Talk:Cass Review#Consider the other side

In "Recommendations", the following sentence appears:

"A separate pathway should be established for the treatment of pre-pubertal treatment, who are ideally to be treated as early as possible"

I believe at least one of the three instances of treatment/treated needs to be removed, but I'm not familiar enough with the report to be sure what they were trying to say.--MilesVorkosigan (talk) 16:32, 11 April 2025 (UTC)

:Fixed. Lewisguile (talk) 18:07, 11 April 2025 (UTC)

:Done. Jaredroach (talk) 18:10, 11 April 2025 (UTC)

{{User:ClueBot III/DoNotArchiveUntil|2037883047}}

• {{cite web |last1=Vinter |first1=Robyn |title=Trans children in England worse off now than four years ago, says psychologist |url=https://www.theguardian.com/society/2024/apr/11/trans-children-in-england-worse-off-now-than-four-years-ago-says-psychologist |website=The Guardian |date=11 April 2024}}
• {{cite web |title=The Guardian view on the Cass report: rising numbers of gender distressed young people need help |url=https://www.theguardian.com/commentisfree/2024/apr/11/the-guardian-view-on-the-cass-report-rising-numbers-of-gender-distressed-young-people-need-help |website=The Guardian |date=11 April 2024}}
• {{cite web |last1=Barnes |first1=Hannah |title=The Cass review into children’s gender care should shame us all |url=https://newstatesman.com/politics/health/2024/04/the-cass-review-into-childrens-gender-care-should-shame-us-all |website=New Statesman |date=10 April 2024}}
• {{cite web |title=The Observer view on the Cass review: children were catastrophically failed by the medical profession |url=https://www.theguardian.com/commentisfree/2024/apr/14/cass-review-gender-identity-services-children-young-people |website=The Observer |date=14 April 2024}}
• {{cite web |title=RCPCH responds to publication of the final report from the Cass Review |url=https://www.rcpch.ac.uk/news-events/news/rcpch-responds-publication-final-report-cass-review |website=RCPCH |language=en}}
• {{cite web |title=Cass Review ‘should mark a watershed moment’ – charity chief |url=https://www.shropshirestar.com/news/uk-news/2024/04/10/cass-review-should-mark-a-watershed-moment--charity-chief/ |website=The Shropshire Star |language=en |date=9 April 2024}}
• {{cite web |last1=Hansford |first1=Amelia |title=Cass report urges 'caution' in prescribing puberty blockers to trans youth |url=https://www.thepinknews.com/2024/04/10/cass-review-extreme-caution-puberty-blockers/ |website=PinkNews {{!}} Latest lesbian, gay, bi and trans news {{!}} LGBTQ+ news |date=10 April 2024}}
• {{cite journal |last1=Dyer |first1=Clare |title=Guidelines on gender related treatment flouted standards and overlooked poor evidence, finds Cass review|url=https://www.bmj.com/content/385/bmj.q820 |journal=BMJ |date=9 April 2024 |pages=q820 |doi=10.1136/bmj.q820}}
• {{cite journal |last1=Abbasi |first1=Kamran |title=The Cass review: an opportunity to unite behind evidence informed care in gender medicine|url=https://www.bmj.com/content/385/bmj.q837 |journal=BMJ |date=11 April 2024 |pages=q837 |doi=10.1136/bmj.q837}}
• {{cite journal |last1=Abbasi |first1=Kamran |title=“Medication is binary, but gender expressions are often not”—the Hilary Cass interview|url=https://www.bmj.com/content/385/bmj.q794 |journal=BMJ |date=9 April 2024 |pages=q794 |doi=10.1136/bmj.q794}}
• {{cite journal |last1=Cass |first1=Hilary |title=Gender medicine for children and young people is built on shaky foundations. Here is how we strengthen services |journal=BMJ |date=9 April 2024 |volume=385 |pages=q814 |doi=10.1136/bmj.q814 |url=https://www.bmj.com/content/385/bmj.q814 |language=en |issn=1756-1833}}
• {{cite web |title=Evidence for puberty blockers and hormone treatment for gender transition wholly inadequate {{!}} BMJ |url=https://www.bmj.com/company/newsroom/evidence-for-puberty-blockers-and-hormone-treatment-for-gender-transition-wholly-inadequate/ |website=BMJ}}
• {{cite web |last1=Penna |first1=Dominic |title=Chris Whitty: Debate around transgender issues ‘too vitriolic’ |url=https://www.telegraph.co.uk/politics/2024/04/16/cass-review-chris-whitty-transgender-debate/ |website=The Telegraph |date=16 April 2024}}
• {{cite web |last1=Reed |first1=Erin |title=Why Hilary Cass' NHS report is wrong about trans health care |url=https://www.advocate.com/health/hilary-cass-nhs-report-debunked |website=The Advocate|language=en}}
• {{cite web |title=Gender care review: Children 'let down' by research amid 'exceptionally toxic' debate |url=https://www.itv.com/news/2024-04-09/gender-care-review-children-let-down-by-research-amid-toxic-debate |website=ITV News}}
• {{cite web |title=Hilary Cass: Ideology on all sides directed gender care of children |url=https://www.itv.com/news/2024-04-09/hilary-cass-ideology-on-all-sides-directed-gender-care-of-children |website=ITV News}}
• {{cite journal |last1=Horton |first1=Cal |author-link1=Cal Horton |title=The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children|url=https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2328249 |journal=International Journal of Transgender Health |date=14 March 2024 |pages=1–25 |doi=10.1080/26895269.2024.2328249}}
• {{cite web |title=Gender Identity Service Series |url=https://adc.bmj.com/pages/gender-identity-service-series |website=Archives of Disease in Childhood |language=en}}
• {{cite journal |last1=Thornton |first1=Jacqui |title=Cass Review calls for reformed gender identity services|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00808-0/abstract |journal=The Lancet |date=April 2024 |volume=403 |issue=10436 |pages=1529 |doi=10.1016/s0140-6736(24)00808-0}}
• {{Cite news |last=Ghorayshi |first=Azeen |date=2024-05-13 |title=Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine |url=https://www.nytimes.com/2024/05/13/health/hilary-cass-transgender-youth-puberty-blockers.html |access-date=2024-05-14 |work=The New York Times |language=en-US |issn=0362-4331}}
• {{cite journal |last1=Grijseels |first1=D. M. |title=Biological and psychosocial evidence in the Cass Review: a critical commentary|url=https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2362304 |journal=International Journal of Transgender Health |date=8 June 2024 |doi=10.1080/26895269.2024.2362304}}
• {{cite web|url=https://www.scientificamerican.com/article/the-u-k-s-cass-review-badly-fails-trans-children/|title=The U.K.’s Cass Review Badly Fails Trans Children|first1=Cal|last1=Horton|first2=Ruth|last2=Pearce|author-link1=Cal Horton|author-link2=Ruth Pearce (sociologist)|date=7 August 2024|access-date=13 August 2024|website=Scientific American}}
• {{cite web|url=https://www.nytimes.com/2024/08/13/opinion/cass-report-trans-kids.html|title=The Strange Report Fueling the War on Trans Kids|first=Lydia|last=Polgreen|author-link=Lydia Polgreen|date=13 August 2024|access-date=13 August 2024|website=New York Times}}
• {{Cite journal |last=Budge |first=Stephanie L. |last2=Abreu |first2=Roberto L. |last3=Flinn |first3=Ryan E. |last4=Donahue |first4=Kelly L. |last5=Estevez |first5=Rebekah |last6=Olezeski |first6=Christy L. |last7=Bernacki |first7=Jessica M. |last8=Barr |first8=Sebastian |last9=Bettergarcia |first9=Jay |last10=Sprott |first10=Richard A. |last11=Allen |first11=Brittany J. |date=28 September 2024 |title=Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth |url=https://linkinghub.elsevier.com/retrieve/pii/S1054139X24004397 |journal=Journal of Adolescent Health |doi=10.1016/j.jadohealth.2024.09.009 |issn=1054-139X}}

@FirstPrimeOfApophis Regarding your edit here[https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=prev&oldid=1282813870], which I reverted here[https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=prev&oldid=1282819962],

1. The authors are a co-founder, board member, and member of the ridiculously WP:FRINGE group the fr:Observatoire de la petite sirène - who are known for promoting misinformation and conversion therapy
2. This is not a well-respected journal with a reputation for fact checking and accuracy, it's the inagural edition
3. The paper says that ROGD is real, quotes SEGM, and claims human rights are being considered too much in medical decision-making.

This is a wholly unreliable source Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:34, 28 March 2025 (UTC)

:Adding to this, the article is also plainly incorrect. Finland and Sweden have not blocked access to treatment for trans youth. HenrikHolen (talk) 03:40, 29 March 2025 (UTC)

::HenrikHolen the article doesn't say they have. {{tq|In this context, Sweden, followed by Finland, reversed course, considering the Dutch Protocol to be experimental due to inconsistency and insufficiency of evidence supporting either the benefits or risks of such treatments in children and adolescents. As a result, they issued stricter medicalization criteria for minors treated in gender clinics: puberty blockers and cross-sex hormones can now only be administered within the framework of specific experimental research, at the locations where they are carried out}} pp 2-3 (my emphasis). Hence why the Cass recommendation was in line with them. FirstPrimeOfApophis (talk) 13:32, 29 March 2025 (UTC)

:Your Friendly Neighborhood Sociologist ⚧ Ⓐ

1. WP:FRINGE applies to theories, not people. Involvement of the authors in political advocacy (even for unpopular causes) doesn't automatically invalidate their work, otherwise we would have to remove Horton, Pierce, etc. Also according to the French Wikipedia this organisation seems quite prominent in gender healthcare debates in France.
2. The journal is new but the publisher has a rigorous review process which is detailed here: https://www.sciltp.com/policies/peer-review-policy.
3. ROGD: Assuming https://en.wikipedia.org/wiki/Rapid-onset_gender_dysphoria_controversy#Further_research is accurate, various mainstream researchers advocate studying ROGD further, so there is nothing strange in saying it is or might be "real". SEGM: There are 4 citations to SEGM out of 88 citations in total, and none of these citations are for anything controversial. What role "human rights" should play in healthcare is obviously a matter of opinion and not relevant to the reliability of the source.

:Were these your only objections? FirstPrimeOfApophis (talk) 13:32, 29 March 2025 (UTC)

::# Horton, Pierce, etc are not known for misinformation and promoting conversion therapy, unlike these authors - your comparison isa false equivalance.

::#* WP:FRINGE also notes that {{tq|There are people who are notable enough to have articles included in Wikipedia solely on the basis of their advocacy of fringe beliefs.}} - which the authors organization falls into

::# It still remains the first edition of a journal and as @Cdjp1 noted, from a publisher that's only existed since 2022.[https://en.wikipedia.org/w/index.php?title=User_talk:Your_Friendly_Neighborhood_Sociologist&diff=prev&oldid=1282828795]

::# That section notes there is still no evidence ROGD is real. The article repeatedly notes there is no evidence ROGD is real. Our last RFC on ROGD noted there is consensus there's no scientific backing for it.[https://en.wikipedia.org/wiki/Talk:Irreversible_Damage/Archive_10] {{tq|so there is nothing strange in saying it is or might be "real"}} it's a minority viewpoint it might be real, it's wholly FRINGE to say it is. The source says takes the position it does exist, without evidence {{Tq|this new clinical population of trans-identified adolescents, i.e., those with Rapid Onset Gender Dysphoria (ROGD).}} At no point does the source note the large body of literature noting there's no evidence for it

::#* RS don't generally cite hate groups for anything, controversial or not

::#* {{tq|What role "human rights" should play in healthcare is obviously a matter of opinion and not relevant to the reliability of the source.}} - Medical ethics are generally considered important in healthcare. A source taking fringe views about medical ethics does in fact impact its reliability.

::# The review is not systematic, they say {{tq|The article reviews available evidence-based data on the care of children and adolescents diagnosed with gender dysphoria/incongruence, primarily focusing on systematic reviews, including those used to inform the recent Cass Review. The analysis includes international literature and hypotheses regarding the increase in children and adolescents seeking for sex/gender reassignment.}} - it then goes on to pick and choose letters to the editor (unreliable MEDRS) from quacks as reliable. From spot-checking just the first 10 references, we see commentaries from SEGM activists[https://link.springer.com/article/10.1007/s10508-023-02754-9] and the inventor of gender exploratory therapy[https://link.springer.com/article/10.1007/s10508-019-01517-9], as well as papers by conversion therapists[https://www.publish.csiro.au/sh/SH17067] and people famous for claiming all trans women who aren't straight are fetishists.[https://doi.org/10.1111/jsm.12817]

::This is a paper by WP:QUACKS famous for being QUACKS, citing others famous for QUACKERY, in the first edition of a journal with no evidence of use by others, that makes FRINGE claims such as arguing a hypothesized condition that no evidence supports exists while not mentioning of the criticism of it. WP:FRINGE as it gets really. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:27, 29 March 2025 (UTC)

::{{tqq|rigorous}}, when in the very first section, they show they are below what is accepted as the best practice (double-blind review). -- Cdjp1 (talk) 10:11, 30 March 2025 (UTC)

:::There are then concerns about them for the fact that in the just over 2 years that the publisher has existed, they've spun up 73 journals, spanning the breadth of the sciences, their wanton us of "AI" generated images, the fact none of the journals have any sort of impact presence (this is somewhat expected for how new they are) which is important for assessing the due weight to give papers published by them. -- Cdjp1 (talk) 10:17, 30 March 2025 (UTC)

::::You'd probably know better about this, but is it weird that the name of the journal (disease biology, genetics, and socioecology) doesn't seem to have much to do with the subject matter of the paper whatsoever (the evidence base for gender dysphoria in minors.)? LunaHasArrived (talk) 11:20, 30 March 2025 (UTC)

:::::It's not something that I would flag as potentially concerning, though I can understand that it may do for others. In the end, the publisher and journals could turn out to be perfectly fine (even with only having single-blind review, as there are plenty of journals who follow the process), but at this point I would suggestion caution in citing their papers. -- Cdjp1 (talk) 12:29, 30 March 2025 (UTC)

::::::I think you should be concerned about that, because Wikipedia:Identifying reliable sources (medicine)#Predatory journals is concerned about that: {{xt|Other indications that a journal article may not be reliable are...its content being outside the journal's normal scope (for instance, an article on the efficacy of a new cancer treatment in a psychiatric journal or the surgical techniques for hip replacement in a urology journal)}}.

::::::I agree with you that caution is warranted. WhatamIdoing (talk) 23:01, 2 May 2025 (UTC)

:::Your Friendly Neighborhood Sociologist ⚧ Ⓐ

:::# Before you go any further with this, remember that WP:BLP applies to talk pages. The authors are published researchers in their field, not "quacks" and not {{tq|known for misinformation}}. According to the French Wikipedia one of the authors (Masson) has even received some kind of national award for her work.

:::# This might be a valid concern. I will wait to see what other editors have to say about this before pressing for inclusion of this content.

:::# Fortunately, scientific sources don't have to follow WP RFCs to be considered reliable. The article isn't about ROGD, so it isn't surprising that it doesn't discuss the evidence for and against in detail. It does describe it as "disputed".

:::#* Why do you say that? There are many reasons a group labelled as a "hate group" by their ideological opponents might be cited by an RS (although maybe not as an RS in a WP article).

:::#*That a conflict may arise between giving a patient treatments they ask for and keeping to what evidence deems safe is not a {{tq|fringe view about medical ethics}}.

:::# Correct, it isn't a systematic review. Is that really a standard you want us to start applying? Nearly every one of the 88 citations are either to academic journals or public policy documents ([https://www.sciltp.com/journals/dbgs/2025/1/586/457] pp 11-15), I can't see what "letters to the editor" you are referring to? What is even more extraordinary is that right now you are also arguing for the use of an interview for Dazed Digital as a reliable source (see section above). I am not going to respond to your ad hominem attacks on the researchers cited, suffice to say it needs to stop. FirstPrimeOfApophis (talk) 16:24, 30 March 2025 (UTC)

:::#* I see you mean that some of the citations are to "letters to the editor published in academic journals" rather than in newspapers, so in fact not different to sources this WP article already cites as reliable "academic" commentary e.g. [https://www.jahonline.org/article/S1054-139X(24)00439-7/fulltext] FirstPrimeOfApophis (talk) 16:47, 30 March 2025 (UTC)

::::{{tq|Before you go any further with this, remember that WP:BLP applies to talk pages. The authors are published researchers in their field, not "quacks" and not known for misinformation.}} - Being a "published researcher" does not mean they are not quacks or not known for disinformation. Andrew Wakefield and Joseph Nicolosi are "published researchers". This group's article has an entire section devoted to their misinformation so this is a tendentious argument. And the article notes the award was controversial and winning an award does not mean they're not a quack. They are known for opposing the inclusion of gender identity change efforts in conversion therapy bans ffs.

::::* If you really want, go to WP:FTN and ask if they're WP:QUACKS... If consensus is they aren't, I'll rescind my statement, but until then, I'll continue saying, based on the overwhelming evidence, that they are.

::::{{tq|Fortunately, scientific sources don't have to follow WP RFCs to be considered reliable.}} - We on Wikipedia do have to follow them. When we have overwhelming scientific consensus there is no evidence a thing exists, and an RFC noting there is no evidence it exists, then a source saying it does exist is WP:FRINGE and unreliable.

::::Letters to the editor from conversion therapists and quacks are not MEDRS or even RS. Wikipedia is not in the business of citing the opinions of conversion therapists. If a source cites conversion therapists opinions as reliable, that is a mark against reliability. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:09, 30 March 2025 (UTC)

Re the following in the lede:

{{tq | The review's recommendations were largely welcomed by UK medical organisations, though some noted criticisms of the review and called for their consideration}}

@Your Friendly Neighborhood Sociologist reverted this saying this is supported by statements in the body from RCP and RCPCH.

What the body says about the RCPCH is that they {{tq | acknowledged there had been some academic criticism }} but that there should be no delay. So they acknowledge the criticism of the Cass Review, but explicitly do not give it any consideration.

What they then go on to say is to take not of {{tq | emerging criticisms of any chosen approach}}

This second part is not about the Cass Review, it is about the implementations, and any hypothetical criticisms that may emerge in the future.

So the sentence in the lede is I think contradicted by the RCPCH's position.

As for the RCP, I don't see the word "criticism" or anything similar, or any acknowledgement of "criticisms" of the review or any calling for their consideration.

I think the "{{tq|though some noted criticisms of the review and called for their consideration}}" part of the lede is misleading, undue emphasis, and not supported by the sources, and simpler to just leave it out because "largely" contains enough space. Void if removed (talk) 21:10, 2 May 2025 (UTC)

:RCP: {{tq|“It is also important to recognise that trans members of the College and the wider trans community have raised concerns about the negative impact of the report. This includes how the review's conclusions on the evidence base of different interventions and the need to wait for further research, in combination with the knowledge that existing services are unable to meet demand, will leave gender questioning children and young people feeling unsupported and unseen.
"There is a strong view that the report makes assumptions in areas such as social transition and possible explanations for the increase in the numbers of people who have a trans or gender diverse identity, which contrasts with the more decisive statements about treatment approaches. During implementation, these views should be taken into account to ensure every child, young person and their families feel supported by all. This will require individuals with lived experience being directly and comprehensively involved in the ongoing process. }}[https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2024/04/22/detailed-response-to-the-cass-review%27s-final-report]

:RCPCH: {{tq|RCPCH is aware that the Cass Review has received academic criticism, and that some members of the medical profession are calling for a pause in implementation of the new Gender Identity Services until further reviews have taken place. The closure of the previous service has resulted in unacceptable waiting times for Gender Identity Services, which were already high before the closure.
The College is clear that pausing the implementation of the Cass report recommendations would be a backwards step for Gender Identity Services, as this will again delay care and therefore risks causing further harm to this patient population. It is our absolute priority that this group of children receive timely, holistic and high-quality care.
We are in regular contact with NHS England to offer input into the development of the new Gender Identity Services. As a part of this engagement we will encourage NHSE to consider emerging criticisms of any chosen approach, as would be the case in the delivery of any other children's health service.}}

:{{tq|As for the RCP, I don't see the word "criticism" or anything similar, or any acknowledgement of "criticisms" of the review or any calling for their consideration.}} - You perhaps skimmed over their two paragraphs acknowledging specific criticisms and saying they should be taken into account

:{{tq|So they acknowledge the criticism of the Cass Review, but explicitly do not give it any consideration.}} - No, they acknowledge criticism and calls to pause its implementation. They state they oppose the latter because it would further delay care as trans youth are currently facing worse delays with the clinic closures. They do not state they oppose the former, they say that they will encourage the NHSE to to consider the criticisms. One can criticize the Review and think pausing the roll-out of the recommendations would make trans people suffer more, for the record - it's not a zero-sum game where if you oppose a pause you think the review is above any and all criticism.

:So that's two of the 5 cited bodies 1) acknowledging criticism and 2) calling for its consideration. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:41, 2 May 2025 (UTC)

WRT this reversion: https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=prev&oldid=1288464181

The petition mentioned in the article is here: petition.parliament.uk/petitions/700217

Anyone can create these. They are largely meaningless, other than that if they hit 10k the government has to give a response (usually "Nope"), and if they hit 100k it triggers a debate (usually "Shall we? Nope").

The one saying "I would like there to be another General Election." has 3 million signatures. petition.parliament.uk/petitions/700143

The one titled "Close the Borders! Suspend ALL immigration for 5 years!" has 227,000 signatures. petition.parliament.uk/petitions/700824

These are low-effort nonsense that nobody takes seriously, and that Pink News turned this into a story is yet another reason we shouldn't take a story seriously if it only appears in Pink News. I think this sort of thing needs more coverage for it to be relevant and right now WP:NOTEVERYTHING Void if removed (talk) 21:22, 2 May 2025 (UTC)

I know several of you are interested in scientific evidence and its relationship to politics. I've heard that this is a good book on the topic:

• {{Cite book |last=Parkhurst |first=Justin |url=https://www.taylorfrancis.com/books/9781315675008 |title=The Politics of Evidence: From Evidence-based Policy to the Good Governance of Evidence |date=2016-10-04 |publisher=Routledge |isbn=978-1-315-67500-8 |edition=1 |location=Abingdon, Oxon ; New York, NY : Routledge, 2017. |language=en |doi=10.4324/9781315675008}}

It's open source, so you should be able to download it and read it freely. For the avoidance of doubt, I'm not suggesting that we cite this in this article. It might, however, make useful background information. WhatamIdoing (talk) 06:16, 3 May 2025 (UTC)

Could be of interest to mention it in the article.

https://link.springer.com/article/10.1186/s12874-025-02581-7?utm_source=rct_congratemailt&utm_medium=email&utm_campaign=oa_20250510&utm_content=10.1186%2Fs12874-025-02581-7 —

78.244.246.105 (talk) 15:24, 10 May 2025 (UTC)

:This is the much-referenced Noone preprint, finally published. Void if removed (talk) 15:42, 10 May 2025 (UTC)

:Thanks, hadn't seen this yet, and look forward to giving at a read Bejakyo (talk) 20:52, 12 May 2025 (UTC)

::The ordinary thing to do with a study, in WP:MEDRS terms, is to focus on the key points in the conclusion. I think the most important bit in that paper's ==Conclusions== section is {{xt|"insufficient statistical rigor, unreliable datasets, claims presented without evidence, and misrepresentation of quotes from primary research participants"}}.

::I thought the bit about quotes was likely to be the easiest for Wikipedia editors to understand, since we deal with misquotations in many other contexts. However, the paper provides only a single example of "quotes", and it wasn't actually an inaccurate quotation. The paper says this:

::{{xt|We also found inaccurate communication of participant quotes from the primary qualitative research to support the Cass report’s claims. For example, one participant is quoted as saying “there’s not only one route or one set way to transition or be trans. They might want just hormones, or just surgery, people are different with different experiences, presentations, and bodies. It’s fine for that to be the case, it’s okay to have different plans for your medical transition.” (1; pp 147). While it appears this participant is advocating for increased availability of medical care options for trans people, this quote directly informs 10.81, which suggests “it is important to inform people that medical transition is not the only option and that choosing not to go down that route does not invalidate their identity” (1; pp 147). The report then reframes this response as evidence for the need to reduce the number of medical transitions.}}

::The Noone team's complaint is that the person being quoted says there are lots of options, and the Noone team believes (without giving any evidence to support their belief) the speaker meant there need to be more medical options, but the Cass team used the quote to support a recommendation that providers tell kids that taking the medical route is not required to be a Real™ trans person (which ought to be an uncontroversial statement, right?). The Noone team calls this "inaccurate" and "misrepresentation", but I don't agree. I think the Noone team is overstating this, and I assume that they've given the clearest example that they could find. That makes me feel like we should use the Noone paper more narrowly: "Noone et al. criticized it" rather than "Noone et al. are correct".

::OTOH, after disappointing me by saying that it's improper for an English-speaking government to make its decisions by looking at the English-language literature, without providing any evidence that relevant non-English papers exist (I believe someone else checked this, and found only one non-English [Spanish] paper, and that it wouldn't have affected the conclusions), the Noone team identified two specific papers, with the same lead author, that they believe ought to have been included. I don't know whether these two papers should have been included in the Cass Review, but the specificity gives me more confidence in the Noone team's work, because it's not just handwaving about hypothetical papers.

::After complaining about "claims presented without evidence", the Noone team writes "some also criticised the usefulness of AGREE-II for GAC guidelines", and immediately cite three papers that used AGREE-II for GAC guidelines and do not appear to ciriticize its usefulness, though the cited paper that said {{xt|the overall methodological rigor in guideline development was poor}} – thus finding the same result as the Cass team did, despite the Noone team saying they {{xt|"arrived at quite different conclusions"}} – did say that there are aspects of being trans that are not in "the biomedical model", and therefore AGREE-II isn't looking at the whole picture. This makes me wonder again whether we need to be cautious about how to represent the results of this paper.

::Overall, I think this should be cited, and the only tricky thing is to figure out what we can say that is both fairly representing the source and not being misleading. WhatamIdoing (talk) 22:47, 13 May 2025 (UTC)

:::The key point about the first example, as I read it in Noone at al., is that this is apparently a response to a question about offering individualised care (not a one-size-all-approach) which is being used by Cass as if it were a response to a different question, thus changing its context. It's something of a motte and bailey fallacy.

:::When the person being quoted says "They might want just hormones, or just surgery, people are different with different experiences, presentations, and bodies...", they aren't saying "offer fewer hormones or surgeries", because that wasn't the question they were asked. They're just saying you don't need to have these things in all cases in response to a question about individualised care. We can't infer a judgment about needing to reduce the number of people on hormones or having surgery from this answer, because they're not saying we need fewer of these treatments—only that not everyone needs them, which isn't the same thing.

:::However, I'm still digesting this paper myself and I want to check their claims (including the things you've pointed out here) before making a decision about what I think should be included here. On first read-through, I think some parts of their critique are stronger/more relevant than other parts. Lewisguile (talk) 10:53, 14 May 2025 (UTC)

::::Even though this has only just been published, this has been doing the rounds in preprint form for a year (and was referenced in the Yale white paper) so there are already published critiques of the claims in Noone et al that may be worth looking at. Void if removed (talk) 12:22, 14 May 2025 (UTC)

:::::I did a search for Noone in the archives but could only find three passing mentions. Do you remember what the topic was called? I have a vague memory of having found something on the preprint last year, but I'd struggled to find it then as well. No worries if not. If I find it, I'll post a reminder link on here. Lewisguile (talk) 07:46, 15 May 2025 (UTC)

::::::[https://www.tandfonline.com/doi/full/10.1080/0092623X.2025.2455133#d1e1150 This has been raised before] WRT the various criticisms, not sure where the discussion is on this page but I do know it came up on RSN.

::::::Example response:

::::::{{quote frame | The Yale Critique cited a 2010 paper claiming the NOS scale is unreliable (Stang, 2010), and N24 [<-- Noone et al] asserted the Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS-I) scale should have been used instead. However, more recent research has found similar reliability for the NOS scale and ROBINS-I ([https://pubmed.ncbi.nlm.nih.gov/34002466/ Zhang et al., 2021]), and an analysis of PROSPERO data from 2018 found that NOS was the most commonly used tool for appraisal of nonrandom studies ([https://pubmed.ncbi.nlm.nih.gov/31730014/ Farrah et al., 2019]). Also, the ROBINS-I was used in another systematic review whose findings were consistent with the University of York reviews ([https://pubmed.ncbi.nlm.nih.gov/37069492/ Ludvigsson et al., 2023]).}}

::::::The fact is the York systematic reviews were the most comprehensive ever performed, assessing the most evidence, using the most widely used methodology, and - despite generous quality appraisal - still found it was poor, independently corroborating at least half a dozen other systematic reviews that used different methodology (GRADE and ROBINS-I). Void if removed (talk) 08:47, 15 May 2025 (UTC)

:::::::On the NOS, it's worth noting that the other critiques from Noone et al. are that the York reviewers deviated from the validated use of the NOS (thus rendering its effectiveness questionable), and that they didn't use NOS for all the systematic reviews even though they used the same protocol for them all. Those are causes for concern and generally aren't best practice. Deviations from a published protocol can, in themselves, be a cause for concern as well, and they note that happened with the SRs as well. (Changing a protocol after you've begun can indicate fiddling with the results to get the answer you wanted, which is why it's supposed to be rarely done and requires lots of transparency.)

:::::::I suppose I'll have to re-read all the SRs again to check. Lewisguile (talk) 13:07, 15 May 2025 (UTC)

::::::::{{tq | reviewers deviated from the validated use of the NOS }}

::::::::Yeah this is basically nonsense. The NOS has generic questions you can adapt for the specific subject, and the way this was done [https://www.wjgnet.com/2308-3840/full/v5/i4/80.htm is standard and regarded as one of its strengths]. {{tqq|the adaptability of its indexes on the basis of the investigated topic is very important}}. Just have a search for "modified newcastle-ottawa scale" in any database.

::::::::And [https://www.crd.york.ac.uk/PROSPERO/view/CRD42021289659 here's what they said] about the decision to use different tools on different reviews after originally registering MMAT:

::::::::--

:::::::::Original plan

::::::::::We originally selected the Mixed Methods Appraisal Tool (MMAT) for quality appraisal because we expected the reviews to include a mixture of quantitative, qualitative and mixed methods designs.

:::::::::Revised plan

::::::::::After screening identified articles, we decided to re-assess whether, for each of the review questions and study designs contributing data for these, the MMAT was the most appropriate tool.

::::::::::For questions including a combination of quantitative and qualitative and/or mixed methods studies, the MMAT remained the most appropriate tool.

::::::::::For questions including service audit data, which is not classed as research, critical appraisal tools for research were not deemed appropriate, and we decided to subjectively examine data validity and reliability.

::::::::::For questions including a combination of quantitative cross-sectional, pre-post and cohort studies, we considered various tools and decided to use the Newcastle Ottawa Scale (NOS). The NOS covers a more extensive set of questions than the MMAT and allows for more consistency and transparency in reporting.

::::::::::For questions including clinical guidance, the MMAT was not deemed appropriate. Instead, we used the Appraisal of Guidelines for Research and Evaluation (AGREE2) tool which was developed to assess the quality of clinical guidelines.

::::::::--

::::::::This all seems completely fine, and not at all {{tq | fiddling with the results to get the answer you wanted}}. Void if removed (talk) 14:05, 15 May 2025 (UTC)

:::::::::@Void if removed, I suspect that most people, including many reliable sources, don't actually know much about the Newcastle–Ottawa scale. Do you have the sources to add an example of a generic question plus an example of how that generic question is supposed to be adapted to that article?

:::::::::Because what's actually going on is that we start with a generic item such as:

:::::::::* Comparability of cohorts on the basis of the design or analysis controlled for confounders: One star for controlling for relevant demographic information, one star for controlling for known risk factors, and no stars if the cohorts are different or no information is given.

:::::::::and you're supposed to modify this to say (using pediatric brain cancer as an example):

:::::::::* Comparability of cohorts on the basis of the design or analysis controlled for confounders: One star for controlling for sex and age at diagnosis, one star for controlling for family cancer history, radiation to the head, and tumor grade, and no stars if the cohorts are different or no information is given.

:::::::::but if people can't see with their own eyes that NOS adaptations are normal and even obvious ways to apply the scale, then they may leap to incorrect conclusions. WhatamIdoing (talk) 20:29, 18 May 2025 (UTC)

:::::::The Centre for Reviews and Dissemination at the University of York literally wrote the book on conducting systematic reviews. I'm serious: {{ISBN|9781900640473}}. You can download a copy [https://www.york.ac.uk/crd/guidance/ here] or [https://www.amazon.co.uk/Systematic-Reviews-Guidance-Undertaking-Healthcare/dp/1900640473/ buy it from Amazon]. That's the third edition. The first edition was in 1996, before most people here were born I guess. According to [https://www.york.ac.uk/crd/ their website], they've completed over 200 systematic reviews in the last 20 years. They host and produce PROSPERO, the online international database of systematic reviews, which has about a third of a million entries. They are running an [https://www.york.ac.uk/crd/training-services/introduction-to-systematic-reviews/ online course: Introduction to Systematic Reviews] this very week. This team teach the world how to do systematic reviews.

:::::::While everyone is human, and mistakes can happen, if you are reading a publication claiming the York team made a basic error of judgement when doing their several reviews for the Cass Review, you should treat that claim as being as likely that the UK's National Physical Laboratory can't work out leap years and don't know how to use a weighing scale properly. Alarm bells should be going off. And if they aren't, seriously, ask yourself why. Is it that your definition of "reliable sources" is "ones I agree with" or "ones people I agree with cite" or does that definition need some calibration?

:::::::Writers who have an obvious agenda (as every one of the Noone paper authors and all the York PDF authors have in abundance), should make us doubly cautious when they make extraordinary claims one may wish were true, but if examined neutrally, are as unlikely as moon cheese. If I write the words "The review's dichordant selection of studies was obliquely heteroconformative, and often fraudulently improtectionary." do you nod along to my learned criticism, or recognise I made up at least three bullshit words.

:::::::Anyone telling you the York team don't know how to select and properly use one of the several methods for grading medical studies is bullshitting you. And more to the point, they know they are bullshitting you, and don't care. They only need you to be credulous. -- Colin°^Talk 16:51, 15 May 2025 (UTC)

::::::::York may very well be excellent in the main, but that doesn't mean everything they produce is equally excellent. (Also, I was very much alive in 1996; I don't think we can assume most people here are young just because they might disagree with you.)

::::::::Part of the reason why they needed to switch tools, which their explanation itself alludes to, is because the single protocol they had for the seven different systematic reviews wasn't appropriate for all the reviews they were conducting. Unsurprisingly.

::::::::That's why you are supposed to have tailored protocols for each review. That would've avoided, or at least minimised, the need to deviate from the registered protocol in the first place.

::::::::Noone et al. are also not the only ones who've raised concerns about these changes. The strength of systematic reviews is based, in part, on their replicability and transparency.

::::::::The OP doesn't appear to be making any concrete proposals for changes or additions at this time, so I'm not sure we need to convince each other of anything yet anyway.

::::::::In the meantime, Colin, you don't appear to be assuming good faith with the following:

::::::::{{tq|Alarm bells should be going off. And if they aren't, seriously, ask yourself why. Is it that your definition of "reliable sources" is "ones I agree with" or "ones people I agree with cite" or does that definition need some calibration?}}

::::::::{{tq|Writers who have an obvious agenda (as every one of the Noone paper authors and all the York PDF authors have in abundance), should make us doubly cautious when they make extraordinary claims one may wish were true, but if examined neutrally, are as unlikely as moon cheese.}}

::::::::Your posts here, and the comment about assumed age, are verging on personal attacks and I'd appreciate it if you could dial it back. We should also be mindful of the fact that everyone has bias—whether they're York reviewers or Wikipedia editors. The bias blind spot isn't only something that affects other people. Lewisguile (talk) 08:28, 16 May 2025 (UTC)

:::::::::I'm rather tired of editors who don't understand what "assume good faith" is or what a "personal attack" is, but more than happy to fling those terms about when butt hurt. You are right everyone has bias and nowhere have I suggested I'm immune and others not. You personally may be over 30 but I think my aside that most editors of this talk page are not is likely correct, and if not is unimportant: it is just an aside. Quite why you might think I'm suggesting people are young because I disagree with them boggles me, or why you think speculating someone might be young is a personal attack. Have you got something against young people? I don't. Why are you wasting our time with this?

:::::::::Good faith is not the same thing as due diligence in treating extraordinary claims with due scepticism and is not the same thing as competence. Advice about how editors should deal with sources making extraordinary claims is not a personal attack.

:::::::::A claim by a bunch of writers who's only pertinent qualification is "activist" that "Our critical analysis reveals significant methodological problems in the commissioned systematic reviews" is an extra ordinary claim. Have these authors got any track record in critically appraising systematic reviews? Nope. It seems by some random chance of good fortune, that the first systematic review they decided to critical appraise was one they didn't like the conclusions of. Have any of them ever even done a systematic review of clinical studies. Nope. Or even done any primary clinical research of drugs in humans? Nope. So why should Wikipedia regard their extraordinary claim as of any merit?

:::::::::If it were actually true, the Archives of Disease in Childhood would be required to retract the papers. If it were actually true, the York Centre for Reviews and Dissemination would face serious credibility crisis that would lead to heads rolling. If it were actually true, NHS England and NHS Scotland would distance themselves from any guidance relying on them. These things are not happening in the real world.

:::::::::Rather than arguing about this or that sentence in Noone, these are the fundamental MEDRS and RS questions Wikipedians should be dealing with. Does this source (author, organisation, publication) have any reputation for fact checking and accuracy in this field. No, the authors are as lacking as contestants on day one of Strictly Come Dancing. They have no reputation at all. Is the bias of the source (author, organisation, publication) likely to influence its findings. You betcha. Every single author. Not one is neutral or disinterested.

:::::::::If it was the other way around, and experts from the York Centre for Reviews and Dissemination were highly critical of some gender critical activist research, say, then we'd have something to work with here. But this way around is like my vet having an opinion. -- Colin°^Talk 11:35, 16 May 2025 (UTC)

::::::::::Colin, it's not about being "butthurt"; it's about attempting to work together for the aims of Wikipedia with civility and avoiding yet another argument in this topic area. I calmly asked you for courtesy and politeness so we can take the heat out of this discussion, and keep it fruitful. You've responded with another diatribe, with more passive-aggressive comments about what you're "tired of" from other editors, which I just don't have the time or inclination to engage with. There's no need to escalate everything and, as I've already said, the OP is not proposing adding or amending anything to the article (and nor is anyone else), so it seems a waste of your time and mine. Lewisguile (talk) 13:23, 16 May 2025 (UTC)

:::::::::::Why don't you examine your own comments for putting heat into this. Wildly throwing about bad faith and personal attack claims and your own assumptions about attitudes towards young people. You don't "calmly" claim another is verging on a personal attack. Someone saying they think you are wrong or misguided in approach is not a personal attack. That attitudes towards sources on this talk pages are imo in serious need of recalibration is not a personal attack or assumption of bad faith.

:::::::::::There's no mild way to put the extraordinary claim here, that one of the worlds best centres for doing systematic reviews doesn't know its arse from its elbow. Made by some random psychology lecturer, a physicist, a lawyer, a lab researcher, a vet. I made that last one up.

:::::::::::If this was on the WPATH talk page, and some gender-critical psychology lecturer, a Musk supporting lawyer, a lab researcher who once admitting enjoying a Harry Potter novel, and a vet who is English (so obviously a TERF) had written a paper criticising WPATH, we'd see highly dismissive comments. And the criticism would extend far more than their lack of experience in conducting such an analysis. It would be an voluminous stream of personal attacks about each an every one of them being a intrinsically hateful person, regardless of their experience or ability or what they wrote.

:::::::::::We don't do MEDRS like this: "A team from the York Centre for Reviews and Dissemination published six systematic reviews on the topic of child trans healthcare, which were published in the Archives of Disease in Childhood. But Chris from Galway says they are fundamentally flawed". -- Colin°^Talk 15:02, 16 May 2025 (UTC)

::::::::::::I don't think there was anything "wild" about my comments. But I think it's best we leave this discussion here, as this is clearly beyond constructive territory. Lewisguile (talk) 16:31, 16 May 2025 (UTC)

:::::::::In case anyone's curious, Wikipedia:Wikipedians#Demographics suggests that about half of Wikipedia's editors were born after 1996. WhatamIdoing (talk) 20:39, 18 May 2025 (UTC)

In this article, we cite the Yale Integrity Project white paper on the Cass Review 11 times. This paper is not peer-reviewed, and is not published in any journal or publication. It is hosted on the Yale Law School website, yet it carries the disclaimer "This work reflects the views of individual faculty and does not represent the views of the authors’ affiliated institutions." The Yale Law school website is, it hardly needs to be said, not a MEDRS source - or even an RS source at all, as far as I can tell. There are four sentences that are only cited to this paper. I think these citations should be removed, per Wikipedia:RS, and if no replacement source can be found, text relying on these citations should also be removed.

We also devote a subsection to the Yale Integrity Project white paper. This section is absurdly skewed. [https://adc.bmj.com/content/110/4/251#ref-9 The article in Archives of Disease in Childhood] primarily concerned with the Yale white paper is ignored, and this needs remedy. Furthermore, ADC actually is a MEDRS, and therefore is a source usable on wikipedia to correct false biomedical claims in the Yale white paper. Wanted to post this here first as I don't imagine that making changes along these lines would go undiscussed in any case. Samuelshraga (talk) 19:52, 17 May 2025 (UTC)

:I agree that the white paper is not ideal.

:I also believe that it has made such a splash, at least within certain filter bubbles, that removing it will be challenging. It's like medical news in the New York Times: even if the popular press got the story wrong (e.g., it's not "the cure for cancer"; instead, it's a baby step towards something that will hopefully be a treatment for a particular cancer), people feel better if the things that are important to them are at least mentioned in the Wikipedia article. WhatamIdoing (talk) 20:43, 18 May 2025 (UTC)

::I definitely think we should include the Yale white paper, it received enough 3rd party coverage to be notable. We just shouldn't cite claims to it, and our coverage should be balanced. Samuelshraga (talk) 05:37, 19 May 2025 (UTC)

:::Absolutely - it is a notable document. It is not MEDRS though, and should be attributed and placed in context. It has been edited multiple times and I'm not sure there is an "authoritative" version except the Amicus Brief filed the day it was released? Void if removed (talk) 08:21, 19 May 2025 (UTC)

:It's a collaboration between the schools of law and medicine, but is on the former's website. I'm sure we've discussed that before? It's led by Professor Anne Alstott (Yale Law School) and Dr. Meredithe McNamara (Yale School of Medicine), according to The National.[https://www.thenational.scot/news/24427920.cass-review-john-swinney-responds-yales-serious-flaws-warning/] Lewisguile (talk) 16:05, 19 May 2025 (UTC)

::[https://law.yale.edu/yls-today/news/white-paper-addresses-key-issues-legal-battles-over-gender-affirming-health-care No we established it was Yale Law School]. Irrespective that McNamara and Allsott are at different departments, the Integrity Project is under Yale Law School. See here for an early discussion. Void if removed (talk) 16:19, 19 May 2025 (UTC)

:::That's their website, not a discussion on here. Is that the link you meant to send, as you said "we"? Lewisguile (talk) 17:21, 19 May 2025 (UTC)

::::I reckon you meant this one, actually: https://en.wikipedia.org/wiki/Special:Diff/1271980082/1272053079 And that wording is fine by me still. Lewisguile (talk) 17:38, 19 May 2025 (UTC)

::::There's a hyperlink under "{{tq|here}}". Void if removed (talk) 18:18, 19 May 2025 (UTC)

::@Lewisguile, it is researchers from the law school and the school of medicine, but the white paper carries the disclaimer: "This work reflects the views of individual faculty and does not represent the views of the authors’ affiliated institutions."

::I know the paper has been discussed, but I wanted to specifically raise the issue of the reliability of this source, which is cited extensively in this article. It's a non peer-reviewed paper, put on a university department's website. It has been silently edited since its publication.

::I think the paper itself is therefore broadly similar to a WP:PREPRINT source. I don't know if editors believe that Yale Law school exercises the kind of editorial control that characterises a reliable source, but I would suggest that this is at least questionable, opening issues of whether this source is effectively Wikipedia:Self-published. What I think is not in question is that the Yale Law School website is not a MEDRS. All citations to this source should be reviewed in light of the above. Samuelshraga (talk) 17:02, 19 May 2025 (UTC)

:::I don't dispute that, but wanted to raise that it's not solely a legal project. Having re-read the section in question, it's clearly attributed and explained that it's based at the law school. We also have lots of non-MEDRS also offering commentary on the review, so I'm not sure it's actually a problem? Lewisguile (talk) 17:26, 19 May 2025 (UTC)

::::Sorry I'm not sure which part you're saying you don't dispute and which part you're saying isn't actually a problem? Samuelshraga (talk) 18:19, 19 May 2025 (UTC)