The Cass Review Final Report

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I wonder if some of the angry voices in here decrying the report belong to parents who trusted medical professionals' claims that the science on puberty blockers was settled.

If so, I understand their anger and the fear underlying it. It is terrifying to realize that "experts" misled you on the science, and that you consented to treatments that have not, in fact, been proven to be benign (or reversible).

But I encourage you to read the report. It is publicly available, and free; why not read it? At the least, perhaps you can generate some original criticism, rather than recycling the same three or four objections that are also circulating on other social media. I don't know where those talking points originated, but it's pretty clear that whoever came up with them had not read the entire report.

Literally no one claimed that. Not surprising that someone hyping up this biased report would throw out lazy strawman arguments.

Major medical organizations and organizations advocating for transgender youth just a few years ago were saying that puberty blockers were “fully reversible” and the science around medicalized treatment for transgender youth was settled science. There are many screenshots if you care to look. Of course that’s all been removed now, as it’s obviously inaccurate.

No one was saying it was “settled science”.

DP. Except people were. Activists and laypeople were. Especially as a mechanism to shut down conversations. I remember a specific instance of being told by a particular acquaintance that it was “settled science”.

I mean, just a few days ago CNN was claiming that “mainstream science” agreed that males have no athletic advantages over females (based on a single paper written 7 years ago).

“ But mainstream science does not support that conclusion. A 2017 report in the journal Sports Medicine that reviewed several related studies found “no direct or consistent research” on trans people having an athletic advantage over their cisgender peers, and critics say the bans add to the discrimination trans people face”.

https://amp.cnn.com/cnn/2024/04/08/sport/naia-bans-trans-athletes-dawn-staley-reaj

CNN also consistently characterizes gender affirming care as evidence-based and a “gold standard”, depicting it as a scientific consensus (even in articles that are actually reporting on lack of consensus!)

“ Gender-affirming care is medically necessary, evidence-based individualized care that uses a multidisciplinary approach to help a person transition from their assigned gender – the one the person was designated at birth – to their affirmed gender – the gender by which one wants to be known.”

https://amp.cnn.com/cnn/2024/02/26/health/endocrine-society-gender-affirming-care-guidelines

1. You are misrepresenting what was quoted in the first CNN article. It did not say that. Just look at the quote you included.

2. Neither article say it’s “settled science”. In fact, the second article is discussing updating guidelines.

“ The committee revising the guidelines has had its first meeting, said chairperson Dr. Joshua Safer. The last time the committee updated its gender-affirming care guidelines was in 2017; it previously revised them in 2009.

“To be clear, we’ve been following our usual guideline process that we apply to anything that we do, whether it’s diabetes or thyroid etc., to transgender medical care,” said Safer, a member of the Endocrine Society who also serves as executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York. “Being the doctors in the room, we look at current data to give appropriate recommendations.””

Huh? the first article literally says it is “mainstream science” that transitioned natal males have no athletic advantage. what does “mainstream science” mean to you?

The second article literally says that gender affirming endocrinolgy care (puberty blockers and hormones) are the “gold standard.” Then yes, they quote the doctors stating the exact opposite - that in fact nothing is “gold standard” and they are reassessing.

I’m looking forwards to CNN stealth dropping all of this verbiage as time goes on and it becomes clear that in fact there is no mainstream scientific consensus or gold standard.

1. Your comment was “males have no athletic advantages over females” which is very different than the quote. Transgender women are not representative of all males. Of course you’re being misleading.

2. The “gold standard” means the current best practices. Which change over time.

that’s some absurd back-bending. they cite ONE study on trans athletes then claim that all of “mainstream science” agrees (with a completely counter-instuitive and counter-experience result).

“gold standard” means a degree of consensus not “current best practices”. no gold standard in favor of puberty blockers and hormones actually existed, ever.

“Gold standard” means best available, the benchmark that possible alternatives are compared against.

https://en.m.wikipedia.org/wiki/Gold_standard_(test)


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC557893/

“The concept of a “golden standard” implies a level of perfection that can never be attained by any biological test, and will provoke criticism like that ventilated by Duggan.2 In contrast, a gold standard in its true meaning, derived from the monetary gold standard, merely denotes the best tool available at that time to compare different measures. Even in its glory days, the monetary gold standard was never considered perfect. It was subject to endless debate, and in the end it was abandoned for a better system. Similarly, today's gold standard tests will be replaced by better ones. As was eloquently stated by Versi: “It is the absolute truth that is never reached; gold standards are constantly challenged and superseded when appropriate.””

I mean, the status of pediatric gender medicine didn’t even meet your (dishonest) interpretation of what CNN met. there never was a “best tool available.” and of course advocates strenuously disagreed that it was a matter of “endless debate.”

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Here’s what a high ranking HHS official has consistently said about puberty blockers & hormones for kids:

“ Gender-affirming care is medical care. It is mental health care. It is suicide prevention care. It improves quality of life, and it saves lives. It is based on decades of study. It is a well-established medical practice... The positive value of gender-affirming care is not in serious scientific or medical dispute.”

https://www.hhs.gov/about/news/2022/04/30/remarks-by-hhs-assistant-secretary-for-health-adm-rachel-levine-for-the-2022-out-for-health-conference.html

Ok…and? That’s how science/medicine works. You act based on the current guidelines. Those change over time - obviously.

No, false claims of certainty are not “how science/medicine works.”

Just because some random food doctor doesn’t agree doesn’t mean they are “false claims”.

Have you lost your marbles entirely? What on earth are you going on about with random food doctors? The Cass review was authored by one of the most well-respected pediatricians in the entire UK and her analysis has the explicit endorsement of some of the UKs most well-respected physicians.

It seems like you’re having trouble following. We are discussing the link above.

Great quote from it:
“Those who now attack our LGBTQI+ community are driven by an agenda that has nothing to do with medicine, nothing to do with science, and nothing to do with warmth, empathy, compassion or understanding. “

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Here’s what a high ranking HHS official has consistently said about puberty blockers & hormones for kids:

“ Gender-affirming care is medical care. It is mental health care. It is suicide prevention care. It improves quality of life, and it saves lives. It is based on decades of study. It is a well-established medical practice... The positive value of gender-affirming care is not in serious scientific or medical dispute.”

https://www.hhs.gov/about/news/2022/04/30/remarks-by-hhs-assistant-secretary-for-health-adm-rachel-levine-for-the-2022-out-for-health-conference.html

Ok…and? That’s how science/medicine works. You act based on the current guidelines. Those change over time - obviously.

But when those current guidelines are proven false, you don’t kick and scream and insist they’re right. You change the guidelines. And follow the new ones. That’s how science/medicine works.

Ok. As soon as we have better guidelines, the medical practitioners will adjust.

Until then, they will stick with the current best practices.

As a medical practitioner, a study like this would be enough for me to change my practice. It would be enough for many of us.

Are you the prison podiatrist who thinks that transgenderism is a mental illness?

I don't know who PP is, but I am a new poster and medical practitioner working at a federal facility in the perioperative area.

I wonder if the feds will tap the brakes on the current no-questions-asked approval of gender surgeries in federal hospitals, paid for by taxpayers. Probably not, because Biden needs to win and can't alienate any more Gen Z voters.

Sensing a window closing, there has been a quantifiable surge of eligible people booking gender surgeries in my facility. They'll freely acknowledge this during the pre-op assessment period. They're probably not wrong about what will happen if Trump wins.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I wonder if some of the angry voices in here decrying the report belong to parents who trusted medical professionals' claims that the science on puberty blockers was settled.

If so, I understand their anger and the fear underlying it. It is terrifying to realize that "experts" misled you on the science, and that you consented to treatments that have not, in fact, been proven to be benign (or reversible).

But I encourage you to read the report. It is publicly available, and free; why not read it? At the least, perhaps you can generate some original criticism, rather than recycling the same three or four objections that are also circulating on other social media. I don't know where those talking points originated, but it's pretty clear that whoever came up with them had not read the entire report.

Literally no one claimed that. Not surprising that someone hyping up this biased report would throw out lazy strawman arguments.

Major medical organizations and organizations advocating for transgender youth just a few years ago were saying that puberty blockers were “fully reversible” and the science around medicalized treatment for transgender youth was settled science. There are many screenshots if you care to look. Of course that’s all been removed now, as it’s obviously inaccurate.

No one was saying it was “settled science”.

DP. Except people were. Activists and laypeople were. Especially as a mechanism to shut down conversations. I remember a specific instance of being told by a particular acquaintance that it was “settled science”.

I mean, just a few days ago CNN was claiming that “mainstream science” agreed that males have no athletic advantages over females (based on a single paper written 7 years ago).

“ But mainstream science does not support that conclusion. A 2017 report in the journal Sports Medicine that reviewed several related studies found “no direct or consistent research” on trans people having an athletic advantage over their cisgender peers, and critics say the bans add to the discrimination trans people face”.

https://amp.cnn.com/cnn/2024/04/08/sport/naia-bans-trans-athletes-dawn-staley-reaj

CNN also consistently characterizes gender affirming care as evidence-based and a “gold standard”, depicting it as a scientific consensus (even in articles that are actually reporting on lack of consensus!)

“ Gender-affirming care is medically necessary, evidence-based individualized care that uses a multidisciplinary approach to help a person transition from their assigned gender – the one the person was designated at birth – to their affirmed gender – the gender by which one wants to be known.”

https://amp.cnn.com/cnn/2024/02/26/health/endocrine-society-gender-affirming-care-guidelines

1. You are misrepresenting what was quoted in the first CNN article. It did not say that. Just look at the quote you included.

2. Neither article say it’s “settled science”. In fact, the second article is discussing updating guidelines.

“ The committee revising the guidelines has had its first meeting, said chairperson Dr. Joshua Safer. The last time the committee updated its gender-affirming care guidelines was in 2017; it previously revised them in 2009.

“To be clear, we’ve been following our usual guideline process that we apply to anything that we do, whether it’s diabetes or thyroid etc., to transgender medical care,” said Safer, a member of the Endocrine Society who also serves as executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York. “Being the doctors in the room, we look at current data to give appropriate recommendations.””

Huh? the first article literally says it is “mainstream science” that transitioned natal males have no athletic advantage. what does “mainstream science” mean to you?

The second article literally says that gender affirming endocrinolgy care (puberty blockers and hormones) are the “gold standard.” Then yes, they quote the doctors stating the exact opposite - that in fact nothing is “gold standard” and they are reassessing.

I’m looking forwards to CNN stealth dropping all of this verbiage as time goes on and it becomes clear that in fact there is no mainstream scientific consensus or gold standard.

1. Your comment was “males have no athletic advantages over females” which is very different than the quote. Transgender women are not representative of all males. Of course you’re being misleading.

2. The “gold standard” means the current best practices. Which change over time.

that’s some absurd back-bending. they cite ONE study on trans athletes then claim that all of “mainstream science” agrees (with a completely counter-instuitive and counter-experience result).

“gold standard” means a degree of consensus not “current best practices”. no gold standard in favor of puberty blockers and hormones actually existed, ever.

“Gold standard” means best available, the benchmark that possible alternatives are compared against.

https://en.m.wikipedia.org/wiki/Gold_standard_(test)


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC557893/

“The concept of a “golden standard” implies a level of perfection that can never be attained by any biological test, and will provoke criticism like that ventilated by Duggan.2 In contrast, a gold standard in its true meaning, derived from the monetary gold standard, merely denotes the best tool available at that time to compare different measures. Even in its glory days, the monetary gold standard was never considered perfect. It was subject to endless debate, and in the end it was abandoned for a better system. Similarly, today's gold standard tests will be replaced by better ones. As was eloquently stated by Versi: “It is the absolute truth that is never reached; gold standards are constantly challenged and superseded when appropriate.””

I mean, the status of pediatric gender medicine didn’t even meet your (dishonest) interpretation of what CNN met. there never was a “best tool available.” and of course advocates strenuously disagreed that it was a matter of “endless debate.”

You misspelled accurate.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Here’s what a high ranking HHS official has consistently said about puberty blockers & hormones for kids:

“ Gender-affirming care is medical care. It is mental health care. It is suicide prevention care. It improves quality of life, and it saves lives. It is based on decades of study. It is a well-established medical practice... The positive value of gender-affirming care is not in serious scientific or medical dispute.”

https://www.hhs.gov/about/news/2022/04/30/remarks-by-hhs-assistant-secretary-for-health-adm-rachel-levine-for-the-2022-out-for-health-conference.html

Ok…and? That’s how science/medicine works. You act based on the current guidelines. Those change over time - obviously.

No, false claims of certainty are not “how science/medicine works.”

Just because some random food doctor doesn’t agree doesn’t mean they are “false claims”.

Have you lost your marbles entirely? What on earth are you going on about with random food doctors? The Cass review was authored by one of the most well-respected pediatricians in the entire UK and her analysis has the explicit endorsement of some of the UKs most well-respected physicians.

It seems like you’re having trouble following. We are discussing the link above.

Great quote from it:
“Those who now attack our LGBTQI+ community are driven by an agenda that has nothing to do with medicine, nothing to do with science, and nothing to do with warmth, empathy, compassion or understanding. “

So, yes, you’ve lost your marbles.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Here’s what a high ranking HHS official has consistently said about puberty blockers & hormones for kids:

“ Gender-affirming care is medical care. It is mental health care. It is suicide prevention care. It improves quality of life, and it saves lives. It is based on decades of study. It is a well-established medical practice... The positive value of gender-affirming care is not in serious scientific or medical dispute.”

https://www.hhs.gov/about/news/2022/04/30/remarks-by-hhs-assistant-secretary-for-health-adm-rachel-levine-for-the-2022-out-for-health-conference.html

Ok…and? That’s how science/medicine works. You act based on the current guidelines. Those change over time - obviously.

No, false claims of certainty are not “how science/medicine works.”

Just because some random food doctor doesn’t agree doesn’t mean they are “false claims”.

Have you lost your marbles entirely? What on earth are you going on about with random food doctors? The Cass review was authored by one of the most well-respected pediatricians in the entire UK and her analysis has the explicit endorsement of some of the UKs most well-respected physicians.

It seems like you’re having trouble following. We are discussing the link above.

Great quote from it:
“Those who now attack our LGBTQI+ community are driven by an agenda that has nothing to do with medicine, nothing to do with science, and nothing to do with warmth, empathy, compassion or understanding. “

Warmth, empathy and understanding should not be in the same sentence as medicine and science.

[Anonymous]

Well, the above-discussed link between antivaxxers and proponents of medicalized care for gender dysphoria in children is now explicit. Dr. Andrew Wakefield has signed on to this letter criticizing the Cass Review, which appears to be genuine (shocking, given how transparently awful the writing and data analysis is in the letter):

http://uncommon-scents.blogspot.com/2024/04/letter-from-academics-concerned-about.html

It appears the fraudulent doctor had found a new and different group of vulnerable children to harm.

I think anyone with a modicum of ethics would conclude that if Dr. Wakefield is on your side, perhaps you need to reevaluate. But I suspect that is not what is going to happen.

[Anonymous]

Anonymous wrote:Well, the above-discussed link between antivaxxers and proponents of medicalized care for gender dysphoria in children is now explicit. Dr. Andrew Wakefield has signed on to this letter criticizing the Cass Review, which appears to be genuine (shocking, given how transparently awful the writing and data analysis is in the letter):

http://uncommon-scents.blogspot.com/2024/04/letter-from-academics-concerned-about.html

It appears the fraudulent doctor had found a new and different group of vulnerable children to harm.

I think anyone with a modicum of ethics would conclude that if Dr. Wakefield is on your side, perhaps you need to reevaluate. But I suspect that is not what is going to happen.

I’d rather have Trump on my side. Wakefield is the worst of the worst when it comes to science and medicine.

[Anonymous]

Andrew Wakefield is not a doctor, so his "medical" opinion is irrelevant one way or the other.

The fact remains that Cass downgraded studies with the flimsy justification that children were provided "unblinded" medical care while receiving care.

http://uncommon-scents.blogspot.com/?m=1

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Here’s what a high ranking HHS official has consistently said about puberty blockers & hormones for kids:

“ Gender-affirming care is medical care. It is mental health care. It is suicide prevention care. It improves quality of life, and it saves lives. It is based on decades of study. It is a well-established medical practice... The positive value of gender-affirming care is not in serious scientific or medical dispute.”

https://www.hhs.gov/about/news/2022/04/30/remarks-by-hhs-assistant-secretary-for-health-adm-rachel-levine-for-the-2022-out-for-health-conference.html

Ok…and? That’s how science/medicine works. You act based on the current guidelines. Those change over time - obviously.

No, false claims of certainty are not “how science/medicine works.”

Just because some random food doctor doesn’t agree doesn’t mean they are “false claims”.

Have you lost your marbles entirely? What on earth are you going on about with random food doctors? The Cass review was authored by one of the most well-respected pediatricians in the entire UK and her analysis has the explicit endorsement of some of the UKs most well-respected physicians.

It seems like you’re having trouble following. We are discussing the link above.

Great quote from it:
“Those who now attack our LGBTQI+ community are driven by an agenda that has nothing to do with medicine, nothing to do with science, and nothing to do with warmth, empathy, compassion or understanding. “

Warmth, empathy and understanding should not be in the same sentence as medicine and science.

This dehumanization of people is exactly the problem.

[Anonymous]

Anonymous wrote:Andrew Wakefield is not a doctor, so his "medical" opinion is irrelevant one way or the other.

The fact remains that Cass downgraded studies with the flimsy justification that children were provided "unblinded" medical care while receiving care.

http://uncommon-scents.blogspot.com/?m=1

Don’t defend the analysis in that letter if you want people to think you have even the most basic understanding of data analysis and medical studies. It’s embarrassingly bad.

I mean, there is a reason that quackery is endorsed by the King of Quacks.

[Anonymous]

Anonymous wrote:Well, the above-discussed link between antivaxxers and proponents of medicalized care for gender dysphoria in children is now explicit. Dr. Andrew Wakefield has signed on to this letter criticizing the Cass Review, which appears to be genuine (shocking, given how transparently awful the writing and data analysis is in the letter):

http://uncommon-scents.blogspot.com/2024/04/letter-from-academics-concerned-about.html

It appears the fraudulent doctor had found a new and different group of vulnerable children to harm.

I think anyone with a modicum of ethics would conclude that if Dr. Wakefield is on your side, perhaps you need to reevaluate. But I suspect that is not what is going to happen.

They’re not wrong:

As academics with decades of research experience between us we can confidently say that The Cass Review would fail if it were submitted as an undergraduate dissertation. Its methodology is shoddy in the extreme and it is clearly biased throughout.

It does not include a proper systematic literature review or material published in any language other than English as well as excluding most research evidence because it fails to reach the impossibly high bar of a double-blind trial. In fact trans healthcare is inappropriate for a double-blind trial; if you give hormones to one group of people and not to another, they will very quickly notice. It would also be completely unethical and in fact most medicine is not based on this kind of evidence anyway.

In contrast The Cass Review provides very little evidence for the proposals it comes up with, and much of that 'evidence' is anecdotal. In effect the Cass proposals are largely un-evidenced and seem to be based on anti-trans rhetoric rather than science.

The failure to systematically include trans peoples’ voices while liberally presenting anti-trans campaigners’ rhetoric - including those accused of supporting ‘conversion therapy’ - reveals a level of bias that is unacceptable in something as important as this.

We regard The Cass Review as methodologically unsound, biased in the extreme (despite its reasonable-sounding language), dangerous, and rights-stripping in its proposals. If implemented it will cause great harm to trans and non-binary young people. This report should be scrapped, trans children deserve so much better than this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Andrew Wakefield is not a doctor, so his "medical" opinion is irrelevant one way or the other.

The fact remains that Cass downgraded studies with the flimsy justification that children were provided "unblinded" medical care while receiving care.

http://uncommon-scents.blogspot.com/?m=1

Don’t defend the analysis in that letter if you want people to think you have even the most basic understanding of data analysis and medical studies. It’s embarrassingly bad.

I mean, there is a reason that quackery is endorsed by the King of Quacks.

Which part was wrong?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Andrew Wakefield is not a doctor, so his "medical" opinion is irrelevant one way or the other.

The fact remains that Cass downgraded studies with the flimsy justification that children were provided "unblinded" medical care while receiving care.

http://uncommon-scents.blogspot.com/?m=1

Don’t defend the analysis in that letter if you want people to think you have even the most basic understanding of data analysis and medical studies. It’s embarrassingly bad.

I mean, there is a reason that quackery is endorsed by the King of Quacks.

Which part was wrong?

the part where they completely misunderstand that the studies were ranked based on quality; not ideology. if they think specific studies are stronger than they were represented, they should specifically say why. instead they just come up with a vapid, tweetable conclusion: “the Cass Report is biased! It screened out all the pro-medical-transition studies!”

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Andrew Wakefield is not a doctor, so his "medical" opinion is irrelevant one way or the other.

The fact remains that Cass downgraded studies with the flimsy justification that children were provided "unblinded" medical care while receiving care.

http://uncommon-scents.blogspot.com/?m=1

Don’t defend the analysis in that letter if you want people to think you have even the most basic understanding of data analysis and medical studies. It’s embarrassingly bad.

I mean, there is a reason that quackery is endorsed by the King of Quacks.

Which part was wrong?

Oh, man, where to start? To do a full analysis would be a post that is too long for DCUM. So let’s just pick one idiotic sentence from the letter to start with:

It does not include a proper systematic literature review or material published in any language other than English as well as excluding most research evidence because it fails to reach the impossibly high bar of a double-blind trial.

Dispensing with the easy nonsense first: The claim about the lack of reviews from languages other than English is just stupid and betrays a complete lack of understanding of how meta-analysis of this type works. English is, right now, the global language of medical research. It is standard practice to only look at literature reviews that are in English, because the vast majority of them are in English.

But let’s take this claim at face value. Normally if you are claiming extensive non-English data is relevant to a medical literature review and meta-analysis, you would identify such sources and data. The problem the authors have is that relevant non-English data and literature does not actually exist in any statistically relevant manner. You don’t have to actually take my word for that: WPATH made that exact point themselves in Statement 2.4 of Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. (I have linked directly to the PDF below if you want to read it yourself.) WPATH noted that 96% of the research literature concerning transgender care is in English. So, the point about the English language is just dumb. It’s also incumbent on the letter writers to identify all that extensive non-English literature if they believe that literature would have changed the outcome of the Cass review, and of course they didn’t do that, because they can’t. Link below:

https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

Second of all, the claim that the Cass review excludes literature because it doesn’t reach the standard of a double-blind trial is also clearly false. First, as reference, the actual review is linked here:

https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview_Final.pdf

There were six systematic reviews referenced in the Cass report. These are listed in Table 1, page 53 of the PDF. You can actually look at the reviews yourself if you want.

What these reviews do among other points is grade the quality of evidence available for the subject. That’s typical in meta-analysis, so much so that there is a general protocol for how studies are graded into one of four categories: high, moderate, low, very low. People who don’t understand this, like the letter writers and signatories, assume that studies that are not graded “high,” (which is based on neutral analytical factors) are not evaluated. That is simply not true, and was not true in the Cass review.

This is already too long and I’m not going to go through every page, but as an example look at Section 14 of the report, which discusses puberty blockers. 14.19 talks about how the evidence was assessed for quality, and then the low quality evidence was excluded. But the moderate quality studies were indeed kept. This is just one example of how that sentence is transparently false.

I could probably do this for every single line of that stupid letter if I wanted to waste the rest of my day on abject nonsense, but I have better things to do.