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Talk:Cass Review

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sources for consideration[edit]

German Medical Association[edit]

I added this content today:

  • On May 10 2024 the Assembly of the German Medical Association ( aka Bundesärztekammer (BÄK) wrote that it "calls on the Federal Government to only permit puberty blockers, sex-change hormone therapies or gender reassignment surgery in under 18-year-olds with gender incongruence (GI) or gender dysphoria (GD) in the context of controlled scientific studies and with the involvement of a multidisciplinary team and a clinical ethics committee and after medical and, in particular, psychiatric diagnosis and treatment of any mental disorders". And that results must be followed up for at least least ten years." [https://128daet.baek.de/data/media/BIc48.pdf 1 2

That english text comes from the source SEGM.org.uk. The original German vs Google translate is:

German English
DER DEUTSCHE ÄRZTETAG MÖGE BESCHLIESSEN:

Der 128. Deutsche Ärztetag 2024 fordert die Bundesregierung auf, Pubertätsblocker, geschlechtsumwandelnde Hormontherapien oder ebensolche Operationen bei unter 18- Jährigen mit Geschlechtsinkongruenz (GI) bzw. Geschlechtsdysphorie (GD) nur im Rahmen kontrollierter wissenschaftlicher Studien und unter Hinzuziehen eines multidisziplinären Teams sowie einer klinischen Ethikkommission und nach abgeschlossener medizinischer und insbesondere psychiatrischer Diagnostik und Behandlung eventueller psychischer Störungen zu gestatten

THE GERMAN MEDICAL CONFERENCE SHOULD DECIDE: The 128th German Medical Congress 2024 calls on the federal government to reduce puberty blockers, sex-reassignment hormone therapies or similar operations for people under 18 with gender incongruence (GI) or gender dysphoria (GD) only in the controlled scientific studies and with the assistance of a multidisciplinary teams, as well as a clinical ethics committee and completed medical and, in particular, psychiatric diagnostics and treatment of any mental disorders

This is the Voting page - that shows it was accepted (Angemonnen) as item 'Ic - 48 Behandlung einer Geschlechtsdysphorie bei Minderjährigen ' — Preceding unsigned comment added by Peckedagain (talk • contribs) 12:04, 12 May 2024 (UTC)[reply]

Since this doesn't mention "Cass" anywhere I think this isn't WP:DUE and should be removed from this page, but might be relevant on Puberty blockers. — Preceding unsigned comment added by Void if removed (talk • contribs) 12:06, 12 May 2024 (UTC)[reply]
Good advice Void if removed (talk), I have done that now.— Preceding unsigned comment added by Peckedagain (talk • contribs) 12:29, 12 May 2024 (UTC)[reply]
A better secondary source is definitely needed in order to judge the significance of this, but that's a matter for the other page. If it does eventually get linked to Cass, it could be the start of an "influence" section. Barnards.tar.gz (talk) 13:25, 12 May 2024 (UTC)[reply]
SEGM is an anti-trans activist group, and therefore very much not a reliable source.
No comment on the original German, though (except to agree that without a direct reference to the Cass Review it doesn't go here). It depends on the relevance of the organization behind it in Germany. Loki (talk) 14:39, 12 May 2024 (UTC)[reply]
The German GMA (aka Bundesärztekammer ) has ~400,000 doctors as members and is I guess the equivalent to the UJ's British Medical Association . Peckedagain (talk) 19:52, 12 May 2024 (UTC)[reply]

Critical papers[edit]

There are a couple new papers out that are critical of the review. This critical commentary was published. Then there's this paper which is still in prepublication and may look a bit different in final publication. I would say we could watch for when the latter reaches publication. VintageVernacular (talk) 01:59, 13 June 2024 (UTC)[reply]

I disagree with how this was added - these are not "responses from journals" these are individual responses, and so are they DUE?
Maybe we need a section for academic responses, but this sort of thing has to be attributed opinion to the author per WP:RSOPINION if significant. Void if removed (talk) 11:48, 18 June 2024 (UTC)[reply]
It can be re-attributed and the section renamed "Responses in medical journals"; why remove the whole addition even initially? It's written by a neuroscience postdoc, while touching on e.g. brain development, comorbidity with neurodevelopmental conditions, and brain structure. Elsewhere the commentary highlights that a systematic review which the Cass report relied on had falsely reported an increased incidence of autism in a gender dysphoric group from 1.8% to 15.1%; the cited study actually said it was 13.8% to 15.1%. Stands on its own, but referentially, are these sorts of critiques in a specialist journal any less "DUE" than the already included statements by politicians, lobby groups, etc.? VintageVernacular (talk) 12:39, 18 June 2024 (UTC)[reply]
It's written by a neuroscience postdoc
Is this a notable neuroscience postdoc, or just the one who published some critical commentary first?
The new section was written as if to attribute opinion to the journal - not the researcher - and consisted of three quotes, which would seem excessive. To trim it down to the meat of the conclusion, I think you'd end up with something like:

A critical commentary on the Cass Review by postdoc researcher Dorieke Grijseel, published 14 June 2024, called into question "the robustness of the evidence the Review bases its claims on.".

Is that due, and even if it is is it worthy of a new section? In that form would it just go under "assorted opinion"? I'm not sure this is of any significance yet. I don't know to what extent we can even summarise what's in this paper, possibly the only part worth mentioning is:
highlights that a systematic review which the Cass report relied on had falsely reported an increased incidence of autism in a gender dysphoric group from 1.8% to 15.1%; the cited study actually said it was 13.8% to 15.1%.
From what I can make out that appears to be a legitimate howler, though not one that changes anything other than to increase the autism prevalence estimate fractionally. Still that's a point to watch.
than the already included statements by politicians
The political response is due, because this is taking place in a political context and politicians are manifestly acting on the results of the review. "Response from lobbying organisations" and "assorted responses", feel free to delete as far as I'm concerned, I think they are pointless fluff.
A "Responses in medical journals" section could work, but I think that any such section that could conceivably include this individual response, should also reinstate the BMJ editorial by Kamran Abbasi and other followup publications. Void if removed (talk) 13:32, 18 June 2024 (UTC)[reply]
Wikipedia represents a global view and all of those 4 pieces you mentioned are from the U.K., which the Cass Review itself is from too. Since the Cass Review itself has run counter to the most common current worldwide medical standard on transgender care, which is set forth by WPATH and followed by many countries of the world, so WP:DUE may apply here to ensure that, while the British medical community seems to rally behind the Cass review, the worldwide medical community on transgender care does not, since they mostly have criticized, or ignored it.
We can add those 4 British papers, noting they multiple people from the country of the Cass review have come out in support of it, but it needs to be contextualized as such, to ensure we maintain a WP:NPOV. Raladic (talk) 14:29, 18 June 2024 (UTC)[reply]
Your reversion took no account of my comments that this needs to be rewritten with attribution to the author, and I have no idea why you brought up WP:NOTCENSORED. Void if removed (talk) 14:52, 18 June 2024 (UTC)[reply]
It is already attributed. to be specific, it is attributed to "a paper in the international journal of transgender health". Which is the appropriate type of attribution to give in a case where we describe a publication in a paper from a non-public figure. --Licks-rocks (talk) 15:04, 18 June 2024 (UTC)[reply]
No it really isn't appropriate. It is the kind of aggrandising puffery that we have guidelines against. I can't remember the shortcut right now. @WhatamIdoing will know. It is important that D. M. Grijseels is a postdoc in brain research and might know a thing or two about marmoset vocalising but why on earth should an international encyclopaedia find their views on the Cass Review important? Seems WPATH's house journal accepts any papers critical of the Cass Review, no matter what one's qualifications or expertise is. -- Colin°Talk Colin°Talk 10:35, 19 June 2024 (UTC)[reply]
Because those views are published in a proper, internationally recognised, peer reviewed, academic journal, which means it's not just the name and reputation of the author that matters, but at least three other qualified experts in the relevant field (all of whose opinions alone would likely qualify as DUE under WP:EXPERTSPS) have gone over it and given their seal of approval.
Seems WPATH's house journal accepts any papers critical of the Cass Review, no matter what one's qualifications or expertise is.
Do you expect a serious reaction to this? Because this is the kind of comment I expect to see on WP:FRINGE, and I don't mean from any of the long term editors there. --Licks-rocks (talk) 11:17, 19 June 2024 (UTC)[reply]
It's WP:MEDSAY: "Do not hype a study by listing the names, credentials, institutions, or other "qualifications" of their authors. The text of the article should not needlessly duplicate the names, dates, titles, and other information about the source that you list in the citation. Always omit professional titles and academic degrees: use "Smith" or "Jones" rather than "Dr Smith" or "Prof Jones". It is necessary to specifically include such information only when a specific individual is being cited as an example of a person holding a minority view..."
We should not write things like "In June 2024, a critical commentary about the Cass Review was published in the International Journal of Transgender Health..." A more normal way to say this is "The Cass Review was criticized for..." (if you believe this view to be representative of a view held by a fairly large group) or to give the author's name with a brief description, e.g., "Neuroscientist Dorieke Grijseels said..." (if you believe this view to be held by a smaller group of people). In the latter case, these descriptions are usually just one word and profession-focused ("postdoctoral researcher" would be another option in this case[1]), but if you thought you needed a non-professional label, then Grijseels identified as "Dutch" and "queer" in this source. WhatamIdoing (talk) 14:32, 19 June 2024 (UTC)[reply]
There are many articles on Wikipedia that mention the journal that the article was published in. I don't believe there are any guidelines against that. It's very common, so it seems quite silly to blow up this one issue about it. Hist9600 (talk) 14:44, 19 June 2024 (UTC)[reply]
WP:MEDSAY is part of Wikipedia:Manual of Style/Medicine-related articles, which is a guideline. Naming the journals is WP:NEWSSTYLE ("A study published in the Journal of Important Things today says...") and should generally be avoided, especially when the journal is reputable, because it sounds like WP:HYPE. WhatamIdoing (talk) 16:28, 19 June 2024 (UTC)[reply]
I agree with the analysis, neither of them are due. Draken Bowser (talk) 11:33, 19 June 2024 (UTC)[reply]
This is an important commentary on the review, and it obviously should be included. A criticism published in a peer-reviewed journal is not merely an "opinion", and you are incorrect to characterize it as such. Hist9600 (talk) 15:04, 18 June 2024 (UTC)[reply]
It looks a lot like an expert opinion by a non-notable expert, are you claiming it is something else? Draken Bowser (talk) 15:03, 19 June 2024 (UTC)[reply]
It's an analysis of the Cass Review published in a peer-reviewed academic journal on the topic of transgender health, that examines the methodology and findings of the Cass Review. Hist9600 (talk) 15:18, 19 June 2024 (UTC)[reply]
You are not disputing anything I said, what's the specific point you're trying to make? Draken Bowser (talk) 16:11, 19 June 2024 (UTC)[reply]
There is also this paper - The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children that was published two months ago and also raises some serious concerns on the report, highlighting the lack of transgender health experts in the authoring of the report and its resulting cisnormative bias, and pathologization, which should likely be included in the new Cass Review#Academic response section. Raladic (talk) 03:11, 19 June 2024 (UTC)[reply]
Raladic, that "Cis-supremacy" paper has been discussed to death already. It is now also irrelevant as it was commenting on the interim review and the speculation about "the lack of transgender health experts in the authoring of the report" would seem to be entirely that: speculation. See earlier discussions. -- Colin°Talk 10:22, 19 June 2024 (UTC)[reply]
That wasn't speculation, that was an explicit part of the Cass Review's original Terms of Reference: Wider stakeholders around Cass were likewise selected for an absence of trans specific knowledge or experience, including exclusion of those with lived experience of being trans. The original published Terms of Reference (ToR) for the Cass Review’s assurance group explicitly excluded trans expertise, stating that it “deliberately does not contain subject matter experts or people with lived experience of gender services” [Report 1, version 1]. The current (updated) assurance group ToR is worded less clearly, yet still conveys exclusion of those with expertise or lived experience, as such individuals would naturally be expected to have an interest in the outcome of the review: Members are independent of NHS England and NHS Improvement and of providers of gender dysphoria services, and of any organisation or association that could reasonably be regarded as having a significant interest in the outcome of the Review. [Report 1, p. 2] (emphasis added)
I still believe the article should be included, handwaving away all peer reviewed criticism of a report/recommendations criticized by health organizations around the world cheapens the article and does not follow WP:NPOV. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:56, 19 June 2024 (UTC)[reply]
You know, this is typical silo-amateur-chitchat-nonsense. Read the actual words here. The "assurance group" is designed "to provide expert advice and challenge about the approach and processes used to conduct the review, and to ensure that the Review is conducted in accordance with its terms of reference". It contains just seven people. They are to be process nerds, utterly utterly unconcerned with the topic being analysed, but concerned with process. That link concludes "The Assurance Group advises on the Review process and not its outcome. Professional and lived experience will be used to determine the outcome and recommendations of the Review and will be captured through our participative and consensus development approach." Honestly, this is like complaining that the creative design team for the publication PDF and the IT department who arranged zoom meetings didn't contain any activist voices or people with lived experience.
YFNS you've just emphasised why we don't juxtapose serious medical reviews with the opinions of someone's mum. The whole sentence "the lack of transgender health experts in the authoring of the report" is bullshit through and through. This "assurance group" aren't authors at all. They have no opinions about trans healthcare at all and weren't asked for them. They were explicitly chosen to be independent (because, you know, it is an independent review) in order to ensure nobody could say they came to it prejudiced. This emphasises my point about the dregs that people are googling for and digging up. One the one had we have world renowned experts who spent years on this review, and on the other hand we have complete amateurs who are so filled with activist rage that they don't even read the documents carefully before banging out their criticism. -- Colin°Talk 10:39, 22 June 2024 (UTC)[reply]

I think we need to be careful to avoid the trap that many culture-war articles fall into. There's a great tendency, for a subject one hates, to google articles that criticise it and then push hard for them to be included. We see it on all sides of these debates. The hope is that some of the shit thrown will stick. I despair. It isn't how articles should be written. We have here a respected consultant paediatrician asked to conduct an independent review. They spend four years consulting with experts on all sides and with patients and their parents. They commission a bunch of systematic reviews from the top academics who are expert in in conducting such reviews. Their systematic reviews are published in a top journal. Their final report is published and recommendations put into practice. And then some marmoset researcher from Germany gets their criticism published in a big paragraph on Wikipedia as though that's it: Cass Review is a pile of crap after all, because someone who studies monkey calls for a living says so. Can you imagine if our cancer or diabetes articles were written that way. That the UK approach to diabetes treatment was held up to criticism because some car mechanic from Croydon disagrees, and claims the whole thing is dodgy because they found a typo on page 13. If you sat down and wrote an article on diabetes treatment in the UK, would you consider a car mechanic to have any relevance? So why on earth should a monkey brain researcher be relevant? -- Colin°Talk 11:01, 19 June 2024 (UTC)[reply]

Why are you bringing up Grijseels' past paper about monkey neuroscience in this thread as if to insinuate they aren't a human neuroscience expert? If I just wanted to insert any old paper criticizing the review, I would have started with Horton's published before the final report, but I started this section about two papers (one forthcoming) that offer very substantial critiques of the evidence base. Grijseels' paper published in a top transgender medicine specialist journal deals with, as I mentioned: brain development, structure, and comorbidity with neurodevelopmental conditions, which are key to the critique. VintageVernacular (talk) 11:31, 19 June 2024 (UTC)[reply]
On top of that, Scientific journals, by design, don't care about author credentials. They aren't allowed to care, and it would majorly dent their credibility if they did. We cite people by their initials and use things like double-blind peer review to avoid tunnel-visioning on author credentials. This is scientific method 101. --Licks-rocks (talk) 11:38, 19 June 2024 (UTC)[reply]
This might be so for actual scientific research. Not so for commentary pieces like this one (I have absolutely no idea why it is tagged "research article" in the header, as it certainly isn't scientific research: the introduction describes itself as a "commentary" so the question for any journal editor or journal reader is why we should care to listen to their commentary). The author's credentials do actually matter to Wikipedia. Are they someone who is notable for their expertise with systematic reviews (doesn't appear they have ever done one, let alone written about them). Are they someone who is notable for their expertise with clinical studies of healthcare in humans (no, they do their science on mice, monkeys, or computer models). Are they an expert in trans healthcare or at least adolescent or mental healthcare (no, they work in a lab). This paper gives us an idea of motivation for why the sudden shift to writing an attack piece on a review, but motivation is not expertise and motivation of editors here to include this piece is also not a reason we should include it. It's a rather weak document, a rambling list of things the author decided to be critical about, with no knockout findings (such as a missing gold-standard study that actually provides the evidence that Cass says isn't there). -- Colin°Talk 11:01, 22 June 2024 (UTC)[reply]
Why is it significant the writer signed a letter in a top journal, Cell, calling for challenging discrimination? It may tell us where the writer is coming from but has no actual bearing on the merit of the arguments in the paper. VintageVernacular (talk) 11:40, 22 June 2024 (UTC)[reply]
You're correct that promoting their vision for justice in one letter does not tell us anything about the merits of the arguments in another paper. It suggests a certain amount of bias (remember that bias is okay in reliable sources), but does not tell us whether the arguments are good or bad. To find out whether the arguments are good or bad, we would need another reliable source. In between now and the appearance of such sources, the best we can usually do is to follow the WP:PRIMARY policy: we avoid relying on primary sources at all, and say only things that can be clearly supported from them, without commentary, editorializing, hyping, etc. WhatamIdoing (talk) 21:18, 22 June 2024 (UTC)[reply]
An article on the Cass Review requires sources that analyze it multiple perspectives, using different methods. There is no reason why a study that analyzes the Cass Review, and points out certain issues, should be omitted from the article. Hist9600 (talk) 14:47, 19 June 2024 (UTC)[reply]
There is an important context in this, which is that medical organizations around the world have similarly given harsh criticism of the Cass Report, so it's not like this paper is some isolated opinion.
We also have to keep in mind that the Cass Report has been ordered by a government from a country that has shown a dramatic rise in "the extensive and often virulent attacks on the rights of LGBTI people for several years" as highlighted in a report by the Council of Europe and scientists from a country are not immune to the pressure of scientific misconduct as a survey in the BMJ has shown is Scientific misconduct is worryingly prevalent in the UK, shows BMJ survey in the very journal that the Cass Review is based on, or that there are politics of LGBT+ Health Inequality at play in the UK.
So rather than repeating the arguments that the Cass Report is unimpeachable, it is not, we should ensure that we give due weight to the global response of it, be it from WPATH, EPATH or other scientists that publish papers in reputable peer-reviewed journals. Raladic (talk) 15:26, 19 June 2024 (UTC)[reply]
We don't bring in sources that are not due because they say the same thing as other sources that are due. The opinions of relevant medorgs are already in the article. Draken Bowser (talk) 16:14, 19 June 2024 (UTC)[reply]
medical organizations around the world have similarly given harsh criticism of the Cass Report
And the Cass Review gave harsh criticism of the standards produced by those medical organizations. So we have a dispute between high-level MEDRS, between what are supposed to be top-of-the-pyramid medical standards, and an equivalently-top-of-the-pyramid systematic review of those standards which found them wanting.
This is a hard disagreement to navigate, but it isn't on its own an excuse to bring in any old random paper that rubbishes the Cass Review as if it carries any weight.
as highlighted in a report by the Council of Europe
I am strongly in favour of a moratorium on trying to disparage sources from the UK by citing that Council of Europe declaration. Void if removed (talk) 09:04, 21 June 2024 (UTC)[reply]
How did you come to the conclusion it's just some "random paper" and not a reasonable critique of the review by a scientist with relevant expertise + published in a specialist journal? It does seem to have due weight. VintageVernacular (talk) 11:27, 21 June 2024 (UTC)[reply]
The author appears to have no professional expertise (only personal experience). WhatamIdoing (talk) 21:20, 22 June 2024 (UTC)[reply]
Well, a PhD in neuroscience might equip you to better interpret brain research. But is that required to make a statement like: "A set of key points (7.16-7.20) [in the Cass Review] poses a possible link between increased availability of sexually explicit materials and gender dysphoria, based on an article by Nadrowski (2024). This article does not contain any primary research, but rather poses a yet untested theory. Indeed, the article itself notes that 'no studies have yet directly linked exposure to pornography with gender dysphoria' (Nadrowski, 2024, p. 294). The argument in the Nadrowski paper is not supported by data, and as the only source, is not sufficient to suggest a link"?
Or "they wrongly report the incidence of autism spectrum condition (ASC) as reported by Morandini et al. (2022), writing '[o]ne study reported data separately for 2012 and 2015 and demonstrated an increase from 1.8% to 15.1%' (Taylor et al., 2024d, p. 5), when the reported numbers were a non-significant increase from 13.8% to 15.1% (p= .662) (Morandini et al., 2022)."?
The journal editors, many of which I would expect do have professional expertise given the background, may have seen some value. VintageVernacular (talk) 22:11, 22 June 2024 (UTC)[reply]
"The author is an expert in the subject matter" and "There is value in this publication" are largely unrelated concepts.
The author has studied questions like how a particular gene changes blood flow in the mouse brain and which part of the brain is used when monkey perceive a voice. That is not really relevant to the Cass Review, which is largely not about neuroscience.
But let me engage with the two bits you've quoted, because they might make good examples of the sort of decisions Wikipedia editors need to make.
  1. "Access to sexually explicit content" (7.16–7.20 in the report) is 11 sentences long. It is largely a recitation of statistics.
    • Grijseel says it "poses a possible link between increased availability of sexually explicit materials and gender dysphoria". If you wrote that in a Wikipedia article, we'd probably slap Template:Failed verification on it, because the relevant section in the final report says that other sources (e.g., "Research commentators recommend...") have posed this possible link.
    • Ditto for "as the only source", because anybody can see that three sources are named in that section: Children’s Commissioner, 2023" in 7.16, "Hanson 2020" in 7.19, and finally "Nadrowski, 2023" in 7.20. IMO Nadrowski could have been fairly described the only cited source from an academic journal, but that is not quite the same thing as "the only source".
    • Consider the claim that "The argument in the Nadrowski paper is not supported by data". This is a bit of a pot calling the kettle black situation, as Grijseel's publication is also not "supported by data" – in the narrow sense of "providing new data". There's nothing wrong with not providing new data; commentaries aren't intended to present new data, and neither are proposals for future research directions. But underneath it, all three (the Cass Review, Nadrowski, and Grijseel) agree: Nadrowski says there's not been much research about this, Cass says there's not been much research about this, and Grijseel says there's not been much research about this.
  2. About "they wrongly report the incidence of autism spectrum condition (ASC) as reported by Morandini et al. (2022), writing '[o]ne study reported data separately for 2012 and 2015 and demonstrated an increase from 1.8% to 15.1%' (Taylor et al., 2024d, p. 5)..."
    • This is not in the final Cass report, and as far as I can tell from a quick search, that paper was not cited in support of any claim about any alleged increase in autism in the final report.
    • The error appears to be accurately described, but it seems like it would be more relevant to alert the editors of the journal where the error was published, so they can issue a simple correction (losing a single character is often the result of a typo).
    • Neither the Cass report nor the paper that contains the error claims that these numbers show a significant increase. Therefore this error doesn't seem relevant for us here, when we are writing Cass Review.
Overall, it feels like these statements are true (in some sense) but sort of stretching to find every possible complaint – less "This is fundamentally misguided" and more "How dare they rely on a paper that contains a typo!" WhatamIdoing (talk) 23:32, 22 June 2024 (UTC)[reply]
I'd also add that since 13.8 is higher than 1.8, the only result will be to fractionally increase the estimated prevalence of ASC in this demographic.
This really does seem to be the only substantive criticism. The rest is padding. Void if removed (talk) 08:06, 23 June 2024 (UTC)[reply]
We would slap a "failed verification" label on it? In the "Increase in referrals" section, that exact same claim about the review is made.
The ASC incidence is significant to what the Cass final report says on pages 93 and 97 where "ASD" stands for "autism spectrum disorder", and it cites the exact same systematic review, quoting it to say the increase in referrals was accompanied by "higher than expected levels of ASD". VintageVernacular (talk) 10:29, 23 June 2024 (UTC)[reply]
The systematic review assessed multiple papers and synthesized an average, this is detailed in the paper.
If one of the two dozen or so figures they used was erroneously too low due to a typo, will correcting it make the average go up or down do you think? Void if removed (talk) 11:14, 23 June 2024 (UTC)[reply]
VintageVernacular, that section does not contain "the exact same claim", or any claims about the prevalence of autism at all. WhatamIdoing (talk) 18:39, 23 June 2024 (UTC)[reply]
Meant the other part: "Suggested influences included ... early exposure to online pornography." VintageVernacular (talk) 18:43, 23 June 2024 (UTC)[reply]
That doesn't actually say that the final report has come up with this idea. I'd have chosen less ambiguous wording, but it's reasonable to read "suggested influences" as ideas that were suggested to the Cass team, rather than ideas they came up with themselves. WhatamIdoing (talk) 18:48, 23 June 2024 (UTC)[reply]
Also, Grijseel's criticism is about the change in the prevalence (from the incorrect 1.8% to the correct 15.1%). The claim in the Cass final report is only that the actual amount (which is not stated) is higher than expected (=the population baseline percentage, probably 1–2%, depending on your definition). The claim in the Cass final report is only that a lot of trans kids are also on the autism spectrum, and would still be true even if the review article had correctly type 13.8% as the 2012 prevalence. WhatamIdoing (talk) 18:44, 23 June 2024 (UTC)[reply]
It's all a bit notwithstanding, my point was basically you don't need to have written prescriptions to make basic arguments like those in a journal article; the ones I cited were just examples and selected because I perceived them as some of the most straightforward. Though whether these specific points showed up in the final report or not, they would have probably influenced it since these systematic reviews were its key basis. (Not every conversation Cass & co. had in consultation was cited directly either.) VintageVernacular (talk) 09:54, 24 June 2024 (UTC)[reply]
So, we've got two papers attacking the Cass review which have been shown to be seriously flawed themselves, and authored by people with no clinical expertise or in clinical research or systematic reviewing, which the review is founded upon. The "Cis-supremacy" paper that YFNS keeps banging on about contains a total falsehood about the "authorship" of the review, a falsehood that doesn't seem to stop people repeating it all over the internet on the basis that it is too good to be checked to see if it is actually true. And the monkey-researcher paper that has as its most challenging argument a typo that when corrected actually just reinforces the argument Cass was making about the levels of autism in the cohort. Almost as if Cass was totally familiar with the correct numbers all along, which one might expect if one had spent four years working on a report. -- Colin°Talk 07:41, 2 July 2024 (UTC)[reply]
I agree with Void about this Council of Europe thing. I'm utterly fed up with this xenophobic nonsense that no researchers in England are capable of higher thoughts because Liz Truss once said something awful. And the commentary is not by a scientist with "relevant expertise". That very very much is not the case. They are an activist who is writing outside their field of expertise. This frankly is a repeat of MMR and Covid silliness, where people are given a platform because they are on a particular side in a culture war, not because they actually know anything about the science or healthcare matters from an expert position. -- 11:05, 22 June 2024 (UTC) Colin°Talk 11:05, 22 June 2024 (UTC)[reply]
Could you explain how brain science is outside the expertise of a neuroscientist? VintageVernacular (talk) 11:24, 22 June 2024 (UTC)[reply]
With all due respect, Colin, you are increasingly sounding like the people over at race and intelligence who whine that the current state of the field is only the way it is because most scientists are just biased or taking a side in a culture war or too afraid to say otherwise, and that therefore J. Philippe Rushton and the Pioneer Fund are the only credible scientists. Constantly complaining that one side of a scientific dispute is only saying the things it is because of culture war bullshit is a space that's more aligned with WP:PROFRINGE than opposed to it. Loki (talk) 02:52, 24 June 2024 (UTC)[reply]
The comparison to scientific racism is false; this is something rejected by the scientific community pretty much everywhere, whereas there are disagreements on the issue of gender dysphoria in children, with notable differences between countries.
I agree that the Council of Europe thing means nothing about the validity of British researchers, just as the antics of Donald Trump and his party means nothing about the validity of American ones.
As for the original topic of the discussion, I'll say that I don't have a problem with the author or journal, and this could be used as an addition citation to the statement that among academics, "others in both the UK and internationally disagreed with the report's methodology and findings." But here's a question: what does this source add to the article that isn't provided by other critical (in the negative sense) sources? Anywikiuser (talk) 16:38, 24 June 2024 (UTC)[reply]
I think the comparison to scientific racism is not entirely wrong. What we are seeing is a movement against the rights of a minority group, using fringe theories promoted by advocacy groups like Genspect and SEGM, that do not represent the scientific mainstream. The statements by the Council of Europe are useful in providing context about anti-LGBTQ+ sentiments that have increased in the UK in recent years. Hist9600 (talk) 21:14, 24 June 2024 (UTC)[reply]
This is a kind of meta-WP:OR, cobbling together negative sentiment from a variety of sources to cast doubt on WP:RS and it just isn't on.
This isn't adding anything, it is just being insulting. Please stop, it has absolutely no place on this page, where we are talking very specifically about the Cass Review, and none of this has any bearing whatsoever. Void if removed (talk) 08:14, 25 June 2024 (UTC)[reply]
What you're describing seems to be us contesting you on WP:WEIGHT. WP:OR is inapplicable on the talk page and the sources used are WP:RS. --Licks-rocks (talk) 14:43, 25 June 2024 (UTC)[reply]
I'm well aware that policy against WP:OR doesn't apply to talk pages, what I was referring to was cobbling together negative sentiment from a variety of sources to cast doubt on WP:RS and it just isn't on.. You are not judging WEIGHT by any empirical assessment of the source itself, or even conducting WP:OR in directly critiquing the source, you're defending the completely unwarranted citation of a random statement by a committee of the Council of Europe and some wild speculation to downweight sources from the UK and elevate the importance of criticism of them. The context was the statement:
We also have to keep in mind that the Cass Report has been ordered by a government from a country that has shown a dramatic rise in "the extensive and often virulent attacks on the rights of LGBTI people for several years" as highlighted in a report by the Council of Europe and scientists from a country are not immune to the pressure of scientific misconduct
The logic is: the government of the country that conducted the Cass Review was criticised by a committee in the Council of Europe for rejecting legal change of sex on basis of self-declaration, therefore the UK is institutionally suspect, therefore we should treat this completely unrelated, independent, expert report as suspect and throw terms like scientific misconduct around and therefore this absolutely terrible paper by some random postgrad is WP:DUE as a response.
This whole line of argument is egregious and offensive and veering into conspiracism, and I am asking again that it stop, and also that you stop defending it. None of this is relevant or useful, just inflammatory. Void if removed (talk) 08:00, 26 June 2024 (UTC)[reply]
Right, because a report carried out on behalf of a government is obviously unrelated to that government and what it thinks. Also, let's not pretend that this council of Europe thing is the strongest argument here, or that I agree with you on how you describe that paper, or that it's just that paper making these arguments.--Licks-rocks (talk) 11:03, 26 June 2024 (UTC)[reply]
A few comments ago, an editor was calling others "xenophobic" for contextualizing the Cass Review in relation to the poor and declining state of transgender rights in the United Kingdom. However, that context is important, and it should be considered when we see a sharp contrast between the support given to the Cass Review in the UK, and the more cautious or skeptical stances taken internationally. Hist9600 (talk) 01:10, 26 June 2024 (UTC)[reply]
This might be the only useful comment to come out of any complaint about the UK's bias and the Cass review. However this does not affect the Cass review by itself and should probably only be kept in mind with the reception section. LunaHasArrived (talk) 15:59, 26 June 2024 (UTC)[reply]
i think this page needs to be rewritten. the subject is of a scientific matter. better to include less news articles and more papers about the issue. Bird244 (talk) 01:57, 27 June 2024 (UTC)[reply]
@Hist9600 no editor has called other editors xenophobic". There's a difference between talking about what someone wrote and making a personal attack on their character. I don't think anyone here is xenophobic but some are getting carried away when repeating arguments they've read elsewhere and which seemed to resonate with that different crowd. Xenophobia is "having or showing a dislike of or prejudice against people from other countries" and every mention of that Council of Europe memo in order to discredit either Cass, their four-year independent review, or the world experts at conducting systematic reviews at York, is literally that. It needs to stop. Not least from the "people in glass houses" angle, bearing in mind the latest news about the rise of the Far Right in Europe and Trump in the USA. This low-brow level of debate might work when preaching to the converted on a blog or among one's twitter crowd, but has no place on Wikipedia. This review can be criticised for whatever claimed facts are wrong or disputed ,or disagreed with for whatever recommendations someone else thinks differently about. But criticising it because both Liz Truss and Cass have English accents is just plain offensive. -- Colin°Talk 07:31, 2 July 2024 (UTC)[reply]
I'm not aware of anybody here disliking the UK, but it's interesting to me that you think that editors here have a personal dislike of that country. Being critical of the state of transgender healthcare in the UK, as well as the relatively poor state of trans rights in the UK, and the context in which the review was developed and published, is not xenophobia. Maybe you could stay on topic and assume WP:GOODFAITH of other editors, rather than making baseless accusations. People may be critical of something within a country, without having personal antipathy towards that country. As an example, being critical of the healthcare system in the United States, is not the same as anti-Americanism. Hist9600 (talk) 22:24, 2 July 2024 (UTC)[reply]
@Hist9600 please stop trying to turn this into a personal accusation. I am talking about what people wrote. Editors here are repeating stuff they read elsewhere (I've read it elsewhere too) and putting words on the page that are xenophobic. I have no interest in what they think in their own heads when they think their own thoughts. I'm not the one posting nonsense here that a nation of tens of millions are an unreliable source on trans issues because some document moaned about what Truss once said or the Telegraph once published. -- Colin°Talk 07:15, 4 July 2024 (UTC)[reply]
You are construing the words of others in the worst possible ways, and also creating straw men along the lines of because both Liz Truss and Cass have English accents. The development and overall context of the Cass Review matter. Especially when we see the strong difference between reception of the review in the UK, and reception internationally. Hist9600 (talk) 15:19, 4 July 2024 (UTC)[reply]
Loki, this is not at all a subject like scientific racism or global warming or vaccines where the science is overwhelming and solid. There can be disagreements about what to do and how to act when we don't have good evidence for this therapy or that approach. But pretending one does have good evidence, when plainly one doesn't, is not science. Relying on old evidence based on cohort X when today we have cohort Y is also not science. This review has disappointing findings for some. What those York researchers did is not fringe science, but gold standard evidence-based-medicine, and their criticisms that some clinical guidelines should be more honest about their lack of evidential grounding is valid. I have yet to see any serious expert challenge to this, and the most repeated challenge on this page seems to be that because Cass has an English accent, she must be transphobic. -- Colin°Talk 07:56, 2 July 2024 (UTC)[reply]

@VintageVernacular: I just read Grijseels article. My reading suggests that Colin's description of this as being authored by someone without relevant expertise is largely correct.

The following is the every mention of neuroscience in Grijseels' article:

  • page 4, in one sentence, Grijseels rejects Cass Report's claim that the brain completes maturation in the mid-20s instead asserting that the brain continually changes throughout the lifespan. I note that our article Human brain development timeline § Childhood and adolescence seems to support the Cass Report against Grijseels on this issue.
  • page 4, in two paragraphs, Cass Report notes the existence of critical period of adolescence and suggests this should be considered in their care. Grijseels recalls the definition of a "critical period" in brain development in the source cited by the Cass Report, "a time of increased plasticity when the neuronal network and its individual parts are particularly sensitive to incoming stimuli", and suggests such a period may not be relevant for brain maturation. (Which is confusing, because Grijseels just rejected the concept of brain maturation entirely.) Grijseels says there is not sufficient evidence on brain development for this line of study to have any impact on legal policies.
  • page 5, in one paragraph, Grijseels criticizes the lack of a control group in available studies of the impact of cross-sex hormones on brain structure.
  • page 5-6, in one paragraph, Grijseels argues that Cass misinterprets Mueller et al. (2021) on the neurobiology of transgender persons. I haven't dug into this deeply, but I note that Maite Arraiza Zabalegui says that Mueller et al. (2021) paradoxically endorses both brain mosaicism and neuroanatomical dimorphism. (Details on author, journal)

In my judgement, 13% of the article (655 of 5071 words) is about neuroscience. There is no indication in this article that the author has relevant prior knowledge and expertise in neuroscience. Rather, the entire article could plausibly have been written by an academic in any field. Further, the neuroscientific issues raised on page 4 are passing mentions in the Cass Report which are very peripheral to its conclusions. Only the last item in my list is a substantial disagreement between Grijseels and Cass on neuroscience. Daask (talk) 17:11, 27 June 2024 (UTC)[reply]

That's one's judgment (WP:OR). There's multiple ways to measure what's relevant. It excludes the part about comorbidity with autism, and the criticism of Cass citing Nadrowski's commentary positing a pornography–gender dysphoria link in autistic people from "reduced mentalization capacities" and "social contagion". I would say that's relevant to brain research since autism is categorized as a neurodevelopmental condition (discussed above, and I'm not arguing how important it is overall, but as an example of a subject excluded from this count). Yet I'd rather have it play out among published researchers approved by relevant expert editorial boards than Wikipedia editors... if I wanted to post every technical criticism of the Cass report on this talk page, I could, but they aren't all in WP:RS so what would be the point. VintageVernacular (talk) 17:49, 27 June 2024 (UTC)[reply]
Looks like the author has this title: Postdoctoral scholar at Max Planck Institute for Brain Research. In other words, an academic neuroscience background. I daresay far more of a background in neuroscience, than Hilary Cass had in transgender healthcare. And as you mention, there are some very outdated ideas about autism and transgender identities in the Cass Review, that are not in line with modern review studies on the subject. Hist9600 (talk) 20:16, 27 June 2024 (UTC)[reply]
I note that the article you're citing to reject Grijseels' first claim cites the claim that the brain stops maturing to a Slate article (i.e. very much not a WP:MEDRS source), and not only that but the source itself is making the directly opposite argument: that the brain does not stop maturing in the mid-20s.
Out of the two scholarly sources in that paragraph, one (bizarrely) has a note on it that says in this paper, the age 25 statement is attributed to another paper which actually makes no claims whatsoever about brain development, while the other directly refutes the claim by demonstrating a type of brain development that continues into the mid-30s. Or in other words, Grijseels' is both clearly correct here, and we really need to improve the article you've linked. Loki (talk) 22:50, 27 June 2024 (UTC)[reply]

Having said that, this talk page is getting far more edits than the article itself. Further conversation here may not be the best use of your energy. Daask (talk) 17:11, 27 June 2024 (UTC)[reply]

report to consider[edit]

this Yale report Is more criticism to consider. It's place on the evidence hierarchy has to be considered, but it's been a while since I got involved here and just wanted to add to evidence. LunaHasArrived (talk) 08:52, 2 July 2024 (UTC)[reply]

The link here seems to be a Yale Law School blog post about a Microsoft Word document sitting in a documents folder in a Yale Law School server. The "Integrity Project" seems to be just two people who are focused on American youth trans healthcare activism. Is this some kind of draft document intended to get published somewhere in future? At the moment, this isn't even what I'd call "published", never mind "published in a reputable journal". It may well be an important critique but maybe we can discuss it more if it actually gets properly published as I'm not sure this is citable at present. -- Colin°Talk 10:02, 2 July 2024 (UTC)[reply]
I see now the actual file is a PDF, but my browser tab says "Microsoft Word - Cass Response.docx", so it looks like someone has just done "Save as PDF" or similar. This really isn't a published source we could cite yet. -- Colin°Talk 10:09, 2 July 2024 (UTC)[reply]
That's what I thought might be the case, thank you for putting in your input. LunaHasArrived (talk) 11:17, 2 July 2024 (UTC)[reply]
That page lists more than two authors. Did you read it?
"In addition to Alstott and Dr. McNamara, the distinguished authors include Kellan Baker, Ph.D., Executive Director of the Whitman-Walker Institute; Kara Connelly, M.D., Associate Professor of Pediatrics, Division of Endocrinology, School of Medicine, Oregon Health & Science University; Aron Janssen, M.D., Associate Professor of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine; Johanna Olson-Kennedy, M.D., Professor of Clinical Pediatrics, Keck School of Medicine of USC; Ken C Pang, FRACP, Ph.D., NHMRC Leadership Fellow and Senior Principal Research Fellow, Murdoch Children’s Research Institute, VIC Australia; Ayden Scheim, Ph.D., Assistant Professor of Epidemiology, Drexel University Dornsife School of Public Health; Jack Turban, M.D., Assistant Professor, Psychiatry, University of California, San Francisco." VintageVernacular (talk) 00:20, 3 July 2024 (UTC)[reply]
That page lists more than two authors.
What Colin said was:
The "Integrity Project" seems to be just two people
This isn't a comment about the full list of co-authors its about the size/notability of the grand-sounding "Integrity Project" and their focus. Void if removed (talk) 11:36, 3 July 2024 (UTC)[reply]
It has has been picked up by the press in Scotland now, so it’s definitely citable and as VintageVernacular pointed out above, it was co authored by a lot more than just two people. Raladic (talk) 01:25, 3 July 2024 (UTC)[reply]
With that citation I think this is, at best, another cite that can be added to the line:

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

If it gets published in a peer-reviewed journal, then the report itself would likely be WP:DUE because of the notability of the authors. Void if removed (talk) 11:30, 3 July 2024 (UTC)[reply]
I'm struggling to get past the first line of that report's introduction because it's balatanty factually incorrect: "In 2020, the United Kingdom’s National Health Service (NHS) commissioned an inquiry to provide recommendations for the healthcare of transgender adolescents." Zeno27 (talk) 11:38, 3 July 2024 (UTC)[reply]
"The Independent Review of Gender Identity Services for Children and Young People (The Cass Review) was commissioned by NHS England and NHS Improvement in Autumn 2020 to make recommendations about the services provided by the NHS to children and young people who are questioning their gender identity or experiencing gender incongruence. "
Is from the Cass reviews own website. If you want to argue about NHS UK not existing thats fine, but it's a response to the Cass review mainly, I don't think it's too relevant who exactly commissioned it. LunaHasArrived (talk) 12:30, 3 July 2024 (UTC)[reply]
I'm not arguing about it, just pointing out they get off to a bad start by getting basic facts wrong. Still working my way through the rest of it. Zeno27 (talk) 16:07, 3 July 2024 (UTC)[reply]
I don’t think confusing UK/England is fatal. The organisational structure of healthcare in the UK is not the material point, and papers aren’t materially harmed by making simple errors outside of their core chain of reasoning. It’s the kind of issue that might get picked up in peer review, the lack of which is the main issue with this paper. Let’s see if it gets published, and then evaluate the published version. Barnards.tar.gz (talk) 09:24, 4 July 2024 (UTC)[reply]
Or any kind of review, peer or editorial. It's self published. I'm perplexed about their comments on NOS. When the earlier NICE reviews were published, activists complained that they use GRADE, which is weak for studies that aren't RCTs. Now they use NOS, which is more appropriate for the studies being looked at, and this paper seems to be saying they should have used GRADE. They use "political language" like "not recommended by" to say things in a dishonest way. Well it seems Cochrane did recommend NOS for systematic reviews of non-randomised studies, but then developed their own in house "Risk of Bias" tool. That sounds to me a bit like saying Apple doesn't recommend using Google Pixel phones. Well they would, wouldn't they. They go on at length about why they think this tool is bad. You know the old phrase "If you're explaining, you're losing". Well, if their opinion on NOS was widely accepted, they could just cite someone and move on. Instead, we have here a self-published doc trying to discredit a major review and it has to try to conduct original research in front of its readers about why the authors think NOS is bad. That's a big red flag. Futhermore, it is all like complaining about the font the author's used, if it doesn't change the result. The result, about lack of good evidence, has been something systematic reviews have been saying for years, and wouldn't change if they did it another way. -- Colin°Talk 09:57, 4 July 2024 (UTC)[reply]
reading section 6 (as only 6 and 7 actually consider the York SRs) they don't seem to have made any recommendation on which quality appraisal tool to use. They do recommend GRADE and the AHRQ approach when it comes to assessing the entire body of evidence (something the York SR's didn't seem to use a tool for whatsever) and They do in fact cite multiple studies to say NOS is inaccurate. The robis tool that Noone uses is a tool to assess whether a systematic review is at risk of bias, not a tool to assess the quality of individual studies. LunaHasArrived (talk) 12:31, 4 July 2024 (UTC)[reply]
You mean the study they cited to say "Using NOS, reviewers often come up with different quality appraisals" but the study was one where they asked two researchers to use NOS and assessed whether they come up with similar. So "two researchers" in one study isn't "reviewers often come up with different quality appraisals". The point is, if NOS was explicitly "not recommended" then they'd be able to cite one or two big names that say "We do not recommend using NOS for this kind of thing". And they don't.
Their line "NOS includes items that are immaterial to assessing risk of bias" cites source 96 which is here and which says "The Cochrane Handbook highlights two other tools for use in nonrandomized studies: the Downs and Black and Newcastle Ottawa Scale. They implicitly recommend the Newcastle Ottawa Scale over the Downs and Black because the Downs and Black is time-consuming to apply, requires considerable epidemiology expertise, and has been found difficult to apply to case-control studies. The Newcastle Ottawa Scale is frequently used in systematic reviews for articles about studies with this type of design. It contains separate questions for cohort and case-control studies. It was developed based on threats to validity in nonrandomized studies" which I suppose was being positive about it so they didn't cite that bit. Another source they cite seems very very old, making me think it even predates NOS.
If you google the scale, you find that it is widely widely used and also like all such tools, widely discussed for its strengths and limitations. The criticism here seems to be a bit like someone saying they used a PC to write the Cass Review and then citing lots of "Mac User" articles and forums saying how Macs are better. -- Colin°Talk 14:31, 4 July 2024 (UTC)[reply]
Macs actually are better. ;-p WhatamIdoing (talk) 02:41, 5 July 2024 (UTC)[reply]
That's honestly what I was thinking at the moment, they're clearly subject matter experts and the reports been used by others. We might at some point want to reconsider the balance attributed in that sentence, but I can see that being a point to consider down the road. LunaHasArrived (talk) 12:33, 3 July 2024 (UTC)[reply]
Based on what others have said, I support including it. Snokalok (talk) 02:18, 3 July 2024 (UTC)[reply]

The Yale Integrity report by eight distinguished legal scholars and scientists presents the mainstream perspective and is essentially the most comprehensive (for now) mainstream counter-report, and clearly needs to be discussed. The Cass report has been widely criticized and promotes ideas that are quite fringe. Badenoch has admitted that it was meant to promote gender-critical ideas. Gender-critical ideology was recently described by the UN as an extremist movement that uses "hateful propaganda and disinformation to target and attempt to delegitimize people with diverse sexual orientations, gender identities, gender expressions, and sex characteristics". [2] --Amanda A. Brant (talk) 21:46, 3 July 2024 (UTC)[reply]

What is this "Yale Integrity report"? The "Integrity Project" is two people who happen to work at Yale Law School. The document itself has some medical co-authors but that doesn't make it a Yale university official body. It is also not a "medical organisation" so I've removed the two refs to it from the lead. Also the document is at present not actually in any publication at all, but a PDF on a documents folder on the server of a law school. Until it is published by a reliable source, we can't cite it. At present it itself is no more reliable than a Substack post or an Unherd rant. I have absolutely no idea why Badenoch is being mentioned. Could editors please contain their rants to their personal blog space or whatever. -- Colin°Talk 07:27, 4 July 2024 (UTC)[reply]

The removal of sourced content for no other reason than WP:IDONTLIKEIT is completely unacceptable, as is the attempt to portray Amnesty and anti-trans hate groups as being "the same" with a misleading and biased title. Also, the lead should accurately reflect the content of the article, also regarding what kind of organizations that have criticized this report. It or the use/weaponization of it by anti-trans groups has been widely criticized by human rights organizations (such as Amnesty), LGBTIQ+ rights groups in addition to medical organization, and is indeed a key feature of it, from a US perspective indeed its main claim to fame. This is a matter of human rights as much as it is a matter of medicine, in a climate where the UK has become known internationally for "virulent attacks on the rights of LGBTI people".[3] --Amanda A. Brant (talk) 22:39, 3 July 2024 (UTC)[reply]

Amanda, please read the discussion above, and self revert. You're massively over inflating a non peer reviewed document. Void if removed (talk) 05:45, 4 July 2024 (UTC)[reply]
Having removed the link to Yale's own blog post, the only "reliable" independent source mentioning this report that we are citing is to Ross Hunter, Multimedia Journalist at The National, which is a niche newspaper (circulation less than 3,000) focused on Scottish Independence. We need to do better than that for this to be notable. -- Colin°Talk 07:32, 4 July 2024 (UTC)[reply]

Nobody has claimed it is a "medical organization". Transgender/LGBTIQ+ rights are matters of human rights and law, just as much as they are matters of medicine. The claim that the report isn't "published" is flatly wrong and misunderstands how the legal field works. In law, peer reviewed journal publications are not the only authoritative sources, other kinds of opinions are too, including judgements and expert opinions by prominent jurists. In the legal field, what matters is whether the opinion is authored by reputable jurists. Additionally, what matters for us is whether there are reliable sources describing this report[4]. I understand that medical science works somewhat differently, as it relies much more on peer-reviewed journal articles.

Note that the Cass report is not a peer-reviewed publication like an article in a peer-reviewed journal. It is a "report," similar to the Yale report. There is nothing wrong with that; academics sometimes publish reports to investigate various issues. Typically, peer-reviewed publications aim to advance knowledge, but reports can be aimed at a broader group of stakeholders and provide an overview of a topic. The Cass report is clearly not just aimed at academics, and the response from a group of prominent legal scholars, published in the same format, is part of the conversation around it. The claims about "two people" are nonsensical when there are eight co-authors, and there are no policy-based reasons for the removal of this sourced content. WP:IDONTLIKEIT is not an acceptable reason to remove it

Also, the attempt to portray Amnesty and extremist anti-trans hate groups as being "the same" by having them in the same section with a biased title insinuating they are the same kinds of organizations, is unacceptable. --Amanda A. Brant (talk) 16:20, 4 July 2024 (UTC)[reply]

I'm not following the conversation very closely (apologies), but in The National's report it seems to attribute to both "Yale Law School and the Yale School of Medicine". VintageVernacular (talk) 16:33, 4 July 2024 (UTC)[reply]
Alstott is from Yale Law School and McNamara is from the Yale School of Medicine. The report is from "The Integrity Project" which they both run, but which seems to be attached to the Law School. Void if removed (talk) 16:54, 4 July 2024 (UTC)[reply]
This looks like a self-published WP:PREPRINT.
There are bits that seem silly. For example, Expertise is not considered bias in any other realm of science or medicine... The MDs among the authors, at least, should be familiar with the idea that if you don't want surgery, you shouldn't ask a surgeon for advice, because surgeons are biased towards surgery.
Much more generally, thinking about the critical sources in general, I think the two "sides" are talking past each other. The Cass Review seem to be starting from the POV that you have kids in distress. They need help, and you've no idea which ones will be helped long-term with gender-affirming social and medical care. The critics seem to be starting from the POV that you have trans kids who need gender-affirming social and medical care.
Here's an example of how that plays out in the Integrity Project report: The report asserts that anyone who wants to make a clinical recommendation (e.g., about trans kids) must be a subject-matter expert (e.g., in trans kids). Cass and her committee are not experts specifically in providing gender-affirming care; therefore, (according to the Integrity Project) they are not even allowed to ask a qualified team to perform a systematic review on the subject. The Cass team, on the other hand, are saying that these are distressed kids, and they are experts in distressed kids, so they actually are qualified to commission research by other experts on this subject.
(For myself, I keep cynically thinking that all of these critics would cheerfully accept large grants from utterly unqualified people/foundations to conduct such systematic reviews themselves, because the main problem really isn't that the Cass team commissioned the systematic reviews. The problem is that the systematic reviews accurately showed that the emperor is missing part of his clothes, and that's being politically exploited to produce some very severe practical problems in the short-term. I doubt that any of actual experts believed that the evidence base was spectacular. They just very sensibly don't want the dirty laundry to be aired in public, especially since part of the reason the evidence base is so bad is because of chronic underfunding due to bigotry.) WhatamIdoing (talk) 02:31, 5 July 2024 (UTC)[reply]
The Cass Review seem to be starting from the POV that you have kids in distress. [..] The critics seem to be starting from the POV that you have trans kids who need gender-affirming social and medical care.
That is the entire dispute in a nutshell. Void if removed (talk) 09:36, 5 July 2024 (UTC)[reply]

dispute over sources in this article[edit]

due to disputes in this talk section over which sources used in this article are reliable, i ask that anyone who edits this article in future only cite peer reviewed scientific papers and medical journals such as Scientific American, new England journal of medicine and the British Medical Journal. this is a matter of medical and scientific importance that is complicated, and it would be immoral to add misleading information. Bird244 (talk) 11:10, 4 July 2024 (UTC)[reply]

We use sources in accordance with their reliability and due weight. For biomedical claims we have stricter standards: WP:MEDRS. We consider sources in context, and we do not have a pre-determined list of which sources are usable. Often it is necessary to discuss each one on its own merits.
By the way, are you aware that Scientific American is not a peer reviewed medical journal or source of scientific papers? Barnards.tar.gz (talk) 11:21, 4 July 2024 (UTC)[reply]
oh. my mistake Bird244 (talk) 23:39, 4 July 2024 (UTC)[reply]
As Barnards said, we use sources as they become relevant. If for instance the Cass Review is cited as the reason for a change in political policy, we can very well cite a new report on that change. If a medical org puts out a statement on the report, we can cite that statement as a source for that org saying whatever it said. Snokalok (talk) 11:46, 4 July 2024 (UTC)[reply]
There is no need to reinvent WP:MEDRS. Flounder fillet (talk) 13:42, 5 July 2024 (UTC)[reply]

Bizarre title "Response from lobbying organisations"[edit]

The title "Response from lobbying organisations" is biased and misleading. This section groups opinions from anti-trans hate groups with those of recognized human rights organizations like Amnesty. This misleading title implies equivalence between these groups – in fact that appears to be the whole point of the title. Additionally, including the Yale Integrity Project report and labeling Yale Law School and reputable legal scholars as a "lobbying organization" is inappropriate. Since there has been no attempt to even justify this biased title, and since the title is clearly biased and inappropriate, I am correcting it. --Amanda A. Brant (talk) 22:19, 4 July 2024 (UTC)[reply]

These headings are still a bit of mess and the content doesn't always match the heading:
Response from human rights organisations: a human rights organisation and two lobbying organisations.
Response from gender-critical organisations: two lobbying organisations, one of which is a human rights organisation
Yale report: I can't see why this has its own heading and why it's in here.
Assorted responses: a UK Government statutory body, various others and a UN Special Rapporteur
Suggestions for improvement? Zeno27 (talk) 23:01, 4 July 2024 (UTC)[reply]
None of the anti-trans groups are "human rights organizations". The Yale report merits its own sub heading, and it also doesn't fit in any of the other sections, or the section where it had been placed, on purported "lobbying" (sic!) organizations alongside the opinions of anti-trans fringe/hate groups. How can a report by eight Yale scholars be a "lobbying organization"? --Amanda A. Brant (talk) 01:13, 5 July 2024 (UTC)[reply]
A government agency also can't be a lobbying organization, because lobbying is about trying to influence the government. The Yale Integrity Project probably counts as "an organization". Back in the day, we probably would have called them a Special interest group. WhatamIdoing (talk) 02:14, 5 July 2024 (UTC)[reply]
The Yale Integrity Project is a project at a law school. They focus on bridging the gap between law and medicine. More here[5] --Amanda A. Brant (talk) 03:09, 5 July 2024 (UTC)[reply]
Sex Matters is a registered charity and their charitable objects - as accepted by the Charity Commission - state they aim "TO PROMOTE HUMAN RIGHTS (AS SET OUT IN THE UNIVERSAL DECLARATION OF HUMAN RIGHTS AND SUBSEQUENT UNITED NATIONS CONVENTIONS AND DECLARATIONS) THROUGHOUT THE WORLD"[6] To not describe them as a human rights organisation in the face of this cannot be NPOV unless and until balancing evidence to the contrary is provided. Zeno27 (talk) 09:30, 5 July 2024 (UTC)[reply]
That doesn't make them a human rights organization. Working against trans people's (human) rights is the very opposite of working for human rights. The Soviet constitution described the Soviet Union as a perfect democracy, which didn't make it true. Sex Matters is an anti-trans hate group, and a fringe group. It doesn't even have its own article, it's really just an anti-trans activist who claims to have lost her job and now spends her time campaigning against trans rights. Comparing that to Amnesty is absurd. --Amanda A. Brant (talk) 12:33, 5 July 2024 (UTC)[reply]
I have provided evidence they are considered a human rights organisation by the Charity Commission: for balance, what's the NPOV evidence this is incorrect? Zeno27 (talk) 13:41, 5 July 2024 (UTC)[reply]
The counter is that the United Nations has called out gender critical organizations being against human rights, such as the recent callout by UN Women as outlined in our article on Gender-critical feminism. The consensus is that they are not a human rights organization, but against human rights. Raladic (talk) 15:35, 5 July 2024 (UTC)[reply]
That is not any sort of consensus. Void if removed (talk) 15:46, 5 July 2024 (UTC)[reply]
There is clear consensus on Wikipedia that anti-trans hate groups cannot be described as "human rights organizations," that we don't describe them as such in Wikipedia's voice. It's really quite an extreme statement. Any racist, anti-semitic or transphobic organization may claim to work for "human rights", but it doesn't make it true. The abuse of human rights language and concepts by anti-gender and other extremist movements has in fact been commented widely upon in scholarship and by recognized human rights organizations. --Amanda A. Brant (talk) 16:27, 5 July 2024 (UTC)[reply]
The question isn't whether the United Nations has called out gender critical organisations as being against human rights; the question here is whether Sex Matters has been called out and whether that criticism is well-founded. Sex Matters was not even mentioned by UN Women in their 'explainer'. That Gender-critical feminism article also does not say that Sex Matters is not a human rights organisation. So all we have here is vague hand-waving versus the Charity Commission's acceptance of them as such. Zeno27 (talk) 16:02, 5 July 2024 (UTC)[reply]
Moved Yale under "Assorted", until it gets wider coverage or peer-reviewed publication it is not due for a whole section to itself like this. Void if removed (talk) 09:34, 5 July 2024 (UTC)[reply]
That's not a good solution. We're talking about a thorough counter-report by scholars, reactions from large human rights organizations, opinions of SPLC-designated hate groups, and individual opinions from, for example, a former children's author. What on Earth do all these have in common? They belong in separate sections. Badenoch has openly said the aim of the report is to promote the gender-critical narrative, so a section on the gender-critical response would be appropriate. The reception by academics and mainstream human rights organizations has very little to do with the beliefs of SPLC-designated hate groups and individual anti-trans activists. --Amanda A. Brant (talk) 13:33, 5 July 2024 (UTC)[reply]
My preference is to remove them all, per WP:NOTEVERYTHING. More important responses have come along since these were chucked in at the report's release, so these seem like unnecessary/irrelevant padding to me. Eg. get rid of all of the following:
Amnesty International criticised "sensationalised coverage" of the review, stating "This review is being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people." Trans youth charity Mermaids and the LGBTQIA+ charity Stonewall endorsed some of the report's recommendations, such as expanding service provisions with the new regional hubs, but raised concerns the review's recommendations may lead to barriers for transgender youth in accessing care. Gender-critical organisations including Sex Matters and Genspect welcomed the report. Stella O'Malley of Genspect expressed concern that if a conversion therapy ban were to criminalise any exploration into why a child identifies as trans, it "would ban the very therapy that Cass is saying should be prioritised". Void if removed (talk) 13:40, 5 July 2024 (UTC)[reply]
No, Amnesty's response definitely belongs there. The anti-trans groups' response can be included too, but it shouldn't be mixed with the reactions from recognized human rights bodies. --Amanda A. Brant (talk) 13:46, 5 July 2024 (UTC)[reply]

Due weight[edit]

Why exactly do we use 231 characters to report the opinion of a single person affiliated with an SPLC-designated hate group (Genspect), while the paragraph on a report by eight Yale scholars – essentially the counter-report from a mainstream academic perspective – has been shortened to just 130 characters? --Amanda A. Brant (talk) 13:33, 5 July 2024 (UTC)[reply]

I reverted that change. Yale’s opinion is obviously more notable than that, and it’s peculiar to me that breadth of coverage was never the bar for previous statements by relevant orgs, but it somehow is here Snokalok (talk) 14:02, 5 July 2024 (UTC)[reply]
It is not the opinion of "Yale".
It is a self-published document by a small political project at Yale Legal School that has received little coverage.
We give due weight to notable organisations, which this isn't. Void if removed (talk) 15:33, 5 July 2024 (UTC)[reply]
the counter-report from a mainstream academic perspective
This is overblown, can you please stop inflating the importance of this opinion. Void if removed (talk) 15:34, 5 July 2024 (UTC)[reply]
This is not how academia works. Universities don't have "opinions". Scholars do. In this case a group of eight prominent scholars and scientists working on the intersection of law and medicine/health policy who are affiliated with a very prominent university. The expert opinion carries weight. The report is essentially the most comprehensive (for now) counter-report from a mainstream academic perspective and should be treated as such. What they do is summarizing peer-reviewed scientific knowledge for a legal audience[7] and the report reflects mainstream scholarship and science in this area. Your absurd claim that this is a "political project" really says it all. --Amanda A. Brant (talk) 16:10, 5 July 2024 (UTC)[reply]
If the expert opinion carries weight in academia, where are the other academic publications citing this? WhatamIdoing (talk) 16:14, 5 July 2024 (UTC)[reply]
Again, this comment fundamentally misunderstands how this field works. Academic publications don't cite a report released days ago because academic publications don't appear within days, but years, months at best. Plus, the report isn't really intended as an academic publication, but aimed at a broader legal audience, per the goals of the project[8]. It's not a report that advances any new scientific claims, but that engages with another report (also not peer-reviewed or anything) by summarizing existing scholarship and knowledge. --Amanda A. Brant (talk) 16:19, 5 July 2024 (UTC)[reply]
So it is an unreviewed, self-published document by some US-based legal academics and members of WPATH that for some inexplicable reason has (so far) been reported in a tiny Scottish Nationalist paper, and Teen Vogue.
And as such it should be given very little weight because this is not a MEDORG statement or a statement from a notable organisation, nor is it a peer-reviewed MEDRS response, nor is it some comparable "counter-report", and it should definitely not sit in its own whole section.
Its also, as an aside, really, really poor. Void if removed (talk) 16:28, 5 July 2024 (UTC)[reply]
This is a matter of law and human rights, just as it is a matter of medicine. MEDORG and MEDRS have no relevance. The legal field has quite different traditions than medicine, and works quite differently. If you are going to push this point, the Cass report is an "unreviewed, self-published document" too. --Amanda A. Brant (talk) 16:39, 5 July 2024 (UTC)[reply]
I have a general concern, which includes but is by no means limited to, the Yale Integrity Project, that we are choosing sources that have the Right™ POV, even though they are self-published and do not seem to get much attention outside of this article.
For example, the first sentence has two inline citations, and I'm pretty sure that both of them could be replaced by proper Wikipedia:Independent sources, such as a BBC article. In fact, I wouldn't be surprised if they could be replaced by one of the news articles that is already cited in the article.
I think it would be desirable to get some agreement on the characteristics of sources that we would like to be relying on, and see if we can match that. WhatamIdoing (talk) 16:13, 5 July 2024 (UTC)[reply]
It's not "self-published" any more than the Cass report is. The Cass report is a "report" too, just published by the authors, not in a peer-reviewed journal or anything. Badenoch has openly admitted it was meant to promote a gender-critical (i.e. fringe and pseudoscientific) narrative, a narrative recently described as extremist by UN Women[9]. The insistence that the counter-report (that engages with the Cass report based on mainstream scholarship) should meet a completely different standard is just weird. It's an expert report by eight reputable scholars, published by Yale. --Amanda A. Brant (talk) 16:21, 5 July 2024 (UTC)[reply]

Several international medical orgs[edit]

@Kronix1986

You’ve been reverted several times at this point for changes to the lede in direct contradiction to the article. Take it to talk. Snokalok (talk) 14:43, 5 July 2024 (UTC)[reply]

I'm not Kronix. When challenged to provide citations showing non-WPATH orgs critising the Cass Review, you pointed to this article which contains statements from the AAP and the Endocrine Society. Neither of these statements criticises the Cass Review. The AAP's does not mention the review at all. The Endocrine Society's simply said that the evidence presented didn't cause them to update their guidelines. None of the other international health bodies summarised in the body are described as criticising the Review either, the closest thing is the Dutch org disagreeing about the state of evidence for puberty blockers. This is all in very stark contrast to the WPATH responses summmarised immediately below, which contain harsh criticism of the credibility and methods of the Report. It is misleading to lump these two very different kinds of responses together. 212.36.63.7 (talk) 15:08, 5 July 2024 (UTC)[reply]
I don’t know how to tell you that an org saying “This paper’s conclusions/recommendations are wrong and outside of best practice” *is* a criticism. And if you read the entire Endocrine Society statement, it says “NHS England’s recent report, the Cass Review, does not contain any new research that would contradict the recommendations made in our Clinical Practice Guideline on gender-affirming care” and then spends a page explaining how puberty blockers and the like continue to be important despite Cass. That is a criticism. It’s saying very simply, “The Cass Review didn’t do any research that justifies a change in best practice, and its conclusions are out of step with the best ones, set forth here”. I don’t disagree WPATH’s criticism is harsher. But criticism of conclusions and outcome is still criticism. Snokalok (talk) 15:14, 5 July 2024 (UTC)[reply]
criticism of conclusions and outcome is still criticism. It doesn't even say what Cass' conclusions and outcome are to criticise them! The ES statement says that Cass produced no new evidence that would change its position, and then gives an almost boilerplate outlining of what that existing position is. This is a very creative interpretation of a document that doesn't engage with the content of Cass at all as 'criticism' of it. 212.36.63.7 (talk) 15:25, 5 July 2024 (UTC)[reply]
I think an acceptable compromise to this would be using language to the effect of 'disagreed with its conclusions' with the existing citations. It is simply not true, given the evidence currently in the article, that the report has been substantively criticised by any non-WPATH medical organisations. 212.36.63.7 (talk) 15:31, 5 July 2024 (UTC)[reply]
It should also be noted that the 'several international medical organisations' language in the article predates the AAP and ES statements by a week or two. In my view it's always been a misleading attempt to characterise WPATH and its regional affiliates as independent expert authorities. 212.36.63.7 (talk) 15:14, 5 July 2024 (UTC)[reply]
They are independent expert authorities. That’s their entire point, they are the expert medorg on trans healthcare. Before 2013 they recommended conversion therapy. After 2013 they changed their approach to affirmation as that proved to be a better mode of treatment. They’re not some sort of activist org as you seem to think, simply because they disagree with the British media Snokalok (talk) 15:16, 5 July 2024 (UTC)[reply]
The regional affiliates of WPATH are not independent of WPATH, obviously, so presenting them as assorted 'international medical organisations' rather than one umbrella organisation is highly misleading. 212.36.63.7 (talk) 15:25, 5 July 2024 (UTC)[reply]
This is a tangent:
I think we have done a poor job of highlighting areas of agreement. For example, the Cass Report and its critics all agree that some sort of gender-affirming care is appropriate for some people. Everyone agrees that the UK needs to put more money/resources into caring for trans kids. Everyone agrees that the UK needs to put more money/resources into caring for kids with mental health issues (trans and non-trans). Everyone agrees that the number of people seeking care is higher than it used to be. Everyone agrees that the percentage of trans kids who have autism (15% of all trans kids) is higher than the percentage of non-trans kids without autism (1 or 2% of all non-trans kids). Everyone even agrees that the state of research isn't ideal; the only dispute is over whether it's (barely) good enough in certain specific areas to justify those specific treatments, or not really good enough.
If you glance down this article, it doesn't give that impression. The overall impression is that Cass says some things, and they're wrong, wrong, wrong! (Or, if you're on the other political side, that they're right, right right! to draw opposition from the pro-trans groups.) I wonder if we could fix this, so that we highlight areas of agreement. Imagine a world in which people, perhaps first hearing a speech from a conservative politician and then reading this article, could discover that the Cass Report actually recommends (for example) enrolling trans kids in a research program that will give them puberty blockers. WhatamIdoing (talk) 16:26, 5 July 2024 (UTC)[reply]
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