Nearly 900 doctors have written to the British Medical Association (BMA) expressing their “disappointment” and “dismay” at the position the doctors’ union is taking on puberty blockers and the Cath review. New Statesman can be revealed.
in press release Last week the BMA criticised the ban on new prescriptions of puberty blockers, a restriction introduced by the Conservative government in June following a four-year review into gender identity services for children and young people by Dr Hilary Cass. Dr Cass’ final report was published on 10 April this year. In response, the BMA has called for the recommendations from Dr Cass’ review to be suspended, describing them as “unfounded”.
letterThis was addressed to Philip Banfield, chairman of the BMA UK Council. New Statesman and British Medical JournalIt begins: “As doctors we say, ‘not in my name’. We are extremely disappointed that the BMA Council has passed a motion to ‘criticise’ the Cass Review and lobby against its recommendations.”
The letter was signed by 57 professors and 22 former or current presidents of Royal Colleges of Physicians, as well as other clinical leaders. Of the 870 signatories, more than two-thirds are BMA members. “The number of people who have signed this letter speaks to the level of concern doctors have about the BMA Council’s motion against the Cass review,” said Dr Camilla Kingdon, former president of the Royal College of Paediatrics and Child Health, and one of the letter’s signatories.
July 16th, New Statesman The motion tabled by the BMA called on BMA members to “engage and work with other relevant organisations and stakeholders to oppose the implementation of the Cass review recommendations.” The BMA’s policy-making body, the UK Council, voted on a slightly amended motion the following day; rather than voting to “reject” the Cass review, it voted to “publicly criticise” it. The motion also described Cass’ recommendations as “driven by unexplained deviations in research protocols, vague eligibility criteria and the exclusion of transgender-affirming evidence.”
In a press release on July 31, the BMA confirmed the results of the vote. motionIn their letter to the BMA, the doctors criticised the process that had led to the organisation’s position on the Cass review as “opaque and secretive” and “not representative of the views of the wider membership, whose views were not sought”.
It is unclear how many of the BMA’s 69 council members voted in favour of the motion. Under council rules, motions need a simple majority to pass, with abstentions ignored. BMA members who signed the letter said the withholding of voting details amounted to a “failure of accountability to members” and was “completely unacceptable”. Recent BMA Poll In a written response to those who signed the letter, Philip Banfield said the discussion and vote at the council meeting followed due process and that the outcome of the vote would be communicated to BMA members once the minutes of the meeting had been approved.
After the vote, the BMA issued a press release criticising the government’s decision to ban the private prescription of puberty suppressants to people under the age of 18 for the treatment of sexual problems. In March, NHS England announced that puberty suppressants were It will no longer be prescribed The NHS has stepped up to treat gender-related distress. The statement “There is insufficient evidence to prove its safety or clinical effectiveness,” he said. [puberty blockers] The ban will not currently be made available for routine use, but will only be prescribed as part of clinical research. be ruled legal by the High Court Last month, Health Minister Wes Streeting also signalled his support for it.
Cass found that gender medicine rests on “shaky foundations.” “This is an area where the evidence is extremely weak,” she said. ReportThe biggest problem with [hormonal] “Interventions to manage gender-related distress”
Speaking exclusively New StatesmanMs Cass said she was “disappointed” that the BMA’s UK council had not contacted her to discuss her concerns in the four months since the review was published. [team] “We spoke to representatives from the BMA during the course of our work and the recommendations in our final report reflect the issues they raised – specifically concerns about a lack of appropriate training in this area and pressure on GPs from private healthcare providers to prescribe in an area that many feel is outside their competence.”
The letter, which strongly supports Mr Cass, accuses the union of failing to take an evidence-based approach to medicine. It states: “The Cass Review: [puberty blockers’] “There is no guarantee of safety or effectiveness and therefore it should only be prescribed under research conditions,” the letter said. “By lobbying against the best evidence we have, the BMA is going against the principles of evidence-based medicine and ethical practice.”
The question of banning the prescription of puberty-blocking drugs was explicitly not put to a vote in Parliament. Following the BMA’s announcement, NHS England said: “Dr Cath spent four years gathering evidence for the most comprehensive report of its kind. Her expertise and advice has been invaluable in helping the NHS create fundamentally better and safer services for children and young people.” NHS England has “full confidence” in her report and is “committed to bringing forward its recommendations.”
talk New StatesmanMr Kingdon and Ms Claire Gerada (former president of the British Association of General Practitioners and another signatory) echoed the letter, arguing that the Cath review was “the most comprehensive review of its kind ever carried out”. “Patients, and patients including children, have a right to treatment based on the best evidence,” Ms Gerada added. “This is particularly important when that treatment is a life-changing intervention.”
Many who signed the letter added further comments below the text. They were unreserved: “Appalled,” “horrified,” “shocked,” “reprehensible,” “irresponsible,” “wrong.” Some argued the move would directly harm children, while others said it showed “an abject failure of leadership.” Another wrote that “the BMA has overstepped its bounds in attempting to criticize a voluminous body of carefully conducted professional research.” Many were baffled as to why the BMA, the doctors’ trade union, was getting involved, suggesting that the organization should focus on pay and working conditions rather than “challenging an evidence-based document that has been painstakingly produced over four years.” (These comments were made to the BMA, which declined to comment.) Following last week’s announcement, several signatories said they had left the organization.
Dr Peter Green, co-chair of the National Network of Designated Health Professionals (NNDHP), which makes up members with responsibility for child protection across the NHS, is a life member of the BMA and a signatory to the letter.
“The NNDHP has supported the Cass Review from the beginning as a means of providing answers to conflicting clinical questions,” Green said. New Statesman“The review has been admirably rigorous in its approach and has brought sober clarity to the centre of a public storm. The NNDHP is surprised by the BMA’s intervention and whilst we respectfully urge this world-renowned association to re-evaluate its approach and position.”
“I cannot understand what the BMA thinks it can add to this complex area of medicine,” Kingdon said. “There is a really urgent need to implement the recommendations of the Cass review and back up our research with further research to answer important questions about our approach, particularly with regard to hormone use,” she added.
The signatories are deeply concerned about the thousands of vulnerable children who need help. The latest figures show: Over 5,700 I am on the Youth Gender Services waiting list.
In support of its position, the BMA said: paper The letter criticising the Cass review was written by people whose work was criticised in the evidence review on which the Cass study was based. “We note that the sources on which the BMA relies to cast doubt on the review were written by groups with serious conflicts of interest and have not been peer reviewed,” the letter states. All seven systematic reviews on which the Cass report is based have been peer reviewed.
The BMA will now undertake its own review of the Cass Review, which it hopes to complete by the end of the year. In a press release on 31 July, the BMA said that the organisation’s “Task and Finish” group will “pay particular attention to the methodology on which the report’s recommendations are based”. But the letter questions whether the BMA has the expertise to do this, arguing that “it is extremely difficult to offer a fair criticism in a situation where the BMA has already attacked the review and voted against implementing its recommendations”.
“While the BMA Council chose not to consult its members, this review has consulted hundreds of clinical staff most involved in the care of children and young people with gender-related concerns – many of whom are of course BMA members. We also spoke regularly with the Royal Colleges of Medicine and other professional bodies responsible for producing guidelines and setting professional standards, and have carried out an extensive engagement programme with service users and people with lived experience,” Cath said in a statement.
In a two-page response to the letter’s signers, New StatesmanBanfield said the “motion passed by the BMA’s UK council criticises the Cass review and the measures that have been taken in its name”, but that “criticism must begin from a neutral position and any assessment must be evidence-based. The idea that no review should be criticised, even on such a sensitive topic, I believe goes against the very principles of the scientific process,” he added.
“A ban on puberty suppressants for transgender and gender variant young people goes further than any recommendation from the Cass review, which said they should only be used under research conditions,” Mr Banfield said. He argued the impact of the government’s decision “means that people who could currently benefit from care are denied that option”.
The publication of the Cath Review’s final report in April 2024 seemed to bring a moment of calm and clinical consensus to a noisy and harmful debate about how best to care for gender-questioning children. Its findings have been accepted by both the former Conservative and the current Labour governments. NHS England has committed to fully implementing the findings and yesterday published an update on its implementation plans. A third specialist gender centre will open in Bristol later this year, with others due to open in future. As the letter to the BMA makes clear, doctors are now seriously concerned that the situation will get worse.
The letter, addressed to Philip Banfield, expresses the signatories’ “disappointment” that the BMA has chosen to criticise Cath. The letter concludes: “We call on the BMA to stop this pointless attempt and for the British Association of Psychiatrists, the British College of General Practitioners, the British Association of Paediatrics and Child Health and the British College of Psychiatrists to welcome and follow the Cath review. Royal Academy of Medicine i did it.”
