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sources for consideration

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) reply

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) reply
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) reply
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) reply
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) reply
"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) reply
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) reply
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) reply
@ 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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
"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) reply
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) reply
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) reply
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) reply
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) reply
@ 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) reply
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) reply
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) reply
> 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) reply
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) reply
And where on the MEDRS pyramid does an FAQ on the website fall? Snokalok ( talk) 12:32, 5 May 2024 (UTC) reply
@ 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) reply
@ 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) reply
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) reply
@ 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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
"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) reply
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) reply
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) reply
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) reply
@ 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) reply
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) reply
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) reply
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) reply
They're not professional associations, they're medical associations. They fully fall under MEDORG. Snokalok ( talk) 11:34, 4 May 2024 (UTC) reply
@ 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) reply
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) reply
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) reply
"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) reply
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) reply
“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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
@ 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) reply
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) reply
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) reply
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) reply
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) reply
Ah right, forgot @ LilianaUwU. Anyone else I'm missing? Snokalok ( talk) 12:56, 4 May 2024 (UTC) reply
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) reply
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) reply
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) reply

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) reply

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) reply
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) reply
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) reply

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 [1]

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) reply

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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply
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) reply

References

  1. ^ Cass review final report 2024, p. 178.

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) reply

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) reply
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) reply
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) reply
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) reply
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) reply

Critical papers

There are a couple new papers out that are critical of the review. This critical commentary was published. Then there's this paper which is still in prepublication and may look a bit different in final publication. I would say we could watch for when the latter reaches publication. VintageVernacular ( talk) 01:59, 13 June 2024 (UTC) reply

I disagree with how this was added - these are not "responses from journals" these are individual responses, and so are they DUE?
Maybe we need a section for academic responses, but this sort of thing has to be attributed opinion to the author per WP:RSOPINION if significant. Void if removed ( talk) 11:48, 18 June 2024 (UTC) reply
It can be re-attributed and the section renamed "Responses in medical journals"; why remove the whole addition even initially? It's written by a neuroscience postdoc, while touching on e.g. brain development, comorbidity with neurodevelopmental conditions, and brain structure. Elsewhere the commentary highlights that a systematic review which the Cass report relied on had falsely reported an increased incidence of autism in a gender dysphoric group from 1.8% to 15.1%; the cited study actually said it was 13.8% to 15.1%. Stands on its own, but referentially, are these sorts of critiques in a specialist journal any less "DUE" than the already included statements by politicians, lobby groups, etc.? VintageVernacular ( talk) 12:39, 18 June 2024 (UTC) reply
It's written by a neuroscience postdoc
Is this a notable neuroscience postdoc, or just the one who published some critical commentary first?
The new section was written as if to attribute opinion to the journal - not the researcher - and consisted of three quotes, which would seem excessive. To trim it down to the meat of the conclusion, I think you'd end up with something like:

A critical commentary on the Cass Review by postdoc researcher Dorieke Grijseel, published 14 June 2024, called into question "the robustness of the evidence the Review bases its claims on.".

Is that due, and even if it is is it worthy of a new section? In that form would it just go under "assorted opinion"? I'm not sure this is of any significance yet. I don't know to what extent we can even summarise what's in this paper, possibly the only part worth mentioning is:
highlights that a systematic review which the Cass report relied on had falsely reported an increased incidence of autism in a gender dysphoric group from 1.8% to 15.1%; the cited study actually said it was 13.8% to 15.1%.
From what I can make out that appears to be a legitimate howler, though not one that changes anything other than to increase the autism prevalence estimate fractionally. Still that's a point to watch.
than the already included statements by politicians
The political response is due, because this is taking place in a political context and politicians are manifestly acting on the results of the review. "Response from lobbying organisations" and "assorted responses", feel free to delete as far as I'm concerned, I think they are pointless fluff.
A "Responses in medical journals" section could work, but I think that any such section that could conceivably include this individual response, should also reinstate the BMJ editorial by Kamran Abbasi and other followup publications. Void if removed ( talk) 13:32, 18 June 2024 (UTC) reply
Wikipedia represents a global view and all of those 4 pieces you mentioned are from the U.K., which the Cass Review itself is from too. Since the Cass Review itself has run counter to the most common current worldwide medical standard on transgender care, which is set forth by WPATH and followed by many countries of the world, so WP:DUE may apply here to ensure that, while the British medical community seems to rally behind the Cass review, the worldwide medical community on transgender care does not, since they mostly have criticized, or ignored it.
We can add those 4 British papers, noting they multiple people from the country of the Cass review have come out in support of it, but it needs to be contextualized as such, to ensure we maintain a WP:NPOV. Raladic ( talk) 14:29, 18 June 2024 (UTC) reply
Your reversion took no account of my comments that this needs to be rewritten with attribution to the author, and I have no idea why you brought up WP:NOTCENSORED. Void if removed ( talk) 14:52, 18 June 2024 (UTC) reply
It is already attributed. to be specific, it is attributed to "a paper in the international journal of transgender health". Which is the appropriate type of attribution to give in a case where we describe a publication in a paper from a non-public figure. -- Licks-rocks ( talk) 15:04, 18 June 2024 (UTC) reply
No it really isn't appropriate. It is the kind of aggrandising puffery that we have guidelines against. I can't remember the shortcut right now. @ WhatamIdoing will know. It is important that D. M. Grijseels is a postdoc in brain research and might know a thing or two about marmoset vocalising but why on earth should an international encyclopaedia find their views on the Cass Review important? Seems WPATH's house journal accepts any papers critical of the Cass Review, no matter what one's qualifications or expertise is. -- Colin° Talk Colin° Talk 10:35, 19 June 2024 (UTC) reply
Because those views are published in a proper, internationally recognised, peer reviewed, academic journal, which means it's not just the name and reputation of the author that matters, but at least three other qualified experts in the relevant field (all of whose opinions alone would likely qualify as DUE under WP:EXPERTSPS) have gone over it and given their seal of approval.
Seems WPATH's house journal accepts any papers critical of the Cass Review, no matter what one's qualifications or expertise is.
Do you expect a serious reaction to this? Because this is the kind of comment I expect to see on WP:FRINGE, and I don't mean from any of the long term editors there. -- Licks-rocks ( talk) 11:17, 19 June 2024 (UTC) reply
It's WP:MEDSAY: "Do not hype a study by listing the names, credentials, institutions, or other "qualifications" of their authors. The text of the article should not needlessly duplicate the names, dates, titles, and other information about the source that you list in the citation. Always omit professional titles and academic degrees: use "Smith" or "Jones" rather than "Dr Smith" or "Prof Jones". It is necessary to specifically include such information only when a specific individual is being cited as an example of a person holding a minority view..."
We should not write things like "In June 2024, a critical commentary about the Cass Review was published in the International Journal of Transgender Health..." A more normal way to say this is "The Cass Review was criticized for..." (if you believe this view to be representative of a view held by a fairly large group) or to give the author's name with a brief description, e.g., "Neuroscientist Dorieke Grijseels said..." (if you believe this view to be held by a smaller group of people). In the latter case, these descriptions are usually just one word and profession-focused (" postdoctoral researcher" would be another option in this case [3]), but if you thought you needed a non-professional label, then Grijseels identified as "Dutch" and "queer" in this source. WhatamIdoing ( talk) 14:32, 19 June 2024 (UTC) reply
There are many articles on Wikipedia that mention the journal that the article was published in. I don't believe there are any guidelines against that. It's very common, so it seems quite silly to blow up this one issue about it. Hist9600 ( talk) 14:44, 19 June 2024 (UTC) reply
WP:MEDSAY is part of Wikipedia:Manual of Style/Medicine-related articles, which is a guideline. Naming the journals is WP:NEWSSTYLE ("A study published in the Journal of Important Things today says...") and should generally be avoided, especially when the journal is reputable, because it sounds like WP:HYPE. WhatamIdoing ( talk) 16:28, 19 June 2024 (UTC) reply
I agree with the analysis, neither of them are due. Draken Bowser ( talk) 11:33, 19 June 2024 (UTC) reply
This is an important commentary on the review, and it obviously should be included. A criticism published in a peer-reviewed journal is not merely an "opinion", and you are incorrect to characterize it as such. Hist9600 ( talk) 15:04, 18 June 2024 (UTC) reply
It looks a lot like an expert opinion by a non-notable expert, are you claiming it is something else? Draken Bowser ( talk) 15:03, 19 June 2024 (UTC) reply
It's an analysis of the Cass Review published in a peer-reviewed academic journal on the topic of transgender health, that examines the methodology and findings of the Cass Review. Hist9600 ( talk) 15:18, 19 June 2024 (UTC) reply
You are not disputing anything I said, what's the specific point you're trying to make? Draken Bowser ( talk) 16:11, 19 June 2024 (UTC) reply
There is also this paper - The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children that was published two months ago and also raises some serious concerns on the report, highlighting the lack of transgender health experts in the authoring of the report and its resulting cisnormative bias, and pathologization, which should likely be included in the new Cass Review#Academic response section. Raladic ( talk) 03:11, 19 June 2024 (UTC) reply
Raladic, that "Cis-supremacy" paper has been discussed to death already. It is now also irrelevant as it was commenting on the interim review and the speculation about "the lack of transgender health experts in the authoring of the report" would seem to be entirely that: speculation. See earlier discussions. -- Colin° Talk 10:22, 19 June 2024 (UTC) reply
That wasn't speculation, that was an explicit part of the Cass Review's original Terms of Reference: Wider stakeholders around Cass were likewise selected for an absence of trans specific knowledge or experience, including exclusion of those with lived experience of being trans. The original published Terms of Reference (ToR) for the Cass Review’s assurance group explicitly excluded trans expertise, stating that it “deliberately does not contain subject matter experts or people with lived experience of gender services” [Report 1, version 1]. The current (updated) assurance group ToR is worded less clearly, yet still conveys exclusion of those with expertise or lived experience, as such individuals would naturally be expected to have an interest in the outcome of the review: Members are independent of NHS England and NHS Improvement and of providers of gender dysphoria services, and of any organisation or association that could reasonably be regarded as having a significant interest in the outcome of the Review. [Report 1, p. 2] (emphasis added)
I still believe the article should be included, handwaving away all peer reviewed criticism of a report/recommendations criticized by health organizations around the world cheapens the article and does not follow WP:NPOV. Your Friendly Neighborhood Sociologist ⚧ Ⓐ ( talk) 15:56, 19 June 2024 (UTC) reply
You know, this is typical silo-amateur-chitchat-nonsense. Read the actual words here. The "assurance group" is designed "to provide expert advice and challenge about the approach and processes used to conduct the review, and to ensure that the Review is conducted in accordance with its terms of reference". It contains just seven people. They are to be process nerds, utterly utterly unconcerned with the topic being analysed, but concerned with process. That link concludes "The Assurance Group advises on the Review process and not its outcome. Professional and lived experience will be used to determine the outcome and recommendations of the Review and will be captured through our participative and consensus development approach." Honestly, this is like complaining that the creative design team for the publication PDF and the IT department who arranged zoom meetings didn't contain any activist voices or people with lived experience.
YFNS you've just emphasised why we don't juxtapose serious medical reviews with the opinions of someone's mum. The whole sentence "the lack of transgender health experts in the authoring of the report" is bullshit through and through. This "assurance group" aren't authors at all. They have no opinions about trans healthcare at all and weren't asked for them. They were explicitly chosen to be independent (because, you know, it is an independent review) in order to ensure nobody could say they came to it prejudiced. This emphasises my point about the dregs that people are googling for and digging up. One the one had we have world renowned experts who spent years on this review, and on the other hand we have complete amateurs who are so filled with activist rage that they don't even read the documents carefully before banging out their criticism. -- Colin° Talk 10:39, 22 June 2024 (UTC) reply

I think we need to be careful to avoid the trap that many culture-war articles fall into. There's a great tendency, for a subject one hates, to google articles that criticise it and then push hard for them to be included. We see it on all sides of these debates. The hope is that some of the shit thrown will stick. I despair. It isn't how articles should be written. We have here a respected consultant paediatrician asked to conduct an independent review. They spend four years consulting with experts on all sides and with patients and their parents. They commission a bunch of systematic reviews from the top academics who are expert in in conducting such reviews. Their systematic reviews are published in a top journal. Their final report is published and recommendations put into practice. And then some marmoset researcher from Germany gets their criticism published in a big paragraph on Wikipedia as though that's it: Cass Review is a pile of crap after all, because someone who studies monkey calls for a living says so. Can you imagine if our cancer or diabetes articles were written that way. That the UK approach to diabetes treatment was held up to criticism because some car mechanic from Croydon disagrees, and claims the whole thing is dodgy because they found a typo on page 13. If you sat down and wrote an article on diabetes treatment in the UK, would you consider a car mechanic to have any relevance? So why on earth should a monkey brain researcher be relevant? -- Colin° Talk 11:01, 19 June 2024 (UTC) reply

Why are you bringing up Grijseels' past paper about monkey neuroscience in this thread as if to insinuate they aren't a human neuroscience expert? If I just wanted to insert any old paper criticizing the review, I would have started with Horton's published before the final report, but I started this section about two papers (one forthcoming) that offer very substantial critiques of the evidence base. Grijseels' paper published in a top transgender medicine specialist journal deals with, as I mentioned: brain development, structure, and comorbidity with neurodevelopmental conditions, which are key to the critique. VintageVernacular ( talk) 11:31, 19 June 2024 (UTC) reply
On top of that, Scientific journals, by design, don't care about author credentials. They aren't allowed to care, and it would majorly dent their credibility if they did. We cite people by their initials and use things like double-blind peer review to avoid tunnel-visioning on author credentials. This is scientific method 101. -- Licks-rocks ( talk) 11:38, 19 June 2024 (UTC) reply
This might be so for actual scientific research. Not so for commentary pieces like this one (I have absolutely no idea why it is tagged "research article" in the header, as it certainly isn't scientific research: the introduction describes itself as a "commentary" so the question for any journal editor or journal reader is why we should care to listen to their commentary). The author's credentials do actually matter to Wikipedia. Are they someone who is notable for their expertise with systematic reviews (doesn't appear they have ever done one, let alone written about them). Are they someone who is notable for their expertise with clinical studies of healthcare in humans (no, they do their science on mice, monkeys, or computer models). Are they an expert in trans healthcare or at least adolescent or mental healthcare (no, they work in a lab). This paper gives us an idea of motivation for why the sudden shift to writing an attack piece on a review, but motivation is not expertise and motivation of editors here to include this piece is also not a reason we should include it. It's a rather weak document, a rambling list of things the author decided to be critical about, with no knockout findings (such as a missing gold-standard study that actually provides the evidence that Cass says isn't there). -- Colin° Talk 11:01, 22 June 2024 (UTC) reply
Why is it significant the writer signed a letter in a top journal, Cell, calling for challenging discrimination? It may tell us where the writer is coming from but has no actual bearing on the merit of the arguments in the paper. VintageVernacular ( talk) 11:40, 22 June 2024 (UTC) reply
You're correct that promoting their vision for justice in one letter does not tell us anything about the merits of the arguments in another paper. It suggests a certain amount of bias (remember that bias is okay in reliable sources), but does not tell us whether the arguments are good or bad. To find out whether the arguments are good or bad, we would need another reliable source. In between now and the appearance of such sources, the best we can usually do is to follow the WP:PRIMARY policy: we avoid relying on primary sources at all, and say only things that can be clearly supported from them, without commentary, editorializing, hyping, etc. WhatamIdoing ( talk) 21:18, 22 June 2024 (UTC) reply
An article on the Cass Review requires sources that analyze it multiple perspectives, using different methods. There is no reason why a study that analyzes the Cass Review, and points out certain issues, should be omitted from the article. Hist9600 ( talk) 14:47, 19 June 2024 (UTC) reply
There is an important context in this, which is that medical organizations around the world have similarly given harsh criticism of the Cass Report, so it's not like this paper is some isolated opinion.
We also have to keep in mind that the Cass Report has been ordered by a government from a country that has shown a dramatic rise in "the extensive and often virulent attacks on the rights of LGBTI people for several years" as highlighted in a report by the Council of Europe and scientists from a country are not immune to the pressure of scientific misconduct as a survey in the BMJ has shown is Scientific misconduct is worryingly prevalent in the UK, shows BMJ survey in the very journal that the Cass Review is based on, or that there are politics of LGBT+ Health Inequality at play in the UK.
So rather than repeating the arguments that the Cass Report is unimpeachable, it is not, we should ensure that we give due weight to the global response of it, be it from WPATH, EPATH or other scientists that publish papers in reputable peer-reviewed journals. Raladic ( talk) 15:26, 19 June 2024 (UTC) reply
We don't bring in sources that are not due because they say the same thing as other sources that are due. The opinions of relevant medorgs are already in the article. Draken Bowser ( talk) 16:14, 19 June 2024 (UTC) reply
medical organizations around the world have similarly given harsh criticism of the Cass Report
And the Cass Review gave harsh criticism of the standards produced by those medical organizations. So we have a dispute between high-level MEDRS, between what are supposed to be top-of-the-pyramid medical standards, and an equivalently-top-of-the-pyramid systematic review of those standards which found them wanting.
This is a hard disagreement to navigate, but it isn't on its own an excuse to bring in any old random paper that rubbishes the Cass Review as if it carries any weight.
as highlighted in a report by the Council of Europe
I am strongly in favour of a moratorium on trying to disparage sources from the UK by citing that Council of Europe declaration. Void if removed ( talk) 09:04, 21 June 2024 (UTC) reply
How did you come to the conclusion it's just some "random paper" and not a reasonable critique of the review by a scientist with relevant expertise + published in a specialist journal? It does seem to have due weight. VintageVernacular ( talk) 11:27, 21 June 2024 (UTC) reply
The author appears to have no professional expertise (only personal experience). WhatamIdoing ( talk) 21:20, 22 June 2024 (UTC) reply
Well, a PhD in neuroscience might equip you to better interpret brain research. But is that required to make a statement like: "A set of key points (7.16-7.20) [in the Cass Review] poses a possible link between increased availability of sexually explicit materials and gender dysphoria, based on an article by Nadrowski (2024). This article does not contain any primary research, but rather poses a yet untested theory. Indeed, the article itself notes that 'no studies have yet directly linked exposure to pornography with gender dysphoria' (Nadrowski, 2024, p. 294). The argument in the Nadrowski paper is not supported by data, and as the only source, is not sufficient to suggest a link"?
Or "they wrongly report the incidence of autism spectrum condition (ASC) as reported by Morandini et al. (2022), writing '[o]ne study reported data separately for 2012 and 2015 and demonstrated an increase from 1.8% to 15.1%' (Taylor et al., 2024d, p. 5), when the reported numbers were a non-significant increase from 13.8% to 15.1% (p= .662) (Morandini et al., 2022)."?
The journal editors, many of which I would expect do have professional expertise given the background, may have seen some value. VintageVernacular ( talk) 22:11, 22 June 2024 (UTC) reply
"The author is an expert in the subject matter" and "There is value in this publication" are largely unrelated concepts.
The author has studied questions like how a particular gene changes blood flow in the mouse brain and which part of the brain is used when monkey perceive a voice. That is not really relevant to the Cass Review, which is largely not about neuroscience.
But let me engage with the two bits you've quoted, because they might make good examples of the sort of decisions Wikipedia editors need to make.
  1. "Access to sexually explicit content" (7.16–7.20 in the report) is 11 sentences long. It is largely a recitation of statistics.
    • Grijseel says it "poses a possible link between increased availability of sexually explicit materials and gender dysphoria". If you wrote that in a Wikipedia article, we'd probably slap Template:Failed verification on it, because the relevant section in the final report says that other sources (e.g., "Research commentators recommend...") have posed this possible link.
    • Ditto for "as the only source", because anybody can see that three sources are named in that section: Children’s Commissioner, 2023" in 7.16, "Hanson 2020" in 7.19, and finally "Nadrowski, 2023" in 7.20. IMO Nadrowski could have been fairly described the only cited source from an academic journal, but that is not quite the same thing as "the only source".
    • Consider the claim that "The argument in the Nadrowski paper is not supported by data". This is a bit of a pot calling the kettle black situation, as Grijseel's publication is also not "supported by data" – in the narrow sense of "providing new data". There's nothing wrong with not providing new data; commentaries aren't intended to present new data, and neither are proposals for future research directions. But underneath it, all three (the Cass Review, Nadrowski, and Grijseel) agree: Nadrowski says there's not been much research about this, Cass says there's not been much research about this, and Grijseel says there's not been much research about this.
  2. About "they wrongly report the incidence of autism spectrum condition (ASC) as reported by Morandini et al. (2022), writing '[o]ne study reported data separately for 2012 and 2015 and demonstrated an increase from 1.8% to 15.1%' (Taylor et al., 2024d, p. 5)..."
    • This is not in the final Cass report, and as far as I can tell from a quick search, that paper was not cited in support of any claim about any alleged increase in autism in the final report.
    • The error appears to be accurately described, but it seems like it would be more relevant to alert the editors of the journal where the error was published, so they can issue a simple correction (losing a single character is often the result of a typo).
    • Neither the Cass report nor the paper that contains the error claims that these numbers show a significant increase. Therefore this error doesn't seem relevant for us here, when we are writing Cass Review.
Overall, it feels like these statements are true (in some sense) but sort of stretching to find every possible complaint – less "This is fundamentally misguided" and more "How dare they rely on a paper that contains a typo!" WhatamIdoing ( talk) 23:32, 22 June 2024 (UTC) reply
I'd also add that since 13.8 is higher than 1.8, the only result will be to fractionally increase the estimated prevalence of ASC in this demographic.
This really does seem to be the only substantive criticism. The rest is padding. Void if removed ( talk) 08:06, 23 June 2024 (UTC) reply
We would slap a "failed verification" label on it? In the "Increase in referrals" section, that exact same claim about the review is made.
The ASC incidence is significant to what the Cass final report says on pages 93 and 97 where "ASD" stands for "autism spectrum disorder", and it cites the exact same systematic review, quoting it to say the increase in referrals was accompanied by "higher than expected levels of ASD". VintageVernacular ( talk) 10:29, 23 June 2024 (UTC) reply
The systematic review assessed multiple papers and synthesized an average, this is detailed in the paper.
If one of the two dozen or so figures they used was erroneously too low due to a typo, will correcting it make the average go up or down do you think? Void if removed ( talk) 11:14, 23 June 2024 (UTC) reply
I agree with Void about this Council of Europe thing. I'm utterly fed up with this xenophobic nonsense that no researchers in England are capable of higher thoughts because Liz Truss once said something awful. And the commentary is not by a scientist with "relevant expertise". That very very much is not the case. They are an activist who is writing outside their field of expertise. This frankly is a repeat of MMR and Covid silliness, where people are given a platform because they are on a particular side in a culture war, not because they actually know anything about the science or healthcare matters from an expert position. -- 11:05, 22 June 2024 (UTC) Colin° Talk 11:05, 22 June 2024 (UTC) reply
Could you explain how brain science is outside the expertise of a neuroscientist? VintageVernacular ( talk) 11:24, 22 June 2024 (UTC) reply
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