Talk:Cass Review#c-Relmcheatham-20241021100800-Exclude

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• {{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}}

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)

::::::::::::I find Colin persuasive. Pearl clutching and "cautioning" is a form of control and a form of derailing the conversation in order to unfocus it. 24.63.3.107 (talk) 13:12, 23 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)

:Cass's core thesis concerned the dearth of high quality evidence for specific treatments. Refuting this core thesis should have been trivial: cite the high-quality evidence. If Cass didn't have a point, it should have been super easy to point this out - if that high-quality evidence actually existed. Cass's critics have largely focused on peripheral and trivial issues, and that is largely true for this paper, except this one does actually identify two papers that it claims should have been included:

:1) Olson KR, Gülgöz S. Early Findings From the TransYouth Project: Gender Development in Transgender Children. Child Dev Perspect. 2018;12(2):93–7.[https://hudl.princeton.edu/sites/g/files/toruqf361/files/2020-09/Olson.Gulgoz.2018-1.pdf]

:2) Rae JR, Gülgöz S, Durwood L, DeMeules M, Lowe R, Lindquist G, et al. Predicting Early-Childhood Gender Transitions. Psychol Sci. 2019;30(5):669–81. [https://pmc.ncbi.nlm.nih.gov/articles/PMC6512159/]

:However, it doesn't claim that inclusion of these two papers would have altered the conclusion of the systematic review, and if we take a look, we can see why: these are both observational in nature, with no data on mental health outcomes, and if they had been included would clearly have been subject to, as the York SR puts it: "the key methodological limitation was the approach to recruitment, relying on self-selecting groups or referral to gender services leading to samples which were unrepresentative of the broader population".

:The search for the missing WMDs (Works of Medical Data) continues, and the longer we have to wait, the less weight we should be giving to critics. They have had a year now in which to mount a refutation, and have only been able to grasp at straws. Barnards.tar.gz (talk) 09:54, 24 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)

:::::I'm clearly going blind. Thank you! Lewisguile (talk) 12:45, 20 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)

:::::Sorry, that was clear as mud! What I meant was that I don't dispute what you say in your first paragraph about the disclaimer.

:::::I also meant to say that an attributed comment in the responses section, as we have here, seems fine to me. Where it can be better sourced in the article for other statements (I think it's nearly always one source among several?), then WhatamIdoing's suggestion of simply replacing it is fine and unlikely to cause any disagreements. Lewisguile (talk) 12:49, 20 May 2025 (UTC)

::::::I (think I) broadly agree. Of course replacing it/relying on the other cited sources only works if another source can be found/the other citations actually support the text. I think for now if I find any that don't and no replacement sources are immediate to hand, I will just leave a maintenance tag. This can avoid controversial changes to the text for now, but make clear what areas need work. Samuelshraga (talk) 14:02, 20 May 2025 (UTC)

:::I think it's fair to describe it as a WP:PREPRINT.

:::The obvious (to me; feel free to disagree) first step would be to replace citations to this with a citation to a better source. If it's being used to support a claim about something other than its own contents, and we could replace that with a source that's actually published in an academic journal (medical, legal, etc.), then that should be considered a net improvement. We might be able to replace most, or just a few, or even just one, but that would reduce our reliance on it. Who would like to do that work? WhatamIdoing (talk) 19:09, 19 May 2025 (UTC)

::::A great suggestion. I'll try and do some of this when I get a chance, hope that there can be consensus on this at least. Samuelshraga (talk) 20:29, 19 May 2025 (UTC)

:::::People rarely object if you replace the contents of a little blue clicky number with a better source. However, if you decide to change the text of the sentence at the same time, then objections might well be raised. WhatamIdoing (talk) 20:35, 19 May 2025 (UTC)

::::::Indeed! Mostly citations to the white paper appear together with other citations so at least there's a starting point to where to look for verification.

::::::I want to try to verify the statement "Academics have also criticised unsupported claims that social transition and puberty blockers may "change the trajectory of psychosexual and gender identity development" and that youth who transition may lose the opportunity to experience adulthood as a gender they don't identify with." I don't see support for this statement in the [https://journals.library.columbia.edu/index.php/bioethics/article/view/13149#_ftn23 second source]. If somebody finds an alternative source for this statement, that might be a good place to start. Samuelshraga (talk) 21:02, 19 May 2025 (UTC)

:::::::No, I don't see that in that source either. Closest I can find is Noone et al:

:::::::{{quote frame | However, the Cass report emphasises their distress, rather than their treatment wishes: the report describes them as “children with gender dysphoria and/or gender-related distress” and then emphasises the resolution of this distress as the main goal of interventions. Further, we contend that the commentary on developmental trajectories frames early social transition and detransition through a pathologising lens that leaves little room for the possibility that the formation of gender identity is non-linear and may be experienced positively. Framed in this way, GAC becomes one of several treatment options for a quasi-psychiatric condition, rather than the authentic preference of competent individuals [...]. Given that transgender people have a care need rather than a disease and seek actualisation of their identities as opposed to a cure, this paternalistic lens is inappropriate and pathologising.}}

:::::::So this is all just opinion really. Void if removed (talk) 21:23, 19 May 2025 (UTC)

:Another concerning sentence sourced to the white paper is this one:

:{{quote frame | Various scholars also criticised the emphasis on high and moderate quality evidence, saying that paediatric care often relies on low quality evidence in other areas; that in downgrading qualitative research, the patient voice was minimised; and that the highest quality evidence (such as from randomised controlled trials) may be difficult or unethical to obtain in this area.}}

:This is additionally sourced to these [https://journals.library.columbia.edu/index.php/bioethics/article/view/13149 Xian] and [https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2328249#d1e381 Horton] articles. Xian et al is certainly not MEDRS, and I read in the FAQ section below this one that Horton is a social scientist from a business school, and so I don't think they are qualified to comment on what kind of evidence underpins paediatric care in other areas. Xian et al at least make an extremely basic factual error in their description of Cass' grading of evidence.

:Maybe these sources can be used for a criticism of 'minimising the patient voice'. Inasmuch as we can find a more convincing source for the issue of reliance on low quality evidence in other areas, and addressing the false implication that randomised control trials were the only high quality evidence, we should balance it with this [https://adc.bmj.com/content/110/4/251.long (high-grade MEDRS) response to those criticisms]. Samuelshraga (talk) 12:32, 22 May 2025 (UTC)

::Horton's paper predates the 2024 final report of the Cass Review, and is about the interim report and the 2020 NICE reviews.

::"Voices in bioethics" isn't indexed and so there's no impact factor. Void if removed (talk) 13:33, 22 May 2025 (UTC)

:::Looking at [https://journals.library.columbia.edu/index.php/bioethics/about/editorialTeam the masthead for Voices in Bioethics] ({{ISSN|2691-4875}}), it appears to be a student journal. The editors are both (fairly recent) graduates of the school's bioethics program, and all the associate editors are current students in that program. WhatamIdoing (talk) 17:34, 22 May 2025 (UTC)

Having some agreement above that the Yale paper should be treated as a WP:PREPRINT, the question arises of how to treat it in the section devoted to it. Currently that section is largely devoted to repeating the Yale paper's claims (albeit attributed). This is not consistent with treating it as a pre-print/self-published source. It would be more usual to summarise coverage of the paper that appears in RS. I'd suggest that we start there, by removing all statements only cited to the Yale paper or finding RS that cover them. Samuelshraga (talk) 20:46, 24 May 2025 (UTC)

:What? We already attribute all claims cited to the Integrity Project white paper, which is what we would normally do for an WP:EXPERTSPS. Loki (talk) 20:48, 24 May 2025 (UTC)

::Certainly I agree that inasmuch as we repeat the criticisms, they should be attributed. However, per WP:EXPERTSPS: {{tq|Exercise caution when using such sources: if the information in question is suitable for inclusion, someone else will probably have published it in independent, reliable sources.}} Then on the question of how we should cover it, WP:DUE here: {{tq|Neutrality requires that mainspace articles and pages fairly represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in those sources.}} Using the Yale paper as the sole source justifying inclusion of content from itself therefore goes against two core policies. We should still cover it, by summarising the coverage of it from RS. Samuelshraga (talk) 21:09, 24 May 2025 (UTC)

:::Loki, I see the paper being cited (sometimes redundantly) in sentences/paragraphs that do not give WP:INTEXT attribution.

:::Samuel, I think the simpler and more important action is to remove/replace the citations to the Yale paper that are outside of that section. WhatamIdoing (talk) 00:03, 25 May 2025 (UTC)

::::@WhatamIdoing, I will also continue to participate in that action, but I don't see a reason not to do both. Samuelshraga (talk) 07:04, 25 May 2025 (UTC)

A while ago, I thought it might be helpful to create a FAQ for this talk page, since the same things keep coming up. The above section on the Yale Integrity Project makes me think about this again. I'm imagining things like this:

; What is the Cass Review?

: If someone says "the Cass Review", they might mean one of several things. They might mean a group of people ("The Cass Review didn't have any trans people in it"). They might mean the project ("The Tories commissioned the Cass Review"). They might mean the results ("The Cass Review stopped private clinics from giving puberty blockers to trans kids"). They might mean the artifacts produced ("The Cass Review consists in seven commissioned reviews, an interim report, and a final report"). They might mean only the final report ("The Cass Review wasn't externally peer reviewed"). Please try to be specific about what you mean (e.g., "The final report said..."), and if someone says something about "the Cass Review" that doesn't seem correct, please ask them to clarify their statement.

; What is the Yale Integrity Project?

: The Yale Integrity Project is a collaboration between two professors at Yale. One is in the School of Medicine and the other in the Yale Law School. The documents on their website are not peer reviewed or fact-checked, and the contents of the documents are sometimes changed without notice. Under Wikipedia's ordinary rules, these documents are self-published. "The" white paper from Yale Integrity Project should be handled as a WP:PREPRINT and not used for biomedical information, but may be useful for non-medical content.

; Who is Cal Horton?

: Cal Horton is a research fellow at the Oxford Brookes Business School (formerly Oxford Polytechnic; not its world-famous neighbor). Horton, who uses they/them pronouns,[https://www.rsc.org/events/detail/80493/inclusion-and-diversity-forum-2025/speakers] is the parent of a trans kid and studies the experiences of trans kids in schools and families.[https://www.bera.ac.uk/blog/trans-inclusion-raising-our-ambition-for-trans-pupils] Horton is a social scientist, not a healthcare provider or medical researcher.

and so forth.

I'm hoping that this could save us some time and drama. OTOH, there's a risk that the FAQ itself could turn into a battleground ("This is a very good source and must never be questioned again, even if I write that it explains the meaning of life and is a map to the lost city of Atlantis"). What do you think? WhatamIdoing (talk) 21:44, 20 May 2025 (UTC)

:Looks good to me. Flounder fillet (talk) 00:25, 21 May 2025 (UTC)

:Sounds like a very good idea. Void if removed (talk) 11:23, 21 May 2025 (UTC)

:I don’t dislike the idea, but I think it has to be workshopped more. I’m going to tag @Your Friendly Neighborhood Sociologist for her thoughts, since she’s good at this. Snokalok (talk) 12:07, 21 May 2025 (UTC)

::Looking at the next section, it looks like we would benefit from "Is the Cass Review peer-reviewed?", possibly with an answer of "The systematic reviews were externally peer reviewed. The interim report and the final report had just as much external peer reviewed as the RAND report", might also be helpful. We have had multiple rounds already about how to discredit the Cass Review by labeling it non-peer reviewed, and we need to be done with the back and forth. These are actually simple facts.

::(I say "discredit", because nobody expects government reports to undergo external peer review, so why would we point this out for this one report, if we're not trying to imply that it has some sort of failing? The Morbidity and Mortality Weekly Report#First report of AIDS wasn't externally peer reviewed. The 1964 Smoking and Health report wasn't externally peer reviewed. The Heckler Report on Black people's health wasn't externally peer reviewed. Nobody says "Oh, tobacco's fine – you can't trust anything that isn't externally peer reviewed", and nobody thinks it's important to know that the US Surgeon General's denunciation of tobacco in 1964 wasn't externally peer reviewed.) WhatamIdoing (talk) 16:54, 21 May 2025 (UTC)

:::I don't really like the angle you're taking here. The reason it's important to point out the Cass Review-as-in-the-final-report wasn't peer reviewed is because that could be confusing, because:

::::a) It's called the Cass Review, implying it's a systematic review (which would normally be peer reviewed), when in fact it should really be the Cass Report which was based on systematic reviews.

::::b) The Cass Review as you point out could refer to many things, some of which were peer reviewed and some of which weren't. So in that context it's important to mention that the thing most often referred to as the "Cass Review" was not peer reviewed.

::::c) A big reason the Cass Review is controversial is because it seems like in some segments Cass went beyond the underlying reviews to give recommendations based solely on her own professional opinion. In fact some of the most controversial parts were parts like that. This makes it more necessary than usual to differentiate between the report and the reviews it's based on.

:::That all being said, I also agree we need sources to specifically mention that the report wasn't peer reviewed before we mention it specifically. Loki (talk) 23:44, 21 May 2025 (UTC)

::::I doubt that the name was chosen to imply that it's any sort of review article (systematic or otherwise) or that it's peer reviewed. In particular, the NHS seems to use the "independent review" language regularly, e.g.:

::::* Independent Review into Thomas Oliver McGowan’s LeDeR Process

::::* Independent Review into the care and treatment provided by Greater Manchester Mental Health NHS Foundation Trust

::::* Independent Review into the death of Clive Treacey

::::* The Cavendish Review: An Independent Review into Healthcare Assistants and Support Workers in the NHS and social care settings

::::* Independent review into the independent sector provider One to One Midwives

::::* Independent Review into the operational effectiveness of the Care Quality Commission

::::It just seems to be the local bureaucratese for "someone will look into this, and it won't be the perpetrators investigating themselves". "Independent investigation" seems to be another frequent word choice.

::::I also doubt that it's important to point out anything about peer review, since almost no reliable sources have thought this worth mentioning. Additionally, I'd guess that >98% of people can't describe what peer review is and >99% of them don't know what a review article is. There's a reason that editors (mostly from WP:MED) have put links to the Wikipedia article on review article on more than 15,000 talk pages, and it's not because the concept is widely understood. But I do agree with you that if we're going to say anything about what is or isn't peer reviewed, then we should be clear that which documents we're talking about. WhatamIdoing (talk) 01:45, 22 May 2025 (UTC)

::::I think the vast majority of readers have no idea what a "systematic review" is, while "review" is a commonly understood general term for independent inquiries and similar processes, eg. The Macpherson Review. Void if removed (talk) 06:26, 22 May 2025 (UTC)

:The general idea seem sound but I don't like answers 2 or 3, which seem to take up only one side of the argument on questions that actually got a lot of debate on this page. Something should only go in the FAQ if we really do agree on it (like answer 1). Loki (talk) 23:48, 21 May 2025 (UTC)

::Oh, I agree. The whole thing would have to be re-written from scratch. Those aren't necessarily even the most important questions. WhatamIdoing (talk) 01:16, 22 May 2025 (UTC)

:::Loki, for the avoidance of doubt: I'd be happy to have you draft the whole thing. We just need to document some of our "perennial" things so that we can move on to new discussions. WhatamIdoing (talk) 01:47, 22 May 2025 (UTC)

::::Yeah, I definitely agree with that at least. Loki (talk) 01:49, 22 May 2025 (UTC)

::::So, how does this work then? Can we create a separate discussion page at, eg Talk:Cass_Review/FAQ? Void if removed (talk) 10:04, 22 May 2025 (UTC)

:I should note I’ll be in transit a lot over the next few days, so my replies on this may not be as timely, however it is an idea I wish to take part in discussing Snokalok (talk) 01:18, 22 May 2025 (UTC)

:Another suggested Q: is it a government report? (No). Void if removed (talk) 06:27, 22 May 2025 (UTC)

::What? It clearly is a government report, what are you talking about? Loki (talk) 06:32, 22 May 2025 (UTC)

:::It depends on what "it" is, right? The committee is not a government report. Two of the resulting documents are government reports, but others are not. WhatamIdoing (talk) 06:56, 22 May 2025 (UTC)

::::I disagree.

::::NHS England and NHS Improvement are not "government departments". They are non-departmental public bodies that have some measure of independence from the actual department that sets policy in this area (DHSC). As such their decisions are not government decisions and their actions are not government actions.

::::Further, when it commissioned an independent review, that review is itself commissioned by NHS England, but independent of it, that being the point of it being independent. It is not an NHS England review, and the final report is not an NHS England report.

::::So you could say it is an independent review commissioned by a non-departmental public body - but "government report" implies a report commissioned by the government itself, for the government, usually to directly inform policy. That's not what the Cass Review is.

::::The final report is to the government as I am to Kevin Bacon, ie several steps removed.

::::We had a similar misconception last year when EHRC's resposne to the Cass Review was repeatedly classified as part of "government responses" before arriving at the current consensus in the article that makes clear it is a "non departmental public body". These are distinct things. Void if removed (talk) 08:06, 22 May 2025 (UTC)

:::::It sounds like we need to be careful about how we use the word government, as we have different (US vs UK) expectations.

:::::For me, any organization that runs directly on tax dollars is a government agency. For example, the famously independent Federal Reserve Board is not part of "the Trump administration", but it is part of "the US government". Similarly, the Governor of the Bank of England is what I'd call a government employee – but not what I'd call part of "the Starmer administration". However, editors from the UK might find this confusing; they might say that these people are not part of "the government" because "the government" means "the Starmer administration", and instead you should say something like "the civil service".

:::::NHS England, therefore, is "part of the government" in American English but "not part of the government" in British English. Officially, its UK classification is a non-departmental public body. In American English "public body" == "government agency". In American English, anything that isn't run by the government is private, not public. WhatamIdoing (talk) 17:25, 22 May 2025 (UTC)

::::::I agree with WhatamIdoing here that this is probably a UK/US language issue. From an American perspective, an organization that is funded by taxes and supervised by a government minister would very clearly be part of the government. But if you asked me if it's part of the administration I'd probably say no. (But, I should note, I don't think that's as clear as for the Fed: the NHS, while more independent than your average government organization, is supervised by the secretary of health, so it can be influenced by the party in government to a degree the President can't really touch the Fed.)

::::::Since this is a page on a report from the UK we should try to stick to UK English here, while also being as clear as possible to non-UK readers. Since "government report" means different things in different WP:ENGVARs we should avoid using it, though we may want to have a section of the FAQ clarifying this issue. Loki (talk) 18:07, 22 May 2025 (UTC)

:Yes, I agree with the idea. I wouldn't use the wording suggested in most cases, so I'm glad it will be workshopped. Lewisguile (talk) 19:43, 22 May 2025 (UTC)

Yale University doesn’t endorse the views of The Integrity Project. Their report on the Alabama case included a disclaimer stating: “This report reflects the academic work of individual Yale faculty and does not represent the views of Yale University, Yale Law School, or Yale School of Medicine”. [https://web.archive.org/web/20220729035848/https://medicine.yale.edu/lgbtqi/research/gender-affirming-care/biased-science/] They also make it clear on their website that their work reflects their own opinions, not those of the university: “In every case, our scholarship expresses our professional views independent of our institutional affiliations.” [https://law.yale.edu/centers-workshops/integrity-project] It may be worth pointing this out. JonJ937 (talk) 09:46, 22 May 2025 (UTC)

:I don't think it's worth pointing out standard boilerplate disclaimers. WhatamIdoing (talk) 17:35, 22 May 2025 (UTC)

:For what it's worth I actually do think it's worth pointing out that the Yale Integrity Project report is not actually associated with Yale.

:If I had to write what we should put in the FAQ for that, I'd say something like:

:{{tq2|The Yale Integrity Project white paper, despite the name, is not associated with Yale. It's called that because two of the nine co-authors are also the founders of the Integrity Project at Yale, a collaboration between Yale Law School and Yale School of Medcine, and the white paper can primarily be found on the Integrity Project website. However, both Yale as well as the paper itself have explicitly said the paper is not associated with Yale and the opinions expressed are only those of the authors.
Several of the authors are doctors but some aren't, including one of the two associated with the Integrity Project. So far this white paper has only been published on the Integrity Project website, and thus is currently an WP:EXPERTSPS for the professional opinions of the authors. It should therefore only be used with caution and attribution.}} Loki (talk) 18:25, 22 May 2025 (UTC)

::@LokiTheLiar, I'd prefer saying "physicians" instead of "doctors" (lawyers technically have doctorates), but otherwise I think that's fine. Do you want to start Talk:Cass Review/FAQ with that question? WhatamIdoing (talk) 17:35, 26 May 2025 (UTC)

:::I'm fine with that change and also with starting that talk page. Loki (talk) 17:39, 26 May 2025 (UTC)

::::Thanks. I [https://en.wikipedia.org/w/index.php?title=Talk:Cass_Review/FAQ&diff=prev&oldid=1292395035 made a few changes]. What do you think about "Is this a government report?" as the next question? WhatamIdoing (talk) 18:43, 26 May 2025 (UTC)

:::::Changes seem fine and that seems like a good next question. Loki (talk) 18:54, 26 May 2025 (UTC)

::::::I've added "Is the final report a government report?" My first draft feels "good enough" but not great, so I'd welcome any tweaks you think are helpful. Also, we should probably copyedit the article with that ENGVAR complication in mind. WhatamIdoing (talk) 23:47, 26 May 2025 (UTC)

:::::I think we need a much clearer "no" on this - the review states very clearly on p17 {{tq | The Review is independent of the NHS and Government and neither required nor sought approval or sign-off of this report’s contents prior to publication.}} Void if removed (talk) 10:07, 27 May 2025 (UTC)

::::::Yes, that's the British sense of government. They even capitalized that so it would be clear. Loki (talk) 16:13, 27 May 2025 (UTC)

:::::::I would quote the review as the first sentence, ie: {{tq|According to the Cass Review, it was " independent of the NHS and Government"}} and then go on to explain. Because it is independent of the NHS, it isn't a government report in the US sense either. Void if removed (talk) 16:21, 27 May 2025 (UTC)

::::::::So make the change. The worst that will happen is that someone will disagree, and we'll try again. WhatamIdoing (talk) 16:26, 27 May 2025 (UTC)

::::::::It was definitely commissioned by the NHS and funded by tax money. That makes it in the American sense clearly a government report. A special prosecutor is independent from the Justice Department but they are still a prosecutor and a government employee. Loki (talk) 16:41, 27 May 2025 (UTC)

::::::::Echoing Loki here, it was produced by state entities for the state's purposes. That makes it a government report, regardless of what it calls itself. Snokalok (talk) 07:15, 28 May 2025 (UTC)

:::::::::The problem is that this is not true in British English (i.e., what the article is supposed to be written in). Here's a simple example:

:::::::::* "the Trump administration" (American English) == "the government" (British English)

:::::::::* "the local school district" (American English) == "not part of the government" (British English)

:::::::::* "the federal appeals court" (American English) == "not part of the government" (British English)

:::::::::I agree that the team was assembled, the research was commissioned, the reports were written, etc. by taxpayer funded entities and for the official purposes. I agree that if we were using American English, that we would call this a government report.

:::::::::However, the article is written in British English, in which "government report" means something like "written by Boris Johnson and the members of his political party, for the purpose of getting themselves re-elected". That's not what happened here, and British readers will be confused or even misled if we call it a "government report". WhatamIdoing (talk) 17:10, 28 May 2025 (UTC)

::::::::::In the case of a less contentious article, I'd perhaps agree with your point, but I think the issue here is that, the Cass Review is not a solely British phenomenon, it's being used to extensive political effect in the rest of the first world which overwhelmingly speaks American English either as a first language or as an administrative and diplomatic language. Thus, the overwhelming majority of readers of this article, if they see "non-governmental report" will think NGO. That is to say, to say it's not governmental will give the overwhelming majority of even highly educated readers a fundamentally incorrect impression. For a less critical distinction, deferring to the nuanced particulars of British English might be fine, but here those nuanced particulars would give the reader an impression that is the exact opposite of the truth. Snokalok (talk) 12:57, 29 May 2025 (UTC)

:::::::::::So we need to find a set of words that doesn't include the word government (or non-government) and yet correctly describes the situation. This is not an unusual problem (e.g., "Let's table this issue at the committee meeting" has opposite meanings in BrEng and AmEng), and we can handle it.

:::::::::::The point of the FAQ is to tell folks why they need to be careful about that word. WhatamIdoing (talk) 16:19, 29 May 2025 (UTC)

::::::::::::I want to say “state-produced” (and not state-commissioned because that implies an outside entity), but I’m worried state-produced doesn’t flow well Snokalok (talk) 18:33, 29 May 2025 (UTC)

:::::::::::::"State" might be another challenging word, since I understand that in the UK, the monarch is the head of state and the prime minister is the head of government, and this is legally neither of them. But I think that's the kind of idea we need to be thinking of: a word (or phrase, or whole sentence, if we really have to) that makes sense on both sides of the Atlantic. WhatamIdoing (talk) 22:43, 29 May 2025 (UTC)

::::::::::::::Seriously don't see what's wrong with just saying it was commissioned by NHS England. Let people either side of the Atlantic interpret that how they will. Void if removed (talk) 22:53, 29 May 2025 (UTC)

:::::::::::::::That’s too narrow imo, since as I recall Kemi Badenoch bragged extensively about the roll the tories played in seeing it done.[https://x.com/KemiBadenoch/status/1799509912143151611?lang=en] Snokalok (talk) 23:09, 29 May 2025 (UTC)

::::::::::::::::And you believed her? Politicians take credit for other people's work all the time. WhatamIdoing (talk) 03:03, 30 May 2025 (UTC)

:::::::::::::::It's true that it was commissioned by NHS England. In fact, at no point in the current article do we call it a "government report" in those words.

:::::::::::::::What we're talking about is what goes in the FAQ for editors, and in particular that we need to be careful about the word "government" in this article. Loki (talk) 23:21, 29 May 2025 (UTC)

::::::::::::::I think "state-produced" is legible in the UK, and in fact I think that even whether the NHS is "part of the government" is legally ambiguous. I am not a lawyer in any country, so I could very well be wrong about this, but my understanding is that NHS England:

::::::::::::::: a. Is not legally part of the Department of Health and Social Care.

::::::::::::::: b. But is overseen by the health secretary, who is unambiguously part of the government.

::::::::::::::: c. But the health secretary's oversight is fairly indirect and mostly seems to amount to appointing the members of the NHS board which actually runs the NHS.

::::::::::::::: d. And is definitely under Parliament (as it was established by statute and its budget is regularly approved by Parliament), which is headed by the Prime Minister, who technically speaking is appointed by the monarch.

::::::::::::::Which is to say, it is definitely part of the state and one could argue that it is part of the government in the UK sense, although that would be much more contentious.

::::::::::::::I think "public" or "official" are also reasonably clear alternatives if we don't like "state-produced". I personally think "state-produced" is very clear but slightly awkward-sounding. Loki (talk) 23:01, 29 May 2025 (UTC)

:::::::::::::::I think "official" has some potential. WhatamIdoing (talk) 03:02, 30 May 2025 (UTC)

@Snokalok you have reverted [https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=1291466956&oldid=1291458759 this edit]. Per enforced BRD here's a discussion.

Your edit comment only talks about inclusion of the RAND report. This was not the substance of my change which continued to cite the RAND report.

The issue is that for "non-peer reviewed" the relevant part of this citation is line 2 of Table 2.1 of the report, which says only:

"Cass Review (2022) / Narrative review / Gender dysphoria treatments / Yes / No / 59"

Where "No" equals "Peer-review".

Cass Review (2022) is the interim report. I moved the citation and the description to the document they reference. I suggest that this is an accurate use of this citation and a reasonable compromise between those who insist on having this detail in, and actually applying correctly it to the specific document referenced. Void if removed (talk) 13:08, 21 May 2025 (UTC)

• I am commenting here only because I was made aware of this in an admin capacity (prior to VIR posting on my talk page). I take no position on what I consider content issues, but I want to note that using a source that clearly anchors an assessment to 2022, to discuss the report as of 2024, would be something I consider source misrepresentation as an admin. We have sanctioned people at AE for less. This is a CTOP, as everyone here is well aware - that means editors should be sticking very carefully to wording used in the source. Vanamonde93 (talk) 16:25, 21 May 2025 (UTC)

:Having read over it more thoroughly, fair enough I’ll self revert. It perhaps became an easy miss because every other reference to that Cass Review in the RAND report has (2024) next to it. Snokalok (talk) 17:12, 21 May 2025 (UTC)

::Just want to be clear I brought this up back in January multiple times, that trying to cite "narrative review" and "non-peer-reviewed" to this source was wrong because the table in question referenced the 2022 interim review, not the cass review, or the final report. I have raised it on other pages when it has been cited in this way also. Void if removed (talk) 19:18, 21 May 2025 (UTC)

:::There's a whole bunch of parts of the Cass Review, some of which were peer reviewed WP:MEDRS and some of which weren't. In particular: when someone just says "the Cass Review" they're more often than not referring to the final report, which was not peer reviewed, as it's a government report. It was based in part on systematic reviews commissioned specifically for it, which (of course) were peer reviewed.

:::I think it's important to mention that the final report was not peer-reviewed, as this could be confusing to a reader who wasn't aware of all this background. But I also agree we'd need a specific source saying that to say that ourselves. Loki (talk) 23:26, 21 May 2025 (UTC)

::::Even with a specific source, it's borderline undue. The final report to the government not being peer reviewed does not change the fact that it was, as you say, based on primarily peer reviewed studies, whether commissioned directly for the report or otherwise. I only support the current information about the interim report not being peer reviewed being included. For me to support including something along the lines of "the final report was not peer-reviewed", I would need to see strong context that is going to be provided directly before or after that claim. The context would need to include that the final report was a summary of mostly peer-reviewed evidence, and that the final report was not peer-reviewed solely because of its purpose as a summary of those sources for the Government to use to make decisions specific to the UK - and not because of any (identified) issues that would've prevented it from passing peer reviewed. -bɜ:ʳkənhɪmez | me | talk to me! 23:32, 21 May 2025 (UTC)

:::::I think if the sources we have say all that, we can also say it, but otherwise we shouldn't.

:::::Like, we have good reason for possibly saying a lot of things, and the best way we have of breaking this tie is by relying on what the sources choose to mention. Normally this wouldn't necessarily be a consideration because we're not bound by the wording of the sources, only their facts, but since this is particularly controversial I think the wording of the sources is a good way to break this tie. Loki (talk) 01:38, 22 May 2025 (UTC)

::::::I don't see this as a wording issue at all. It's a context issue. We aren't doing our duty by presenting the fact the final report was not peer-reviewed without both explaining the context as to why (because it was for government agencies so was a policy document) and explaining that the facts in the review were taken from mostly peer-reviewed sources. In other words, it would be undue weight to include a statement regarding it's peer-review without also including the context of that statement. You're right that we aren't bound by the wording (or even organization/context) of the sources - but that doesn't mean we shouldn't strive to present mitigating factors when they are there - even when many/most/all sources don't directly connect those to each other in context. Per WP:DUE: {{tq|Undue weight can be given in several ways, including but not limited to the depth of detail, the quantity of text, prominence of placement, the juxtaposition of statements, and the use of imagery}} (emphasis mine).{{pb}}The prominence of this statement compared to what I called the "mitigating factors" will create an undue weight issue. In other words, if it's stated early on that the final report was not peer-reviewed, but only later on explained that it was intended for government policy decisions and not clinical decision-making, then people may think it wasn't peer-reviewed because it didn't pass peer review. Likewise, if the statements ("not peer-reviewed", the why, and the studies used to form the review) are not placed near each other, people may not identify (for example) the importance of the fact that most of the studies it reviewed were themselves peer-reviewed.{{pb}}Ultimately, I personally don't even think it's important to include that the final report was not peer reviewed at all. But if it is included, it needs to be in context. For example, the section about the Yale Law School Integrity Project doesn't say anything about how their white paper was not peer-reviewed - yet it makes the same types (but different outcome) of biomedical claims that the Cass Review itself did. -bɜ:ʳkənhɪmez | me | talk to me! 07:34, 22 May 2025 (UTC)

This will be my final comment here. Like Void, I have been banging on about this "not peer-reviewed" claim for some time. Even if we do manage to find a blog reprint in a culture magazine, or opinion piece in an Scottish newspaper with a circulation smaller than some church newsletters... it is still undue and also, well, nonsense. Sensible reliable neutral sources do not say that. It indicates the writer doesn't know when peer review is used and thinks that it must be a good and essential thing, has heard via unreliable channels the Cass Review wasn't, and so therefore that's a bad thing that it doesn't have it. It is a fine example of misinformation.

Peer review is a form of review which, for publications, is peculiar to academic journals. It doesn't happen, for example, with newspapers or textbooks or the NHS site or the government tax information pages. In most other publications, the authors are hired for their expertise but in academic publications (outside editorials) the work is submitted from random strangers who don't work for the publication and aren't commissioned. One could imagine an editorial team who reviewed such submissions in-house but the academic world has decided to use peer review to perform this function. And that has limitations that are well known. And it isn't a mark that the statements within such a work are all true and has consensus (never mind universally accepted). Claims and statements, especially of the opinion variety, only have to be reasonable and the work is checked for mistakes. That a work was peer reviewed does not make it a consensus statement: that's an entirely different kind of work where all the people who reached consensus are named as authors. A peer reviewed work can make oddball claims and can offer opinions that are not shared by others. It isn't a sign of Truth.

MEDRS rejects nearly all peer reviewed academic works. Because they are primary research papers (or are opinion pieces or editorials, which are useful only for opinion). We prefer narrative reviews, systematic reviews, and professional textbooks, because we trust those authors to analyse the research, not editors.

Many reliable professional textbooks appoint an expert editor who commissions chapters from various other experts they trust, and the review process for that is in-house. You don't get an epilepsy textbook with a chapter on the drug vigabatrin that was sent randomly in the post to the editor or the publisher: the editor chose someone they knew was an expert in vigabatrin to write that chapter. The NHS website has an editorial team who write and review their work in-house. In house review is normal.

Hilary Cass was chosen by NHS England (at the time a non-governmental body and not under direct control of cabinet ministers, despite what they may claim on Twitter) because they were "a retired consultant paediatrician and the former president of the Royal College of Paediatrics and Child Health" and because they had no pre-conceived views on the topic. The author's final report rests on their name. It is literally Cass's recommendations. The process by which Cass got their work reviewed before publication isn't all public. They certainly had a procedural team who checked that the process for such reviews was carried out correctly and all the i's were dotted and t's crossed. And I'm sure they had people check it over, because it is a 400 page document with no errata. So there was in-house review of some kind.

Such reviews are never peer reviewed. A similar one might be commissioned to work out which new hospitals NHS England needs and where they should be. Or to judge whether they are training enough surgeons of the right speciality. Nobody goes off to the French to ask them whether NHS England's hospital building report was reasonable. It is up to the author of said report to either be an expert or to find experts to consult with, and to commission or draw on evidence and publications.

Many such reviews end up on a desk somewhere, put in a drawer, and forgotten about because they sensibly asked for more money to be spent on something and there isn't the money. NHS England could have rejected or ignored it. They reviewed it and accepted it. NHS Scotland (who are separate and have different practises) also reviewed it. They appointed a multi-disciplinary team of health experts and the process took several months and produced a weighty document of Scottish recommendations.

Some of the most controversial aspects of the Cass Review such as those around the evidence for puberty blockers or the weaknesses of WPATH guidelines come from peer-reviewed systematic reviews that are part of the Cass Review. Whereas Cass's recommendations about how NHS England should structure its clinics and what disciplines the health professionals should be drawn from are hers, and formed from her speaking to over a 1000 other people and groups, including trans people and including healthcare professionals who provide for trans people. Even the final report is such a mixed collection of 30 recommendations and other opinions and claims that questions like "Is the Cass Review a reliable source" are meaningless without specifics. -- Colin°^Talk 09:20, 22 May 2025 (UTC)

:Are we agreed on the list of pros and cons?

class="wikitable" |+ Should the article say that the 2022 interim report wasn't peer reviewed?
{{yes}}, we should say this. ! {{no}}, we should not say this.
scope="col" width="50%" | Readers might think that something called "the Cass Review" is peer reviewed. Readers might think that something called "the Cass Review" is a review article. We found one source, from a US think tank (the RAND Corporation) that says this. | scope="col" width="50%" | We have no evidence that readers make such guesses based on the article title. External peer review (i.e., ordinary peer review for scholarly journals) is not a normal process for an interim report, so calling out this fact, without explaining that it's normal and expected, is WP:UNDUE. Only one of the 262 source cited in the article mentions this, so mentioning this is WP:UNDUE. (That source also did not undergo external peer review and was only published on the organization's own website.)
colspan=2 |Note: We have found zero reliable sources making this claim about the final report. Therefore we cannot say that the final report was not peer reviewed, even though we believe that statement is true.

Would anyone add anything else to the list? WhatamIdoing (talk) 17:56, 22 May 2025 (UTC)

:If we say it's not peer-reviewed, by that logic we would have to elaborate on that statement because of what readers may then assume. Kolya Butternut (talk) 18:51, 22 May 2025 (UTC)

::So long as we're clear that the final report recommendations =/= the systematic reviews, I'm happy with that.

::To put some of the original discussion into context, the reason some of us argued strongly for "non-peer reviewed" about the final report was because, at the time, an editor was expanding the section on the systematic reviews significantly (much longer than other sections of the article), and there was, for some of us, a lack of clarity between the final report and those systematic reviews in their edits. I argued against needing a source at all for "non-peer reviewed", because it's merely a descriptive term for a report that quite obviously wasn't peer reviewed. RAND was something of a compromise.

::The article has since been edited countless times, so it's clearer, but we still get people coming here occasionally and asking if the final report was peer reviewed. Thankfully, this FAQ should clarify all of that as well, which hopefully addresses any future confusion before it happens. Lewisguile (talk) 19:38, 22 May 2025 (UTC)

:The one thing I would like to add to the "no" side is something like

:

It is undue because neither the interim nor final Cass Review were published in academic journals. However, if they were published in academic journals AND not peer-reviewed, that would be notable.

:PositivelyUncertain (talk) 20:42, 22 May 2025 (UTC)

:I disagree with every statement in the cons column:

:1. Yes we do have evidence. The evidence are the reasons people are suggesting that might happen: namely that it sounds similar and it's part of a process that included some peer reviewed elements. What we don't have is proof. But the proof we'd ideally like to have (documentation of someone actually having been confused) is not the only possible evidence that it's confusing. In fact the vast majority of the time a confusing wording is fixed on Wikipedia we do it because of intuition about the English language and not further evidence.

:2. It's not necessarily WP:UNDUE to call out the absence of something whose absence is normal. So for instance, on our article on Tide Pods we explicitly mention they are not safe to eat even though that it's normal for detergent to be unsafe to eat. The reason we mention it is that, even though it's normal for detergent to be unsafe to eat, some people did in fact try to eat it. Similarly here we have good reason to expect that, even though it's normal for government reports to not be peer reviewed, some people would assume that this particular government report would be unless we say otherwise.

:3. That denominator is meaningless. For one, many of the citations in the article are different pages of the Cass Review itself. But more importantly, not every source would be expected to mention it, right? Most of the claims in this article are present in only one or two sources, so this argument would mean that almost nothing about the Cass Review could be mentioned at all. In fact almost nothing about any subject could be mentioned at all.

:That a claim is mentioned only briefly in one source is definitely reason to not give a lot of weight to it, but it's not a reason to not mention it at all unless it's contradicted by other sources. And we don't currently give this claim a lot of weight. We barely give it any weight at all. It's literally two words. Loki (talk) 23:36, 24 May 2025 (UTC)

::There's an entire article full of RS on Consumption of Tide Pods. There isn't a single secondary source which states in narrative form that the Cass Review is not peer reviewed? Kolya Butternut (talk) 01:20, 25 May 2025 (UTC)

:::This is my thoughts exactly. As Loki says, it's not necessarily undue to mention. But there would need to be a very good reason to - for example, kids eating Tide Pods. Trying to force "non peer-reviewed" in here is something that I can only call activism or trying to diminish the validity of the Cass Review because they disagree with it. In other words, it's an attempt to discredit the review on a technicality, when that technicality is not relevant to the purpose of the review. -bɜ:ʳkənhɪmez | me | talk to me! 02:20, 25 May 2025 (UTC)

::@LokiTheLiar, what's the evidence that it's actually happening? The con statement is "We have no evidence that readers make such guesses based on the article title." You've given reasons (not evidence) why you believe "readers might make such guesses". Where is the evidence that readers actually do make such guesses? For example, is there a tweet somewhere in which someone says something like "#TIL the Cass Review's final report isn't peer-reviewed. I thought it was illegal to call something a review unless it was peer reviewed." WhatamIdoing (talk) 17:40, 26 May 2025 (UTC)

@Lewisguile Just a friendly reminder that this page is still subject to enforced BRD, and I'm pretty sure that [https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=next&oldid=1291701997 putting this back] in after 2 different editors have taken it out is a violation (although there's been a lot of edits to that sentence today so I may have lost track). Void if removed (talk) 21:46, 22 May 2025 (UTC)

:Ah, thank you! I was thinking of 3RR again. I'm editing across too many subjects at once. Sorry about that! In the meantime, I will self-revert, although we should probably revert to the prior consensus text until discussed (the text did have consensus until today, and it is accurate).

:@Samuelshraga first removed the text as a BLP violation, although it's well sourced on the Kenneth Zucker page and the conversion therapy page that his living in your own skin model is considered conversion therapy.{{Cite book |last1=Rivera |first1=David P. |title=The Case Against Conversion Therapy: Evidence, Ethics, and Alternatives |last2=Pardo |first2=Seth T. |publisher=American Psychological Association |year=2022 |isbn=978-1-4338-3711-1 |editor-last=Haldeman |editor-first=Douglas C. |pages=51–68 (58) |language=en |chapter=Gender identity change efforts: A summary |doi=10.1037/0000266-003 |s2cid=243776563 }}{{pb}}{{Cite book |last1=Ashley |first1=Florence |title=Banning Transgender Conversion Practices: A Legal and Policy Analysis |date=2022 |publisher=University of British Columbia Press |isbn=978-0774866958 |location=Vancouver, BC |pages=4–6}}{{pb}}{{Cite book |title=Banning 'conversion therapy': legal and policy perspectives |publisher=Hart |year=2023 |isbn=978-1-5099-6117-7 |editor-last=Trispiotis |editor-first=Ilias |location=Oxford London New York New Delhi Sydney |pages=134 |editor-last2=Purshouse |editor-first2=Craig}}{{pb}}{{Cite book |last1=Chung |first1=Kathleen |last2=Rhoads |first2=Sarah |last3=Rolin |first3=Alicia |last4=Sackett-Taylor |first4=Andrew C. |last5=Forcier |first5=Michelle |editor-last1=Forcier |editor-first1=Michelle |editor-last2=Van Schalkwyk |editor-first2=Gerrit |editor-last3=Turban |editor-first3=Jack L. |date=2020 |title=Pediatric Gender Identity: Gender-affirming Care for Transgender & Gender Diverse Youth |publisher=Springer |chapter=Treatment Paradigms for Prepubertal Children |page=177 |isbn=978-3030389086}}{{Cite news |date=2015-12-15 |title=CAMH to 'wind down' controversial gender identity clinic services |url=https://www.theglobeandmail.com/news/toronto/camh-to-wind-down-controversial-gender-identity-clinic-services/article27766580/ |access-date=2025-05-22 |work=The Globe and Mail |language=en-CA}}Martino, Wayne; Kuhl, Diana; Omercajic, Kenan (2020). "Epistemological Significance of Transgender Studies". In Niemi, Nancy S.; Weaver-Hightower, Marcus B. (eds.). The Wiley Handbook of Gender Equity in Higher Education. Wiley-Blackwell. pp. 505–507. ISBN 978-1119257585. I added additional sources to verify that part, but actually, should have raised those here and left the Yale ref in.

:As a result of leaving that original source out, @PositivelyUncertain removed it as unsourced (correctly, although the info itself is accurate with the right source). The new wording doesn't mention Zucker, and quotes the Yale paper directly. Since the issue was primarily the sourcing in the second case, I thought that was what needed addressing more than anything else. On checking the Yale paper, I noticed it didn't mention Zucker in the prose (it only referenced his work to that claim), so I thought removing his name would clear up any confusion. It is significantly different to the prior wording. Lewisguile (talk) 22:01, 22 May 2025 (UTC)

::No worries, lots of pages in flux. I was looking at those sources previously - three of them are expensive books and I didn't fancy shelling out for them just to check this though. Void if removed (talk) 22:22, 22 May 2025 (UTC)

::Yes, that's correct and I didn't see it as a 1RR violation but reinserting the cite. However, after looking into the quoted text, it seems to me that the YIP authors are being m highly misleading. Correct me if I'm wrong, but Zucker is only used for one specific statistic: a desistance rate. PositivelyUncertain (talk) 23:01, 22 May 2025 (UTC)

:I just looked at the YIP doc to look at their citation (pg 21 ret 52) and I'm not sure either I'm having a brain fart or the citation makes no sense. When they say {{tq|Per one such individual:..}} what are they referring to? It's not in the Cass Report, so are they picking a random quote from Zuckerberg's book?

:Regardless, the YIP report is really quite something. They complain that Cass favorably references Zucker but fail to disclose that all references to Zucker's work are in regards to desistance rates and Cass caveats his findings with statements about changes in diagnostic criteria. The only thing that could be interpreted as "favorably" of Zucker is a quote from a different paper describing the three models of care. PositivelyUncertain (talk) 22:35, 22 May 2025 (UTC)

::Thanks for checking. This requires some investigation, I think.

::I have had a look myself. It seems some of the papers Zucker is involved with are cited in-text by the primary author, so some of the references come up under other names. E.g., de Vries 2015 has Zucker listed among the authors. On p. 67, Zucker 1985 and Drummond 2008 both include Zucker as an author. On p. 89, Aitken 2015 includes Zucker as an author. On p. 91, de Vries 2015 includes Zucker. On p. 95, de Geaaf 2020 also includes Zucker. It's possible there are others, but I'm checking on my phone so it's a bit of a pain to keep going back and forth in the text. Not all of these have caveats like the studies cited to Zucker directly do, so the YIP paper could be critiquing the final report's uncritical use of these papers? If I can, I'll check these papers later.

::More likely, however, I think the issue is with the source the YIP paper quotes (Zucker 1985). This is the Zucker paper that advocates for conversion therapy, which is generally considered harmful by most medical authorities, and Cass doesn't mention that caveat (but does mention the critique of it based on lack of appropriate diagnostic criteria). I know others may disagree here, but relying on a source which advocates for conversion therapy without realising all the limitations of that source does reduce the final report's reliability, in my eyes. It's something an expert in the subject area may have spotted immediately. (YIP, of course, has it's own limitations as well, although their weaknesses don't also excuse the Cass Review's.)

::For this particular issue, I would probably have chosen the word "uncritically" instead of "favourably", but that's what I assume they meant from the context and the reference given. Lewisguile (talk) 09:57, 23 May 2025 (UTC)

:::@Lewisguile, am I right in understanding that the suggestion is that we should use the Yale white paper as a source for the line: "Specific criticism surrounded the Cass Review's citation of research by Kenneth Zucker, who advocates methods of suppressing transgender identity in children", or "Academics from The Integrity Project also said the report "favorably cites literature proposing methods that claim to suppress transgender identity in children"?

:::In the case of the former (which I think is what I removed), I would say this is insufficient sourcing for what is clearly a BLP claim. I think it's established sufficiently in the talk page above that given that the white paper is effectively self-published, and undergoes silent revisions, it is definitely not acceptable for contentious BLP claims. Samuelshraga (talk) 12:34, 23 May 2025 (UTC)

::::I suggested the latter as that's what the Yale report says, and Zucker is only mentioned by name in the footnote. The Yale paper's body text only makes a generic statement about "individuals", not a statement about Zucker directly. However, I also noted above the many sources who do describe Zucker's living in your own skin model as conversion therapy, so it's not a BLP violation if it's true. The Yale paper directly quotes his own words, in which he states that it's acceptable to attempt to change the gender identity of minors with therapy, so it's also true by his own admission. Lewisguile (talk) 10:12, 24 May 2025 (UTC)

:::::The issue here is taking a generic line of criticism from the text of an SPS about the Cass Review, combining it with an interpretation of a footnote about what a named BLP meant 40 years ago, and then justifying that with a bunch of other sources, which is SYNTH. Whether it is due and supportable on other pages of immaterial to whether it is due and supportable on this page, with this source. The obvious compromise IMO is to not bring in BLP concerns and stick to just what the source says in the body of the text. Void if removed (talk) 10:24, 24 May 2025 (UTC)

::::::That's what my last edit attempted to do. I removed the direct mention of Zucker from the text to align with what the Yale report says. Yale is the only source needed for that version, which was attributed.

::::::As I said upthread, the other sources were my attempt to show it's not a BLP violation to say Zucker's work is considered conversion therapy. Whether mentioning him specifically is due or not is another issue, but BLP violations are a bigger issue, so I wanted to address that specifically just for the avoidance of doubt.

::::::With that out of the way, it seems we're broadly in agreement about the rest, and that quoting the Yale source directly is the best option. Lewisguile (talk) 10:56, 24 May 2025 (UTC)

:::::::Here's the version I've just added: https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=prev&oldid=1291953084 Hopefully it's acceptable on the basis that it's attributed, is a direct quotation, and doesn't require more than the Yale reference itself.

:::::::It's basically the same as my prior version (which I self-reverted), with the addition of clarifying that this is the same Yale white paper mentioned elsewhere. It doesn't mention Zucker at all, who I think was probably added in during one of the earlier large-scale edits of the "Responses" section. Lewisguile (talk) 11:07, 24 May 2025 (UTC)

::::::::@Lewisguile, I think the attributed quote is only WP:DUE for inclusion if RS report on the criticism, given the Yale paper is not itself an RS. Samuelshraga (talk) 20:01, 24 May 2025 (UTC)

:::::::::They are a reliable source for their own views. But this particular criticism was also made by others, including [https://www.motherjones.com/politics/2024/05/cass-review-transgender-health-care-nhs-gender-affirming-care/ Mother Jones] and [https://www.advocate.com/health/hilary-cass-nhs-report-debunked The Advocate], so maybe {{tq|academics at the Integrity Project and others have said the final report cites proponents of conversion therapy}} is better? Either way, there seemed to be consensus here to include the claim with attribution, rather than to remove it altogether. Lewisguile (talk) 15:19, 26 May 2025 (UTC)

::::::::::That's not what those sources directly say. Mother Jones says talks about citations to "cites notable exploratory therapists like Ken Zucker" and makes it clear in the same article that exploratory therapy is not necessarily conversion therapy. The Advocate says "Cass repeatedly cites Ken Zucker, including the often-challenged “85%” rate from his research. Notably, Zucker has recommended that parents withhold “wrongly-gendered” toys from their children as a strategy to change their gender identity." If the implication of this is that he's a conversion therapist is debatable, but I think it's clear that this is not directly stated. Samuelshraga (talk) 06:38, 28 May 2025 (UTC)

:::::::::::I feel like saying that Mother Jones {{tq|makes it clear in the same article that exploratory therapy is not necessarily conversion therapy}} is on some level a misrepresentation of what it's actually saying. The article is very clearly arguing that exploratory therapy is conversion therapy. It says

:::::::::::"What’s more, the therapeutic approach Cass seems to suggests has close ties to conversion therapy. While Cass does not recommend a specific modality, she repeatedly advocates for an “exploratory” approach. "

:::::::::::"these are the same talking points that conversion therapists use to describe their work. There’s even a group, Therapy First, devoted to pushing the idea of “gender exploratory therapy.” Therapy First’s co-founder has advocated to make conversion therapy bans more lenient to make room for an “exploratory” approach. The US Substance Abuse and Mental Health Services Administration has stated that gender change efforts are often “misleadingly referred to as ‘exploratory therapy.’”

:::::::::::And then it quotes one individual to say that

:::::::::::"Streed explains that “at best, gender exploratory therapy is just delaying people’s access to the care they need, and at worst, it is conversion therapy. That is what we’ve seen in multiple studies, and it is associated with harm.” Keuroghlian puts it more bluntly: “Not providing gender affirming care in a timely way” is “trafficking in conversion efforts.”"

:::::::::::Which is the weakest wording in the article but also, still just quoting one person in service of the overall argument.

:::::::::::Additionally, we have very thorough sourcing on the conversion therapy page already for gender exploratory therapy being a form of conversion therapy, and thorough sourcing on the Kenneth Zucker page calling his work conversion therapy in the lead. Snokalok (talk) 07:29, 28 May 2025 (UTC)

::::::::::::{{tq | Additionally, we have very thorough sourcing on the conversion therapy page}}

::::::::::::A helpful reminder that Wikipedia is not a reliable source. The sourcing on that page has consistently excluded multiple sources like the Cass Review saying it is not, as you know, because you were involved in the discussions. Void if removed (talk) 09:47, 28 May 2025 (UTC)

:::::::::::::{{tq| Wikipedia is not a reliable source}}

:::::::::::::Right, okay, but I'm not saying that Wikipedia is a reliable source here, I'm saying that one can go to those pages, and see that there is already more than enough sourcing to safely say "GET is conversion therapy and Kenneth Zucker is a conversion therapist" in wikivoice. Snokalok (talk) 09:56, 28 May 2025 (UTC)

::::::::::::::When the sourcing for that page excludes this source which says it is not, then the sourcing for that page is suspect. And when you read the talk, much of it revolved around arguing that what the Cass Review referred to wasn't, so it wasn't a relevant source to cite. So forgive me if I find this unconvincing. Void if removed (talk) 10:05, 28 May 2025 (UTC)

:::::::::::::::Considering how the Cass Review has been thrown in the shredder as at best not reliable and at worst a hitjob by every other country's medical and academic spheres other than the UK on very clearly articulated grounds, yeah, there are very reasonable sourcing arguments there for not including it. Snokalok (talk) 10:15, 28 May 2025 (UTC)

@Your Friendly Neighborhood Sociologist In this [https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=prev&oldid=1292206734 edit] you removed a neutral description of the methodology and replaced it with a lot of commentary about what the review wasn't and did not do, filled with "scare quotes". This strikes me as not terribly NPOV, nor is it remotely DUE. Void if removed (talk) 19:36, 25 May 2025 (UTC)

:@Void if removed I think that a nearly entirely self sourced description of the methodology is a lot less neutral and due than using an international clinical practice guidelines authored by dozens of medorgs (ie, top tier MEDRS) which has multiple pages discussing the Cass Review's methodology, and strengths and weaknesses thereof. Can you please explain why, in terms of MEDRS and our RS policies, we should ignore the top tier MEDRS in favor of what is mostly self description? Especially given, as the article covers, that the methodology was highly criticized - it seems a massive NPOV violation to not use the top tier MEDRS account of it. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:00, 25 May 2025 (UTC)

::@Your Friendly Neighborhood Sociologist could you please provide page numbers for claims and quotes cited to AWMF? Your citation was to page 17 that is not relevant to what you added. Samuelshraga (talk) 04:03, 26 May 2025 (UTC)

:::This is on p.3 of the German clinical guidelines (Google Translate version): {{tq|The involvement of clinical experts in the preparation of these recommendations is not given, or is at least not transparent or is questionable}}. I'm not sure about the rest. Lewisguile (talk) 16:02, 26 May 2025 (UTC)

::::Okay, p. 20 of Appendix B:

::::{{tq|It is not documented which other persons, apart from the author [Cass], were involved in the preparation of the review and in what way. Hillary Cass was appointed as chair of the review by NHS England (Cass, 2024). Hillary Cass is a renowned paediatrician (among other things, an expert in Rett syndrome, autism, intellectual disability, etc.) without proven expertise in the treatment of or research into GD in children and adolescents. Medical societies were not identifiably involved in the preparation of the report. An "Assurance Group" was appointed, but this group was expressly not involved in developing the recommendations of the Cass review. There are reports that an "Advisory Board" was also established. The composition and specific contribution of this "Advisory Board" are not documented (Ruuska et al., 2024; Cass, 2024). Therefore, no assessment of the expertise of its members can be made.}}

::::And p. 21:

::::{{tq|No consensus-building process (e.g., DELPHI) was specified, and it is unclear who was involved in formulating the recommendations and the rest of the text. The text discussed the effects and side effects of physical medical interventions, but did not weigh them against each other in a structured way. The effects and side effects of psychosocial interventions or potential negative effects of the review's recommendations themselves (e.g., potential undertreatment) were barely discussed.}}

::::And p. 22:

::::{{tq|Stakeholder involvement achieved low DELBI scores. The patient, caregiver, and practitioner perspectives were captured through interviews and surveys. The results are reported, and implications are briefly discussed, which is considered positive. However, it is not shown whether, and if so, the results of the interviews and surveys influenced the recommendations. Furthermore, it was not disclosed which individuals were involved in developing the recommendations (see "Methodology of Development"). The involvement of professionals in relevant disciplines (e.g., child and adolescent psychiatry; sexology, psychotherapy, medical ethics) is also not documented.}}

::::{{tq|One negative aspect is that no consensus-building process is specified. Since no co-authors were named alongside the author, it appears that all recommendations were ultimately determined by the author alone and not by a group representative of the field in a structured process based on the evidence gathered. Furthermore, no external review was conducted prior to publication.}} Lewisguile (talk) 16:45, 26 May 2025 (UTC)

:::::The citation for the "Advisory Board" to Ruuska et al 2024 is exceptionally weird. That is [https://mentalhealth.bmj.com/content/ebmental/27/1/e300940.full.pdf this paper]. To find out what they're alluding to you have to read the "competing interests" for Riittakerttu Kaltiala, which includes "{{tq | The Cass Review, member of advisory board}}". Void if removed (talk) 16:57, 26 May 2025 (UTC)

::::::It's not that weird. The Cass Review talks about an Advisory group but doesn't mention who the members are. Some people have publicly claimed to be members in other locations. Citing an instance of disclosure when discussing it seems exceptionally straightforward. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:07, 26 May 2025 (UTC)

:::::::But all they say is {{tq | The composition and specific contribution of this "Advisory Board" are not documented}} - and for that all they need to do is Cite the Cass Review to see that it is, indeed, not documented. Its just odd to make a citation that isn't actually in support of the text, but in support of an unspoken implication we think this person is on that advisory board, based on this disclosure statement. Void if removed (talk) 22:10, 26 May 2025 (UTC)

::::::::I agree that this information should be included. My instinct is that we either need this to go in the "Methodology" section, where it was, or in a new "Authorship"/"Governance" section. These are reasonable details to include, which have been mentioned by multiple sources, and they are part of the context of the review. Lewisguile (talk) 09:48, 27 May 2025 (UTC)

:::::::::There is literally nothing in the cass review about having an "advisory board". It isn't even undocumented who was in it - it is undocumented that it even existed - and inferring it did from a COI statement in one paper is quite the leap.

:::::::::[https://www.gmc-uk.org/professional-standards/good-medical-practice-2024/good-medical-practice-advisory-forum Here's another person] who is apparently on the "advisory board".

:::::::::Except - if you look here, [https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143732/https://cass.independent-review.uk/about-the-review/assurance-group/ she was actually on the Assurance Group].

:::::::::On the "[https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143817/https://cass.independent-review.uk/contribute-to-the-review/clinical-engagement/ clinical engagement]" page however we know there was a "clinical expert group"

:::::::::[https://www.thejournal.ie/readme/tavistock-cass-report-ireland-6356357-Apr2024/ Here's someone who says they were a member of that group]. Is this what Kaltiala is referring to? We can't know.

:::::::::In fact the only place I can find reference to the "advisory board" is social media and activist blogs, all pointing at this one COI statement to imply there was some secret shadowy advisory board as well as the clinical expert group. Maybe there was! Or maybe Riittakerttu Kaltiala called it the wrong thing just like Emma Cave did. No clue.

:::::::::FWIW, I think the Cass Review should have published the names of the "Clinical Expert Group" if at all possible (all the review notes is that it included two GIDS clinicians), but this sort of gossip is incredibly surprising to see repeated in clinical guidelines - especially given that the guidelines don't even mention the unnamed "Clinical Expert Group". They don't mention that - names or not - this is stated to have included clinical expertise in relevant fields, ie {{tq | including representatives of professional bodies, NHSE’s phase one provider units, gender experts and others with expertise in children and young people’s care}}.

:::::::::For this guideline's assessment to not mention something referenced multiple times in the review, and instead reference something that has only seemingly been raised on activist blogs to speculate about its possible existence, is, again, surprising. Void if removed (talk) 10:58, 27 May 2025 (UTC)

:::::About statements in sources like {{xt|it is unclear who was involved in formulating the recommendations and the rest of the text}}: Last I heard, the identity and qualifications of people formulating recommendations and writing the text of a paper is not in any formal model for evaluating a paper's methodology. The dissonance between "they didn't use Delphi method" (which is anonymized, by the way) and "they didn't expose the anonymized experts' names so the internet could attack them" is enormous, at least for me. WhatamIdoing (talk) 16:29, 29 May 2025 (UTC)

::::::The Delphi method is anonymous in the sense that the views of committee members aren't attributed to individuals but are pooled and summarised; the people involved in the consensus-making process are usually named, however. It's more like the Chatham House rule rather than true anonymity.

::::::E.g., when NICE publishes a new clinical guideline with recommendations based on their evidence reviews, the names of the guideline development committee are published as well (usually well in advance of any actual deliberations occurring). But the guideline doesn't say "Dr. x said this, and Dr. y said that." The names of the reviewers and NICE staff involved in developing the guidelines are also included.

::::::This is a necessary requirement for transparency, so that it's clear what expertise was involved in drafting the guideline and so that COIs can be clearly identified. If recommendations are made by a secret committee, then we don't know what COIs might exist, and it leads to gossip (as has happened here).

::::::But not saying who said what, or what views they expressed during meetings, is necessary for letting people speak freely, without worry that they personally will be attacked. Lewisguile (talk) 08:43, 31 May 2025 (UTC)

:::::::Saying who was involved isn't done for "transparency"; it's done for career-building purposes, e.g., publish or perish.

:::::::When recommendations are made by people who can't take credit for it and can't get any personal or professional benefits from the recommendations, then people who disagree with the recommendations may stir up rumors, but, as you say, it will let them make the recommendations they believe are best, without worrying that they will receive death threats for it. WhatamIdoing (talk) 19:12, 31 May 2025 (UTC)

::Just FYI, these are s2k guidelines, so opinion/consensus based, not evidence based (s2e/s3). As such they are not a "top of the pyramid" source.

::I also note these are not without their own controversy, and there's about 30 pages of dissenting opinion from DGPPN in the Appendix. Void if removed (talk) 16:09, 26 May 2025 (UTC)

:::They are still clinical guidelines, authored by a panel of major medical organisations. There are two pyramids on the WP:MEDRS page, and one has clinical guidelines at the top; the other has systematic reviews at the top. The Cass Review final report is neither a set of clinical guidelines nor a systematic review (itself). Nor did it involve expert consensus (a critical pillar of evidence-based medicine). So while it's another imperfect source, it's at least as valuable/relevant as the Cass Review, and according to one of the pyramids, it is at the top (while the CR final report is at the top of neither). Lewisguile (talk) 16:14, 26 May 2025 (UTC)

::::And with some notable dissent. The point being - this is due for the section on these guidelines and the criticism they made. It isn't due for a rundown of what the Cass Review isn't. If these authors want to criticise the Cass Review for its intentional independence, then fine, it goes in the appropriate section (as it is now) - but that isn't something we put in the methodology. Void if removed (talk) 16:54, 26 May 2025 (UTC)

:::::That runs the risk (more than there already is) of creating POV forks. Significant caveats should be included alongside the information they modify, rather than reserved for a separate "responses" section. This is information about methodology and authorship, so it belongs in that section. It also doesn't replace information that was already there but adds to it.

:::::Currently, the article doesn't state anywhere in Wikivoice that Cass was the only author of the interim and final reports, which is a significant omission and baffling now I think about it. It's notable because multiple sources have mentioned this fact specifically, including the Canadian Paediatric Society and several of the critics, but also a lot of the news coverage.

:::::That said, I would reword it from YFNS' version somewhat. Lewisguile (talk) 09:42, 27 May 2025 (UTC)

::::::{{tq | doesn't state anywhere in Wikivoice that Cass was the only author of the interim and final reports}}

::::::Ok, that sounds like a thing we should be able to source from somewhere. Quite straightforwardly, [https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/camh.12723 this editorial] states she's the author of the final report. Void if removed (talk) 10:01, 27 May 2025 (UTC)

:This part of the text wasn't changed however the part where we write {{tq| The review examined English-language studies of minors, excluding case studies}} is incorrect. Whilst it seems the York team set out with this in mind (the exclusion criteria set out in The Cass Review appendix 2 pg 2 says they excluded case studys) in their psychosocial support systematic review [https://doi.org/10.1136/archdischild-2023-326347 here] they included [https://doi.org/10.1111/famp.12677 this] (according to the abstract) case study of a single family and they appraised it as the only moderate quality study.

:This demonstrates a good reason why wikipedia prefers secondary independent sources. We should also remove the part about excluding case studies because it is verifiably incorrect. LunaHasArrived (talk) 22:30, 25 May 2025 (UTC)

::Good spot, looks like the systematic reviews excluded case series and case reports, not case studies. Probably better to cite the York reviews directly for their methodology. Void if removed (talk) 08:13, 26 May 2025 (UTC)

:::I mean, appendix 2 in the final report of the Cass review was written by the York team. I think writing the inclusion criteria for each study would become very tedious in writing and would probably give undue weight to a very minor part.

:::I was just giving an example of why we can't trust primary sources to give accurate summaries. LunaHasArrived (talk) 09:05, 26 May 2025 (UTC)

::::I agree that we shouldn't rely solely on primary, non-independent sources here. The SRs are primary (and non-independent) when they talk about themselves. If secondary sources disagree with them, them we should probably defer to the secondary sources. We can always clarify what the primary sources say about themselves, but this would require attribution and proper weighting. Lewisguile (talk) 13:24, 26 May 2025 (UTC)

:::::I'm pretty sure that what we were doing here was using the Cass Review as a secondary source on the systematic reviews. However, it turned out to be wrong because it was based on the original PROSPERO, and not the updated one (once they expanded the criteria to include more evidence). Void if removed (talk) 14:06, 26 May 2025 (UTC)

::::::If Appendix 2 was written by the York team, they'd still be a primary source on themselves. Is Luna correct on this? Lewisguile (talk) 15:15, 26 May 2025 (UTC)

:::::::I mean it would definitely be a non-independant source, (wiki) primary would depend on when the York team wrote it. Either way it probably shouldn't be used over secondary independent sources, especially if it's prone to some mistakes like this. LunaHasArrived (talk) 15:20, 26 May 2025 (UTC)

::::::::I'll note that having checked for alternatives, another (independent) secondary source we already cite - the RAND report - makes the exact same "case studies" mistake. I think in this instance we need to stick to the primary sources we know are accurate, until a secondary source gets it right. Void if removed (talk) 22:06, 26 May 2025 (UTC)

:I have reverted to the MEDRS version. Your edit summary referred to an international clinical practice guideline by dozens of MEDORGs as a {{tq|primary source}}[https://en.wikipedia.org/w/index.php?title=Cass_Review&diff=prev&oldid=1292207943], which is a complete dismissal of MEDRS and novel interpretation of primary. So far, two other editors agree that using independent sources is better. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:22, 26 May 2025 (UTC)

::VIR re-reverted[https://en.wikipedia.org/w/index.php?title=Cass_Review&curid=76551101&diff=1292404417&oldid=1292390618]. @LunaHasArrived @Lewisguile was I correct in reading your comments as support for the version based on the AWMF? VIR's edit summary said he can't see any consensus, I think you were both pretty clear in supporting sourcing to the AWMF, respectively saying {{tq|This demonstrates a good reason why wikipedia prefers secondary independent sources ... I was just giving an example of why we can't trust primary sources to give accurate summaries. ... Either way it probably shouldn't be used over secondary independent sources, especially if it's prone to some mistakes like this.}} and {{tq|So while it's another imperfect source, it's at least as valuable/relevant as the Cass Review, and according to one of the pyramids, it is at the top (while the CR final report is at the top of neither). ... I agree that we shouldn't rely solely on primary, non-independent sources here. The SRs are primary (and non-independent) when they talk about themselves. If secondary sources disagree with them, them we should probably defer to the secondary sources}} Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:05, 26 May 2025 (UTC)

:::Can confirm, no reason to be using the non-independent summary when we do have independent medrs summaries. LunaHasArrived (talk) 21:23, 26 May 2025 (UTC)

:::I didn't see this discussion as referring to that, just a general preference for secondary sourcing that came up in a side-issue about the case study/case series.

:::The question is (since this is your issue) how should we describe the methodology? You don't like citing the review, ok, so lets get secondary sources on the methodology.

:::That's not what you have here - what you have is a document in German giving a critique of the approach (that is already in the article) - and you've rendered that critique as the methodology, to the exclusion of actually describing the methodology.

:::This isn't an question about whether to use secondary sources where possible (fine) - its about whether what you added communicates anything useful about the review, neutrally, to the reader. Supplanting what the Cass Review did do with what this document says it didn't do is not useful or informative or neutral. Void if removed (talk) 21:47, 26 May 2025 (UTC)