Talk:Cass Review/Archive 6

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Refactoring the Reception -> Final report subsection

I think the Reception -> Final report subsection is in dire need of changes; it's very disorganised, there are lots of non-reliable sources being used as references, and we're including statements from fringe patient advocacy groups who don't have the credibility to warrant their inclusion under WP:WEIGHT.

It's currently a long, messy list of statements. To improve its organisation, I think it'd be helpful to further split up "Final report" into several subsections of its own. For example, we could split it up into: responses from politics; responses from medicine; and other responses. The second subsection can contain responses from "reputable major medical and scientific bodies" (per WP:MEDORG). The third can contain responses from those who are involved neither in politics nor medicine, but whose reactions are still notable enough to warrant inclusion.

When I brought up removing responses to the report not referenced by reliable news sources (and therefore lacking coverage) before, people said it would be inappropriate because it falls under WP:BMI. Per WP:MEDORG, "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources...major medical and scientific organizations sometimes clash with one another...which should be resolved in accordance with WP:WEIGHT." Some of these statements and responses are critical and contradict the Cass Review, which is the most credible and authoritative source on the topics it covers. It is the most credible and authoritative source on the topics it covers because it is based upon systematic reviews, per WP:MEDASSESS, and was commissioned by the NHS, one of the "reputable major medical and scientific bodies" explicitly named in WP:MEDORG. We currently include dissenting opinions from groups like PATHA and AusPATH which are so niche they don't even have a Wikipedia page. They are patient advocacy groups. They are not, as WP:MEDORG sets out, "reputable major medical and scientific bodies". Therefore, per WP:MEDORG and WP:WEIGHT, we shouldn't be including their contradictions to the best evidence there is on this subject. WP:MEDORG also tells us "to avoid WP:original research by only using the best possible sources". Clearly, statements from these fringe groups that contradict the findings of the report are not the best possible sources. We're also including, for example, the EHRC, which is not a WP:MEDORG, and doing so with a reference from its own website rather than a secondary source (seeing as it isn't a medical organisation).

Non-reliable sources we're using as references in this section include WP:DAILYDOT; the Evening Standard; and them.us. If we are going to use secondary news articles as references, surely we can (and should) use better sources than these. 13tez (talk) 22:47, 3 May 2024 (UTC)

If your agenda was any more transparent, birds would kill themselves flying into it. 2601:1C0:717E:4C0:7CC7:E299:DF59:A01E (talk) 23:44, 3 May 2024 (UTC)

You should note I oppose the use of the sources being used to reference Sex Matters and Genspect supporting the report and, therefore, the inclusion of their stances in the article until better, reliable sources (that also show they're notable) are found. 13tez (talk) 00:59, 4 May 2024 (UTC)

I support the aim to tidy up the Reception: Final Report section.

Another section that is poor: is the Findings section. It's phrased in complex sentences that are not clear. It would benefit from using more direct text from the report: as other editors have suggested. Eg maybe the entire FAQ sections of the Review could be included.

Here in the UK, all political sides have supported the Cass Review and most mainstream health organisations have too - and YET the article here is phrased in ways to hint at discrediting the report, and that it is not well founded in science.

Those of us who have tried to edit to bring the article in line: have been on the receiving end of some over-zealous reversion and on the Talk page even personal comments about our 'editing style'. Hopefully now that partisan period is over here on wikipedia: which is appropriate as the partisan views on under-18's puberty-blockers are now pretty much over in the wider world. Even staunch proponents of them have moderated their views: and MPs in parliament have apologised for their earlier criticisms of Cass. Peckedagain (talk) 00:12, 4 May 2024 (UTC)

Thanks for your thoughts. Would you support the ideas to remove the PATHA and AusPATH statements and to improve the reliability of the news sources used or else remove the content they currently support? I see you support the idea of the sub-headings I mentioned before. 13tez (talk) 00:56, 4 May 2024 (UTC)

"Here in the UK, all political sides have supported the Cass Review and most mainstream health organisations have too - and YET the article here is phrased in ways to hint at discrediting the report, and that it is not well founded in science."

A. The UK is not the only country in the world.

B. MEDORG criticism, even if it's from outside the UK, bears weight.

C. The findings section was written to be remarkably neutral in its statements of the report, using directly cited findings with page numbers in SFN and neutral wording in accordance with MOS:CLAIM. If you're reading it as discrediting, then what does that say about the findings themselves? Snokalok (talk) 12:42, 4 May 2024 (UTC)

A) straw-man. The UK has a good reputation for science and healthcare; and a four year research project by the state health system the NHS.

In the Parliament, an MP publically apologised for wrongly criticising the report.

C) - it says nothing!

@Snokalok - what will it take for you to accept that the report is scientifically robust, as other editors have eg @Colin argued that criticism of it is unscientific. Peckedagain (talk) 14:28, 4 May 2024 (UTC)

You’re approaching from entirely the wrong angle. It’s not about whether the UK is a good country for science and medicine or whether the report even is a good one, science is not a set of doctrinal ideas from a designated authority wielder on high that are not allowed to be controverted. Even if the report was 100%, indisputably accurate (which it’s not but whatever), the fact is that criticism from contemporary scientific organizations is relevant and bears including. It doesn’t matter if the report is right or wrong, it matters that the criticism bears weight regardless. It is not our job as editors to determine one set of ideas to be inherently right (let alone just because the British govt said so) and then censor anything to the contrary, our job is to write an article which fully and fairly encapsulates the topic - and if numerous medorgs are criticizing the report, then it’s not fair nor accurate to exclude those simply because we believe the report to be right. Snokalok (talk) 14:49, 4 May 2024 (UTC)

@Snokalok - a strawman - it is not being suggested that criticism be excluded.

It's about weight. Much of the criticism is fundamentally unscientific, because the very FAQs in the Cass report disprove them!

Would you object to the FAQ's being copied directly here?

• Did the Review set a higher bar for evidence than would normally be expected? No
• Did the Review reject studies that were not double blind randomised control trials No
• Did the Review reject 98% of papers demonstrating the benefits of affirmative care? No
• Has the Review recommended that no one should transition before the age of 25 and that Gillick competence should be overturned. No
• Is the Review recommending that puberty blockers should be banned? No
• Has the Review recommended that social transition should only be undertaken under medical guidance? (The Review has advised that a more cautious approach)
• Did the Review speak to any gender-questioning and trans people when developing its recommendations? Yes

Peckedagain (talk) 15:02, 4 May 2024 (UTC)

The authors of the Cass Review say these things about their own review, and the hundred medorgs and academic voices we have cited in the article resoundingly disagree. We don’t censor criticism because the people being criticized say “Nuh uh” Snokalok (talk) 15:13, 4 May 2024 (UTC)

At least some of these points are objective truth, e.g. that they didn't reject 98% of papers. We can't include criticism based upon claims that simply aren't true. Please remember the systematic reviews that informed the report were peer-reviewed. Therefore, the authors can't just lie about them. 13tez (talk) 16:14, 4 May 2024 (UTC)

Perhaps the page could a have a table, one column per FAQ: with one row per body that is critical: so that an X marks which FAQs each body have questioned - for visual clarity and reduce repetition: as the same points are raised by several bodies. Peckedagain (talk) 18:36, 4 May 2024 (UTC)

I think adding the FAQs from the Cass Review website in a manner like you've described is a good idea. If we're following MEDRS sourcing (so not using news articles), we should probably be taking the key findings and recommendations from it too. 13tez (talk) 19:59, 4 May 2024 (UTC)

I wonder if that wouldn't take up a disproportionate amount of space. Additionally, a number of these answers are far less concrete than a simple factual yes or no. For example, there are strong arguments to be made of a higher bar indeed being expected, given that somewhere around half of all medical care only has low quality evidence supporting it, and that the majority of children's medicine is prescribed off-label. Furthermore, the report directly says that the evidence for psychosocial intervention is as weak as that for hormonal treatments, but recommends psychosocial as the default and against hormonal treatment in the majority of cases. That itself is a higher bar required for hormones vs therapy. Snokalok (talk) 20:25, 4 May 2024 (UTC)

Ultimately, this is a primary source and can only really be taken as the review responding to criticism, that is - it can be taken as one side in the debate, not as objective fact. If you want to implement the contents of this FAQ in the Cass Response section or somewhere similar, that's one thing, but in and of itself this FAQ is not a reliable source to censor criticism with because it's effectively somewhere between "Nuh uh" and "We've investigated ourselves and found no wrongdoing" Snokalok (talk) 20:27, 4 May 2024 (UTC)

And this is exactly the thing I was getting at when I was kvetching about primary sources above, or about Cass herself not necessarily being a reliable source for even the contents of the report. The sourcing guidelines on Wikipedia are there for good reasons and those reasons don't stop applying in MEDRS cases no matter how strong the evidence is within the context of MEDRS. Loki (talk) 20:37, 4 May 2024 (UTC)

Hey, thanks again for your further thoughts.

I wonder if that wouldn't take up a disproportionate amount of space.

I was thinking of replacing our own summaries of findings and recommendations with those from the review website itself. There are only 8 FAQs which we can summarise.

For example, there are strong arguments to be made of a higher bar indeed being expected, given that somewhere around half of all medical care only has low quality evidence supporting it, and that the majority of children's medicine is prescribed off-label. Furthermore, the report directly says that the evidence for psychosocial intervention is as weak as that for hormonal treatments, but recommends psychosocial as the default and against hormonal treatment in the majority of cases.

I think the authors of a NHS-commissioned report better understand the quality, nature, and quantity of evidence to support medical practice and how that evidence should shape practice than any of us here, so we should go with what they say.

Ultimately, this is a primary source and can only really be taken as the review responding to criticism, that is - it can be taken as one side in the debate, not as objective fact... in and of itself this FAQ is not a reliable source

It's a follow-up by a report commissioned by the NHS, a reputable major and national medical organisation that defines the guidelines for and carries out almost all medicine in the UK. If we're using MEDRS sources here - as is the consensus - we're not delving into normal practice of requiring mostly secondary sources etc set out at WP:PSTS.

it's effectively somewhere between "Nuh uh" and "We've investigated ourselves and found no wrongdoing"

A lot of the claims the FAQs address are objectively and obviously not true, which is well-documented at this point. They don't deserve serious consideration. Apart from anything else, it's sad they've felt the need to refute them. The misinformation helps nobody, least of all trans people. 13tez (talk) 20:49, 4 May 2024 (UTC)

"I was thinking of replacing our own summaries of findings and recommendations with those from the review website itself. There are only 8 FAQs which we can summarise."

I remember that was done early on, and eventually it was decided that the summary page was vague and open to misinterpretation from all sides, and that using direct pieces from the report was better.

"I think the authors of a NHS-commissioned report better understand the quality, nature, and quantity of evidence to support medical practice and how that evidence should shape practice than any of us here, so we should go with what they say."

The international medical community disagrees. They can't investigate themselves and find no wrongdoing, that's a blatant conflict of interest. Even someone with no scientific or medical expertise could see that.

"It's a follow-up by a report commissioned by the NHS, a reputable major and national medical organisation"

Again, conflict of interest here. They can't say "We've investigated the criticism leveled against us by other medical orgs and decided nuh uh"

"A lot of the claims the FAQs address are objectively and obviously not true, which is well-documented at this point."

Well since we are using MEDRS sources, again, the entire international medical community is in apparent disagreement right now. Only UK sources have been speaking in favor of the Cass Review, and while they're not invalid sources, they do not hold supremacy over consensus. Snokalok (talk) 21:23, 4 May 2024 (UTC)

It doesn't matter how reliable you consider the NHS for medical info, the fact is the NHS is always a primary source when talking about the NHS. Snokalok (talk) 21:25, 4 May 2024 (UTC)

The international medical community disagrees.

The international medical community - the WHO, the National Institutes of Health, Health Canada, etc - haven't rejected the Cass Review. A similar Swedish systematic review also found that there's a severe lack of evidence for current practice. There isn't some great disagreement here.

They can't investigate themselves and find no wrongdoing, that's a blatant conflict of interest.

They aren't investigating themselves for alleged wrongdoing. They're explaining why common misconceptions and misinformation are incorrect. Again, a lot of the claims still circulating are clearly just objectively false at this point.

the entire international medical community is in apparent disagreement right now. Only UK sources have been speaking in favor of the Cass Review

This isn't true. See Sweden and their aforementioned review, Ireland, Norway, and Finland, Denmark, the Netherlands, and the European Academy of Paediatrics. You're making an assertion here that the rest of the world is against the findings of this review or of different opinions, but it's simply not the case.

It doesn't matter how reliable you consider the NHS for medical info, the fact is the NHS is always a primary source when talking about the NHS.

As discussed, the consensus is that the report falls under BMI, so MEDRS sources are needed. The NHS and the report qualify as MEDRS sources. 13tez (talk) 23:08, 4 May 2024 (UTC)

Afaik the consensus was that it's complicated in regards to BMI and primary and therefore depends on what one is commenting on. I think the larger problem with the FAQs is that we're trusting Cass with that those are in fact the FAQs (definitely not BMI) and that the questions aren't being misrepresented in any way. As well as this as far as I can tell I have no way to verify who the FAQs page was written by and what process went into writing it, feel free to show me where but this also seems to pose a problem. LunaHasArrived (talk) 23:54, 4 May 2024 (UTC)

As well as this I think if somebody says "the Cass review ignored 98% of evidence" and someone else says "the systematic reviews actually considered more evidence than that". These 2 people are arguing past eachother, I think one can claim that in Cass's findings and recommendations they only wanted high quality evidence for this kind of care. Not to say the first statement is correct by any means just that saying "the systematic reviews considered that evidence" isn't really enough to refute it by itself. LunaHasArrived (talk) 00:06, 5 May 2024 (UTC)

@LunaHasArrived

Are you not simply re-stating, in different words, again and again, that you view that the Cass report is not a top-quality reliable report?

> I think the larger problem with the FAQs is that we're trusting Cass ... I have no way to verify who the FAQs page was written by and what process went into writing it,

The FAQs are on the official Cass Review website! What more is needed for us to 'trust' the FAQs?!

Looking at your view of Cass: in your own words:

> I think a very important thing to say that Cass's report whilst based on systematic reviews is not top tier medical evidence.

> Oh yes, I'm not saying at all that the Cass review itself should be discredited. It's just...

> this isn't to say Cass isn't Medrs or unreliable. It's just to say ... Peckedagain (talk) 00:28, 5 May 2024 (UTC)

Hey @LunaHasArrived, thanks for your thoughts.

I have no way to verify who the FAQs page was written by

I understand that concern, however it is published on the official Cass Review website. To me, this gives it credibility in the same way as something published on the NHS website.

As well as this I think if somebody says "the Cass review ignored 98% of evidence" and someone else says "the systematic reviews actually considered more evidence than that". These 2 people are arguing past eachother

One side of such arguments is objectively wrong and undermines the credibility of the report, though. You can see this in the peer-reviewed systematic reviews that informed the report, regardless of any reservations you might have about the report itself or the website. Furthermore, reliable sources reject these claims too; The Guardian has said: "To understand the broader effects of puberty blockers, researchers at the University of York identified 50 papers that reported on the effects of the drugs in adolescents with gender dysphoria or incongruence. According to their systematic review, only one of these studies was high quality, with a further 25 papers regarded as moderate quality. The remaining 24 were deemed too weak to be included in the analysis." Seeing as there were ~100 papers considered in total, if 26 were considered just in the systematic review on puberty blockers, it's clear that 98% weren't rejected. 13tez (talk) 00:55, 5 May 2024 (UTC)

I admit I could have phrased my bit better, I 100% agree that the systematic reviews covered and considered all the evidence. I think one can argue that Cass's recommendations do not. Saying to this later argument that the systematic reviews considered the evidence isn't refuting the argument. It's a matter of the recommendations which aren't more than peer reviewed medical expert opinion. LunaHasArrived (talk) 00:59, 5 May 2024 (UTC)

> I think one can argue that Cass's recommendations do not.

This is still going in circles, you've moved on from not trusting the Cass FAQs: and now you don't trust the Cass recommendations. Really?

After dropping that, will you go back to the 98% thing again?

There is no logic to regurgitating the same, un-true allegations endlessly. If Colin (the science and stats guy')'s arguments has not helped to clarify for you that the Cass resort is quite simply sound: and the patient time invested by @13tez and me and others too.

Question: what would you need to happen, to decide that the Cass resort is quite simply sound?

eg -would a discussion with Colin or someone on their home page be helpful for you? Peckedagain (talk) 01:24, 5 May 2024 (UTC)

I 100% agree that the systematic reviews covered and considered all the evidence. I think one can argue that Cass's recommendations do not.

IIRC the systematic reviews considered around 60% of the papers they had in their syntheses, the remainder being of too low quality to use. Cass's recommendations were informed by the systematic reviews (which the report commissioned) and their meta-analyses. It makes references to them and their findings and explains them throughout. They're contained within a review that was commissioned and later endorsed by the NHS and written by medical professionals. They know much better than anyone here how to interpret the systematic reviews and, consequently, what the review should come to in its findings and recommendations. This is why large parts of the final report are purely explanatory. 13tez (talk) 01:36, 5 May 2024 (UTC)

And where on the MEDRS pyramid does an FAQ on the website fall? Snokalok (talk) 12:32, 5 May 2024 (UTC)

@Snokalok

> Additionally, a number of these answers are far less concrete than a simple factual yes or no.

Not true -the Cass FAQs nearly all start with a Yes or a No ! Peckedagain (talk) 23:39, 4 May 2024 (UTC)

@Snokalok

This is just going round in circles - it's been raised here before, @Colin already shot it down, as Cass already explicitly addressed this exact issue:

> For example, there are strong arguments to be made of a higher bar indeed being expected,... and that the majority of children's medicine is prescribed off-label.

Yet when editors suggest including exact quotes from cass that cover false criticisms like this, you write: "I wonder if that wouldn't take up a disproportionate amount of space."

You can't have it both ways - if coverage of bodies that basically lie about Cass is desirable in the page: then the text from Cass that proves their claims are lies is vital.

Snokalek - the page history says

> Found 154 edits by Snokalok (30.02% of the total edits made to the page)

I don't know what the wiki rules are on over-coming a log-jam. Peckedagain (talk) 23:55, 4 May 2024 (UTC)

I mean I think this is probably the best example of why we can't always use Cass about itself. We have medorgs saying the Cass review has a higher bar of evidence for some care over others, then we have Cass saying no it is the same bar. We have 2 distinct opinions here about what the findings and recommendations said and I think saying it's a false criticism is unhelpful. This is not a case of WP:Bluesky and the Cass side of it seems a little like a school saying it has an anti-bullying policy so it doesn't have bullying. (I.e we said we were equal to different care, therefore we were). This is not to say either side is correct just that it's not clearly so. LunaHasArrived (talk) 00:22, 5 May 2024 (UTC)

@LunaHasArrived

Have you gone back and read @Colin's earlier comments here.? It would reduce the repetition here if you would.

This 'higher bar of evidence' thing has ALREADY been shot down in this talk page. Already explained that the issue the medorgs raise is explicitly covered by Cass, head on.

QED: the medorgs you mention are IGNORING Cass itself and proving themselves to be unreliable sources, and not applying the normal logic of scientific debate.

The Cass FAQ

Did the Review set a higher bar for evidence than would normally be expected?

No.

No, the approach to the assessment of study quality was the same as would be applied to other areas of clinical practice – the bar was not set higher for this Review.

Clarification:

The same level of rigour should be expected when looking at the best treatment approaches for this population as for any other population so as not to perpetuate the disadvantaged position this group have been placed in when looking for information on treatment options.

The systematic reviews undertaken by the University of York as part of the Review’s independent research programme are the largest and most comprehensive to date. They looked at 237 papers from 18 countries, providing information on a total of 113,269 children and adolescents.

All of the University of York’s systematic review research papers were subject to peer review, a cornerstone of academic rigour and integrity to ensure that the methods, findings, and interpretation of the findings met the highest standards of quality, validity and impartiality.

end--of--cass--faq-snippet Peckedagain (talk) 00:43, 5 May 2024 (UTC)

This is arguing directly past me and strawmanning, one can easily say that Cass's recommendations required higher quality of evidence for one thing than another, this is a comment about interpretation of the systematic reviews. That Cass says this didn't happen isn't an answer to this. That the systematic reviews considered all qualities of evidence isn't an answer to this. The fact that you think any medorg criticising this is ignoring the entirety of the report and unreliable because of it would lead to the conclusion of the Cass report being infallible just because it is LunaHasArrived (talk) 00:50, 5 May 2024 (UTC)

Your entire argument keeps centering on the idea of “The Cass Report is infallible. If a MEDORG makes a criticism of it that the Review team says is not true, then that criticism is automatically not true and the org is an unreliable source” which is, not at all how any of this works. Snokalok (talk) 12:29, 5 May 2024 (UTC)

I'd support that.

It would reduce alot of the Talk here - people would not raise 'criticisms' of Cass that Cass itself disproves alreadY Peckedagain (talk) 23:38, 4 May 2024 (UTC)

I'd support the sub-headings you propose ( responses from politics; responses from medicine; and other responses.) Peckedagain (talk) 00:14, 4 May 2024 (UTC)

A point of order… PATHA and AusPATH are not patient advocacy groups, they are professional associations. However, I think their statement is only in the article because it was one of the first to be released. Now that we have a statement from the far more relevant and notable WPATH, the views of the non-notable other PATHs are less important.

We shouldn’t be presenting any views in a way that serves to offset, undermine or contradict the findings of the systematic reviews unless those views are based on equivalently weighty research.

We should also make clear that some of these responding organisations were directly criticised in the report (most notably WPATH). That makes their views more relevant but also more WP:MANDY. Barnards.tar.gz (talk) 06:39, 4 May 2024 (UTC)

I agree, especially since as time passes the significant responses will be those that have lasting impact and significant coverage. It is hard to see why PATHA especially receive so much space - especially when their response is, frankly, ill-informed gibberish. Adding subdivisions is, I think, just going to provide extra WP:COATRACK space, and better to keep this devoted to actually pertinent response and not a blow by blow of any old partisan commentary. Plus the political and medical are deeply intertwined here and clear separation is not going to be so straightforward I fear.

Though I have to say, WPATH still don't seem to have actually published a statement, and all we have, still, is second-hand reporting of an email statement? Void if removed (talk) 08:34, 4 May 2024 (UTC)

"their response is, frankly, ill-informed gibberish"

Plenty of people say the same about the Cass Report. MEDORGs have weight. Just because they favor allowing trans people to transition over what has widely been criticized as conversion therapy, doesn't make them partisan. Snokalok (talk) 12:44, 4 May 2024 (UTC)

Plenty of people say the same about the Cass Report

That doesn't matter. PATHA, AusPATH, etc, aren't "reputable major medical and scientific bodies" like WP:MEDORG sets out, and in fact they're dissenting from the NHS, which is one of the examples explicitly given there. Per WP:MEDASSESS, "editors should rely on high-level evidence, such as systematic reviews. Low-level evidence (such as case reports or series) or non-evidence (such as anecdotes or conventional wisdom) are avoided." This is pretty much what we're weighing up here: the findings from systematic reviews carried out by an actual MEDORG vs conventional wisdom from professional associations. 13tez (talk) 13:08, 4 May 2024 (UTC)

That's the thing though, they are reputable major medical and scientific bodies, they're the medical orgs for Australia and New Zealand regarding gender medicine. You're the only one calling them "fringe patient advocacy groups", which is a novel and wildly in an of itself fringe take to say the least. Snokalok (talk) 13:12, 4 May 2024 (UTC)

they are reputable major medical and scientific bodies

From WP:MEDORG: "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the National Academy of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization." PATHA and AusPATH clearly don't meet the standard set out here. They shouldn't be overriding the findings of systematic reviews carried out by the NHS, one of the examples explicitly given. 13tez (talk) 13:57, 4 May 2024 (UTC)

@Snokalok Anybody that describes CASS as 'frankly, ill-informed gibberish"' is plainly not a reliable source.

You are right that plenty of people say that - but by definition, the fact that they say that is proof that they are unscientific. Peckedagain (talk) 14:49, 4 May 2024 (UTC)

You keep using that word, “unscientific”. I do not think it means what you think it means.

Just because someone has a badge saying “designated authority wielder” does not make their ideas automatically correct and all others heretical, this is not the Vatican. And again, even if they were correct, the fact that they’re being criticized by their contemporaries bears including regardless of all else. Snokalok (talk) 15:17, 4 May 2024 (UTC)

That is again a strawman - no one is suggesting that a badge : "makes their ideas automatically correct and all others heretical,".

You said that "Plenty of people " say that the Cass Report is "ill-informed gibberish" - but you didn't answer my point, that any such person 'is plainly not a reliable source." Peckedagain (talk) 17:18, 4 May 2024 (UTC)

I think the idea that one view immediately makes someone unreliable is heavily pov and unproductive on Wikipedia. This is especially the case in controversial topics such as this. It can certainly question a sources reliability, but this statement means that, for example if the BMJ said this in 2 years time, the BMJ would be unreliable. LunaHasArrived (talk) 19:45, 4 May 2024 (UTC)

They're not professional associations, they're medical associations. They fully fall under MEDORG. Snokalok (talk) 11:34, 4 May 2024 (UTC)

@Barnards.tar.gz @Void if removed thanks for your thoughts. I take your points that they are professional associations and that WPATH's response still isn't covered much anywhere.

We shouldn’t be presenting any views in a way that serves to offset, undermine or contradict the findings of the systematic reviews unless those views are based on equivalently weighty research.

This was my main point. WP:MEDORG tells us "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources." Clearly, PATHA, AusPATH, etc, are not "major medical and scientific bodies" and so we shouldn't be listing their oppositions from the most credible body of research available from the NHS, which does meet the aforementioned definition set out by WP:MEDORG and is explicitly listed as an example there. 13tez (talk) 13:01, 4 May 2024 (UTC)

Okay well they are medical and scientific, this is undisputed, and they are national level for two Commonwealth countries, so they are fairly major. Just like how the NHS is a national level medical body from a Commonwealth country. I notice the issue you're taking is, per your own statement, that they're criticizing the Cass Report. That just makes this entire thing an issue of NPOV. Snokalok (talk) 13:06, 4 May 2024 (UTC)

PATHA and AusPATH are in no way equivalent to the NHS. It's the national health service for the whole of the UK vs niche professional organisations in Australia and New Zealand that don't even have Wikipedia articles.

the issue you're taking

My issue is the undue weight they're being given as dissenting opinions from two niche groups against the most credible source on the topic from a major MEDORG. From WP:MEDORG: "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the National Academy of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization." PATHA and AusPATH clearly don't meet the standard set out here. 13tez (talk) 13:16, 4 May 2024 (UTC)

"that don't even have Wikipedia articles."

Right, and most orgs for various fields of medicine (heart health for instance) in France, Germany, the NL, etc don't have their own pages. That doesn't make them irrelevant, it means the project still has more work to do.

"My issue is the undue weight they're being given"

PATHA got three lines, Auspath got two. That's not a ton of weight. And I disagree that PATHA and AusPATH do not meet the standard there. The names listed are all very recognizable for ease of understanding, but if the American Society of Nephrology criticized a report on kidney health, their criticism would still bear indisputable weight. This is no different. Snokalok (talk) 13:46, 4 May 2024 (UTC)

Right, and most orgs for various fields of medicine (heart health for instance) in France, Germany, the NL, etc don't have their own pages. That doesn't make them irrelevant, it means the project still has more work to do.

This is English Wikipedia, so organisations in countries that don't speak English as a first language are unlikely to have articles; let's discount them. Using your example of heart health, the British Cardiovascular Society (BCS) is (positively) mentioned on the NHS website, the RCP website, and in the BMJ. Since it's mentioned positively in these credible organisations, it's reasonable for us to assume the BCS is itself credible. WP:MEDORG essentially tells us statements from credible and major medical organisations (examples are national and international organisations such as the NHS and WHO) can be used as references, though we have to give due weight, especially in case of disagreements.

If you think the BCS counts as a major medical organisation, then it makes sense that you can use its statements as references, since it's also credible. However, it doesn't fit the examples or definition of major organisations given in WP:MEDORG: national and international organisations that present recommendations and opinions that many caregivers rely upon (or may even be legally obliged to follow). It would be better to take information on cardiology from the NHS or WHO, major medical organisations which meet these criteria and have a broader view of the topic than any one association of cardiologists.

Furthermore, per WP:MEDORG, even if you were to use their statement as a reference, it would still have to be within what's due weight, especially when it is in disagreement with other strong evidence. This means that the outcomes of strong scientific evidence (e.g. NHS-run systematic reviews) would have precedence over a BCS statement based on conventional wisdom, per WP:MEDASSESS. The questions we need to answer are: can we establish PATHA is credible in the same way I described above? Do we think it's a major medical organisation such as the examples given at WP:MEDORG? Given the strength of the evidence it's in disagreement with per WP:MEDASSESS, is it within due weight to include its dissenting response?

ATHA got three lines, Auspath got two.

The due weight point is regarding the following from WP:MEDORG, not the amount of text in WP:WEIGHT: "Guidelines by major medical and scientific organizations sometimes clash with one another (for example, the World Health Organization and American Heart Association on salt intake), which should be resolved in accordance with WP:WEIGHT." 13tez (talk) 15:20, 4 May 2024 (UTC)

“national and international organisations that present recommendations and opinions that many caregivers rely upon (or may even be legally obliged to follow)”

And both PATHA and AusPATH took part in helping to write the WPATH standards of care, and even outside of that they are the bodies providing these opinions and standards for Australia and New Zealand. Therefore yes, they do apply.

“The due weight point is regarding the following from WP:MEDORG, not the amount of text in WP:WEIGHT”

The issue is here that we’re not writing a page on puberty blockers, we’re not writing a page on HRT, we’re not writing a page on any secondary topic. We’re writing a page on the Cass Report itself. The Cass Report’s role in this page is as the subject, the same way a War and Peace’s role in the War and Peace page is as the subject. I’m not saying every citation to the Cass Report in secondary topic articles needs to have “PATHA criticized this” underneath it, I’m saying that for an article about a report put out by the British government, the responses to that report by relevant medorgs hold weight in the article responses section. Rishi Sunak is not an MEDRS source yet we certainly include his opinion on the matter. Snokalok (talk) 15:29, 4 May 2024 (UTC)

And both PATHA and AusPATH took part in helping to write the WPATH standards of care, and even outside of that they are the bodies providing these opinions and standards for Australia and New Zealand. Therefore yes, they do apply.

Do they "present recommendations and opinions that many caregivers rely upon (or may even be legally obliged to follow)"? You mentioned their contribution to the WPATH SOC. Can we establish how many or what proportion of caregivers rely upon them, especially after criticism from the Cass Review? Do they form the primary guidance caregivers in gender-related healthcare follow in New Zealand or internationally? What was the extent of their contribution? Does it really count to lump them in as part of WPATH's SOC when the other organisations listed in WP:MEDORG disseminate their own? There are lots of factors to consider here. It's a lot easier to establish with NICE, for example, publishing guidance on behalf of the NHS.

relevant medorgs hold weight in the article responses section

Sure, if we decide they're credible organisations, major, and not outweighing higher-level evidence. 13tez (talk) 15:47, 4 May 2024 (UTC)

AusPATH:

Standards of care, including primary guidance composed by them specifically independent of other orgs:

https://auspath.org.au/standards-of-care/

Royal Children's Hospital Melbourne outlining their treatment protocol and citing AusPATH for endorsement of said protocol:

https://www.rch.org.au/uploadedFiles/Main/Content/adolescent-medicine/australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf

South Australian govt citing AusPATH standards of care and saying that AusPATH should be used as the primary guiding point for GAC in South Australia:

https://www.sahealth.sa.gov.au/wps/wcm/connect/d70c3a24-a054-4f6a-b56c-17152faa9d5c/Model+of+care_Gender+Diversity_Jul2023_FINAL_FOR+PUBLICATION+%281%29.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-d70c3a24-a054-4f6a-b56c-17152faa9d5c-oJF0hpN

The Australian govt's health information page lists them as a valuable resource for info on GAC:

https://www.healthdirect.gov.au/gender-affirming-surgery

So that's AusPATH sorted.

PATHA:

Their own primary guidance composed specifically by them independent of other orgs:

https://patha.nz/Guidelines

NZ Ministry of Health meeting with PATHA to help improve their trans healthcare system:

https://www.pharmacytoday.co.nz/article/unfiltered/unfiltered/patha-vision-transgender-healthcare-under-2022-health-reforms

Royal New Zealand College of General Practitioners Guidelines on GAC directly citing PATHA as having played a major role in writing them:

https://blogs.otago.ac.nz/rainbow/files/2023/03/Primary-Care-GAHT-Guidelines_Web_29-Mar.pdf

So yeah, I think they're sorted as well. They're MEDORGs Snokalok (talk) 16:15, 4 May 2024 (UTC)

Hey, thanks for your thoughts and research; let's discuss what you've found against the criteria I mentioned (summarising those in MEDORG for a rough analysis of adherence) and the questions I posed in my last message in this thread.

Let's look at AusPATH first. On the positive side:

• They appear to have made original guidance on informed consent for gender-affirming hormone therapy, which increases their credibility by a small amount
• Their endorsement was featured in the Equinox protocols, which increases their credibility by a small amount
• An article in a medical journal with an impact factor of 2.2 in 2022 (the most recent year I could find) mentioned AusPATH's endorsement, which increases their credibility by a small amount
• They made major contributions to a position statement with recommendations on managing hormones in adult TGNC people published in a medical journal with an impact factor of 11.4 in 2022 (the most recent year I could find), which increases their credibility by a moderate amount
• The RCHM citing AusPATH's endorsement of their protocol increases AusPATH's credibility by a moderate amount
• The South Australian government listing AusPATH as one of several suitable training providers in their model of care for gender-diverse people increases their credibility by a moderate amount
• The Australian government linking to AusPATH's list of providers isn't an endorsement of their protocols, but linking to their site at all increases their credibility by a moderate amount

Conversely, on the negative side:

• They included WPATH's SOC in their guidance; as I have discussed at Talk:Standards_of_Care_for_the_Health_of_Transgender_and_Gender_Diverse_People#Lynne-Joseph_quote, there has been substantial credible criticism that the SOC are not evidence-based, so this decreases their credibility by a moderate amount
• No evidence that AusPATH's guidelines are followed at the national or international level, which decreases their credibility by a large amount and means they aren't a major medical organisation
• No evidence AusPATH's guidelines are followed as the primary guidance for caregivers or those they legally must follow

Overall, though AusPATH has some credibility, there is no evidence that they make guidance that "many caregivers rely upon (or may even be legally obliged to follow)" at any level, let alone the national or international level. They do appear to be a medical organisation of a moderate degree of credibility and reputation within Australia. Conversely, they aren't a "reputable major medical and scientific body" such as "the U.S. National Academies (including the National Academy of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization." They are of vastly lower reputation, credibility, and influence. Therefore, AusPATH does not meet the characteristics of an organisation whose "Statements and information...may be valuable encyclopedic sources" described by WP:MEDORG.

Moving on to PATHA, on the positive side:

• They have created original guidance on Gender Affirming Healthcare, which increases their credibility by a small amount
• Meeting with the Ministry of Health in New Zealand to discuss trans healthcare increases PATHA's credibility by a small amount (though I can't verify the website substantiating this is reliable)
• The RNZCGP's Primary Care Gender Affirming Hormone Therapy Initiation Guidelines thanks PATHA, among other groups, for feedback on earlier drafts and links to their web page on gender-affirming surgery, which increases PATHA's credibility by a moderate amount

On the negative side:

• The systematic review examining the quality of existing guidelines in the Cass Review gave a very poor score and the second-lowest score to PATHA's guidelines (under "Oliphant 2018"), which decreases their credibility by a large amount
• They included WPATH's SOC in their guidance; as I have discussed at Talk:Standards_of_Care_for_the_Health_of_Transgender_and_Gender_Diverse_People#Lynne-Joseph_quote, there has been substantial credible criticism that the SOC are not evidence-based, so this decreases their credibility by a moderate amount
• The only independent guidance they've created themselves was rated very poorly in the systematic review, which decreases their credibility by a large amount
• No evidence that PATHA's guidelines are followed at the national or international level, which decreases their credibility by a large amount and means they aren't a major medical organisation
• No evidence PATHA's guidelines are followed as the primary guidance for caregivers or those they legally must follow

Overall, PATHA has some credibility from creating original guidance, giving feedback on clinical guidance, and holding discussions with the Ministry of Health. However, the best quality analysis available says that PATHA's only piece of original guidance is of very poor quality, and there is no evidence that they make guidance that "many caregivers rely upon (or may even be legally obliged to follow)" at any level, let alone the national or international level. They do appear to be a medical organisation of some degree of credibility and reputation within New Zealand. Conversely, they aren't a "reputable major medical and scientific body" such as "the U.S. National Academies (including the National Academy of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization." They are of vastly lower reputation, credibility, and influence. Therefore, PATHA does not meet the characteristics of an organisation whose "Statements and information...may be valuable encyclopedic sources" described by WP:MEDORG.

Please let me know what your thoughts are. Thanks! 13tez (talk) 00:52, 12 May 2024 (UTC)

If we're starting up discussion on this again, we should tag those previously involved. @Colin @WhatamIdoing @Anywikiuser @Nil Einne @LokiTheLiar @Your Friendly Neighborhood Sociologist @LunaHasArrived @Sideswipe9th @Licks-rocks @Draken Bowser @Cixous Snokalok (talk) 11:28, 4 May 2024 (UTC)

If WPATH ever gets around to issuing an actual full response, then we can remove PATHA and AusPATH. But we shouldn't before then. I agree with Snokalok that they're clearly WP:MEDORGs, and that the reasoning for removing their response would be that they're included in WPATH rather than that they're not reliable. Loki (talk) 11:35, 4 May 2024 (UTC)

_{I see we're starting this one off strong by calling AusPath and PATHA "fringe patient advocacy groups".} grumbling aside, I'm with Loki in that we might want to wait for a more official response. I think I said that in the last discussion, and not much seems to have changed, so it also seems a bit soon to be restarting this discussion in full. _{And who spilled all this spaghetti on the floor?} --Licks-rocks (talk) 12:18, 4 May 2024 (UTC)

Yeah, it wasn't my most neutral or objective language. My issue is that we're overriding the best evidence we have on this topic from a legitimately major medical organisation with dissent from much, much smaller groups because they (sincerely, I'm sure) believe its implementation will prevent what they see as being the best care for trans people. However, medicine is based on evidence, not on anecdotes or conventional wisdom. Therefore, the findings of this report (the best evidence available, based on peer-reviewed systematic reviews carried out by the NHS) take priority over the various statements (from small, relatively unknown professional associations and based upon their conventional wisdom). There's a vast difference between the report and these statements, per WP:MEDASSESS. The best thing to do for everybody in need of medical treatment is to stay within what the evidence supports (except when gathering evidence on new treatments). In this sense, it's the best thing for those trans people in need of help, too. 13tez (talk) 14:40, 4 May 2024 (UTC)

You keep claiming that this is "the best evidence available" or earlier "the most credible and authoritative source on the topics it covers", seemingly with the implication that there is no better evidence available. I think it's neccesary to push back on that. It is not the most credible and important source out there. WPATH for example publishes similar reports, which are read and used worldwide, and released at regular intervals to keep up with the state of the science. --Licks-rocks (talk) 14:50, 4 May 2024 (UTC)

Hi @Licks-rocks, thanks for your thoughts.

It is not the most credible and important source out there. WPATH for example publishes similar reports, which are read and used worldwide, and released at regular intervals to keep up with the state of the science.

I disagree, I think it is. It was created by the NHS, which is a "major medical and scientific organization...[that] present[s] recommendations and opinions that many caregivers rely upon (or may even be legally obliged to follow)", per WP:MEDORG, as well as one of the explicit examples it lists of suitable organisations. The report is based upon peer-reviewed systematic reviews, which are the highest level of evidence in medical research, per WP:MEDASSESS. The NHS and the Centre for Reviews and Dissemination are more reputable than WPATH in medical research. Systematic reviews take precedence over the conventional wisdom presented in the Standards of Care for the Health of Transgender and Gender Diverse People. 13tez (talk) 15:29, 4 May 2024 (UTC)

Just because something's a good source does not mean other good sources are automatically worse. The standards of care are an internationally recognised clinical practice guideline, which stands at the very top at least in the proctor & gamble version of the medical source quality pyramid, so at worst they are equals. Calling the information contained within "conventional wisdom" also seems a touch demeaning. --Licks-rocks (talk) 16:30, 4 May 2024 (UTC)

Thanks for your further thoughts.

Just because something's a good source does not mean other good sources are automatically worse.

If you agree that the Cass Review is a reliable source and credible, you should know that one of the peer-reviewed systematic reviews that informed the Cass Review found that: "The WPATH and Endocrine Society international guidelines, which like other guidance lack developmental rigour and transparency have, until recently, dominated the development of other guidelines. Healthcare professionals should consider the lack of quality and independence of available guidance when utilising this for practice. Future guidelines should adhere to standards for guideline development and provide greater transparency about how recommendations are developed and links between evidence and recommendations." Here, they're saying (among other things) the WPATH guidelines fail to adhere to evidence-based medicine, which is essential and foundational to modern medicine. Since this is being said in part of the body of work you consider to be a reliable source published by the NHS, a major and reputable national medical organisation, and in a peer-reviewed systematic review (the highest level of evidence in medical research), you should believe it. Therefore, we can say that the WPATH guidelines aren't as credible as the Cass Review.

The standards of care are an internationally recognised clinical practice guideline, which stands at the very top at least in the proctor & gamble version of the medical source quality pyramid, so at worst they are equals.

The Procter & Gamble builds up in the same way as other pyramids; each level informs the one above it. In it, clinical practice guidelines are informed by systematic reviews (in other words, the best evidence available) which are, in turn, informed by the lower levels. As we discussed before, however, this isn't the case with these guidelines: they were not adequately based upon scientific evidence.

Calling the information contained within "conventional wisdom" also seems a touch demeaning.

Conventional wisdom is a widely used phrase, but maybe not the most polite one available, given the contention. Maybe "popular belief" or "current practice" would be better in that regard?

Thanks again. 13tez (talk) 17:20, 4 May 2024 (UTC)

I feel like you're doing some mental gymnastics here to support your position. Each rung on the source quality pyramid is supported by those below it, and is therefore based on multiple publications from the rungs below it. This upward accumulation of evidence and cross-comparison is what makes the sources further up on the ladder so reliable. Going back down this informational ladder in order to use something you find there to discredit a better source further up is not how this works. In short, you appear to be cherrypicking here. --Licks-rocks (talk) 18:13, 4 May 2024 (UTC)

I feel like you're doing some mental gymnastics here to support your position. Each rung on the source quality pyramid is supported by those below it, and is therefore based on multiple publications from the rungs below it. This upward accumulation of evidence and cross-comparison is what makes the sources further up on the ladder so reliable.

I agree. The WPATH guidance fails to do this, hence its lack of credibility.

Going back down this informational ladder in order to use something you find there to discredit a better source further up is not how this works.

As discussed, the clinical guidance from WPATH is not based on the evidence in the levels below it. This fact is supported by a systematic review peer-reviewed and published in the BMJ. Therefore, it shouldn't be considered valid at all, let alone of higher quality than the Cass Review or its peer-reviewed systematic reviews. 13tez (talk) 18:33, 4 May 2024 (UTC)

You can't cite the thing I've just disagreed with as the reason I should agree with you. I could theoretically just take my previous comment and copy it here, but I don't think there's much point, so this is where I take my leave. (Okay, one more point: you should be wary of when a paper says stuff it can't really back up. If just one review study came to that conclusion, it's highly possible that this claim reflects the opinions of the authors, rather than necessarily being based in fact. It happens.) --Licks-rocks (talk) 18:37, 4 May 2024 (UTC)

Okay, sorry we couldn't see eye-to-eye. Thanks for talking it out anyway. It's worth saying that methods of ranking the quality of different types of evidence like WP:MEDASSESS and the levels of evidence in medical research are based upon the assumption that each piece of evidence is itself scientifically scrupulous (peer-reviewed etc). Even if a piece of evidence is of a type relatively high in these hierarchies, if it's not scientifically valid, it isn't good evidence.

If just one review study came to that conclusion

Firstly, it's a study of extremely high quality, so we shouldn't be questioning its credibility or findings. Secondly, another paper published in Social Science & Medicine says "TGNC people and clinicians have criticized the [WPATH] SOC for relying too heavily on expert opinion and called for updates that incorporate stronger evidence (Berli et al., 2017; Riggs et al., 2019)." 13tez (talk) 18:47, 4 May 2024 (UTC)

I think a very important thing to say that Cass's report whilst based on systematic reviews is not top tier medical evidence. I also think that proper criticism to the systematic reviews will take much longer than a month and that I'm sure there's a lot of people researching why these reviews found different results to other systematic reviews. Some people are claiming that this is just because the other reviews accepted lower quality evidence but anybody saying that at this point just probably hasn't done the full research necessary to produce that response. Because of this I think it's important to consider, whats the strongest possible condemnation to this report possible at this moment in time when weighing up what to put in this article. Not saying we should weigh medorg statements equally with a systematic review, but consider that if there are proper problems with the systematic reviews, all a medorg could have done by this time is put out a statement. LunaHasArrived (talk) 16:58, 4 May 2024 (UTC)

@LunaHasArrived

> I think a very important thing to say that Cass's report whilst based on systematic reviews is not top tier medical evidence.

Not true. This has been argued at length above: @colin is perhaps the most science/statistics savvy editor here and has backed Cass: "the evidence about e.g. puberty blockers really doesn't make the grade".

That was 3 weeks ago: and yet editors are stilling making unsupported claims to the opposite.

I'd recommend anyone confused about the calibre off Cass, take time to read Colin's comments here. Peckedagain (talk) 18:00, 4 May 2024 (UTC)

I should have been more specific. The idea that anybody critiquing Cass is critiquing systematic reviews is just plain wrong. This isn't to say Cass isn't Medrs or unreliable. It's just to say Cass is not the systematic reviews Cass made her report on and us editors need to be very specific about what people are referring to and that people can rightly critique Cass's report without going against the top of the Medrs pyramid. Especially on the less BMI and more opinionated parts of the report. LunaHasArrived (talk) 20:02, 4 May 2024 (UTC)

Cass's report whilst based on systematic reviews is not top tier medical evidence

At the risk of people jumping on this to discredit the review, yes there's some nuance there; it isn't itself a peer-reviewed systematic review, but it is informed by several it specifically commissioned, it was written by qualified medical researchers, and it was itself commissioned by the NHS.

I also think that proper criticism to the systematic reviews will take much longer than a month

I agree. If criticism gets past peer-review in a credible medical journal, it'll be reasonably scrupulous, even if not as high a level of evidence.

whats the strongest possible condemnation to this report possible at this moment in time...all a medorg could have done by this time is put out a statement

That's a good point. 13tez (talk) 18:04, 4 May 2024 (UTC)

it is informed by several [systematic reviews] it specifically commissioned

When I say this, what I mean is that the review is a discussion and almost an explanation of what the systematic reviews are showing and making findings and recommendations from them. And it's qualified people doing it who were commissioned to do so by the NHS. 13tez (talk) 18:06, 4 May 2024 (UTC)

Oh yes, I'm not saying at all that the Cass review itself should be discredited. It's just medorgs criticising it can do so without criticising systematic reviews, they're criticising Cass's recommendations and findings. LunaHasArrived (talk) 18:18, 4 May 2024 (UTC)

Ah right, forgot @LilianaUwU. Anyone else I'm missing? Snokalok (talk) 12:56, 4 May 2024 (UTC)

This may be a bit of a late response (life be like that sometimes), but I agree with Loki. I think what LunaHasArrived just above hits the nail on its head: the medical organisations are not necessarily criticising the meta-analysis, but the recommendations. An official response would be fantastic, but we sadly don't have one yet Cixous (talk) 11:04, 7 May 2024 (UTC)

Okay except, they are widely reputed MEDORG's. Just because their findings are in favor of GAC does not make them fringe nor advocacy groups, and it's pretty blatant POV to try and frame them as otherwise. Snokalok (talk) 11:32, 4 May 2024 (UTC)

Yeah, we don't disqualify opinions. The receptions section is about the public debate following the review. To the extent that opinions by relevant orgs and pundits were repeated by reliable sources, we're liable to include them. Draken Bowser (talk) 22:43, 4 May 2024 (UTC)

I took a break and catching up have skimmed the above. I'm seeing an awful lot of wikilawyering going on, with MEDORG and PRIMARY being used as weapons. One of the problems with wikilawyering is that two editors with opposite POVs they want to push can end up arguing past each other endlessly. It is frankly tedious to keep seeing the words "primary" being invoked against Cass and the NHS, and the Cass final report FAQ being dismissed as though the plain objective facts it states must suddenly be regarded as unreliable, and yet all the BS that came out from people-who-should-know-better was somehow reliable. I imagine that those who say "Anything Cass says about the report is primary and can be dismissed as unreliable" will later forget to argue "Anything WPATH say in their defence (of the criticism that their guidelines are not evidence based and built on shaky foundations) is primary and can be dismissed as unreliable". This sort of wikilawyering is getting us nowhere useful.

I repeat the comment I made earlier that the each layer in the MEDRS pyramid depends on the layers below. One can only point to clinical guidelines as top-tier evidence sources when they are themselves based on top-tier evidence sources, such as systematic reviews, randomised controlled trials and so on. Currently the WPATH guidelines have been explicitly called out, by a systematic review in a top tier journal, as not being evidence based. That leaves them in an uncertain position, and one that isn't typical.

My name has been mentioned a few times and generally to argue a simplistic point. I'm not saying the Cass Review and the systematic reviews are perfect and that any possible criticism of them is scientifically unsound. I am saying that currently these systematic reviews represent the best MEDRS sources for Wikipedia's voice on whether certain therapies work and are safe. If those claiming "there is evidence" and "these reviews are flawed" are right, then I look forward to them publishing a better systematic review in the NEJM. Merely saying "there is evidence" isn't enough and we can't RIGHTGREATWRONGS by choosing who we want to believe and giving them a voice in our article. And I'm saying that most of the criticism published so far is easily dismissed as flat out wrong, not merely matter-of-opinion wrong. But that may change. I also separate criticism of the scientific evidence gathering and criticism of "well what should we do in the absence of evidence", which is far more something that reasonable people might disagree about.

Lastly, the myth that the systematic reviews dismissed 98% of the evidence was easily shown false because the reviews themselves spell out what evidence they used. This myth seems to have been replaced now with a social media myth that OK, the systematic reviews looked at most of studies, but Cass herself didn't. This is a made up story with nothing to support it. Wanting something to be true seems to make people spread all sorts of nonsense. -- Colin°^Talk 12:36, 5 May 2024 (UTC)

Regarding primary, the simple fact is that while the Cass Report may be considered an MEDRS for secondary topics (puberty blockers, HRT, etc) it is a primary source on the Cass report. A text is inherently a primary source on its own contents, that’s simply a fact. Beyond that, while no one is saying that the Review’s FAQ response is inherently invalid, it cannot be taken as reason to exclude other criticisms. Excluding criticisms from reliable and weighty sources simply because the one being criticized said “Nuh uh” and “We’ve investigated ourselves and found no wrongdoing” is such a wild conflict of interest and places so much more privilege on the source being criticized than the one criticizing. Not to mention, the FAQ is not a systematic review. At best it’s a MEDORG statement.

Regarding the quote “Anything WPATH say in their defence (of the criticism that their guidelines are not evidence based and built on shaky foundations) is primary and can be dismissed as unreliable" if WPATH answered criticisms, their answer would be notable as an answer to criticisms, but it would not be a reason to exclude those criticisms entirely as some are arguing for.

” Lastly, the myth that the systematic reviews dismissed 98% of the evidence was easily shown false because the reviews themselves spell out what evidence they used.”

Right but that’s only one topic the FAQ addressed. There are others where its answers are of more variable factuality, such as their claim that they didn’t use an uneven standard of evidence when in the report they directly say that the evidence for psychosocial intervention is as weak as that for hormonal, and yet they then recommend psychosocial as the default and for excluding medical interventions in the majority of patients. Snokalok (talk) 12:58, 5 May 2024 (UTC)

Snokalok, I've been over this "primary for itself" wikilawyering tediousness before. Yes, it is primary for "did the Cass review actually say those words or not" and primary for "Cass herself now recommends X" but it is secondary for most of the words we write on this page, which are medical facts about evidence and therapies and patient population trends and whether other guidelines are evidence based and so on and so on. While we do attribute those words in many cases, we simply wouldn't be writing them out in any detail if they were fringe conspiracy theory level beliefs, which some people here seem to be claiming. If people want to argue about which criticisms to include or not, please do it properly, and not by waving PRIMARY in a way that just confirms a lack of understanding.

Describing the FAQ as "We’ve investigated ourselves and found no wrongdoing" is frankly a twitter-level incoherent description of the FAQ. It wasn't an "investigation" and the criticisms that it address are mostly basic reading comprehension and maths ability issues. Please don't frame this like we need some independent commission to look at the review and agree about the points currently at Final FAQ. A FAQ which also mysteriously doesn't mention the "uneven standard of evidence" claim. So you appear to be arguing about something that doesn't exist. -- Colin°^Talk 10:04, 7 May 2024 (UTC)

Whilst not directly the question, I do think the first faq is trying to argue about the standard of evidence. One point of note is that it says "interpretation of the findings met the highest standards of impartiality ", which is only notable as members of SEGM claim they worked on the report. I do agree that the vast majority of the bits in the Faq probably meet WP: BLUESKY, and are trying to give nuance to ideas that had been exaggerated due to the nature of media. LunaHasArrived (talk) 10:46, 7 May 2024 (UTC)

When referring to pre-pubescent females - is 'women' better than 'females?

I changed [1]: TO:

• For transgender females, blockers taken too early can make a later vaginoplasty more difficult, although blockers do prevent lower voice and facial hair

FROM

• "For transgender women, the report advised balancing the need to mitigate the effects of male puberty with the need to allow for a certain level of penile development in the event that the patient later wishes to pursue a vaginoplasty"

Raladic reverted, writing:

• "not an improvement and we use the term transgender women on Wikipedia as per the linked article

I reverted it back, writing:

• "this sentence is about pre-pubescent children so 'women' is not the right word, nor is it used by Cass near this point. In fact Cass uses it 9 times in total, vs 47 for 'female'. "

Raladic reverted again, writing:

• "the usages of “females” as a noun to refer to humans is disparaging and dehumanizing, refer to Female#Etymology and usage - we don’t support using disparaging wording on Wikipedia, whether the report used it or not"

So we don't have consensus right now. Peckedagain (talk) 00:09, 10 May 2024 (UTC)

I went to the most 'safe' page possible for this issue: and choose Feminism. For over 3 years, the page has contained the word 'females'. And twice :

• "Changes in female dress standards and acceptable physical activities for females have often been part of feminist movements."
• "As women earned doctorates in psychology, females and their issues were introduced as legitimate topics of study."

Peckedagain (talk) 00:20, 10 May 2024 (UTC)

Thanks for pointing out that mistake on Feminism, that article does also use the word women 428 times. I've corrected the two mistaken occurrences you found per the same reasoning of why I reverted your change - we use the word Woman as a noun on Wikipedia - the word female is an adjective and its use as a noun should be avoided as it can been seen as dehumanizing/disparaging per the references on Female#Etymology and usage, and that page being the better page to look for the meaning behind the word Female and its uses, why it has a Etymology section to begin with. You can also check out wikt:en:female#Usage notes with the same.

You may find reading this article interesting on the problematic use of female as a noun. Raladic (talk) 01:15, 10 May 2024 (UTC)

Thanks for pointing out that section, which was based on weak sources. I've left in the Jezebel piece, which is basically an opinion piece agreeing with a BuzzFeed listicle, but I've added Fowler's Dictionary of Modern English Usage for the important points.

NB that this is a "some people believe" situation, not an "it universally is" situation. The dictionaries are not marking this as derogatory (except for one, which marked it derogatory if and only if it was used to describe an effeminate man). @SMcCandlish, you might be interested in looking at this, and maybe seeing whether parallel updates to Male need to be made. (Garner's, which is in WP:TWL under the Oxford Reference item, wasn't informative.) WhatamIdoing (talk) 05:08, 10 May 2024 (UTC)

I did also find that the APA style guide, as one of the foremost style guides for professional and scholarly writing, also similarly calls out the avoidance of “males” and “females” as a noun. Raladic (talk) 06:28, 10 May 2024 (UTC)

They don't say it's disparaging, though; it's just not their style, except in two circumstances, when it is their style: "Use “male” and “female” as nouns only when the age range is broad or ambiguous or to identify a transgender person’s sex assignment at birth (e.g., “person assigned female at birth” is correct, not “person assigned girl at birth”)."

I think it's interesting that anyone now would push the late-Victorian POV that female is derogatory because that word is also used for animals and humans are better than other animals. I suspect that it's fundamentally based in an anti-evolution, pro-Christian worldview, so it doesn't feel like it fits in the modern era. (I also wonder if the OED made the same claim about male in 1895.) WhatamIdoing (talk) 16:37, 10 May 2024 (UTC)

On the original question: woman is basically never appropriate for any pre-pubertal human, as it is defined as referring to adults (under any definition of adult, including legal, social, or biological status). Female is confusing because it is primarily, but not exclusively, used to refer to biological sex; consequently, transgender females will be read by some people as referring to transfeminine people and by others as referring to AFAB non-binary and trans people. You might consider trans girl or perhaps something like child who was assigned male at birth. WhatamIdoing (talk) 05:24, 10 May 2024 (UTC)

For pre-pubescents, the term is girls; and for male pre-pubescent, boys. This is just kinda basic English. As for female[s] being "disparaging and dehumanizing", that seems to be yet another activistic "language reform" position, and one of very recent origin. I'm not aware of any reliable sources on English usage that suggest this notion, though I suppose there could be some somewhere that have adopted this stance by now. I would predict AP Stylebook and other journalism style guides to make such a change first (because they bend over backwards to avoid offense to even a small portion of their target, mostly left-leaning, market, and will do so at the expense of clarity/precision and in defiance of everyday actual usage). However, the AP Stylebook 2022 ed. (the newest I have, but it changes very little from edition to edition) actually recommends using female: "female: Use female as an adjective, not woman or girl. 'She is the first female governor of North Carolina.'" It doesn't address the plural or singular noun forms at all. The term female is also entirely conventional, adjectivally, in anthropological, medical, and related writing to refer to women and girls, e.g. "female gender roles", "female social status", "heritability dependent on the female line (matrilineality)", "an exclusively female medical condition", etc. However, the plural noun form is also very, very common in such material, including when the search is constrained to papers published after 2020 [2]. So, what's really happening here is that "females" is academic/scientific/medical terminology, that is somewhat depersonalized, approaching women and girls as a subject of study (same with men and boys, as male[s]). This does not actually translate to "dehumanizing" much less "disparaging", though the usage would not be appropriate for all contexts. E.g., "the two females in the band" doesn't make much sense, since bands are not generally subjects of scientific inquiry, but more personal-warmth-infused biography. As with nearly everything about writing on Wikipedia, the wording to use in a particular context is going to be a judgement call, and WP:Use common sense applies. But we're not going to outright ban the word "females" in reference to humans. If anyone wants to push such an idea anyway, the proper venue for that is WT:MOSWTW. Anyway, in this case, the source material clearly prefers female[s] by a wide margin, and women doesn't make sense in a pre-pubescent context. But there may simply be a way to rewrite the material to avoid the question, e.g. by using female adjectivally.  — SMcCandlish ☏ ¢ 😼  20:33, 10 May 2024 (UTC)

I don't think the problem is with female as an adjective. It's when people are reduced to a characteristic in noun form. People then complain it is dehumanising, but forget we are often happy to do it for many words. I think the key thing is whether the writer or reader considers that characteristic negative, or the overall impression of the sentence is that it is negative. For example, we are happy to talk about cyclists, teenagers and the elderly, and in those cases we are describing a people group, as nouns, by their characteristic. We aren't saying people who cycle or teenage children or elderly people but nobody complains that teenager is dehumanising. But if you pick a negative characteristic, like a disability, you run into trouble. Calling people epileptics isn't acceptable in any style guide.

The low-quality source cited and the listicle that it cites both forget that "women" can be used by misogynistic men in a demeaning way. Think of someone uttering that word in a complaining tone and rolling their eyes. So while I am sure there are many articles using the word "females" in a disparaging way, it probably isn't inherent in the word itself, and trying to get the noun banned might be saying something about a writer's internalised misogyny vs owning the term.

I think overall WAIDs comment that it can be ambiguous for this kind of article is the stronger one. We must also be wary of adulting children. -- Colin°^Talk 11:36, 12 May 2024 (UTC)

References

German Medical Association

I added this content today:

• On May 10 2024 the Assembly of the German Medical Association ( aka Bundesärztekammer (BÄK) wrote that it "calls on the Federal Government to only permit puberty blockers, sex-change hormone therapies or gender reassignment surgery in under 18-year-olds with gender incongruence (GI) or gender dysphoria (GD) in the context of controlled scientific studies and with the involvement of a multidisciplinary team and a clinical ethics committee and after medical and, in particular, psychiatric diagnosis and treatment of any mental disorders". And that results must be followed up for at least least ten years." [https://128daet.baek.de/data/media/BIc48.pdf 1 2

That english text comes from the source SEGM.org.uk. The original German vs Google translate is:

German

English

DER DEUTSCHE ÄRZTETAG MÖGE BESCHLIESSEN: Der 128. Deutsche Ärztetag 2024 fordert die Bundesregierung auf, Pubertätsblocker, geschlechtsumwandelnde Hormontherapien oder ebensolche Operationen bei unter 18- Jährigen mit Geschlechtsinkongruenz (GI) bzw. Geschlechtsdysphorie (GD) nur im Rahmen kontrollierter wissenschaftlicher Studien und unter Hinzuziehen eines multidisziplinären Teams sowie einer klinischen Ethikkommission und nach abgeschlossener medizinischer und insbesondere psychiatrischer Diagnostik und Behandlung eventueller psychischer Störungen zu gestatten

THE GERMAN MEDICAL CONFERENCE SHOULD DECIDE: The 128th German Medical Congress 2024 calls on the federal government to reduce puberty blockers, sex-reassignment hormone therapies or similar operations for people under 18 with gender incongruence (GI) or gender dysphoria (GD) only in the controlled scientific studies and with the assistance of a multidisciplinary teams, as well as a clinical ethics committee and completed medical and, in particular, psychiatric diagnostics and treatment of any mental disorders

This is the Voting page - that shows it was accepted (Angemonnen) as item 'Ic - 48 Behandlung einer Geschlechtsdysphorie bei Minderjährigen ' — Preceding unsigned comment added by Peckedagain (talk • contribs) 12:04, 12 May 2024 (UTC)

Since this doesn't mention "Cass" anywhere I think this isn't WP:DUE and should be removed from this page, but might be relevant on Puberty blockers. — Preceding unsigned comment added by Void if removed (talk • contribs) 12:06, 12 May 2024 (UTC)

Good advice Void if removed (talk), I have done that now.— Preceding unsigned comment added by Peckedagain (talk • contribs) 12:29, 12 May 2024 (UTC)

A better secondary source is definitely needed in order to judge the significance of this, but that's a matter for the other page. If it does eventually get linked to Cass, it could be the start of an "influence" section. Barnards.tar.gz (talk) 13:25, 12 May 2024 (UTC)

SEGM is an anti-trans activist group, and therefore very much not a reliable source.

No comment on the original German, though (except to agree that without a direct reference to the Cass Review it doesn't go here). It depends on the relevance of the organization behind it in Germany. Loki (talk) 14:39, 12 May 2024 (UTC)

The German GMA (aka Bundesärztekammer ) has ~400,000 doctors as members and is I guess the equivalent to the UJ's British Medical Association . Peckedagain (talk) 19:52, 12 May 2024 (UTC)

dispute over sources in this article

due to disputes in this talk section over which sources used in this article are reliable, i ask that anyone who edits this article in future only cite peer reviewed scientific papers and medical journals such as Scientific American, new England journal of medicine and the British Medical Journal. this is a matter of medical and scientific importance that is complicated, and it would be immoral to add misleading information. Bird244 (talk) 11:10, 4 July 2024 (UTC)

We use sources in accordance with their reliability and due weight. For biomedical claims we have stricter standards: WP:MEDRS. We consider sources in context, and we do not have a pre-determined list of which sources are usable. Often it is necessary to discuss each one on its own merits.

By the way, are you aware that Scientific American is not a peer reviewed medical journal or source of scientific papers? Barnards.tar.gz (talk) 11:21, 4 July 2024 (UTC)

oh. my mistake Bird244 (talk) 23:39, 4 July 2024 (UTC)

As Barnards said, we use sources as they become relevant. If for instance the Cass Review is cited as the reason for a change in political policy, we can very well cite a new report on that change. If a medical org puts out a statement on the report, we can cite that statement as a source for that org saying whatever it said. Snokalok (talk) 11:46, 4 July 2024 (UTC)

There is no need to reinvent WP:MEDRS. Flounder fillet (talk) 13:42, 5 July 2024 (UTC)

report to consider

this Yale report Is more criticism to consider. It's place on the evidence hierarchy has to be considered, but it's been a while since I got involved here and just wanted to add to evidence. LunaHasArrived (talk) 08:52, 2 July 2024 (UTC)

The link here seems to be a Yale Law School blog post about a Microsoft Word document sitting in a documents folder in a Yale Law School server. The "Integrity Project" seems to be just two people who are focused on American youth trans healthcare activism. Is this some kind of draft document intended to get published somewhere in future? At the moment, this isn't even what I'd call "published", never mind "published in a reputable journal". It may well be an important critique but maybe we can discuss it more if it actually gets properly published as I'm not sure this is citable at present. -- Colin°^Talk 10:02, 2 July 2024 (UTC)

I see now the actual file is a PDF, but my browser tab says "Microsoft Word - Cass Response.docx", so it looks like someone has just done "Save as PDF" or similar. This really isn't a published source we could cite yet. -- Colin°^Talk 10:09, 2 July 2024 (UTC)

That's what I thought might be the case, thank you for putting in your input. LunaHasArrived (talk) 11:17, 2 July 2024 (UTC)

That page lists more than two authors. Did you read it?

"In addition to Alstott and Dr. McNamara, the distinguished authors include Kellan Baker, Ph.D., Executive Director of the Whitman-Walker Institute; Kara Connelly, M.D., Associate Professor of Pediatrics, Division of Endocrinology, School of Medicine, Oregon Health & Science University; Aron Janssen, M.D., Associate Professor of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine; Johanna Olson-Kennedy, M.D., Professor of Clinical Pediatrics, Keck School of Medicine of USC; Ken C Pang, FRACP, Ph.D., NHMRC Leadership Fellow and Senior Principal Research Fellow, Murdoch Children’s Research Institute, VIC Australia; Ayden Scheim, Ph.D., Assistant Professor of Epidemiology, Drexel University Dornsife School of Public Health; Jack Turban, M.D., Assistant Professor, Psychiatry, University of California, San Francisco." VintageVernacular (talk) 00:20, 3 July 2024 (UTC)

That page lists more than two authors.

What Colin said was:

The "Integrity Project" seems to be just two people

This isn't a comment about the full list of co-authors its about the size/notability of the grand-sounding "Integrity Project" and their focus. Void if removed (talk) 11:36, 3 July 2024 (UTC)

It has has been picked up by the press in Scotland now, so it’s definitely citable and as VintageVernacular pointed out above, it was co authored by a lot more than just two people. Raladic (talk) 01:25, 3 July 2024 (UTC)

With that citation I think this is, at best, another cite that can be added to the line:

The report was praised by some academics in the UK, who agreed with its findings stating a lack of evidence; while others both in the UK and internationally disagreed with the report's methodology and findings

If it gets published in a peer-reviewed journal, then the report itself would likely be WP:DUE because of the notability of the authors. Void if removed (talk) 11:30, 3 July 2024 (UTC)

I'm struggling to get past the first line of that report's introduction because it's balatanty factually incorrect: "In 2020, the United Kingdom’s National Health Service (NHS) commissioned an inquiry to provide recommendations for the healthcare of transgender adolescents." Zeno27 (talk) 11:38, 3 July 2024 (UTC)

"The Independent Review of Gender Identity Services for Children and Young People (The Cass Review) was commissioned by NHS England and NHS Improvement in Autumn 2020 to make recommendations about the services provided by the NHS to children and young people who are questioning their gender identity or experiencing gender incongruence. "

Is from the Cass reviews own website. If you want to argue about NHS UK not existing thats fine, but it's a response to the Cass review mainly, I don't think it's too relevant who exactly commissioned it. LunaHasArrived (talk) 12:30, 3 July 2024 (UTC)

I'm not arguing about it, just pointing out they get off to a bad start by getting basic facts wrong. Still working my way through the rest of it. Zeno27 (talk) 16:07, 3 July 2024 (UTC)

I don’t think confusing UK/England is fatal. The organisational structure of healthcare in the UK is not the material point, and papers aren’t materially harmed by making simple errors outside of their core chain of reasoning. It’s the kind of issue that might get picked up in peer review, the lack of which is the main issue with this paper. Let’s see if it gets published, and then evaluate the published version. Barnards.tar.gz (talk) 09:24, 4 July 2024 (UTC)

Or any kind of review, peer or editorial. It's self published. I'm perplexed about their comments on NOS. When the earlier NICE reviews were published, activists complained that they use GRADE, which is weak for studies that aren't RCTs. Now they use NOS, which is more appropriate for the studies being looked at, and this paper seems to be saying they should have used GRADE. They use "political language" like "not recommended by" to say things in a dishonest way. Well it seems Cochrane did recommend NOS for systematic reviews of non-randomised studies, but then developed their own in house "Risk of Bias" tool. That sounds to me a bit like saying Apple doesn't recommend using Google Pixel phones. Well they would, wouldn't they. They go on at length about why they think this tool is bad. You know the old phrase "If you're explaining, you're losing". Well, if their opinion on NOS was widely accepted, they could just cite someone and move on. Instead, we have here a self-published doc trying to discredit a major review and it has to try to conduct original research in front of its readers about why the authors think NOS is bad. That's a big red flag. Futhermore, it is all like complaining about the font the author's used, if it doesn't change the result. The result, about lack of good evidence, has been something systematic reviews have been saying for years, and wouldn't change if they did it another way. -- Colin°^Talk 09:57, 4 July 2024 (UTC)

reading section 6 (as only 6 and 7 actually consider the York SRs) they don't seem to have made any recommendation on which quality appraisal tool to use. They do recommend GRADE and the AHRQ approach when it comes to assessing the entire body of evidence (something the York SR's didn't seem to use a tool for whatsever) and They do in fact cite multiple studies to say NOS is inaccurate. The robis tool that Noone uses is a tool to assess whether a systematic review is at risk of bias, not a tool to assess the quality of individual studies. LunaHasArrived (talk) 12:31, 4 July 2024 (UTC)

You mean the study they cited to say "Using NOS, reviewers often come up with different quality appraisals" but the study was one where they asked two researchers to use NOS and assessed whether they come up with similar. So "two researchers" in one study isn't "reviewers often come up with different quality appraisals". The point is, if NOS was explicitly "not recommended" then they'd be able to cite one or two big names that say "We do not recommend using NOS for this kind of thing". And they don't.

Their line "NOS includes items that are immaterial to assessing risk of bias" cites source 96 which is here and which says "The Cochrane Handbook highlights two other tools for use in nonrandomized studies: the Downs and Black and Newcastle Ottawa Scale. They implicitly recommend the Newcastle Ottawa Scale over the Downs and Black because the Downs and Black is time-consuming to apply, requires considerable epidemiology expertise, and has been found difficult to apply to case-control studies. The Newcastle Ottawa Scale is frequently used in systematic reviews for articles about studies with this type of design. It contains separate questions for cohort and case-control studies. It was developed based on threats to validity in nonrandomized studies" which I suppose was being positive about it so they didn't cite that bit. Another source they cite seems very very old, making me think it even predates NOS.

If you google the scale, you find that it is widely widely used and also like all such tools, widely discussed for its strengths and limitations. The criticism here seems to be a bit like someone saying they used a PC to write the Cass Review and then citing lots of "Mac User" articles and forums saying how Macs are better. -- Colin°^Talk 14:31, 4 July 2024 (UTC)

Macs actually are better. ;-p WhatamIdoing (talk) 02:41, 5 July 2024 (UTC)

That's honestly what I was thinking at the moment, they're clearly subject matter experts and the reports been used by others. We might at some point want to reconsider the balance attributed in that sentence, but I can see that being a point to consider down the road. LunaHasArrived (talk) 12:33, 3 July 2024 (UTC)

Based on what others have said, I support including it. Snokalok (talk) 02:18, 3 July 2024 (UTC)

The Yale Integrity report by eight distinguished legal scholars and scientists presents the mainstream perspective and is essentially the most comprehensive (for now) mainstream counter-report, and clearly needs to be discussed. The Cass report has been widely criticized and promotes ideas that are quite fringe. Badenoch has admitted that it was meant to promote gender-critical ideas. Gender-critical ideology was recently described by the UN as an extremist movement that uses "hateful propaganda and disinformation to target and attempt to delegitimize people with diverse sexual orientations, gender identities, gender expressions, and sex characteristics". [3] --Amanda A. Brant (talk) 21:46, 3 July 2024 (UTC)

What is this "Yale Integrity report"? The "Integrity Project" is two people who happen to work at Yale Law School. The document itself has some medical co-authors but that doesn't make it a Yale university official body. It is also not a "medical organisation" so I've removed the two refs to it from the lead. Also the document is at present not actually in any publication at all, but a PDF on a documents folder on the server of a law school. Until it is published by a reliable source, we can't cite it. At present it itself is no more reliable than a Substack post or an Unherd rant. I have absolutely no idea why Badenoch is being mentioned. Could editors please contain their rants to their personal blog space or whatever. -- Colin°^Talk 07:27, 4 July 2024 (UTC)

@Amanda A. Brant, can you provide a source for that contentious statement about a living person?

I'm not sure why it's relevant (was Badenoch involved in the report?), but if the BLP rules apply on talk pages, too. WhatamIdoing (talk) 17:04, 5 July 2024 (UTC)

Refers to this (non-X link), and while it can be interpreted the way that was mentioned, it's ambiguous enough I don't think it's worth discussing here without interpretation by RS. VintageVernacular (talk) 17:53, 5 July 2024 (UTC)

I think that is an unfair interpretation. The comment is in response to why , and the politician's response is that it happened because she (the minister of equalities) is gender-critical herself. IMO it's a stretch too far for our BLP rules to say that a comment that says "The Cass Review would **never** have been commissioned under a Labour govt" actually means "it [the Cass Review] was meant to promote gender-critical ideas". WhatamIdoing (talk) 19:48, 5 July 2024 (UTC)

It is a perfectly reasonable interpretation of it. See journalist Erin Reed's comments on it[4][5][6]. --Amanda A. Brant (talk) 22:46, 6 July 2024 (UTC)

Amanda, Reed is an activist blogger who's work is occasionally reprinted by activist publications. They aren't a "journalist" of standing enough to support BLP claims. Wasting our time with conspiracy theories about the purpose or origin of the Cass Review is not helpful, as is all the stuff below about the UK and Russia. This is not a forum. -- Colin°^Talk 15:03, 7 July 2024 (UTC)

The removal of sourced content for no other reason than WP:IDONTLIKEIT is completely unacceptable, as is the attempt to portray Amnesty and anti-trans hate groups as being "the same" with a misleading and biased title. Also, the lead should accurately reflect the content of the article, also regarding what kind of organizations that have criticized this report. It or the use/weaponization of it by anti-trans groups has been widely criticized by human rights organizations (such as Amnesty), LGBTIQ+ rights groups in addition to medical organization, and is indeed a key feature of it, from a US perspective indeed its main claim to fame. This is a matter of human rights as much as it is a matter of medicine, in a climate where the UK has become known internationally for "virulent attacks on the rights of LGBTI people".[7] --Amanda A. Brant (talk) 22:39, 3 July 2024 (UTC)

Amanda, please read the discussion above, and self revert. You're massively over inflating a non peer reviewed document. Void if removed (talk) 05:45, 4 July 2024 (UTC)

Having removed the link to Yale's own blog post, the only "reliable" independent source mentioning this report that we are citing is to Ross Hunter, Multimedia Journalist at The National, which is a niche newspaper (circulation less than 3,000) focused on Scottish Independence. We need to do better than that for this to be notable. -- Colin°^Talk 07:32, 4 July 2024 (UTC)

Nobody has claimed it is a "medical organization". Transgender/LGBTIQ+ rights are matters of human rights and law, just as much as they are matters of medicine. The claim that the report isn't "published" is flatly wrong and misunderstands how the legal field works. In law, peer reviewed journal publications are not the only authoritative sources, other kinds of opinions are too, including judgements and expert opinions by prominent jurists. In the legal field, what matters is whether the opinion is authored by reputable jurists. Additionally, what matters for us is whether there are reliable sources describing this report[8]. I understand that medical science works somewhat differently, as it relies much more on peer-reviewed journal articles.

Note that the Cass report is not a peer-reviewed publication like an article in a peer-reviewed journal. It is a "report," similar to the Yale report. There is nothing wrong with that; academics sometimes publish reports to investigate various issues. Typically, peer-reviewed publications aim to advance knowledge, but reports can be aimed at a broader group of stakeholders and provide an overview of a topic. The Cass report is clearly not just aimed at academics, and the response from a group of prominent legal scholars, published in the same format, is part of the conversation around it. The claims about "two people" are nonsensical when there are eight co-authors, and there are no policy-based reasons for the removal of this sourced content. WP:IDONTLIKEIT is not an acceptable reason to remove it

Also, the attempt to portray Amnesty and extremist anti-trans hate groups as being "the same" by having them in the same section with a biased title insinuating they are the same kinds of organizations, is unacceptable. --Amanda A. Brant (talk) 16:20, 4 July 2024 (UTC)

I'm not following the conversation very closely (apologies), but in The National's report it seems to attribute to both "Yale Law School and the Yale School of Medicine". VintageVernacular (talk) 16:33, 4 July 2024 (UTC)

Alstott is from Yale Law School and McNamara is from the Yale School of Medicine. The report is from "The Integrity Project" which they both run, but which seems to be attached to the Law School. Void if removed (talk) 16:54, 4 July 2024 (UTC)

This looks like a self-published WP:PREPRINT.

There are bits that seem silly. For example, Expertise is not considered bias in any other realm of science or medicine... The MDs among the authors, at least, should be familiar with the idea that if you don't want surgery, you shouldn't ask a surgeon for advice, because surgeons are biased towards surgery.

Much more generally, thinking about the critical sources in general, I think the two "sides" are talking past each other. The Cass Review seem to be starting from the POV that you have kids in distress. They need help, and you've no idea which ones will be helped long-term with gender-affirming social and medical care. The critics seem to be starting from the POV that you have trans kids who need gender-affirming social and medical care.

Here's an example of how that plays out in the Integrity Project report: The report asserts that anyone who wants to make a clinical recommendation (e.g., about trans kids) must be a subject-matter expert (e.g., in trans kids). Cass and her committee are not experts specifically in providing gender-affirming care; therefore, (according to the Integrity Project) they are not even allowed to ask a qualified team to perform a systematic review on the subject. The Cass team, on the other hand, are saying that these are distressed kids, and they are experts in distressed kids, so they actually are qualified to commission research by other experts on this subject.

(For myself, I keep cynically thinking that all of these critics would cheerfully accept large grants from utterly unqualified people/foundations to conduct such systematic reviews themselves, because the main problem really isn't that the Cass team commissioned the systematic reviews. The problem is that the systematic reviews accurately showed that the emperor is missing part of his clothes, and that's being politically exploited to produce some very severe practical problems in the short-term. I doubt that any of actual experts believed that the evidence base was spectacular. They just very sensibly don't want the dirty laundry to be aired in public, especially since part of the reason the evidence base is so bad is because of chronic underfunding due to bigotry.) WhatamIdoing (talk) 02:31, 5 July 2024 (UTC)

The Cass Review seem to be starting from the POV that you have kids in distress. [..] The critics seem to be starting from the POV that you have trans kids who need gender-affirming social and medical care.

That is the entire dispute in a nutshell. Void if removed (talk) 09:36, 5 July 2024 (UTC)

politicians positions

In our section "reception among UK politicians" almost all the positions are now outdated (thank you general election). Having read part of MOS adding former or at the time before any positions would seem correct however I think this would probably bloat the paragraph a lot. I'm opening up the discussion here for any advice on how to fix this problem as I'm not certain about the solution. LunaHasArrived (talk) 13:17, 9 July 2024 (UTC)

I think at most an extra line saying that the labour manifesto included it is sufficient. I don’t think much has changed in the way of “both major parties supported it” beyond that. Snokalok (talk) 13:44, 9 July 2024 (UTC)

Saying Prime minister Rishi sunak is inaccurate as he's no longer prime minister (this is in the body of the article). This was the major point, sorry if I didn't make this clear. LunaHasArrived (talk) 13:57, 9 July 2024 (UTC)

Expand lede

With all the debate about how to refer to "international criticism" I realise the lede as it stands is woefully vague.

We don't even give the casual reader a headline description of what the reports recommendations even were!

Where it says:

The final report was published on 10 April 2024, and its recommendations were endorsed by NHS England and both the Conservative and Labour parties.

I think we need something like the following:

The final report was published on 10 April 2024, and concluded that the evidence base for medical interventions on adolescents was weak. The review assessed existing international standards of care and determined the majority lacked methodological rigour and independence. The final report delivered 32 recommendations covering multiple areas, and overall recommended a more cautious, holistic approach. These recommendations were endorsed by NHS England and both the Conservative and Labour parties. Void if removed (talk) 09:57, 7 July 2024 (UTC)

Seems okay. Probably doesn't require your second sentence. First and third sentence seems like a full summary. Zenomonoz (talk) 11:18, 7 July 2024 (UTC)

I want to be very careful about MOS:CLAIM here, the word choice here reads like something that treats the report as ironclad and infallibly reliable when - as we’ve seen - that is a position only really held in the UK. Additionally, it didn’t only conclude the evidence for medical interventions was weak. It said the same of psychotherapy, but endorsed those as the primary method of treatment regardless, and I feel that needs mentioning.

Consider:

The final report was published on 10 April 2024, and stated that the evidence base for both medical and psychotherapeutic interventions on adolescents was weak, but recommended the latter as the primary course of treatment; along with a number of other proposed changes to gender-related treatment as part of its 32 recommendations. These recommendations were endorsed by NHS England and both the Conservative and Labour parties. Snokalok (talk) 13:14, 7 July 2024 (UTC)

@Void if removed as I said in the edit summary, see the thread. BRD. You should know this Snokalok (talk) 19:53, 8 July 2024 (UTC)

2:1 is not a consensus and you well know it Snokalok (talk) 19:54, 8 July 2024 (UTC)

Per BRD, self revert. Had you reverted my change and brought it here, fine. You did not, you added your own, minority wording. Void if removed (talk) 19:58, 8 July 2024 (UTC)

I’ll restore it to before we started fighting over this entirely Snokalok (talk) 20:01, 8 July 2024 (UTC)

I don’t actually know how to do that, so I’ll just revert them all Snokalok (talk) 20:03, 8 July 2024 (UTC)

Thank you. I'll leave this till others offer an opinion. Void if removed (talk) 20:03, 8 July 2024 (UTC)

I think I prefer Snokaloks paragraph, but I'm hesitant in imposing a pov not included in the article (perhaps "and recommended..." Instead of "but recommended..."). I will add that if we go with Voids paragraph more clarity might be needed in the comparative words (i.e "a more cautious, holistic approach than NHS England previously provided"). Also voids 2nd sentence seems to be too strong, the quote comes from the analysis of all the guidelines but most of the guidelines analysed were not international guidelines (we should probably change the title of that part of findings as well) LunaHasArrived (talk) 13:02, 9 July 2024 (UTC)

I’m okay with changing “but” to “and” Snokalok (talk) 13:26, 9 July 2024 (UTC)

I prefer Snokalok's version but I don't think the opinions of political parties on a medical report should be in the lead. So something like:

The final report was published on 10 April 2024, and stated that the evidence base for both medical and psychotherapeutic interventions on adolescents was weak, but recommended psychotherapy as the primary course of treatment. It also recommended several other proposed changes to gender-related treatment. These recommendations were endorsed by NHS England.

would be preferable. Loki (talk) 05:16, 14 July 2024 (UTC)

Sorry Loki but that's pretty awful prose and the "but" in there is editorialising (not neutral). The review's opinion on the evidence for medical interventions is the most important as it directly led to changes in that area in the UK and generated the most controversy. The opinions on psychotherapeutic interventions is more complex to explain, a tiny aspect of the overall review, and the proposed texts by Snokalok/Loki are not presenting it neutrally. I think that is probably too contentious an area to try to resolve in a lead sentence and not a major shift: these kids were and are being referred to psychiatrists at a child and adolescent mental health clinic so this is what's expected anyway. I like Void's third sentence, which seems to be dropped in the other variants in favour of totally vague "several other", not all of which are "gender-related treatment" as such, but practical things like setting up new clinics and new research. The second sentence is also important since if the review looked at existing guidelines and thought they were great, it would have adopted or been based on them. We need to explain to the reader the reason given by the authors for not doing so. The endorsement of the outgoing and incoming governments is important. This is primarily a review to advise NHS England, but that there is political support from those who count is leadworthy.

Overall I think Void's summary is an excellent proposal and hugely superior to the other two proposed at present. -- Colin°^Talk 18:20, 14 July 2024 (UTC)