Summary
The Cass Report is controversial because many organisations have criticised it, contrasting it with the more transparent Swiss Report which contradicts Cass in its approach to treatment, evidence, and data interpretation.
The Cass Report Scandal
It is debatable at what point a controversy turns into a scandal, but this week, the Case Report made a significant step toward becoming the latter. Perhaps the saddest issue, though, is the right-wing media has never even reported the Cass Report as highly controversial. Some light came from the Scottish Labour Conference this week, with the delegates refusing to pass a motion to support Cass – needless to say, the press reported the delegates as left-wing renegades out to cause trouble.
To date, thirteen high-profile organisations globally have criticised the Cass Report, and this week, it emerged that Switzerland published their version of Cass, flying in the face of what Hillary Cass and her advisory board have suggested. Unlike Cass, the report from Switzerland is open and transparent, naming all the health professionals who contributed to their report. Despite numerous efforts to find out, Cass’s advisory board is shrouded in secrecy, causing alarm that she worked solely with those who disapprove of gender-affirming care, such as SEGM, Bayswater and other gender-critical groups.
Bayswater, allegedly a parent-led group, has been at the centre of allegations of some members supporting conversion therapy and child abuse. At the same time, SEGM has been named as an SPLC “Hate Group.”
The Swiss Report titled “Medical Treatment for Minors With Gender Dysphoria” contradicts Cass in several areas. While both address ethical considerations and the well-being of young people, they diverge in their emphasis on caution, evidence standards, and the interpretation of existing research.
Emphasis on Caution vs Potential for Intervention:
Cass Review: The Cass Review emphasises caution due to the weak evidence base for medical interventions like puberty blockers and hormone therapy. It calls for more research to understand the long-term outcomes and potential risks.
Swiss Report: The Swiss Report also advocates a cautious approach, emphasising thorough monitoring and transparent communication about potential risks. However, it acknowledges the potential benefits of gender-affirming treatments in alleviating distress and promoting well-being, stressing the importance of not increasing distress through pressure to conform.
This contradiction highlights a difference in the threshold for intervention. The Cass Review prioritises minimising potential harms in light of uncertain evidence, while the Swiss Report balances this with the need to alleviate current distress, even with some uncertainty.
Evidence Standards:
Cass Review: The Cass Review stresses evidence-based practice and criticises the poor quality of existing evidence supporting medical interventions for gender dysphoria. It notes that many studies are small, uncontrolled, and have short follow-up periods.
Swiss Report: The Swiss report argues that evidence standards should not be higher than those applied to comparable interventions where randomised, double-blind studies are not feasible.
This reflects a fundamental disagreement on what constitutes acceptable evidence. The Cass Review demands high-quality evidence to justify medical interventions, while the Swiss document suggests a more pragmatic approach, acknowledging the research limitations in this area.
Satisfaction with Treatment:
Swiss Report: The Swiss Report highlights that satisfaction levels with treatment are high, and regret is low across different studies.
Cass Review: The Cass Review, while acknowledging lived experiences, focuses on the uncertainty and knowledge gaps regarding the long-term outcomes of both medical and non-medical interventions. It emphasises the need for systematic data collection and research to understand the benefits and harms of different approaches.
This contradiction reveals a difference in interpreting existing data. The Swiss document emphasises patient-reported satisfaction, while the Cass Review calls for more objective and long-term data to assess the true impact of treatments.
Social Transition:
Cass Review: The Cass Review expresses concern over the weakness of research regarding social transition and its impact on gender development and mental health. It questions whether social transition alters the trajectory of gender development and what the short and longer-term effects on mental health may be.
Swiss Report: The Swiss report notes beneficence requires that society avoid increasing distress through pressure to conform. This highlights differing views on the role of social factors. The Cass Review calls for caution and more research.
Conclusion:
In conclusion, while both the Cass Review and the Swiss Report aim to promote the well-being of minors with gender dysphoria, they diverge in their approaches to treatment, evidence, and the interpretation of existing data.
Our own report, The Cass Review: A solution-focused Approach (compiled by leading healthcare experts excluded by Cass), highlighted issues similar to those of the Swiss. We have also produced a briefing note regarding Cass for MPs.
The Swiss report is unlikely to be the final nail in the Cass Report coffin. Still, as evidence mounts that Cass has some areas of her report badly wrong, the question is how long the UK will remain an outlier in the healthcare of gender dysphoric children, which, because of the Cass report and the current puberty blocker ban, is currently causing them and their parents immense distress.
