THE Cass Review into transgender care for young people “transgresses medical law, policy, and practice”, US experts have claimed.
Writing in the New England Journal of Medicine, law professors Daniel G Aaron MD and Craig Konnoth raised concerns about how the review was conducted and its recommendations implemented.
The pair say that, had Dr Hilary Cass’s work been published in the US, it “would have violated federal law because the authors failed to adhere to legal requirements protecting the integrity of the scientific process”.
However, they say that the review has been cited by US states looking to ban gender-affirming care (GAC), as well as the UK in its now-permanent ban on puberty blockers for people under 18.
Among other issues, the paper in the New England Journal of Medicine says that the Cass Review:
- Was “not verified by experts”. It adds: “The review thus departed from standard practice; indeed, as mentioned above, if the US government issued a report in a similar manner, it would be violating federal law.”
- “Deviates from pharmaceutical regulatory standards in the United Kingdom” and “calls for evidentiary standards for GAC that are not applied elsewhere in paediatric medicine”.
- Contravenes international standards by failing to list authors. “We do know that Cass chaired the review, but observers must speculate about who else participated in the manuscript’s drafting – and whether they held bias against LGBTQ+ people”, it states.
- Had a “high risk of bias according to the Risk of Bias Assessment Tool for Systematic Reviews and a ‘substandard level of scientific rigor’”.
- “Improperly excluded non-English articles, ‘gray literature’ (non–peer-reviewed articles and documents), and other articles not identified by its simplistic search strategy”.
Professors Aaron and Konnoth wrote: “The review’s departure from the evidentiary and procedural standards of medical law, policy, and practice can be understood best in the context of the history of leveraging medicine to police gender norms.
“Recent efforts to increase the presence of women in medicine, improve access to reproductive services, and offer GAC seek to break from that history, but the Cass Review represents a return to the past.”
Konnoth is the Martha Lubin Karsh and Bruce A Karsh Bicentennial Professor of Law at the University of Virginia, while Aaron is associate professor of law at the University of Utah’s SJ Quinney College of Law.
Last summer, academics from Yale Law School and the Yale School of Medicine also raised concerns about the Cass Review, saying it “obscures key findings, misrepresents its own data, and is rife with misapplications of the scientific method”.
In the UK, the British Medical Association (BMA) took an official position against the Cass Review, which singled it out among the establishment and led to more than 1000 medical professionals signing a letter in opposition. The BMA then said it was "neutral" and would conduct a review of Cass's findings.
Elsewhere in the UK, the review has been widely accepted, including by the Labour and SNP Governments.
Jolyon Maugham, a KC and director of the Good Law Project, said of the latest intervention from the US: “None of this will change Labour's position.
“It will abase itself before JK Rowling and [Rupert] Murdoch, and align itself with Trump and Putin, and others with more power than the minorities they target.
“But the rest of us should know: the Cass Review is policy based evidence making.”
Cass now sits as a crossbench peer in the House of Lords after being given the position by former prime minister Rishi Sunak.
In December, Labour said that ban on the sale and supply of puberty blockers through private prescriptions for under-18s is to be indefinite.
While health is a devolved matter, the ban applies across the UK, the UK Government said, adding that the decision had been taken in consultation with the Scottish and Welsh governments, and in agreement with the Northern Ireland government.
Plans are in place to set up a clinical trial into the use of puberty blockers next year, with an aim to recruit the first patients by spring.
