Catholic Medical Quarterly Volume 74(4) Nov 2024
Correspondence
An Open Letter to BMA chair about Cass Review decision
To Professor Philip Banfield ,
Chair of BMA Council 2 August 2024
Dear Professor Banfield,
We write as doctors to say, “not in my name”.
We are extremely
disappointed that the BMA Council has passed a motion to conduct a
“critique” of the Cass Review and to lobby to oppose its recommendations.
https://www.bma.org.uk/bma-media-centre/bma-to-undertake-an-evaluation-of-the-cass-review-on-gender-identity-services-for-children-and-young-people
The passing of the motion was opaque and secretive. It does not reflect the views of the wider membership, whose opinion you did not seek. We understand that no information will be released on the voting figures and how Council members voted. That is a failure of accountability to members and simply not acceptable.
You wrote “as doctors we want to be sure they get the most appropriate care and the support they need.” Implementation of the Cass Review recommendations will be the best way to ensure children and young people with gender related distress get exactly that.
The Cass Review is the most comprehensive review into healthcare for children with gender related distress ever conducted. It took 4 years to complete and commissioned 7 systematic reviews from the University of York. It recommended a new approach based on safe, holistic, evidence-based care. It has thirty-two recommendations to improve and extend clinical services for this vulnerable group, with ongoing and embedded audit and research.
Which recommendations does the BMA oppose and why? By lobbying against the best evidence we have, the BMA is going against the principles of evidence-based medicine and against ethical practice.
In particular the BMA call to continue the current use of puberty blockers until there is a “solid evidence base” is not an evidence based approach. The Cass Review has got it right when it says that because there is so little evidence about their safety and efficacy they should only be prescribed under research conditions.
We note that the sources the BMA is relying on to cast doubt on the review are authored by groups with serious conflicts of interest and have not been through peer-review.
We are told the BMA ‘task and finish’ group will pay particular attention to the methodology used to underpin the Review’s recommendations. We note not all doctors or academics are suitably qualified to comment on systematic review methodology if they do not have specific expertise. We believe it will be very difficult for the BMA to produce a fair critique when it has already attacked the Review and voted to oppose implementation of its recommendations.
We welcome the Academy of Medical Royal Colleges statement: “Our view
is that further speculative work risks greater polarisation on this matter
which is not helpful and our focus should be on implementing the
recommendations of the Cass Review by providing the most appropriate
treatment for children and young people with gender dysphoria or gender
related distress.”
https://www.aomrc.org.uk/publication/academy-statement-implementation-of-the-cass-review/
One of Dr Cass’s recommendations was: “Professional bodies must come together to provide leadership and guidance on the clinical management of this population taking account of the findings of this report”.
We are dismayed that the BMA has done the opposite.
We call on the BMA to abandon this pointless exercise and to welcome and follow the Cass Review as RCPsych, RCGP and AoMRC have done.
Yours sincerely,
Signed by a total of 870 doctors, including 557 BMA
members, 57 professors and 22 former or current presidents of royal
medical colleges and other clinical leaders, among others (New Statesman
8.8.24)