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World Professional Association for Transgender Health (WPATH) Files
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I'm sure what you
meantto say was thatyouemailedthe schoolin advance… etc.You can be as sure as you like, but I didn't mean to say that, because I didn't do that. I try to be as factually correct as I can in my posts. Now, it was over 20 years ago, so I'm not 100% sure of the details, however I am 100% sure that I didn't contact the school at all. Myself and his mother supported him in contacting the school - he initiated the contact by suggesting that he attend school during our vacation, and we adjusted our planned travel dates to accommodate that request. As I recall he emailed the teacher (with our help), most likely by using a generic school email. At any rate the reply came from the teacher. But none of the above negates the point I was making, which was that he had such a positive experience during his school attendance when we were resident in Oregon, that he wanted to attend again. My mentioning of the schoolteacher providing her home number to parents for the convenience of parents was making a separate point about how seriously this teacher took her obligations to do everything she could to provide a good education. You chose to twist my words to make a point about teachers being inappropriately familiar with kids. Nothing could have been further from the actual situation - the school was run very professionally, there was a high standard of discipline (absent random beatings by psychopaths), oh, and as local taxpayers everything was provided, even the copies - none of this (in)voluntary contribution nonsense. Now, I suppose I could have made a proper, unambiguous, detailed post, including what we'd all had for breakfast, the serial number and date of manufacture of the computer the email was typed on, and the weather conditions at the time, but no doubt you'd have found fault with that, whether due to arseholery or some other reason.
Now, if the above paragraph seems off topic, there is one thing I remember that is pertinent to the current debate. My son was generally well behaved, and rarely generated any negative comments from teachers. One day he came home Oregon school and announced that he had gotten a tardy slip, as he had been a couple of minutes late. It was a big deal. Nowadays such a focus on punctuality would be seen as white supremacy, and that in turn is another aspect of the DEI religion that has infiltrated all sorts of public organisations and led us to the current mess. Thankfully there are signs that the pendulum is beginning to swing in the opposite direction, albeit slowly.
Regarding your second point, I don't know what you are trying to say - what is it that I am mistaken about? I could paste a chunk of Jesse Singal's article, but another poster kindly linked it and it's easily found if anyone feels the need. Suffice it to say that Singal has clearly laid out the many ways in which Meredithe McNamara has misled people regarding her experience, in such a way as to cast serious doubt on her own credibility and the credibility of the Yale report you linked, and that she submitted as an affadavit:
Btw Singal has decided that rather than just a second part, he needs a three part article to discuss the Yale critique properly - again the material is easily found.
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Singal has described, in considerable detail, how the foregoing is neither true nor correct. Most concerning is how the document posted online differs from the version in the affidavit, with no explanation for edits. You'd expect a bit better from the Yale Law School in general, and the authors in particular, but those expectations seem to be in vain.
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Quite a few things to deal with:
Yes, as an engineer, there’s no way to avoid a fair bit of reading. However I’m lucky in that most of the stuff I have to deal with relates to things that can be independently verified by internationally agreed methods. I don’t get to dismiss stuff out of hand – if I need a certain result for my project to proceed, and I find information that conflicts with that, then I can’t just say “that’s not true” without providing evidence, or “that’s true but it’s nothing to do with anything”. I can’t just say I don’t give a sh1t about what someone else thinks if they have provided a critique worthy of consideration - I'd have to say why.
When you said that “Cass got the result the NHS desired”, did you mean that she set out with a particular outcome in mind?
Again regarding Cass, you said:
“She was under no obligation whatsoever, moral, professional or otherwise, to attempt to influence the review process in which her participation was not requested”.
Here’s the gist of her letter:
“It was outside the Review’s remit to attempt to validate the accounts I received, or to determine whether all the issues are still current. In addition, practice and standards may be markedly different between different clinics. However, there were common themes which I hope will be explored in the upcoming review of adult gender services that NHS England is planning to undertake. “
She then lists the various concerns that have been raised to her, before finishing:
“I hope this is helpful to NHS England as it embarks on the review of adult services.”
The first bit I bolded shows that she is very clear in what her remit was. Hoping something will be explored and hoping the information she has provided will be helpful are hardly signs of an attempt to influence a process – if you believe she was trying to influence the process then you’d have to accept the argument that withholding the information would equally be an attempt to influence the process. There’s nothing in her letter suggesting what form the review process should take, or what the desired outcome should be, so your attempt to attribute improper conduct to her falls a bit flat.
You asked: “Does it occur to you that critics of the review too have a moral, ethical or professional obligation to do so? “
They do, it’s open to anyone who has concerns to raise them through any forum they have access to, however there are a number of problems with the Yale document. You’ve listed the authors, and stated how the views are their own, but given that the document is posted on the Integrity Project section of the Yale Law School website, it does look like they are trying to benefit from the reputation of that institution. Given that, and the “Integrity” bit, I would have expected them to disclose the following conflicts of interest, but no such disclosure appears at the beginning or end of the document. From Singal:
“Let’s start with some of the authors’ roles as paid expert witnesses for parties fighting American bans or restrictions on youth gender medicine: McNamara ($400per hour), Janssen ($400per hour), Olson-Kennedy ($200per hour), and Turban ($400or $250 per hour, depending on the task) have all received money as expert witnesses in cases fighting bans or restrictions of youth gender medicine in American states. If someone gets paid as an expert witness, does that mean we should never trust them? Of course not. But it does mean that they need to disclose this when appropriate ,especially when they are touting the “transparency” of their work. In other cases, co-authors on this document also have consulting and textbook royalty income riding directly on the continuing availability of youth gender medicine, which of course also bears mentioning.
Moreover, multiple studies published by Turban were rated as low quality by the Cass team’s systematic reviewers. One of Turban’s studies (footnote 53) was deemed low quality in the SR on puberty blockers; another(footnote 65) was deemed low quality in the SR on hormones (if you’re a subscriber to this newsletter, the weaknesses of these studies will not come as a surprise). Three of Olson-Kennedy’s studies were rated “moderate” in the puberty blocker and hormones SRs. This warranted disclosure as well, because readers have a right to know about these sorts of conflicts: Here Turban is co-authoring a searing assessment of a project that rated his own work poorly. Guyatt agreed that the expert witness, royalty, consulting, and authorship conflicts should have been disclosed.
Finally, there’s the simple fact that a number of the authors work in gender clinics. They tout this rather than hide it (albeit without mentioning, by name, who works in gender clinics), and to be fair, this isn’t usually considered a conflict of interest. But it really should be: If you work in a youth gender clinic, you are obviously conflicted when it comes to evaluating a document that rates the evidence for youth gender transition poorly! How can anyone even contest this? I asked Guyatt and he agreed both that this isn’t usually seen as a conflict and that it should be.”
I never thought I’d reference Warren Buffet on this thread, but all the above seems a lot like barbers telling us we need haircuts (that advice would be particularly redundant in my case 😀).
The Yale document is also full of self-contradictory stuff: first they decry the Cass review for mentioning GRADE but not sticking rigidly to its evidence quality terminology:
“Under GRADE, quality designations such as “high,” “moderate,” “low,” and “very low” are used to describe evidence. There is a shared understanding of what these terms mean in medical science, which allows experts to use them in developing clinical recommendations for broad application.
The Review introduces GRADE (p 55) but never evaluates the evidence using the GRADE framework. The Review borrows GRADE terminology in repeatedly expressing a desire to see “high quality” evidence dominate the field of transgender health. Thus, the Review falls seriously short in not describing or applying a formal method for assigning evidence quality. Thus, the Review speaks a language that may seem familiar, but its foundations are pseudoscientific and subjective. For instance, unscientific evidence quality descriptors such as “weak” and “poor” were identified 21 times and 10 times respectively.”
Then they cast doubt on the utility of evidence quality terminology:
“The usefulness of evidence quality terminology is thoughtfully debated in the medical community. Different assessors often disagree and make divergent evidence quality assessments. There are no well-described processes by which such disagreements should be resolved.”
Another contradiction pasted directly from Singal’s blog: (page15 of the report)
“Wait, I thought you weren’t allowed to say “long-term” without specifying “exactly” what is meant by it? For the record, here’s the amount of space between McNamara and her colleagues complaining about that construction and using it:”
I’d be disappointed with a Junior cert student who presented such a sloppy argument.
You said “you responded that you didn’t expect anyone would actually watch the video”, when what I actually said was:
“Regarding the first link, I didn't expect anyone to actually watch / listen to all of it” - you were being uncharacteristically economical with your verbiage, hopefully unintentionally, as there wouldn’t be much point in posting a link that I didn’t intend people to at least have a quick scan or browse at.
Since you mention Stella O’Malley, yes, she did say that she didn’t understand the grades, but she was mostly concerned about phrases like “meets expectations” on her kids’ report cards, when those expectations have not been clearly defined (maybe the Integrity Project wrote the reports 😀).
Regarding Maud Maron, she was removed from the NYC Education council as a result of a message written in a private forum which related to a personal belief, but her troubles began when she proposed that female athletes should be invited to take part in a conversation on matters that would affect their sports. Her resolution was passed by 8 votes to 3, but the Chairman rescinded it. I don’t know if he was actually entitled to do that based on the board charter, but it seems profoundly undemocratic. At any rate it’s an illustration of the point I was making about people shutting down opposing voices rather than engaging in debate. In a democratic society (I know, it’s the US, so the quality of democracy is debatable) when faced with opinions you don’t agree with, I think the proper course of action is to come up with a better argument, and make that argument as passionately and articulately as you can, rather than trying to get the person stating the offensive opinions removed from the position they hold. Your posting of a Father Ted clip reminded me of the fate that befell Graham Linehan, merely for challenging the trans orthodoxy.
From the document you linked, twice:
“Discussion
As a result, this also calls into question whether the Review is able to provide the evidence to substantiate its recommendations to deviate from the international standard of care for trans children and young people.”
Would the bit I bolded be referring to the WPATH guidelines by any chance?
Finally, we can definitely agree that the health service in the UK, and Ireland and the US is in a mess at the moment. It might be best then to investigate the sudden rise in ROGD among teenage girls, so as to limit the extra load on already burdened services.
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Quite a few things to deal with:
That’s more like it, and with a bit of humour too, always a bonus! 😊
Yes, as an engineer, there’s no way to avoid a fair bit of reading. However I’m lucky in that most of the stuff I have to deal with relates to things that can be independently verified by internationally agreed methods. I don’t get to dismiss stuff out of hand – if I need a certain result for my project to proceed, and I find information that conflicts with that, then I can’t just say “that’s not true” without providing evidence, or “that’s true but it’s nothing to do with anything”. I can’t just say I don’t give a sh1t about what someone else thinks if they have provided a critique worthy of consideration - I'd have to say why.
You can, you must, or you’d spend considerable resources going down rabbit holes, when all that is in question is your capacity to focus your attention long enough to read and understand a couple of paragraphs. You’ve demonstrated, as I suspected by virtue of you being an engineer, you are capable of being able to do so. That’s all I needed to know. Without meaning to be rude – the extra clarification again just isn’t necessary.
When you said that “Cass got the result the NHS desired”, did you mean that she set out with a particular outcome in mind?
I mean that Cass understood the assignment. The NHS, those who commissioned Cass to chair the Review, had a particular outcome in mind, and they set the parameters, or terms of reference and the scope of the review, and determined that Cass was a suitable candidate (she was the only candidate considered!) for the role of Chair of the Review. Cass delivered exactly what was expected of her – she got the results the NHS desired. She had to set out with a particular outcome which was given to her and had to work within the constraints which would lead to that outcome.
Again, regarding Cass, you said:
“She was under no obligation whatsoever, moral, professional or otherwise, to attempt to influence the review process in which her participation was not requested”.
Here’s the gist of her letter:
“It was outside the Review’s remit to attempt to validate the accounts I received, or to determine whether all the issues are still current. In addition, practice and standards may be markedly different between different clinics. However, there were common themes which I hope will be explored in the upcoming review of adult gender services that NHS England is planning to undertake. “
She then lists the various concerns that have been raised to her, before finishing:
“I hope this is helpful to NHS England as it embarks on the review of adult services.”
The first bit I bolded shows that she is very clear in what her remit was. Hoping something will be explored and hoping the information she has provided will be helpful are hardly signs of an attempt to influence a process – if you believe she was trying to influence the process then you’d have to accept the argument that withholding the information would equally be an attempt to influence the process. There’s nothing in her letter suggesting what form the review process should take, or what the desired outcome should be, so your attempt to attribute improper conduct to her falls a bit flat.
I don’t have to accept the argument that withholding the information would equally be an attempt to influence the process, not only because that’s a sloppy argument, but because you’ve left out the contents of the letter which formed the basis of her comments, those claims which she presented without evidence, which I also pointed out was a feature of the review – rife with claims which lacked evidence, something I noted on reading the review long before I read the critiques which pointed out the lack of evidence for many of the claims in the review. The only reason she couldn’t influence the process of a review of adult gender services is because the NHS reminded her in the most diplomatic terms that her services are no longer required.
You asked: “Does it occur to you that critics of the review too have a moral, ethical or professional obligation to do so? “
They do, it’s open to anyone who has concerns to raise them through any forum they have access to, however there are a number of problems with the Yale document. You’ve listed the authors, and stated how the views are their own, but given that the document is posted on the Integrity Project section of the Yale Law School website, it does look like they are trying to benefit from the reputation of that institution. Given that, and the “Integrity” bit, I would have expected them to disclose the following conflicts of interest, but no such disclosure appears at the beginning or end of the document. From Singal:
“Let’s start with some of the authors’ roles as paid expert witnesses for parties fighting American bans or restrictions on youth gender medicine: McNamara ($400per hour), Janssen ($400per hour), Olson-Kennedy ($200per hour), and Turban ($400or $250 per hour, depending on the task) have all received money as expert witnesses in cases fighting bans or restrictions of youth gender medicine in American states. If someone gets paid as an expert witness, does that mean we should never trust them? Of course not. But it does mean that they need to disclose this when appropriate ,especially when they are touting the “transparency” of their work. In other cases, co-authors on this document also have consulting and textbook royalty income riding directly on the continuing availability of youth gender medicine, which of course also bears mentioning.
Moreover, multiple studies published by Turban were rated as low quality by the Cass team’s systematic reviewers. One of Turban’s studies (footnote 53) was deemed low quality in the SR on puberty blockers; another(footnote 65) was deemed low quality in the SR on hormones (if you’re a subscriber to this newsletter, the weaknesses of these studies will not come as a surprise). Three of Olson-Kennedy’s studies were rated “moderate” in the puberty blocker and hormones SRs. This warranted disclosure as well, because readers have a right to know about these sorts of conflicts: Here Turban is co-authoring a searing assessment of a project that rated his own work poorly. Guyatt agreed that the expert witness, royalty, consulting, and authorship conflicts should have been disclosed.
Finally, there’s the simple fact that a number of the authors work in gender clinics. They tout this rather than hide it (albeit without mentioning, by name, who works in gender clinics), and to be fair, this isn’t usually considered a conflict of interest. But it really should be: If you work in a youth gender clinic, you are obviously conflicted when it comes to evaluating a document that rates the evidence for youth gender transition poorly! How can anyone even contest this? I asked Guyatt and he agreed both that this isn’t usually seen as a conflict and that it should be.”
I never thought I’d reference Warren Buffet on this thread, but all the above seems a lot like barbers telling us we need haircuts (that advice would be particularly redundant in my case 😀).
The reason I made that point is because initially you presented the critique in the interests of fairness or balance, and said that it pointed out ways in which the Cass review could have done better, and then later you made the point that you’d seen comments that didn’t amount to anything substantial, but when I provided that review and the other commentary I provided (they were the most relevant as they examine the evidence used in the Cass review in support of its recommendations), that’s when you introduced Singal’s critique of a critique. It’s then that I pointed out Singal’s and another bloggers efforts to discredit the authors of the review amounted to nothing. They still don’t.
The Yale document is also full of self-contradictory stuff: first they decry the Cass review for mentioning GRADE but not sticking rigidly to its evidence quality terminology:
“Under GRADE, quality designations such as “high,” “moderate,” “low,” and “very low” are used to describe evidence. There is a shared understanding of what these terms mean in medical science, which allows experts to use them in developing clinical recommendations for broad application.
The Review introduces GRADE (p 55) but never evaluates the evidence using the GRADE framework. The Review borrows GRADE terminology in repeatedly expressing a desire to see “high quality” evidence dominate the field of transgender health. Thus, the Review falls seriously short in not describing or applying a formal method for assigning evidence quality. Thus, the Review speaks a language that may seem familiar, but its foundations are pseudoscientific and subjective. For instance, unscientific evidence quality descriptors such as “weak” and “poor” were identified 21 times and 10 times respectively.”
Then they cast doubt on the utility of evidence quality terminology:
“The usefulness of evidence quality terminology is thoughtfully debated in the medical community. Different assessors often disagree and make divergent evidence quality assessments. There are no well-described processes by which such disagreements should be resolved.”
Another contradiction pasted directly from Singal’s blog: (page15 of the report)
What they’re casting doubt on, is the fact that the review falls short of applying a formal methodology for assigning evidence quality, instead using language that is pseudoscientific and subjective. Where you suggest they cast doubt on the utility of evidence quality terminology is not what they’re doing – they’re making the point that there are different standardised ways to assess the quality of evidence, and that while the Cass review gives a passing mention to GRADE, it uses it’s own customised interpretation of a combination of MMAT and Newcastle-Ottawa scale tools, and there are no well-described processes by which divergent evidence quality assessments which come from the use of each tool, should be resolved. That’s not a contradiction, it’s a statement of fact.
“Wait, I thought you weren’t allowed to say “long-term” without specifying “exactly” what is meant by it? For the record, here’s the amount of space between McNamara and her colleagues complaining about that construction and using it:”
I’d be disappointed with a Junior cert student who presented such a sloppy argument.
I’d be as disappointed as you would be should a student at any level present such a sloppy argument, though I take it Singal’s argument is not the argument which you’re referring to. There is nothing in the report which suggests anyone isn’t allowed to say “long-term” without specifying “exactly” what is meant by it. The point the authors of the report are making is that Cass having excluded long-term data, claims there is no long-term data, and therefore the exclusion requires an explanation of exactly what conditions would satisfy the term “long-term data” as the term is used in the Cass review. Further, it goes on to make the point that by virtue of how they are used, and when they are used, long-term data on the use of puberty blockers would not at least be ethically possible to collect (puberty blockers by themselves are a short-term treatment), and further – the review expects for there to be an abundance of long-term data available from treatments that have only been more readily available for gender-affirming purposes over the last 10 years.
Singal’s argument is yet again an attempt to make something out of nothing.
You said “you responded that you didn’t expect anyone would actually watch the video”, when what I actually said was:
“Regarding the first link, I didn't expect anyone to actually watch / listen to all of it” - you were being uncharacteristically economical with your verbiage, hopefully unintentionally, as there wouldn’t be much point in posting a link that I didn’t intend people to at least have a quick scan or browse at.
Since you mention Stella O’Malley, yes, she did say that she didn’t understand the grades, but she was mostly concerned about phrases like “meets expectations” on her kids’ report cards, when those expectations have not been clearly defined (maybe the Integrity Project wrote the reports 😀).
You’ve exceeded my expectations with your use of the term “uncharacteristically economical with your verbiage” (I’m writing that down 😁). It just seemed like you were surprised anyone watched any of it, let alone all of it. I did because I have no reason to assume you’re posting that crap in bad faith, so I figured I’d give you a fair shot. I’m being kind when I say it met expectations, indicating that I wasn’t at all concerned that Stella feels the need to pretend that she doesn’t understand what is meant by “meets expectations” on her children’s report cards.
Regarding Maud Maron, she was removed from the NYC Education council as a result of a message written in a private forum which related to a personal belief, but her troubles began when she proposed that female athletes should be invited to take part in a conversation on matters that would affect their sports. Her resolution was passed by 8 votes to 3, but the Chairman rescinded it. I don’t know if he was actually entitled to do that based on the board charter, but it seems profoundly undemocratic. At any rate it’s an illustration of the point I was making about people shutting down opposing voices rather than engaging in debate. In a democratic society (I know, it’s the US, so the quality of democracy is debatable) when faced with opinions you don’t agree with, I think the proper course of action is to come up with a better argument, and make that argument as passionately and articulately as you can, rather than trying to get the person stating the offensive opinions removed from the position they hold. Your posting of a Father Ted clip reminded me of the fate that befell Graham Linehan, merely for challenging the trans orthodoxy.
Nah man, Maud’s troubles began long before her latest bandwagon jumping attempt to promote her belief that the education system in NY is in decline –
In 2019, Maron and Yitin Chu formed Parent Leaders for Accelerated Curriculum and Education NYC (PLACE NYC) to oppose Bill de Blasio's attempts to shift away from screened middle and high schools. Maron served as co-president. PLACE argues that the city's schools are failing their students, that the city should redouble its focus on academics, and that racism does not contribute to the city's underperforming schools. Other parental groups have described it as shifting rightward.
Graham Linehan’s fate is not a consequence of merely challenging the trans orthodoxy either - Linehan’s fate is also a consequence of being unable to take criticism of his ideas. He tried to use the imbalance of power you referred to earlier in an attempt to silence his critics, resulting instead in bringing a ton of shít down on himself, rather like Maron attempting to use the imbalance of power to silence her critics, resulting in, well, exactly what you suggested.
From the document you linked, twice:
“Discussion
As a result, this also calls into question whether the Review is able to provide the evidence to substantiate its recommendations to deviate from the international standard of care for trans children and young people.”
Would the bit I bolded be referring to the WPATH guidelines by any chance?
Yes it would, in part, as you can read from both the Introduction and the Conclusion, in the document I linked twice, that we can agree you read at least once:
As researchers and pediatric clinicians with experience in the field of transgender healthcare, we read the Review with great interest. The degree of financial investment and time spent is impressive. Its ability to publish seven systematic reviews, conduct years’ worth of focus groups and deeply investigate care practices in the UK is admirable. We hoped it would improve the public’s awareness of the health needs of transgender youth and galvanize improvements in delivery of this care.Indeed, statements of the Review favorably describe the individualized, age-appropriate, and careful approach recommended by the World Professional Association for Transgender Health (WPATH) and the Endocrine Society.Unfortunately, the Review repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculation. Many of its statements and the conduct of the York SRs reveal profound misunderstandings of the evidence base and the clinical issues at hand. The Review also subverts widely accepted processes for development of clinical recommendations and repeats spurious, debunked claims about transgender identity and gender dysphoria. These errors conflict with well-established norms of clinical research and evidence-based healthcare. Further, these errors raise serious concern about the scientific integrity of critical elements of the report’s process and recommendations.…
Conclusion The Cass Review was commissioned to address the failure of the UK National Health Service to provide timely, competent, and high-quality care to transgender youth. These failures include long wait times—often years—and resulting delays in timely treatment by skilled providers.Instead of effectively addressing this issue, however, the Review’s process and recommendations stake out an ideological position on care for transgender youth that is deeply at odds with the Review’s own findings about the importance of individualized and age-appropriate approach to medical treatments for gender dysphoria in youth,consistent with the international Standards of Care issued by the World Professional Association for Transgender Health and the Clinical Practice Guidelines issued by the Endocrine Society.Far from evaluating the evidence in a neutral and scientifically valid manner, the Review obscures key findings, misrepresents its own data, and is rife with misapplications of the scientific method. The Review deeply considers the possibility of gender-affirming interventions being given to someone who is not transgender, but without reciprocal consideration for transgender youth who undergo permanent, distressing physical changes when they do not receive timely care. The vast majority of transgender youth in the UK and beyond do not receive an opportunity to even consider clinical care with qualified clinicians—and the Review’s data demonstrate this clearly.Finally, we can definitely agree that the health service in the UK, and Ireland and the US is in a mess at the moment. It might be best then to investigate the sudden rise in ROGD among teenage girls, so as to limit the extra load on already burdened services.
That would be chasing down a rabbit hole which has already been debunked many, many times already. Given it’s not a clinically recognised term, it remains solely within the domain of culture warriors like Singal and Shrier (numerous times her name is dropped into the conversation in the video you provided, but not remotely a concern), referenced under this section -
The Review reanimates the debunked notion of “social contagion”
Also referenced here in the other commentary I linked to:
Notably, Littman previously published a study on gender dysphoria in adolescents (Littman,Citation2018). This study was subsequently widely criticized for its flawed methodology (Ashley,Citation2020; Restar,Citation2020), leading to a substantial correction of the original manuscript (Littman,Citation2019). Littman’s work should therefore be considered with increased scrutiny, in particular regarding whether the methodology used to obtain the results is robust. Indeed, the cited study (Littman,Citation2021), as well as the second study cited in the Review (Vandenbussche,Citation2022) while discussing reasons for detransitioning, has similar methodological issues to the previous study: potentially biased recruitment practices. In both studies, participants were particularly recruited from online detransition-related groups, potentially artificially inflating the number of people with negative views about transitioning and gender affirmative care.It really wouldn’t be the best use of limited resources to go down rabbit holes, but as for what the NHS are likely to do with the Cass Review, and the forthcoming adult review, it would seem they are determined to do exactly as they have done in other areas of the NHS… and expect different results:
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