Latest news with #LadyCass
Telegraph
01-05-2025
- Health
- Telegraph
NHS puberty blocker trial ‘not ethical', finds Trump-backed review
An NHS puberty blocker trial is 'not ethical', according to a Donald Trump-ordered review of children's gender medicine. The US federal review goes even further than Britain's Cass Review by raising 'serious concerns about medical interventions' of any form in children and teenagers. Its Department of Health and Human Services concluded that 'the overall quality of evidence is very low' to justify giving puberty blockers or cross-sex hormones to adolescents, including in trials such as the Pathways research planned by the NHS. The highly critical review likens the trial of puberty blockers by the health service to trying to test the harms of jumping out of a plane without a parachute. It was ordered by Mr Trump within days of taking office, having made gender ideology a central theme of his campaign in the run-up to the election. Dr Jay Bhattacharya, the director of the National Institutes of Health, which is responsible for public health research in the US and contributed to the report, said: 'Our duty is to protect our nation's children – not expose them to unproven and irreversible medical interventions. 'We must follow the gold standard of science, not activist agendas.' The findings echo the Cass Review, led by retired paediatrician Baroness Cass, who said gender medicine had been built on 'shaky foundations' and called for an end to the medical and 'affirmative' approach to treating children with gender dysphoria. While the anonymous authors of the 409-page report agreed with Lady Cass that there was a lack of evidence to support the use of powerful puberty blockers in children, it went further by declaring that the potential for harms to children were known. They said that for the use of drugs in children experiencing gender confusion, 'the evidence base does not support strong conclusions about their effectiveness'. And that 'the evidence for harm is less uncertain', arguing that there is a clear biological basis for believing they carry significant risks, and that the lack of thorough studies into the harm caused does not mean it does not exist. 'We can be certain in the ordinary sense of 'certain' that these interventions cause harm, even if we do not have 'high certainty' evidence in the technical sense,' the report said, citing the 'experimental nature' of the interventions, including removing breasts or interfering with the reproductive system. The authors also liken the trialling of the drugs to an 'unethical parachute test'. It said: 'The likelihood of infertility when puberty blockers are provided at the early stage of puberty and followed by cross-sex hormones does not have to be demonstrated in a clinical trial. This is because the mechanism is well understood and conducting a trial would amount to an unethical 'parachute test'.' The work builds on the work by Lady Cass and points to a 'a growing body of evidence pointing to significant risks – including irreversible harms such as infertility – while finding very weak evidence of benefit'. The federal review also said attacks on Lady Cass by pro-trans US doctors were 'ridden with misrepresentations of the Cass review and contain multiple factual errors'. But while Lady Cass recommended a trial of the treatment to establish both benefits and harms, those in the US argued it 'may conflict with well-established ethical standards for human subjects research'. They cited recommendations from the World Medical Association that doctors must understand risks properly before beginning a trial, and point to the Nuremberg Code, which was drawn up in response to Nazi medical experiments and say trials should be designed so that 'the anticipated results will justify the performance of the experiment'. They said: 'It is not ethical to subject adolescents to hormonal and surgical interventions used in [child transition], even in a research trial, until and unless the state of the evidence suggests a favourable risk-benefit profile. 'The state of the science does not support a favourable risk/benefit profile, nor does it give researchers a basis for confidence that the risks of [treatment] can be satisfactorily managed.' The review was contributed to by medical doctors and ethical experts and made up of people across the political spectrum with underlying commitment to scientific principles. It also criticised the use of phrases such as 'assigned sex at birth', which suggested an 'arbitrary decision' rather than 'the observation of a characteristic present long before birth, namely the child's sex'. It claimed that activists 'go to extraordinary lengths to avoid the plain use of these [biological] words, and related words such as boy and girl'. An NHS spokesman said: 'As is the case with any rigorous academic study, the Pathways proposal has been subject to independent academic peer review and a review by the National Institute of Health and Care Research committee – ahead of progressing to the usual strict ethical and regulatory approvals, which ensure stringent safeguards in scientific research.'
Yahoo
01-05-2025
- Health
- Yahoo
NHS puberty blocker trial ‘not ethical', finds Trump-backed review
An NHS puberty blocker trial is 'not ethical', according to a Donald Trump-ordered review of children's gender medicine. The US federal review goes even further than Britain's Cass Review by raising 'serious concerns about medical interventions' of any form in children and teenagers. Its Department of Health and Human Services concluded that 'the overall quality of evidence is very low' to justify giving puberty blockers or cross-sex hormones to adolescents, including in trials such as the Pathways research planned by the NHS. The highly critical review likens the trial of puberty blockers by the health service to trying to test the harms of jumping out of a plane without a parachute. It was ordered by Mr Trump within days of taking office, having made gender ideology a central theme of his campaign in the run-up to the election. Dr Jay Bhattacharya, the director of the National Institutes of Health, which is responsible for public health research in the US and contributed to the report, said: 'Our duty is to protect our nation's children – not expose them to unproven and irreversible medical interventions. 'We must follow the gold standard of science, not activist agendas.' The findings echo the Cass Review, led by retired paediatrician Baroness Cass, who said gender medicine had been built on 'shaky foundations' and called for an end to the medical and 'affirmative' approach to treating children with gender dysphoria. While the anonymous authors of the 409-page report agreed with Lady Cass that there was a lack of evidence to support the use of powerful puberty blockers in children, it went further by declaring that the potential for harms to children were known. They said that for the use of drugs in children experiencing gender confusion, 'the evidence base does not support strong conclusions about their effectiveness'. And that 'the evidence for harm is less uncertain', arguing that there is a clear biological basis for believing they carry significant risks, and that the lack of thorough studies into the harm caused does not mean it does not exist. 'We can be certain in the ordinary sense of 'certain' that these interventions cause harm, even if we do not have 'high certainty' evidence in the technical sense,' the report said, citing the 'experimental nature' of the interventions, including removing breasts or interfering with the reproductive system. The authors also liken the trialling of the drugs to an 'unethical parachute test'. It said: 'The likelihood of infertility when puberty blockers are provided at the early stage of puberty and followed by cross-sex hormones does not have to be demonstrated in a clinical trial. This is because the mechanism is well understood and conducting a trial would amount to an unethical 'parachute test'.' The work builds on the work by Lady Cass and points to a 'a growing body of evidence pointing to significant risks – including irreversible harms such as infertility – while finding very weak evidence of benefit'. The federal review also said attacks on Lady Cass by pro-trans US doctors were 'ridden with misrepresentations of the Cass review and contain multiple factual errors'. But while Lady Cass recommended a trial of the treatment to establish both benefits and harms, those in the US argued it 'may conflict with well-established ethical standards for human subjects research'. They cited recommendations from the World Medical Association that doctors must understand risks properly before beginning a trial, and point to the Nuremberg Code, which was drawn up in response to Nazi medical experiments and say trials should be designed so that 'the anticipated results will justify the performance of the experiment'. They said: 'It is not ethical to subject adolescents to hormonal and surgical interventions used in [child transition], even in a research trial, until and unless the state of the evidence suggests a favourable risk-benefit profile. 'The state of the science does not support a favourable risk/benefit profile, nor does it give researchers a basis for confidence that the risks of [treatment] can be satisfactorily managed.' The review was contributed to by medical doctors and ethical experts and made up of people across the political spectrum with underlying commitment to scientific principles. It also criticised the use of phrases such as 'assigned sex at birth', which suggested an 'arbitrary decision' rather than 'the observation of a characteristic present long before birth, namely the child's sex'. It claimed that activists 'go to extraordinary lengths to avoid the plain use of these [biological] words, and related words such as boy and girl'. An NHS spokesman said: 'As is the case with any rigorous academic study, the Pathways proposal has been subject to independent academic peer review and a review by the National Institute of Health and Care Research committee – ahead of progressing to the usual strict ethical and regulatory approvals, which ensure stringent safeguards in scientific research.' Broaden your horizons with award-winning British journalism. Try The Telegraph free for 1 month with unlimited access to our award-winning website, exclusive app, money-saving offers and more.
Western Telegraph
01-05-2025
- Politics
- Western Telegraph
Generation will be lost to poor mental health without safeguards on tech
Baroness Hilary Cass said the impact of smart devices on children's sleep, attention span, and education is 'not just a moral problem but an economic timebomb'. The independent crossbencher called for teachers to receive dedicated training on the issue, in addition to education for parents, as peers debated the Children's Wellbeing and Schools Bill. Independent crossbencher Lady Cass (Yui Mok/PA) Then-Dr Hilary Cass previously led a landmark review into gender services for young people, which found children had been let down by a lack of research and evidence on the use of puberty blockers and hormones. Speaking during the Bill's second reading debate on Thursday, she told the Lords: 'Any legislation addressing the subject of safeguarding children, and opportunity, and safety in schools, cannot possibly ignore the impact of digital technology on the lives of children and young people.' Lady Cass argued it's not just 'deliberate harm', such as cyber bullying, emotional abuse, sexual abuse, exploitation and grooming that children are at risk of. 'That's just the tip of the iceberg, there are multiple other risks associated with digital technology that have been discussed in this House, including adverse affects of learning, attention, sleep, educational attainment and mental health. 'And addictive apps are particularly a problem, especially for boys,' she said. We are looking at losing a generation to poor mental health and to even more young adults being unable to contribute to the workforce Lady Cass Lady Cass continued: 'This is not just an issue of whether we ban smartphones in schools, there's a wide array of possible actions that can be part of a strategic, multi-faceted approach to the problem. 'For example, RSE (relationships and sex education) is compulsory in schools, and yet there is no requirement to teach young people how to manage the digital technology that occupies so many hours of their lives. 'Nor indeed to include appropriate training for the staff that are teaching our infants or older children. 'There's insufficient consideration of the impact of loss of safe place spaces, which would give children alternative recreational activities to spending time on their digital devices. 'There's no focus on providing education and advice to parents on how to manage access to technology so that they can facilitate their children's learning and development. 'So I very much hope that the Government will be receptive to a range of amendments that will address these deficits in the Bill, and thus gift our children with a safer, healthier future. 'Without such measures we are looking at losing a generation to poor mental health and to even more young adults being unable to contribute to the workforce. 'So this is not just a moral problem, but an economic timebomb that we can ill afford.'
Telegraph
27-04-2025
- Health
- Telegraph
NHS to test all ‘trans' children for autism
The NHS will test all children who believe they are transgender for autism under new plans seen by The Telegraph. Every child referred to a gender clinic will be 'screened for neurodevelopmental conditions' such as autism and ADHD under new guidance, to be introduced in the wake of the Cass review. The review, by paediatrician Baroness Cass, found that the mental health conditions were disproportionately common among children and young people with gender dysphoria. Medics will also evaluate each child's mental health, their relationship with their family and their sexual development, including whether they are experiencing same-sex attraction. As part of a proposal to incorporate Lady Cass's recommendations, the health service will move away from the 'medical model' operated by the controversial Tavistock's Gender Identity Development Service in favour of a 'holistic' approach. The new guidance will be released for public consultation imminently before being rolled out later this year. It will be used by established children's gender clinics in London and Manchester, and was reviewed by Lady Cass at the start of 2025. Medics will also evaluate each child's mental health, relationship with their family and sexual development, including whether they are experiencing same-sex attraction. However, some groups criticised a 'serious flaw' in the policy as it leaves an open door to the use of cross-sex hormones. They also condemned its absence of recognition of the wider societal issues to which children are exposed. Policy probes eight key areas The new NHS Children and Young People's Gender Service will explore eight key areas of a child's life. To assess 'development', doctors will take a 'detailed history' of the child's social, cognitive and physical growth, particularly because of the 'substantial' changes that take place during puberty. They will screen children for autism and learning disabilities and look into whether further 'cognitive assessments' are necessary. The specification says: 'Given the high prevalence of neurodiversity identified within this population, all those attending the NHS Children and Young People's Gender Service should receive screening for neurodevelopmental conditions.' The 'multidisciplinary team' of experts, including a consultant specialising in neurodevelopmental disorders, will create a treatment plan for each individual depending on their diagnosis. If screening 'identifies the presence of neurodevelopmental conditions, including autism spectrum disorder (ASD), a referral should be considered to the Paediatric Neurodevelopmental Service or Paediatric ASD Service,' the guidance states. In such cases, the team of doctors will have to determine if the child's symptoms are caused by autism or whether they also need separate treatment for gender dysphoria. They could also be kept under review every six months while getting help for their autism or discharged from the service. Cases of both conditions have risen sharply in recent years. Recorded rates of gender confusion in under 18s have risen from 0.14 per 10,000 people in 2011 to 4.4 per 10,000 in 2021, driven largely by girls entering adolescence. At the same time, autism has gone from being diagnosed in about one in 2,500 children, to one in 34 children aged 10-14 as of estimates for 2018. Prof Michael Craig, clinical lead for the NHS National Autism Unit from 2007 until 2023, previously estimated half of patients seen by the Tavistock's clinic had autism after observing sessions. In her review, Baroness Cass linked the rise in teenage girls 'struggling with gender identity, suicidal ideation and self-harm' with cases of 'undiagnosed autism, which is often missed in adolescent girls'. She said it was the 'common denominator' with one study finding transgender people were three to six times more likely to be autistic than those who are not. Patients at the new service will also undergo a thorough mental health assessment because of the 'higher rates of mental health difficulties' among gender-questioning children. The NHS guidance described a previous 'reluctance to explore or address' mental health conditions because gender dysphoria was not classified as one, but said that 'identifying and treating' any mental illness should be an 'integrated part' of their care. It added that they should undergo a 'mental state examination' and be questioned about 'mood, anxiety, emotional regulation, beliefs around weight, potential somatic symptoms, concentration, sleep and appetite, self-harm, and suicidal thoughts and behaviours'. 'Family context' Another key area is dubbed 'family context', with medics being tasked to paint a picture of each child's upbringing and familial relationships. The specification noted that 'there is evidence of an increased frequency of family parental physical and/or mental ill health and other family stressors in this group'. Under the section titled sexual development, knowledge and sexual orientation, it said 'clinicians should seek to understand the child/young person's emerging sexuality and sexual orientation'. If this has been a previous issue, doctors should consider whether the child was exposed to 'adversity and trauma'. They will also examine the children's physical health needs and the impact of any long-term conditions, along with their broader well-being, school relationships and educational attainment. Medical teams will 'undertake an in-depth assessment' of how the gender dysphoria 'manifested', how it has been managed by the family, if any 'social transition' has taken place and the impact of any distress caused. They have been told to look out for 'safeguarding issues' such as 'transphobic bullying', 'online grooming' and a 'breakdown in relationships with families'. The Clinical Advisory Network on Sex and Gender welcomed the 'proposed holistic approach and prioritisation of psychological interventions'. NHS wait times 'very long' Dr Louise Irvine, a GP and the group's co-chairman, said: 'The new service recognises that many also experience mental health, neurodevelopmental and/or personal, family or social complexities in their lives. 'The challenge will be to ensure NHS services can provide prompt access to appropriate service for any identified needs as waiting lists are currently very long.' But she went on to say a 'serious flaw' in the policy was that it 'leaves the door open for referral of children and young people under 18 for cross-sex hormones'. She described the guidance's reference to a drug policy that is 'seriously out of date, was published before the Cass Review and does not take on board the scientific reviews which showed lack of evidence of benefit of hormones in this group' as 'irresponsible'. A spokesman for Bayswater Support Group, which advocates for evidence-based care on behalf of 600 families with trans-identifying children, said: 'The more careful and holistic assessment by the NHS is welcome, however, there is still scant recognition of the environmental factors influencing children's understanding of gender issues. 'Schools continue to teach gender identity as fact and socially transition children without parental consent. Young social media influencers monetise content claiming the health benefits of controversial medical treatments. 'And authority figures, including politicians, cast doubt on the findings of the Cass Review and falsely associate evidence-based findings with far-Right narratives.' They added: 'Within this context, it is very difficult indeed for professionals to make accurate diagnoses or to determine the most effective support for a patient experiencing distress.' An NHS spokesman said: 'We will soon be going to full public consultation on this draft specification which sets out the new holistic assessment framework that was described by Dr Cass in her report. 'NHS England has recently changed the referral pathway so child patients can only access gender services that we commission if they're referred by a paediatrician or a child and adolescent mental health worker.'
