In the following brief commentary, Peter Jenkins casts a critical eye over EPATH’s recent published response to Cass. He notes that EPATH is highly selective in its approach, based on the unreliable WPATH Standards of Care 8, and argues for expanding gender affirming care, despite Cass’s conclusion that the evidence base for such an approach is weak and inconclusive.
Rationale for the Cass Review
The EPATH response is highly selective in its choice of terms regarding the rationale for the establishment of the Cass Review. Hence,
“The review took place after concerns arose around the increase in referrals, the evidence base for provided care, and the functioning of the NHS Tavistock Clinic’s Gender Identity Development Service…” (1).
In truth, the Cass Review actually arose out of the damning Care Quality Commission inspection report of the GIDS in 2020, which deemed the GIDS to be ‘inadequate’. This inspection had in turn been prompted by professional concerns brought to light by the landmark judicial review by Keira Bell and others regarding the use of the Gillick principle to obtain consent for experimental treatment for gender dysphoria.
Research
EPATH claim that:
“clinical research evaluations, like Cass now recommends in England, have always been part of adolescent transgender care in the Netherlands…”
There is research, and then there is conclusive research. Clearly, not all research is of equal value. The original Dutch research had a limited, highly selective sample (n: 55), which has been over-generalised to other completely dissimilar populations, with a preponderance of young female adolescents. EPATH’s positive reference to WPATH Standards of Care is unconvincing and very concerning. WPATH SOC 8 concluded, in spite of the overwhelming evidence to the contrary, that “a systematic review regarding outcomes of treatment in adolescents is not possible…” (Coleman, et al, 2022: S46). It has now emerged from the recent release of US court documents that WPATH allegedly commissioned a systematic review from Harry Hopkins University, but then blocked its further publication because it failed to provide the required evidence.
Public health stance
EPATH start from the completely mistaken premise about the rights of young people to access gender healthcare. This is taken from the WPATH private enterprise model of full patient autonomy and consequent open access to stepped gender affirming care, without any government interference. Cass follows a much more cautious well-established public health model, governed by the principle of ‘First, do no harm’, based on systematic reviews, caution in authorising potentially harmful medications, and primary reliance on psychological interventions. This stance is now taken by medical and therapy associations in Finland, Norway, Sweden, Denmark, Germany, France, Italy and the UK, in an emerging Pan-European consensus, with which EPATH is clearly out of step. (See Figure 1: The emerging Pan-European consensus on a public health approach to gender care.)
Figure 1: The emerging Pan-European consensus on a public health approach to gender care.
Rather than assuming, as EPATH does, that “expanding care is important”, the very diagnosis of the supposedly ‘transgender child’ is a self-fulfilling ideological narrative, lacking scientific proof or testable criteria, apart from self-declaration by the child patient. EPATH’s unverified claim regarding “an adolescent’s right to participate in their own decision-making process” in obtaining unsafe and potentially lifelong harming and irreversible medical interventions was decisively refuted by expert evidence in the Keira Bell judicial review, in acknowledging the strict limits to the Gillick principle as applied to accessing puberty stopping medication.
https://epath.eu/response-cass-review-on-transgender-care-for-adolescents/
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