The British Medical Association has been criticised by doctors and NHS leaders for making “unethical” demands that children be given puberty-suppressing drugs.
The doctors’ union announced last week that it would oppose the implementation of the recommendations of Dr Hilary Cass’s report, which called for an overhaul of services for children who want to change their gender. In a meeting that critics described as secretive, the BMA’s board passed a motion calling for a “criticism” of Dr Cass’s report and arguing that stopping the prescribing of sex hormones to children would be discriminatory.
But the decision has angered medical leaders, doctors and many of the union’s 195,000 members, who have published an open letter saying the BMA’s “unacceptable” stance was “ A wider membership
The letter, addressed to BMA chairman Professor Philip Banfield, said: “As doctors we say ‘not in my name’. We are extremely disappointed that the BMA Council has passed a motion to ‘critique’ the Cass Review and lobby against its recommendations.”
“The passing of the motion was done in opaque and secretive fashion. It does not reflect the views of the wider membership, whose opinions you did not solicit. I understand that no information will be released about vote counts or how council members voted. This is a failure of accountability to the membership and is simply unacceptable.”
The letter goes on to say that the Cass study is essential to ensure children receive appropriate care, and that it is “the most comprehensive study to date of health care for children with gender-related concerns.”
The committee called on the BMA to “stop its pointless exercise” in criticising the Cass report, adding that “by lobbying against the best evidence we have, the BMA is acting contrary to the principles of evidence-based medicine and ethical practice”.
A review by Dr Hilary Cass recommended a ban on the use of puberty suppressants outside clinical trials.
Yui Mok/PA
The letter is thought to have been signed by dozens of prominent doctors, including paediatric surgeon Professor Simon Kenny, national clinical lead for children and young people in NHS England.
Dr Cass’ four-year investigation produced 32 recommendations, calling for a radical shift in approach from medical intervention to a holistic model that addresses other mental health issues, as well as a ban on prescribing puberty suppressants outside of clinical trials.
Details of the open letter to the BMA were revealed on Wednesday as the NHS outlined plans to overhaul gender services for children to ensure “safer care”.
The NHS has announced that early next year it will begin clinical trials of puberty suppressants in children, led by experts from King’s College London, to assess the “potential harms and benefits” of giving puberty suppressants to children and teenagers who want to change their gender.
The trial is expected to involve hundreds of children referred to NHS gender services, and will track the long-term outcomes of those who are prescribed the drug and those who are not. Due to the large size of the trial, the results are awaited with interest around the world and will fill a major gap in the evidence base for gender medicine.
• Doctors’ Union Calls for Lifting Ban on Puberty Blockers
Puberty suppressants block the production of sex hormones that cause physical changes such as breast development and facial hair growth during puberty. The drugs have been widely prescribed to under-16s struggling with gender over the past decade. But their use on the NHS was banned in March after Cath raised safety concerns. The government then passed legislation making it illegal to prescribe them outside clinical trials.
The NHS will open a network of eight gender clinics for children, replacing the previous gender clinic at Tavistock and Portman NHS Trust in London. Children will only be referred to the gender clinic if they have been referred by their paediatrician or mental health services, rather than only by their GP as before. The new services will have no minimum age limit and will accept referrals from across the country. Two have already opened – in Great Ormond Street in London and Alder Hey in Liverpool – and the next service is due to open in Bristol in November.
The NHS has also launched a review into whether adult sex services are safe, which will be led by NHS medical directors and will look at the use of sex-changing hormones for patients over 18 years of age.
Mr Cath said: “I am pleased that NHS England has plans to fully implement the recommendations of my review. The crucial next step – making it a reality – will be the most difficult one. “He said the service would take a holistic approach to care and respond to the needs of each individual.
Health Minister Wes Streeting welcomed the new service and the trial of puberty suppressants, saying “children’s health care should always be evidence-based”, adding: “We want transgender people in this country to feel safe, accepted and able to live with freedom and dignity.”
The BMA declined to comment on the open letter to its chairman, Professor Philip Banfield.
Carl Cort/Getty Images
All major medical bodies except the BMA have supported the Cass review. Dr Janet Dixon, president of the Royal Academy of Medicine, said: “We welcome these important steps towards implementing the recommendations of the Cass review because at the heart of this issue are thousands of children and young people who need care. The sooner they can receive treatment in the right way, and by the most appropriate specialists, the better.”
Professor Stephen Powis, national medical director for the NHS, said: “These plans set out in detail how we will establish a radically different and safer model of care for children and young people. The work that Dr Cath has done has been invaluable in shaping the new service delivery, and we have already started to transform these services with the opening of two new regional centres this year.”
The BMA declined to comment on the open letter.
