusion about whether the report covers people aged 19–25 and whether the evidence reviews can be extended to this age range or older. But as an endnote, it's out of sight. Another possibility would be to replace "minors" with "participants up to 18 years old" to be absolutely clear in the body text, but that felt too long. | |||
| * I have merged the MMAT and NOS info into the bit about confidence ratings, so that we haven't removed @]'s additions but now they're more explicitly relevant. (An alternative would be to use some of the Yale comments about use of these tools instead, but that feels like a whole other can of worms. | |||
| * For the evidence base, I used Cass and the BMJ as sources for "assist" and "supplemented", rearranging the order a bit as per those sources. Because the "engagement programme" is explicitly supplementary, I've put that at the end, as it was in my prior edit and yours. Because the qualitative/quantitative research is described as supplementary ''and'' part of the research programme in the BMJ overview, I have put that with the York stuff, but have marked it as supplementary in the text. As I understand it, York wasn't involved in the focus groups, etc, so this also clearly delineates the research programme from the engagement programme. (I can see the latter were performed by market research types.) | |||
| * I have updated the BSN note to better reflect where that conversation left off, although I still think there was generally consensus that the source itself is high quality (regardless of whether one thinks it's exactly equal to Cass or not) and that the approach taken by Cass for her own conclusions and recommendations is a narrative one (a narrative review can use systematic reviews as well). Personally, I would remove that tag, but didn't want to without confirming you were satisfied first. | |||
| * The agreed upon endnotes should all still be intact as well. @], did I get yours in here too? | |||
| I think that should cover most of our concerns. I'm sure there are still bits we both think should/shouldn't be there, but I feel happy with this level of compromise. Is it okay with you?] (]) 10:52, 3 January 2025 (UTC) | |||
| :Science evolves and so does often the reception of a piece, so yes this is DUE as it appears very well that the worldwide reception of the Cass Review is being continued to be criticized (so far, pretty universally outside the UK), which by itself may show that the Cass Review may fall into the abyss of being disregarded by the scientific community. | |||
| :That by itself makes the continued worldwide criticism levied notable and not a coatrack and may over time actually change the focus of the article to become one that highlights the shift of the original positive reception within the UK to the then almost universally negative reception of it worldwide with highlights of some of its shortcomings, or in some cases, the failings of the conclusion drawn by the UK government thereafter (such as the imposition of a ban on puberty blockers). With the original findings of the Cass Review itself becoming a secondary background to this, just as say the ] was originally about the world being flat, until it turned into the Myth of it. Writings evolve, and so does the coverage of topics. | |||
| :The lack of citations for the quote you are claiming is uncited are a re-iterating of a paragraph they make earlier in the paper - {{tq|Existing research demonstrates the effectiveness of medical GAC interventions through the alleviation of distress , , , ] and improvement in well-being and quality of life. , , }}. So, they are well cited. | |||
| :The whole paper then ties it into Cass with {{tq|The above-mentioned critiques are not new but have been highlighted in a recent non–peer-reviewed, independently published report by Cass (2024) that has gained traction in the media. }}, so basically the paper, just as the title of it being '''Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth''' suggests is a response to the Cass Review claiming in part that there isn't evidence. So with this, this paper isn't an opinion piece as you claimed, as it very clearly links the cited evidence for gender affirming care and has been published by a group of scientists in a peer reviewed journal, citing the evidence that exists and why RCTs are not ethically feasible. So please refrain from claiming every piece of critique that comes up against the Cass Review is just an opinion piece as you have also done in the past. ] (]) 16:42, 7 October 2024 (UTC) | |||
| ::It's "commentary". It's in the "commentary" section. It's RSOPINION. Can you please stop ignoring BRD. ] (]) 19:15, 7 October 2024 (UTC) | |||
| :::BRD is one content resolution strategy, but so is ], which is how the majority of consensus of content is formed on Misplaced Pages, which happened here prior to your unilateral removal, as 4 separate editors ({{ping|Your Friendly Neighborhood Sociologist|Usr Trj|Daff22}} and myself) collaboratively edited on the paragraph. | |||
| :::So instead, next time, you should start a discussion before you unilaterally remove content against implied consensus. | |||
| :::This is actually highlighted at BRD - ] - the diagram on the side outlines how often there is subsequent changes to new consensus. In those cases we are at implicit consensus territory per the preferred ] and it is typically advised if you disagree with it to start a discussion, but not revert, per ]. ] (]) 19:29, 7 October 2024 (UTC) | |||
| ::You've now ignored my comments about the fact this is merely commentary, and expanded the paragraph on this commentary piece to be almost the same length as the paragraph in the source that actually references Cass, with lengthy quotes and ] fluff like general statements about GAC. The source only spends 150 words on Cass or thereabouts. | |||
| ::When I ask you to follow BRD, I mean actually meaningfully discuss content. | |||
| ::I say: this is a commentary piece that adds nothing novel. It is no different to other opinions from individual academics we have previously collapsed. | |||
| ::So: why does this one get expanded? ] (]) 09:07, 8 October 2024 (UTC) | |||
| :Is this piece peer reviewed? It doesn't look like it. (Under "Article info", there's no date indicating when it was "received" or "accepted", which usually indicate peer review.) | |||
| :It is labeled as "". Does that mean that it is currently a pre-print? ] (]) 04:20, 9 October 2024 (UTC) | |||
| ::No it's not a pre-print. The journal has the concept of "", which means the article has been fully accepted, reviewed and proofed and will appear exactly the same online a few weeks ahead - {{tq|The online article is identical to the version subsequently published in the print journal and is citable by the digital object identifier (DOI) assigned at the time of online publication.}} ] (]) 04:27, 9 October 2024 (UTC) | |||
| ::It is a "commentary" piece, which means it is opinion. I can't tell if its been peer-reviewed, they usually aren't, but it varies. ] (]) 08:14, 9 October 2024 (UTC) | |||
| ::Here is a . | |||
| ::In terms of source - is there any difference between this, and the commentary piece? I don't believe so - commentary and letters to the editor are supposed to present opinionated points of view for discussion. They are not authoritative statements. | |||
| ::This letter concludes: | |||
| ::{{quote frame | The Cass Review, based on nine studies, eight of which were systematic reviews assessing the quality of evidence, as well as extensive stakeholder consultation is the most thorough review of gender-affirming treatments in young people conducted to date. It carefully considered the meteoric rise of young people presenting with gender distress, the dramatic reversal of the sex ratio in this population, the co-occurring mental health and neurodiverse conditions, the socio-cultural and developmental contexts that may contribute to trans-identification, as well as the literature on detransition, and made prudent recommendations. '''The Cass Review represents the new international standard of care.''' Given that the current Canadian model parallels the UK’s prior gender-affirming care model, the findings of the Cass Review are pivotal. Canadian youth deserve the same protection of evidence-based guidelines as children in Finland, Sweden, and the UK.}} ] (]) 08:31, 10 October 2024 (UTC) | |||
| :I don't think this {{tq | though certainty-of-evidence ratings were not provided for individual outcomes}} makes sense in isolation. What's happening here is that the RAND report took one approach, and the York reviews took another. The RAND report simply lists the differences in approach, so saying what the York reviews did not do in this way is misleading. It is like York cycled to work, Rand drove to work, and so we say in wikivoice "York did not drive to work". I think far too much is being made of this fleeting comparison. Also, again, that opening sentence - the Cass Review was a '''process''', that ended up producing two reports, only the first of which this document describes as a "narrative review". Describing the process as a "narrative review" doesn't make sense, and in any event the only thing this source can plausibly be used to describe as a "narrative review" is the interim report, so this claim as presented is unsupported by the source. ] (]) 11:35, 3 January 2025 (UTC) | |||
| == Response bloat == | |||
| ::Re: process versus review: The problem is that we can cite a review but we can't cite an intangible "process". Even if that process is outlined in a document, it's the document we're referencing. However, we could change the wording to clarify that we're talking about the reports/conclusions and recommendations themselves, such as: {{tq|The Cass Review's final conclusions and recommendations were published in a non-peer-reviewed ], which synthesised evidence from multiple sources to make policy recommendations for services offered to transgender and gender-expansive youth in the NHS...}}? But that seems more complicated. | |||
| ::Re: certainty of outcomes: it's relevant to know that confidence ratings weren't published ''for individual outcomes''. Confidence ratings aren't necessarily interchangeable with quality ratings, but also, if you want to know specific confidence ratings for particular/individual outcomes in different studies, rather than the quality rating of studies as a whole, these SRs won't provide that information. That is a significant difference from most systematic reviews conducted by NICE, the WHO, and others, and is a notable limitation (though that doesn't mean it's necessarily a ''criticism'' either). ], which is the international standard for systematic reviews (rather than the MATT and NOS), does provide this data because confidence ratings can vary between different outcomes in a single study, as well as between studies. This then allows you to pool outcomes across different studies, while properly weighting it. The Cass Review doesn't do that, even though it's an international standard, so that should be noted. ] (]) 12:30, 3 January 2025 (UTC) | |||
| :::{{tq | Even if that process is outlined in a document, it's the document we're referencing.}} | |||
| :::No, the "methodology" section refers to the review as a whole. This is the process by which a series of systematic reviews were commissioned, stakeholder involvement took place, and two reports were produced. | |||
| :::This page is about The Cass Review, and the final report of The Cass Review has its own dedicated section within it. This is the wrong place for this information, even if were correct or due. | |||
| :::When you cite "The Cass Review", what you're citing is the final report of the Cass Review. See all the citations on the page to "Cass review final report 2024". Describing the process by which that final report was produced as a "narrative review" makes no sense whatsoever. | |||
| :::{{tq | The Cass Review's final conclusions and recommendations were published in a non-peer-reviewed}} | |||
| :::We can't say that because it isn't true and it isn't sourced. | |||
| :::Put it another way - WPATH's SOC8 is not a "narrative review" - it is a set of guidelines and best practices. However, within it, Chapter 6 (Adolescents) ''contains'' a narrative review. | |||
| :::{{quote frame | a systematic review regarding outcomes of treatment in adolescents is not possible. A short narrative review is provided instead.}} | |||
| :::If someone were to refer to the evidence on adolescent treatment in SOC8, they might accurately describe it as a narrative review but it would be an inaccurate description of SOC8 as a whole. | |||
| :::In the RAND document, they describe the interim report of the Cass Review on the topic of "Gender dysphoria treatments" as a "narrative review". That might be true. Therefore, with this source, you could say that the Interim report of the Cass Review contains a narrative review of gender dysphoria treatments. | |||
| :::But that is not everything contained in the interim report, and to describe the whole document as a "narrative review" is as wrong as calling the WPATH SOC8 a "narrative review", and neither of which are as wrong as calling a 4-year independent service review a "narrative review". | |||
| :::This is all a very unnecessary series of hoops to jump through to justify an inappropriate label. I simply don't understand why so much energy is spent on trying to wrongly describe an independent service review as a narrative review. ] (]) 15:16, 3 January 2025 (UTC) | |||
| ::::I disagree that the scope of the article is about a process rather than the product of that process. In 10 years, people may still be referring to the final report, but they won't be talking about the process (except inasmuch as it informed the final report). The process itself isn't notable but the report and its conclusions/recommendations are. Consider the ] and ] – they're relevant for their recommendations and not for the process of writing them. The process is only relevant to explain how the final report came about. | |||
| ::::I also think "narrative review" is a ] statement for the final report, since it describes the existing literature base and uses that to make conclusions and recommendations of its own. For those who weren't satisfied with that, RAND also suffices to source this statement (the protocol didn't change between the interim and final reports, only before that point, so it didn't change from one type of review to another). It also seems the clearest and most precise language we can use which explains to the lay person what the review is (e.g., I can't find a page on here that satisfactorily explains what an "independent review" is, in this context, because the term is so broad). | |||
| ::::All that said, I think the article is looking good and I appreciate we've all done some compromising here, including you. I don't want to be unreasonable – and, as I've said before, I'm not particularly attached to using the "narrative review" language even if it seems accurate to me. I'd be happy with "non-peer-reviewed, independent service review" if we can get consensus on it. I think it was @] who originally added the "narrative review" wording. So, if they're happy with it, we could use that wording instead? ] (]) 12:33, 5 January 2025 (UTC) | |||
| :::::{{tq | I also think "narrative review" is a WP:SKYBLUE statement}} | |||
| :::::I think it is ] that this is just incoherent language - it is comparing apples to bicycles, and doing so on the basis of one field in one table in one report by a US think tank that references only one subject area within the ''interim report''. Neither the independent review itself, nor either of its reports, nor any of the other independent inquiries and reviews you brought up are "narrative reviews". | |||
| :::::You seem to be under the impression that everything called a "review" must fall into a binary of either "narrative" or "systematic", when that's just terminology that applies to a specific form of literature review in academia. When a public body commissions an independent service review, that is neither of those things. | |||
| :::::The Cass Review is an authoritative source on itself. It is an "independent review", or if you prefer an "independent service review". Not only that, it is referred to in those terms consistently across a wide range of secondary sources, just as other independent service reviews are. I don't think this is even remotely debatable. The current wording is both factually incorrect and not even supported by this one source. ] (]) 15:40, 5 January 2025 (UTC) | |||
| ::::::I've tried changing the opening line of methodology to ditch all language about what sort of "review" it was, and simply state what its remit was, which fits with the questions the methodology was supposed to answer. I also changed it to actually cite the review itself and use the language of the review for what its subject matter was instead of this US report, because the "gender expansive" language is incongruous and inconsistent with all other usage. | |||
| ::::::{{tq | The Cass Review was commissioned to make recommendations about the services provided by the NHS to children and young people questioning their gender identity or experiencing gender incongruence.}} cited to: https://cass.independent-review.uk/about-the-review/terms-of-reference/ and https://cass.independent-review.uk/home/publications/final-report/ | |||
| ::::::This is simpler and cleaner and doesn't require outside third-party sourcing. ] (]) 10:32, 6 January 2025 (UTC) | |||
| :::::::Our posts crossed. I've reverted your new wording as this also undoes a lot of other consensus wording from the past few weeks. I've just implemented "service review" instead, since you seemed to accept that as a compromise. ] (]) 10:38, 6 January 2025 (UTC) | |||
| ::::::Please ]. I did offer a compromise, and I'm not under any binary assumptions – narrative reviews can include a variety of methods and can be used for a variety of purposes. Cass describes the literature, draws conclusions from it, and then makes recommendations based on those conclusions. That fits the definition of a narrative review. In the same sentence, we also state that it looked at NHS services and made recommendations for improvements in that area. And then we detail the research and engagement programmes. So nothing is left out by this description either – we're not saying it's A over B, we're saying it's A + B + a bit of C and D as well. RAND also describes the final report as a "summary of research evidence" on p. 31, which fits its description of the Cass Review as a narrative review in the table on p. 10. Describing it as "independent" or anything else doesn't contradict the "narrative review" part, and those other elements (reviewing a service) are already mentioned too. The nature of other reports and reviews is immaterial, but I didn't actually say they were narrative reviews either – I was comparing the scope of their articles. | |||
| ::::::If you feel that this isn't up for debate, then I'm more than happy to stick to the current wording ("non-peer-reviewed, independent narrative review"), since we've already discussed this and you're the only person continuing to challenge this wording at present. But I don't think you want that, which is why I'm trying to engage in discussion so we can reach a compromise. So, to clarify, would you be happy with "non-peer-reviewed, independent service review" as a compromise? I'm still hoping @] will support this as well, but I think we can have consensus between us if not. ] (]) 10:35, 6 January 2025 (UTC) | |||
| :::::::I'd support that. I think it's more important to note the lack of peer review than the fact it was a narrative review. ] (]) 13:06, 6 January 2025 (UTC) | |||
| ::::::::Perfect. That's 3/3. We can leave it as is. ] (]) 13:39, 7 January 2025 (UTC) | |||
| == International Guidelines == | |||
| As time has moved on, what were "responses" to the Cass Review upon its publication are increasingly more broad effects and impacts. Citations to it in guidelines. Commentary in opinion pieces. This is getting unwieldy. | |||
| @] You've reverted my change here https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1267315347 | |||
| I think we need to start restructuring into immediate, direct responses, and subsequent impact (domestically and internationally) on guidelines like the Japanese ones which are more "contextual", and the Australian review of services. | |||
| There's no consensus for the Italian response being where you've placed it, because I added it where it was - this was ''a new addition''. The point was this was additional and wider impact of the Cass Review on guidelines internationally, as it was with the Japanese ones - new context justifies new presentation of old information. | |||
| I suggest citing (which for some reason we aren't) which very explicitly notes the difference in reception between the UK and the US, and this places into context the polarised responses. | |||
| I simply don't understand your insistence on stuffing "reception" with this. Can you please explain why it is so important to you to have it there, rather than where I placed it, especially now we had new guidelines from Italy to justify this move? Neither are a "response" and both are examples of international guidelines taking account of the Cass Review. | |||
| So something like: | |||
| Also, calling this "shot down 100 times" is very ] and hyperbole. I may be misremembering, but the only discussion on this specific move was ] I think. | |||
| * Reception (containing some of what's there already, but only the actual immediate direct reception | |||
| * Subsequent impact (for eg. the creation of a review into adult services, the impact on services in Scotland etc) with an international section, which can contain the Japanese and Australian content, which aren't really "responses" but "things that happened after, in the context of the cass review's findings" | |||
| * Further commentary (noting the divisions between the US/UK per the BMJ piece, notable opinion pieces etc) | |||
| Your objection at the time was {{tq | it makes them read the reception section and think those are the only responses.}} which again I don't understand - people will read as much of the article as they read, and they'll use the section headings to navigate or skip over information as appropriate. An ever-expanding dumping ground of "reception" is only making it more likely readers will give up rather than read nicely organised, summarised and well-presented information. ] (]) 17:43, 6 January 2025 (UTC) | |||
| :Also I've removed the bit you added about Meloni which was ] - the source actually says: | |||
| :I didn't think it was that bloated or hard to read. However, it seems misleading to say the Cass Review had an impact on the Japanese guidelines and the Australian review of services. The Japanese guidelines continued to recommend puberty suppression and seemingly dismissed it's relevance to Japan by calling it "specific to the unique situation in the UK" and the review of Australian services was rejected and so nothing really changed. I think both of these fit better in the response section. ] (]) 10:24, 8 October 2024 (UTC) | |||
| :{{quote frame | This month, a '''separate''' National Bioethics Committee issued a nonbinding recommendation that puberty blockers be limited to controlled trials, with children allowed to enter only if they have been involved in psychiatric therapy, as well.}} | |||
| ::They aren't a "response to cass" is my point. They are things that happened after, taking cass into consideration. The more time passes and the more we try and cram into "responses" the worse it is going to get. | |||
| :The Meloni appointees is a completely different committee. ] (]) 17:49, 6 January 2025 (UTC) | |||
| ::Many things in "responses" are very clear statements in response. | |||
| ::It's a different committee to the other one the article was talking about, but based on the context in the article they both must have been appointed by the Meloni government. ; you'll notice that they were created in December 2022 and ] took power in October 2022. ] (]) 18:54, 6 January 2025 (UTC) | |||
| ::Others aren't, but could go in a different section just fine. ] (]) 10:33, 8 October 2024 (UTC) | |||
| :::That is SYNTH. ] (]) 19:22, 6 January 2025 (UTC) | |||
| :::Then maybe you should've called the section "Aftermath" or something else instead. Using the word "Impact" implies that the Cass Review had a notable influence on Australia and Japan and led to notable changes in those countries, which it hasn't. ] (]) 10:54, 8 October 2024 (UTC) | |||
| :Okay first off, calling “shot down 100 times” battleground is a stretch. The use of a military-based metaphor does not mean battleground, it just means that early 21st century English takes most of its idioms from military and wartime sources due to the fact that the English speaking world is always invading *somewhere*. If I say someone is “calling the shots”, I don’t mean they’re ordering a sniper to shoot someone, I mean they wield substantial directive influence. | |||
| ::::I'm not sure I agree, the section being "impact" can also be used to highlight notable points of ''lack'' of impact IMO. Aftermath sounds a bit dramatic to me, what about just "influence"? Or "Subsequent events"? ] (]) 11:26, 8 October 2024 (UTC) | |||
| :With that aside, you’ve more or less answered your own question - {{tq| people will read as much of the article as they read, and they'll use the section headings to navigate or skip over information as appropriate}} exactly, if people are looking for how it was received, they’ll look at reception, but if they don’t see Japan and Italy, they’ll think those countries aren’t part of the reception when they absolutely are, and there is no practical reason to separate them. Originally this was proposed I recall as further reception, and now as guidelines, but the fact is that, there’s no reason to separate guidelines anymore than further reception. It’s simply how the relevant org responded, how it received the Review. If you’d like to create a subsection of the “other global health bodies” for guidelines, I wouldn’t oppose that, but there is certainly no reason to remove Italy and Japan from the reception section entirely in favor of a completely separate section when guideline responses are objectively part of the Cass Review’s reception. ] (]) 17:58, 6 January 2025 (UTC) | |||
| :::::"Subsequent events" will probably be confusing. People might expect to find (e.g.,) information about when new programs were opened, or if there was a follow-up report. ] (]) 04:21, 9 October 2024 (UTC) | |||
| ::{{tq | The use of a military-based metaphor }} | |||
| ::::::Sure - that was where I was originally hoping to put the material about adult services review etc. These aren't directly about the cass review, but are things that happened as a result. I'm trying to draw a line under the most significant direct responses and create somewhere else in this article that can be expanded with relevant but less directly responsive material. I'm out of synonyms though. "Later developments"? "Outcomes"? ] (]) 08:27, 9 October 2024 (UTC) | |||
| ::That's not what ] means. Not everything has to be a fight. | |||
| :Also, I think the interviews with Cass that you moved to "Further Commentary" fit much better under the "Hilary Cass's response" section as they were previously, since Cass was directly responding to criticism in them. ] (]) 10:29, 8 October 2024 (UTC) | |||
| ::{{tq | there’s no reason to separate guidelines anymore than further reception}} | |||
| ::Hilary Cass published extensive reflections on the review a month ago. Right now, there is nowhere for these to go, but they are certainly due. I hope that by starting this section with some of her comments it can be expanded with . ] (]) 10:35, 8 October 2024 (UTC) | |||
| ::Other than that reception is turning into an unreadable dumping ground. It was discussed back in October when it was really only Japan at issue, with a fairly even split of interest, and even yourself saying you didn't mind the idea of initial/further reception, and IMO the emergence of new Italian guidelines changes that a bit. | |||
| :I don’t think it’s helpful to the reader to separate the responses like this, it makes them read the reception section and think those are the only responses. ] (]) 12:24, 8 October 2024 (UTC) | |||
| ::{{tq | to remove Italy and Japan from the reception}} | |||
| ::The point is to separate immediate, direct, PR type reactions like RCGPs and WPATH's from longer term, more contextual outcomes and influences like the adult services review. How about "initial reception" instead of "reception"? ] (]) 12:45, 8 October 2024 (UTC) | |||
| :: |
::Italy was never in the reception. I added it where you removed it from. You've moved it to a new location. ] (]) 22:43, 6 January 2025 (UTC) | ||
| :::{{tq|Not everything has to be a fight.}} | |||
| ::::I draw the line at, basically, the direct responses we currently have from major orgs (or anything simliar to that which happens to come along, though it seems unlikely at this late stage). | |||
| :::That’s what I’m saying. Using a military-related metaphor doesn’t mean I see us as opposing forces, it just is the way the English language has formed. If I say that an admin is “calling the shots” somewhere (an idiom derived from spotters giving orders or ‘calls’ for snipers to take a specific shot) I’m not saying the admin is ordering adverse surgical action against an enemy force, just that they wield some level of influence. | |||
| :::: I think the Japanese guidelines are too vaguely connected - nothing says they are a "response" to Cass (which is why I object to their inclusion at all ''in that current section''). They don't describe it as such themselves, and it doesn't even really contain a response to Cass, merely describing it. However, it is clear they are a "response" to a changing context, with The Cass Review and WPATH butting heads making it reasonable to reissue service guidelines that make it clear what it all means for clinicians there. I think that is a sort of "second wave" wider impact sort of thing (as is the review of adult services, NHS Scotland etc). | |||
| :::{{tq|Other than that reception is turning into an unreadable dumping ground.}} | |||
| ::::IMO, if it is a press release explicitly stating "here's what we think of the Cass Review" its a response. Anything vaguer than that (rejected calls for a similar review in Australia) to me feel like a second order effect - and the advantage is that something structured like that can ''grow'' without cluttering up the more immediate responses. The more that gets added there, the harder it is a for a reader to grok the timeline, frankly. Every future international guideline that cites the Cass Review (whether endorsing or rejecting it) could be relevant in that sort of section. ] (]) 13:36, 8 October 2024 (UTC) | |||
| :::Mild disagree on the grounds that the blue/red text helps the reader see which countries said what very easily, and also, it’s much less bad on desktop. | |||
| :::::I’d be okay with sections labeled “Early reception” and “Later reception” ] (]) 14:21, 8 October 2024 (UTC) | |||
| :::{{tq|Italy was never in the reception. I added it where you removed it from. You've moved it to a new location.}} | |||
| ::::::Yes I think that's preferred rather than this completely separate section that's now below. | |||
| :::I reverted your creation of a new section to put certain receptions in, but I didn’t oppose the inclusion of the Italian guidelines, so when moving Japan back to reception per the revert, I put Italy there as well. If you want to delete Italy entirely until we sort this out since that would be a much more full revert, I wouldn’t contest that. ] (]) 01:16, 7 January 2025 (UTC) | |||
| ::::::Also regarding the line @] is trying to draw - that's not how the medical community works - reception in medical papers is done through discussion and citing of them within a new separate paper - it is still inherently reception. | |||
| ::::{{tq | If you want to delete Italy entirely until we sort this out since that would be a much more full revert}} | |||
| ::::::So I think with that, @]'s suggestion to split it into early and later works better if you're concerned about timeline. ] (]) 14:55, 8 October 2024 (UTC) | |||
| ::::I'd appreciate it if you did that, with the other edits in the interim its simpler if you just take the whole paragraph out yourself (ie we treat that as you fully reverting it back to what it was before, and we BRD from there). | |||
| :::::::I think you'll want to reconsider your claim. If it's true that "reception in medical papers is done through discussion and citing of them within a new separate paper", then none of the self-published press releases we're citing should be considered True™ Responses, and perhaps they should all be removed. | |||
| ::::Returning to this concern: | |||
| :::::::(Sure, it's an ], but I suspect you won't like the consequences of your claim.) ] (]) 04:24, 9 October 2024 (UTC) | |||
| ::::{{tq | if people are looking for how it was received, they’ll look at reception}} | |||
| ::::::::Add the word "often" to the sentence {{tq|..reception in medical papers is ''often'' done through discussion and citing..}} if we must quibble about words. | |||
| ::::So how about we stick a hatnote at the start of "reception" that says something like "This section covers the initial response to the publication of the final report of the Cass Review. For further in depth response and analysis see §x, for the impact on international guidelines see §y". | |||
| ::::::::I think it was clear what I meant to say, which was only in response to VIR's point that if something doesn't explicitly says "{{tq|here's what we think of the Cass Review}}" then it's not a response, which isn't how stuff is commonly addressed in published papers and I didn't say that only peer-reviewed responses are responses, just that a common way of mentioning something in citation and discussing it in papers and that such a mention still constitutes a response. Basically, the inverse of what you are implying, VIR was saying that papers that are not explicitly titled "response to Cass" are not a response, which is what I tried to refute. ] (]) 04:47, 9 October 2024 (UTC) | |||
| ::::And then section link to the later sections (assuming we can agree to create them/name them)? That way any reader is under no illusion that the initial reception is all there is, and it gets away from this constant expansion of the reception with a blow by blow of increasingly disconnected events from several months down the line. ] (]) 10:33, 7 January 2025 (UTC) | |||
| :::::::::@], I'm not sure exactly what kind of source you're talking about. Which of these two categories sounds closest to the mistake that we need to avoid? | |||
| :::::{{tq| I'd appreciate it if you did that}} | |||
| :::::::::* Cass Review gets published, and ____ puts out a press release to say that Cass got some facts wrong: ]. | |||
| :::::It’s done. | |||
| :::::::::* Cass Review gets published, and ____ publishes a paper about trans teens that never mentions the Cass Review by name, but Misplaced Pages editors decide that this paper is a response to the Cass Review (because the subject matter overlaps, and the entire trans-healthcare profession, at least insofar as this can be determined from social media, is thinking of nothing else, so obviously any publication ''post hoc'' is indisputably ''ergo propter hoc''): ] violation. | |||
| :::::{{tq| So how about we stick a hatnote at the start of "reception"}} | |||
| :::::::::] (]) 18:34, 9 October 2024 (UTC) | |||
| :::::So, I’ll say that I vastly prefer “further reception” to a guidelines section, but consider also the idea that we simply divide up the current reception section by country the way we do on the puberty blockers article. Otherwise I’d want to perhaps discuss dividing reception up by specific time. That is, 2024, 2025, first year after, second year after, etc. But at the same time, I don’t expect us to have new material in future to rival that which we have now, so I’d perhaps suggest reception (first year after) and then reception (beyond April 2025) ] (]) 13:24, 7 January 2025 (UTC) | |||
| ::::::So what counts as "early"? What counts as "later"? | |||
| ::::::I could see it in going in either location, TBH. Happy to go with consensus on this one, or to be convinced either way. ] (]) 13:38, 7 January 2025 (UTC) | |||
| ::::::The line I'm trying to draw is the difference between essentially breaking, reactive responses, and considered, down the line impacts/incorporation/rejection of actual findings. | |||
| ::::::That's more of a qualitative split, though it becomes somewhat temporal by necessity. | |||
| ::::::For example, the BMA's response is, IMO, is a "response" - but it isn't an early one because it took them months to actually state it. ] (]) 15:10, 8 October 2024 (UTC) | |||
| :::::::Actually I just took a look at what the responses are, and what we have is scientific responses, published by the scientific community, and we have some advocacy organization responses. | |||
| :::::::So I just took another stab to separate it like that, as well as to address the timeline issue, I actually found after reading the paragraphs that all that was needed was adding dates to some of the early in April one to make it clear those were immediately following the release and the new later responses already mostly had the dates and I added a few where I felt it was useful to readers without having to open the ref. | |||
| :::::::I also kept Cass's individul personal responses in her section, rather than having them split up across different sections, to make it clear that those are her individual personal opinions as a person, rather than in an official capacity of the review itself. ] (]) 15:14, 8 October 2024 (UTC) | |||
| ::::::::We went over that before - they aren't "scientific responses". Most of them are comments in popular journalistic sources, and the Yale white paper is not a scientific publication. Old section title was least bad consensus. ] (]) 15:21, 8 October 2024 (UTC) | |||
| :::::::::They are scientific responses by medical and legal scholars, many of them published in peer reviewed journals, which is how the scientific community operates. | |||
| :::::::::In any case, I renamed it into academic, which is irrefutably accurate. ] (]) 15:26, 8 October 2024 (UTC) | |||
| ::::::::::I mean, you say "{{tq | many of them published in peer reviewed journals}}", but only two in this section are published in journals, and at least one of those citations isn't peer-reviewed, and probably neither. So, in the first sentence: | |||
| ::::::::::{{tq | The report was praised by some academics in the UK, who agreed with its findings stating a lack of evidence; while others both in the UK and internationally disagreed with the report's methodology and findings. }} | |||
| ::::::::::None of the citations here are peer-reviewed, even Abbasi's editorial in the BMJ, and aside from that one these are just comments in popular press so it doesn't justify this title. The Yale white paper isn't peer-reviewed either. This latest commentary probably isn't, it is hard to say for sure, I think it is at the editor's discretion at JAH? | |||
| ::::::::::(I really think that this latest commentary would be better under a "further commentary" section - it is commentary on the commentary as much as anything, noting the other responses. And that is the sort of section that can be expanded with other perspectives, illustrating the different points of view. There will be other academic works providing commentary and perspectives beyond simply a straightforward "response") | |||
| ::::::::::And the "advocacy organizations" title doesn't fit with the EHRC (who are not an advocacy org, but a regulator). Also, minor, but "organisations" please. TBH I would happily lose that entire section at this point, there's plenty of better material now, surely ]... ] (]) 16:09, 8 October 2024 (UTC) | |||
| :::::::::::They are still academic responses. As I said, some are peer reviewed, but nonetheless, even others such as the Yale white paper were still drafted by academics with academic citing and all. | |||
| :::::::::::The same for the latest, which was published in a journal and it didn’t just reference the other responses, it also specifically cited the existing evidence that does exist and is the basis why gender affirming puberty blockers for transgender youth is still used in most of the world outside the U.K. | |||
| :::::::::::As for advocacy organizations as a title, I carefully considered it and actually checked the charter of the EHRc before I made that title and they are also that {{tq| The Commission has responsibility for the promotion and enforcement of equality and non-discrimination laws in England, Scotland and Wales…}} Promotion is advocacy, so aside from also being tasked with enforcement, they are also tasked with promotion, which is advocacy, so as a banner it is appropriate. ] (]) 16:24, 8 October 2024 (UTC) | |||
| ::::::::::::No, this is wrong - ] seek to influence and bring about political change. The EHRC is an independent body set up by the UK government to reflect and enforce existing law and policy. There are quite significant differences between lobbying and pressure groups and a regulator like the EHRC, and this title misrepresents that. I disagree with your interpretation of "{{tq | promotion}}" as making them the same thing, when they are not. | |||
| ::::::::::::{{tq | some are peer reviewed}} | |||
| ::::::::::::I think by "some" it is "at most one, and possibly none". This sort of thing is why it was compromised to "assorted", so as not to mislead the reader into thinking these opinions had a more academic stamp than they actually do. ] (]) 17:00, 8 October 2024 (UTC) | |||
| :::::::::::::I didn’t call the section advocacy groups, it was titled organization. | |||
| :::::::::::::In any case, this easy to solve since we already had other UK government bodies further up from the NHS response, so I moved it up there and renamed it into UK government bodies to accurately group it. ] (]) 19:24, 8 October 2024 (UTC) | |||
| ::::::::::::::It's not a government agency. It is an independent regulator. | |||
| ::::::::::::::Again, all these details are why we had "assorted", which was fine. ] (]) 19:29, 8 October 2024 (UTC) | |||
| :::::::::::::::It’s a ], which is a very U.K. specific thing. | |||
| :::::::::::::::You have to remember that we write Misplaced Pages for a global audience, so I renamed the section to include the word public bodies now and specifically linked to the ] for the EHRC, which is helpful for readers who want to understand that they are a public body that is still accountable to parliament, but not directly part of the government as you pointed out. But they are still vested with their power through the county’s respective legal framework, just as most other ]s are to be able to actually enforce the charter they are tasked with. ] (]) 19:45, 8 October 2024 (UTC) | |||
| ::::::::::::::::Aside from the retitling - which is inaccurate and confusing still - there was a logic to the organisation of responses which this now breaks. | |||
| ::::::::::::::::Previously, the responses flowed in decreasing order of importance. | |||
| ::::::::::::::::1. Political responses. The immediate acceptance of the Cass Review across the political spectrum was hugely significant for an issue that is still deeply politically polarised in the US for example, and sits above the national health service, which the gov ultimately controls. | |||
| ::::::::::::::::2. Health services. As the implementers of the review's recommendations, these responses were paramount. | |||
| ::::::::::::::::3. UK medical bodies. As the bodies responsible for training and accrediting doctors, these responses again would affect how well-accepted the review was within the UK medical community. | |||
| ::::::::::::::::4. International medical orgs. No direct influence on implementation, but a huge impact on how this was received by the broader medical community (will other countries follow suit, or will the UK be isolated?), and may have an impact over the long term | |||
| ::::::::::::::::5. Others. Basically notable interesting but not directly impactful responses. | |||
| ::::::::::::::::The EHRC fits into this latter category. Its opinion is interesting but utterly unimportant to the actual implementation of the review. | |||
| ::::::::::::::::The way you've restructured it doesn't follow this flow, and also misrepresents the response of health services as government responses. | |||
| ::::::::::::::::The previous title and order was absolutely fine, and EHRC being dumped under "assorted" was not a problem, so I don't know why you're insisting on retitling this section confusingly and cumbersomely in order to justify it. ] (]) 08:22, 9 October 2024 (UTC) | |||
| == UCU == | |||
| ==Substack content reposted on Lemkin Institute website== | |||
| :@] the blogpost you've reinstated is atrocious, it doesn't belong under advocacy orgs, and is the sort of irrelevant musings of random activists that has no place here in any form, let alone a whole paragraph. ] (]) 17:59, 14 October 2024 (UTC) | |||
| ::I agree that it does appear pretty atrocious that public health officials are speakers at an openly ] conference and that them being involved in the Cass Review does not help the optics of the neutrality of the Cass review. Since the ] endorsed the report by republishing it and it doesn’t appear that the report is factually inaccurate, it links to the agenda of the conference and such for the facts summarized in the article by the paragraph that {{ping|Snokalok}} added, it definitely appears due for inclusion as relevant context on the reception of the Cass Review. ] (]) 18:44, 14 October 2024 (UTC) | |||
| :::My notifs still aren’t working, I saw this by checking the page history, but, how does everyone feel about splitting the difference with | |||
| :::“In 2024 the ] published a piece by ], stating that (blahblahblah)” That way the org is given its due, while still making clear to the reader that the piece itself is being written externally. ] (]) 20:26, 14 October 2024 (UTC) | |||
| ::::Yes I think that is appropriate and what I tried to do with the attributed modified version I tried to re-instate. | |||
| ::::The latest did not cite relevant policy that warranted its removal (and itself bordering on ] without that editor having made any attempt at discussion here themself), so I think given the factual summary of facts from the as republished report with the the Lemkin institute endorsing it, you can go ahead and place your proposed amended version there @]. ] (]) 20:36, 14 October 2024 (UTC) | |||
| ::::I think that we've rolled up individual responses far more notable and reliable than this, and Reed is an unreliable source with a history of spreading outright falsehoods about the Cass Review, so definitely not reliable for anything on this page. ] (]) 20:40, 14 October 2024 (UTC) | |||
| :::::] as you well know, having reverted a number of my edits without discussion, the onus is on the editor wishing to add content to establish consensus on Talk. | |||
| :::::As to this source: it is not correct to attribute authorship to the Lemkin Institute. As you can see here: https://www.lemkininstitute.com/world-news "We post articles from media outlets around the world that either cover ongoing cases of genocide and its aftermaths or that are tied to patterns and red flags of genocide." The Institute itself does not claim to have reviewed or published them. This particular repost is a self-published source which has been reposted by a member called "elsabis2014". I think anyone arguing for inclusion of this needs to establish how exactly the Lemkin Institute is "endorsing" this content, otherwise it is just a self-published source. ] (]) 20:53, 14 October 2024 (UTC) | |||
| @] you have reinstated the following text: | |||
| :::::The policy I think is most relevant is ] "Some newspapers, magazines, and other news organizations host online pages, columns or rolling text they call blogs. These may be acceptable sources '''if the writers are professionals''', but use them with caution because '''blogs may not be subject to the news organization's normal fact-checking process'''." Erin Reed is not a reliable source by herself as VoidIfRemoved points out. And the Lemkin Institute does not claim to be subjecting these posts to '''any''' fact-checking process. ] (]) 21:16, 14 October 2024 (UTC) | |||
| ::::::Erin Reed uses exclusively she/her pronouns, not they/them. I’m going to ask you to edit your response to use the correct pronouns. ] (]) 21:28, 14 October 2024 (UTC) | |||
| :::::::Absolutely. Thanks ], I wasn't aware. ] (]) 21:32, 14 October 2024 (UTC) | |||
| ::::::It's a ] and Lemkin doesn't have any editorial oversight, but are an advocacy org reposting blog content on their website. ] (]) 21:56, 14 October 2024 (UTC) | |||
| :::::::Yes, I was looking for a policy specific to that use-case but WP:NEWSBLOG was the closest I could find. ] (]) 22:06, 14 October 2024 (UTC) | |||
| {{quote frame | In June 2024, the ]'s (UCU) national executive committee unanimously passed a motion saying that the review "falls short of the standard of rigorous and ethical research expected of research professionals" and "provides no evidence for the ‘new approach’ it recommends". The motion described the Cass Review as having "serious methodological flaws" and defined by "selective use of evidence and promotion of unevidenced claims". They resolved to "commit to working with trans-led organisations to resist the Cass Report recommendations". }} | |||
| == UK puberty blocker restrictions == | |||
| Claiming this was "more neutral" than what was previously there which was: | |||
| https://en.wikipedia.org/search/?title=Cass_Review&diff=1250787222&oldid=1250782373 | |||
| {{quote frame | In June 2024, the ]'s (UCU) national executive committee was condemned as "anti-scientific" by some academics after it unanimously passed a motion criticising the review and committing to "working with trans-led organisations to resist the Cass Report recommendations".}} | |||
| ] has reverted some changes I have made with the edit summary "the changed terminology is not easier to understand by readers. Wikipedias purpose is to summarize a topic for the readers." | |||
| I remind you that ] is about representation of sources, not about your own personal opinion. ] from sources to convey a particular POV that is not reflective of the balance of coverage in those sources is not NPOV. | |||
| The current title ''"Legal ban preventing non-NHS medical providers from prescribing puberty blockers"'' does not accurately summarise what the sources say about this regulation. The regulation explicitly states that non-NHS prescribers may prescribe puberty blockers, to over-18s in the same way as previously and to under-18s in a more restricted way. Also "legal ban" is redundant. | |||
| With that in mind, the opening paragraph of the source in question - and thus the aspect that this source emphasises most strongly - is: | |||
| The current text ''"The ban restricted their use to only those already taking them, or within a clinical trial"'' is also inaccurate. The regulation imposes no new restrictions on NHS prescriptions. As mentioned above, it doesn't restrict over-18 use at all. It also specifically allows for private prescriptions for reasons other than treating gender dysphoria. | |||
| {{quote frame | Academics have condemned the University and College Union’s decision to campaign against a widely praised independent review into NHS treatment for gender-questioning children, claiming its position is “anti-scientific” and could expose researchers to harassment.}} | |||
| Do you see why the current text needs to be changed? | |||
| By my count, that article is roughly half about the condemnation of the motion and praise for the Cass Review, and half coverage of the motion itself, which is why I specifically devoted about half the length to each in my revised wording. As it is, given the opening POV of the article, and its balance of coverage, I would say my text is a fairer representation of the source. | |||
| As for the other changes: | |||
| I ask you to self revert, or explain why you think your representation is an accurate and neutral representation of this source. ] (]) 22:57, 6 January 2025 (UTC) | |||
| "Instigated" is almost always a negative term in English, and implies the Good Law Project were doing something mischievous or immoral by bringing the challenge. See https://www.merriam-webster.com/dictionary/instigate. This is POV. | |||
| :Just so that we are on the same page, I reinstated the language from before your edit, this is not something I have written. The language of the current version succinctly describes the motion passed without making judgements as to whether this was the correct decision. Your edit editorialized the paragraph and created the impression that the author believes the UCU acted in error when passing the motion. | |||
| "Reception by advocacy organisation" is just poor English if you are talking about more than one organisation, which we are. ] (]) 15:25, 12 October 2024 (UTC) | |||
| :I am not opposed to including responses from third parties. However, when doing so, we cannot solely present the opinions of third parties who opposed the move. Moreover, the "academic criticism" in question refers to tweets by one professor and an interview with one other, not published academic literature. I have to question whether this is even due. ] (]) 00:26, 7 January 2025 (UTC) | |||
| ::This is not about the motion, this is about the source. You are editorializing by selective representation of the source, excluding aspects that are reported with at least equal prominence. ] says {{tq | A source must be fairly represented for the purpose of the article and that includes contradictory and qualifying information}}, see ] for policy. | |||
| :On Misplaced Pages we ] what ] say and they use the term "puberty blocker ban" as is linked from the cited sources of the paragraph and was previously discussed. | |||
| ::Again, from ] | |||
| :The reversion was about your change of the consensus language from this as it is counter to our policies. We tend to avoid ] sources as you have linked and prefer to lean on ] sources and summarizing what they say. | |||
| ::{{tq | As to contradictory information that needs to be reported in Misplaced Pages, if, for example, a source says "Charlie loves all blue coats and hates all red coats", to report in Misplaced Pages that according to that source "Charlie loves all ... coats" is cherrypicking from the source. '''It is cherrypicking words with the effect of changing the meaning of what the source is saying.''' It is cherrypicking even if the source is precisely cited. It is still cherrypicking even if the editor meant well in changing the meaning; the issue is not the editor's intention, but how the Misplaced Pages article represents the source's meaning.}} | |||
| :If you have new reliable secondary sources that use other language or supports the details you are talking about, then we can discuss this, but the current paragraph summarizes the case based on the common language used by multiple reliable sources and is a summary of them. | |||
| ::This is exactly the case of this paragraph. | |||
| :As for the other two things you mentioned of "instigated" and plural, yes those are fine separate improvements and . ] (]) 15:58, 12 October 2024 (UTC) | |||
| ::{{tq | Your edit editorialized the paragraph and created the impression that the author believes the UCU acted in error when passing the motion}} | |||
| ::I did no such editorializing and created no such impression. I accurately represented the balance of treatment in the source, which gave no indication of the author's opinion, but merely the conveyed the reaction to UCU's actions, which was given equal weight in the originating source. | |||
| ::] citations to legislation are fine, there is even a WP template for it: https://en.wikipedia.org/Template:Cite_act (EDIT: as Raladic says, legislation is still a primary source). If you prefer, I can add these as well: https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers or https://mermaidsuk.org.uk/news/puberty-blocker-restrictions-explainer/. | |||
| ::If you want to remove the paragraph because it isn't DUE, do so. ] (]) 10:50, 7 January 2025 (UTC) | |||
| :::I think you're misreading the cherry-picking guidelines. Cherry-picking would be to include only criticism of the UCU motion but not support, or vice versa. The current state includes no responses from third parties, neither supportive nor critical, and so I am struggling to see how that can be construed as cherry-picking. | |||
| ::But in fact it is the current text which is unsourced - where in the current sources does it say that non-NHS prescribers can no longer prescribe puberty blockers or "The ban restricted their use to only those already taking them, or within a clinical trial"? ] (]) 17:10, 12 October 2024 (UTC) | |||
| :::When it comes to the language, the phrasing "was condemned for" in the topic sentence, in my view, creates a clear impression of wrongdoing by the UCU, and does not give equal prominence to the fact that the move was lauded by many. | |||
| :::Answering your questions: {{tq|where in the current sources does it say that non-NHS prescribers can no longer prescribe puberty blockers }} - here in the : {{tq|The ban means that puberty blockers cannot be obtained from private prescribers and only from the NHS within a clinical trial, but Coppel said no trial had yet been established, despite Cass’s support for it.}} | |||
| :::I suggest we let other editors weigh in and possibly post this in ] | |||
| :::And {{tq|or "The ban restricted their use to only those already taking them, or within a clinical trial"?}} - is from this one in the - {{tq|Puberty blockers are now only available to under-18s with gender dysphoria who are already taking the drugs. They can also be used in NHS clinical trials and in a few other circumstances.}} | |||
| ::: ] (]) 13:53, 7 January 2025 (UTC) | |||
| :::The Mermaid source you just linked also summarizes the restriction as such here: {{tq|Young people who did not receive a first prescription for this type of medication before 3 June 2024 and are accessing, or considering, private healthcare.}} | |||
| :I am frankly suspicious of using the Times as our sole source here. They're known to be biased on trans issues, and in my experience especially in this specific way, where they portray anything trans-supportive as controversial but anything trans-hostile as obvious. | |||
| :::Again, as I said above, it doesn't mean we don't sometimes add a primary citation, but the existence of templates for it doesn't override our general policies to prefer reliable independent secondary sources and that we ] the core points as so described, which appear well sourced and accurate. ] (]) 17:30, 12 October 2024 (UTC) | |||
| :I also second Henrik's skepticism that the criticisms they mention in this article constitute "academics have condemned", the very NPOV old framing. (Even if we rely on the Times for facts, there's no reason we need to copy their biased language.) I don't think that they even reach "academics were critical". Maybe "a small handful of particular academics were critical"; certainly it seems likely from the totality of the sources that WPATH would be fine with it, and they're academics. ] (]) 01:00, 7 January 2025 (UTC) | |||
| ::::] I think you are misreading both the Guardian and BBC sources. | |||
| ::::In any case, this is irrelevant, because we have a government-published secondary source answering these questions (https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers). It is not credible that the government would publish erroneous information about the details of their own regulations, so if (as you say) other sources conflict with it, we should go with the government source. ] (]) 18:12, 12 October 2024 (UTC) | |||
| ::::So that we are clear on what we are disagreeing about, I am saying that the most reliable source says the following: | |||
| ::::The ban/regulation prohibits the sale or supply of GnRH analogues, except to: | |||
| ::::#anyone over the age of 18 ("The government has today introduced regulations to restrict the prescribing and supply of puberty-suppressing hormones, known as ‘puberty blockers’, to children and young people under 18 in England, Wales and Scotland.") | |||
| ::::#anyone under 18 with an '''NHS prescription''' (although other regulations may apply in this case) ("It will apply to prescriptions written by UK private prescribers and prescribers registered in the European Economic Area (EEA) or Switzerland. During this period no new patients under 18 will be prescribed these medicines for the purposes of puberty suppression in those experiencing gender dysphoria or incongruence under the care of these prescribers.") | |||
| ::::#anyone under 18 with a private prescription from a UK-based prescriber who started on a course of treatment '''before 3rd June 2024'''. ("Patients already established on these medicines by a UK prescriber for these purposes can continue to access them.") | |||
| ::::#anyone under 18 with a private prescription from a UK-based prescriber for a '''condition other than gender dysphoria''' ("They will also remain available for patients receiving the drugs for other uses, from a UK-registered prescriber.") | |||
| ::::] can you see why saying "non-NHS prescribers can no longer prescribe puberty blockers" and "The ban restricted their use to only those already taking them, or within a clinical trial" are both inaccurate, if UK-based private prescribers can still prescribe in cases 1, 3 and 4 above, and new patients can still be prescribed in cases 1, 2 and 4? ] (]) 19:05, 12 October 2024 (UTC) | |||
| :::::I would be interested in knowing how many people age 18 and older are on puberty blockers. I saw a news article from a non-binary person suing to stay on the drugs for the rest of their life, so I suppose the answer is at least one. | |||
| :::::@], the sources are writing in the context of pediatric care. It would be appropriate for this article to be clear about that. Since someone has raised a concern over that, maybe we can find a way to be just a bit clearer that this only affects the under-18s. ] (]) 20:09, 12 October 2024 (UTC) | |||
| ::::::Yes, which is why I made earlier to add the words “for minors” just in case it wasn’t clear from context. ] (]) 21:28, 12 October 2024 (UTC) | |||
| :::::Regarding point 2 - the routine prescription even under NHS was further restricted to just under clinical trials. From your government source - {{tq| The NHS stopped the routine prescription of puberty blocker treatments to under-18s following the Cass Review into gender identity services. In addition, the government has also introduced indefinite restrictions to the prescribing of these medicines within NHS primary care in England, in line with NHS guidelines.}} This is part of the second sentence, which further outlined that other than existing prescriptions, even within the NHS new prescriptions will only be issued for clinical trials (refer to the sent by the NHS). I’ve it now per the sources. ] (]) 21:51, 12 October 2024 (UTC) | |||
| ::::::] and I have reverted those changes due to POV language and inaccuracies you introduced. It is not for you to say whether the exceptions are "narrow" or not. And you have misunderstood the significance of the December 2023 date; if patients have been prescribed puberty blockers for gender dysphoria '''after''' that date, then it is treated as if they were already undergoing a course of treatment, even if they have not started to take medication ("In addition to those patients who have actually started treatment, patients are treated as having started treatment, whether or not they have actually taken a GnRH analogue, if they were prescribed with a GnRH analogue on or after 3 December 2023." page 2 of your explainer letter). ] (]) 22:48, 12 October 2024 (UTC) | |||
| ::::::] and why have you falsely accused me of "engaging in an edit war" here https://en.wikipedia.org/User_talk:FirstPrimeOfApophis#October_2024? ] (]) 22:57, 12 October 2024 (UTC) | |||
| :::::::Please see below message from @] on the purpose of that section and how you changed the meaning of it and your was number 3 after number 2 and your of the content from the prior consensus, thus your last one is one too many and afoul of our ] rule. ] (]) 23:03, 12 October 2024 (UTC) | |||
| ::This section is about the ban on '''non-NHS''' prescriptions. This was a separate, specific action. Talking about narrow exceptions or changing the title to remove the explicit reference to '''non-NHS''' prescriptions renders the section nonsensical. You are conflating multiple things here, and this is not an improvement. ] (]) 22:45, 12 October 2024 (UTC) | |||
| :::I think you’re replied to the wrong person. It was @] who changed the title and expanded it to not only apply about non-NHS prescriptions. | |||
| :::As a response to that, there was no conflation as that expansion required those clarifications, since this then requires to make it clear that even on NHS, there are no more new prescriptions issued outside of clinical trials as announced by the NHS, and as the article already says further about about the stop of routine prescriptions. | |||
| :::@]now just reverted the content again, and for the 3rd time from the prior consensus version, thus now being afoul of ] - please self revert back to the previous consensus version prior to your change. | |||
| :::I agree with @] that this section was specifically about the new non-NHS restrictions, so those additions for the NHS parts are not helpful additions since they are already summarized further up in the parent paragraph - {{tq| Puberty suppressing hormones are no longer routinely available in NHS youth gender services.}} ] (]) 22:59, 12 October 2024 (UTC) | |||
| ::::Yes, sorry that was directed above, I agree - the NHS parts are not relevant. | |||
| ::::It is very important this be a separate section because it was a separate process, one which the NHS had ''no power to implement'', which the government of the day enacted, and the subsequent Labour government retained and widened. ] (]) 23:09, 12 October 2024 (UTC) | |||
| :::::OK, if that is consensus, I will revert to the original version. ] (]) 23:20, 12 October 2024 (UTC) | |||
| ::::Are we certain that "no longer routinely available" is the right understanding? Things can be "only in a clinical trial", but if the clinical trial itself is "routinely available" , then that would still be "routinely available". ] (]) 23:46, 12 October 2024 (UTC) | |||
| :::::At the current moment, they are not routinely available, since they are just setting up the plans for a trial right now, so I think the current summary is accurate as of this current discussion. | |||
| :::::If in the future such trials are available and do provide routine access we can change it, but right now we'd be in ] territory until that point. ] (]) 23:52, 12 October 2024 (UTC) | |||
| If this section is only about non-NHS prescriptions, should we be mentioning "clinical trials" at all in this section? The sources seem to discuss this only in the context of NHS prescriptions. ] (]) 14:46, 13 October 2024 (UTC) | |||
| == New Source in the BMJ addresses Yale white paper and BMA == | |||
| Recently published in the BMJ, is quite scathing about the Yale report. One to discuss. | |||
| https://adc.bmj.com/content/early/2024/10/13/archdischild-2024-327994 | |||
| This sort of thing is why I wanted to move away from the current bloated "response" structure. It's getting complicated and the responses are evolving and generating their own responses. ] (]) 21:17, 14 October 2024 (UTC) | |||
| :] how would you prefer to restructure it? ] (]) 21:27, 14 October 2024 (UTC) | |||
| ::See ] (]) 21:30, 14 October 2024 (UTC) | |||
| :::OK, I support it. ] (]) 21:49, 14 October 2024 (UTC) | |||
| :I think adding responses to the Cass Review is obviously necessary, but adding all these different responses to other responses to it like that article may be overdoing it. I think that everything that's currently in the article is fine, but do we really need to add every new article that is released criticizing or giving an opinion on another organization's response? Some may be an exception, but for the most part, I think we should just stick with organizations responding to the Cass Review instead of organizations responding to other organizations on it. That would help prevent the response section from becoming more "bloated" in the future. ] (]) 03:54, 15 October 2024 (UTC) | |||
| ::This adds significant new perspective on some existing content (especially the Yale white paper). It is a high quality, peer-reviewed source, far better than some recent additions, and clearly ]. Aside from direct responses and additional context applicable to claims currently in this page, the paper also has lots of information that can be used as a high quality source to expand the background, implementation and general reception. For example: | |||
| ::{{quote frame | The purpose of the Cass Review was to make recommendations to the National Health Service (NHS) in England (NHSE) on how to improve services for people under 18 experiencing issues with gender identity. It was underpinned by a robust research programme, engaged over 1000 stakeholders and took 4 years to complete. The results of the Review were embraced by the UK clinical community, as well as a number of other professional and third sector organisations and both main political parties. The editor-in-chief of the BMJ aptly observed, ‘The Cass Review is an opportunity to pause, recalibrate, and place evidence informed care at the heart of gender medicine. It is an opportunity not to be missed for the sake of the health of children and young people.’ NHSE accepted the Review’s recommendations in full and has initiated a 3-year implementation plan.}} ] (]) 08:44, 15 October 2024 (UTC) | |||
| :::I am not in favor of responses to responses either ] (]) 12:02, 15 October 2024 (UTC) | |||
| ::If we have a low-quality initial response that is debunked by a high-quality further response (like here), it isn't acceptable for us to present only the initial source. This will lead to ] between responses and mislead readers. ] (]) 16:34, 15 October 2024 (UTC) | |||
| :] on second thoughts, separating immediate and further responses seems risky. For example, a reader will read our lengthy and uncritical presentation of the Integrity Project paper in "Initial Responses" and not be informed of its flaws unless they read the "Further Responses" section as well, where we present a summary of this peer-reviewed journal article. This risks amplifying misinformation. | |||
| :As a compromise, I suggest where further responses address a specific initial response, the initial response and further response should be presented in the same place. Where further responses address a range of initial responses (e.g. this: https://www.bmj.com/content/385/bmj.q1141) they should go in a "Further Responses" section. ] (]) 16:34, 15 October 2024 (UTC) | |||
| ::In an ideal world, what I would like to see is: | |||
| ::* Background | |||
| ::* Methodology | |||
| ::* Interim Review | |||
| ::* Final Review | |||
| ::** Findings | |||
| ::** Recommendations | |||
| ::** Implementation | |||
| ::* Reception | |||
| ::** UK Political (Labour, Conservative, SNP) | |||
| ::** UK Medical (NHSE, RCPCH, RCGP, BPS, RCP, AoMRC, BMA) | |||
| ::** International Medical (AAP, Endocrine Society, CPS, AUMC, WPATH, PATHA) | |||
| ::* Subsequent Events | |||
| ::** Ban on private puberty blockers | |||
| ::** Adult clinic review | |||
| ::** Scottish gender clinics | |||
| ::* Wider Response | |||
| ::** Cass Reflections on review | |||
| ::** Yale team criticism (inc. response) | |||
| ::** Scholarly reactions | |||
| ::** Others etc... | |||
| ::** Popular media | |||
| ::Keep reception to the best, most relevant, highest quality and immediate responses. Cull or rehome everything else in "Wider Response". ] (]) 17:00, 15 October 2024 (UTC) | |||
| :::Interesting. So Final Review > Implementation would only be what is currently in the NHS England section? ] (]) 17:43, 15 October 2024 (UTC) | |||
| ::::Yes - I think the other points are notable fallout of the Cass Review, but not actually to do with its implementation. ] (]) 19:07, 15 October 2024 (UTC) | |||
| :::I don't like the idea of separating reception and responses since many people see those things as one and the same. But IF that happens, the RANZCP and JSPN should be kept with the others in the "International Medical" section. What would "Scholarly reactions" be? I don't know what "Popular media" would entail. ] (]) 12:11, 16 October 2024 (UTC) | |||
| :There are quite a few red flags with this paper: | |||
| :* 1) probably shocking almost nobody, one of the authors is the founder of ] (hardly independent from the Yale group) | |||
| :* 2) The section "Medicine, law and The Integrity Project" paints a ridiculously incomplete picture of trans healthcare in the US | |||
| :** 1) It says WPATH, the endocrine society, and trans advocacy groups oppose such bans - ignoring that every major medical org in the US opposes those bans including places like the AAP and APA | |||
| :** 2) It neglects to note the states banning trans healthcare do so entirely due to conservative and anti-LGBT advocacy groups | |||
| :* 3) "Criticism of the Cass Review process" is fairly weak | |||
| :** 1) Yale, and many others, have questioned putting somebody with no experience with trans kids in charge of their future across a country. The paper's response to that seems to be "nuh uh, we wanted somebody like that". That's a difference in values, not an error. Besides, they note that applied to the named systematic reviewers too, not just Cass. | |||
| :** 2) The statement this is critiquing, "many of the Review's author's identities are unknown", cites {{tq|Following the completion of the "research programme" by the University of York, "A Clinical Expert Group (CEG) was established by the Review to help interpret the findings" (p 26), defined as "clinical experts on children and adolescents in relation to gender, development, physical and mental health, safeguarding and endocrinology" (p 62). There is no further information about the qualifications of the members of the CEG, nor how they were selected}}. This paper says Cass was the sole author and mixes up the Review's CEG with it's CPG, ignoring the critique that Cass had an anonymous group discuss how to transform reviews into policy recommendations, and then guffs about "polarization" justifying a secret panel helping develop the recommendations. | |||
| :** 3) Their critique of Yale is that "McNamara et al assert that the Review contravenes standard practice in scientific evaluations by not using GRADE in its recommendations" but they don't, they point out that CPGs are subject to greater scrutiny and scientific rigour than the Review was | |||
| :* 4) It completes skips over the reports criticisms of Cass misrepresenting data and repeating false claims (ie, most kids desist) | |||
| :There were many more issues in this paper, but I wanted to flag some obvious ones. ] (]) 19:44, 15 October 2024 (UTC) | |||
| ::Thank you for doing the work to actually interrogate this source. ] (]) 20:57, 15 October 2024 (UTC) | |||
| ::This looks like a peer-reviewed paper (I assume? I don't know) in a respectable journal, about the subject of the article, and hence quite reasonably eligible to be used as a source, unless there is some overriding reason that it should not be considered reliable. Disagreeing with the conclusions of the paper are not a reason for it not to be considered a reliable source. In short, I don't think your red flags are very red. In long: | |||
| ::1) Guilt by association fallacy based on one of the five authors (not the lead author). | |||
| ::2) It's not the job of this paper to present a complete account of trans healthcare in the US. | |||
| ::3.1) The Integrity Project paper says they would have preferred a review led by someone with industry experience. This paper says they think that would have compromised independence. On this matter, the two papers disagree. So yes, that's not an error. | |||
| ::3.2) What do you mean by "it's CPG"? The paper states that there were over 1000 individual contributors and that it wouldn't have been appropriate to name them. Maybe you would have preferred Cass name them. That's an opinion, not a red flag. | |||
| ::3.3) McNamara et al ''does'' make that assertion, on page 9: {{tq|The Review introduces GRADE (p 55) but never evaluates the evidence using the GRADE framework.}}. This paper explains that (a) the NICE systematic reviews did use GRADE, and (b) {{tq|GRADE is indeed (appropriately) absent from the Cass Review recommendations: but this is because GRADE is a tool for CPGs and not designed for Reviews}} | |||
| ::4) Maybe you think the paper should have covered more ground, but that's not a red flag. | |||
| ::Ultimately this paper is part of the ongoing back-and-forth conversation between increasingly disconnected groups of researchers, and our job here is to summarise that conversation with due weight, not to submit our own entries in the debate. | |||
| ::] (]) 23:12, 15 October 2024 (UTC) | |||
| :::1) SEGM's affiliation does raise issues of ], ], and ] | |||
| :::2) It said it's job was to situate the Yale report in it. It failed and presented a both-sides-ism between anti-LGBT lobbying groups and every major medical org. | |||
| :::3.2) The Cass Review says {{tq|The research programme, led by the University of York, comprised appraisal of the published evidence and guidelines, an international survey and quantitative and qualitative research. A Clinical Expert Group (CEG) was established by the Review to help interpret the findings.}} The cass review repeatedly mentions this group, separately from the workshops and broader polls (see page 62-63). The red flag here is the BMJ's strawman, Yale never called for all those contributors, just the CEG, and the paper is misrepresenting who Yale is talking about. If BMJ said "how dare you ask for the CEG", that'd be a difference of opinion, them saying "you're asking for thousands of names" is nonsense. | |||
| :::3.3) {{Tq|Here, we compare the Review’s approach with one of the most widely accepted frameworks for determining evidence quality: Grading of Recommendations Assessment, Development and Evaluation (GRADE).1}} and {{tq|Clinical practice guidelines throughout medicine consider all relevant factors, but the Review takes the unusual step of elevating its own assessment of evidence quality above the considerations that guideline developers value. }} and {{tq|The Review fixates on evidence quality to the exclusion of many other factors that are rigorously considered by the developers of clinical practice guidelines}} - Simply put, the Cass Review made recommendations for how trans kids should be treated clinically. They did the work of a CPG without the rigor is Yale's critique, and the papers defense is "it isn't officially a CPG so the unrigorous recommendations are fine". | |||
| :::4) Yale noted multiple false statements in the Cass Review. A paper supposedly dissecting it and defending the Cass review ignoring those is noteworthy. At a minimum, it means any attempts to downplay the false statements noted by Yale can't be done using this as some gotcha. | |||
| :::{{tq| our job here is to summarise that conversation with due weight}} - a flawed paper co-authored by the head of a pro conversion therapy group attacking strawmen hardly seems due to me. ] (]) 23:56, 15 October 2024 (UTC) | |||
| ::::@], the metadata for the BMJ article gives the date of acceptance, which is usually a good indicator that it's peer reviewed. | |||
| ::::This source ticks all the boxes for the ] ideal. BTW, it looks like this would be a good moment to mention ]: | |||
| ::::{{xt|Here, "assess evidence quality" essentially means editors should determine the appropriate type of source and quality of publication. Respect the levels of evidence: Do not reject a higher-level source (e.g., a meta-analysis) in favor of a lower one (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source. Editors should not perform detailed academic peer review.}} | |||
| ::::Things like whether one of the authors has been ] for holding a reprehensible POV, or that we think they ought to have mentioned a longer list of organizations, are not actually valid criteria according to MEDRS. | |||
| ::::@], have you considered a structure that is more topical? Like: | |||
| ::::* Multiple centers: Cass recommends, and nobody cared (except maybe some non-London-based parents who will spend less time schlepping their kids halfway across the country to these appointments). | |||
| ::::* Future research: Cass recommends, but This Group has some concerns about privacy. | |||
| ::::* Puberty blockers: Cass discourages, and was roundly condemned by a long list, who in turn were criticized by That Group. | |||
| ::::In other words, instead of having separate ==Findings== and ==Responses== sections, let's have multiple ==Content with responses== (sub)sections. ] (]) 01:28, 16 October 2024 (UTC) | |||
| :::::I just want to make clear that the alleged {{tq | reprehensible POV}} is being part of an organisation that maintains the importance of , which the Cass Review makes explicitly clear is not conversion therapy, stating that it is harmful to conflate the two - indeed, one of the systemic failings identified was that clinicians were fearful of being accused of "conversion therapy" if they engaged in bog-standard exploratory psychotherapy, and so dumped their patients straight onto GIDS, further overloading the service. That this (]) perspective is not mentioned in ] is of course a ]. IMO, Misplaced Pages is not a reliable source, and the BMJ is. | |||
| :::::As for restructuring - I think it is important to have the findings together, as they are all of a whole, and that lets the reader understand the scope and intent of the review. I think interspersing that with criticism is going to make it exceptionally hard to read what the report actually covered, especially given the interdependence of some findings and the criticism thereof. Inevitably, anything on blockers would balloon, but it overlaps with findings on desistence, mental health, social transition, reliability of international standards etc etc. | |||
| :::::Perhaps another approach would be to keep findings as-is, have the immediate reception from the major bodies, then move ''implementation'' after reception, and have coarser implementation measures (blockers etc), along with criticism of those measures? ] (]) 08:33, 16 October 2024 (UTC) | |||
| ::::::I just want to make clear that the alleged "reprehensible POV" is the plain facts ] opposed bans on conversion, is known for spreading pseudoscience, has attempted to ban public healthcare for trans healthcare for all ages, and works with the conversion therapy groups like the ]. RS point out SEGM is inseperable from ], which has done all the same, but also operates a discord for how to put kids through conversion therapy. These are ridiculously FRINGE and trying to paint that as "they just support psychotherapy" is nonsense. | |||
| ::::::Your ] misrepresents sources and puts actual peer reviewed work next to opinion pieces from SEGM leaders and their primary sources. ] (]) 18:11, 16 October 2024 (UTC) | |||
| :::::::This is completely irrelevant to discussion of how to incorporate the response in the BMJ into the article on the Cass review; further attempts to argue about SEGM should be removed per ]. ] (]) 18:24, 16 October 2024 (UTC) | |||
| ::::::::It’s not irrelevant, it’s interrogating a source. Being from an RS doesn’t make a source necessary reliable, and vetting sources is a fully reasonable thing for an editor to do. ] (]) 22:57, 16 October 2024 (UTC) | |||
| :::::::::Interrogating a source is reasonable. Dismissing a peer-reviewed source in a top-tier medical journal by claiming it is ] is not though. Do you have a reason not to cite this? It seems to me to be significant and relevant, and higher quality than several other sources used on this page. ] (]) 09:42, 17 October 2024 (UTC) | |||
| ::::::::::Yes, all the reasons YFNS said and also the fact that responses to responses is something that I and several other editors don’t agree with for this article. The Wakefield study was peer reviewed and published in a top tier journal too, by the logic you’ve presented here that should be sufficient for inclusion. ] (]) 10:42, 17 October 2024 (UTC) | |||
| :::::::::::I ''knew'' someone would try the 'but Wakefield' line. I have no idea why it doesn't apply to sources like the Integrity Project or Horton which have even less standing, but which support the POV you want to push. If the BMJ has fucked up to that extent then there'll be plenty of RS coverage and an eventual retraction which we can definitely put in this page; until then, let's stick with established MEDRS rules. None of the reasons YFNS gave are remotely relevant to whether the source is reliable and due: point 1 is just irrelevant guilt-by-association; and 2-4 are an attempted debunking of the contents of the article, of no bearing here because YFNS' arguments on this talk page are not a ]. ] (]) 12:02, 17 October 2024 (UTC) | |||
| ::::::::::::Horton is a poor example: A peer reviewed study published in the leading journal of trans healthcare that isn't mentioned anywhere in the article despite being cited by nearly every source criticizing the Cass Review. It is 4 times as due as the BMJ piece, and the only apparent reason for not including it is it doesn't support the POV some editors want to push :) ] (]) 15:16, 17 October 2024 (UTC) | |||
| :::::This isn’t even a research paper though, it’s an opinion piece by a freelance journalist ] (]) 11:33, 16 October 2024 (UTC) | |||
| ::::::You might be thinking of earlier investigation by Jennifer Block, the source is a peer-reviewed paper with five co-authors. ] (]) 12:01, 16 October 2024 (UTC) | |||
| :::::::Oh I see, my mistake ] (]) 22:54, 16 October 2024 (UTC) | |||
| :::::I like your idea on the structure. I think that is also somewhat in line with the spirit of ], providing balanced treatment of each topic, rather than repeating the Cass POV in one section and all the criticism (and the criticism of that criticism etc.) in another section. <b style="font-family:Monospace">-- ] (])</b> 15:43, 16 October 2024 (UTC) | |||
| ::::::I also think this structure is better. ] (]) 15:57, 16 October 2024 (UTC) | |||
| ::::::I can't see that being a terribly useful article to the reader. | |||
| ::::::* The Cass review found x relating to puberty blockers | |||
| ::::::** WPATH condemned this and said it was bad | |||
| ::::::** Yale published a white paper saying it was bad | |||
| ::::::** Someone got a letter to the editor published saying they read how the Yale paper said it was bad | |||
| ::::::** Japanese guidelines referred to the Cass review and carried on prescribing blockers | |||
| ::::::* The Cass review found x relating to social transition | |||
| ::::::** WPATH condemned this and said it was bad too | |||
| ::::::** Yale published a white paper saying it was bad too | |||
| ::::::** Someone got a letter to the editor published saying they read how the Yale paper said it was bad as well | |||
| ::::::And so on... | |||
| ::::::You can't separate these things out like that when they are all interrelated. | |||
| ::::::This is a recipe for an unreadable mess. ] (]) 16:02, 16 October 2024 (UTC) | |||
| :::::::Agree with @]. That will make it impossible to follow the Cass Review or what any of the others are saying about it. ] (]) 17:54, 16 October 2024 (UTC) | |||
| :::::::Also agree with @]. The actual findings and recommendations of the Review should be as clear as possible to the reader, and the best way to do that is keep them separate from other content. The ongoing political and scientific discussion of those findings and recommendations should be introduced separately, where all DUE and RS sources can be included. ] (]) 19:28, 16 October 2024 (UTC) | |||
| :::::I'm cautiously optimistic towards restructuring the article. Is there a ballpark estimate for the number of subsections required if we go with the content with responses-standard? ] (]) 18:14, 16 October 2024 (UTC) | |||
| ::::{{tq|SEGM's affiliation does raise issues of WP:DUE, WP:FRINGE, and WP:INDEPENDENT}} — Yes, it raises issues of how ] can possibly be applied to a peer-reviewed article in the BMJ because of affiliations of one of its authors. The policy simply cannot be applied here: peer-reviewed BMJ articles on gender medicine ''are part of mainstream gender medicine''. If anything, SEGM's founder being published in this context is evidence against the organisation more broadly being treated as FRINGE. ] (]) 15:30, 16 October 2024 (UTC) | |||
| ] can you clarify why you have reverted this change https://en.wikipedia.org/search/?title=Cass_Review&diff=1251696753&oldid=1251695385? "strong dispute" needs to be based on actual WP policies to be relevant, otherwise it is just ]. Please see Barnards.tar.gz and WhatamIdoing's detailed policy-based response to the supposed "red flags" above. ] (]) 17:58, 17 October 2024 (UTC) | |||
| :Omg my notifs are working again! | |||
| :Anyway, the complaints are numerous and reasonable. | |||
| :1. responses to responses are unnecessary and UNDUE (not capitalizing this to yell, just to highlight the policy) for the article. | |||
| :2. The source is not INDEPENDENT and has affiliation with a FRINGE organization that pushes conversion therapy. | |||
| :3. DUE weight is also called into question by the fact that we’ve already agreed to cut much more consequential papers on the Cass Review, such as Cal Horton, for reasonable reasons. | |||
| :4. Whether MEDRS even applies to criticism here is tenuous, since this isn’t an article on puberty blockers, GAC, or anything else, it’s an article on a published document - and while the material of that document is biomedically-related, ultimately the subject of the article is the document itself. The Cass Review here is not being cited as a source on puberty blockers, it’s being cited as a source on the Cass Review. This is as much of a history article as it is anything else. | |||
| :There is not a consensus that these issues are sufficiently mitigated, irrelevant, or overcome. I don’t even know if there’s a majority opinion, though that is certainly still a lower bar than a consensus. Thus, we shouldn’t be including it. We wouldn’t include the Wakefield study on a relevant article without consensus either. ] (]) 18:38, 17 October 2024 (UTC) | |||
| ::To clarify, what I meant by strong disputing is that like half the editors on this page are against its inclusion on valid grounds. ] (]) 18:41, 17 October 2024 (UTC) | |||
| ::A reminder that we're talking about a living person, that ] applies to talk pages, and that "pushes conversion therapy" is a strong claim. | |||
| ::Do you have a source for "pushes conversion therapy" that isn't self-published and doesn't boil down to claiming "exploratory therapy is conversion therapy"? Because - I repeat - the Cass Review says it isn't. ] (]) 21:51, 17 October 2024 (UTC) | |||
| :::The Cass Review is only one study, and the vast majority of sources say that SEGM pushes conversion therapy. Also, SEGM is an organization, not a person, living or otherwise. ] (]) 23:57, 17 October 2024 (UTC) | |||
| :::I’m going to go through this point by point because there’s so much to unpack here. | |||
| :::1. BLP doesn’t apply to organizations, and the individual’s connection itself to SEGM (which is the only thing BLP would apply to here) is yet undisputed. | |||
| :::2. Since the point you’re disputing is whether SEGM as an organization pushes conversion therapy, let’s look at SEGM. | |||
| :::Copy pasted from the SEGM page | |||
| :::“In May, 2021, SEGM called for an amendment to the Canadian criminal code ], which outlawed ], falsely claiming that conversion therapy can only be applied to lesbian, gay, and bisexual people as opposed to transgender people as well. This position is not supported by any major medical organization, which define conversion therapy as including efforts to change sexual orientation or gender identity.” Cited to Science-Based Medicine | |||
| :::So already, we have a clear example of them pushing for anti-trans conversion therapy, regardless of specific techniques employed, to remain legal. | |||
| :::3. I’m also glad you agree already that SEGM pushes the specific technique of gender exploratory therapy, good, because GET is widely considered conversion therapy. Here’s a collective statement I pulled from the GET section of the conversion therapy page, by six major MEDORGS all specializing in trans care saying that GET is conversion therapy (see section 9) | |||
| :::4. I don’t recall the Cass Report, which as I recall is not peer reviewed, ever saying such a thing. The most it said about gender exploratory therapy was that there was an unhelpful lack of clear definition for the terms “affirmative” and “exploratory” in a treatment context. But please, if I’m wrong, show me. ] (]) 07:29, 18 October 2024 (UTC) | |||
| ::] thanks for this. | |||
| ::{{tq|1. responses to responses are unnecessary and UNDUE for the article.}} | |||
| ::From ] "Neutrality requires that mainspace articles and pages fairly represent '''all significant viewpoints that have been published by reliable sources''', in proportion to the prominence of each viewpoint in those sources. (The relative prominence of each viewpoint among Misplaced Pages editors or the general public is irrelevant and should not be considered.)" (my emphasis) | |||
| ::Neutrality is not negotiable; it is not for editors to make arbitrary decisions like "we'll include early responses but not later responses which respond to those early responses". | |||
| ::{{tq|2. The source is not INDEPENDENT and has affiliation with a FRINGE organization that pushes conversion therapy.}} | |||
| ::One of the five authors is co-founder and senior adviser to SEGM. Is this what you are referring to? She is not the lead author or the peer reviewer. One of the authors being involved in advocacy is not sufficient conflict of interest to discard a reputable source, otherwise we would have to discard the Integrity Report white paper. | |||
| ::Also see ] "A neutral point of view should be achieved by balancing the bias in sources based on the weight of the opinion in reliable sources and not by excluding sources that do not conform to the editor's point of view." | |||
| ::Considering how badly the white paper fails WP:INDEPENDENT adding this countervailing and more reliable source is the best way to achieve NPOV. | |||
| ::] refers to theories, not people or organisations. There are no fringe theories articulated in this source. Whatever the authors believe (or not) outside this source is not relevant to determining the validity of this source. | |||
| ::{{tq|3. DUE weight is also called into question by the fact that we’ve already agreed to cut much more consequential papers on the Cass Review, such as Cal Horton, for reasonable reasons.}} | |||
| ::This is an argument about other sources, not this one. | |||
| ::{{tq|4. Whether MEDRS even applies to criticism here is tenuous, since this isn’t an article on puberty blockers, GAC, or anything else, it’s an article on a published document - and while the material of that document is biomedically-related, ultimately the subject of the article is the document itself. The Cass Review here is not being cited as a source on puberty blockers, it’s being cited as a source on the Cass Review. This is as much of a history article as it is anything else.}} | |||
| ::I don't really understand this. Are you saying it should be excluded because it meets MEDRS? | |||
| ::{{tq|There is not a consensus that these issues are sufficiently mitigated, irrelevant, or overcome. I don’t even know if there’s a majority opinion, though that is certainly still a lower bar than a consensus. Thus, we shouldn’t be including it.}} | |||
| ::Opposition to changes is only valid if it is based on genuine Misplaced Pages policies. See ]. | |||
| ::] (]) 07:27, 18 October 2024 (UTC) | |||
| :::1. Yes, all significant viewpoints in proportion to their prominence. What is the prominence in the field of these criticisms of criticisms of criticisms? Has their been some manor surge in citations that would make this paper stand out in the field? What is paper’s significance, even, as a criticism of a criticism of a criticism? If Yale University and this group of researchers go back and forth in a locked room for centuries on end, shall we meticulously record every blow exchanged? Responses to responses are due I’d argue when they’re the Cass Review team or Cass herself responding to criticisms of their work, they are not due when it’s random people chiming in because then where does it end? | |||
| :::2. If an organization’s entire purpose is advocating for fringe theories, then it’s reasonable to say that the organization itself falls under fringe. Likewise, I notice you consider Yale biased for, reasons that aren’t clear. Certainly SEGM has a compelling interest in the furtherance of a biased goal, but what biased goal - what lack of independence - does the Yale group have that needs to be balanced? A look at their website says their only concern is scientific rigor as it applies to pieces of research which may affect policy. I see no bias in this org that needs to be balanced. | |||
| :::3. And? We’re applying our policies evenly, are we not? | |||
| :::4. No, I’m saying that whether or not the hierarchy of MEDRS is an applicable argument to begin with here is debatable. | |||
| :::5. You have your policy based arguments, other editors on this page have theirs which they’ve already stated, but at the end of the day, no matter how invalid you think other editors’ arguments are or how answered by your points they are, you don’t have consensus, and per WP:SATISFY, no one is obligated to satisfy you. ] (]) 07:48, 18 October 2024 (UTC) | |||
| ==Restructuring== | |||
| Can we continue the discussion on restructuring in this section? Currently the "New Source" section has become a bit confused. ] (]) 18:09, 16 October 2024 (UTC) | |||
| OK, I've tried to implement the uncontroversial parts of VoidIfRemoved's proposed structure. I haven't changed the Reception sections at all, other than move the Interim Review reception to a new section and bring all Final Review reception sections up a heading-level. No content has been added or deleted. Let me know what you think. ] (]) 19:00, 16 October 2024 (UTC) | |||
| :I personally don't see the need to restructure. I think the article is fine as it currently is. But I strongly oppose creating different sections for "reception" and "responses" since those things are basically the same and could mislead readers who only read one section into think that's all there is. ] (]) 19:28, 16 October 2024 (UTC) | |||
| ::I agree that reception and responses as separate sections isn’t helpful to the reader. I wouldn’t mind initial vs later reception though. ] (]) 22:56, 16 October 2024 (UTC) | |||
| :Thanks - I've moved more material from "background" into those sections where I think it fits better. ] (]) 09:48, 17 October 2024 (UTC) | |||
| == Cal Horton Again == | |||
| I propose we add {{tq|Cal Horton writing in the ] argued that the Cass review publications between January 2020 and May 2023 indicated prejudice, ] bias, pathologization; and inconsistent standards of evidence.}} to the article. Not only is it a MEDRS, it is heavily cited in reference to the Cass Review: | |||
| {{cot|sample of sources referencing Horton's critique of the Review}} | |||
| * {{tq|That being said, we also acknowledge the existence of concerns that some minors may face undue pressures to change their bodies, or may do so without being adequately informed about the scope or magnitude of the potential risks, many of which are the subject of ongoing research (e.g., Cass 2024; for critiques, see Grijseels 2024; Horton 2024; Noone et al. 2024; }} | |||
| * | |||
| * {{tq|Although the current commentary focuses on the biological and psychosocial evidence pre sented in the Cass Review, other issues with the Review and its process have previously been raised (Horton, 2024). This article raises a number of similar concerns discussed here, in particular inconsistent standards of evidence. However, further concerns regarding prejudice and a cis-normative bias are also examined. Although science claims to be fully impartial, it never exists in a vacuum, and the confounding factors discussed by Horton should be considered carefully when interpreting the Review.}} | |||
| * {{tq| The above-mentioned critiques are not new but have been highlighted in a recent nonepeer-reviewed, independently published report by Cass (2024) that has gained traction in the media. Other scholars have provided lengthy and nuanced rebuttals to the Cass report. }} (45 being Horton) | |||
| * {{tq|The lack of consideration for how rigorous qualitative studies are designed, combined with the aforementioned exclusion of qualitative research from the systematic reviews, and the use of single (and sometimes misrepresented; see below) quotes from participants to support much broader conclusions demonstrates a misunderstanding of qualitative evidence in the Cass Report and the valuable insights about GAC that have been generated through qualitative research (see Horton, 2023}} | |||
| * {{tq|Although the current commentary focuses on the biological and psychosocial evidence presented in the Cass Review, other issues with the Review and its process have previously been raised (Horton, 2024). This article raises a number of similar concerns discussed here, in particular inconsistent standards of evidence. However, further concerns regarding prejudice and a cis-normative bias are also examined. Although science claims to be fully impartial, it never exists in a vacuum, and the confounding factors discussed by Horton should be considered carefully when interpreting the Review}} | |||
| * {{tq|Dr Cal Horton, a research fellow in Oxford Brookes’ Centre for Diversity Policy Research and Practice, wrote an academic paper raising concerns about preliminary documents published as part of the Cass Review. In the article ‘The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children’, published in The International Journal for Transgender Health, Horton argued that the interim recommendations promoted cis-normative standards and ideals.}} | |||
| {{cob}} ] (]) 15:59, 17 October 2024 (UTC) | |||
| :It's in a medical journal, but ] states that low-level evidence should be avoided, and I'm pretty sure ] of documents counts as low-level evidence at best. ] (]) 16:58, 17 October 2024 (UTC) | |||
| ::] is prefixed with {{tq|When writing about any ''']'''}} (bolding present in original). This is not about the ''health effect'', this is peer reviewed scholarship on how multiple publications by an organization describe and treat a minority group, which is comparing apples to oranges. These kinds of review are actually common in trans healthcare, such as this recent systematic review finding pathologizing language and cisgenderism to be fairly frequent across multiple sources. ] explicitly carves out the exception {{tq|News sources may be useful for non-biomedical content, such as information about "society and culture" – see ].)}} - if news sources can be used for such content, academic RS definitely can. ] (]) 17:21, 17 October 2024 (UTC) | |||
| :::It is perhaps worth noting that the health effect link at ] goes to ], not ]. Also this isn't an exception, "society and culture" is ], same with medical ethics. ] (]) 20:49, 17 October 2024 (UTC) | |||
| :] It doesn't seem unreasonable to me, if that is really the wording you are going to use and you aren't going to do something unusual (like put it in the lead). But wasn't this discussed previously here https://en.wikipedia.org/Talk:Cass_Review/Archive_3#Cal_Horton? What do you believe has changed since then? ] (]) 17:37, 17 October 2024 (UTC) | |||
| ::I presume it's just been cited more since then in other RS. ] (]) 18:36, 17 October 2024 (UTC) | |||
| ::I don't think anything's changed since then. It is a response to the interim review. It happens to have been cited a couple of times since then, by better sources which are already cited in this article because they are addressed at the Cass Review itself and are more pertinent, so I don't see what it adds. ] (]) 21:43, 17 October 2024 (UTC) | |||
Latest revision as of 13:53, 7 January 2025
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sources for consideration
- Vinter, Robyn (11 April 2024). "Trans children in England worse off now than four years ago, says psychologist". The Guardian.
- "The Guardian view on the Cass report: rising numbers of gender distressed young people need help". The Guardian. 11 April 2024.
- Barnes, Hannah (10 April 2024). "The Cass review into children's gender care should shame us all". New Statesman.
- "The Observer view on the Cass review: children were catastrophically failed by the medical profession". The Observer. 14 April 2024.
- "RCPCH responds to publication of the final report from the Cass Review". RCPCH.
- "Cass Review 'should mark a watershed moment' – charity chief". The Shropshire Star. 9 April 2024.
- Hansford, Amelia (10 April 2024). "Cass report urges 'caution' in prescribing puberty blockers to trans youth". PinkNews | Latest lesbian, gay, bi and trans news | LGBTQ+ news.
- Dyer, Clare (9 April 2024). "Guidelines on gender related treatment flouted standards and overlooked poor evidence, finds Cass review". BMJ: q820. doi:10.1136/bmj.q820.
- Abbasi, Kamran (11 April 2024). "The Cass review: an opportunity to unite behind evidence informed care in gender medicine". BMJ: q837. doi:10.1136/bmj.q837.
- Abbasi, Kamran (9 April 2024). ""Medication is binary, but gender expressions are often not"—the Hilary Cass interview". BMJ: q794. doi:10.1136/bmj.q794.
- Cass, Hilary (9 April 2024). "Gender medicine for children and young people is built on shaky foundations. Here is how we strengthen services". BMJ. 385: q814. doi:10.1136/bmj.q814. ISSN 1756-1833.
- "Evidence for puberty blockers and hormone treatment for gender transition wholly inadequate | BMJ". BMJ.
- Penna, Dominic (16 April 2024). "Chris Whitty: Debate around transgender issues 'too vitriolic'". The Telegraph.
- Reed, Erin. "Why Hilary Cass' NHS report is wrong about trans health care". The Advocate.
- "Gender care review: Children 'let down' by research amid 'exceptionally toxic' debate". ITV News.
- "Hilary Cass: Ideology on all sides directed gender care of children". ITV News.
- Horton, Cal (14 March 2024). "The Cass Review: Cis-supremacy in the UK's approach to healthcare for trans children". International Journal of Transgender Health: 1–25. doi:10.1080/26895269.2024.2328249.
- "Gender Identity Service Series". Archives of Disease in Childhood.
- Thornton, Jacqui (April 2024). "Cass Review calls for reformed gender identity services". The Lancet. 403 (10436): 1529. doi:10.1016/s0140-6736(24)00808-0.
- Ghorayshi, Azeen (2024-05-13). "Hilary Cass Says U.S. Doctors Are 'Out of Date' on Youth Gender Medicine". The New York Times. ISSN 0362-4331. Retrieved 2024-05-14.
- Grijseels, D. M. (8 June 2024). "Biological and psychosocial evidence in the Cass Review: a critical commentary". International Journal of Transgender Health. doi:10.1080/26895269.2024.2362304.
- Horton, Cal; Pearce, Ruth (7 August 2024). "The U.K.'s Cass Review Badly Fails Trans Children". Scientific American. Retrieved 13 August 2024.
- Polgreen, Lydia (13 August 2024). "The Strange Report Fueling the War on Trans Kids". New York Times. Retrieved 13 August 2024.
- Davie, Max; Hobbs, Lorna (8 August 2024). "Cass: the good, the bad, the critical". Retrieved 18 August 2024.
- Budge, Stephanie L.; Abreu, Roberto L.; Flinn, Ryan E.; Donahue, Kelly L.; Estevez, Rebekah; Olezeski, Christy L.; Bernacki, Jessica M.; Barr, Sebastian; Bettergarcia, Jay; Sprott, Richard A.; Allen, Brittany J. (28 September 2024). "Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth". Journal of Adolescent Health. doi:10.1016/j.jadohealth.2024.09.009. ISSN 1054-139X.
Enforced BRD
Just so nobody misses this: There's a thing called 'enforced BRD', and it now applies to this page. That means that the rules used to be:
- Make your edit
- Get reverted
- Maybe restore your edit (but never to the point of edit warring)
and they are now:
- Make your edit
- Get reverted
- Start a discussion on the talk page (or just decide to never restore your edit)
- At least 24 hours after starting that discussion, you can maybe restore your edit (but never to the point of edit warring, nor if the discussion on the talk page has active opposition. Silence is not active opposition).
See User:Awilley/Enforced BRD FAQ and User:Awilley/Consensus Required vs Enforced BRD for more information.
WhatamIdoing (talk) 04:04, 11 December 2024 (UTC)
- Glad to see this - is it wrong that I think this should be mandatory on GENSEX? Void if removed (talk) 18:06, 11 December 2024 (UTC)
- I think you would be surprised how cumbersome it can be, especially for problems like subtle vandalism. WhatamIdoing (talk) 18:29, 11 December 2024 (UTC)
Was the Cass Review peer reviewed?
Nothing in the article seems to address this question unless I'm overlooking it. Nosferattus (talk) 19:43, 22 December 2024 (UTC)
- We are currently discussing this. Per Cass' own description of the process, she only mentions the systematic reviews being peer reviewed. The whole point of the independent review is that she gets to make her own conclusions based on that evidence. Because she hasn't documented that the review was peer reviewed, I think it's pretty clear that it isn't (and she doesn't pretend that it is). But I'm sure there are people who feel very strongly that we can't include that in the article unless it's explicitly written somewhere. I'm not sure that follows (she included the protocols, process, etc; if it's not in those, it didn't happen), but, well, it's still an ongoing discussion. Lewisguile (talk) 19:55, 22 December 2024 (UTC)
- WP:V will say that we can't include that in the article unless we have a reliable source that WP:Directly supports such a statement. And if none exist, then one has to wonder whether such a statement would be WP:DUE anyway.
- About the above comments on the "peer-reviewed journal": Although that is a common phrase, it is somewhat more accurate to describe individual articles as being peer reviewed, because not everything in a peer-reviewed journal always undergoes (external) peer review. WhatamIdoing (talk) 07:06, 23 December 2024 (UTC)
- I think you've got things reversed here. We can't describe the report itself as peer-reviewed if we can't verify that it was. What it appears to be is an administrative summary of peer-reviewed research. We should avoid using terms that imply that the report itself is peer-reviewed, as well: specifically, we should be very clear about what was in the reviews versus what was in the report summarizing those reviews. Loki (talk) 04:04, 25 December 2024 (UTC)
- I agree. We can neither describe the final report as a peer-reviewed report, nor describe it as non-peer-reviewed report, unless we have sources.
- My preference is to describe the systematic reviews as being peer-reviewed articles, and to describe nothing else (not the reports issued by Cass, not the journal in which the reviews appeared) in that language. WhatamIdoing (talk) 17:28, 25 December 2024 (UTC)
- I'm fine with all of the above. I think we're in agreement. Lewisguile (talk) 17:43, 26 December 2024 (UTC)
- The "non peer reviewed" is inappropriate. Cass is an independent review, it isn't an academic publication. We don't call the Independent Medicines and Medical Devices Safety Review "non peer reviewed" or any other wiki page about an independent review, because they are independent reviews, not academic papers. The source being used to make the claim this is a "narrative review" (which is quite wrong) is one line in a table in a non-peer reviewed document from a thinktank. This is inadequate. Void if removed (talk) 14:30, 1 January 2025 (UTC)
- @Lewisguile you've reverted this saying
If peer-reviewed systematic reviews are gold standard, they are gold standard here too
- please point to me where the RAND document is peer-reviewed? It is not published in any academic journal. Here are their standards for their self-published reports: https://www.rand.org/about/standards.html - Please self-revert. And using this one source to falsely call an independent review a "narrative review" is a stretch. Void if removed (talk) 15:00, 1 January 2025 (UTC)
- Here is the relevant bit:
This work was supported by Indiana University Bloomington and the Medical College of Wisconsin and conducted by the Access and Delivery Program in RAND Health Care and the Social and Behavioral Policy Program in RAND Social and Economic Well-Being. This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.
- Source: https://www.rand.org/pubs/research_reports/RRA3223-1.html
- So it is peer-reviewed. Lewisguile (talk) 15:15, 1 January 2025 (UTC)
- That line (thank you for finding and posting it) would be more reassuring if they specified external peer review. "Internal" peer review is a thing, and "rigorous", like beauty, can be in the eye of the beholder. WhatamIdoing (talk) 00:34, 2 January 2025 (UTC)
- VIR found something elsewhere on their website which said they have at least two reviewers, with one in-house and at least one other/independent, IIRC. I currently find anything on this page as it's now a wall of text. Sorry about that. Lewisguile (talk) 18:17, 2 January 2025 (UTC)
- That line (thank you for finding and posting it) would be more reassuring if they specified external peer review. "Internal" peer review is a thing, and "rigorous", like beauty, can be in the eye of the beholder. WhatamIdoing (talk) 00:34, 2 January 2025 (UTC)
- @Lewisguile you've reverted this saying
- The "non peer reviewed" is inappropriate. Cass is an independent review, it isn't an academic publication. We don't call the Independent Medicines and Medical Devices Safety Review "non peer reviewed" or any other wiki page about an independent review, because they are independent reviews, not academic papers. The source being used to make the claim this is a "narrative review" (which is quite wrong) is one line in a table in a non-peer reviewed document from a thinktank. This is inadequate. Void if removed (talk) 14:30, 1 January 2025 (UTC)
- I'm fine with all of the above. I think we're in agreement. Lewisguile (talk) 17:43, 26 December 2024 (UTC)
- I think you've got things reversed here. We can't describe the report itself as peer-reviewed if we can't verify that it was. What it appears to be is an administrative summary of peer-reviewed research. We should avoid using terms that imply that the report itself is peer-reviewed, as well: specifically, we should be very clear about what was in the reviews versus what was in the report summarizing those reviews. Loki (talk) 04:04, 25 December 2024 (UTC)
- @13tez why did you add a citation needed tag? The source explicitly says it's a narrative review and not peer reviewed on p 10, table 2.1 Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:34, 30 December 2024 (UTC)
- Ah, that's just because I'm not familiar with that source - hence why I put the CR and SRs into different sentences, so they can be referenced separately to avoid just this type of confusion. 13tez (talk) 23:40, 30 December 2024 (UTC)
- @Lewisguile Just wanted to give you a heads up I think you slightly over-reverted here. I agree with the main removal of the bloated background, but want to check if you meant to also revert the additions to methodology clarifying the review was a non-peer reviewed narrative review and expanding on its methods - I'm assuming that was accidental collateral lol. Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:06, 31 December 2024 (UTC)
- I thought about it, but I think if we add that in, then we also need to add in that the systematic reviews were peer reviewed. And the problem is, small additions can result in a bunch of other things being added too, so every small change is potentially a big one. This is the draft I have been working on:
Methodology
The Cass Review was an independent narrative review which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS. It was not peer-reviewed but it commissioned a series of systematic reviews which were. In addition to the systematic reviews, the review also commissioned qualitative and quantitative research into young people with gender dysphoria and their health outcomes, conducted listening sessions and focus groups with service users and parents, held meetings with advocacy groups, and gathered existing evidence and grey literature on the lived experiences of patients. The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity, which were carried out by the University of York's Centre for Reviews and Dissemination and published in Archives of Disease in Childhood. The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. The reviews covered:
- Characteristics of children and adolescents referred to specialist gender services
- Impact of social transition in relation to gender for children and adolescents
- Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence
- Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers)
- Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy)
- Care pathways of children and adolescents referred to specialist gender services
- Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence
The systematic reviews assessed the quality of the studies available and used meta-analysis to combine the results of multiple studies. The results informed Cass' conclusions and recommendations, along with the results of the other forms of evidence collected. Lewisguile (talk) 17:40, 31 December 2024 (UTC)
- @Snokalok @13tez @Your Friendly Neighborhood Sociologist @Bluethricecreamman What do you think of this draft? Lewisguile (talk) 17:51, 31 December 2024 (UTC)
- Looks overall good to me! I only have the minor quibble that 2/3 sentences seem a little redundant,
The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity
could probably be merged intoIt was not peer-reviewed but it commissioned a series of systematic reviews which were
or even removed considering the bullets.The systematic reviews assessed the quality of the studies available and used meta-analysis to combine the results of multiple studies. The results informed Cass' conclusions and recommendations, along with the results of the other forms of evidence collected
feels very redundant, explaining what systematic reviews are, and we already note Cass commissioned all these things
- Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:58, 31 December 2024 (UTC)
- I'll drop the first redundant line. For the second, I will drop both sentences. Lewisguile (talk) 08:40, 1 January 2025 (UTC)
- All done. Check out the latest version. I think it's much more balanced now. I also added the RAND systematic review to the "other academics" section for lack of a better home. That seems appropriate since it's also a systematic review, mentions Cass, and details some of the similarities/differences in their approaches and conclusions. Lewisguile (talk) 09:52, 1 January 2025 (UTC)
- Hey @Lewisguile,
- The Background and Methodology sections were separate sections, which I think made sense. Why is the Methodology section (describing how the review was carried out) now a subsection of the Background section (describing why the review was carried out)?
- The new version of the Methodology section is still diluted compared to the version in place before my originally contested edits. Before them, the article said that the SRs were peer-reviewed and independent without having to state the CR itself wasn't peer-reviewed, which some people want to, citing WP:BALANCE. However, balance is not just weighing all viewpoints or sides of an argument equally, or even equally based on how much each are voiced, it's weighing their coverage in the article in proportion to their coverage in suitable/reliable sources.
- We've now removed all mention of the SRs' independence, while adding that the CR wasn't itself peer-reviewed and criticism of the SRs from RAND Corporation ("The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes.").
- To me, this seems WP:UNDUE because there's consensus the (externally peer-reviewed and independent) SRs were fine, even among people who criticise the CR; I've seen no MEDRS source that criticises them; the SRs commissioned by the CR concurred with others, e.g. the Swedish and Finnish SRs; and the SRs commissioned by the CR are of higher quality than RAND's SR because they were commissioned for the NHS, carried out by the Centre for Reviews and Dissemination, independent, and externally peer-reviewed by published in Archives of Disease in Childhood, a high-quality and peer-reviewed medical journal associated with the RCPCH, while the RAND SR was created by and for a think tank and research organisation. Furthermore, I don't think the RAND review is a WP:MEDRS source because it wasn't published in a medical journal or created by a major medical or scientific organisation.
- We've also relegated the explanation of what the Centre for Reviews and Dissemination is to an endnote. While I'm okay with that change in and of itself, it's another dilution from the version in place before my original edits. Editors trying to maintain balance have pushed the ship back further the other way than my changes swayed it to begin with, and out of proportion with coverage in reliable and MEDRS sources. Therefore, there is now a WP:BALANCE issue.
- The types of evidence other than the SRs ("In addition to the systematic reviews, the review also commissioned...") should be put at the end of the section because the SRs made up most of the evidence base for the review (per the CR other pieces of evidence "supplemented" them) and it makes sense logically for readers to group information on the SRs together.
- Thanks! 13tez (talk) 12:28, 1 January 2025 (UTC)
- The RAND corporation stuff is definitely UNDUE, this is a primary source from a policy thinktank, not any sort of MEDRS. Void if removed (talk) 14:43, 1 January 2025 (UTC)
- It is a peer-reviewed systematic review, so definitely not a primary source. See here: https://www.rand.org/pubs/research_reports/RRA3223-1.html Download the report and read it for yourself. Lewisguile (talk) 15:17, 1 January 2025 (UTC)
- @13tez Methodology was supposed to be a main header. I posted some text for workshopping upthread and had made the header there a subheader so it didn't start a new topic, but when I copied it over, I forgot to fix that.
- RAND is due, as it's another peer reviewed systematic review. They worked with two universities on the report. I have no problem with the SRs, and I don't think stating what they excluded is non-neutral in itself. It's true they only looked at people up to 18, whereas RAND also looked at those up to 25. That was an intentional decision and all of those things, except the bit about confidence of evidence ratings, are also said within the Cass Review itself, so it can have two sources backing it up if you'd like?
- @Void if removed's edits have conflicted with mine, so the changes I made to methodology have been reverted, adding "non-peer reviewed" back in and a few other things. I had suggested the following wording for Methodology, which I think was a fair compromise:
- Methodology
- The Cass Review was an independent narrative review which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS. According to Cass, "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians."
- The systematic reviews looked into different areas of healthcare for children and young people with distress related to gender identity, were carried out by the University of York's Centre for Reviews and Dissemination, and were published in Archives of Disease in Childhood. The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. The reviews covered:
- Characteristics of children and adolescents referred to specialist gender services
- Impact of social transition in relation to gender for children and adolescents
- Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence
- Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers)
- Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy)
- Care pathways of children and adolescents referred to specialist gender services
- Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence
- The review also commissioned qualitative and quantitative research into young people with gender dysphoria and their health outcomes, conducted listening sessions and focus groups with service users and parents, met with advocacy groups, and gathered existing evidence and grey literature on the lived experiences of patients. Lewisguile (talk) 15:26, 1 January 2025 (UTC)
- Re: "supplemented", I did find this in the final report, but in this context
The Review has therefore had to base its recommendations on the currently available evidence, supplemented by its own extensive programme of engagement
(p. 20). This means the engagement activities were supplements, but the qualitative and quantitative research that the Cass Review also commissioned can't reasonably be slotted into the "engagement" category over the "available evidence" category. The quantitative research, certainly, wouldn't fit that criteria. Specifically, she also refers to the SRs on the international GLs as "supplementing" the evidence (p. 53:an appraisal of an international guidelines and international survey were undertaken to supplement this information
). In the box underneath, the appraisal of int'l GLs is the two papers: Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1) and Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2), so I'm not sure we should draw a specific conclusion re: proportionality from the word supplement alone. Was it used more specifically anywhere else that you've found? Lewisguile (talk) 15:54, 1 January 2025 (UTC)- Hey @Lewisguile, thanks for getting back to me.
- RAND is due, as it's another peer reviewed systematic review. They worked with two universities on the report. I have no problem with the SRs, and I don't think stating what they excluded is non-neutral in itself. It's true they only looked at people up to 18, whereas RAND also looked at those up to 25. That was an intentional decision and all of those things, except the bit about confidence of evidence ratings, are also said within the Cass Review itself, so it can have two sources backing it up if you'd like?
- I don't necessarily doubt that it was peer-reviewed or that they worked with two univertisites to make it. However, it wasn't published by a major medical organisation or in a reputable medical journal. Therefore, I don't think we can count it as a MEDRS source, and I certainly don't think so to the extent that its criticism of the CR's SRs (which I view as higher quality sources for the reasons I gave before) should be afforded weight (especially when the quote comes from a paragraph explaining these were minor changes and the SRs mostly worked the same anyway). If you can find some other sources to back it up, that'd be better, both to have sources we all view as MEDRS/suitable stating these criticisms and to ensure there's enough coverage of them in MEDRS/suitable sources to warrant their inclusion (even if we view the RAND review as MEDRS, if these criticisms aren't made in other MEDRS sources, they won't have enough coverage to be included per weight).
- Re: "supplemented", I did....I'm not sure we should draw a specific conclusion re: proportionality from the word supplement alone. Was it used more specifically anywhere else that you've found?
- I think there are one or other two sources I don't have to hand saying the SRs were the foundation of the evidence and the CR's findings. From page 47 of the final report though: "The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews on a range of issues from epidemiology through to treatment approaches, and international models of current practice." You've also seen: "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians." I think the "as well as" puts emphasis more on the SRs being the "bedrock" of the CR. In all, I think it's reasonable to say the SRs were the core of the evidence the CR used; what do you think now, with this all in mind?
- Regarding the draft version of the Methodology section (and comparing to the section before my originally contested edits and after them as well):
- "According to Cass..." We should try to write the text ourselves, rather than quoting, especially given how contentious this article is: people will see "according to Cass" and immediately overwrite it because they "disagree with the review".
- I appreciate you putting the non-SR stuff at the end, I think it works much better that way
- I'm fine with the explanation of the role of the Centre for Reviews and Dissemination moving to an endnote if it helps get a compromise
- Why did you remove the paragraph including the Mixed Methods Appraisal Tool and Newcastle–Ottawa scale? They were key to how the SRs worked and help the reader better understand the CR's overall methodology.
- We've still swayed further towards criticisms of the SRs than even before my edits. For example, the section used to say the SRs were independent and peer-reviewed. Now, it doesn't, and instead we have some (minor in context) criticism of them. The boat has still been pushed back further than it swayed to begin with.
- I might make a revision of the methodology section based upon the version present before my originally contested edits, with some tweaks - maybe adding extra details people want as endnotes and adding more references. What would you think about that?
- Thanks again! 13tez (talk) 17:20, 1 January 2025 (UTC)
- Hi @13tez,
"The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews on a range of issues from epidemiology through to treatment approaches, and international models of current practice." You've also seen: "The bedrock of the Review was a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians." I think the "as well as" puts emphasis more on the SRs being the "bedrock" of the CR. In all, I think it's reasonable to say the SRs were the core of the evidence the CR used; what do you think now, with this all in mind?
I really don't see it that way. In fact, with the "to support this" part in there, that shows me that there's no consistency in how she uses phrases like "support", "supplement", etc. How can the SRs be the most important thing if they only support the other evidence looked at? She's using these terms loosely throughout, and the only logical meaning, from my POV, is that the only consistent statement we can make is that she's using all this information to support her findings/recommendations, not that some evidence is prioritised and the rest is secondary. Anything more than that is WP:OR. Given the ambiguity, I think we either have to include her direct quotation or remove the claim of SR centrality altogether.However, it wasn't published by a major medical organisation or in a reputable medical journal. Therefore, I don't think we can count it as a MEDRS source, and I certainly don't think so to the extent that its criticism of the CR's SRs (which I view as higher quality sources for the reasons I gave before) should be afforded weight (especially when the quote comes from a paragraph explaining these were minor changes and the SRs mostly worked the same anyway). If you can find some other sources to back it up, that'd be better, both to have sources we all view as MEDRS/suitable stating these criticisms and to ensure there's enough coverage of them in MEDRS/suitable sources to warrant their inclusion (even if we view the RAND review as MEDRS, if these criticisms aren't made in other MEDRS sources, they won't have enough coverage to be included per weight).
As I said upthread, the Cass Review and its SRs already state what the remit of the review was, and therefore its limitations. So this is equally sourced by the Cass Review/SRs. The only part that isn't is the part about confidence ratings, and I'm happy for that particular part to be removed (although, the Cass Review doesn't include confidence ratings, so it's also not untrue). Besides which, we don't necessarily exclude RSes just because some sources are better. Only if the better source conflicts. But there isn't a conflict here, since Cass isn't contradicting RAND. Furthermore, RAND is peer reviewed (Cass isn't) and RAND's health research arm is well regarded and influential, having provided evidence for the US government among others. The SRs being published in peer reviewed journals is one-nil to the Cass Review, but the fact the overall RAND report is peer reviewed and Cass isn't makes it one-all. So there's not much in it. And again, Cass supports RAND's statement about limitations because those limitations were largely intentional.- But I feel very strongly that we shouldn't exclude RAND just because some editors prefer Cass or think it's more reliable, since the fact Cass has been based on SRs has been repeatedly used to already exclude other sources that are critical of the review. We need to be consistent here. Moreover, we shouldn't be excluding all criticism here; at worst, we should be including stuff with caveats to reflect the uncertainty Cass herself says exists in the evidence base (and therefore in her own findings). The person who added RAND in the first place obviously agrees it's due and so do I. Minimising critique (or perceived critique, since I don't feel RAND is actually giving a critique rather than simply explaining limitations) introduces bias in itself.
"According to Cass..." We should try to write the text ourselves, rather than quoting, especially given how contentious this article is: people will see "according to Cass" and immediately overwrite it because they "disagree with the review".
It's a direct quote. That's the whole point. The compromise is to include the direct quote so that others can make up their own mind. Going back to a statement in Wikivoice isn't a compromise, because one of us is going to disagree with how it's framed. The only Wikivoice statement I think is justified is something along the lines of "to draw her conclusions, Cass commissioned systematic reviews, qualitative and quantitative research, etc".Why did you remove the paragraph including the Mixed Methods Appraisal Tool and Newcastle–Ottawa scale? They were key to how the SRs worked and help the reader better understand the CR's overall methodology.
The final report section details the tools used for each outcome/finding, so it's redundant. Also, specific trumps the general here, so being able to say "this SR used x" is better than a generalised statement.- If you want to propose some new text, please add a draft here and ping me. Then we can discuss it and workshop it without any intervening edit conflicts or reversions. However, I did make several compromises already and they have been repeatedly undone afterwards (I know there have been lots of editors making changes), so the draft I've proposed is far closer to your preferred wording than mine. I also suspect it's still a bit quiet here after Christmas, and we might want to give others a chance to chime in too, since there seems to be only 3 or 4 of us engaging regularly at the moment. Lewisguile (talk) 18:24, 1 January 2025 (UTC)
- Hey @Lewisguile, thanks for sharing your thoughts again.
- How can the SRs be the most important thing if they only support the other evidence looked at?
- She said: "The Review has to be grounded in a thorough examination of the most robust existing evidence. To support this, we commissioned systematic reviews..." She's saying the SRs were commissioned to support the ability of the review to be "grounded in a thorough...". This ability ("to be grounded...") is the "this" in "support this", not the other types of evidence. After pointing that out, and considering the other references we've discussed so far ("supplemented" and "the bedrock"), is your mind changed at all?
- As I said upthread, the Cass Review and its SRs already state what the remit of the review was, and therefore its limitations. So this is equally sourced by the Cass Review/SRs
- I'd be happy to include the scope/remit/limitations of the SRs or CR if they can be sourced from the CR or SRs themselves and are due etc. Do you think we could include something like that instead of the RAND stuff altogether to move forwards on this?
- So there's not much in it.
- I don't want to debate the relative quality of the two sources much more, since it isn't really productive, but: the NHS is the type of medical organisation (and listed as an example) in WP:MEDORG and they commissioned the review (and the group who carried it out serve the NHS); and the SRs were published in a (highly) reputable medical journal. Neither of these points are true for the RAND review, so I consider it to be of lower quality and credibility.
- Again, I'm not assuming it's wrong - it doesn't even seek to criticise or "debunk" the SRs/CR anyway - just that I don't think we can assess its quality to be high enough under MEDRS to warrant the inclusion of its content in the article which is currently being presented in a manner that undermines the credibility of the SRs/CR.
- I don't feel RAND is actually giving a critique rather than simply explaining limitations
- Yeah, I don't feel that way either. RAND never says "the Cass Review was wrong" and the limitations are discussed, in context, as small differences from their own approach and not as criticisms anyway. However, the whole basis of including some of their described limitations of the SRs seemed to be critical and included to form some kind of balance "against the systematic reviews".
- It's a direct quote. That's the whole point. The compromise is to include the direct quote so that others can make up their own mind
- I was trying to say we don't need to make up our own minds on whether the CR commissioned "a series of seven systematic reviews commissioned from the University of York, as well as a survey of international practice and a qualitative study examining the range of experiences and outcomes of patients, and the perspectives of parents/carers and clinicians". All of this is currently in the quote from Cass. However, this is all objectively true, not being contended here, and supported by MEDRS sources other than Cass. We can move that the CR commissioned that stuff out of the quote. I think it'd be beneficial because we should use direct quotes sparingly and, given how contentious this article is, people will see "according to Cass" and immediately overwrite it or add other text afterwards to "debunk" it because they "disagree with the review". Do you see what I mean about moving what we can out of the direct quote?
- The final report section details the tools used for each outcome/finding, so it's redundant. Also, specific trumps the general here, so being able to say "this SR used x" is better than a generalised statement.
- Yeah, I take your point that the Newcastle–Ottawa scale is redundant when included in both the methodology and final report sections. I think it makes more sense to include in the methodology section than the final report sections. In other words, describe how the quality of research was assessed in the methodology section, then describe the outcome of these processes in the final report section. What would you think about that? Ditto for the Mixed Methods Appraisal Tool.
- However, we're now missing the explanation of why these tools were used ("because no blinded controlled studies – those usually thought of as having the highest quality – were available") and that meta-analyses were used to combine the results of different research in the SRs. I think this is important information, in part because "the CR excluded non-blinded studies which was unfair" is a widely covered and shared claim, and, in part, to explain the methodology underpinning the SRs and CR. Do you agree with me here? How do you think we could restore this information? I genuinely thought that paragraph had been removed accidentally, because I hadn't seen anyone objecting to it before.
- If you want to propose some new text, please add a draft here and ping me. Then we can discuss it and workshop it without any intervening edit conflicts or reversions.
- Sure, thanks again for working in good faith to compromise. I might make one in my sandbox or something similar and ping you with it.
- Thanks! 13tez (talk) 22:13, 1 January 2025 (UTC)
- Again, though, "to support this" doesn't mean "we used the systematic reviews over everything else". There's no explicit statement to support "we used this more than anything else", so the rest is a matter of interpretation. If the meaning is as clear as you think it is, then it will be equally clear if we include an original, direct quote? We could remove
According to Cass
, since the statement is sourced, while still using the direct quote. That will avoid the impulse for someone to try to counter it. We can also add invisible text to advise others not to do that in future. - Re: RAND versus the Cass Review, R (it's still sourced)AND has existed since c.1948, was funded by NIH and others, and regularly contributed research to the CDC and other governmental departments in the U.S. While it wasn't published in a journal (it says all its publishing is "open publishing"), their review was written by multiple authors and peer reviewed. The only person who needed to be convinced in the Cass Review was Cass (a self-described non-expert), so she was free to interpret the evidence how she wanted to. Which is why, in places, she makes her own conclusions, and draws from disparate bits of evidence like sex-rearing in DSD.
- My main concern at this stage is that if nothing is allowed in that isn't deemed to be equal to the Cass Review by a small group of editors, then we effectively minimise any critique, discussion or nuance. WP:MEDRS shouldn't be used to silence disagreement, especially when the medical consensus across multiple countries isn't as clear-cut. That's before we even get into the politics of this – Cass is a politician, and members of the last government were proud to announce their own support of the review, even after they had made non-neutral statements about this subject before. Indeed, similar claims have been made about Cass.
- All of which is to say that no evidence is perfect, all sources are biased, and the Cass Review itself isn't perfect. The SRs are mostly fine, but the CR =/= the SRs alone. There's a significant amount of synthesis and interpretation occurring to create the conclusions and recommendations, and Cass herself doesn't deny that.
- What I suggested to VIR elsewhere was that we could remove the part about certainty ratings and then cite the remainder to both RAND and the Cass Review.
- As for the grading tools, some of those would have been used either way. That's what a systematic review does. RAND used GRADE, which is what NICE uses, whereas York used a mixed approach. It's different but not particularly unusual, and so not majorly notable. However, I have no problem with those more specific statements from the findings being replaced with a more generic statement – so long as you're aware that's what's happening. I also don't mind the statement about no blinded studies being in there. Though, blinded RCTs are usually the highest standard and there are particular circumstances that make blinded RCTs unlikely or difficult to obtain here – e.g., control will always be treatment x + treatment y versus treat ebt X or y alone, or treatment x versus treat ebt y. You'll never get treatment x versus placebo for blockers, for example, because it's obvious whether you're going through puberty or not (especially if you have dysphoria). So someone is likely to feel, at some point, that this clarification also needs to be made. Not mentioning the blinded part avoids that. We already explain most of the evidence was of insufficient quality, which does the same thing for those who are interested in knowing such details anyway.
- If you post a draft in sandbox, I'll happily take a look. Thank you. I'm going to put a notice in the WikiProject so we can get more eyes on this anyway. There's a danger whatever we say here will get reverted again otherwise. Lewisguile (talk) 08:59, 2 January 2025 (UTC)
- About this sentence, which is what I believe you're talking about: The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. This is a selective statement of differences between the RAND report and the Cass report. (It leaves out "used different risk-of-bias assessment tools, excluded studies meeting less than 50 percent of bias assessment criteria from syntheses in the hormonal intervention reviews".)
- I don't think that the first even sounds like a "criticism" of Cass; it sounds like a simple, factual description. In order:
- The Cass Review looked at studies of the relevant population. This is a good thing, right? (If the world never sees another study for children with cancer that relies on geriatric results, it will still be too soon.)
- The Cass final report excluded weak evidence. The RAND report included weak evidence, and I guess that's their choice, but it's not actually bad to exclude weak evidence.
- The Cass final report also excluded studies that were not published in the international language of science. Not only is this usual, but nobody has since reported even a single study in any other language that could be used to seriously challenge any of Cass' recommendations. The RAND report says they didn't exclude non-English sources and still only found one non-English study that met their inclusion criteria (in Spanish; I believe it was PMID 36705053). This is therefore an unimportant difference between the RAND and Cass reports.
- So what's left is: It did not provide certainty-of-evidence ratings for outcomes.
- My main concern is that this sentence will not be understood by some (probably most) readers. We have seen unfortunate misunderstandings happen before (e.g., in the "they rejected 98% of the scientific studies!" misinformation), and I would like us to do our part, small as our part may be in this instance, to avoid setting off another round of drama on antisocial media. If we dump this in the article, some people are going to believe that they have now, finally, after all these months, found the detail that proves the Cass Review is 100% bad, because they have no idea what this means, but it sounds all science-y and it must be some kind of stunning criticism, or else Misplaced Pages wouldn't have mentioned it.
- What RAND's statement means is that they intend to spam (low certainty) and (very low certainty) at the end of certain sentences in their report, and they notice that the Cass final report did not do this. (With a quick search, RAND didn't label anything in their report as having a certainty rating higher than "low".) RAND writes, e.g., in their Summary (bottom of page V) that puberty blockers slow pubertal progression (low certainty), GAH is associated with cross-sex pubertal changes (low certainty), and both of these reduced gender dysphoria (very low certainty), where Cass would have said basically the same thing, except not spammed "(low certainty)" after the items.
- Including this label is the standard form for GRADE approach#Certainty of evidence, but including or omitting that information doesn't actually change the recommendation/assessment, and both the interim and the final report already said that the evidence base sucks in general. See, e.g., this line in the Cass final report:
- This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.
- That pretty much tells you that the certainty of evidence for "outcomes" is low (except when it's very low, or non-existent).
- Additionally, quite a lot of the Cass final report isn't something that would have this sort of statement anyway. You can't have a certainty-of-evidence rating about whether Further research is needed.
- My bottom line is that if we're going to mention this – and there's no clear reason why we should – we need to be precise in what we're saying and explain what that means and why it (doesn't) matter in practice. It might help to stop thinking of this as a criticism. RAND isn't complaining about Cass's choice. Also, they did a review of the evidence in a somewhat different way (e.g., including case studies), and still ended up in the same place, namely that the existing evidence base sucks (or is entirely non-existent for two of their categories). WhatamIdoing (talk) 11:38, 2 January 2025 (UTC)
- I don't see it as criticism of Cass. I see it as describing limitations, which is also pretty neutral in this context. I've said as much elsewhere. My feeling, however, was that people are unduly anxious that it is a critique, which is why they don't want it in the article at all. I disagree with that stance and believe RAND is suitable to use. RAND isn't/wasn't just used in the article to cite the sentence above – it was also used to cite the limitations in terms of other countries. I.e., this is a review for the NHS and isn't necessarily applicable to other countries' health services. Which again, is blindly obvious to us, but a lot of people have spread misinformation about that part, such as that US politician who has tried to ban certain treatments citing Cass. That is relevant for the same reasons you cite: avoiding misinformation. So, broadly speaking, if we're in agreement that RAND is fair to use in the article, I'm happy.
- However, if we're also including lots of detail on the SRs, then mentioning the (intentional) limitations is also warranted. I wanted less explanation of the SRs in general, but as 13tez feels very strongly that we need more info on them, then we should balance that out by adequately setting expectations. Lewisguile (talk) 18:30, 2 January 2025 (UTC)
- I don't feel like we're including "lots of detail on the SRs".
- The text currently says:
:::::::::::::It commissioned a series of several peer-reviewed, independent systematic reviews that looked into different areas of healthcare for children and young people with distress related to gender identity, was carried out by the University of York's Centre for Reviews and Dissemination, and was published in Archives of Disease in Childhood. The reviews were restricted to studies focusing on minors, excluded case studies and non-English studies, and did not provide certainty-of-evidence ratings for outcomes. The reviews covered:
- Characteristics of children and adolescents referred to specialist gender services
- Impact of social transition in relation to gender for children and adolescents
- Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence
- Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence (puberty blockers)
- Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence (transgender hormone therapy)
- Care pathways of children and adolescents referred to specialist gender services
- Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence
- Which is to say, it provides basic information about who-what-where and the main subjects of the seven reviews.
- The "restricted to studies focusing on minors" is redundant with "looked into different areas of healthcare for children and young people". Mentioning the "non-English studies" thing implies that this is a material restriction, which is known to be false. For that matter, "non-English studies" implies that there was more than one non-English study, which RAND says is false. I think we should remove both of those.
- Also, that first sentence is 50 words long. Maybe that could be split. WhatamIdoing (talk) 22:40, 2 January 2025 (UTC)
- Again, though, "to support this" doesn't mean "we used the systematic reviews over everything else". There's no explicit statement to support "we used this more than anything else", so the rest is a matter of interpretation. If the meaning is as clear as you think it is, then it will be equally clear if we include an original, direct quote? We could remove
- None of this is DUE - the RAND report could maybe go on puberty blockers or gender-affirming healthcare but its not a response to or critique of Cass, nor is it an authoritative source on Cass' methodology. It doesn't encompass the same evidence, and it isn't published in any reputable journal. Void if removed (talk) 21:10, 1 January 2025 (UTC)
- That's your opinion, and frankly this feels like WP:BLUDGEONING at this point. You've vigorously fought every single source which critiques Cass in even the lightest terms possible. It risks becoming WP:STATUSQUOSTONEWALLING. Lewisguile (talk) 08:37, 2 January 2025 (UTC)
- I lean towards agreeing with Void's suggestion that RAND is more relevant to other articles. Also, I think you're wrong to interpret RAND as "critiquing" Cass at all. WhatamIdoing (talk) 11:39, 2 January 2025 (UTC)
- See above. I don't think it's critiquing Cass. But the objection to it seems motivated by keeping out criticism, whether it actually is or not. Lewisguile (talk) 18:32, 2 January 2025 (UTC)
- I lean towards agreeing with Void's suggestion that RAND is more relevant to other articles. Also, I think you're wrong to interpret RAND as "critiquing" Cass at all. WhatamIdoing (talk) 11:39, 2 January 2025 (UTC)
- That's your opinion, and frankly this feels like WP:BLUDGEONING at this point. You've vigorously fought every single source which critiques Cass in even the lightest terms possible. It risks becoming WP:STATUSQUOSTONEWALLING. Lewisguile (talk) 08:37, 2 January 2025 (UTC)
- Re: "supplemented", I did find this in the final report, but in this context
- The RAND corporation stuff is definitely UNDUE, this is a primary source from a policy thinktank, not any sort of MEDRS. Void if removed (talk) 14:43, 1 January 2025 (UTC)
- Looks overall good to me! I only have the minor quibble that 2/3 sentences seem a little redundant,
- ^ R. Dopp, Alex; Peipert, Allison; Buss, John; De Jesús-Romero, Robinson; Palmer, Keyton; Lorenzo-Luaces, Lorenzo (November 26, 2024) . Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research - RAND_RRA3223-1.pdf (PDF) (Report). RAND Corporation. Retrieved 2024-12-28.
- ^ Thornton, Jacqui (April 2024). "Cass Review calls for reformed gender identity services". The Lancet (News). 403 (10436): 1529. doi:10.1016/S0140-6736(24)00808-0. PMID 38643770.
Cass commissioned four systematic reviews of the evidence on key issues...
- ^ Cass review final report 2024, p. 28. sfn error: no target: CITEREFCass_review_final_report2024 (help)
- ^ Cass review final report 2024, pp. 52–53. sfn error: no target: CITEREFCass_review_final_report2024 (help)
- ^ Cass review final report 2024, p. 60. sfn error: no target: CITEREFCass_review_final_report2024 (help)
- ^ Cass review final report 2024, p. 56. sfn error: no target: CITEREFCass_review_final_report2024 (help)
- ^ Cass review final report 2024, p. 8, Appendix 2. sfn error: no target: CITEREFCass_review_final_report2024 (help)
- "Homepage | Archives of Disease in Childhood". Archives of Disease in Childhood. Archived from the original on 19 December 2024. Retrieved 19 December 2024.
- ^ Clayton, Alison; Amos, Andrew James; Spencer, Jillian; Clarke, Patrick (31 August 2024). "Implications of the Cass Review for health policy governing gender medicine for Australian minors". Australasian Psychiatry: 3. doi:10.1177/10398562241276335.
- ^ "Gender Identity Service Series". Archives of Disease in Childhood (Series of reviews commissioned to inform the Cass Review). Archived from the original on 10 April 2024. Retrieved 10 April 2024.
- ^ Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Characteristics of children and adolescents referred to specialist gender services: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s3 – s11. doi:10.1136/archdischild-2023-326681. ISSN 0003-9888. PMID 38594046. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
- ^ Hall, Ruth; Mitchell, Alex; Taylor, Jo; Heathcote, Claire; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Impact of social transition in relation to gender for children and adolescents: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s12 – s18. doi:10.1136/archdischild-2023-326112. PMID 38594055. Archived from the original on 22 April 2024. Retrieved 22 April 2024.
- ^ Heathcote, Claire; Mitchell, Alex; Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth; Jarvis, Stuart William (9 April 2024). "Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s19 – s32. doi:10.1136/archdischild-2023-326347. PMID 38594045. Archived from the original on 23 April 2024. Retrieved 23 April 2024.
- ^ Taylor, Jo; Mitchell, Alex; Hall, Ruth; Heathcote, Claire; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s33 – s47. doi:10.1136/archdischild-2023-326669. ISSN 0003-9888. PMID 38594047. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
- ^ Taylor, Jo; Mitchell, Alex; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s48 – s56. doi:10.1136/archdischild-2023-326670. ISSN 0003-9888. PMID 38594053. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
- ^ Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Care pathways of children and adolescents referred to specialist gender services: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s57 – s64. doi:10.1136/archdischild-2023-326760. PMID 38594052. Archived from the original on 28 April 2024. Retrieved 28 April 2024.
- ^ Taylor, J; Hall, R; Heathcote, C; Hewitt, CE; Langton, T; Fraser, L (9 April 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)". Archives of Disease in Childhood (Review). 109 (Suppl 2): s65 – s72. doi:10.1136/archdischild-2023-326499. PMID 38594049. Archived from the original on 2 August 2024. Retrieved 13 April 2024.
- ^ Taylor, J; Hall, R; Heathcote, C; Hewitt, CE; Langton, T; Fraser, L (9 April 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)". Archives of Disease in Childhood (Review). 109 (Suppl 2): s73 – s82. doi:10.1136/archdischild-2023-326500. PMID 38594048. Archived from the original on 29 June 2024. Retrieved 13 April 2024.
- Cass review final report 2024, p. 161. sfn error: no target: CITEREFCass_review_final_report2024 (help)
- Cass review final report 2024, pp. 2, 3, Appendix 2. sfn error: no target: CITEREFCass_review_final_report2024 (help)
- James, Beal (26 April 2024). "Cass author condemns 'misinformation' spread by trans lawyer". The Times (News). Archived from the original on 2024-04-22. Retrieved 26 April 2024.
During a systematic review, researchers looking at studies on transgender healthcare found no blind control ones — so used another system altogether to determine study quality.
- Cass review final report 2024, p. 243. sfn error: no target: CITEREFCass_review_final_report2024 (help)
- ^ Cite error: The named reference
bbc-cass-misinfowas invoked but never defined (see the help page). - Cass, Hilary (2024-09-06). "Gender identity services for children and young people: navigating uncertainty through communication, collaboration and care". The British Journal of Psychiatry. 225 (2): 302–304. doi:10.1192/bjp.2024.162. ISSN 0007-1250.
- "Homepage | Archives of Disease in Childhood". Archives of Disease in Childhood. Archived from the original on 19 December 2024. Retrieved 19 December 2024.
Updates and copyedits
I have gone through the article to make some general copyedits for length and repetition, and to add page refs to some of the citations (see diffs here – moving stuff up has made some edits look larger in markup). I have tried to keep the meaning the same. In a few instances, I have removed text that was either apparently unsourced or which didn't reflect the source material (see thread immediately above this one). Where I could, I simply reworded such text, and only removed it when it wasn't there at all in the sources or was unclear/misleading. I'm noting here a few of my own queries/things we might still want to consider:
There are conflicting views about the clinical approach, with expectation at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services.
We previously said clinicians had expectations far from the norm based on this, but I think this is actually talking about the expectations of service users and their families. I.e., that the expectation among patients and their families that they will/should receive treatment x, and that clinicians who don't offer this worry they'll suffer sanctions or face a complaint. That was a strong theme in the York papers, and makes sense in the context. If I'm reading that wrong, I'm happy to restore that wording or an alternative, as needed.- In-keeping with the general consensus for orgs over individuals in the Responses section (which is still really long), I have trimmed or removed statements by, e.g., the president or chair of an organisation if their comments were substantively the same as those of their org. E.g., if the org says "Yes!" and they say "Yay!" I've left quotes that add extra/different info ("Yay, but..." or "No").
- On responses in general, the length is partly to due with lots of direct quotes. We could probably round up some of the Responses (in the format of
orgs x, y and z supported the review but x said "something else" as well
). In the meantime, I have trimmed the direct quotes a bit, both for length and to avoid extensive reproduction of text from sources. I don't believe these have changed the meaning of any quotes, but please ping me if I've left something important out or misinterpreted anything. - I think the Methodology section spends too much time on the independent systematic reviews, rather than the Cass Review process itself. This may need some workshopping.
- Do we need a terminology or "concepts" section? There are some concepts that are overlapping and the nuances may not immediately be clear to readers (e.g., gender dysphoria, gender incongruence, gender-related distress). We can outline how the systematic reviews and Cass Review use these terms, if there are differences.
- I added one sentence to summary Cass' response at the end of the lede:
Following high profile media coverage, Cass expressed concern that misinformation about the review had spread online and elsewhere, and that her review was being weaponised against trans people.
It seems important to mention both of these things. This wording seems fairly neutral to me and hopefully conveys the points in broad strokes, without needing to go into too much detail here. Hopefully this isn't controversial, but as always, I am happy to self-revert if necessary.
Thoughts are always welcome. Lewisguile (talk) 10:44, 27 December 2024 (UTC)
- I agree with your idea of summarizing responses, and suggest that it should be "orgs x, y and z supported the review, and x said "something else" as well". One risk is that the supporters may be easy to summarize, which could result in "A, B, C, D, E, F, G, H, I, J, K, L, M, O, N, P, Q, R, S, T, U, V, W, and X all supported the review, but Y said <multiple sentences of disagreement> and Z said <long paragraph of disagreement>", which would amount to providing UNDUE weight to a minority of organizations.
- Right now, we have a long list of subsections, to which I have added a quick guess at the overall 'feel' of the contents:
- Response from UK political parties and public bodies: 90% support
- Response from devolved governments: 80% support
- Response from health bodies in the United Kingdom: 90% support
- Response from other health bodies globally: 10% support
- Response from transgender specialist medical bodies: 0% support
- Other academic responses: 20% support
- Reception by charities and human rights organisations: 40% support
- Reception by gender-critical organisations: 100% support
- The thing about summarizing is that the high levels of support are fairly boring: A, B, C, D, etc., all basically support the review and its recommendations. The opponents, however, are all over the map: N disagrees about this specific thing. O disagrees about a different specific thing. P throws out an ad hominem attack on Cass herself. Q makes an (unsubstantiated?) claim that Bad People were involved. R thinks it's fine, as long as it doesn't get imported into R's country. And so forth. The net result for the reader is that a concise summary of (for example) 60% support could look like 90% opposition, merely because the opposition can't be summarized as simply. WhatamIdoing (talk) 21:39, 27 December 2024 (UTC)
- I hear you. But one way around that is to cluster them by the groupings we currently have. So "political parties x, y and z said this", "medical groups a, b and c said that", and so on. If we workshop the text here we might be able to pare it down fairly while making sure it doesn't feel unbalanced? We did something similar for November 2024 Amsterdam riots and it worked quite well. That section was equally long and got pared right back. Lewisguile (talk) 07:56, 28 December 2024 (UTC)
- I'll take a stab at a draft tomorrow and post it here. I think we can do it without unbalancing things. I think we can keep it balanced through the space we give to each side. Lewisguile (talk) 18:42, 28 December 2024 (UTC)
- I hear you. But one way around that is to cluster them by the groupings we currently have. So "political parties x, y and z said this", "medical groups a, b and c said that", and so on. If we workshop the text here we might be able to pare it down fairly while making sure it doesn't feel unbalanced? We did something similar for November 2024 Amsterdam riots and it worked quite well. That section was equally long and got pared right back. Lewisguile (talk) 07:56, 28 December 2024 (UTC)
- Catching up now on the many changes over Xmas. So the "weaponisation" is not representative of the source given, which is clear that she's talking about the fear of weaponisation. I've clarified the body and removed from the lede, as I don't think its a significant enough statement in context. Void if removed (talk) 13:56, 1 January 2025 (UTC)
- I have put the entire sentence because I don't think your reading is clear either. She's saying that she didn't say that trans people don't exist, not that there isn't weaponisation of the report. She's saying that there is fear, yes, but that doesn't mean that the fear isn't due to weaponisation. Arguably, the fear is caused by the weaponisation and that's what she's saying. Lewisguile (talk) 14:15, 1 January 2025 (UTC)
- No, it is not - she's concerned people are fearful. You had written that she was concerned it was being weaponised. These are different. If you have to put the full quote in to try and make sense of it, I think that's WP:OVERQUOTE for such a trivial detail, and as written it is nowhere near ledeworthy.
- The quote is
I think there is an appreciation that we are not about closing down health care for children. But there is fearfulness — about health care being shut down, and also about the report being weaponized to suggest that trans people don’t exist. And that’s really disappointing to me that that happens, because that’s absolutely not what we’re saying.
- The "disappointing" is ambiguous. Is it the fear or the weaponisation she's referencing? If it was the latter, and if it was significant, there'd be other sources, because she's been very vocal about attacking the misinformation about her review. This feels like making a lot out of a passing comment. There are other, better sources for Cass' reflections, including a whole peer-reviewed article by her. I'd focus on the totality of her reflections as a whole rather than taking a tiny ambiguous quote like this and making it the focus. Void if removed (talk) 14:26, 1 January 2025 (UTC)
- She says it's disappointing that that happens, because that's absolutely not what we're saying. It doesn't make logical sense that she's saying "we're not saying that there is fearfulness", or "we're not saying that there's weaponisation", while also saying "fearfulness is happening". The only way that "happening" and "saying" makes sense is if she's saying "weaponisation is happening but we didn't say ". Moreover, you admit yourself it's ambiguous what "disappointing" is referring to, so a direct quote avoids having to make a definitive statement about something you say isn't clear.
- Incidentally, I think there was an edit conflict, so 13tez had inadvertently restored my text. I have edited the text again to address 13tez's edit conflict. The quote now isn't a blockquote, and it's shorter. I didn't re-add it to the lede after you removed it, but including it in the body isn't undue. ::::@Snokalok @Your Friendly Neighborhood Sociologist @Bluethricecreamman @13tez what do you think Cass is trying to say here? Lewisguile (talk) 15:13, 1 January 2025 (UTC)
- If you have to parse the statement this much to get the meaning you want, then I think you should look for a better source, and if there isn't one, it doesn't belong. She just says its disappointing "that happens". What is the that? The fearfulness? The weaponisation? The whole messy situation where some peoeple are afraid and others draw the wrong conclusions from her work? I get the sense of her throwing her hands up at the whole mess. This is a brief statement in an interview, and seizing on one interpretation of these words and highlighting them to imply she was concerned about people weaponizing the report when she didn't outright say that is not NPOV.
- The best source for Cass' reflections on the review is this peer-reviewed editorial.
- AFAICT, we still don't cite this, and I don't know why. I brought it up months ago, and it gives a lot of useful material about what Cass felt was the most important takeaways. Weaponisation isn't in there, but she does reiterate:
This Review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves, or rolling back on people's rights to healthcare
- I would revisit this source and expand from there the points she actually made and felt worth making, at length, in her own considered words, rather than over-interpreting an NY Times interview. Void if removed (talk) 18:06, 1 January 2025 (UTC)
If you have to parse the statement this much to get the meaning you want, then I think you should look for a better source, and if there isn't one, it doesn't belong.
That's your opinion, and my opinion is that your interpretation seems to be the unlikely one. I still don't see why you object so much to the direct quotation. If it does indeed mean what you think it does, what harm would it cause to include that wording, rather than making a claim in Wikivoice which one of us is going to dispute? It is a direct answer to someone asking her about the reaction to the report, which is relevant to the section it was in. I believe I am trying to compromise here. Lewisguile (talk) 19:16, 1 January 2025 (UTC)you object so much to the direct quotation
- I don't feel strongly about the direct quotation - I think its overlong but, if that's the compromise fine.
- But ideally, I would like to go to her peer-reviewed editorial and build this section from that, rather than quotes in interviews. I think that's a much better source for her considered reflections. But that's for another discussion. Void if removed (talk) 10:46, 2 January 2025 (UTC)
- I have put the entire sentence because I don't think your reading is clear either. She's saying that she didn't say that trans people don't exist, not that there isn't weaponisation of the report. She's saying that there is fear, yes, but that doesn't mean that the fear isn't due to weaponisation. Arguably, the fear is caused by the weaponisation and that's what she's saying. Lewisguile (talk) 14:15, 1 January 2025 (UTC)
Background changes
Hi @Snokalok, hope you're doing well.
After I made an edit to expand the background section to give readers, you subsequently removed one of the paragraphs I added, citing WP:SYNTH. I reverted your edit removing my changes, explaining why I felt this paragraph didn't constitute SYNTH. Afterwards, you made another edit in which you removed this paragraph again and warned me not to WP:EDITWAR and that this article currently has a WP:1RR in place.
The 1RR rule states: "An editor must not perform more than one revert on a single page—whether involving the same or different material—within a 24-hour period. An edit or a series of consecutive edits that undoes or manually reverses other editors' actions—whether in whole or in part—counts as a revert."
As I've described, you have now made two edits which removed this paragraph I added, so you are actually in violation of this rule. Please could you explain why you think this paragraph constitutes SYNTH, regardless of the explanation I offered? Thank you. 13tez (talk) 22:48, 30 December 2024 (UTC)
- Ah, yes, regarding the 1RR, this page is actually under enforced BRD, not 1RR. That was my mistake for getting them mixed up. Regardless, the fact is that you made an addition, it was partially reverted, and under enforced BRD, you’re not to add it back in without consensus.
- As for synth, there’s no evidence that I saw in your citations that Sweden’s opinions had any bearing on the Cass Report. Otherwise we could just as easily add in all of the countries that said the opposite prior to the report’s publication. Snokalok (talk) 22:58, 30 December 2024 (UTC)
- Hey, thanks for getting back to me.
- As for synth, there’s no evidence that I saw in your citations that Sweden’s opinions had any bearing on the Cass Report
- The paragraph in question did not state or imply that the findings of the SR commissioned by Sweden did influence the Cass Review. If you are curious about this point, the Swedish guidelines are explicitly discussed in the final report (e.g. page 132) and the SR discussing guidelines. It is, however, part of the background context behind the review being commissioned, namely the debate over the strength of evidence for care like that provided at GIDS.
- SYNTH refers to using two referenced pieces of information being used to argue for a third, without that third piece of information itself being supported by references. It is not text being irrelevant.
- Please remove "which are meant to buy time without undergoing any permanent bodily changes for patients to assess their options" as this point is argumentative, discussed elsewhere, unsupported by sources, and not relevant to the concerns of the GIDS staff members.
- Thanks!13tez (talk) 23:09, 30 December 2024 (UTC)
- Okay starting with the buying time point, it’s in the latter two BBC sources attached to that sentence and since this is the background section and the sources mentioned it, it’s relevant to mention for a full and balanced picture.
- As for synth, adding the Sweden thing suggests that the Cass Review was influenced by Sweden’s decision, but no cited sources said that; if you have a citation in the Cass Review, by all means add it back in with citation and we’ll go from there. Snokalok (talk) 23:46, 30 December 2024 (UTC)
- Okay starting with the buying time point, it’s in the latter two BBC sources attached to that sentence.
- The closest thing I could see is: "These drugs stop a young person's body developing, with the aim of helping to relieve gender dysphoria - distress caused when a person's gender identity does not match their biological sex. The NHS now recognises, external that little is known about their long term side effects." Am I right in thinking this is the sentence you're basing it off?
- since this is the background section and the sources mentioned it, it’s relevant to mention for a full and balanced picture
- Do you think describing the aim of the use of puberty blockers is relevant in a subsection discussing criticism of GIDS? Why not describe puberty blockers elsewhere, where they're discussed in more detail, so this point would be more relevant?
- As for synth, adding the Sweden thing suggests that the Cass Review was influenced by Sweden’s decision
- Well, the paragraph you removed doesn't say there's any link between Sweden's decision and the Cass Review. It was meant to describe the ongoing debate over the extent to which evidence supported the types of treatments given at GIDS and how several countries were also examining them at the time. Do you think we should instead make this point more clearly by describing how several other European countries were examining these treatments because of this ongoing debate (and came to similar conclusions) so this is more explicit? After all, the CR was commissioned by NHSE back in 2020, so the Swedish review couldn't have influenced it being created.
- Thanks! 13tez (talk) 00:04, 31 December 2024 (UTC)
- the recent research part is definitely synth and adds bulk to a background section. And why exactly Sweden specifically for a review article? Bluethricecreamman (talk) 00:07, 31 December 2024 (UTC)
- Maybe we should remake it to focus more on the debate over the extent to which evidence supported the types of treatments given at GIDS and how several countries were also examining them at the time. That was my intent - to illustrate that other countries were also undertaking similar investigations because of this debate.
- We can cut out the unique findings of the Swedish systematic review. I just thought it should be included since it's significant in what it found and its impact - the changes in clinical practice in Sweden. 13tez (talk) 00:30, 31 December 2024 (UTC)
- If other countries are also looking at this evidence, that's something for the Responses section. At best, it requires a sentence in the Background section, but I think it definitely veers into WP:COATRACK territory. What's important to know is that there were concerns about GIDS and evidence, and that's what the Cass Review looked at. That's all well described in the Background section as it was before these additions, and is also discussed in the relevant parts of the Interim report, Final report and Responses sections.
- I have added some of the extra info you created over the last day or so as endnotes, but really, none of this is needed for the article at hand. It's already getting long. It may be that there's a changing attitude to things like the Dutch Protocol across Europe, and maybe even elsewhere, but that could be covered at the relevant article or could form a new article. I don't think it needs to be here. Lewisguile (talk) 12:26, 31 December 2024 (UTC)
- I think we may have gotten a bit confused. There are four publications to consider:
- the February 2022 guideline from the Swedish National Board of Health and Welfare (with a final update in December 2022; English summary)
- the March 2022 Cass interim report,
- the 2023 Swedish systematic review (, cited in this diff), and
- the 2024 Cass final report.
- The 2023 Swedish systematic review does not actually mention Cass's work. It mentions some of NICE's work (linking to the NICE's documents on the Cass Review's website). "Last, there have been studies in this field published after the date of our literature search (9 November 2021). These have not been added to this study in order to not depart from the systematic approach. We nevertheless wish to comment on some of the publications. First, the National Institute for Health and Care Excellence in England (NICE) conducted evidence reviews of GnRHa as well as CSHT for children with gender dysphoria, which were independent from our work. The conclusions generally align with our findings."
- NICE's work was (according to the Cass website) one of the things that led to the creation of the Cass Review, but the Cass Review itself is not mentioned in the 2023 Swedish systematic review.
- The Cass final report discusses the 2022 Swedish National Board of Health and Welfare guideline at some length (primarily pages 129–135). The Cass final report mentions the 2023 Swedish systematic review in a single sentence in 15.25, only as an example of other papers that agree with Cass's commissioned reviews: "This is in line with other systematic reviews published previously (Ludvigsson et al., 2023)."
- My first conclusion is that the 2023 Swedish systematic review is certainly not "a response" to Cass, since it doesn't mention Cass at all. It could be considered background information.
- My second conclusion is that the Cass Review was influenced by the 2022 Swedish National Board of Health and Welfare guideline, since it spends quite a lot of time talking about it and agreeing with it. WhatamIdoing (talk) 20:38, 31 December 2024 (UTC)
- Hey @Lewisguile,
- I agree with WhatAmIdoing, both here ("I think we may have gotten a bit confused. There are four publications..") and below ("As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies.").
- I'm not talking about other countries reacting to the Cass Review with similar reviews of their own or debate over the evidence underpinning treatments given to TGGNC youth that took place after the CR. This happened before the CR, so is part of the situational context before and that led to it. Therefore, it belongs in the Background section, not the Responses section.
- The controversy over GIDS, including the "whistleblowers", legal cases, etc, led, in part, to the review and has been given extensive coverage in the news and has some in the report too. Therefore, per WP:DUE, so the reader can understand what led to the CR, and so the reader can understand the background on GIDS without having to go and read its article, its discussion is warranted in this article, albeit in a neutral tone, WP:Summary style, etc. For example, the Mermaids controversy got a lot of coverage, but after an investigation, there were found to be no inappropriate links between Mermaids and GIDS. Therefore, if we felt it was within due weight and included it here, we'd do so while giving that proviso. 13tez (talk) 13:30, 1 January 2025 (UTC)
- Hi @Lewisguile and @WhatamIdoing,
- Per the discussion here, I've added a reduced and summarised version of the previous content I added to the background section. It doesn't go into the general history of GIDS and says explicitly what the issues and background were behind the CR. Please let me know what you think when you have time. Thanks! 13tez (talk) 14:37, 1 January 2025 (UTC)
- As I said elsewhere, I had attempted to come to a compromise on the wording, but VIR's hasty edits have restored much of the objectionable text (for you and for me). Find a version I think is quite fair here: https://en.wikipedia.org/Special:Diff/1266638132/1266639348 Note that it still has the SRs first, but it uses Cass's direct wording (which could be read to mean "this is the bedrock, and these things are also the bedrock" as well as "this is the bedrock, and these are other things we did which aren't the bedrock"), which allows us to briefly mention the other things too. Then the part about the other bits of research are included at the end, but without "supplemented" (since we've used the "bedrock" quote instead). It removes "non-peer reviewed" and "peer-reviewed" but keeps in where it was published. I think that gives you most of what you feel should be included while also doing the same for what I think should be in there? Lewisguile (talk) 15:37, 1 January 2025 (UTC)
- Hey @Lewisguile, thanks for trying to compromise again!
- I basically just restored your version of the new paragraph (the only differences are: I added a sentence explaining what GIDS is since it hadn't yet been done, at least by that point in the article; I changed the see also link to point to the GIDS article, not its history subsection; I made the text "systematic reviews" link to their article, since they hadn't yet been mentioned in this article; I removed a parameter causing an error in a reference which wasn't needed anyway; and I corrected "the NHS England Policy Working Group" to "an NHS England Policy Working Group").
- @Lewisguile @Void if removed Please can you let me know if we can agree to leave the Background section as it is now in order to create a compromise and prevent frequent article changes?
- I'm personally against the changes made to the Background section in the new paragraph ("In the years leading up to the Cass Review, several GIDS staff...") because the references say "debate" rather than "concerns"; there were other (highly covered) legal cases apart from BvT; and the legal cases also examined the evidence base as well as the ability to gain informed consent. However, I'm happy to compromise on them to get the paragraph added because I think it leaves readers more informed, and it allows us to resolve at least that section.
- Thanks! 13tez (talk) 16:13, 1 January 2025 (UTC)
- Thank you. I do want to get this right. I know we're all reading things slightly differently here, and I find myself more frustrated than usual with the text of the report itself (which is often imprecise), but I think we're inching closer to getting this article to a good place.
- I changed "debate" to "concerns" just because "debate" sounded like it was a formal debate, rather than an ongoing series of issues being raised. If anything, I think that would veer too much on the side of the negative side of the debate over the positive, but I think it is a fair reflection of where things were at.
- What did you think of my Methodology wording linked above? I think it also addressed many of your issues while also addressing some of mine. Are you happy for that to be restored as well? Lewisguile (talk) 16:19, 1 January 2025 (UTC)
- Thank you. I do want to get this right. I know we're all reading things slightly differently here, and I find myself more frustrated than usual with the text of the report itself (which is often imprecise), but I think we're inching closer to getting this article to a good place.
- Thanks again for working in good faith! I agree. Like I said, I'm happy to agree to leave the Background section where it is now, but I wouldn't mind getting another version we all think is an improvement either.
- I changed "debate" to "concerns" just because "debate" sounded like it was a formal debate, rather than an ongoing series of issues being raised. If anything, I think that would veer too much on the side of the negative side of the debate over the positive, but I think it is a fair reflection of where things were at.
- "on the negative side" meaning the toxic culture war side of things? I see what you mean. We could quote the MEDRS source directly and say "professional disagreement"? You might prefer "disagreement" to "debate", and it focuses the debate/concerns/disagreement to those among medical scientists, rather than toxic discourse between pro-trans and anti-trans groups.
- What did you think of my Methodology wording linked above?
- I'll take a look and reply in the Methodology section here (of this talk page), just so everything stays separated.
- Thanks again! 13tez (talk) 16:30, 1 January 2025 (UTC)
- This got lost in the wall of text. Professional disagreement would be ideal, in fact! Lewisguile (talk) 13:11, 5 January 2025 (UTC)
- @Lewisguile I have no idea what you're talking about with
hasty edits
, please be specific, with diffs. Void if removed (talk) 17:36, 1 January 2025 (UTC)- I meant the number of overlapping edits made in a short period of time, which meant that edits made by me and 13tez were reverted accidentally. I had realised all three of us were editing at the same time and tried to restore some of 13tez's text, but that got undone too.
- Here, for example, you said you were reverting one part of the edit, but you also restore prior text from a previous edit at the same time: https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266631684
- Here you restored the "non-peer-reviewed" text you yourself had previously removed, as well as the blockquote I had previously added which you had also objected to: https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266637868 I had removed "non-peer-reviewed" in response to 13tez (I hadn't added it and RAND in the first place).
- Those could have been intentional, of course, but since you specifically objected to my use of a direct quote over Wikivoice and felt the RAND sourcing was undue, it seemed unlikely. Lewisguile (talk) 18:30, 1 January 2025 (UTC)
Here you restored the "non-peer-reviewed"
- Aha thank you! This is the problem edit on my part. Yes, that was only supposed to be a section header change, my bad, I blame visual editor/too many tabs etc.
- Hopefully a one off, but please, if I do anything like that again, ping me with the diff at the outset. Void if removed (talk) 21:45, 1 January 2025 (UTC)
- I meant the number of overlapping edits made in a short period of time, which meant that edits made by me and 13tez were reverted accidentally. I had realised all three of us were editing at the same time and tried to restore some of 13tez's text, but that got undone too.
- As I said elsewhere, I had attempted to come to a compromise on the wording, but VIR's hasty edits have restored much of the objectionable text (for you and for me). Find a version I think is quite fair here: https://en.wikipedia.org/Special:Diff/1266638132/1266639348 Note that it still has the SRs first, but it uses Cass's direct wording (which could be read to mean "this is the bedrock, and these things are also the bedrock" as well as "this is the bedrock, and these are other things we did which aren't the bedrock"), which allows us to briefly mention the other things too. Then the part about the other bits of research are included at the end, but without "supplemented" (since we've used the "bedrock" quote instead). It removes "non-peer reviewed" and "peer-reviewed" but keeps in where it was published. I think that gives you most of what you feel should be included while also doing the same for what I think should be in there? Lewisguile (talk) 15:37, 1 January 2025 (UTC)
- I still think some of it is WP:SYNTH because it's drawing connections that Cass hasn't. It would be best to stick to things Cass specifically mentions as influences on the report. Lewisguile (talk) 14:49, 1 January 2025 (UTC)
- I think we may have gotten a bit confused. There are four publications to consider:
- the recent research part is definitely synth and adds bulk to a background section. And why exactly Sweden specifically for a review article? Bluethricecreamman (talk) 00:07, 31 December 2024 (UTC)
- @Snokalok, it's not quite right to say under enforced BRD, you’re not to add it back in without consensus. That's the Misplaced Pages:Consensus required restriction. Under enforced BRD, you're not to add something back in until you've posted a comment about it on the talk page and waited 24 hours.
- Of course, if, during those 24 hours, a significant amount of opposition appears, then you shouldn't add it back in until the discussion gets settled, but that's due to the ordinary WP:EPTALK policy, not the enforced BRD rules specifically. WhatamIdoing (talk) 20:41, 31 December 2024 (UTC)
- The background section is significantly expanded by nearly 3x... is all of it necessary or could you just link to the GIDS article for a lot of this criticism? Bluethricecreamman (talk) 23:44, 30 December 2024 (UTC)
- Well, I expanded the section to allow readers to understand the current situation and history of transgender healthcare for young people in the UK at the time of the review and the concerns and events which led to it. This is important context describing the situation in which the review was commissioned and made. It's given coverage in the report itself because it aids the reader's understanding of the review: how can you understand its recommendations if you don't understand the prior situation they were meant to change. 13tez (talk) 00:33, 31 December 2024 (UTC)
- It's not at all necessary. This is a huge addition of text added without consensus. This should be a paragraph at most, since the article already lays out the complaints against GIDS well. I will revert and we can sort out a new paragraph. Lewisguile (talk) 08:58, 31 December 2024 (UTC)
- I've posted what I think is a decent compromise on the Methodology section here: https://en.wikipedia.org/Talk:Cass_Review#c-Lewisguile-20241231174000-Methodology_2 As for the Background, I stuck in the "See also" link and added some of the extra detail as endnotes. I'm hoping this avoids bloat while retaining the details people wanted in there for those who want it. Lewisguile (talk) 17:55, 31 December 2024 (UTC)
- It's not at all necessary. This is a huge addition of text added without consensus. This should be a paragraph at most, since the article already lays out the complaints against GIDS well. I will revert and we can sort out a new paragraph. Lewisguile (talk) 08:58, 31 December 2024 (UTC)
- As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies. WhatamIdoing (talk) 20:46, 31 December 2024 (UTC)
- The article does not the reasons why the Cass Review was commissioned. We could certainly add a sentence or two more, but we don't need the entire history. Lewisguile (talk) 14:32, 1 January 2025 (UTC)
- I've taken a stab at compressing what @13tez just added. It seems better now, although it was simpler before either edit. Lewisguile (talk) 14:46, 1 January 2025 (UTC)
- TBH I'm not sure why any of this is here - we already "see also" to GIDS, which covers all this in more detail. Void if removed (talk) 15:51, 1 January 2025 (UTC)
- I didn't think it was due anyway, but 13tez very clearly wanted more context there, which is why I trimmed the longer version to a shorter one as a compromise. Lewisguile (talk) 18:34, 1 January 2025 (UTC)
- Hey @Void if removed, I gave my reasoning for including this stuff before as follows: "I expanded the section to allow readers to understand the current situation and history of transgender healthcare for young people in the UK at the time of the review and the concerns and events which led to it. This is important context describing the situation in which the review was commissioned and made. It's given coverage in the report itself because it aids the reader's understanding of the review: how can you understand its recommendations if you don't understand the prior situation they were meant to change."
- I also agree with the broad strokes of what WhatamIdoing said was their reasoning for agreeing with the idea of including at least some of the information I added, at least in some form: "As a general rule, each article should be able to stand alone. That means that it shouldn't be necessary to stop reading this article to go read the GIDS article for a while, to be able to understand this one. But we can include only what's strictly necessary here. Readers need to know, for example, that GIDS was struggling in multiple ways. They do not need to know (e.g.,) GIDS's founding date or which agency approved which of GIDS' policies." 13tez (talk) 21:27, 1 January 2025 (UTC)
- Ok, I take the point of having something in some form. Void if removed (talk) 22:05, 1 January 2025 (UTC)
- Thanks! Glad we can agree or at least compromise on it :) 13tez (talk) 22:17, 1 January 2025 (UTC)
- Ok, I take the point of having something in some form. Void if removed (talk) 22:05, 1 January 2025 (UTC)
- I didn't think it was due anyway, but 13tez very clearly wanted more context there, which is why I trimmed the longer version to a shorter one as a compromise. Lewisguile (talk) 18:34, 1 January 2025 (UTC)
- TBH I'm not sure why any of this is here - we already "see also" to GIDS, which covers all this in more detail. Void if removed (talk) 15:51, 1 January 2025 (UTC)
- I've taken a stab at compressing what @13tez just added. It seems better now, although it was simpler before either edit. Lewisguile (talk) 14:46, 1 January 2025 (UTC)
- The article does not the reasons why the Cass Review was commissioned. We could certainly add a sentence or two more, but we don't need the entire history. Lewisguile (talk) 14:32, 1 January 2025 (UTC)
- Well, I expanded the section to allow readers to understand the current situation and history of transgender healthcare for young people in the UK at the time of the review and the concerns and events which led to it. This is important context describing the situation in which the review was commissioned and made. It's given coverage in the report itself because it aids the reader's understanding of the review: how can you understand its recommendations if you don't understand the prior situation they were meant to change. 13tez (talk) 00:33, 31 December 2024 (UTC)
- Hey @Snokalok @Lewisguile @Void if removed @WhatamIdoing @Bluethricecreamman, I hope you're all doing well!
- Since nobody has changed the background section in a while (past some minor tweaks), I was wondering if you all think we can now agree to leave the section as it is now? It is a compromise since it's not how any of us left it ourselves, but we've managed to stop the disruptive back-and-forth editing there at least, which is a big win.
- I was thinking of adding the following notice to the start of the section (which would only show when you go to edit it and doesn't change the article when being read). Please can you let me know if you'd support its addition (or something like it)?
- </!-- January 2025: The current content of this section of the article was formed as a compromise after lengthy discussion between editors (https://en.wikipedia.org/Talk:Cass_Review#Background_changes) who have agreed to leave it in its current state (as of https://en.wikipedia.org/search/?title=Cass_Review&oldid=1267517052#Background). Therefore, and since this article has proven to be contentious and led to frequent, disruptive, back-and-forth editing, if you think changes could improve this section, instead of making them outright, please consider proposing them in the talk page for this article. -->
- Thanks! :) 13tez (talk) 14:27, 5 January 2025 (UTC)
- I generally think that such messages, no matter how heartfelt the sentiment, are ultimately not very helpful, and when they're either present or enforced for more than a few weeks, begin to contradict Misplaced Pages:Be bold and Misplaced Pages:Consensus can change. WhatamIdoing (talk) 05:51, 6 January 2025 (UTC)
- I'm happy with the Background section as it is now. Per usual policy, if there are no further changes to text, consensus can be assumed anyway, but it's always good to have explicit consensus to point to. I don't object to the invisible text, per se, but I know some people interpret policies and suggestions more narrowly than I do, meaning some people might be more likely to avoid editing the text as a result. One alternative might be to take a middle road. E.g., add a much shorter statement like
<!-- Consensus text agreed January 2025. See discussion for more info: https://en.wikipedia.org/Talk:Cass_Review#Background_changes for further info.-->
That doesn't tell people to edit/not edit, but it does flag this discussion for additional context. Lewisguile (talk) 09:01, 6 January 2025 (UTC)
"Narrative review"
The Cass Review is not a narrative review. A narrative review is an academic review of existing literature. The Cass Review is an independent service review with a wide remit, that commissioned new research and engaged with stakeholders. Relying on one primary source to falsely call it a "narrative review" is wrong, and actually speaks to the reliability of the original source. This was a new addition which I have taken out, but @Lewisguile has reverted with an edit comment that by my reading wrongly refers to a document from a think tank as "peer-reviewed". I ask this be self-reverted and this badly-sourced misrepresentation actually be discussed before adding. Void if removed (talk) 15:13, 1 January 2025 (UTC)
- I've told you twice now: it is peer-reviewed. You are frantically editing the page and adding talk page comments, and it's becoming a chaotic mess. You've actually restored text I had taken out because I agreed with 13tez that those things may not be needed, meaning the text is now more objectionable to more people as a result. Please take a breather and read your replies. Lewisguile (talk) 15:33, 1 January 2025 (UTC)
- Just so we're clear about that process: https://www.rand.org/pubs/periodicals/health-quarterly/peer-review.html
All RAND documents are peer reviewed by at least two qualified reviewers—usually a RAND staff member and an outside expert. Reviewers are chosen for technical expertise, policy experience, and ability to provide an objective review. Reviewers are selected by the senior staff member in each RAND division responsible for quality assurance.
- So it is sort of peer reviewed, semi in-house, and selected in-house. Not really comparable to an academic journal. This isn't the "gold standard".
- Can you please take out the "narrative review" description - it is false. Void if removed (talk) 15:41, 1 January 2025 (UTC)
- The Cass Review didn't have a peer review at all and you've argued that trumps almost everything else? I don't think we should have double standards here. It's a peer reviewed systematic review. NICE also publishes its own systematic reviews, but that doesn't invalidate them.
- Either way, I didn't add that description, and you reverted my prior edit of that section when you made all your edits recently. It's probably best to go back and figure out who added it and ask them. Lewisguile (talk) 16:41, 1 January 2025 (UTC)
- You're not comparing like with like.
- The Cass Review is an independent review, and the final report is a culmination of a four-year process encompassing dozens and dozens of contributors and stakeholders, and multiple specifically commissioned systematic reviews. It is not a policy document or a peer-reviewed paper, and iti definitely isn't a "narrative review" - it is a service review, commissioned by a national health body. On this page, the cass review is an authoritative source about itself.
- Other independent reviews that aren't peer-reviewed are things like the LCP Care Pathway - these aren't peer-reviewed sources, they are a different thing entirely.
NICE also publishes its own systematic reviews
- NICE is not a policy thinktank.
I didn't add that description
- So why did you revert to re-add it? If you aren't defending it, take it out again.
- Also, having now read it in more detail, that RAND source is even more questionable.
- It describes the 2022 Cass Review (so the Interim Report) as a narrative review, so it isn't applicable anyway. It also places, at the same level, two blogposts on SBM, which are also described as "narrative reviews".
- https://sciencebasedmedicine.org/gender-affirming-care-is-not-experimental/
- https://sciencebasedmedicine.org/gender-affirming-care-is-not-experimental-part-ii/
- Likewise the "what we know project" which is little more than a group blog. This mixing of high quality sources like Cass with self-published stuff is pretty poor frankly.
- Also the literature cutoff of September 2023 manages to exclude all the major work like Zepf et al that came just after that date. This document is already out of date, frankly, and seeing as it doesn't actually reference the final Cass Review beyond noting it exists, is not terribly relevant for this page. Void if removed (talk) 17:30, 1 January 2025 (UTC)
Also the literature cutoff of September 2023 manages to exclude all the major work like Zepf et al that came just after that date.
All research has limitations. Of course they had a cutoff, because that's common practice.This document is already out of date, frankly, and seeing as it doesn't actually reference the final Cass Review beyond noting it exists, is not terribly relevant for this page.
But in this case, RAND specifically talks about the applicability of Cass to other contexts than the NHS, and talks about its limitations. So I disagree that it's not terribly relevant.iti definitely isn't a "narrative review" - it is a service review, commissioned by a national health body
One isn't exclusive of the other. A service review can be a narrative review as well. According to RAND, its own "research is sponsored by U.S. government agencies; U.S. state and local governments; allied non-U.S. governments, agencies, and ministries; international organizations; colleges and universities; foundations; professional associations; other nonprofit organizations; and industry".- In this case: "This work was supported by Indiana University Bloomington and the Medical College of Wisconsin. In addition, RAND provided funding to support publication production, quality assurance, and supplemental research analyses. The research was carried out within the Access and Delivery Program in RAND Health Care and the Social and Behavioral Policy Program in RAND Social and Economic Well-Being. In addition, Lorenzo-Luaces was funded by grant numbers KL2TR002530 and UL1TR002529 (A. Shekhar, principal investigator ) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award (NCATS); Peipert was funded by grant number TL1TR002531 (T. Hurley, PI) from NCATS; and Buss was funded by T32-MH103213-07 (W. Hetrick, PI) from the National Institutes of Mental Health. RAND Health Care oversaw the quality assurance process for completing and publishing this report; otherwise, funders did not influence the conduct or reporting of this research. The authors declare that they have no competing interests."
NICE is not a policy thinktank.
But RAND is not just a policy thinktank either. It has conducted high profile research for the US government. You can see its prior commissioners here: https://www.rand.org/health-care.html. It uses open publication.So why did you revert to re-add it? If you aren't defending it, take it out again.
I reverted to the Methodology section that 13tez had edited and which I had re-edited afterwards. 13tez had left it in and I saw (and still see) no reason to take it out. It was about the entirety of that section, not one particular part, which you reverted, thereby reinstating the "non-peer-reviewed" text as well. (See the diffs I posted elsewhere on this page.)- I'm trying to engage in good faith here, but it feels like you're unwilling to compromise on anything. Your responses seem consistently aggressive and WP:BATTLEGROUND-like. Not to mention the mess made with edit conflicts (not only your fault, but I was trying to fix that when I got reverted again, which made me give up). That makes it very difficult to form a consensus, and the article will just end up being resolved by who can shout the longest. Can we call it a day and come back to this with cooler heads? I'm sure there's a consensus to be had, but it will require all of us to engage with the ongoing attempts to agree wording on this talk page so we don't all keep reverting each other (whether accidentally or not). Lewisguile (talk) 19:09, 1 January 2025 (UTC)
- The edit I'm currently concerned with is here:
- https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266632416
- You undid this here along with other changes:
- https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1266634667
- Since then you've made accusations on my part of hasty editing, called for cooler heads, and cast aspersions, with accusations of aggression, while I'm simply trying to get you to engage in good faith on this edit.
- Ignore everything else about this source to save distractions and just on this one specific point: I removed a recently added and IMO redundant new sentence in this section that incorrectly calls it a "narrative review" based on a source that doesn't actually call the cass review a "narrative review", and would be wrong to do so if it did.
- You've reverted my change amid a whole bunch of other issues, which AFAICT are nothing to do with this edit, and then when I asked you why, told me you don't actually want that text in but to to take it up with whoever added it. That isn't how mandatory BRD is supposed to work. If you don't want to defend "narrative review", take it out please. Void if removed (talk) 21:34, 1 January 2025 (UTC)
based on a source that doesn't actually call the cass review a "narrative review", and would be wrong to do so if it did.
- p 10, table 2.1 of the RAND report does call it that...- You keep saying the Cass Review is a "service review" rather than a "narrative review", but those are not in any sense mutually exclusive. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:55, 1 January 2025 (UTC)
- It refers to the interim report as that. It is incorrect to do so, and also wrong to apply it to the Cass Review as a whole, or the final report. Void if removed (talk) 10:08, 2 January 2025 (UTC)
- @Void if removed, you realise you made reverts and edits after mine, right? You left that part in but restored text from RAND, including the "non-peer-reviewed" statement I had removed and RAND's description of limitations which @13tez and I were discussing. I was restoring the text 13tez and I were quibbling over but broadly in agreement on and we were still discussing the nuances when you reverted it. You then removed the GC responses section and the comments of a GP which were also, incidentally, in line with a statement made by the BMA (the same source says:
Many GPs are not trained to provide the specialist care these patients need and therefore fear risking patient safety.
) to insert a statement which was less supported in said source, and now you keep demanding that I revert something you yourself have subsequently edited and left in. I'm not being difficult, but I'm well aware of the WP:3RR, and unfortunately, some editors interpret it narrowly (i.e., including self-reverts as well). Also, if I removed the text I would be obligated to also re-edit the text you restored, since 13tez and I were working on getting it up to scratch and both disagreed with several parts of the restored text. - As for the "narrative review" versus "service review" dichotomy, per WP:MEDRS, which you're familiar with:
Reviews may be narrative or systematic (and sometimes both). Narrative reviews provide a general summary of a topic based on a survey of the literature, which can be useful when outlining a topic. A general narrative review of a subject by an expert in the field can make a good secondary source covering various aspects of a subject within a Misplaced Pages article. Such reviews typically do not contain primary research but can make interpretations and draw conclusions from primary sources that no Misplaced Pages editor would be allowed to do.
This fits the definition of Cass to a tee. The primary sources are the York papers and the secondary review is Cass. The York papers also indicate they use narrative methods in addition to systematic reviews in in multiple places. (See Taylor J, Hall R, Langton T, et al. Arch Dis Child 2024;109:s3–s11 (s3).)Lewisguile (talk) 09:54, 2 January 2025 (UTC)
- The definition you are talking about applies to review articles. The Cass Review is not a review article - you're trying to apply terminology across different kinds of document, when "review" has multiple meanings, both broad and narrow. The Cass Review is an independent service review (in the broad sense) that, as part of its process, commissioned multiple systematic reviews (in the narrow sense) and produced an interim report and a final report. It isn't a "review article" published in an academic journal and isn't straightforwardly either a systematic or narrative review. Rather the "review" is a 4-year process, and its output was two reports giving a series of recommendations and guidelines to the NHS about how it structures its service, which the NHS then followed. Quite where the final report fits on the MEDRS pyramid isn't straightforward, but it is much more in line with something like, say, clinical practice guidelines than anything. Void if removed (talk) 10:20, 2 January 2025 (UTC)
- In the interests of moving on - I apologise unreservedly for this edit, which mistakenly reinserted text, when the only intention was to change a section heading.
- Until you pointed to that diff last night, I did not realise that's what happened, as I was looking only at this specific diff relating to "narrative review" and its reversion. Had I realised, I would have reverted it myself. I'm not trying to get you to 3RR, or make demands, I'm just trying in the best possible faith not to fall afoul of enforced BRD. Void if removed (talk) 10:41, 2 January 2025 (UTC)
- To avoid problems with enforced BRD, worried editors may find it useful to make no more than one edit to the article per 24 hours. WhatamIdoing (talk) 11:55, 2 January 2025 (UTC)
- Yes, I suspected you didn't mean to restore that text. That was what I was trying to say yesterday. I suspect all three of us were working on edits at the same time and merely pressed publish at different points. Which explains why stuff which was taken out got put back in again, and sometimes in unusual ways. I'm sorry if I implied bad faith on anyone's part – it's always hard to convey/read tone online. Lewisguile (talk) 17:46, 2 January 2025 (UTC)
Gender-Critical Responses
VIR, you've removed the entire section on gender-critical responses saying Remove the "gender critical" organisations response, this seems like passing and non-notable coverage, and hardly deserved its own section, we have plenty of better responses now WP:NOTEVERYTHING
We have the guardian saying Parts of Cass’s review have been proclaimed as wholesale vindication by gender-critical feminists
We have Them and Mother Jones saying The Cass Review won’t have an immediate impact on how gender medicine is practiced in the United States, but both Europe’s “gender critical” movement and the anti-trans movement here in the US cited the report as a win, claiming it is the proof they need to limit medical care for trans youth globally. Notable anti-trans group the Society for Evidence Based Gender Medicine called the report “a historic document the significance of which cannot be overstated,” and argued that “it now appears indisputable that the arc of history has bent in the direction of reversal of gender-affirming care worldwide.”
Right now we talk about how LGBT orgs have recieved the report, but don't mention gender-critical orgs once. Considering it's a fairly BLUESKY statement that the gender-critical movement in the UK is large and broadly opposed to youth transition, why remove mention of the fact they broadly supported Cass's review? It seems unbalanced to reference only LGBT orgs without any mention of gender-critical ones.
I think the section should be put back in and expanded. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:11, 1 January 2025 (UTC)
- Agreed. There is an issue with balance in the article overall, so this section should go back in. Lewisguile (talk) 09:11, 2 January 2025 (UTC)
- What I would hope is that we can get away from the constant blow by blow responses, and start thinking about the wider context and aftermath and subsequent political flashpoints as more secondary and reflective pieces come out. One line in a guardian piece in april saying unnamed "feminists" claim "vindication" doesn't justify a whole section in "responses"
- We have a wide variety of contemporaneous responses from major political parties and health bodies domestically and internationally that gives an accurate reflection of how it was received at the time. We have a ton of individual responses we've culled because frankly everyone and their dog has an opinion so we have to keep it to the most significant ones. It is already hard to prioritise.
- But what would be really good is to start working on what I suggested last year, which would be another section to expand on the wider response over time and larger political context in the aftermath. I think we should keep the immediate responses as focused as possible and start fleshing out everything after about August or so in a new section.
- What was the immediate response? Domestic political parties and health bodies almost unanimously endorsed it, with a couple of notable exceptions like the BMA. Internationally the picture varied from cautious agreement on some points to outright condemnation. That is a picture we can present in the "responses" based on the best possible and most notable opinions. What was the wider context and aftermath? Maybe we can build a more useful picture of that from other sources but I don't think it is a good to keep expanding this section like this with every minor note of celebration or protest gathered from passing mentions in rolling news coverage at the time. Void if removed (talk) 09:59, 2 January 2025 (UTC)
- And just so we're clear, the sourcing of this section was one passing mention right at the end of an Economist article that just happened to have a quote from Stella O'Malley, and a self-published statement by Sex Matters. Neither of these are DUE. We have avoided individual responses, and if there was decent secondary coverage dedicated to either of these organisations as a whole then fine, but this is not notable coverage. Void if removed (talk) 10:06, 2 January 2025 (UTC)
- Again, it's your opinion that it's not notable. Our view is different. There isn't consensus for your removal. Lewisguile (talk) 10:16, 2 January 2025 (UTC)
- My opinion is based on the dearth of coverage. If there were more coverage (ie an article about sex matters' response in a RS, or an article about Genspect's response), I would agree, but as it is this section is poorly sourced to one quote from one individual, and a self-published statement that I don't think is enough to establish notability. We wouldn't have covered Stonewall's response had it not received press attention in its own right, and Stonewall are vastly more notable, and similarly we wouldn't have framed a quote from an individual connected to Stonewall as Stonewall's official response either. I don't see coverage of a response from either Genspect or Sex Matters and unless there actually is any I don't think this is WP:DUE. Void if removed (talk) 10:26, 2 January 2025 (UTC)
- I don't think that it's necessary to expand this content, or to name any of those orgs. It's enough to say that gender-critical orgs praised it, citing Misplaced Pages:Independent sources for this fact. WhatamIdoing (talk) 11:58, 2 January 2025 (UTC)
- To be fair, though, the same could be said of the various politicians whose views don't diverge from their party's. (I think I've said this before, so apologies if I'm a stuck record.) Until then, we have got a blow by blow, so it should be representative of the key parties. Lewisguile (talk) 17:39, 2 January 2025 (UTC)
- Eventually, I think most of those soundbites will get removed.
- The bit about the Green Party issuing and then retracting a statement, for example, is just unencyclopedic. Encyclopedias summarize, with a focus on facts that made a difference. The net effect of the response from the Green Party – one of the smallest political parties in the UK, holding 0.6% of seats in Parliament, by no means a "key party" – on the world, on the Cass Review, on the implementation, on anything except themselves was: nothing. IMO that whole paragraph should be removed. WhatamIdoing (talk) 23:08, 2 January 2025 (UTC)
- They probably will get removed but there isn't consensus for that just yet. We'll get there, though. Lewisguile (talk) 11:45, 3 January 2025 (UTC)
- To be fair, though, the same could be said of the various politicians whose views don't diverge from their party's. (I think I've said this before, so apologies if I'm a stuck record.) Until then, we have got a blow by blow, so it should be representative of the key parties. Lewisguile (talk) 17:39, 2 January 2025 (UTC)
Enforced BRD (again)
@Lewisguile you have undone my reverts here.
These are recent additions by @Your Friendly Neighborhood Sociologist, which I have reverted. My understanding of enforced BRD is that these should then be brought here for discussion and then consensus established before being re-added. Void if removed (talk) 10:59, 2 January 2025 (UTC)
- Hmmm. You raise a good point/grey area. My understanding is that @Your Friendly Neighborhood Sociologist can't reinstate their own edit for 24 hours, not that nobody can. The examples refer to Editor A and Editor B, where Editor A can't restore until they've discussed with Editor B. But Editor C isn't mentioned at all.
- Enforced BRD is also intended to have the advantage that Editor B can't use 1RR+"consensus needed" to stonewall new edits being added, and to prevent Editor A from reverting the revert of Editor B.
- I think Editor C restoring text isn't falling afoul of enforced BRD, but I'm happy to self-revert if there's no consensus for this text. At the moment, the additions (with your restored correction of removing Badenoch) seems fair and balanced, since LGBTQ groups are relevant and have mostly been removed from this article. It's quite relevant that most LGBTQ+ and trans groups have criticised the review, for example, but that's somehow not in the lede and has been whittled to almost nothing in the Responses section. Lewisguile (talk) 11:19, 2 January 2025 (UTC)
- I've started a discussion either way: https://en.wikipedia.org/Talk:Cass_Review#c-Lewisguile-20250102113700-Responses_section_(picking_up_per_BRD) I noticed there wasn't one previously. Lewisguile (talk) 11:38, 2 January 2025 (UTC)
- I would disagree TBH, this was added because of a tendency for bold additions to be added, reverted, and then re-added without discussion, and attempts to discuss ignored. I would say that if it can by bypassed by essentially tag-teaming (not an accusation, merely saying that that would permit bypassing EBRD), then it is a worthless measure, and not really in the spirit of the restriction. Void if removed (talk) 11:41, 2 January 2025 (UTC)
- Ok, so from the FAQ:
You can reinstate the edit without violating this sanction, but if your revert gets reverted you must then discuss and wait 24 hours before re-reverting. That said, unless the revert was really bad it's a better idea to go to the talkpage before reverting. And if you stumble upon an active edit war between multiple editors you should definitely try to find a compromise/consensus on the talk page before participating in any reverting.
- So basically, you aren't technically violating it, but it does seem to be not in the spirit of things to revert without discussion first.
- I'd ask you in future to at least open a discussion first, or slow down and wait to see if the original editor takes it to talk, there's no rush. Void if removed (talk) 11:54, 2 January 2025 (UTC)
- Yes, this is unclear, too. I think whoever wrote the FAQ simply didn't consider that a third editor might come along and revert a revert, which is why it only talks about the second person reverting the revert of their revert. Hmmm. It seems @WhatamIdoing has pinged someone for clarity, so that may help.
- In any case, BRD does require an attempt to engage in said discussion by the reverter as well, if it's to work. I didn't see a topic for those reversions, which is why I have created this one. I think, in general, I would agree to the "no reverts of reverts" principle for all parties so long as whoever makes the first revert also actually opens up said discussion first. Then it's clear when an enforced BRD process has begun for all parties and it means we can gauge whether there's consensus or not for the edits. Lewisguile (talk) 17:35, 2 January 2025 (UTC)
- Pinging Awilley, who may be able to tell us whether tag-team reverting is technically okay, and/or get the rules fixed to be clear about it. WhatamIdoing (talk) 12:00, 2 January 2025 (UTC)
- Editor C can revert Editor B's revert of Editor A's "bold edit" without first discussing or waiting 24 hours. But of course if editor D reverts Editor C's edit, then C must slow down and join the conversation as well before making any more reverts. Sometimes a disagreement is simple and can be resolved in a couple of edits/reverts without a ton of discussion, especially when a third party shows up. Sometimes it's not simple and there are many editors with different and nuanced viewpoints. That's where we want people to slow down and engage on the talk page instead of just having people "tag-team" up to their 3RR limit. If you want to think of "Enforced BRD" as one round of tag-teaming followed by discussion you can, but I prefer if people would treat it more like a true BRD rather than going through the motions of discussing just so they can revert again tomorrow. ~Awilley (talk) 00:37, 5 January 2025 (UTC)
- Excellent. Thanks for the clarification. I think so far people have followed your intention, and the enforced BRD has pushed us to come up with wording that has consensus. Except over Christmas, when things slowed a little, this has also happened relatively quickly. Lewisguile (talk) 11:53, 5 January 2025 (UTC)
- Editor C can revert Editor B's revert of Editor A's "bold edit" without first discussing or waiting 24 hours. But of course if editor D reverts Editor C's edit, then C must slow down and join the conversation as well before making any more reverts. Sometimes a disagreement is simple and can be resolved in a couple of edits/reverts without a ton of discussion, especially when a third party shows up. Sometimes it's not simple and there are many editors with different and nuanced viewpoints. That's where we want people to slow down and engage on the talk page instead of just having people "tag-team" up to their 3RR limit. If you want to think of "Enforced BRD" as one round of tag-teaming followed by discussion you can, but I prefer if people would treat it more like a true BRD rather than going through the motions of discussing just so they can revert again tomorrow. ~Awilley (talk) 00:37, 5 January 2025 (UTC)
Responses section (picking up per BRD)
We have a discussion already about the GC responses in the Responses section. We don't currently have one for the additions of LGBTQ+ groups in that section – these were initially reverted by @Void if removed and then restored by me. Personally, I agreed with the original editor, @Your Friendly Neighborhood Sociologist, that these are WP:DUE, since the article otherwise includes very little of the LGBTQ+ response to the review (which has largely been mixed to critical, with some outright opposing it).
As it's not entirely clear to me whether enforced BRD also applies to third party editors, I figured I should start the discussion anyway and I can revert the text again if there's not a consensus to keep it. Lewisguile (talk) 11:37, 2 January 2025 (UTC)
- Lots of people have opinions, as do lots of activist groups. The student officer for a minor affiliated group in the Labour Party is not an opinion that is as notable as, say, WPATH's. So, we give lots of space to WPATH, and don't waste space on trivia with no significant secondary coverage.
- I have in the past said that the responses should be limited to the notable and immediate reaction and implementation, and that wider things (like what you're concerned about) should be used to flesh out a new section covering the wider sociopolitical response and aftermath. I'm fully prepared to believe such things could go in there, but I simply disagree that what a minor political activist thought about the review is of any consequence, compared to how the royal colleges responded straight away. I think this continual attempt to expand "responses" rather than accept a limit there and start expanding further down the article is to the detriment of the article as a whole. My impression of the discussion at the time was that editors perhaps didn't want to see criticism relegated to the bottom of the article, but that's not how I see it - I think there's plenty of space for all that, but it should be contextualised properly as something wider than simply "responses". The Cass Review fits into a large and complicated divide in opinion and perception and we can give that its due, but not by simply recounting responses one by one, and each attempt to bring something new in there simply brings about new conflict.
- I think it would be more fruitful to discuss how to expand a new section with a broader remit than to continue to bloat the responses. Void if removed (talk) 11:43, 2 January 2025 (UTC)
- To the extent that it's feasible, I think that most groups should be presented in summaries: Most UK politicians and doctors supported it, the gender-critical people danced in the streets, UK trans groups were appalled by the puberty blocker restrictions but liked the idea of having more than one clinic in the whole country, the parent groups distrusted anything that would require more funding, American trans groups were terrified that it would prompt even more restrictions in the US, etc.
- I also think that, to the extent that it's feasible, we should be citing reliable sources that are both independent and secondary for these claims. This will probably get easier as time goes on (e.g., if we get a "one year ago today" kind of news story later this year). WhatamIdoing (talk) 12:06, 2 January 2025 (UTC)
- A one paragraph intro to the "Reception" section encompassing that sort of high level summary is probably a good idea?
- I still think a new "Further Commentary" section or similar would be a good place to expand with some of the other stuff. Void if removed (talk) 12:53, 2 January 2025 (UTC)
- I certainly wouldn't object to an overview like that, either. I think it sorely needs it. I would also have a compressed version in the lede, since it more accurately reflects the pro/anti in broad strokes rather than the flat statement we have in the lede at present. But the former is probably a higher priority. One good outcome of that is that we may, in time, be able to remove or further condense these sections in Responses altogether. It's more important to show the broad support/opposition among groups rather than listing individual comments, but that applies to all support/opposition and needs to be done carefully. Lewisguile (talk) 17:18, 2 January 2025 (UTC)
- I agree with Lewis and Friendly Sociologist. Trans people are the affected party, so we should include responses from groups established to protect their interests. HenrikHolen (talk) 14:07, 2 January 2025 (UTC)
- Thanks, Henrik. Lewisguile (talk) 17:19, 2 January 2025 (UTC)
- The approach taken in Misplaced Pages policy is to ignore our (i.e., Misplaced Pages editors') beliefs about who "the affected party" is, and to rely on what the published reliable sources say, with special attention to sources that are WP:SECONDARY and WP:INDEPENDENT. If the independent, secondary reliable sources don't care what Organization A says, then editors should be cautious about assuming that this article should include information from groups that nobody else thought was worth discussing. WhatamIdoing (talk) 07:31, 3 January 2025 (UTC)
- We don't need a source to say the sky is blue, but luckily, there are plenty of sources which discuss the Cass Review as affecting/pertaining to trans people or subsets of trans people (such as the review itself). I don't think anyone here needs to go over the basics of reliable sources, but thanks for offering your advice. Lewisguile (talk) 11:41, 3 January 2025 (UTC)
- I don't think my earlier comment was clear. I believe that there are multiple affected parties, including, but not limited to:
- Children and teens who would have been seen at GIDS, except that it's been closed;
- Parents seeking gender care for their kids;
- Healthcare providers, who have to learn new referral systems and standards;
- Gender care providers, whose jobs have disappeared, been relocated, or changed;
- People in the UK who would not have been seen at GIDS (e.g., because they're adults) but who are affected by subsequent decisions (e.g., schools that have to update their policies); and
- Trans people outside the UK, especially in the US, who worry what the politicians will do.
- But the fact that a Misplaced Pages editor holds these beliefs is not important. What's important is what the reliable sources say. And for better or worse, the reliable sources don't seem to care much about what some of the small or marginal groups are saying. Therefore, the Misplaced Pages articles shouldn't care much either.
- I think this is a straightforward case of following the sources' lead. WhatamIdoing (talk) 02:55, 4 January 2025 (UTC)
- I don't think my earlier comment was clear. I believe that there are multiple affected parties, including, but not limited to:
- We don't need a source to say the sky is blue, but luckily, there are plenty of sources which discuss the Cass Review as affecting/pertaining to trans people or subsets of trans people (such as the review itself). I don't think anyone here needs to go over the basics of reliable sources, but thanks for offering your advice. Lewisguile (talk) 11:41, 3 January 2025 (UTC)
- The approach taken in Misplaced Pages policy is to ignore our (i.e., Misplaced Pages editors') beliefs about who "the affected party" is, and to rely on what the published reliable sources say, with special attention to sources that are WP:SECONDARY and WP:INDEPENDENT. If the independent, secondary reliable sources don't care what Organization A says, then editors should be cautious about assuming that this article should include information from groups that nobody else thought was worth discussing. WhatamIdoing (talk) 07:31, 3 January 2025 (UTC)
- Thanks, Henrik. Lewisguile (talk) 17:19, 2 January 2025 (UTC)
ILGA, Transgender Europe, and IGLYO Joint Statement
The largest and oldest international LGBT watchdog ILGA, one of the largest and oldest international trans watchdogs Transgender Europe, and the largest LGBT student group IGLYO released a joint statement criticizing UK government policy and said The “Keeping Children Safe in Education 2024” guidance uses the Cass Review as an evidentiary basis for this policy change, despite its poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts. As stated by healthcare activist and feminist researcher Dr Ruth Pearce in an article titled “What’s wrong with the Cass Review? A round-up of commentary and evidence” (2024), the Cass Review “has been extensively criticised by trans community organisations, medical practitioners, plus scholars working in fields including transgender medicine, epidemiology, neuroscience, psychology, women’s studies, feminist theory, and gender studies”.
@Void if removed removed it saying this is about a government action, and it happens to mention the Cass Review in passing. This is not due, and also citing a blog?
- This is about a government action explicitly justified by the Cass Review, which the statement spends a paragraph critiquing
- They explicitly reference the blog in their statement. We aren't citing it directly, we're providing a courtesy link to who ILGA et al cited.
Today alone, you removed the fact the UK's LGBT doctors org explicitly criticized it, that the labour party's LGBT chapter criticized it , and are now removing criticism from Europe's largest LGBT rights watchdog and trans rights watchdog by claiming, somehow, a paragraph criticizing the Cass review is not relevant to the section "Reception by charities and human rights organisations". That's today alone, there are dozens of diffs of you trying to remove criticism from LGBT rights orgs, hell you even tried to remove that PATHA criticized them for whitewashing a form of conversion therapy.
Please self-revert. This is painfully obviously due, and your continued removal of criticisms from LGBT orgs is getting tendentious to the extreme. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:54, 2 January 2025 (UTC)
- ILGA are huge and influential. If ILGA release a statement about the Cass Review, and it gets coverage in a RS, it is arguably more due than the Stonewall and Mermaids statements.
- This, OTOH, is a self-published statement about a completely different matter, 9 months after the release of the final report. that happens to mention the Cass Review. It isn't a response and doesn't belong in "reception".
- Now, if we had a section for wider impacts, or further coverage about related sociopolitical events, there's a case for it there, but even so, I'd hope for a secondary source that directly links this statement to the Cass Review. For example, perhaps if we had coverage of the "Keeping Children Safe in Education 2024" guidance that RS explicitly linked to the Cass Review, and a section in "wider impacts" or something that mentioned it and explained what it was, then this response to that guidance would go there.
- And citing a blog is terrible sourcing.
- So I would say: if this statement gets reliable secondary coverage relating it to the guidance, and there's coverage of the guidance relating it to the cass review, and we build enough to make a section relating all three things together in some sort of "wider impacts" or "subsequent events" section of this article, then it would be due. Void if removed (talk) 21:56, 2 January 2025 (UTC)
- I dont understand why we cannot use advocacy group statements in attributed voice on Misplaced Pages in a reception section, and you just admitted that they are a giant watchdog. I also do not understand, this is clearly a large portion of info about the Cass Review and its effect on government policy. It is like arguing that a report about lung cancer criticizing cigarettes as a cause for cancer in a single paragraph is not about cigarettes and cannot be used as evidence.
- The statement isn't a blog either and is part of the IGLYO website. this seems like tendetious editing. Bluethricecreamman (talk) 22:13, 2 January 2025 (UTC)
I dont understand why we cannot use advocacy group statements in attributed voice on Misplaced Pages in a reception section
- If it were ILGA's statement upon the release of the Cass Review you'd have a point. That's not what this is, it is a statement about a different thing, months down the line.
- The problem here is the longstanding resistance to expanding this article and instead turning "reception" into a coatrack, because it seems everyone wants their favourite response to be in "reception".
- I would like to expand this article. I think you could make a better case for this statement as part of an expansion in a different section. It isn't "reception" because this is months down the line and a response to a completely unrelated political matter.
- I think a better approach rather than continuing to bloat "reception" with ever more tenuous things is: make the case that the political matter itself is due, explain what it is and why, and then include ILGA's response to that.
- The Cass Review is significant. It has had a significant impact. Now lots of subsequent matters rely on it. I think it is well past time to try to move past "reception" and into broader matters, and I would like to see the subsequent critical to and fro in that light, where they can be properly presented.
- The guidance in question is here and the sole reference to Cass is:
However, the Cass review identified that caution is necessary for children questioning their gender as there remain many unknowns about the impact of social transition and children may well have wider vulnerabilities, including having complex mental health and psychosocial needs, and in some cases additional diagnoses of autism spectrum disorder and/or attention deficit hyperactivity disorder
- That's literally it, and it is hardly contentious. Now if there's secondary coverage of this guidance, that makes the point it is directly the result of the Cass Review, then there's a case to be made for creating a section in "subsequent government actions" for this, and then arguably ILGA's response would be due as a response to that. I couldn't find any but I didn't look hard so be my guest. The only ones I found on a cursory search making a big deal out of it is Sex Matters, but that's nowhere near enough, it needs secondary coverage to make it notable, not just advocacy orgs taking predictably polarised positions.
The statement isn't a blog either
- The edit included a citation to a blog. Void if removed (talk) 22:31, 2 January 2025 (UTC)
- To be clear: this is a blog, by someone very invested in collecting every bad thing anyone said about the Cass Review all in one place. This is not a reliable source for anything, and there's no reason to cite it. Trying to justify citing it by calling it a "courtesy link" is no policy I've ever come across. As it stood, the edit inappropriately inflated the opinion of this individual blog.
- We have a longstanding consensus to avoid individual responses in the "reception" section because there are so very many of them, and if we start adding them, there are a dozen higher quality ones in the queue before this one. Trying to add one like this, attached to the ILGA statement, is reopening an old argument.
- So aside from the fact ILGA aren't even responding to the Cass Review I also strongly object to trying to get this extensive opinionated quote in:
They also quoted healthcare activist and feminist Dr Ruth Pearce, who collated criticisms of the review and said it "has been extensively criticised by trans community organisations, medical practitioners, plus scholars working in fields including transgender medicine, epidemiology, neuroscience, psychology, women’s studies, feminist theory, and gender studies"
- Attempting this simply because ILGA cite this blog is ridiculous when we've excluded far, far more weighty and significant contemporaneous individual responses from, say, the editor-in-chief of the BMJ and surely nobody wants to have the "individual response" argument all over again. Void if removed (talk) 22:57, 2 January 2025 (UTC)
- Bruh, ILGA cited them and quoted them. It was not cited for the statement, ILGA was cited quoting them. It would be silly to not provide a courtesy link. It is common practice on Misplaced Pages, when a source quotes and references another, to link the original.
We have a longstanding consensus to avoid individual responses in the "reception" section
- Once again, it was ILGA et als response being quoted. The fact you don't like what they quoted doesn't mean they didn't quote it. If we have a source that says "BMJ editor-in-cheif said so and so", that would be different, but we don't. Apples and oranges. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:09, 2 January 2025 (UTC)that would be different
- It is not - we have dozens of sources of individuals being quoted, and we took the decision not to include any of them because it was so contentious, and it was more important to focus on what, say, WPATH thought, than what, say, David Bell thought. Once we got past the immediate and significant political and medical figures directly responsible for policy and implementation, just adding endless quotes from Doctor X saying "I think its great" and Doctor Y saying "I think its terrible" wasn't adding a lot. Void if removed (talk) 23:16, 2 January 2025 (UTC)
- And here we have ILGA saying according to this collection of criticism and commentary of the Cass Review, it is xyz. Those are individual responses, this is a collation of responses that ILGA thought important enough to name, quote, and reference. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:22, 2 January 2025 (UTC)
- Well, let's get some outside opinions. Would you like me to ask at WT:CITE, since this seems to be a question closer to formatting than to whether her blog contains the quote? Or do you have a different policy/guideline/noticeboard that you think would be more relevant? WhatamIdoing (talk) 23:34, 2 January 2025 (UTC)
- That might help actually! Though, I did just find MOS:QUOTE saying
Per the verifiability policy, direct quotations must be accompanied an inline citation
which seems straightforward. Formatting and policy wise, when have source A saying X and and as B said Y, it makes sense to cite it asA said X. It cited B saying Y.
Somebody should make WP:RECURSIVEQUOTES for this lol Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:55, 2 January 2025 (UTC)- WP:V only requires a single source.
- I've posted it at Misplaced Pages talk:Citing sources#Convenience links. It took a while to figure out how to explain the situation for people who know nothing about the subject matter, but I think it will be clear enough. We'll probably get at least one response in the next 24 hours. WhatamIdoing (talk) 04:37, 3 January 2025 (UTC)
- Interested to see what other people say. WP:CONVENIENCE is about alternative hosting for the same source. So, eg, a formal citation to a book, and a convenience link to an archived public domain copy. I can't see how that justifies adding a direct citation to a blog mentioned in a source. Void if removed (talk) 09:36, 3 January 2025 (UTC)
- First response: It's permitted but not required.
- Years ago, we did something similar for mass media explanations of medical sources, with the
|lay-sourceparameter in {{cite journal}}, but it wasn't used much, and eventually the community voted to remove the parameters, with the idea that any such secondary source should be presented with its own little blue clicky number (or a WP:REFBUNDLE). WhatamIdoing (talk) 23:29, 4 January 2025 (UTC)
- Interested to see what other people say. WP:CONVENIENCE is about alternative hosting for the same source. So, eg, a formal citation to a book, and a convenience link to an archived public domain copy. I can't see how that justifies adding a direct citation to a blog mentioned in a source. Void if removed (talk) 09:36, 3 January 2025 (UTC)
- That might help actually! Though, I did just find MOS:QUOTE saying
- Well, let's get some outside opinions. Would you like me to ask at WT:CITE, since this seems to be a question closer to formatting than to whether her blog contains the quote? Or do you have a different policy/guideline/noticeboard that you think would be more relevant? WhatamIdoing (talk) 23:34, 2 January 2025 (UTC)
- And here we have ILGA saying according to this collection of criticism and commentary of the Cass Review, it is xyz. Those are individual responses, this is a collation of responses that ILGA thought important enough to name, quote, and reference. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:22, 2 January 2025 (UTC)
a response to a completely unrelated political matter.
- How exactly is UK government policy explicitly justified by the Cass Review "Completely unrelated"?- We should expand on the anti-trans schools guidance, and note ILGA's criticisms, in the section on "Subsequent government actions in the UK". But also cover what they explicitly said about the Cass Review itself in the section on human rights orgs.
- WRT
That's literally it, and it is hardly contentious.
- That is ridiculously contentious...- Almost every criticism of the Cass Review highlights the fearmongering about supposed dangers of social transition. It's a human right, not requiring any kind of "caution".
- Almost every criticism of the Cass Review highlights referring to kids who explicitly identity as trans "gender questioning".
- Right after the Cass quote, they recommend multiple things Cass called for, which were also heavily criticized such as 1) outing trans kids to their parents 2) telling parents to take their pre-pubertal (ie, in no need of any medical treatment) trans kids to a clinic
- As ILGA noted, the guidance previously said trans kids should be affirmed. That was replaced with "LGB kids should be affirmed", followed immediately with
However, the Cass review
, which is then followed by saying Cass's recommendations about trans kids
The edit included a citation to a blog.
which ILGA et al explicitly referenced and linked. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:00, 2 January 2025 (UTC)How exactly is UK government policy explicitly justified by the Cass Review
- Do you have some good secondary sourcing for that? If so, please, expand on this in "subsequent government actions", ideally under a heading like "Keeping children safe in education 2024 guidance" and add the ILGA response there.
which ILGA et al explicitly referenced and linked
- So? Void if removed (talk) 23:06, 2 January 2025 (UTC)
- I said
How exactly is UK government policy explicitly justified by the Cass Review "Completely unrelated"?
. You have no compelling arguments for why it isn't, we have a statement from multiple reliable watchdogs that it is. Also, the fact it's blindingly obvious and verifiable. The guidance changed from "affirm LGBT youth" to "affirm LGB youth, however the Cass Review said XYZ about trans kids, so do the things Cass said for trans kids", - Like I said, ILGA's response to the guidance can go into a section on education, but the response to the Cass Review should be in the normal place.
So?
If we mention what ILGA said, we mention the quote they gave, and there's no good reason not to provide a link and plenty of reasons too. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:20, 2 January 2025 (UTC)- You keep saying
How exactly is UK government policy explicitly justified by the Cass Review
. - I'm asking you to provide secondary coverage that would justify this statement.
- If it is indeed
explicitly justified by the Cass Review
, I would very much like to see a dedicated section explaining how, and then the ILGA statement in response, because that is what ILGA are responding to and it demonstrates, for better or worse, the wide impact of Cass on policy, and the ongoing criticism of Cass by orgs like ILGA every time that policy comes up. This would benefit the article as a whole. Void if removed (talk) 23:29, 2 January 2025 (UTC)- Page 55 of the DfE guidance says to consult the Cass Review in this area. The guidance is here. Lewisguile (talk) 13:06, 5 January 2025 (UTC)
- You keep saying
- I said
- very clearly due and should be included. Bluethricecreamman (talk) 22:07, 2 January 2025 (UTC)
- Clearly due. The source is appropriate as per WP:USESPS and WP:ABOUTSELF, since ILGA is a well-recognized expert group and because the statement concerns the source itself.
- The revert was unwarranted and the content should be reintroduced. HenrikHolen (talk) 23:12, 2 January 2025 (UTC)
- @Void if removed I don't have the energy for this. Consensus is against you, you aren't convincing anybody, please self-revert so this can be dropped. Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:26, 2 January 2025 (UTC)
- I've started wondering (not just due to this, but this is a fine example) if Misplaced Pages's whole notion of sourcing is rapidly becoming outdated.
- Fifteen years ago, when our Official™ Rules started calcifying, we would have said that if ILGA/this joint statement was actually important, you would know that because someone other than the self-publishers would have picked up on it. There'd be a newspaper article, or a magazine story, or some independent source we could cite. If we were lucky (and we frequently were) that source would combine several, so that we had a single source telling us which of several press releases we needed to pay attention to.
- But here we are, four months later, and it sounds like nobody's picked this up. Traditionally, we'd have said that was evidence that the joint statement was not important to get mentioned on Misplaced Pages, as it's too easy for editors to accidentally end up with NPOV failures if we get to cherry pick which sources we personally deem important.
- That said, in this case (and some others), I wonder if the problem is that our old assumptions about journalism are now unrealistic. Why would the news media write a story about this statement, when the people who want to read about it have already heard all about it on social media? WhatamIdoing (talk) 04:52, 3 January 2025 (UTC)
- Here's how I'd expect something like this to be covered:
In September 2024, the UK Government released new statutory guidance for schools and colleges, titled "Keeping children safe in education 2024". This provided guidance for safeguarding in education, covering a variety of topics from physical abuse to mental health, along with escalation pathways and statutory duties for educators. The guidance contained new measures explicitly justified by the Cass Review, regarding social transition within the education environment, cautioning that schools and college should be aware of the Review's findings and guidance in this area. IGLYO, ILGA-Europe and TGEU released a statement strongly condemning the new guidance, expressly criticising its reliance on the Cass Review as an evidentiary basis.
- Or something similar, expand ILGA's effusive condemnation as appropriate etc. If that could be sourced I would support that at a minimum for starters, and as I suggested, it would fit nicely under "further government actions".
- The problem is that everything up until the mention of the ILGA statement has absolutely zero coverage that I can find. This guidance has been roundly ignored by the press since it came out 4 months ago, nobody has made any connection to the Cass Review outside of activist groups, and the mention of Cass in the actual document boils down to a single paragraph in a 180-page document, making the "explicitly justified" overstating things somewhat. Without the underlying guidance being notable, and without it having some relation to the Cass Review as established in a RS, there's no real grounds for incorporating ILGA's statement on this page, as if it were a direct response to the Cass Review when it is - very explicitly, from the title on down - a response to new statutory guidance and a criticism of that guidance's reliance on the Cass Review.
- So I would say you could make a case that ILGA etc are big and notable enough that their self-published statement doesn't need a secondary source to establish notability, but I think you need a secondary source to establish the notability of what they're actually responding to, and that connects that government guidance to the Cass Review, so you can hang the ILGA statement off it. Otherwise we're going to be mining every activist statement that responds to every policy downstream of the Cass Review, and chucking it in "reception" pretending they're responses to Cass, when they aren't - they're responses to further events the Cass Review precipitated, which individually should be included if they're notable. Void if removed (talk) 09:18, 3 January 2025 (UTC)
- I thought the source itself was fine (subject matter experts talking about themselves and not about a BLP), and it is notable. But it's probably too long where it was. I would support it going under "further govt action" as per @Void if removed. I'd suggest the following:
In September 2024, the UK Government released new statutory safeguarding guidance for schools and colleges, titled "Keeping children safe in education 2024". Among the topics covered by the guidance, it contained new measures regarding social transition within the education environment, saying that schools and colleges should follow the Cass Review in this area. International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA), international LGBTQ student organization IGLYO, and Transgender Europe released a joint statement condemning the new guidance, and criticising its reliance on the Cass Review for its "poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts".
Lewisguile (talk) 11:19, 3 January 2025 (UTC)- Ok, now find a good secondary source for the first two sentences to establish notability and relevance of the topic to Cass so we're not just cobbling it together from WP:OR and primary sources and I'll agree.
- The best I found was:
- https://www.tes.com/magazine/analysis/general/keeping-children-safe-in-education-kcsie-safeguarding-guidance
- Which describes it as "only minor changes in language", stressing how inconsequential the update is, and no reference at all to Cass or social transition. Absent a better source, this seems to not be WP:DUE. Void if removed (talk) 15:41, 3 January 2025 (UTC)
- A primary source is adequate for the first two sentences, since the interpretation is provided by the second source itself (the ILGA statement). The DfE report mentions the Cass Review directly on p. 55. As the DfE is an expert source on this area, there's no problem using it. Your source also helps. Secondary sources are needed for interpretation – but the IGLA statement is a secondary source for the purposes of discussing the DfE report. Lewisguile (talk) 12:53, 5 January 2025 (UTC)
- I'm not entirely sure that your primary/secondary analysis holds up. I'd have to spend more time looking at what, exactly, the joint statement says. Something like "This report uses the Cass Review" could be a simple WP:LINKSINACHAIN situation and therefore still primary. Also, the DfE document is not the Cass Review or either of the Cass Reports, so what the joint statement says about the DfE document is irrelevant.
- Even if we stipulate that the joint statement is secondary, it is also self-published, which is a reason to not use it at all.
- To look at our third usual point, although I don't think Misplaced Pages:Independent sources addresses advocacy groups specifically (at least, it didn't when I re-wrote it years ago), it is possible that the community would not judge them to be an independent source, either. It would depend on whether editors saw the organizations more as political rivals. Two candidates for the same political office, or two businesses producing rival products, would not usually be considered independent. If editors saw advocacy groups vs government agencies in a similar light, they'd consider it non-independent, which would be another reason not to use it at all. But they might see such orgs as completely independent. I really don't know what they would say if we asked, e.g., whether People for the Ethical Treatment of Animals is independent of veganism, or of a law promoting meat-eating that they oppose. That would be something interesting (to me, anyway) to discuss elsewhere, unrelated to this joint statement. WhatamIdoing (talk) 05:45, 6 January 2025 (UTC)
- The DfE guidance is relevant because it says "because of the Cass Review, we should do x", and then ILGA and others commented on that. Regardless of how one feels about the IGLA statement, the DfE guidance is a potentially relevant topic for the "other government responses" section. The DfE is generally considered notable and reliable, and few people would argue against its inclusion. A literal reading of policy does mean it's also "self-published", but that's the tension inherent to the policy and guidance we have in this area.
- If we do include the DfE guidance, the second question is whether the ILGA/IGLYO statement should also be mentioned with it, whether it should be mentioned separately in charity responses, or whether it shouldn't be mentioned at all. That's where consensus is needed.
- The DfE report is certainly notable. ILGA is generally considered notable and an expert in its area, as is IGLYO. They are writing within their areas of expertise, in this case. From this past discussion at WP:V, I see that many people did
- Given differences in how policy is interpreted, I think we can resolve this with consensus among ourselves. VIR suggested some wording upthread, which I have tweaked and offered some sources for, and I think that could be used (potentially with more sources if needed).. Lewisguile (talk) 12:08, 6 January 2025 (UTC)
- I agree that the Department for Education is WP:Notable, but I disagree that "The DfE report is certainly notable". Do you mean that the report is subjectively important to you?
- The story here appears to be:
- A government agency issued a 185-page-long document. It mentions the subject of this article by name in exactly one (1) sentence. 99% of the document is not about trans students, gender-questioning students, or anything else related to the subject of this article.
- That one sentence is under the bold-faced subheading that says "N.B. This section remains under review, pending the outcome of the gender questioning children guidance consultation, and final gender questioning guidance documents being published."
- Three advocacy organizations have self-published a joint statement objecting to the Cass Review's POV being mentioned.
- No independent media has mentioned the Cass Review in connection with the DfE's document.
- No independent media has mentioned the joint statement objecting to the DfE's document mentioning the Cass Review.
- Are we agreed on these facts? WhatamIdoing (talk) 20:42, 6 January 2025 (UTC)
- A primary source is adequate for the first two sentences, since the interpretation is provided by the second source itself (the ILGA statement). The DfE report mentions the Cass Review directly on p. 55. As the DfE is an expert source on this area, there's no problem using it. Your source also helps. Secondary sources are needed for interpretation – but the IGLA statement is a secondary source for the purposes of discussing the DfE report. Lewisguile (talk) 12:53, 5 January 2025 (UTC)
- @Void if removed I don't have the energy for this. Consensus is against you, you aren't convincing anybody, please self-revert so this can be dropped. Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:26, 2 January 2025 (UTC)
- I think the statement should be mentioned in the article (as it is significant), but no more than a single sentence should be needed. Also, I agree with Void that the blog should not be cited, nor is it necessary to discuss the blog post specifically. Nosferattus (talk) 07:00, 4 January 2025 (UTC)
- Are you saying that it's "significant" that this trio of organizations issued a press release? How do we know that this is significant, since other reliable sources have apparently completely ignored it?
- I think that both Void's suggested text above and Lewisguile's might be vulnerable to a WP:SYNTH challenge precisely because all the sources have ignored it. WhatamIdoing (talk) 23:38, 4 January 2025 (UTC)
- @Nosferattus' suggestion works for me. The ILGA statement is a primary source on itself but a secondary source on the DfE report. The DfE report is a primary source on itself and a secondary source on the Cass Review (p. 55). The DfE is also an expert in this area (education policy). So, the ILGA statement comments on the DfE report which comments on the Cass Review. The ILGA statement and the DfE report can both therefore be cited for this statement.Lewisguile (talk) 13:02, 5 January 2025 (UTC)
- Well quite, my example was how it could be written if sources existed to justify doing so.
- I looked and they do not. There's no notable secondary coverage of this guidance, which has been ignored for four months, and what little there is makes no mention of Cass and describes it as a fairly trivial update.
- I think we need a higher standard for statements to be added to the "reception" of the Cass Review, in that they are principally about the Cass Review, and not about tertiary events. I have no objection to including these in response to tertiary events elsewhere (and as I've made clear would actively encourage that approach), but unless that tertiary event becomes notable, this statement - no matter how notable the organisation issuing it - is also not notable.
- Trying to assemble the wording I posited as a hypothetical from primary sources is SYNTH. Void if removed (talk) 14:48, 5 January 2025 (UTC)
- The guidance has been discussed by several legal organisations, who also note the impact of the Cass Review
- Here: https://www.hcrlaw.com/news-and-insights/kcsie-2024-what-to-expect/
- And another: https://www.stoneking.co.uk/literature/e-bulletins/have-you-implemented-changes-keeping-children-safe-education-kcsie-2024
- And here: https://www.irwinmitchell.com/news-and-insights/expert-comment/post/102jhbf/keeping-children-safe-in-education-guidance-whats-changed
- And here: https://wslaw.co.uk/insight/keeping-children-safe-in-education-2024-the-main-changes-and-action-required/
- And here: https://www.brownejacobson.com/insights/keeping-children-safe-in-education-kcsie-2024-the-main-changes-and-what-to-do-next
- The draft DfE guidance was also mentioned here: https://www.irwinmitchell.com/news-and-insights/expert-comment/post/102j6jj/cass-review-implications-for-schools-and-colleges
- LifeLessons, an education website, published an article about it here: https://lifelessons.co.uk/resource/kcsie-updates-2024/ The Key, originally a government start-up, also wrote about the guidance here: https://schoolleaders.thekeysupport.com/pupils-and-parents/safeguarding/managing-safeguarding/keeping-children-in-safe-education-kcsie-changes-september-2024/?marker=content-body (both mention the Cass Review). Lewisguile (talk) 12:43, 6 January 2025 (UTC)
- Thank you, I did find most of these when I was looking before but since they're all WP:SPS I didn't think this was notable coverage. I was hoping for a news report that the guidance had even been updated.
- Of them, the ones that I think make the most of the Cass Review are:
- https://www.hcrlaw.com/news-and-insights/kcsie-2024-what-to-expect/
Another change made is in the ‘Children who are lesbian, gay, bisexual or gender questioning’ section. This has been adapted to comply with the gender questioning children guidance terminology. The guidance notes that schools should take a cautious approach as there remain many unknowns about the impact of social transition, and children may have wider vulnerabilities. When families and carers are making decision about support for gender questioning children, KCSIE 2024 notes the recommendation of the Cass review that they should be encouraged to seek clinical help and advice. Schools should consider the broad range of their individual needs, in partnership with the child’s parents when supporting a gender questioning child.
- https://www.stoneking.co.uk/literature/e-bulletins/have-you-implemented-changes-keeping-children-safe-education-kcsie-2024
New wording has been inserted at paragraphs 205 – 209 following the publication of the Cass Review, which, in summary, urges school to “take a cautious approach” and consider the “broad range of individual needs” when supporting a child who is gender questioning.
- https://wslaw.co.uk/insight/keeping-children-safe-in-education-2024-the-main-changes-and-action-required/
this update found in paragraphs 205 – 209 was to be expected following the release of the Cass review report. The main thrust of these paragraphs is that schools exercise caution due to the many unknowns about the impact of social transitioning and need to consider the broad range of needs that the child may have, to include complex mental health and psychosocial needs, and in some cases additional diagnoses of autism spectrum disorder and/or attention deficit hyperactivity disorder.
- Several point out this section is still a work in progress and as the document itself states:
This section remains under review, pending the outcome of the gender questioning children guidance consultation, and final gender questioning guidance documents being published.
- Based on these, if it were to be used I'd phrase it something like:
In September 2024, the UK Government released new statutory safeguarding guidance for schools and colleges, titled "Keeping children safe in education 2024". Following the Cass Review, the guidance contained new draft measures recommending a cautious approach to social transition within the education environment due to the many unknowns, and to consider that gender-questioning children may have wider vulnerabilities. International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA), international LGBTQ student organization IGLYO, and Transgender Europe released a joint statement condemning the new guidance, and criticising its reliance on the Cass Review for its "poor and inconsistent use of evidence, pathologising approaches, and exclusion of service users and trans healthcare experts".
- I still don't think that, without some sort of notable coverage of the first event, this is due. Looking at the other events in the section on "subsequent government actions" they are based on widespread coverage on the BBC, CNN, the Times, The Independent, The Telegraph and The Guardian. If we're having to scrabble round with WP:SPS, this isn't comparably notable. But if others disagree, this is how I'd suggest inclusion. I just get the impression this is work in progress guidance that hasn't become a significant event yet, but might once it is finalised. The outcome of the consultation is due to be published in 2025.
- (On notability - the glaring exception is the section on the charity commission/mermaids which IMO is UNDUE and should be removed.) Void if removed (talk) 13:40, 6 January 2025 (UTC)
- Fair enough. I'd be fine with your wording (probably removing "due to the many unknowns" as redundant given that's already clear from the rest of the article), but on reflection, I don't think it's necessary to go in just now, either. As you say, the final guidance will probably be more notable and will get more coverage. At that point, the ILGA/IGLYO statement might be superceded anyway.
- I've also just realised my browser scrambled my earlier post (sometimes happens when I hit publish). I've edited it to be legible. Sorry about that! Lewisguile (talk) 14:44, 6 January 2025 (UTC)
- I'm doubtful that this is WP:DUE, since we only have self-published sources.
- Law firm websites, in particular, use this kind of post for advertising purposes. It's not considered sufficiently dignified to do hard-sell advertisements, so they subscribe to content services such as these to get blog posts. (AI must be a boon for these services; you can write it once, and then generate a dozen "unique" variations.) Accountants do the same. WhatamIdoing (talk) 20:51, 6 January 2025 (UTC)
- The guidance has been discussed by several legal organisations, who also note the impact of the Cass Review
Methodology V3.0
Hi @13tez,
I've taken a stab at a new consensus version of Methodology, using your comments and some feedback from others. This is a new topic to avoid getting lost in a wall of text. Changes and reasons as follows:
- Restored assessment tools but removed the Times source for why these were used per WP:MEDPOP, as it was conflating two different things (it's standard practice to assess studies in meta-analyses; that's how you know how to weight stuff).
- Per the discussion with @WhatamIdoing, I reworded the sentence about limitations/scope so it hopefully doesn't read as criticism (we all seemed agreed that it wasn't). Now it is more focused on what the review did do, not on what it didn't. E.g., it says it "examined English-language studies of minors" rather than "it excluded non-English studies", etc. I have added an endnote after "minors" to clarify that the systematic reviews looked at ages <=18, while the qualitative review included people up to 30 to speak about their prior experiences. This is important, I think, because there has been some confusion about whether the report covers people aged 19–25 and whether the evidence reviews can be extended to this age range or older. But as an endnote, it's out of sight. Another possibility would be to replace "minors" with "participants up to 18 years old" to be absolutely clear in the body text, but that felt too long.
- I have merged the MMAT and NOS info into the bit about confidence ratings, so that we haven't removed @Your Friendly Neighborhood Socialist's additions but now they're more explicitly relevant. (An alternative would be to use some of the Yale comments about use of these tools instead, but that feels like a whole other can of worms.
- For the evidence base, I used Cass and the BMJ as sources for "assist" and "supplemented", rearranging the order a bit as per those sources. Because the "engagement programme" is explicitly supplementary, I've put that at the end, as it was in my prior edit and yours. Because the qualitative/quantitative research is described as supplementary and part of the research programme in the BMJ overview, I have put that with the York stuff, but have marked it as supplementary in the text. As I understand it, York wasn't involved in the focus groups, etc, so this also clearly delineates the research programme from the engagement programme. (I can see the latter were performed by market research types.)
- I have updated the BSN note to better reflect where that conversation left off, although I still think there was generally consensus that the source itself is high quality (regardless of whether one thinks it's exactly equal to Cass or not) and that the approach taken by Cass for her own conclusions and recommendations is a narrative one (a narrative review can use systematic reviews as well). Personally, I would remove that tag, but didn't want to without confirming you were satisfied first.
- The agreed upon endnotes should all still be intact as well. @Snokalok, did I get yours in here too?
I think that should cover most of our concerns. I'm sure there are still bits we both think should/shouldn't be there, but I feel happy with this level of compromise. Is it okay with you?Lewisguile (talk) 10:52, 3 January 2025 (UTC)
- I don't think this
though certainty-of-evidence ratings were not provided for individual outcomes
makes sense in isolation. What's happening here is that the RAND report took one approach, and the York reviews took another. The RAND report simply lists the differences in approach, so saying what the York reviews did not do in this way is misleading. It is like York cycled to work, Rand drove to work, and so we say in wikivoice "York did not drive to work". I think far too much is being made of this fleeting comparison. Also, again, that opening sentence - the Cass Review was a process, that ended up producing two reports, only the first of which this document describes as a "narrative review". Describing the process as a "narrative review" doesn't make sense, and in any event the only thing this source can plausibly be used to describe as a "narrative review" is the interim report, so this claim as presented is unsupported by the source. Void if removed (talk) 11:35, 3 January 2025 (UTC)- Re: process versus review: The problem is that we can cite a review but we can't cite an intangible "process". Even if that process is outlined in a document, it's the document we're referencing. However, we could change the wording to clarify that we're talking about the reports/conclusions and recommendations themselves, such as:
The Cass Review's final conclusions and recommendations were published in a non-peer-reviewed narrative review, which synthesised evidence from multiple sources to make policy recommendations for services offered to transgender and gender-expansive youth in the NHS...
? But that seems more complicated. - Re: certainty of outcomes: it's relevant to know that confidence ratings weren't published for individual outcomes. Confidence ratings aren't necessarily interchangeable with quality ratings, but also, if you want to know specific confidence ratings for particular/individual outcomes in different studies, rather than the quality rating of studies as a whole, these SRs won't provide that information. That is a significant difference from most systematic reviews conducted by NICE, the WHO, and others, and is a notable limitation (though that doesn't mean it's necessarily a criticism either). GRADE, which is the international standard for systematic reviews (rather than the MATT and NOS), does provide this data because confidence ratings can vary between different outcomes in a single study, as well as between studies. This then allows you to pool outcomes across different studies, while properly weighting it. The Cass Review doesn't do that, even though it's an international standard, so that should be noted. Lewisguile (talk) 12:30, 3 January 2025 (UTC)
Even if that process is outlined in a document, it's the document we're referencing.
- No, the "methodology" section refers to the review as a whole. This is the process by which a series of systematic reviews were commissioned, stakeholder involvement took place, and two reports were produced.
- This page is about The Cass Review, and the final report of The Cass Review has its own dedicated section within it. This is the wrong place for this information, even if were correct or due.
- When you cite "The Cass Review", what you're citing is the final report of the Cass Review. See all the citations on the page to "Cass review final report 2024". Describing the process by which that final report was produced as a "narrative review" makes no sense whatsoever.
The Cass Review's final conclusions and recommendations were published in a non-peer-reviewed
- We can't say that because it isn't true and it isn't sourced.
- Put it another way - WPATH's SOC8 is not a "narrative review" - it is a set of guidelines and best practices. However, within it, Chapter 6 (Adolescents) contains a narrative review.
a systematic review regarding outcomes of treatment in adolescents is not possible. A short narrative review is provided instead.
- If someone were to refer to the evidence on adolescent treatment in SOC8, they might accurately describe it as a narrative review but it would be an inaccurate description of SOC8 as a whole.
- In the RAND document, they describe the interim report of the Cass Review on the topic of "Gender dysphoria treatments" as a "narrative review". That might be true. Therefore, with this source, you could say that the Interim report of the Cass Review contains a narrative review of gender dysphoria treatments.
- But that is not everything contained in the interim report, and to describe the whole document as a "narrative review" is as wrong as calling the WPATH SOC8 a "narrative review", and neither of which are as wrong as calling a 4-year independent service review a "narrative review".
- This is all a very unnecessary series of hoops to jump through to justify an inappropriate label. I simply don't understand why so much energy is spent on trying to wrongly describe an independent service review as a narrative review. Void if removed (talk) 15:16, 3 January 2025 (UTC)
- I disagree that the scope of the article is about a process rather than the product of that process. In 10 years, people may still be referring to the final report, but they won't be talking about the process (except inasmuch as it informed the final report). The process itself isn't notable but the report and its conclusions/recommendations are. Consider the Scarman Report and MacPherson Report – they're relevant for their recommendations and not for the process of writing them. The process is only relevant to explain how the final report came about.
- I also think "narrative review" is a WP:SKYBLUE statement for the final report, since it describes the existing literature base and uses that to make conclusions and recommendations of its own. For those who weren't satisfied with that, RAND also suffices to source this statement (the protocol didn't change between the interim and final reports, only before that point, so it didn't change from one type of review to another). It also seems the clearest and most precise language we can use which explains to the lay person what the review is (e.g., I can't find a page on here that satisfactorily explains what an "independent review" is, in this context, because the term is so broad).
- All that said, I think the article is looking good and I appreciate we've all done some compromising here, including you. I don't want to be unreasonable – and, as I've said before, I'm not particularly attached to using the "narrative review" language even if it seems accurate to me. I'd be happy with "non-peer-reviewed, independent service review" if we can get consensus on it. I think it was @Your Friendly Neighborhood Sociologist who originally added the "narrative review" wording. So, if they're happy with it, we could use that wording instead? Lewisguile (talk) 12:33, 5 January 2025 (UTC)
I also think "narrative review" is a WP:SKYBLUE statement
- I think it is WP:SKYBLUE that this is just incoherent language - it is comparing apples to bicycles, and doing so on the basis of one field in one table in one report by a US think tank that references only one subject area within the interim report. Neither the independent review itself, nor either of its reports, nor any of the other independent inquiries and reviews you brought up are "narrative reviews".
- You seem to be under the impression that everything called a "review" must fall into a binary of either "narrative" or "systematic", when that's just terminology that applies to a specific form of literature review in academia. When a public body commissions an independent service review, that is neither of those things.
- The Cass Review is an authoritative source on itself. It is an "independent review", or if you prefer an "independent service review". Not only that, it is referred to in those terms consistently across a wide range of secondary sources, just as other independent service reviews are. I don't think this is even remotely debatable. The current wording is both factually incorrect and not even supported by this one source. Void if removed (talk) 15:40, 5 January 2025 (UTC)
- I've tried changing the opening line of methodology to ditch all language about what sort of "review" it was, and simply state what its remit was, which fits with the questions the methodology was supposed to answer. I also changed it to actually cite the review itself and use the language of the review for what its subject matter was instead of this US report, because the "gender expansive" language is incongruous and inconsistent with all other usage.
The Cass Review was commissioned to make recommendations about the services provided by the NHS to children and young people questioning their gender identity or experiencing gender incongruence.
cited to: https://cass.independent-review.uk/about-the-review/terms-of-reference/ and https://cass.independent-review.uk/home/publications/final-report/- This is simpler and cleaner and doesn't require outside third-party sourcing. Void if removed (talk) 10:32, 6 January 2025 (UTC)
- Our posts crossed. I've reverted your new wording as this also undoes a lot of other consensus wording from the past few weeks. I've just implemented "service review" instead, since you seemed to accept that as a compromise. Lewisguile (talk) 10:38, 6 January 2025 (UTC)
- Please WP:AGF. I did offer a compromise, and I'm not under any binary assumptions – narrative reviews can include a variety of methods and can be used for a variety of purposes. Cass describes the literature, draws conclusions from it, and then makes recommendations based on those conclusions. That fits the definition of a narrative review. In the same sentence, we also state that it looked at NHS services and made recommendations for improvements in that area. And then we detail the research and engagement programmes. So nothing is left out by this description either – we're not saying it's A over B, we're saying it's A + B + a bit of C and D as well. RAND also describes the final report as a "summary of research evidence" on p. 31, which fits its description of the Cass Review as a narrative review in the table on p. 10. Describing it as "independent" or anything else doesn't contradict the "narrative review" part, and those other elements (reviewing a service) are already mentioned too. The nature of other reports and reviews is immaterial, but I didn't actually say they were narrative reviews either – I was comparing the scope of their articles.
- If you feel that this isn't up for debate, then I'm more than happy to stick to the current wording ("non-peer-reviewed, independent narrative review"), since we've already discussed this and you're the only person continuing to challenge this wording at present. But I don't think you want that, which is why I'm trying to engage in discussion so we can reach a compromise. So, to clarify, would you be happy with "non-peer-reviewed, independent service review" as a compromise? I'm still hoping @Your Friendly Neighborhood Sociologist will support this as well, but I think we can have consensus between us if not. Lewisguile (talk) 10:35, 6 January 2025 (UTC)
- I'd support that. I think it's more important to note the lack of peer review than the fact it was a narrative review. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 13:06, 6 January 2025 (UTC)
- Perfect. That's 3/3. We can leave it as is. Lewisguile (talk) 13:39, 7 January 2025 (UTC)
- I'd support that. I think it's more important to note the lack of peer review than the fact it was a narrative review. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 13:06, 6 January 2025 (UTC)
- Re: process versus review: The problem is that we can cite a review but we can't cite an intangible "process". Even if that process is outlined in a document, it's the document we're referencing. However, we could change the wording to clarify that we're talking about the reports/conclusions and recommendations themselves, such as:
International Guidelines
@Snokalok You've reverted my change here https://en.wikipedia.org/search/?title=Cass_Review&diff=prev&oldid=1267315347
There's no consensus for the Italian response being where you've placed it, because I added it where it was - this was a new addition. The point was this was additional and wider impact of the Cass Review on guidelines internationally, as it was with the Japanese ones - new context justifies new presentation of old information.
I simply don't understand your insistence on stuffing "reception" with this. Can you please explain why it is so important to you to have it there, rather than where I placed it, especially now we had new guidelines from Italy to justify this move? Neither are a "response" and both are examples of international guidelines taking account of the Cass Review.
Also, calling this "shot down 100 times" is very WP:BATTLEGROUND and hyperbole. I may be misremembering, but the only discussion on this specific move was here I think.
Your objection at the time was it makes them read the reception section and think those are the only responses.
which again I don't understand - people will read as much of the article as they read, and they'll use the section headings to navigate or skip over information as appropriate. An ever-expanding dumping ground of "reception" is only making it more likely readers will give up rather than read nicely organised, summarised and well-presented information. Void if removed (talk) 17:43, 6 January 2025 (UTC)
- Also I've removed the bit you added about Meloni which was WP:SYNTH - the source actually says:
This month, a separate National Bioethics Committee issued a nonbinding recommendation that puberty blockers be limited to controlled trials, with children allowed to enter only if they have been involved in psychiatric therapy, as well.
- The Meloni appointees is a completely different committee. Void if removed (talk) 17:49, 6 January 2025 (UTC)
- It's a different committee to the other one the article was talking about, but based on the context in the article they both must have been appointed by the Meloni government. Here's their website; you'll notice that they were created in December 2022 and Meloni took power in October 2022. Loki (talk) 18:54, 6 January 2025 (UTC)
- That is SYNTH. Void if removed (talk) 19:22, 6 January 2025 (UTC)
- It's a different committee to the other one the article was talking about, but based on the context in the article they both must have been appointed by the Meloni government. Here's their website; you'll notice that they were created in December 2022 and Meloni took power in October 2022. Loki (talk) 18:54, 6 January 2025 (UTC)
- Okay first off, calling “shot down 100 times” battleground is a stretch. The use of a military-based metaphor does not mean battleground, it just means that early 21st century English takes most of its idioms from military and wartime sources due to the fact that the English speaking world is always invading *somewhere*. If I say someone is “calling the shots”, I don’t mean they’re ordering a sniper to shoot someone, I mean they wield substantial directive influence.
- With that aside, you’ve more or less answered your own question -
people will read as much of the article as they read, and they'll use the section headings to navigate or skip over information as appropriate
exactly, if people are looking for how it was received, they’ll look at reception, but if they don’t see Japan and Italy, they’ll think those countries aren’t part of the reception when they absolutely are, and there is no practical reason to separate them. Originally this was proposed I recall as further reception, and now as guidelines, but the fact is that, there’s no reason to separate guidelines anymore than further reception. It’s simply how the relevant org responded, how it received the Review. If you’d like to create a subsection of the “other global health bodies” for guidelines, I wouldn’t oppose that, but there is certainly no reason to remove Italy and Japan from the reception section entirely in favor of a completely separate section when guideline responses are objectively part of the Cass Review’s reception. Snokalok (talk) 17:58, 6 January 2025 (UTC)The use of a military-based metaphor
- That's not what WP:BATTLEGROUND means. Not everything has to be a fight.
there’s no reason to separate guidelines anymore than further reception
- Other than that reception is turning into an unreadable dumping ground. It was discussed back in October when it was really only Japan at issue, with a fairly even split of interest, and even yourself saying you didn't mind the idea of initial/further reception, and IMO the emergence of new Italian guidelines changes that a bit.
to remove Italy and Japan from the reception
- Italy was never in the reception. I added it where you removed it from. You've moved it to a new location. Void if removed (talk) 22:43, 6 January 2025 (UTC)
Not everything has to be a fight.
- That’s what I’m saying. Using a military-related metaphor doesn’t mean I see us as opposing forces, it just is the way the English language has formed. If I say that an admin is “calling the shots” somewhere (an idiom derived from spotters giving orders or ‘calls’ for snipers to take a specific shot) I’m not saying the admin is ordering adverse surgical action against an enemy force, just that they wield some level of influence.
Other than that reception is turning into an unreadable dumping ground.
- Mild disagree on the grounds that the blue/red text helps the reader see which countries said what very easily, and also, it’s much less bad on desktop.
Italy was never in the reception. I added it where you removed it from. You've moved it to a new location.
- I reverted your creation of a new section to put certain receptions in, but I didn’t oppose the inclusion of the Italian guidelines, so when moving Japan back to reception per the revert, I put Italy there as well. If you want to delete Italy entirely until we sort this out since that would be a much more full revert, I wouldn’t contest that. Snokalok (talk) 01:16, 7 January 2025 (UTC)
If you want to delete Italy entirely until we sort this out since that would be a much more full revert
- I'd appreciate it if you did that, with the other edits in the interim its simpler if you just take the whole paragraph out yourself (ie we treat that as you fully reverting it back to what it was before, and we BRD from there).
- Returning to this concern:
if people are looking for how it was received, they’ll look at reception
- So how about we stick a hatnote at the start of "reception" that says something like "This section covers the initial response to the publication of the final report of the Cass Review. For further in depth response and analysis see §x, for the impact on international guidelines see §y".
- And then section link to the later sections (assuming we can agree to create them/name them)? That way any reader is under no illusion that the initial reception is all there is, and it gets away from this constant expansion of the reception with a blow by blow of increasingly disconnected events from several months down the line. Void if removed (talk) 10:33, 7 January 2025 (UTC)
I'd appreciate it if you did that
- It’s done.
So how about we stick a hatnote at the start of "reception"
- So, I’ll say that I vastly prefer “further reception” to a guidelines section, but consider also the idea that we simply divide up the current reception section by country the way we do on the puberty blockers article. Otherwise I’d want to perhaps discuss dividing reception up by specific time. That is, 2024, 2025, first year after, second year after, etc. But at the same time, I don’t expect us to have new material in future to rival that which we have now, so I’d perhaps suggest reception (first year after) and then reception (beyond April 2025) Snokalok (talk) 13:24, 7 January 2025 (UTC)
- I could see it in going in either location, TBH. Happy to go with consensus on this one, or to be convinced either way. Lewisguile (talk) 13:38, 7 January 2025 (UTC)
UCU
@HenrikHolen you have reinstated the following text:
In June 2024, the University and College Union's (UCU) national executive committee unanimously passed a motion saying that the review "falls short of the standard of rigorous and ethical research expected of research professionals" and "provides no evidence for the ‘new approach’ it recommends". The motion described the Cass Review as having "serious methodological flaws" and defined by "selective use of evidence and promotion of unevidenced claims". They resolved to "commit to working with trans-led organisations to resist the Cass Report recommendations".
Claiming this was "more neutral" than what was previously there which was:
In June 2024, the University and College Union's (UCU) national executive committee was condemned as "anti-scientific" by some academics after it unanimously passed a motion criticising the review and committing to "working with trans-led organisations to resist the Cass Report recommendations".
I remind you that WP:NPOV is about representation of sources, not about your own personal opinion. WP:CHERRYPICKING from sources to convey a particular POV that is not reflective of the balance of coverage in those sources is not NPOV.
With that in mind, the opening paragraph of the source in question - and thus the aspect that this source emphasises most strongly - is:
Academics have condemned the University and College Union’s decision to campaign against a widely praised independent review into NHS treatment for gender-questioning children, claiming its position is “anti-scientific” and could expose researchers to harassment.
By my count, that article is roughly half about the condemnation of the motion and praise for the Cass Review, and half coverage of the motion itself, which is why I specifically devoted about half the length to each in my revised wording. As it is, given the opening POV of the article, and its balance of coverage, I would say my text is a fairer representation of the source.
I ask you to self revert, or explain why you think your representation is an accurate and neutral representation of this source. Void if removed (talk) 22:57, 6 January 2025 (UTC)
- Just so that we are on the same page, I reinstated the language from before your edit, this is not something I have written. The language of the current version succinctly describes the motion passed without making judgements as to whether this was the correct decision. Your edit editorialized the paragraph and created the impression that the author believes the UCU acted in error when passing the motion.
- I am not opposed to including responses from third parties. However, when doing so, we cannot solely present the opinions of third parties who opposed the move. Moreover, the "academic criticism" in question refers to tweets by one professor and an interview with one other, not published academic literature. I have to question whether this is even due. HenrikHolen (talk) 00:26, 7 January 2025 (UTC)
- This is not about the motion, this is about the source. You are editorializing by selective representation of the source, excluding aspects that are reported with at least equal prominence. WP:CHERRYPICKING says
A source must be fairly represented for the purpose of the article and that includes contradictory and qualifying information
, see WP:BALASP for policy. - Again, from WP:CHERRYPICKING
As to contradictory information that needs to be reported in Misplaced Pages, if, for example, a source says "Charlie loves all blue coats and hates all red coats", to report in Misplaced Pages that according to that source "Charlie loves all ... coats" is cherrypicking from the source. It is cherrypicking words with the effect of changing the meaning of what the source is saying. It is cherrypicking even if the source is precisely cited. It is still cherrypicking even if the editor meant well in changing the meaning; the issue is not the editor's intention, but how the Misplaced Pages article represents the source's meaning.
- This is exactly the case of this paragraph.
Your edit editorialized the paragraph and created the impression that the author believes the UCU acted in error when passing the motion
- I did no such editorializing and created no such impression. I accurately represented the balance of treatment in the source, which gave no indication of the author's opinion, but merely the conveyed the reaction to UCU's actions, which was given equal weight in the originating source.
- If you want to remove the paragraph because it isn't DUE, do so. Void if removed (talk) 10:50, 7 January 2025 (UTC)
- I think you're misreading the cherry-picking guidelines. Cherry-picking would be to include only criticism of the UCU motion but not support, or vice versa. The current state includes no responses from third parties, neither supportive nor critical, and so I am struggling to see how that can be construed as cherry-picking.
- When it comes to the language, the phrasing "was condemned for" in the topic sentence, in my view, creates a clear impression of wrongdoing by the UCU, and does not give equal prominence to the fact that the move was lauded by many.
- I suggest we let other editors weigh in and possibly post this in WP:NPOVN
- HenrikHolen (talk) 13:53, 7 January 2025 (UTC)
- This is not about the motion, this is about the source. You are editorializing by selective representation of the source, excluding aspects that are reported with at least equal prominence. WP:CHERRYPICKING says
- I am frankly suspicious of using the Times as our sole source here. They're known to be biased on trans issues, and in my experience especially in this specific way, where they portray anything trans-supportive as controversial but anything trans-hostile as obvious.
- I also second Henrik's skepticism that the criticisms they mention in this article constitute "academics have condemned", the very NPOV old framing. (Even if we rely on the Times for facts, there's no reason we need to copy their biased language.) I don't think that they even reach "academics were critical". Maybe "a small handful of particular academics were critical"; certainly it seems likely from the totality of the sources that WPATH would be fine with it, and they're academics. Loki (talk) 01:00, 7 January 2025 (UTC)
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- "Joint statement: Trans children and young people in schools deserve safety and understanding". ILGA Europe. September 2, 2024. Retrieved 2025-01-02.
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