World Professional Association for Transgender Health (WPATH) Files

Adams and her colleagues asked for guidance about how to answer service users who wanted to know if AB was male. They were told to tell rape victims requesting female-only care that ERCC does not employ men.

But this wasn't true, was it? Because Mridul Wadhwa, for one, is male and has no GRC which is required in Scottish law for someone to be considered legally female.

Secondly, Roz Adams was basically witch-hunted out of ERCC for daring to ask this sort of question in the first place. And that was not just done by Mridul Wadhwa, but by a number of women including several higher up, such as Sandy Brindley. And condoned by Nicola Sturgeon.

But this wasn't true, was it? Because Mridul Wadhwa, for one, is male and has no GRC which is required in Scottish law for someone to be considered legally female. 

It was true from the point of view of the Management of the organisation. Roz knew this too long before she sent an email to management cc’ing the counsellor in question, when she went walkies with the Chief Operating Officer back when she had just joined the organisation:

Adams had at first welcomed the centre’s trans-inclusive policies, the tribunal heard. However, in December 2020, the rape centre worker went for a walk with Maggie Chapman, Green MSP for North East Scotland, who was then the chief operating officer for ERCC.

The judgment stated: “This was the first time that [Adams] heard what she described … as the ‘mantra’ that ‘trans women are women’.

“She felt concerned that there was no real definition or clarification associated with this statement. She felt it was odd.

“Once she started work she felt it became more and more apparent that there were issues regarding the way that gender issues were dealt with in the organisation … She described things around the issue as being ‘eggshelly’.”

The panel heard that a particular issue for Adams, referred to as the claimant, was what to say to service users who wanted to be sure that they would be seen by someone who was biologically a woman.

https://www.thenational.scot/news/24332247.dismissed-rape-centre-worker-wins-tribunal-case-gender-beliefs/


The intake interview and subsequent matching with a counsellor who fits the users preferences is all that is required there. It’s not the issue Adams was making it out to be. It’s not as though Adams couldn’t have been aware of the circumstances involved:

Wadhwa began receiving abuse in 2019, while working as the director of the Forth Valley rape crisis centre in Stirling. The abuse intensified after she announced her candidacy as an SNP MSP in the 2021 Scottish Parliament election, and intensified again after her appointment as director of the Edinburgh Rape Crisis Centre (ERCC). The abuse received at the ERCC included hate speech on social media and on phone calls, letters and emails containing baseless accusations of predatory behaviour, racist commentary, and threats of vigilante violence. Nearly all comments intentionally misgendered Wadhwa.

Articles criticising Wadhwa were published on the websites of Wings Over Scotland and The Christian Institute, with the series of articles by The Christian Institute amplified by the United States-based Christian Today and Life Site News. YouTuber Kellie-Jay Keen-Minshull released a video which, according to OpenDemocracy, "made a series of unfounded and unevidenced accusations about Wadhwa and her work". Referring to Graham Linehan, OpenDemocracy said "the first time Wadhwa says she truly feared for her life was when Linehan published part of her home address".

https://en.m.wikipedia.org/wiki/Mridul_Wadhwa

Secondly, Roz Adams was basically witch-hunted out of ERCC for daring to ask this sort of question in the first place. And that was not just done by Mridul Wadhwa, but by a number of women including several higher up, such as Sandy Brindley. And condoned by Nicola Sturgeon.

Yes she was, there’s no disputing that as that’s exactly what happened, which is why Adams won her case for constructive dismissal. The reason I pointed out that she wasn’t fired, that she resigned, is because that’s the only way she could have pursued a case for constructive dismissal. Hell of a difference between being fired, and being constructively dismissed. The EAT and the subsequent independent investigation commissioned by RCS didn’t seek to establish whether it was appropriate for the organisation to employ Wadhwa either.

I think the poster you responded to claimed that Cass is not a scientist, but the last time I looked, doctors received a thorough training in various branches of science. On top of that, Wikipedia calls Medicine a "health science":

Medicine is an applied science or practice of the diagnosis, treatment, and prevention of disease.

There seems to be some sort of an agenda here, and truth appears to me to be a casualty.

But nobody in this discussion at least has said anything to imply that Cass is a ‘random GP’ in the first instance? If it’s been said somewhere else, then that person is quite likely attempting to discredit Cass, whereas making the point that she is not a scientist, but is rather a Physician, is not in any way attempting to discredit Cass. Even if there were any doubt as to whether or not she is a Physician or a scientist, the letters after her name would offer a clue, as opposed to claiming that the inclusion of Medicine in Health Sciences (an academic area of expertise) indicates Cass is to be regarded or recognised as a scientist.

Frankly it’s a bit of a head-scratcher to refer to Cass as a scientist, which is something I might understand if the person referring to her as a scientist either isn’t familiar with her background, or imagines that she is merely a glorified GP (they’re actually a lot more fun - they’re not consultants, they just charge consultants rates), but they’re not nearly as fun as this particular plane passenger:

https://nypost.com/2018/09/07/passenger-with-phd-ripped-for-insisting-airline-call-her-doctor/

I wouldn’t want to be on that plane experiencing a cardiac event and someone asking is there a doctor on board; someone with the requisite knowledge to administer emergency first-aid will do, regardless of their title or career choice 😁

You don’t clarify whether the story I linked to was irrelevant to the discussion because it’s irrelevant, or simply because you found it annoying on the basis that you’re someone who refuses to refer to your doctor as “Dr.” I don’t see why, but that’s between yourself and your doctor.

The reason the story I linked is relevant is because it relates to how there are people who do actually prefer to be referred to by their title (whether informed by magical thinking or otherwise), and that’s why for some people it was important that Cass be recognised as a scientist - because in their minds qualifications as a scientist are more important than qualifications as a doctor in the role of chair of an independent review into gender identity services for children and young people. Such an over-evaluation, or an evaluation that one role carries more weight than another in that context is an attempt to lend authority to their position. In reality, Cass was always eminently qualified anyway for the role - based not just upon her qualifications, but also her experience in paediatric medicine, her consultant experience and her management experience in GOSH and Evelina Children’s Hospitals.

Essentially - anyone attempting to discredit her or question her suitability for the role of chair of the independent review, could take a running jump.

As far as the links you provide bear relevance to the discussion, well I did waste an hour listening to the podcast, which was less informative than an ICA meeting in that most of it was comprised of their negative experiences of the public education system in the US, which is relevant in the sense that that’s where WPATH are based I guess, an organisation which promotes the idea of social transition in public life for children who are transgender. The whole point of the podcast is that its audience, apart from supporting their cause, were meant to find everything they described, disturbing. So it’s no surprise that you did find their description of the evolution in focus of the ACLU, disturbing. Anyone who is actually familiar with the evolution in focus of the ACLU might still find it disturbing too, but it’s been evolving since the evolution of the Civil Rights movement in the US, even 10 years ago when the ACLU published this article which gives the history of their involvement in advocacy on behalf of people who are transgender:

https://www.aclu.org/documents/aclu-history-advocacy-behalf-transgender-people

As far as the relevance of the article published by Sex Matters is concerned, well they too, like the ACLU, are a political advocacy organisation, and the value of their opinion as regards the correspondence between Cass and the NHS is limited, even more so when they would engage in promoting the magical thinking contained in the letter written by Cass where she states that she has not attempted to validate the accounts she received, but hopes that the themes contained in accounts that amount to hearsay and conjecture (given the lack of evidence), would be considered helpful to the NHS as it embarks on the review of adult services. I sense a theme, a theme, as Andrew Klavan says, is starting to, arise (under other circumstances I’d recommend his video reacting to the phenomenon of ‘speed cleaning’, but here I’d struggle to make it relevant).

The theme I’m referring to in this particular circumstance, is that of magical thinking. Magical thinking in itself, as I’m certain you’re acutely aware, is not limited to the concept of Evidence-based Medicine (need to be careful how one spells that, I almost spelled it ‘Evidence-biased Medicine’, would’ve given a completely different impression), and in the example of Cass’ letter to the NHS, the only thing that’s evident is that Cass, much like Wadhwa earlier, does not understand the limits of her authority. But at least one positive point that can be made about Cass is that there is no evidence she relies on being referred to by her proper title in the practice of her profession, unlike some people who imagine a title puts their opinions above question or criticism. There are far better known examples in society of the kind of people who both engage in magical thinking, and who demand to be referred to by their proper title:

https://youtu.be/rggspuTEir8?si=WzngLa8IJfLZzcWr

The phenomenon is by no means new, unique, or limited to people who prefer when they are addressed in the third person, to be referred to by their preferred personal pronouns.

Qualifications indicate a bit more than someone has passed some exams - they’re a good indicator of many things. One of those things is that the person possesses the requisite relevant knowledge to be able to fulfil the requirements of the role assigned to them, in order to achieve a desired outcome. While Cass is eminently and unquestionably qualified to chair a review into the gender identity services for children and young people, whether or not she did a good job, is an evaluation which can only be considered on completion of the task.

There’s considerable disagreement as to whether it is actually the case that Cass performed the task correctly, but from the point of her employer, the NHS, who commissioned her to chair the review, she did - Cass provided the NHS with the outcomes they desired. On completion of the task she was assigned, she sought to further engage with the NHS review of adult services, and while her efforts were acknowledged, she was reminded in the most diplomatic language that she was now surplus to requirements. Essentially, she had done the job that was required of her, and now her services are no longer required. She was under no obligation whatsoever, moral, professional or otherwise, to attempt to influence the review process in which her participation was not requested.

You’ve seen comments to the effect of “Cass review criticised”, and I’d agree, there isn’t much substance to the comments, no more than there’s any substance to Cass’ comments outlined in her correspondence with the NHS. Does it occur to you that critics of the review too have a moral, ethical or professional obligation to do so? There’s no substance to the comments other than reporting that some group or other doesn’t like the conclusions, but have you taken it upon yourself to investigate why those groups don’t like the conclusions? I have, and there are a whole variety of reasons, some with greater legitimacy than others, some with none, like Cass’ correspondence with the NHS in which she makes claims while failing to provide supporting evidence for her claims. It’s not the first time she does this, it’s also a feature of the review:

https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf

https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2362304#d1e510

It’s the primary reason why I said earlier in the thread, upon reading the review, that it was only useful as bog roll, and even then only in a pinch (one isn’t required to be an engineer to appreciate the difficulty in flushing 80gsm paper round the U-bend, though granted the issue presents differently for Americans with their vacuum toilet system). I digress…

Sex Matters, or rather - it does for people who believe that sex matters, and in that respect the organisation unironically does not engage on any level whatsoever with science or fact. They remain an advocacy group whose most notable achievement to date has been to have what they refer to as ‘gender-critical beliefs’ recognised as a protected characteristic in employment law in the UK. To put that achievement in some sort of context - Ethical Veganism is a protected characteristic in UK employment law:

https://www.lewissilkin.com/en/insights/vegans-protected-by-the-equality-act-what-does-it-mean-for-employers

Sex Matters, as an organisation, though they do have scientists on their Board, don’t appear to make much use of them:

https://sex-matters.org/about-us/board/

How likely they are ever to contribute anything meaningful to science or scientific research or the advancement of science as an academic endeavour, is anyone’s guess really. One of the wonderful characteristics of science is that it is not subject only to the whims of a few scientists who regard themselves as being an authority on any particular subject matter:

https://www.cell.com/news-do/cell-sex-gender-focus-issue

Science, just like law, just the ACLU, evolves and adapts in order not just to survive, but to thrive, in spite of the attempts of some people to hold it back because they dislike where it’s going. Organisations like Sex Matters, by virtue of imagining that sex is the only characteristic that should matter to everyone, will continue to remain on the periphery of society, unironically an outlier in that context. If at some point they realise that their beliefs are not universal, there’s a chance they may evolve beyond the limits they have imposed upon themselves.

Regarding the link, and specifically the ton of shìt coming down on her head, it can’t have escaped your attention that has a tendency to happen when there is an attempt by some people to deprive another group of people of their liberty, or in this particular circumstance, their right to an education free of discrimination. In Maud’s case it happens when she makes stupid remarks about other people who don’t share her opinion that they should be deprived of their liberty and their rights which are recognised not just in the laws of New York State, but in Federal law. Maud has a rather curious habit of relying on the protection of the First Amendment when it suits her purposes, and weaponising the First Amendment against anyone whom she determines disagrees with her political beliefs, in the hopes that they will experience a ton of shìt coming down on their heads:

Maron, who recently said in a private chat that transgender children don’t exist, faced a barrage of criticism Wednesday night at the District 2 CEC meeting for her participation in the Thursday panel.

She doubled down on her decision Thursday night, accusing her critics of being “illiberal” and shying away from arguments. She singled out one young woman who recently challenged her stance on transgender children.

“She identified herself as a proud queer woman,” Maron recalled. “Which I think means she’s a straight girl without a boyfriend.” A parent at Thursday’s event subsequently challenged Maron on the comment, calling it “unnecessary and spiteful.”

https://www.chalkbeat.org/newyork/2024/01/19/protests-at-moms-for-liberty-new-york-city-visit/

https://www.the74million.org/article/as-nyc-removes-two-parents-from-ed-councils-free-speech-violations-charged/

As regards your experiences of the differences and similarities there are between the public education system in the US (Oregon specifically) and Ireland, it really does come down to personal preferences and personal circumstances. I am aware of teachers in Ireland who engage in that sort of over-familiarity with their students that they encourage their students to contact them outside of school hours (one of the things I dislike about the Educate Together philosophy is the idea that they encourage children to refer to teachers by their first name), but one of the good things about education both in Oregon and Ireland, is that schools are not permitted to treat students less favourably on the basis that they are transgender:

https://www.basicrights.org/news/victory-for-oregons-transgender-students

Being able to use the bathroom of their preference is a basic right which supports every child’s right to an education, no different than their equal participation in sports is supportive of their right to an education. If a child is prone to leaving skid marks, then that’s a toilet training issue that their parents need to address, not something which should be the responsibility of the teacher whose only authority is by virtue of the fact that they are recognised in law as acting in loco parentis, and certainly not the responsibility of the local parents council, some of whose members do not understand the limits of their authority in that passing resolutions to recommend policies which seek to limit the rights of others, does not mean that those people in higher positions of authority are required to take their recommendations seriously, no more than the NHS are required to take Cass’ correspondence seriously when she doesn’t understand the limits of her authority which are not overcome by either her qualifications, her experience or indeed her attempts to relate the purported experiences of others when it suits her purposes.

As so often, Jack, it's impossible to work through your posts in any detail, so the fact that I've ignored all but the bit below does not signify either agreement or disagreement. I just haven't really read it, TBH.

But this bit jumped out at me:

Being able to use the bathroom of their preference is a basic right which supports every child’s right to an education, no different than their equal participation in sports is supportive of their right to an education.

Being able to do something because you prefer is not a basic right. I'm not entitled to use the disabled toilets because I don't want to join the queue for the ladies, nor even because I feel that my advancing age should entitle me to when I have no actual disabilities caused by age.

Similarly "equal participation in sports" - males taking part in female sports is not "equal participation" - indeed it excludes females.

As so often, Jack, it's impossible to work through your posts in any detail, so the fact that I've ignored all but the bit below does not signify either agreement or disagreement. I just haven't really read it, TBH.

And you know I wouldn't have it any other way 😁

Being able to do something because you prefer is not a basic right. 

That's not what I said though?

I'm not entitled to use the disabled toilets because I don't want to join the queue for the ladies, nor even because I feel that my advancing age should entitle me to when I have no actual disabilities caused by age.

volchista you're entitled to use whatever toilet you prefer, without feeling any need whatsoever to explain yourself or justify your actions to anyone. There's no catch, there's no need to "surprise" anyone with the revelation that girls actually do piss, poop, and fart just like everyone else, y'know, you just… do you!

And that's why, similarly, as you put it - schools are not permitted to treat students less favourably on the basis that they are transgender:

In summary, we hold that Dallas School District No. 2’s carefully-crafted Student Safety Plan seeks to avoid discrimination and ensure the safety and well-being of transgender students; it does not violate Title IX or any of Plaintiffs’ cognizable constitutional rights. A policy that allows transgender students to use school bathroom and locker facilities that match their self-identified gender in the same manner that cisgender students utilize those facilities does not infringe Fourteenth Amendment privacy or parental rights or First Amendment free exercise rights, nor does it create actionable sex harassment under Title IX. Accordingly, Plaintiffs have failed to state a federal claim upon which relief can be granted. The judgment of the district court is AFFIRMED.

18-35708.pdf (uscourts.gov)

What I intended to say is exactly what I said, is exactly what you quoted:

Being able to use the bathroom of their preference is a basic right.

I didn’t say being able to do something because you prefer is a basic right, as if that applies to anyone and anything.

It doesn’t come as a surprise at all that’s what anyone believes about those door signs on bathrooms, but that’s all they are, is an indicator, not an order. Anyone can use whatever facilities are most comfortable for them, or convenient for them, whatever.

That’s what the case in Dallas was about - that a child who is transgender is permitted to use whatever bathroom they prefer, in the same manner as every child has that right. The parents and others who objected, sought to deprive children of the same rights as every child are entitled to. They failed to make their case. The outcome wouldn’t be any different in Ireland, but I’ve never heard of a school where it’s become an issue for the Courts yet - children use whatever bathroom they prefer and that’s about it, no fuss or melodramatics.

Singal hasn’t done any such thing. All he’s done is repeated other people’s accusations which is their opinion, based upon their reading of the affidavit provided by McNamara, which you’ve suggested is indicative of credibility issues on the part of McNamara, thereby meaning the report itself lacks credibility. You haven’t at all engaged with the substance of the report, what you actually did was make the point that you had seen comments that the Cass Review was this, that and the other, which is why I provided the actual report, and a critical commentary on the biological and psychosocial evidence in the Cass Review, which you didn’t engage with either:

https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2362304

You shouldn’t expect anything from the authors of the report, better, worse or otherwise, especially when in the very first lines of the report, right after the authors listed and acknowledgements of several contributing authors, they make this very clear:

This work reflects the views of individual faculty and does not represent the views of the authors’ affiliated institutions.

The authors and contributors include:

Meredithe McNamara, MD MSc, Assistant Professor of Pediatrics, Yale School of Medicine

Kellan Baker, PhD, MPH, MA, Executive Director, Whitman-Walker Institute

Kara Connelly, MD, MCR, Associate Professor of Pediatrics, Division of Endocrinology, School
of Medicine, Oregon Health & Science University

Aron Janssen, MD, Associate Professor of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine

Johanna Olson-Kennedy, MD, Professor of Clinical Pediatrics, Keck School of Medicine of
University of Southern California

Ken C. Pang, FRACP, PhD. NHMRC Leadership Fellow and Senior Principal Research Fellow,
Murdoch Children’s Research Institute, VIC Australia

Ayden Scheim, PhD, Assistant Professor of Epidemiology, Dornsife School of Public Health,
Drexel University

Jack Turban, MD, MHS, Assistant Professor of Psychiatry & Behavioral Sciences and Affiliate
Faculty at the Philip R. Lee Institute for Health Policy Studies, University of California, San
Francisco

Anne Alstott, JD, Professor of Law, Yale Law School

We would like to thank Richard Body, MB ChB, MRCSEd (A&E), FRCEM, PhD and Annelou de Vries, MD, PhD for their expert feedback on drafts of this report. We would also like to thank Jay Taimish, Colin Kim, Paola Vidal-Espinoza, and Schuylar Bailar for their excellent research support.

https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf

You’re hanging your hat on Singal’s efforts at nit-picking, misdirection and repeating another bloggers deliberate attempt to discredit McNamara by claiming her statements in an affidavit are misleading, false or perjurous even, without actually stating what statements he is referring to that he claims are misleading, etc. Your original point was that you hadn’t seen evidence of any substantive criticism of the Cass Review, my point was simply to present you with evidence of substantive criticism of the Cass Review. I couldn’t give a damn what Singal has to say about anything.

In a similar fashion, you presented the video earlier and posed the question as to why Maud Marron had a ton of shìt coming down on her head, and I presented evidence as to why Maud Marron had a ton of shìt coming down on her head, to which you responded that you didn’t expect anyone would actually watch the video. Why wouldn’t anyone watch the video? It didn’t amount to anything substantial in any case, worst part was Stella O’ Malley claiming she didn’t understand the Irish exam grading system that’s been in existence since 2015, while she claims an interest in youth mental health and well-being. She was talking to a woman who had tried to fight against the entrance exams in Stuyvesant High School being done away with because she wanted the school to remain an elitist institution, Marron decrying what she perceived as the demise of the New York State education system.

You then complained about my response being ‘a wall of text’, but that’s generally the format of a discussion forum, as opposed to a platform like twitter which lends itself quite nicely to sniping, goading and shìtposting, if that’s more your thing. As an engineer I don’t imagine it is, and it shouldn’t be any difficulty for you to read and understand a short post of a few paragraphs, never mind a three page blog post, a 39 page report, or even the Cass Review - a nearly 400 page review with supplementary material. I don’t complain as though I’m being forced to read anything, I do so by choice, and so do you and anyone else who is choosing to contribute to the discussion regarding the provision of healthcare for children who are transgender. Part of that discussion is inevitably centred around their participation in education as it is the right of every child to be entitled to that opportunity because it contributes to their overall health and mental well-being.

Only a vanishingly small number of adults appear to have difficulty with that concept, generally those adults who are more concerned with themselves and their own ideas for how a society should be structured and governed, than seeking to engage with reality, which is how they come up with silly ideas like the recommendations in the Cass Review in the UK, knowing the NHS as it is, and the waiting lists for paediatric care, is in this condition:

https://www.rcpch.ac.uk/news-events/news/record-high-over-400000-children-waiting-treatment-amidst-child-health-crisis

Quite a few things to deal with:

That’s more like it, and with a bit of humour too, always a bonus! 😊

Yes, as an engineer, there’s no way to avoid a fair bit of reading. However I’m lucky in that most of the stuff I have to deal with relates to things that can be independently verified by internationally agreed methods. I don’t get to dismiss stuff out of hand – if I need a certain result for my project to proceed, and I find information that conflicts with that, then I can’t just say “that’s not true” without providing evidence, or “that’s true but it’s nothing to do with anything”. I can’t just say I don’t give a sh1t about what someone else thinks if they have provided a critique worthy of consideration - I'd have to say why.

You can, you must, or you’d spend considerable resources going down rabbit holes, when all that is in question is your capacity to focus your attention long enough to read and understand a couple of paragraphs. You’ve demonstrated, as I suspected by virtue of you being an engineer, you are capable of being able to do so. That’s all I needed to know. Without meaning to be rude – the extra clarification again just isn’t necessary.

When you said that “Cass got the result the NHS desired”, did you mean that she set out with a particular outcome in mind?

I mean that Cass understood the assignment. The NHS, those who commissioned Cass to chair the Review, had a particular outcome in mind, and they set the parameters, or terms of reference and the scope of the review, and determined that Cass was a suitable candidate (she was the only candidate considered!) for the role of Chair of the Review. Cass delivered exactly what was expected of her – she got the results the NHS desired. She had to set out with a particular outcome which was given to her and had to work within the constraints which would lead to that outcome.

Again, regarding Cass, you said:

“She was under no obligation whatsoever, moral, professional or otherwise, to attempt to influence the review process in which her participation was not requested”.

Here’s the gist of her letter:

“It was outside the Review’s remit to attempt to validate the accounts I received, or to determine whether all the issues are still current. In addition, practice and standards may be markedly different between different clinics. However, there were common themes which I hope will be explored in the upcoming review of adult gender services that NHS England is planning to undertake. “

She then lists the various concerns that have been raised to her, before finishing:

“I hope this is helpful to NHS England as it embarks on the review of adult services.”

The first bit I bolded shows that she is very clear in what her remit was. Hoping something will be explored and hoping the information she has provided will be helpful are hardly signs of an attempt to influence a process – if you believe she was trying to influence the process then you’d have to accept the argument that withholding the information would equally be an attempt to influence the process. There’s nothing in her letter suggesting what form the review process should take, or what the desired outcome should be, so your attempt to attribute improper conduct to her falls a bit flat.

I don’t have to accept the argument that withholding the information would equally be an attempt to influence the process, not only because that’s a sloppy argument, but because you’ve left out the contents of the letter which formed the basis of her comments, those claims which she presented without evidence, which I also pointed out was a feature of the review – rife with claims which lacked evidence, something I noted on reading the review long before I read the critiques which pointed out the lack of evidence for many of the claims in the review. The only reason she couldn’t influence the process of a review of adult gender services is because the NHS reminded her in the most diplomatic terms that her services are no longer required.

You asked: “Does it occur to you that critics of the review too have a moral, ethical or professional obligation to do so? “

They do, it’s open to anyone who has concerns to raise them through any forum they have access to, however there are a number of problems with the Yale document. You’ve listed the authors, and stated how the views are their own, but given that the document is posted on the Integrity Project section of the Yale Law School website, it does look like they are trying to benefit from the reputation of that institution. Given that, and the “Integrity” bit, I would have expected them to disclose the following conflicts of interest, but no such disclosure appears at the beginning or end of the document. From Singal:

“Let’s start with some of the authors’ roles as paid expert witnesses for parties fighting American bans or restrictions on youth gender medicine: McNamara ($400per hour), Janssen ($400per hour), Olson-Kennedy ($200per hour), and Turban ($400or $250 per hour, depending on the task) have all received money as expert witnesses in cases fighting bans or restrictions of youth gender medicine in American states. If someone gets paid as an expert witness, does that mean we should never trust them? Of course not. But it does mean that they need to disclose this when appropriate ,especially when they are touting the “transparency” of their work. In other cases, co-authors on this document also have consulting and textbook royalty income riding directly on the continuing availability of youth gender medicine, which of course also bears mentioning.

Moreover, multiple studies published by Turban were rated as low quality by the Cass team’s systematic reviewers. One of Turban’s studies (footnote 53) was deemed low quality in the SR on puberty blockers; another(footnote 65) was deemed low quality in the SR on hormones (if you’re a subscriber to this newsletter, the weaknesses of these studies will not come as a surprise). Three of Olson-Kennedy’s studies were rated “moderate” in the puberty blocker and hormones SRs. This warranted disclosure as well, because readers have a right to know about these sorts of conflicts: Here Turban is co-authoring a searing assessment of a project that rated his own work poorly. Guyatt agreed that the expert witness, royalty, consulting, and authorship conflicts should have been disclosed. 

Finally, there’s the simple fact that a number of the authors work in gender clinics. They tout this rather than hide it (albeit without mentioning, by name, who works in gender clinics), and to be fair, this isn’t usually considered a conflict of interest. But it really should be: If you work in a youth gender clinic, you are obviously conflicted when it comes to evaluating a document that rates the evidence for youth gender transition poorly! How can anyone even contest this? I asked Guyatt and he agreed both that this isn’t usually seen as a conflict and that it should be.”

I never thought I’d reference Warren Buffet on this thread, but all the above seems a lot like barbers telling us we need haircuts (that advice would be particularly redundant in my case 😀).

The reason I made that point is because initially you presented the critique in the interests of fairness or balance, and said that it pointed out ways in which the Cass review could have done better, and then later you made the point that you’d seen comments that didn’t amount to anything substantial, but when I provided that review and the other commentary I provided (they were the most relevant as they examine the evidence used in the Cass review in support of its recommendations), that’s when you introduced Singal’s critique of a critique. It’s then that I pointed out Singal’s and another bloggers efforts to discredit the authors of the review amounted to nothing. They still don’t.

The Yale document is also full of self-contradictory stuff: first they decry the Cass review for mentioning GRADE but not sticking rigidly to its evidence quality terminology:

“Under GRADE, quality designations such as “high,” “moderate,” “low,” and “very low” are used to describe evidence. There is a shared understanding of what these terms mean in medical science, which allows experts to use them in developing clinical recommendations for broad application.

The Review introduces GRADE (p 55) but never evaluates the evidence using the GRADE framework. The Review borrows GRADE terminology in repeatedly expressing a desire to see “high quality” evidence dominate the field of transgender health. Thus, the Review falls seriously short in not describing or applying a formal method for assigning evidence quality. Thus, the Review speaks a language that may seem familiar, but its foundations are pseudoscientific and subjective. For instance, unscientific evidence quality descriptors such as “weak” and “poor” were identified 21 times and 10 times respectively.”

Then they cast doubt on the utility of evidence quality terminology:

“The usefulness of evidence quality terminology is thoughtfully debated in the medical community. Different assessors often disagree and make divergent evidence quality assessments. There are no well-described processes by which such disagreements should be resolved.”

Another contradiction pasted directly from Singal’s blog: (page15 of the report)

What they’re casting doubt on, is the fact that the review falls short of applying a formal methodology for assigning evidence quality, instead using language that is pseudoscientific and subjective. Where you suggest they cast doubt on the utility of evidence quality terminology is not what they’re doing – they’re making the point that there are different standardised ways to assess the quality of evidence, and that while the Cass review gives a passing mention to GRADE, it uses it’s own customised interpretation of a combination of MMAT and Newcastle-Ottawa scale tools, and there are no well-described processes by which divergent evidence quality assessments which come from the use of each tool, should be resolved. That’s not a contradiction, it’s a statement of fact.

“Wait, I thought you weren’t allowed to say “long-term” without specifying “exactly” what is meant by it? For the record, here’s the amount of space between McNamara and her colleagues complaining about that construction and using it:”

I’d be disappointed with a Junior cert student who presented such a sloppy argument.

I’d be as disappointed as you would be should a student at any level present such a sloppy argument, though I take it Singal’s argument is not the argument which you’re referring to. There is nothing in the report which suggests anyone isn’t allowed to say “long-term” without specifying “exactly” what is meant by it. The point the authors of the report are making is that Cass having excluded long-term data, claims there is no long-term data, and therefore the exclusion requires an explanation of exactly what conditions would satisfy the term “long-term data” as the term is used in the Cass review. Further, it goes on to make the point that by virtue of how they are used, and when they are used, long-term data on the use of puberty blockers would not at least be ethically possible to collect (puberty blockers by themselves are a short-term treatment), and further – the review expects for there to be an abundance of long-term data available from treatments that have only been more readily available for gender-affirming purposes over the last 10 years.

Singal’s argument is yet again an attempt to make something out of nothing.

You said “you responded that you didn’t expect anyone would actually watch the video”, when what I actually said was:

“Regarding the first link, I didn't expect anyone to actually watch / listen to all of it”  - you were being uncharacteristically economical with your verbiage, hopefully unintentionally, as there wouldn’t be much point in posting a link that I didn’t intend people to at least have a quick scan or browse at.

Since you mention Stella O’Malley, yes, she did say that she didn’t understand the grades, but she was mostly concerned about phrases like “meets expectations” on her kids’ report cards, when those expectations have not been clearly defined (maybe the Integrity Project wrote the reports 😀).

You’ve exceeded my expectations with your use of the term “uncharacteristically economical with your verbiage” (I’m writing that down 😁). It just seemed like you were surprised anyone watched any of it, let alone all of it. I did because I have no reason to assume you’re posting that crap in bad faith, so I figured I’d give you a fair shot. I’m being kind when I say it met expectations, indicating that I wasn’t at all concerned that Stella feels the need to pretend that she doesn’t understand what is meant by “meets expectations” on her children’s report cards.

Regarding Maud Maron, she was removed from the NYC Education council as a result of a message written in a private forum which related to a personal belief, but her troubles began when she proposed that female athletes should be invited to take part in a conversation on matters that would affect their sports. Her resolution was passed by 8 votes to 3, but the Chairman rescinded it. I don’t know if he was actually entitled to do that based on the board charter, but it seems profoundly undemocratic. At any rate it’s an illustration of the point I was making about people shutting down opposing voices rather than engaging in debate. In a democratic society (I know, it’s the US, so the quality of democracy is debatable) when faced with opinions you don’t agree with, I think the proper course of action is to come up with a better argument, and make that argument as passionately and articulately as you can, rather than trying to get the person stating the offensive opinions removed from the position they hold. Your posting of a Father Ted clip reminded me of the fate that befell Graham Linehan, merely for challenging the trans orthodoxy.

Nah man, Maud’s troubles began long before her latest bandwagon jumping attempt to promote her belief that the education system in NY is in decline –

In 2019, Maron and Yitin Chu formed Parent Leaders for Accelerated Curriculum and Education NYC (PLACE NYC) to oppose Bill de Blasio's attempts to shift away from screened middle and high schools. Maron served as co-president. PLACE argues that the city's schools are failing their students, that the city should redouble its focus on academics, and that racism does not contribute to the city's underperforming schools. Other parental groups have described it as shifting rightward.

Maud Maron - Wikipedia

Graham Linehan’s fate is not a consequence of merely challenging the trans orthodoxy either - Linehan’s fate is also a consequence of being unable to take criticism of his ideas. He tried to use the imbalance of power you referred to earlier in an attempt to silence his critics, resulting instead in bringing a ton of shít down on himself, rather like Maron attempting to use the imbalance of power to silence her critics, resulting in, well, exactly what you suggested.

From the document you linked, twice:

“Discussion

As a result, this also calls into question whether the Review is able to provide the evidence to substantiate its recommendations to deviate from the international standard of care for trans children and young people.”

Would the bit I bolded be referring to the WPATH guidelines by any chance?

Yes it would, in part, as you can read from both the Introduction and the Conclusion, in the document I linked twice, that we can agree you read at least once:

As researchers and pediatric clinicians with experience in the field of transgender healthcare, we read the Review with great interest. The degree of financial investment and time spent is impressive. Its ability to publish seven systematic reviews, conduct years’ worth of focus groups and deeply investigate care practices in the UK is admirable. We hoped it would improve the public’s awareness of the health needs of transgender youth and galvanize improvements in delivery of this care. Indeed, statements of the Review favorably describe the individualized, age-appropriate, and careful approach recommended by the World Professional Association for Transgender Health (WPATH) and the Endocrine Society. Unfortunately, the Review repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculation. Many of its statements and the conduct of the York SRs reveal profound misunderstandings of the evidence base and the clinical issues at hand. The Review also subverts widely accepted processes for development of clinical recommendations and repeats spurious, debunked claims about transgender identity and gender dysphoria. These errors conflict with well-established norms of clinical research and evidence-based healthcare. Further, these errors raise serious concern about the scientific integrity of critical elements of the report’s process and recommendations.

…

Conclusion The Cass Review was commissioned to address the failure of the UK National Health Service to provide timely, competent, and high-quality care to transgender youth. These failures include long wait times—often years—and resulting delays in timely treatment by skilled providers. Instead of effectively addressing this issue, however, the Review’s process and recommendations stake out an ideological position on care for transgender youth that is deeply at odds with the Review’s own findings about the importance of individualized and age-appropriate approach to medical treatments for gender dysphoria in youth,consistent with the international Standards of Care issued by the World Professional Association for Transgender Health and the Clinical Practice Guidelines issued by the Endocrine Society. Far from evaluating the evidence in a neutral and scientifically valid manner, the Review obscures key findings, misrepresents its own data, and is rife with misapplications of the scientific method. The Review deeply considers the possibility of gender-affirming interventions being given to someone who is not transgender, but without reciprocal consideration for transgender youth who undergo permanent, distressing physical changes when they do not receive timely care. The vast majority of transgender youth in the UK and beyond do not receive an opportunity to even consider clinical care with qualified clinicians—and the Review’s data demonstrate this clearly.

Finally, we can definitely agree that the health service in the UK, and Ireland and the US is in a mess at the moment. It might be best then to investigate the sudden rise in ROGD among teenage girls, so as to limit the extra load on already burdened services.

That would be chasing down a rabbit hole which has already been debunked many, many times already. Given it’s not a clinically recognised term, it remains solely within the domain of culture warriors like Singal and Shrier (numerous times her name is dropped into the conversation in the video you provided, but not remotely a concern), referenced under this section -

The Review reanimates the debunked notion of “social contagion”

Also referenced here in the other commentary I linked to:

Notably, Littman previously published a study on gender dysphoria in adolescents (Littman, Citation2018). This study was subsequently widely criticized for its flawed methodology (Ashley, Citation2020; Restar, Citation2020), leading to a substantial correction of the original manuscript (Littman, Citation2019). Littman’s work should therefore be considered with increased scrutiny, in particular regarding whether the methodology used to obtain the results is robust. Indeed, the cited study (Littman, Citation2021), as well as the second study cited in the Review (Vandenbussche, Citation2022) while discussing reasons for detransitioning, has similar methodological issues to the previous study: potentially biased recruitment practices. In both studies, participants were particularly recruited from online detransition-related groups, potentially artificially inflating the number of people with negative views about transitioning and gender affirmative care.

It really wouldn’t be the best use of limited resources to go down rabbit holes, but as for what the NHS are likely to do with the Cass Review, and the forthcoming adult review, it would seem they are determined to do exactly as they have done in other areas of the NHS… and expect different results:

I was elected to lead not to read - YouTube