The BMA’s position on puberty blockers contradicts a fundamental principle of medicine: first, do no harm | Sonia Sodha

Wtrust the doctors with our health. Patients have a right to expect that doctors will make decisions based on evidence-based clinical guidelines, not old-fashioned, “first, do no harm” principles. That’s perhaps no more important than when it comes to life-changing medical treatments for children.

So it is difficult to understand the decision of the governing body of the medical body, the British Medical Association, to pass a recommendation criticizing a rigorous review of the evidence of health care for gender-queering children, led by the distinguished doctor of children Hilary Cass.

It is a highly contested area of ​​medicine, which is why NHS England commissioned an independent review in 2020. Cass published its final damning report in April, concluding that the NHS’s specialist medical center equality for children – now closed – puts an unknown but significant number. children who are questioning their gender with anti-puberty drugs and/or sex hormones, undeterred by the lack of evidence of benefit and the potential risks to their long-term health.

This happened despite the fact that studies suggest that gender dysphoria resolves naturally in most children; it is often associated with other underlying causes, including youth dealing with same-sex attraction, neurodiversity, childhood trauma, fear of puberty (especially -most girls) and mental health problems; and that a childhood diagnosis of gender dysphoria does not predict long-term identity in adulthood. In other words, there is a real danger that putting children on a medical path can seal temporary frustration into something permanent.

The review recommends a comprehensive review of NHS services for children questioning gender: a comprehensive, treatment-first approach, with virginity restrictions only offered to young patients as part of an NHS research trial – recommendations that the NHS has made.

There are no two ways about it: Cass’s review pulled back the curtain on how gender-queer children have failed the medical profession. You might think that would make someone think. Not at the BMA: it has just announced that its governing body of 69 doctors has passed a motion accusing the Cass review of making “unsubstantiated claims”, calling for the BMA to “publicly condemn” the review and “allow … the implementation of its recommendations”, including stopping the use of unproven drugs in children. The BMA has also, surprisingly, asked the government not to implement the Cass review when It’s doing its review. It would be one thing if the BMA had a serious review. It didn’t tell me what the recommendations were of Cass, which the court believes lacks evidence, said it would not prejudge its review. it must also declare a conflict of interest – as evidence of sufficient concern about the audit process to justify its suspension.

The Yale Law School paper cited by the BMA was written by a mix of legal and medical experts, many of whom are members of the International Association of Professionals for Transgender Health. WPATH is a US organization whose clinical guidelines for gender-queer children were directly criticized by the Cass review for lacking development power and failing to address its systematic review of testimony. Evidence has emerged suggesting that WPATH actually tried to suppress the systematic reviews it commissioned from Johns Hopkins University because the results undermined its preferred method, and that it was suppressed by the Biden administration. removing the minimum age of treatment from its standards of care by 2022. . The Cass review also found the study of at least one of the paper’s authors to be of low quality.

The second paper that the BMA cites is an article that takes the view that evaluating these medical interventions for mental health outcomes is a misguided endeavor because it “resists the depathologization of transness”. One of its authors is the original contributor to a public letter spreading misinformation about Cass’s testing methodology that has since been completely debunked.

What position did the BMA find itself in when its doctors demanded that the NHS return an anonymous prescription to children, prompting the Academy of Royal Medical Colleges and the Association of Clinical Psychologists to issue statements in support of the review? I have spoken to several of its members who are very angry at the lack of consultation outside the council, elected by only 7% of the BMA’s 160,000 members, and the way this seems to have been organized behind the scenes. doors, although an advisory committee last year passed a motion to the BMA to run a Cass inspection hearing. One member of the council came out of the report saying that he believed that the position of the BMA was not aligned with its members.

It is not the first time the BMA has embarrassed itself by getting involved in critical health policy issues that it does not fully understand; did the same on Covid vaccines in 2021.

The leadership of the BMA appears to be embroiled in a cross-examination, characterized by a campaign of misinformation by activists and academics who do not like the findings of the Cass review. That campaign included an unsuccessful judicial review of the state’s decision to ban the private prescription of blockers for gender dysphoria (the high court last week ruled that Cass’s review amounted to “compelling evidence of science that supports restrictions on the supply of youth blockers.”), and the false allegations made about youth and suicide that the government’s adviser on suicide prevention described last month as “distressing. and dangerous”.

Yes, the BMA is run by doctors. But it was the first nurses who caused this scandal. The BMA’s intervention serves as a reminder of how easily some doctors can be blinded by misinformation on the reasons, rationale and evidence that is important to patients.

It shows that the coverage of the Cass test is not enough. Many doctors who stand by “first, do no harm” must ensure that their colleagues return to the evidence related to this group of vulnerable children who deserve the most benefit from the work of medicine.

Sonia Sodha is a columnist for the Observer

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