Talk:Cass Review/Archive 10

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New Source in the BMJ addresses Yale white paper and BMA

Recently published in the BMJ, is quite scathing about the Yale report. One to discuss.

https://adc.bmj.com/content/early/2024/10/13/archdischild-2024-327994

This sort of thing is why I wanted to move away from the current bloated "response" structure. It's getting complicated and the responses are evolving and generating their own responses. Void if removed (talk) 21:17, 14 October 2024 (UTC)

Void if removed how would you prefer to restructure it? FirstPrimeOfApophis (talk) 21:27, 14 October 2024 (UTC)

See here Void if removed (talk) 21:30, 14 October 2024 (UTC)

OK, I support it. FirstPrimeOfApophis (talk) 21:49, 14 October 2024 (UTC)

I think adding responses to the Cass Review is obviously necessary, but adding all these different responses to other responses to it like that article may be overdoing it. I think that everything that's currently in the article is fine, but do we really need to add every new article that is released criticizing or giving an opinion on another organization's response? Some may be an exception, but for the most part, I think we should just stick with organizations responding to the Cass Review instead of organizations responding to other organizations on it. That would help prevent the response section from becoming more "bloated" in the future. Usr Trj (talk) 03:54, 15 October 2024 (UTC)

This adds significant new perspective on some existing content (especially the Yale white paper). It is a high quality, peer-reviewed source, far better than some recent additions, and clearly WP:DUE. Aside from direct responses and additional context applicable to claims currently in this page, the paper also has lots of information that can be used as a high quality source to expand the background, implementation and general reception. For example:

The purpose of the Cass Review was to make recommendations to the National Health Service (NHS) in England (NHSE) on how to improve services for people under 18 experiencing issues with gender identity. It was underpinned by a robust research programme, engaged over 1000 stakeholders and took 4 years to complete. The results of the Review were embraced by the UK clinical community, as well as a number of other professional and third sector organisations and both main political parties. The editor-in-chief of the BMJ aptly observed, ‘The Cass Review is an opportunity to pause, recalibrate, and place evidence informed care at the heart of gender medicine. It is an opportunity not to be missed for the sake of the health of children and young people.’ NHSE accepted the Review’s recommendations in full and has initiated a 3-year implementation plan.

Void if removed (talk) 08:44, 15 October 2024 (UTC)

I am not in favor of responses to responses either Snokalok (talk) 12:02, 15 October 2024 (UTC)

If we have a low-quality initial response that is debunked by a high-quality further response (like here), it isn't acceptable for us to present only the initial source. This will lead to WP:FALSEBALANCE between responses and mislead readers. FirstPrimeOfApophis (talk) 16:34, 15 October 2024 (UTC)

Void if removed on second thoughts, separating immediate and further responses seems risky. For example, a reader will read our lengthy and uncritical presentation of the Integrity Project paper in "Initial Responses" and not be informed of its flaws unless they read the "Further Responses" section as well, where we present a summary of this peer-reviewed journal article. This risks amplifying misinformation.

As a compromise, I suggest where further responses address a specific initial response, the initial response and further response should be presented in the same place. Where further responses address a range of initial responses (e.g. this: https://www.bmj.com/content/385/bmj.q1141) they should go in a "Further Responses" section. FirstPrimeOfApophis (talk) 16:34, 15 October 2024 (UTC)

In an ideal world, what I would like to see is:

• Background
• Methodology
• Interim Review
• Final Review
  • Findings
  • Recommendations
  • Implementation
• Reception
  • UK Political (Labour, Conservative, SNP)
  • UK Medical (NHSE, RCPCH, RCGP, BPS, RCP, AoMRC, BMA)
  • International Medical (AAP, Endocrine Society, CPS, AUMC, WPATH, PATHA)
• Subsequent Events
  • Ban on private puberty blockers
  • Adult clinic review
  • Scottish gender clinics
• Wider Response
  • Cass Reflections on review
  • Yale team criticism (inc. response)
  • Scholarly reactions
  • Others etc...
  • Popular media

Keep reception to the best, most relevant, highest quality and immediate responses. Cull or rehome everything else in "Wider Response". Void if removed (talk) 17:00, 15 October 2024 (UTC)

Interesting. So Final Review > Implementation would only be what is currently in the NHS England section? FirstPrimeOfApophis (talk) 17:43, 15 October 2024 (UTC)

Yes - I think the other points are notable fallout of the Cass Review, but not actually to do with its implementation. Void if removed (talk) 19:07, 15 October 2024 (UTC)

I don't like the idea of separating reception and responses since many people see those things as one and the same. But IF that happens, the RANZCP and JSPN should be kept with the others in the "International Medical" section. What would "Scholarly reactions" be? I don't know what "Popular media" would entail. Usr Trj (talk) 12:11, 16 October 2024 (UTC)

There are quite a few red flags with this paper:

• 1) probably shocking almost nobody, one of the authors is the founder of SEGM (hardly independent from the Yale group)
• 2) The section "Medicine, law and The Integrity Project" paints a ridiculously incomplete picture of trans healthcare in the US
  • 1) It says WPATH, the endocrine society, and trans advocacy groups oppose such bans - ignoring that every major medical org in the US opposes those bans including places like the AAP and APA
  • 2) It neglects to note the states banning trans healthcare do so entirely due to conservative and anti-LGBT advocacy groups
• 3) "Criticism of the Cass Review process" is fairly weak
  • 1) Yale, and many others, have questioned putting somebody with no experience with trans kids in charge of their future across a country. The paper's response to that seems to be "nuh uh, we wanted somebody like that". That's a difference in values, not an error. Besides, they note that applied to the named systematic reviewers too, not just Cass.
  • 2) The statement this is critiquing, "many of the Review's author's identities are unknown", cites Following the completion of the "research programme" by the University of York, "A Clinical Expert Group (CEG) was established by the Review to help interpret the findings" (p 26), defined as "clinical experts on children and adolescents in relation to gender, development, physical and mental health, safeguarding and endocrinology" (p 62). There is no further information about the qualifications of the members of the CEG, nor how they were selected. This paper says Cass was the sole author and mixes up the Review's CEG with it's CPG, ignoring the critique that Cass had an anonymous group discuss how to transform reviews into policy recommendations, and then guffs about "polarization" justifying a secret panel helping develop the recommendations.
  • 3) Their critique of Yale is that "McNamara et al assert that the Review contravenes standard practice in scientific evaluations by not using GRADE in its recommendations" but they don't, they point out that CPGs are subject to greater scrutiny and scientific rigour than the Review was
• 4) It completes skips over the reports criticisms of Cass misrepresenting data and repeating false claims (ie, most kids desist)

There were many more issues in this paper, but I wanted to flag some obvious ones. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:44, 15 October 2024 (UTC)

Thank you for doing the work to actually interrogate this source. Snokalok (talk) 20:57, 15 October 2024 (UTC)

This looks like a peer-reviewed paper (I assume? I don't know) in a respectable journal, about the subject of the article, and hence quite reasonably eligible to be used as a source, unless there is some overriding reason that it should not be considered reliable. Disagreeing with the conclusions of the paper are not a reason for it not to be considered a reliable source. In short, I don't think your red flags are very red. In long:

1) Guilt by association fallacy based on one of the five authors (not the lead author).

2) It's not the job of this paper to present a complete account of trans healthcare in the US.

3.1) The Integrity Project paper says they would have preferred a review led by someone with industry experience. This paper says they think that would have compromised independence. On this matter, the two papers disagree. So yes, that's not an error.

3.2) What do you mean by "it's CPG"? The paper states that there were over 1000 individual contributors and that it wouldn't have been appropriate to name them. Maybe you would have preferred Cass name them. That's an opinion, not a red flag.

3.3) McNamara et al does make that assertion, on page 9: The Review introduces GRADE (p 55) but never evaluates the evidence using the GRADE framework.. This paper explains that (a) the NICE systematic reviews did use GRADE, and (b) GRADE is indeed (appropriately) absent from the Cass Review recommendations: but this is because GRADE is a tool for CPGs and not designed for Reviews

4) Maybe you think the paper should have covered more ground, but that's not a red flag.

Ultimately this paper is part of the ongoing back-and-forth conversation between increasingly disconnected groups of researchers, and our job here is to summarise that conversation with due weight, not to submit our own entries in the debate.

Barnards.tar.gz (talk) 23:12, 15 October 2024 (UTC)

1) SEGM's affiliation does raise issues of WP:DUE, WP:FRINGE, and WP:INDEPENDENT

2) It said it's job was to situate the Yale report in it. It failed and presented a both-sides-ism between anti-LGBT lobbying groups and every major medical org.

3.2) The Cass Review says The research programme, led by the University of York, comprised appraisal of the published evidence and guidelines, an international survey and quantitative and qualitative research. A Clinical Expert Group (CEG) was established by the Review to help interpret the findings. The cass review repeatedly mentions this group, separately from the workshops and broader polls (see page 62-63). The red flag here is the BMJ's strawman, Yale never called for all those contributors, just the CEG, and the paper is misrepresenting who Yale is talking about. If BMJ said "how dare you ask for the CEG", that'd be a difference of opinion, them saying "you're asking for thousands of names" is nonsense.

3.3) Here, we compare the Review’s approach with one of the most widely accepted frameworks for determining evidence quality: Grading of Recommendations Assessment, Development and Evaluation (GRADE).1 and Clinical practice guidelines throughout medicine consider all relevant factors, but the Review takes the unusual step of elevating its own assessment of evidence quality above the considerations that guideline developers value. and The Review fixates on evidence quality to the exclusion of many other factors that are rigorously considered by the developers of clinical practice guidelines - Simply put, the Cass Review made recommendations for how trans kids should be treated clinically. They did the work of a CPG without the rigor is Yale's critique, and the papers defense is "it isn't officially a CPG so the unrigorous recommendations are fine".

4) Yale noted multiple false statements in the Cass Review. A paper supposedly dissecting it and defending the Cass review ignoring those is noteworthy. At a minimum, it means any attempts to downplay the false statements noted by Yale can't be done using this as some gotcha.

our job here is to summarise that conversation with due weight - a flawed paper co-authored by the head of a pro conversion therapy group attacking strawmen hardly seems due to me. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:56, 15 October 2024 (UTC)

@Barnards.tar.gz, the metadata for the BMJ article gives the date of acceptance, which is usually a good indicator that it's peer reviewed.

This source ticks all the boxes for the WP:MEDRS ideal. BTW, it looks like this would be a good moment to mention WP:MEDASSESS:

Here, "assess evidence quality" essentially means editors should determine the appropriate type of source and quality of publication. Respect the levels of evidence: Do not reject a higher-level source (e.g., a meta-analysis) in favor of a lower one (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source. Editors should not perform detailed academic peer review.

Things like whether one of the authors has been cancelled for holding a reprehensible POV, or that we think they ought to have mentioned a longer list of organizations, are not actually valid criteria according to MEDRS.

@Void if removed, have you considered a structure that is more topical? Like:

• Multiple centers: Cass recommends, and nobody cared (except maybe some non-London-based parents who will spend less time schlepping their kids halfway across the country to these appointments).
• Future research: Cass recommends, but This Group has some concerns about privacy.
• Puberty blockers: Cass discourages, and was roundly condemned by a long list, who in turn were criticized by That Group.

In other words, instead of having separate ==Findings== and ==Responses== sections, let's have multiple ==Content with responses== (sub)sections. WhatamIdoing (talk) 01:28, 16 October 2024 (UTC)

I just want to make clear that the alleged reprehensible POV is being part of an organisation that maintains the importance of exploratory psychotherapy, which the Cass Review makes explicitly clear is not conversion therapy, stating that it is harmful to conflate the two - indeed, one of the systemic failings identified was that clinicians were fearful of being accused of "conversion therapy" if they engaged in bog-standard exploratory psychotherapy, and so dumped their patients straight onto GIDS, further overloading the service. That this (IMO highly pertinent) perspective is not mentioned in the article on the subject is of course a subject of much discussion over many months. IMO, Wikipedia is not a reliable source, and the BMJ is.

As for restructuring - I think it is important to have the findings together, as they are all of a whole, and that lets the reader understand the scope and intent of the review. I think interspersing that with criticism is going to make it exceptionally hard to read what the report actually covered, especially given the interdependence of some findings and the criticism thereof. Inevitably, anything on blockers would balloon, but it overlaps with findings on desistence, mental health, social transition, reliability of international standards etc etc.

Perhaps another approach would be to keep findings as-is, have the immediate reception from the major bodies, then move implementation after reception, and have coarser implementation measures (blockers etc), along with criticism of those measures? Void if removed (talk) 08:33, 16 October 2024 (UTC)

I just want to make clear that the alleged "reprehensible POV" is the plain facts SEGM opposed bans on conversion, is known for spreading pseudoscience, has attempted to ban public healthcare for trans healthcare for all ages, and works with the conversion therapy groups like the American College of Pediatricians. RS point out SEGM is inseperable from Genspect, which has done all the same, but also operates a discord for how to put kids through conversion therapy. These are ridiculously FRINGE and trying to paint that as "they just support psychotherapy" is nonsense.

Your Sandbox link misrepresents sources and puts actual peer reviewed work next to opinion pieces from SEGM leaders and their primary sources. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:11, 16 October 2024 (UTC)

This is completely irrelevant to discussion of how to incorporate the response in the BMJ into the article on the Cass review; further attempts to argue about SEGM should be removed per WP:NOTFORUM. 212.36.63.7 (talk) 18:24, 16 October 2024 (UTC)

It’s not irrelevant, it’s interrogating a source. Being from an RS doesn’t make a source necessary reliable, and vetting sources is a fully reasonable thing for an editor to do. Snokalok (talk) 22:57, 16 October 2024 (UTC)

Interrogating a source is reasonable. Dismissing a peer-reviewed source in a top-tier medical journal by claiming it is WP:FRINGE is not though. Do you have a reason not to cite this? It seems to me to be significant and relevant, and higher quality than several other sources used on this page. Void if removed (talk) 09:42, 17 October 2024 (UTC)

Yes, all the reasons YFNS said and also the fact that responses to responses is something that I and several other editors don’t agree with for this article. The Wakefield study was peer reviewed and published in a top tier journal too, by the logic you’ve presented here that should be sufficient for inclusion. Snokalok (talk) 10:42, 17 October 2024 (UTC)

I knew someone would try the 'but Wakefield' line. I have no idea why it doesn't apply to sources like the Integrity Project or Horton which have even less standing, but which support the POV you want to push. If the BMJ has fucked up to that extent then there'll be plenty of RS coverage and an eventual retraction which we can definitely put in this page; until then, let's stick with established MEDRS rules. None of the reasons YFNS gave are remotely relevant to whether the source is reliable and due: point 1 is just irrelevant guilt-by-association; and 2-4 are an attempted debunking of the contents of the article, of no bearing here because YFNS' arguments on this talk page are not a WP:MEDRS. 212.36.63.7 (talk) 12:02, 17 October 2024 (UTC)

Horton is a poor example: A peer reviewed study published in the leading journal of trans healthcare that isn't mentioned anywhere in the article despite being cited by nearly every source criticizing the Cass Review. It is 4 times as due as the BMJ piece, and the only apparent reason for not including it is it doesn't support the POV some editors want to push :) Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:16, 17 October 2024 (UTC)

This isn’t even a research paper though, it’s an opinion piece by a freelance journalist Snokalok (talk) 11:33, 16 October 2024 (UTC)

You might be thinking of earlier investigation by Jennifer Block, the source currently under discussion is a peer-reviewed paper with five co-authors. Void if removed (talk) 12:01, 16 October 2024 (UTC)

Oh I see, my mistake Snokalok (talk) 22:54, 16 October 2024 (UTC)

I like your idea on the structure. I think that is also somewhat in line with the spirit of WP:CRITS, providing balanced treatment of each topic, rather than repeating the Cass POV in one section and all the criticism (and the criticism of that criticism etc.) in another section. -- Maddy from Celeste (WAVEDASH) 15:43, 16 October 2024 (UTC)

I also think this structure is better. Loki (talk) 15:57, 16 October 2024 (UTC)

I can't see that being a terribly useful article to the reader.

• The Cass review found x relating to puberty blockers
  • WPATH condemned this and said it was bad
  • Yale published a white paper saying it was bad
  • Someone got a letter to the editor published saying they read how the Yale paper said it was bad
  • Japanese guidelines referred to the Cass review and carried on prescribing blockers
• The Cass review found x relating to social transition
  • WPATH condemned this and said it was bad too
  • Yale published a white paper saying it was bad too
  • Someone got a letter to the editor published saying they read how the Yale paper said it was bad as well

And so on...

You can't separate these things out like that when they are all interrelated.

This is a recipe for an unreadable mess. Void if removed (talk) 16:02, 16 October 2024 (UTC)

Agree with @Void if removed. That will make it impossible to follow the Cass Review or what any of the others are saying about it. Zeno27 (talk) 17:54, 16 October 2024 (UTC)

@Zeno27, I'd like you to imagine a paragraph that says something like this (I'm making this up):

The Cass Review found that social transition should be approached cautiously, as if it were a behavioral intervention with potentially lasting effects. The Twitterverse ridiculed it for saying that haircuts were medical treatments that needed approval from a doctor. WPATH and Yale said it was bad and there's no evidence behind it.

Can you tell me how this make it difficult to figure out what the critics are saying about this part of the Cass Review? Do you really think that it's harder to find out what Cass said and what critics said when they're all in the same paragraph, instead of having one paragraph towards the top of the article that has the first sentence, and all the critics responses several screens lower in the article? WhatamIdoing (talk) 23:23, 19 October 2024 (UTC)

I will say that the way you've phrased that paragraph is maybe not the best example because it's currently unclear whether WPATH is criticizing Cass or the Twitterverse. Loki (talk) 23:29, 19 October 2024 (UTC)

My issue with presentation like that is the possibility of false balance, that is when (as in your example) what Cass is summarising is the findings of a systematic review. We wouldn't ordinarily present a MEDRS like that with people griping about hyperbolic misrepresentations of it on social media.

My other issue is the degree to which criticisms of the Cass Review are holistic: that is allegations of excluding evidence, cisnormative bias, involvement of allegedly FRINGE groups etc. These are criticisms that aren't simply point by point, they are levelled at the report as a whole and underpin all criticisms.

I think we're much better explaining what the report as a whole was about and give coverage to why people objected to it as a whole, because I think that really gets to the heart of a significant difference of opinion, which is (broadly):

• Cass approached this as children and young people experiencing gender-related distress, and how to alleviate that with a minimal harm approach
• Critics believe these are transgender children and young people, and that affirmation of that identity alleviates distress

Everything spins out of this difference of perspective, and I don't think reiterating it piecemeal throughout the review's findings capture quite how fundamental it is. When people object to Cass' findings and recommendations on social transition, or puberty blockers, or diagnostic overshadowing, or desistence, or exploratory therapy, that all stems from this different perspective. It is also exceptionally hard to talk about because of the strong social stigma associated with anything that even remotely looks like denying someone's identity - but from the critical perspective that's essentially the starting point of the Cass Review.

To navigate this requires looking at the same patient group from two entirely different and fundamentally incompatible perspectives and fairly rendering both positions neutrally. Void if removed (talk) 09:06, 20 October 2024 (UTC)

Also agree with @Void if removed. The actual findings and recommendations of the Review should be as clear as possible to the reader, and the best way to do that is keep them separate from other content. The ongoing political and scientific discussion of those findings and recommendations should be introduced separately, where all DUE and RS sources can be included. FirstPrimeOfApophis (talk) 19:28, 16 October 2024 (UTC)

I'm cautiously optimistic towards restructuring the article. Is there a ballpark estimate for the number of subsections required if we go with the content with responses-standard? Draken Bowser (talk) 18:14, 16 October 2024 (UTC)

SEGM's affiliation does raise issues of WP:DUE, WP:FRINGE, and WP:INDEPENDENT — Yes, it raises issues of how WP:FRINGE can possibly be applied to a peer-reviewed article in the BMJ because of affiliations of one of its authors. The policy simply cannot be applied here: peer-reviewed BMJ articles on gender medicine are part of mainstream gender medicine. If anything, SEGM's founder being published in this context is evidence against the organisation more broadly being treated as FRINGE. 212.36.63.7 (talk) 15:30, 16 October 2024 (UTC)

Lengthy analysis of the Cass Review in The Times, with coverage of this paper: https://www.thetimes.com/uk/healthcare/article/six-months-on-how-has-the-cass-review-reshaped-gender-medicine-cj33lsgnm

In an article published this week in the Archives of Disease in Childhood, a peer-reviewed British medical journal, a group of leading paediatricians identified a series of unfounded claims, misrepresentations and factual errors in the US paper that underpins the BMA’s stance. They found the McNamara paper was “tailored for the courtroom” and written with the “primary purpose” of supporting lawsuits in the US, where the issue of gender medicine remains bitterly divided along party political lines and is settled through legal action. It warned that doctors should not use the flawed paper to “jeopardise the implementation of crucial reforms” in the NHS. The lead author Dr Ronny Cheung, a paediatrician based in London, said the US report had been “very influential in swaying online discourse” and he was “very surprised” it was cited by the BMA, whose stance is at odds with the rest of the medical profession. “The overwhelming response from medical royal colleges, and politicians on both sides of the debate, has been to recognise the potential for the Cass Review to help us move things forward,” Cheung said. Cass welcomed moves to debunk the critiques of her report. She said it had been “frustrating” to see her report misrepresented, but that “it is heartening to see respected clinicians and academics now feel able to challenge the misinformation”.

Void if removed (talk) 08:58, 19 October 2024 (UTC)

Snokalok can you clarify why you have reverted this change http://en.wiki.x.io/w/index.php?title=Cass_Review&diff=1251696753&oldid=1251695385? "strong dispute" needs to be based on actual WP policies to be relevant, otherwise it is just WP:STONEWALLING. Please see Barnards.tar.gz and WhatamIdoing's detailed policy-based response to the supposed "red flags" above. FirstPrimeOfApophis (talk) 17:58, 17 October 2024 (UTC)

Omg my notifs are working again!

Anyway, the complaints are numerous and reasonable.

1. responses to responses are unnecessary and UNDUE (not capitalizing this to yell, just to highlight the policy) for the article.

2. The source is not INDEPENDENT and has affiliation with a FRINGE organization that pushes conversion therapy.

3. DUE weight is also called into question by the fact that we’ve already agreed to cut much more consequential papers on the Cass Review, such as Cal Horton, for reasonable reasons.

4. Whether MEDRS even applies to criticism here is tenuous, since this isn’t an article on puberty blockers, GAC, or anything else, it’s an article on a published document - and while the material of that document is biomedically-related, ultimately the subject of the article is the document itself. The Cass Review here is not being cited as a source on puberty blockers, it’s being cited as a source on the Cass Review. This is as much of a history article as it is anything else.

There is not a consensus that these issues are sufficiently mitigated, irrelevant, or overcome. I don’t even know if there’s a majority opinion, though that is certainly still a lower bar than a consensus. Thus, we shouldn’t be including it. We wouldn’t include the Wakefield study on a relevant article without consensus either. Snokalok (talk) 18:38, 17 October 2024 (UTC)

To clarify, what I meant by strong disputing is that like half the editors on this page are against its inclusion on valid grounds. Snokalok (talk) 18:41, 17 October 2024 (UTC)

A reminder that we're talking about a living person, that WP:BLP applies to talk pages, and that "pushes conversion therapy" is a strong claim.

Do you have a source for "pushes conversion therapy" that isn't self-published and doesn't boil down to claiming "exploratory therapy is conversion therapy"? Because - I repeat - the Cass Review says it isn't. Void if removed (talk) 21:51, 17 October 2024 (UTC)

The Cass Review is only one study, and the vast majority of sources say that SEGM pushes conversion therapy. Also, SEGM is an organization, not a person, living or otherwise. Loki (talk) 23:57, 17 October 2024 (UTC)

The Cass Review is only one study

The Cass Review is not a study, it is an independent review.

SEGM is an organization, not a person, living or otherwise

We are talking about the 5 co-authors of this paper, one of whom founded SEGM. I think we're in BLP territory if you want to exclude a MEDRS on the basis that one of the authors founded, in your words, an organisation that "pushes conversion therapy" Void if removed (talk) 07:53, 18 October 2024 (UTC)

I’m going to go through this point by point because there’s so much to unpack here.

1. BLP doesn’t apply to organizations, and the individual’s connection itself to SEGM (which is the only thing BLP would apply to here) is yet undisputed.

2. Since the point you’re disputing is whether SEGM as an organization pushes conversion therapy, let’s look at SEGM.

Copy pasted from the SEGM page

“In May, 2021, SEGM called for an amendment to the Canadian criminal code C-6, which outlawed conversion therapy, falsely claiming that conversion therapy can only be applied to lesbian, gay, and bisexual people as opposed to transgender people as well. This position is not supported by any major medical organization, which define conversion therapy as including efforts to change sexual orientation or gender identity.” Cited to Science-Based Medicine[1]

So already, we have a clear example of them pushing for anti-trans conversion therapy, regardless of specific techniques employed, to remain legal.

3. I’m also glad you agree already that SEGM pushes the specific technique of gender exploratory therapy, good, because GET is widely considered conversion therapy. Here’s a collective statement I pulled from the GET section of the conversion therapy page, by six major MEDORGS all specializing in trans care saying that GET is conversion therapy (see section 9)[2]

4. I don’t recall the Cass Report, which as I recall is not peer reviewed, ever saying such a thing. The most it said about gender exploratory therapy was that there was an unhelpful lack of clear definition for the terms “affirmative” and “exploratory” in a treatment context. But please, if I’m wrong, show me. Snokalok (talk) 07:29, 18 October 2024 (UTC)

six major MEDORGS all specializing in trans care saying that GET is conversion therapy

I'm glad you cited this, because that is WPATH's response to the Interim Cass review, calling the "psychotherapeutic" approach and "exploratory therapy" "tantamount to 'conversion'".

These were defined in both the Interim and final review as:

Therapeutic approaches that acknowledge the young person’s subjective gender experience, whilst also engaging in an open, curious, non-directive exploration of the meaning of a range of experiences that may connect to gender and broader self-identity (Bonfatto & Crasnow, 2018; Churcher Clarke & Spiliadis, 2019; Di Ceglie, 2009; Spiliadis, 2019)

I made this point to you back in June. So now we're all clear that the exploratory approach described in the Cass Review is the same thing as the what SEGM advance, and that Cass says is not conversion, and that it is harmful to compare the two. Void if removed (talk) 08:18, 18 October 2024 (UTC)

Alright, then we get a new problem - the fact that the Cass Review, while it does rely on systematic reviews, is not a systematic review itself, merely the opinion of an unknown list of individuals led by Hillary Cass without, to my knowledge, peer review. That does not make it particularly definitive; and it is not for the British government to unilaterally dictate what is and isn’t conversion therapy in contravention to the global field of trans health, as represented by the assortment of medorgs I cited above. The wider consensus of the global medical field remains that GET is conversion therapy, and may I repeat: SEGM has advocated for trans conversion therapy to remain legal regardless of whether it takes the form of GET or not. Snokalok (talk) 08:40, 18 October 2024 (UTC)

it is not for the British government

As I'm very tired of repeating, an independent review commissioned by NHSE is not the British government.

SEGM has advocated for trans conversion therapy to remain legal

That isn't what the sources say.

What they actually said in 2021 was:

In young people, gender dysphoria arises from a wide range of causes, often in complex developmental and family contexts (Churcher Clarke & Spiliadis, 2019; D’Angelo, 2020). Should Bill C-6 pass as written, it will effectively make it illegal to consider the role of developmental, family, and mental health issues in generating or contributing to a young person’s gender dysphoria. There is a very real risk that all forms of supportive and explorative psychotherapies for young patients who present with gender dysphoria will be classified as “conversion”.

And what the Cass Review said in 2024 was:

concerns were expressed about potential accusations of conversion practice when following an approach that would be considered normal clinical practice when working with other groups of children and young people. Throughout the Review, clinicians working with this population have expressed concerns about the interpretation of potential legislation on conversion practices and its impact on the practical challenges in providing professional support to gender-questioning young people. This has left some clinical staff fearful of accepting referrals of these children and young people. Clinical staff must not feel that discharging their clinical and professional responsibility may expose them to the risk of legal challenge, and strong safeguards must be built into any potential legislation on conversion practices to guard against this eventuality. This will be of paramount importance in building (as opposed to diminishing) the confidence of clinicians working in this area. Any ambiguity could serve to further disadvantage these children and young people rather than support them.

These are the exact same thing. Expressing concerns about the potential criminalisation of exploratory psychotherapy is not "pushing conversion therapy". Bearing in mind that what you're arguing is that a peer-reviewed source published in a well-respected medical journal should not be cited because you're claiming one of the five authors founded an organisation which pushes "conversion therapy", do you actually have a source for that which isn't based on the claim psychotherapy is conversion and isn't also blatantly applicable to the Cass Review itself? Void if removed (talk) 09:51, 18 October 2024 (UTC)

This discussion is irrelevant and distracting. You can't decide in a Talk page whether or not exploratory therapy is the same as conversion therapy, and it has no bearing on whether or not this source should be included. Please try to stay on topic and avoid WP:FORUM. 62.172.33.18 (talk) 13:28, 18 October 2024 (UTC)

Snokalok thanks for this.

1. responses to responses are unnecessary and UNDUE for the article.

From WP:DUE "Neutrality requires that mainspace articles and pages fairly represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in those sources. (The relative prominence of each viewpoint among Wikipedia editors or the general public is irrelevant and should not be considered.)" (my emphasis)

Neutrality is not negotiable; it is not for editors to make arbitrary decisions like "we'll include early responses but not later responses which respond to those early responses".

2. The source is not INDEPENDENT and has affiliation with a FRINGE organization that pushes conversion therapy.

One of the five authors is co-founder and senior adviser to SEGM. Is this what you are referring to? She is not the lead author or the peer reviewer. One of the authors being involved in advocacy is not sufficient conflict of interest to discard a reputable source, otherwise we would have to discard the Integrity Report white paper.

Also see WP:ALLOWEDBIAS "A neutral point of view should be achieved by balancing the bias in sources based on the weight of the opinion in reliable sources and not by excluding sources that do not conform to the editor's point of view."

Considering how badly the white paper fails WP:INDEPENDENT adding this countervailing and more reliable source is the best way to achieve NPOV.

WP:FRINGE refers to theories, not people or organisations. There are no fringe theories articulated in this source. Whatever the authors believe (or not) outside this source is not relevant to determining the validity of this source.

3. DUE weight is also called into question by the fact that we’ve already agreed to cut much more consequential papers on the Cass Review, such as Cal Horton, for reasonable reasons.

This is an argument about other sources, not this one.

4. Whether MEDRS even applies to criticism here is tenuous, since this isn’t an article on puberty blockers, GAC, or anything else, it’s an article on a published document - and while the material of that document is biomedically-related, ultimately the subject of the article is the document itself. The Cass Review here is not being cited as a source on puberty blockers, it’s being cited as a source on the Cass Review. This is as much of a history article as it is anything else.

I don't really understand this. Are you saying it should be excluded because it meets MEDRS?

There is not a consensus that these issues are sufficiently mitigated, irrelevant, or overcome. I don’t even know if there’s a majority opinion, though that is certainly still a lower bar than a consensus. Thus, we shouldn’t be including it.

Opposition to changes is only valid if it is based on genuine Wikipedia policies. See WP:JUSTDONTLIKEIT.

FirstPrimeOfApophis (talk) 07:27, 18 October 2024 (UTC)

1. Yes, all significant viewpoints in proportion to their prominence. What is the prominence in the field of these criticisms of criticisms of criticisms? Has their been some manor surge in citations that would make this paper stand out in the field? What is paper’s significance, even, as a criticism of a criticism of a criticism? If Yale University and this group of researchers go back and forth in a locked room for centuries on end, shall we meticulously record every blow exchanged? Responses to responses are due I’d argue when they’re the Cass Review team or Cass herself responding to criticisms of their work, they are not due when it’s random people chiming in because then where does it end?

2. If an organization’s entire purpose is advocating for fringe theories, then it’s reasonable to say that the organization itself falls under fringe. Likewise, I notice you consider Yale biased for, reasons that aren’t clear. Certainly SEGM has a compelling interest in the furtherance of a biased goal, but what biased goal - what lack of independence - does the Yale group have that needs to be balanced? A look at their website says their only concern is scientific rigor as it applies to pieces of research which may affect policy. I see no bias in this org that needs to be balanced.

3. And? We’re applying our policies evenly, are we not?

4. No, I’m saying that whether or not the hierarchy of MEDRS is an applicable argument to begin with here is debatable.

5. You have your policy based arguments, other editors on this page have theirs which they’ve already stated, but at the end of the day, no matter how invalid you think other editors’ arguments are or how answered by your points they are, you don’t have consensus, and per WP:SATISFY, no one is obligated to satisfy you. Snokalok (talk) 07:48, 18 October 2024 (UTC)

You seem to think 'consensus' means that you get to veto the inclusion of this source no matter the majority opposing you. I'm afraid that's not how it works, and I would really appreciate it if you'd read the writing on the wall before I have to waste hours of my life writing up a complaint to the administrators about your extremely blatant POV pushing. 212.36.63.7 (talk) 13:12, 18 October 2024 (UTC)

No, consensus means not having half the thread against inclusion. But please, if you find that problematic, ask ANI, and you can explain how it’s not just me that’s challenging the inclusion of this source, it’s @LokiTheLiar, @Your Friendly Neighborhood Sociologist, @Usr Trj, @LunaHasArrived and I *think* @Maddy from Celeste(?) - none of whom are obligated to satisfy you simply because you don’t find their reasons for opposing inclusion to be good enough.

I’m not the only one vetoing inclusion. I’m just the one you’re arguing with right now. If it was just me, you’d have consensus since consensus doesn’t mean unanimous, but it isn’t. By my measure it’s about half the editors in this thread. But please, if you believe that to still be an issue, I invite you to ask ANI. Snokalok (talk) 13:47, 18 October 2024 (UTC)

I'll say I echo snokalok here and am especially concerned about including criticisms of criticisms. I would also say the Void should probably stop pushing for this article being included as it cites his substack (which strikes me as a minor COI and he should have mentioned). LunaHasArrived (talk) 13:58, 18 October 2024 (UTC)

Wait were you in this thread already or am I misremembering? Either way, I didn’t know about the COI but that feels really significant Snokalok (talk) 14:18, 18 October 2024 (UTC)

I've not been in this thread before (been in others surrounding). The Coi should probably have been disclosed (perhaps void should edit the first comment in this topic and insert it) and as I said, Void should probably stop pushing for inclusion. LunaHasArrived (talk) 14:32, 18 October 2024 (UTC)

Yes, you are 'misremembering'. Of the five people you mentioned only one, YFNS, expressed any opposition to the inclusion of the source in the thread or in the page edit history. 212.36.63.7 (talk) 14:33, 18 October 2024 (UTC)

I don't really have an opinion on the inclusion of the source, as I haven't looked into this besides just skimming this thread. I would, however, caution about using words like found here as it may imply accuracy and thus skew the POV. -- Maddy from Celeste (WAVEDASH) 14:02, 18 October 2024 (UTC)

Snokalok it looks like we will be moving to other forms of dispute resolution, but since you took the time to respond I ought to reply.

1. Yes, all significant viewpoints in proportion to their prominence. What is the prominence in the field of these criticisms of criticisms of criticisms? Has their been some manor surge in citations that would make this paper stand out in the field?

Where does "prominence in the field" come from? It is "...published by reliable sources, in proportion to the prominence of each viewpoint in those sources." The reliable source here is Cheung et al, an article published in a peer-reviewed medical journal, basically the highest level of RS on Wikipedia. The viewpoint is "the Integrity Project white paper misrepresented the role and process of the Cass Review, and its methodological criticism of Cass and the Yorkshire systematic reviews were unfounded." Whether or not you agree with that viewpoint, do you accept that that wording is proportionate to its prominence in the source in question?

What is paper’s significance, even, as a criticism of a criticism of a criticism?

It is significant because it was published in a peer-reviewed scientific journal. It is also significant as a response to Cass in its own right, because it examines the background, methodology, recommendations and implementation of the Review. Also AFAIK it is the only peer-reviewed published response to the Cass Review Final Report (maybe another editor can correct me on that?) so the views expressed therein are significant by default.

If Yale University and this group of researchers go back and forth in a locked room for centuries on end, shall we meticulously record every blow exchanged? Responses to responses are due I’d argue when they’re the Cass Review team or Cass herself responding to criticisms of their work, they are not due when it’s random people chiming in because then where does it end?

It ends when new significant viewpoints stop being published in reliable sources. Your comparison with a history article in point 4 above is apt. There are new significant viewpoints on historical events published in RS millennia after they took place. There is no arbitrary time-limit on a DUE source and editors cannot impose one of their own. Obviously, later sources will often be phrased as responses to earlier ones, that's normal scholarship.

2. If an organization’s entire purpose is advocating for fringe theories, then it’s reasonable to say that the organization itself falls under fringe.

It may be reasonable if you are using the word "fringe" in another context. WP:FRINGE refers to theories, not people or organisations. Anyway, it's a moot point, because SEGM hasn't published this article or contributed significantly to its preparation.

Likewise, I notice you consider Yale biased for, reasons that aren’t clear. Certainly SEGM has a compelling interest in the furtherance of a biased goal, but what biased goal - what lack of independence - does the Yale group have that needs to be balanced?

I am surprised you ask, because it is addressed prominently in Cheung et al:

"On the same day the paper was published on The Integrity Project website which is hosted by Yale Law School, a version of it was introduced into evidence in a landmark US legal case in which the lead author served as an expert witness. Another iteration has been submitted by the same author group to a Supreme Court case in the USA...Several of the McNamara et al coauthors have served and continue to serve as paid expert witnesses, so far in more than a dozen ongoing court cases over the practice of regulation of youth gender medicine, where they oppose the state bans on medical and surgical gender transition treatments. Various versions of McNamara et al have already been introduced into evidence in at least two high-profile court cases." (my emphasis)

From WP:IIS "An independent source is a source that has no vested interest in a given Wikipedia topic and therefore is commonly expected to cover the topic from a disinterested perspective. Independent sources have editorial independence (advertisers do not dictate content) and no conflicts of interest (there is no potential for personal, financial, or political gain to be made from the existence of the publication). Interest in a topic becomes vested when the source (the author, the publisher, etc.) develops any financial or legal relationship to the topic. "

A look at their website says their only concern is scientific rigor as it applies to pieces of research which may affect policy. I see no bias in this org that needs to be balanced.

Hopefully you can see why this is not a good way to gauge an organisation's bias.

3. And? We’re applying our policies evenly, are we not?

My point is, the Horton article was excluded for different reasons to the ones you are giving for excluding Cheung et al. They are unrelated.

4. No, I’m saying that whether or not the hierarchy of MEDRS is an applicable argument to begin with here is debatable.

I am not trying to be obtuse, but I still don't understand how this supports excluding Cheung et al.

FirstPrimeOfApophis (talk) 17:55, 18 October 2024 (UTC)

2.1) The founder of SEGM was one of the authors so I'm not sure how you got SEGM hasn't "contributed significantly to its preparation."

2.2) This circles back to my original red flag #2: Those bans are opposed by every major medical organization in the United States, and are only supported by anti-LGBT lobbying groups. For example, here's the APA[3], and here's the Endocrine Society, American Medical Association, American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Urological Association, the American Society for Reproductive Medicine, the American College of Physicians, and the American Association of Clinical Endocrinology[4], opposing these bans and saying As political attacks on gender-affirming care escalate, it is the responsibility of the medical community to speak out in support of evidence-based care.

- The BMJ piece takes issue with an organization following the advice of every major medical organization in the U.S., and tries to paint it as "transgender advocacy groups" vs states. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:45, 18 October 2024 (UTC)

SEGM's involvement is not relevant. You keep bringing them up so you can allege this makes the BMJ source WP:FRINGE, even though as a published peer-reviewed review article in a top medical journal it is part of the academic consensus used to determine which views are mainstream and which are fringe. Frank Forfolk (talk) 13:19, 19 October 2024 (UTC)

It certainly is relevant, or at least it can be relevant. If we were talking about a study over at race and intelligence, and it came out that one of the authors was a founder of the Pioneer Fund, that would be extremely relevant even if the study was peer reviewed and published in a mainstream journal.

Does it overwhelm everything else? No, and I'll admit that being peer reviewed in a mainstream journal certainly does count for something, but the dodgy authorship combined with the fact that it goes against the recommendation of most WP:MEDORGs suggests that we're at least in WP:FRINGE/ALT territory. Loki (talk) 20:21, 19 October 2024 (UTC)

That is an outrageous comparison. You're comparing literal Nazi eugenicists to one named co-author of a paper in a top medical journal. Void if removed (talk) 20:38, 19 October 2024 (UTC)

We quite simply are not. This is a matter of legitimate controversy among reliable sources, with a range of credible positions in WP:MEDRS, none of which can be called ‘fringe’ for disagreeing with a strong consensus that does not exist. WP:FRINGE is there to keep homeopaths and climate deniers from trying to sneak false balance into articles; it is not there for editors to dismiss high-tier MEDRS, concurring with top-tier MEDRS, that they don’t like, and simply reading the actual guidelines makes it obvious why they don’t apply here. Scholarly opinion is generally the most authoritative source to identify the mainstream view, and this is a weighty scholarly opinion. Frank Forfolk (talk) 21:08, 19 October 2024 (UTC)

I tend to agree with Loki here. The comparison with the Pioneer Fund hypothetical might not be exact, but it's a reasonable analogy. XOR'easter (talk) 00:41, 20 October 2024 (UTC)

I really don’t think it is. Can you point to any policy or guideline that would support treating this as anything other than a high quality WP:MEDRS because one secondary author out of five is affiliated with an alleged (with vigorous disagreement, going by the SEGM talkpage) fringe group? Frank Forfolk (talk) 03:49, 20 October 2024 (UTC)

WP:FRINGE/WP:PROFRINGE. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 04:22, 20 October 2024 (UTC)

Yes, that is also why literally just yesterday/today, a discussion at the Village pump (Wikipedia:Village_pump_(policy)#RfC_on_reform_of_WP:FTN,_WP:FRINGE) re-affirmed why we have strong anti-fringe policy on Wikipedia.

The WP:GENSEX CTOP area sees its fair share of fringe theories, this is not just for homeopaths or climate deniers.

Fringe people, such as authors involved in this paper, do publish papers to try to make their position appear less fringe, but that's where strong eyes are needed to discern things such as this. Raladic (talk) 05:46, 20 October 2024 (UTC)

So you can tell this has fringe authors (plural) because you have "strong eyes"? Do those who disagree have weak eyes? Void if removed (talk) 07:09, 20 October 2024 (UTC)

Do you have a source for that? Void if removed (talk) 07:02, 20 October 2024 (UTC)

In this discussion I see hyper-fixation on one co-author's affiliation, and near-zero consideration of the other 80% of co-authors. The lead author, Dr. (C.) Ronny Cheung, is/was an National Institute for Health and Care Excellence advisor, and was appointed Officer of Health Services at the Royal College of Paediatrics and Child Health[5]. Elaine Lockhardt is Chair of the Royal College of Psychiatrists' Child and Adolescent Faculty.[6]. Ian K. Maconochie, among other qualfications, is a Fellow of the Royal College of Paediatrics and Child Health, Fellow of the American College of Emergency Physicians. Camilla C. Kingdon is a former president of the Royal College of Paediatrics and Child Health. These are qualified pediatric researchers, not minor players or grad students authoring a white paper. Dismissing all of these authors, published in a well regarded peer-reviewed journal, based on guilt-by-association or dislike of their view (even if it's a minority view in some circles), is nothing more than ideological gate-keeping. I do share the wariness of tedious "response to response to response" play-by-play, that are more likely to confuse than educate readers (remember, we should be writing for a global general audience, not merely to amuse ourselves or show a teacher how good we are at finding sources), and there is discussion to be had about how much weight this and other papers should receive, but if nothing else, this paper can be used to assess due weight to give to other views. And, bad-faith Wakefield comparisons aside, I will place editorial decisions of Archives of Disease in Childhood high above the opinions of any Wikipedian (even those who might agree with me). Ours is not to do the jobs of journal editors or even journalists, ours is to summarize significant views in reliable sources in proportion to the prominence of those views, even opinionated, biased, or disagreeable views. --Animalparty! (talk) 01:40, 27 October 2024 (UTC)

Straw poll on inclusion

Since the actual numbers here have become a matter of some dispute, can we actually separate the issues of how to include the source (i.e. how to structure the page to minimise recursive response bloat) with whether the source is reliable and due, in principle. To my mind, productive discussion on the former broke down in the face of highly contentious discussion about the latter. Frank Forfolk (talk) 15:17, 18 October 2024 (UTC)

"The source" is:

• Cheung, C. Ronny; Abbruzzese, Evgenia; Lockhart, Elaine; Maconochie, Ian K.; Kingdon, Camilla C. (2024-10-14). "Gender medicine and the Cass Review: why medicine and the law make poor bedfellows". Archives of Disease in Childhood (Review). doi:10.1136/archdischild-2024-327994. ISSN 0003-9888. PMID 39401844.

WhatamIdoing (talk) 23:49, 19 October 2024 (UTC)

Include

1. If we're going to have a paragraph describing the claims made by the Integrity Project white paper then I think it would be negligent not to provide readers with a sentence's worth of context letting them know that a WP:MEDRS strongly criticised those claims. Nobody in this thread has given credible arguments against the review being a MEDRS. Frank Forfolk (talk) 15:17, 18 October 2024 (UTC)
2. It's obviously eligible in the sense that it is a MEDRS. The more interesting question is what is the proposed text that uses it as a source. Barnards.tar.gz (talk) 11:58, 19 October 2024 (UTC)
3. Yes, of course. It's a review article in a major medical journal, thus a top-shelf WP:MEDRS. And it is specifically relevant to the topic of this article. Arguments to exclude don't appear to be based on Wikipedia policy, which does not have provisions for personal "peer-review" and negation of sources, or say anything about responses-to-responses. I suggest turning this into a proper WP:RFC and notifying WP:MED; I think further arguing amongst the existing participants will be a waste of time. Crossroads ^-talk- 22:08, 19 October 2024 (UTC)

   I definitely think getting outside eyes on this is the right approach. Frank Forfolk (talk) 11:45, 20 October 2024 (UTC)

4. I support Flounder fillet's revised text, for reasons given here and here. I also agree with Crossroads wrt opening an RFC. FirstPrimeOfApophis (talk) 06:34, 20 October 2024 (UTC)
5. Inlcude, with care. As I've stated above, 4 out of 5 co-authors are well-regarded pediatricians & psychiatrists. And even if all 5 were card-carrying members of SEGM, it wouldn't make a lick of difference, as all are independent of the CASS review, and being "non-neutral" is a red-herring anyway: per WP:BIASEDSOURCES, reliable sources are allowed to be biased and/or non-neutral. Per WP:SCHOLARSHIP, WP:BESTSOURCES, and WP:MEDRS, a peer-reviewed science article in a reputable journal beats the pants off a non-peer-reviewed white paper, and so should help determine WP:DUEWEIGHT to devote to various opinions. --Animalparty! (talk) 20:36, 27 October 2024 (UTC)

Exclude

1. The connection to SEGM is suspicious enough for me to not support inclusion yet, at a minimum. Loki (talk) 20:50, 18 October 2024 (UTC)
2. I second this. Usr Trj (talk) 07:40, 19 October 2024 (UTC)
3. Exclude both for SEGM reasons and because responses to responses. Snokalok (talk) 14:00, 19 October 2024 (UTC)
4. ++, we're scraping the bottom of the barrel if we're turning to SEGM for defenses of the review, and we don't need endless responses. Moreover, I find it interesting that multiple include voters oppose comparable sources critical of the review. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 03:45, 20 October 2024 (UTC)
5. I read the discussions above and feel that given the source interrogation presented by YFNS (here) leaves a lot to doubt about the source's quality. That said, much of the discussion concerned WP:MEDRS and WP:MEDASSESS in relation to WP:FRINGE and WP:DUE. I think the participants at WP:MED would be the natural next step for seeking input. I also did not see a detailed proposal as to the content for it were included, but I saw several proposals for how it could be weaved together onto what is currently on the page, which seems like putting the cart before the horse. Relm (talk) 10:08, 21 October 2024 (UTC)
6. Per the very in-depth analysis of the source by @Your Friendly Neighborhood Sociologist and it's lack of WP:INDEPENDENCE at the related thread at Wikipedia:Reliable_sources/Noticeboard#c-Your_Friendly_Neighborhood_Sociologist-20241027153200-FirstPrimeOfApophis-20241026093400. Raladic (talk) 20:44, 27 October 2024 (UTC)

Discussion

So an entirely new account made this straw poll as their first edit? Huh, interesting, that. Silverseren^C 15:22, 18 October 2024 (UTC)

I'm Special:Contributions/212.36.63.7, apologies for not making that obvious. I have a lot on my plate right now. Frank Forfolk (talk) 15:33, 18 October 2024 (UTC)

• @Relm: We are here to discuss the source’s reliability, not whether we personally think it is correct. This should be done by applying WP:MEDRS guidelines. YFNS’ disputations of the claims made in the source are WP:OR and have no bearing on its reliability. Frank Forfolk (talk) 12:18, 21 October 2024 (UTC)

  Per WP:OR

  This policy does not apply to talk pages and other pages which evaluate article content and sources, such as deletion discussions or policy noticeboards. Snokalok (talk) 12:25, 21 October 2024 (UTC)

  Right, but that just says it’s okay to post it. Excluding an RS from article space based on OR is still using OR to determine the content of article space. Frank Forfolk (talk) 12:31, 21 October 2024 (UTC)

  That's not really how it works, because most of how we even make a determination of whether a source is RS is based on OR. Alpha3031 (t • c) 12:42, 21 October 2024 (UTC)

  Surely that applies to determining the reliability of the source — who published it, where, the reputation of that source for accuracy — not its factual accuracy. The only challenge to the former is the SEGM stuff which has its own problems, the rest of YFNS’ ‘interrogation’ is just quoting bits from the source and saying ‘no, wrong’. But YFNS posting on a talkpage is not an RS, and while I admit I’m using common sense reasoning here, the principle behind sourcing and verifiability is that we leave it for RSes to determine what’s true, on Wikipedia we just summarise it (and if RSes vigorously disagree, as in this case, we describe that without taking sides). It seems obvious that OR applies in principle to negative claims (‘an RS says this, but here’s why it’s wrong, so we exclude it’) as to positive claims (‘no RS says this, but here’s why it’s right, let me put it in the article’). I hope I’m making sense here. Frank Forfolk (talk) 13:09, 21 October 2024 (UTC)

  If you open the edit dialog on WP:RSN, you should see an editnotice that says "The reliability of a source depends on its context. Please supply the source, the article it is used in, and the claim it supports." That is because whether a source is considered reliable for a claim depends on the claim being made. Alpha3031 (t • c) 13:37, 21 October 2024 (UTC)

  Okay but the context here is a top-shelf MEDRS directly addressing criticisms of the professional methodology of a major independent medical review and series of studies. It’s one of the best sources you could possibly have in this context. Frank Forfolk (talk) 13:46, 21 October 2024 (UTC)

  That's the source. We also need the statement being made. Alpha3031 (t • c) 14:08, 21 October 2024 (UTC)

  Well what about literally just ‘this review in the BMJ said that the Cass review and York studies were methodologically sound, disputing other sources saying otherwise’. We can’t even get something like that into the article at the moment. Frank Forfolk (talk) 14:47, 21 October 2024 (UTC)

  Sure, that's a proposed wording. Now, if someone inserted that into an article I was watching, I'd probably ask "which other sources". Alpha3031 (t • c) 15:00, 21 October 2024 (UTC)

  I mean this is the actual wording that got reverted. Frank Forfolk (talk) 16:49, 21 October 2024 (UTC)

  And do you not see the problem with this wording? It presents a paper with serious neutrality and independence concerns and which objectively mischaracterizes both the Cass Review and the criticism of such, as being a definitive shut down of any and all criticism broadly construed. This is exactly why we evaluate our sources on an individual basis. Snokalok (talk) 18:45, 21 October 2024 (UTC)

  And I would argue that everything you just said applies to the Yale white paper far more than the BMJ review, which is why when two RS disagree we should summarise what each says rather than trying to decide on the talk page which one is correct. Frank Forfolk (talk) 21:50, 21 October 2024 (UTC)

  And as said previously, what issues of independence and neutrality does Yale University have? Snokalok (talk) 03:34, 22 October 2024 (UTC)

  You’re right, the non-peer-reviewed source where several authors are acting as paid witnesses in court cases the paper was written to support has no independence concerns whatsoever. Frank Forfolk (talk) 04:23, 22 October 2024 (UTC)

  Frank, I'm inclined to agree with Snokalok for this specific wording. See MOS:SAID, for reference, but the degree of certainty expressed would not be appropriate with a single source, even if accepted for the sake of argument that source was much higher quality. Alpha3031 (t • c) 00:49, 22 October 2024 (UTC)

  One thing that needs to be noted is that reliability depends on the context it is used for (see WP:RSCONTEXT, WP:SOURCE). I have not read the earlier discussion fully, and am not sure I will, but there are certainly cases where normally sufficient sources should not be used. It is thus difficult to divorce the appropriateness of using a source from how that source is used. Alpha3031 (t • c) 12:28, 21 October 2024 (UTC)

• @Raladic: Just to be clear, you're placing the opinion of one Wikipedian over the peer-reviewed editorial judgment of a reliable scholarly journal. Like amateur Wikipedans know science better than the science journals themselves? --Animalparty! (talk) 21:42, 27 October 2024 (UTC)

  There is no need to rehash things in multiple places. I stand by the comment that I trust YFNS's assessment of the article.

  Peer-review looks at whether a paper is suitable for publication. It doesn't make them unimpeachable, nor necessarily right.

  This content space has seen a lot of misinformation, much of it pushed by fringe groups including by publishing bad papers. So just blindly ignoring the partial authorship involvement of a group designated as an anti-trans hate group is not going to serve our purpose of maintaining a NPOV and thus, contextual analysis as done by YFNS can help us get better pictures of a particular source. Raladic (talk) 22:12, 27 October 2024 (UTC)

  (EC) We routinely judge and discard poor studies, peer-reviewed or not. That is the basis of WP:FRINGE and our determination of the strength of a study, its contributors, and its overall merits. That is just common practice on science-related topics and has been for years, if not decades, on Wikipedia. Silverseren^C 22:14, 27 October 2024 (UTC)

Response bloat

As time has moved on, what were "responses" to the Cass Review upon its publication are increasingly more broad effects and impacts. Citations to it in guidelines. Commentary in opinion pieces. This is getting unwieldy.

I think we need to start restructuring into immediate, direct responses, and subsequent impact (domestically and internationally) on guidelines like the Japanese ones which are more "contextual", and the Australian review of services.

I suggest citing this BMJ investigation from May (which for some reason we aren't) which very explicitly notes the difference in reception between the UK and the US, and this places into context the polarised responses.

So something like:

• Reception (containing some of what's there already, but only the actual immediate direct reception
• Subsequent impact (for eg. the creation of a review into adult services, the impact on services in Scotland etc) with an international section, which can contain the Japanese and Australian content, which aren't really "responses" but "things that happened after, in the context of the cass review's findings"
• Further commentary (noting the divisions between the US/UK per the BMJ piece, notable opinion pieces etc)

I think there's space for some of the more subjective commentary, but cramming it all into "responses" is not aiding the reader, or balancing it well. Void if removed (talk) 09:29, 8 October 2024 (UTC)

I didn't think it was that bloated or hard to read. However, it seems misleading to say the Cass Review had an impact on the Japanese guidelines and the Australian review of services. The Japanese guidelines continued to recommend puberty suppression and seemingly dismissed it's relevance to Japan by calling it "specific to the unique situation in the UK" and the review of Australian services was rejected and so nothing really changed. I think both of these fit better in the response section. Usr Trj (talk) 10:24, 8 October 2024 (UTC)

They aren't a "response to cass" is my point. They are things that happened after, taking cass into consideration. The more time passes and the more we try and cram into "responses" the worse it is going to get.

Many things in "responses" are very clear statements in response.

Others aren't, but could go in a different section just fine. Void if removed (talk) 10:33, 8 October 2024 (UTC)

Then maybe you should've called the section "Aftermath" or something else instead. Using the word "Impact" implies that the Cass Review had a notable influence on Australia and Japan and led to notable changes in those countries, which it hasn't. Usr Trj (talk) 10:54, 8 October 2024 (UTC)

I'm not sure I agree, the section being "impact" can also be used to highlight notable points of lack of impact IMO. Aftermath sounds a bit dramatic to me, what about just "influence"? Or "Subsequent events"? Void if removed (talk) 11:26, 8 October 2024 (UTC)

"Subsequent events" will probably be confusing. People might expect to find (e.g.,) information about when new programs were opened, or if there was a follow-up report. WhatamIdoing (talk) 04:21, 9 October 2024 (UTC)

Sure - that was where I was originally hoping to put the material about adult services review etc. These aren't directly about the cass review, but are things that happened as a result. I'm trying to draw a line under the most significant direct responses and create somewhere else in this article that can be expanded with relevant but less directly responsive material. I'm out of synonyms though. "Later developments"? "Outcomes"? Void if removed (talk) 08:27, 9 October 2024 (UTC)

Also, I think the interviews with Cass that you moved to "Further Commentary" fit much better under the "Hilary Cass's response" section as they were previously, since Cass was directly responding to criticism in them. Usr Trj (talk) 10:29, 8 October 2024 (UTC)

Hilary Cass published extensive reflections on the review a month ago. Right now, there is nowhere for these to go, but they are certainly due. I hope that by starting this section with some of her comments it can be expanded with this. Void if removed (talk) 10:35, 8 October 2024 (UTC)

I don’t think it’s helpful to the reader to separate the responses like this, it makes them read the reception section and think those are the only responses. Snokalok (talk) 12:24, 8 October 2024 (UTC)

The point is to separate immediate, direct, PR type reactions like RCGPs and WPATH's from longer term, more contextual outcomes and influences like the adult services review. How about "initial reception" instead of "reception"? Void if removed (talk) 12:45, 8 October 2024 (UTC)

I’m not opposed to considering the idea but where do you draw the line? Snokalok (talk) 12:48, 8 October 2024 (UTC)

I draw the line at, basically, the direct responses we currently have from major orgs (or anything simliar to that which happens to come along, though it seems unlikely at this late stage).

I think the Japanese guidelines are too vaguely connected - nothing says they are a "response" to Cass (which is why I object to their inclusion at all in that current section). They don't describe it as such themselves, and it doesn't even really contain a response to Cass, merely describing it. However, it is clear they are a "response" to a changing context, with The Cass Review and WPATH butting heads making it reasonable to reissue service guidelines that make it clear what it all means for clinicians there. I think that is a sort of "second wave" wider impact sort of thing (as is the review of adult services, NHS Scotland etc).

IMO, if it is a press release explicitly stating "here's what we think of the Cass Review" its a response. Anything vaguer than that (rejected calls for a similar review in Australia) to me feel like a second order effect - and the advantage is that something structured like that can grow without cluttering up the more immediate responses. The more that gets added there, the harder it is a for a reader to grok the timeline, frankly. Every future international guideline that cites the Cass Review (whether endorsing or rejecting it) could be relevant in that sort of section. Void if removed (talk) 13:36, 8 October 2024 (UTC)

I’d be okay with sections labeled “Early reception” and “Later reception” Snokalok (talk) 14:21, 8 October 2024 (UTC)

Yes I think that's preferred rather than this completely separate section that's now below.

Also regarding the line @Void if removed is trying to draw - that's not how the medical community works - reception in medical papers is done through discussion and citing of them within a new separate paper - it is still inherently reception.

So I think with that, @Snokalok's suggestion to split it into early and later works better if you're concerned about timeline. Raladic (talk) 14:55, 8 October 2024 (UTC)

I think you'll want to reconsider your claim. If it's true that "reception in medical papers is done through discussion and citing of them within a new separate paper", then none of the self-published press releases we're citing should be considered True™ Responses, and perhaps they should all be removed.

(Sure, it's an Argument from consequences, but I suspect you won't like the consequences of your claim.) WhatamIdoing (talk) 04:24, 9 October 2024 (UTC)

Add the word "often" to the sentence ..reception in medical papers is often done through discussion and citing.. if we must quibble about words.

I think it was clear what I meant to say, which was only in response to VIR's point that if something doesn't explicitly says "here's what we think of the Cass Review" then it's not a response, which isn't how stuff is commonly addressed in published papers and I didn't say that only peer-reviewed responses are responses, just that a common way of mentioning something in citation and discussing it in papers and that such a mention still constitutes a response. Basically, the inverse of what you are implying, VIR was saying that papers that are not explicitly titled "response to Cass" are not a response, which is what I tried to refute. Raladic (talk) 04:47, 9 October 2024 (UTC)

@Raladic, I'm not sure exactly what kind of source you're talking about. Which of these two categories sounds closest to the mistake that we need to avoid?

• Cass Review gets published, and ____ puts out a press release to say that Cass got some facts wrong: Science by press release.
• Cass Review gets published, and ____ publishes a paper about trans teens that never mentions the Cass Review by name, but Wikipedia editors decide that this paper is a response to the Cass Review (because the subject matter overlaps, and the entire trans-healthcare profession, at least insofar as this can be determined from social media, is thinking of nothing else, so obviously any publication post hoc is indisputably ergo propter hoc): Wikipedia:No original research violation.

WhatamIdoing (talk) 18:34, 9 October 2024 (UTC)

So what counts as "early"? What counts as "later"?

The line I'm trying to draw is the difference between essentially breaking, reactive responses, and considered, down the line impacts/incorporation/rejection of actual findings.

That's more of a qualitative split, though it becomes somewhat temporal by necessity.

For example, the BMA's response is, IMO, is a "response" - but it isn't an early one because it took them months to actually state it. Void if removed (talk) 15:10, 8 October 2024 (UTC)

Actually I just took a look at what the responses are, and what we have is scientific responses, published by the scientific community, and we have some advocacy organization responses.

So I just took another stab to separate it like that, as well as to address the timeline issue, I actually found after reading the paragraphs that all that was needed was adding dates to some of the early in April one to make it clear those were immediately following the release and the new later responses already mostly had the dates and I added a few where I felt it was useful to readers without having to open the ref.

I also kept Cass's individul personal responses in her section, rather than having them split up across different sections, to make it clear that those are her individual personal opinions as a person, rather than in an official capacity of the review itself. Raladic (talk) 15:14, 8 October 2024 (UTC)

We went over that before - they aren't "scientific responses". Most of them are comments in popular journalistic sources, and the Yale white paper is not a scientific publication. Old section title was least bad consensus. Void if removed (talk) 15:21, 8 October 2024 (UTC)

They are scientific responses by medical and legal scholars, many of them published in peer reviewed journals, which is how the scientific community operates.

In any case, I renamed it into academic, which is irrefutably accurate. Raladic (talk) 15:26, 8 October 2024 (UTC)

I mean, you say "many of them published in peer reviewed journals", but only two in this section are published in journals, and at least one of those citations isn't peer-reviewed, and probably neither. So, in the first sentence:

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

None of the citations here are peer-reviewed, even Abbasi's editorial in the BMJ, and aside from that one these are just comments in popular press so it doesn't justify this title. The Yale white paper isn't peer-reviewed either. This latest commentary probably isn't, it is hard to say for sure, I think it is at the editor's discretion at JAH?

(I really think that this latest commentary would be better under a "further commentary" section - it is commentary on the commentary as much as anything, noting the other responses. And that is the sort of section that can be expanded with other perspectives, illustrating the different points of view. There will be other academic works providing commentary and perspectives beyond simply a straightforward "response")

And the "advocacy organizations" title doesn't fit with the EHRC (who are not an advocacy org, but a regulator). Also, minor, but "organisations" please. TBH I would happily lose that entire section at this point, there's plenty of better material now, surely WP:NOTEVERYTHING... Void if removed (talk) 16:09, 8 October 2024 (UTC)

They are still academic responses. As I said, some are peer reviewed, but nonetheless, even others such as the Yale white paper were still drafted by academics with academic citing and all.

The same for the latest, which was published in a journal and it didn’t just reference the other responses, it also specifically cited the existing evidence that does exist and is the basis why gender affirming puberty blockers for transgender youth is still used in most of the world outside the U.K.

As for advocacy organizations as a title, I carefully considered it and actually checked the charter of the EHRc before I made that title and they are also that The Commission has responsibility for the promotion and enforcement of equality and non-discrimination laws in England, Scotland and Wales… Promotion is advocacy, so aside from also being tasked with enforcement, they are also tasked with promotion, which is advocacy, so as a banner it is appropriate. Raladic (talk) 16:24, 8 October 2024 (UTC)

No, this is wrong - advocacy groups seek to influence and bring about political change. The EHRC is an independent body set up by the UK government to reflect and enforce existing law and policy. There are quite significant differences between lobbying and pressure groups and a regulator like the EHRC, and this title misrepresents that. I disagree with your interpretation of "promotion" as making them the same thing, when they are not.

some are peer reviewed

I think by "some" it is "at most one, and possibly none". This sort of thing is why it was compromised to "assorted", so as not to mislead the reader into thinking these opinions had a more academic stamp than they actually do. Void if removed (talk) 17:00, 8 October 2024 (UTC)

I didn’t call the section advocacy groups, it was titled organization.

In any case, this easy to solve since we already had other UK government bodies further up from the NHS response, so I moved it up there and renamed it into UK government bodies to accurately group it. Raladic (talk) 19:24, 8 October 2024 (UTC)

It's not a government agency. It is an independent regulator.

Again, all these details are why we had "assorted", which was fine. Void if removed (talk) 19:29, 8 October 2024 (UTC)

It’s a Non-departmental public body, which is a very U.K. specific thing.

You have to remember that we write Wikipedia for a global audience, so I renamed the section to include the word public bodies now and specifically linked to the Non-departmental public body for the EHRC, which is helpful for readers who want to understand that they are a public body that is still accountable to parliament, but not directly part of the government as you pointed out. But they are still vested with their power through the county’s respective legal framework, just as most other National human rights institutions are to be able to actually enforce the charter they are tasked with. Raladic (talk) 19:45, 8 October 2024 (UTC)

Aside from the retitling - which is inaccurate and confusing still - there was a logic to the organisation of responses which this now breaks.

Previously, the responses flowed in decreasing order of importance.

1. Political responses. The immediate acceptance of the Cass Review across the political spectrum was hugely significant for an issue that is still deeply politically polarised in the US for example, and sits above the national health service, which the gov ultimately controls.

2. Health services. As the implementers of the review's recommendations, these responses were paramount.

3. UK medical bodies. As the bodies responsible for training and accrediting doctors, these responses again would affect how well-accepted the review was within the UK medical community.

4. International medical orgs. No direct influence on implementation, but a huge impact on how this was received by the broader medical community (will other countries follow suit, or will the UK be isolated?), and may have an impact over the long term

5. Others. Basically notable interesting but not directly impactful responses.

The EHRC fits into this latter category. Its opinion is interesting but utterly unimportant to the actual implementation of the review.

The way you've restructured it doesn't follow this flow, and also misrepresents the response of health services as government responses.

The previous title and order was absolutely fine, and EHRC being dumped under "assorted" was not a problem, so I don't know why you're insisting on retitling this section confusingly and cumbersomely in order to justify it. Void if removed (talk) 08:22, 9 October 2024 (UTC)

The addition of the recent Mermaids charity commission result to the UK political responses section makes absolutely clear this bloated Response section needs trimming down.

I've moved it to a "Further developments" section and retitled "Reception" to "Initial reception".

I propose also moving to this section everything that is not a timely (say, 3-4 months) and direct actual response to the Cass Review (of the form eg. we welcome/we reject the Cass Review). I suggest relocating:

• The updated Japanese guidelines (not a direct response, later)
• The commentary in JAH (later)
• The NIE extension to the ban on blockers (not a direct response, later)
• The RANZCP rejection of an enquiry (not a direct response)

It can be liberally expanded this way for ongoing commentary and continuing political fallout, but it is overstuffed and unmanagable right now and we can devote more space for these things without disrupting the description of the initial reception. Some of these elements could be used to start their own subsection on eg. Academic commentary etc. Void if removed (talk) 08:55, 25 October 2024 (UTC)

I strongly oppose relocating the Japanese guidelines and the RANZCP rejection of an enquiry. People who want this information are going to go to the "Response from other health bodies globally" section and if there are responses from other global health bodies in other sections, the "Response from other health bodies globally" section becomes pointless and could mislead readers who read only one section into thinking that's all there is. It would also be confusing as it would make readers go all over different sections of the article just to read responses from other global health bodies. For the convenience of the reader, all of these responses from global health bodies should be kept together regardless of whether it's a direct response or not. 2601:483:802:7420:E173:D4CA:97B1:E9B9 (talk) 10:52, 25 October 2024 (UTC)

I second everything said here. Snokalok (talk) 15:16, 26 October 2024 (UTC)

Receptions in the medical world often take time, particularly when they are in the form of published papers or policy changes so I don't think that timeline thing serves anybody as the IP editor above pointed out.

If the response is a reception of the Cass Review, no matter the time since the review, it belongs in the appropriate section of those that we have, which are grouped by their type of reception.

Else likely we'd just have each of those sub-sections twice over time, which doesn't serve encyclopedic value other than being an arbitrary time break.

Also, we already have the Cass_Review#Subsequent_events so the new "Further developments" section you just created makes no sense as Further developments can be seen as synonymous with Subsequent events, so if anything, the charity commission note should be moved there, but the Reception section and all the other receptions that address the Cass Review should stay in it, without renaming of the section. Raladic (talk) 14:34, 25 October 2024 (UTC)

I've renamed it to "wider clinical impact" as it (right now) covers NHSS, blockers and the adult services review. Also moved those after the initial reception.

Seriously don't see why we can't use a "further developments" section as a starting point to grow beyond simply "responses". There is plenty that can be added here. Void if removed (talk) 16:08, 25 October 2024 (UTC)

A "wider clinical impact" would be if the scope of it expands broadly worldwide outside of what the original scope was, which was a review to inform the local UK government policies on transgender youth healthcare, but right now, it appears that the review is widely criticized worldwide, so we have a "narrow clinical impact" by the UK government departments that ordered the review, namely the UK NHS and other UK government bodies.

We don't use WP:CRYSTALBALL's for titling sections, so right now we have receptions, some from the UK, many worldwide which are that.

And separately, we have action by various UK government departments and bodies as a result of the Cass Review, as would be expected if a government orders a document to inform its local government policies. Raladic (talk) 17:12, 25 October 2024 (UTC)

As well as being clumsily-worded, Raladic's section title "Subsequent government actions in the UK" is inaccurate. The UK Government does not set clinical policy for NHS England or NHS Scotland or direct the findings of Charity Commission inquiries.

A "wider clinical impact" would be if the scope of it expands broadly worldwide outside of what the original scope was No, "wider clinical impact" is any impact on clinical practice outside of youth gender services in NHS England, which was the scope of the Review. So adult gender services, NHS Scotland are "wider clinical impact". There is no reasonable interpretation of "wider" that means only "worldwide".

The problem with "wider clinical impact" as a section title is that it includes the ban on puberty blockers, which was a change in regulation rather than clinical practice.

I will change the section title to "Wider impact". FirstPrimeOfApophis (talk) 08:29, 26 October 2024 (UTC)

I mean, the NHS is an arm of the government though. Like objectively speaking, they are an arm of the British government. That’s the entire point of being a public sector entity.

You can certainly debate the level of influence other sections of the British government can and might exert regarding politically contentious healthcare topics, but the fact is, the NHS is objectively a government entity. Snokalok (talk) 15:30, 26 October 2024 (UTC)

Like objectively speaking, "arm of the British government" is a meaningless phrase, and the independence of NHS England, NHS Scotland and the Charities Commission from government interference is a matter of UK law, not "debate". FirstPrimeOfApophis (talk) 16:33, 26 October 2024 (UTC)

First line of Charity Commission for England and Wales: The Charity Commission for England and Wales is a non-ministerial department of His Majesty's Government.

First line of NHS England: NHS England, formerly the NHS Commissioning Board for England, is an executive non-departmental public body of the Department of Health and Social Care. which itself: The Department of Health and Social Care (DHSC) is a ministerial department of the Government of the United Kingdom. - further The Secretary of State publishes annually a document known as the NHS mandate which specifies the objectives which the Board should seek to achieve - so yes, the UK government does set the NHS mandate.

I don't know how you are seriously arguing that they are not part of the wider UK Government.

So now that we have cleared that up, please self-revert the section title since that section summarizes the actions of the various arms of the UK's government, be they "public bodies" or other sub-sidiaries of the ministries. Raladic (talk) 17:10, 26 October 2024 (UTC)

This is just confusing language. Actions taken by bodies like the Charity Commission, the NHS, and the EHRC are not actions by the UK Government. Void if removed (talk) 19:12, 26 October 2024 (UTC)

Again, as we've now proven above, they are.

If you need a convenient list of the Departments of the Government of the United Kingdom, here you go.

Government, or more specifically, the Government of the United Kingdom isn't just the prime minister, it's the governing of the country and is often done so with some separation of power, but it is nonetheless the government of the country. Raladic (talk) 19:23, 26 October 2024 (UTC)

If by proven you mean repeat then sure. Attributing the actions of the Charity Commission to the government of the day is incredibly confusing to anyone in the UK. The CC is an independent body accountable to government and government interference in it's decision making would be seen as highly improper.

https://www.gov.uk/government/publications/charity-commission-governance-framework/governance-framework

The Commission is, by law, independent from ministerial influence or control over its day-to-day operations and decision-making. The Charities Act 2011 (‘the Act’) section 13 (4), states that: ‘In the exercise of its functions, the Commission shall not be subject to the direction or control of any Minister of the Crown or other government department.’

You're just wrong about this. Please revert this incorrect info and DROPTHESTICK. Void if removed (talk) 09:36, 27 October 2024 (UTC)

The NHS is inarguably part of the UK government. I wonder if this is a difference between American and UK English here, where you're using government to mean the party in power, because this seems quite inarguable to me.

The Federal Reserve is part of the US government even though it's very insulated from the President. Similarly no matter how independent the NHS is, it's very clearly part of the UK government. Parliament approves its budget and its expenses are paid by UK taxes. Loki (talk) 16:50, 27 October 2024 (UTC)

You're right that it is a difference between American and British/Commonwealth use of "government", although I'm less sure how you have decided the American use is "inarguably" right for an article on a UK topic describing the UK government? We use "government" to essentially mean the members of the Cabinet, whose powers over other public bodies can be quite limited. According to this article, a comparable term in US English might be the (presidential) "administration". Just as it would not be accurate to describe a decision made by the Federal Reserve tomorrow as an "action" of the Biden Administration, so it is not right to describe the clinical decisions of NHS England as actions of the UK Government. FirstPrimeOfApophis (talk) 20:40, 28 October 2024 (UTC)

In that case: I agree that the NHS is not part of the Starmer administration (or for that matter, part of the Johnson, May, or Sunak administrations), but that's not what anyone here was saying when they said the NHS was part of the government.

The issue here is that there isn't really a better word in UK English for what we're talking about. Loki (talk) 20:00, 31 October 2024 (UTC)

BMJ Investigations article

Raladic has deleted a paragraph sourced to an article published in the BMJ with with the edit comment remove Individual response (not due per established prior consensus on the talk page, else there would be many more others that would also be here)

Raladic is this the "prior consensus" you are referring to? Talk:Cass_Review/Archive_1#Condensing_the_individual_responses FirstPrimeOfApophis (talk) 08:43, 27 October 2024 (UTC)

That and many more discussions that happened subsequently in the Talk page.

You'll find the Talk:Cass Review#sources for consideration up at the top of the talk page, which has some of those sources, many of those individual responses, which are omitted from the article, so in line with this, that new one was also omitted to avoid the bloat of detailing every single response.

The article instead has a sentence in summary at Cass_Review#Other_academic_responses that says that The report was praised by some academics in the UK, who agreed with its findings stating a lack of evidence; while others both in the UK and internationally disagreed with the report's methodology and findings. which WP:SUMMARIZEs the fact that also some individual academics have praised, or criticized it. Raladic (talk) 15:46, 27 October 2024 (UTC)

many more discussions... I don't think so, I have searched the talk page archives and can't find anything like that. Maybe you have some specific discussion in mind?

If it is just the "Condensing the individual responses" discussion, then it looks like six months ago there was a consensus to condense a number of quotes into a single paragraph, and this was to avoid inflating quotes and opinions from individuals to the Review itself. That isn't relevant to this source, because:

• this is a commissioned, peer-reviewed investigative article published by the BMJ. The notability of the author as an individual is not an issue.
• the source isn't "praising" or "criticising" the Review, it's presenting an analysis of the reception to the Cass Review among US medical and media organisations, so it wouldn't be summarised by that "summary sentence" anyway.

So the normal rules of WP:DUE apply, which AFAICT don't allow arbitrary exclusions based on the number of authors.

BTW WP:SUMMARIZE refers to summarising articles in the lead sections and splitting overly-detailed sections into their own articles. So nothing to do with this. Why are you referring to it? FirstPrimeOfApophis (talk) 17:48, 27 October 2024 (UTC)

We try not to rehash and relitigate the same points over and over when a new editor pops up who's trying to come here, but alas as you said you couldn't find some of the others in the archive, here's some for your convenience: there's been Talk:Cass_Review/Archive_6#Refactoring_the_Reception_->_Final_report_subsection (note that one of the editors who was very vocal in this thread on trying to downplay the criticism of Cass has since been topic banned due to their extensive POV pushing). We've also had Talk:Cass_Review/Archive_7#Critical_papers. And some in between that have re-affirmed that by-and large, we have omitted individual responses, which are summarized in the sentence I pointed out and have given slightly more detailed paragraph level summaries for statements from representative organizations.

Also note that the article you tried to include is a primary partial WP:RSOPINION piece journalist commentary (by a person that has been described as a anti-transgender activist, [7]), not a peer-reviewed paper. So inclusion of it on its own merits likely wouldn't be there unless we have WP:RELIABLE WP:INDEPENDENT, WP:SECONDARY sources reporting on it. So even if we didn't already have the current consensus (as otherwise, we'd have many more papers, such as Horton's that has been cited again and again, in the article on limiting individual responses, the article you tried to include wouldn't pass the secondary RS part.

Also note that WP:SUMMARY isn't just about the lead, its sub sections, in particular WP:DETAIL is what was relevant here. What level of detail we give to any particular cite is dependent on the WP:WEIGHT that is relevant to the Wikipedia article. This particular piece you tried to add, being neither academic, nor secondary, would be given very little weight if it was due to begin with. As this commentary is basically just another commentary from the UK of the surprise of why the Cass Review is basically universally criticized outside the UK, it doesn't add anything that isn't already captured in the above sentence that the report has been celebrated in the UK, but not outside. Raladic (talk) 20:05, 27 October 2024 (UTC)

here's some for your convenience: there's been Talk:Cass_Review/Archive_6#Refactoring_the_Reception_->_Final_report_subsection (...). We've also had Talk:Cass_Review/Archive_7#Critical_papers. And some in between...

And in the most recent of those alleged discussions ("Critical Papers"), what do we find? You arguing for the inclusion of the Horton article. So you clearly did not believe that a consensus against individual responses had formed during those previous discussions, did you?

YTFS participated in that discussion, yet she evidently doesn't recognise this consensus against individual responses, because she has continued to advocate for inclusion of the Horton article up until a few days ago.

In fact, less than two weeks ago, you and Snokalok were arguing enthusiastically for the inclusion of reposted substack content from Erin Reed. Clearly neither of you believed there was a consensus against individual responses then either, or else you would have been knowingly editing against it.

In case I am not clear: there is clearly no consensus against single-author sources. Please stop claiming there is until you establish it in one of the usual ways per WP:CONSENSUS.

Also note that the article you tried to include is a primary partial WP:RSOPINION piece journalist commentary ... not a peer-reviewed paper.

I don't know why you would write something that can be so easily disproved. Click on this link https://www.bmj.com/content/385/bmj.q1141 and scroll to the bottom of the page. Below where it says "Footnotes" you will see:

Provenance and peer review: Commissioned, peer reviewed.

This feature has been funded by the BMJ Investigations Unit. For details see bmj.com/investigations.

Using this same mouse-clicking action described above, you can follow the link to BMJ investigations and see what they do, which is not "journalist commentary" but investigative journalism into health topics in society. What could be a more appropriate RS to discuss the comparative impact of a review of medical care on UK and US society?

(by a person that has been described as a anti-transgender activist, [8])

I strongly suggest that you do not repost slurs against living people from activist websites on this Talk page. Be aware that WP:BLP applies to talk pages.

The author has written frequently for BMJ Investigations on various topics, as you can see here.

Also note that WP:SUMMARY isn't just about the lead, its sub sections, in particular WP:DETAIL is what was relevant here. What level of detail we give to any particular cite is dependent on the WP:WEIGHT that is relevant to the Wikipedia article.

No, that isn't what WP:DETAIL says. It is about how different readers require different levels of detail about a topic and for that reason WP presents information at different levels of detail in the parent article lead, parent article body, and child articles. This is interesting stuff, but since we aren't talking about creating a new article this doesn't apply. Posting links to policies can be helpful, but it is good to read the policies first so you don't look silly. FirstPrimeOfApophis (talk) 19:57, 28 October 2024 (UTC)

is a primary partial WP:RSOPINION piece

This is categorically false. A peer-reviewed investigation in the BMJ is pretty close to the gold standard of secondary, independent RSs. Also did you really just cite a highly partisan activist's personal website to call a journalist an "anti-transgender activist" in order to exclude the BMJ? Void if removed (talk) 19:12, 30 October 2024 (UTC)

This, as I've said before, is an excellent source for expanding the wider reception elements of this page, because it discusses the nature of the whole response, and focuses on the clear divide between the UK and the US in particular. It is also peer-reviewed, and not an "individual response". Nor is it in itself a "response". It is a high quality secondary source discussing the various responses to the Cass Review and thus provides a good framework for further coverage. Void if removed (talk) 20:41, 28 October 2024 (UTC)

It also makes some pretty wild and unfounded speculations, like that American doctors aren’t turning on GAC because they’re scared of the government. This is an extraordinary claim that the source 100% does not rise to meet Snokalok (talk) 21:48, 28 October 2024 (UTC)

American doctors aren’t turning on GAC because they’re scared of the government Snokalok I can't find that. Can you post a quote? FirstPrimeOfApophis (talk) 17:40, 29 October 2024 (UTC)

Sorry, the doctors part was the sentence before and I misremembered. The exact quote from the removed text was

speculated that this could have been due to unwillingness by journalists to rebuke their previous support for gender-affirming care or question the US government.

So it was speculation that journalists were afraid to question the US government, which is still a wild claim that the source does not rise to meet. Snokalok (talk) 19:01, 29 October 2024 (UTC)

I meant a quote from the source.The closest I can find is US reporting in the main is sympathetic with, if not following the lead of, authoritative sources such as the US Department of Health and Human Services (HHS) which doesn't sound that wild to me. FirstPrimeOfApophis (talk) 17:49, 30 October 2024 (UTC)

Well, that sounds a little like the added text failed verification to me. Alpha3031 (t • c) 13:42, 1 November 2024 (UTC)

Some confusion here, but I read it as the "it" Snokalok is referring to at the top of the thread is not the added content, but the source itself, ie suggesting *the source* makes wild claims and is thus unsuitable. I would agree that the removed form of words is unsupported, but not that the source itself makes wild claims. Void if removed (talk) 15:30, 1 November 2024 (UTC)

What I propose (at least initially) is a Media Coverage section with something like this, cited to the article in question:

An article comparing the reception of the Cass Review in the UK and US noted that after the Final Report was published "the tone of major print and broadcast media in the UK has shifted" in reporting about gender care and even outlets which had formerly dismissed criticisms of gender services as transphobic reported some such criticisms more sympathetically.

In the US, a number of prominent news organisations reported on the Review in detail, and some of these subsequently published editorials supporting a more precautionary approach to gender care. Many US outlets which had previously taken advocacy positions in support of gender-affirming care did not report on the Review at all, including Scientific American and CNN. Still other outlets likened the Cass recommendations to ongoing political campaigns in the US to restrict access to gender-affirming care.

Is this a fair summary of what the article says about media coverage specifically? FirstPrimeOfApophis (talk) 18:06, 29 October 2024 (UTC)

I don’t think this is accurate. UK media has been well documented as leaning GC long before the Cass Review was published, little was changed on that front by the report’s publication. See these sources and the dates of their publication.[9][10] [11][12]

Everything after that reads as intensely POV and reads as though the US media took a similar position as the British but for a few outliers, which isn’t true at all. Snokalok (talk) 19:08, 29 October 2024 (UTC)

UK media has been well documented as leaning GC long before the Cass Review was published

Both can be true surely? The UK media can be more sceptical of gender-affirming treatment than the US media but become yet more sceptical post the Final Report. In any case the "UK media" is quite heterogenous. I understand the source to be saying that post-Cass even outlets like the Guardian which previously dismissed criticism as transphobic now acknowledge concerns re lack of evidence. Do you read it differently?

(Sidenote: I'm not sure those links all show what you think. The most recent one says the BBC had to apologise twice in one year to the same person for allowing them to be labelled as transphobic on air and eventually issued some internal guidance to stop this from reoccurring. This doesn't suggest much sympathy with gender-critical views.)

Everything after that reads as intensely POV and reads as though the US media took a similar position as the British but for a few outliers, which isn’t true at all.

You're right, we need to make that clear, that's the main point of the article! How about to start the second paragraph instead of

In the US, a number of prominent news organisations reported...

we say

Compared to the UK, the Cass Review received less coverage in the US and that coverage was less favourable. A number of major US news organisations reported....

Would that work? FirstPrimeOfApophis (talk) 18:10, 30 October 2024 (UTC)

Consider these sources across the political spectrum, parroting the common GC talking points on puberty blockers and youth gender medicine.

-The Guardian in 2023[13]

-The Guardian in 2021[14]

-The BBC in 2023 [15]

-The BBC in 2019 [16]

-The Telegraph in 2023 [17]

We could perhaps say that UK media, which had already sympathetically platformed gender critical, became more loudly so - if we can find a reliable source for such a thing. But saying that the British media had this sort of pivot as is being implied, simply isn’t accurate.

As for the US, I’m not opposed to this opening fragment as you’ve rewritten it, but I think the entire paragraph needs to be rewritten because the rest does still read as to give the connotation of tails between legs. Snokalok (talk) 22:53, 30 October 2024 (UTC)

To elaborate, I think a section on media reception is a decent idea, I just think it’s going to need a lot of collaborative work before we get it to something that adequately conveys the situation while satisfying npov Snokalok (talk) 01:21, 31 October 2024 (UTC)

But saying that the British media had this sort of pivot as is being implied, simply isn’t accurate.

At the end of the day, we have a top-quality secondary RS saying there has been a shift in how UK media report gender care, and no sources at all saying there hasn't. We have to go with what the sources say. Even if your sources did show that UK media was somehow "gender critical" beforehand, it doesn't mean that it didn't go further in that direction post the Final Report.

And BTW what you see as parroting the common GC talking points reads to me like evenhanded factual reporting. This is why we need reliable secondary sources for any general statements like "UK media is..." rather than looking for examples which (we think) support our view.

I think the entire paragraph needs to be rewritten because the rest does still read as to give the connotation of tails between legs

We can adjust the wording, of course, but we can't change the information presented in the source. If news organisations refuse to report scientific developments which contradict their political views, this might have a negative connotation regardless of what wording we use, simply because this behaviour is at odds with how people expect news orgs to act. That doesn't violate NPOV, provided we accurately and impartially report what the RS say. How would you like to phrase the US paragraph? FirstPrimeOfApophis (talk) 17:54, 31 October 2024 (UTC)

top-quality secondary RS saying there has been a shift in how UK media report gender care

A. Demonstrably false, see the links above.

B. Jennifer Block is not a top quality secondary source, and the BMJ is not a top quality news outlet (especially without this piece being peer reviewed) - and even if both were otherwise so, reading over this piece, it’s an editorial.

C. The source cites SEGM as “a group of researchers and clinicians that has pushed for systematic reviews and an evidence based approach”, and Jesse Singal as “one of the first American journalists to expose the potential harms of youth gender treatment”, throwing away any pretense of neutrality in favor of platforming a fringe org as legitimate, which on its own makes this not a reliable source.

D. It’s at best, even if all of the above wasn’t true, an individual response. We wouldn’t report every single NYT or CNN article. Snokalok (talk) 21:09, 31 October 2024 (UTC)

A Your collection of links don't demonstrate anything.

B From the article: Provenance and peer review: Commissioned, peer reviewed. And it's not an editorial it's an investigations piece.

C I think you need to accept there are different opinions about all that and chart an NPOV between them.

D It's not an individual response. Void if removed (talk) 21:30, 31 October 2024 (UTC)

A. It absolutely does, it demonstrates that the central point of Block’s argument is at best revisionism. This is a revisionist piece.

B. Fair, I was looking at the fact that there’s no submitted vs publication date at the top.

C. Sorry, to be clear what you’re saying, I need to accept that the fringe group which has been roundly rejected by the international medical community as a conversion therapy lobbyist org may actually have validity because a freelance journalist said so?

D. I only see one name, Jennifer Block. Snokalok (talk) 13:32, 1 November 2024 (UTC)

So much of your reasoning on this page has boiled down to ‘any source that disagrees with my side is fringe, and we know my side is right because only fringe sources disagree.’ The circularity is alarmingly obvious. Frank Forfolk (talk) 17:41, 1 November 2024 (UTC)

Well, of both the sources we’ve argued over, the common thread regarding my personal opposition was that they both had significant involvement from the fringe conversion therapist group SEGM. If you still have strong feelings on the Cheung source, there’s an ongoing thread about it on the RS noticeboard. Here’s the link. Wikipedia:Reliable sources/Noticeboard Snokalok (talk) 18:07, 1 November 2024 (UTC)

Thanks for the link, I had missed it. Would you accept that at some level of participation by SEGM members in mainstream scholarship, it would be incorrect to call the group ‘fringe’, despite your personal opposition to their positions? Frank Forfolk (talk) 23:42, 1 November 2024 (UTC)

This is of course the problem. Editors have that SEGM members were cited by or had some level of involvement with the Cass Review, therefore the Cass Review is tainted (or even fringe), because of a pre-existing POV about SEGM.

You can look at it the exact opposite way - the Cass Review is a serious and authoritative piece of work, and if members of SEGM had some involvement, or it is based on citing their work, then that demonstrates that they are not fringe.

We now have another peer-reviewed investigative piece in the BMJ by Block:

https://doi.org/10.1136/bmj.q2227

This refers to SEGM as "watchdogs", while laying out issues with WPATH's non-publication of systematic reviews. It also mentions SEGM have commissioned four systematic reviews

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=308739

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=448265

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=452171

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324741

Here's one in preprint, with Gordon Guyatt listed as co-author: https://pubmed.ncbi.nlm.nih.gov/39252149/

The BMJ are citing and publishing SEGM, and SEGM they are sponsoring and publishing systematic reviews in reputable journals. At some point this fringe accusation that corrupts discussion of totally valid sources and wastes enormous time and energy has to be dropped. Editors disagreeing with a POV is not a valid reason for exclusion. Void if removed (talk) 12:14, 2 November 2024 (UTC)

it is incredibly crystal ball to say that SEGM are sponsoring and publishing systematic reviews in reputable journals given none of the studies are published. Also is incredible that none of these studies are fully independent as Abbruzzese is a collaborator on all of them. Ignoring the issues with independence and publishing, if this action was primarily what SEGM did (instead of advocating a position before receiving the evidence, as Gordon Guyatt has criticised them for) they probably would be less fringe. If they continue to do this, and become independent of their studies there will be a point in time that they aren't fringe. However fantasizing about the future is not our job and at the moment (given all of these studies aren't published), their advocacy work were they put the cart before the horse and went against medical institutions can only be described as fringe.

If antivaxxers were used as expert witnesses, started to be involved in reviews of vaccine rollouts, and only then started to (try and) publish systematic reviews, we could still call them fringe but argue that they're starting to work against that. I see no reason segm should be treated any different. LunaHasArrived (talk) 17:06, 2 November 2024 (UTC)

No, if antivaxxers had that level of support they wouldn't be fringe. They don't have that level of support, because their theories were proven bogus long ago. In youth gender medicine there's enormous, legitimate uncertainty and controversy between non-fringe scholarship, which is then being wedged through a lens of false certainty by people with a strong ideological determination that one side is correct without the evidence to prove it. Frank Forfolk (talk) 18:15, 2 November 2024 (UTC)

The anti-vaxxers do have that level of support. I’d like to point you to the American College of Pediatricians (ACPeds), not to be confused with the American Academy of Pediatrics. Much like SEGM, they’re a right wing medical lobby group masquerading as a MEDORG and that tries change policy on contentious healthcare topics via institutional capture. Their pet issues are abortion, conversion therapy, and vaccines - and they’re a significant force in the American anti-vaxx movement. We wouldn’t cite ACPeds on vaccines or abortion, we shouldn’t be citing SEGM on trans healthcare. Snokalok (talk) 22:44, 2 November 2024 (UTC)

Have you actually read the article you just linked to? Nowhere does it say ACPeds is antivax, and I could find no other coverage, even in extremely hostile sources like SPLC, that says they are, and their official position is a rather anodyne endorsement of vaccination and rejection of common antivax claims. I wish I could say I’m surprised to see you pulling completely false claims out of nowhere to support your arguments, but I still find it shocking. Frank Forfolk (talk) 00:23, 3 November 2024 (UTC)

It's probably too strong to say they're antivaxx without qualifiers, but they do definitely oppose vaccine mandates, especially for COVID specifically. That second one also has a suspicious line about At this time, the benefits of vaccinating children against COVID-19 are limited. Loki (talk) 02:04, 3 November 2024 (UTC)

Do AcPeds have any sham antivax scholarship published somewhere like the BMJ? Void if removed (talk) 06:23, 3 November 2024 (UTC)

That’s understating the level of false equivalence we’re on. If every systematic review on vaccines had found no evidence they work and no monitoring of their long term effects, that would put it on about the same level as youth gender medicine, and in that alternate universe antivaxxers certainly would not be fringe. Frank Forfolk (talk) 11:28, 3 November 2024 (UTC)

The huge gap between no evidence and poor evidence should not be understated and I hope you made a typo. No evidence is for things like ROGD and Gender exploratory therapy (which genuinely have no evidence of existing / providing benefit), poor evidence is when you want more investigation so patients can be better informed and the risk/benefits of a treatment are better understood. Grading of evidence in medicine is a specific endeavour and the fact that Cass ignored the predifined terms for her own (never defined) terms has been a source of criticism because it can lead to misunderstandings like confusing wanting more evidence (poor evidence) for no evidence existing. LunaHasArrived (talk) 12:26, 4 November 2024 (UTC)

Okay then, poor evidence. In the alternate universe where there was only poor evidence for the efficacy and safety of vaccines, doctors and researchers questioning vaccine safety and efficacy would not be fringe. In our universe the evidence in favour of vaccines is overwhelming and scholarly consensus reflects that, which is why we can apply WP:FRINGE to antivax positions. In our universe there is also poor quality evidence for any benefits of youth gender medicine, there are doctors and researchers questioning its efficacy and safety, and WP:FRINGE does not apply because there is no overwhelming evidence-backed consensus in the field. There is certainly an overwhelming ideological consensus in some camps that youth gender medicine huge benefits, indeed that it’s lifesaving — but this is derived from ideology, not medical evidence, and Wikipedia should treat it like any other political POV, and it certainly shouldn’t be taking sides and declaring actual medical evidence to be ‘fringe’ if it contradicts that POV. Frank Forfolk (talk) 15:41, 4 November 2024 (UTC)

I am so glad you brought that up! Because according to a 2016 systemic review, only 13.5% of medical treatments have high quality evidence, and over 50% had low level evidence.[18] The only ideology here is the one that said that one of those specific treatments needed to be banned for being part of that over 50%. We have countless MEDORG sources on this page saying the same thing, and the overwhelming consensus outside of one island in the Atlantic is that the evidence supports these treatments. Wikipedia should not be citing fringe content from conversion therapy lobby groups like SEGM to try and paint a picture that misleads the reader into thinking that GAC is some ideological craze and not, you know, the well informed consensus of the global medical community. Snokalok (talk) 16:06, 4 November 2024 (UTC)

Because according to a 2016 systemic review, only 13.5% of medical treatments have high quality evidence, and over 50% had low level evidence. And of course it would be absurd to try to call doctors and researchers who called the efficacy of those treatments into question 'fringe'. But for this class of treatments we're meant to pretend we have absolute certainty that they work, that they're lifesaving, despite the lack of good evidence; and what's more because of this absolute certainty on the matter we automatically know that any doctor, researcher or country that publishes dissenting opinions is automatically fringe, no matter how many WP:MEDRS sources do so.

This is, of course, ridiculous. I just want Wikipedia to reflect the truth, that there's major controversy in this field and RS are in conflict. Frank Forfolk (talk) 18:46, 4 November 2024 (UTC)

I also don't think you appreciate what 'poor evidence' means. It does not mean 'we know this works but we want better research on that'. It means 'we have only poor evidence that this works'. This can, and often does, mean that better quality research will see the effect vanish entirely, proven to be purely an illusion of things like publication bias, researcher degrees of freedom and random chance. It also means that the null hypothesis is not fringe. Frank Forfolk (talk) 15:53, 4 November 2024 (UTC)

Void if removed ah, but that just proves the BMJ and the University of York are fringe too, because they are platforming SEGM! They've already unmasked Gordon Guyatt [19]. You can't argue logically with the ideologue, they will always interpret or ignore any evidence to fit the conclusions they "know" to be true. FirstPrimeOfApophis (talk) 20:10, 2 November 2024 (UTC)

Wikipedia:NOTFORUM LunaHasArrived (talk) 23:42, 2 November 2024 (UTC)

Quite right. Struck. FirstPrimeOfApophis (talk) 19:22, 4 November 2024 (UTC)

(A) you have posted some links to news-stories you think proves the UK media was "gender-critical" before the Final Report was published, and are arguing that this proves there could not have been a "shift" as stated in the source. You are wrong because (1) none of the sources you provide are really examples of gender-critical reporting (2) even if those specific examples were gender-critical, it wouldn't be possible to generalise to the whole "UK media" from such a small range of examples (3) even if you could somehow show that the UK media was gender-critical before the Final Report, it doesn't disprove the claim that it underwent a "shift" to become more gender-critical afterwards. Presumably it isn't a binary phenomenon where someone either is or isn't gender-critical. (4) There is a policy against trying to use primary sources to make "an analytic, evaluative, interpretive, or synthetic claim" (WP:SECONDARY), and this situation is exactly why. Please stop.

(B) For anything related to health and society, a commissioned and peer-reviewed BMJ Investigations article is one of the best sources available.

(C) Those descriptions sound fair enough to me, but that doesn't matter. Editors cannot obstruct inclusion of RS because they disagree with what the RS says. This is a cornerstone of NPOV. A number of editors on this article seem to be struggling with this.

(D) As VoidIfRemoved says, it isn't a "response" to the Cass Review at all, individual or otherwise. If you mean it's a source with a single author, there is no policy against that, that was just something an editor on this article made up.

Do you have any further input or concerns about the draft "media coverage" section (based on real WP policy, not personal disagreement with the source)? You mentioned POV earlier; maybe you can elaborate? FirstPrimeOfApophis (talk) 18:50, 1 November 2024 (UTC)

A) We’re allowed to conduct research and use primary sources for the purpose of talk page discussion and evaluation of the quality of secondary sources we might put in the article.

B) Health perhaps, society absolutely not. Society is not a medical topic, it’s at best a non-medical academic one. We wouldn’t start saying “Goth and emo fashion combined with the release of MCR’s Helena” and cite the British Medical Journal.

C) It’s not an RS though. It gets factual information wrong, has dubious sourcing, and presents fringe right wing lobby groups as reasonable MEDORGs. Per WP:FALSEBALANCE, we do not have to give factually incorrect, poorly researched, and fringe information a platform simply because of the media source that published it. An example: The BBC is an RSP green source, but that doesn’t make "We're being pressured into sex by some trans women" a reliable article to cite - it’s still fringe, poorly sourced, and citing right wing lobby groups as neutral. we as editors have a duty to evaluate a source based on its individual merits, not merely the name of its publication.

D) This point’s actually fair, I shall not push it further. Snokalok (talk) 22:59, 2 November 2024 (UTC)

(A) you're not evaluating the quality though, you are trying to evaluate the truthfulness of the source with a view to excluding it if you decide it's "wrong". That is not the place of editors to do. Neutrality requires that mainspace articles and pages fairly represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in those sources. The relative prominence of each viewpoint among Wikipedia editors or the general public is irrelevant and should not be considered.

(B) By "Health and society" I meant social impact of health affairs. You can see the type of areas BMJ Investigations covers here [20] In these areas, yes, BMJ Investigations are clearly an RS. It would be strange to cite claims about Goth and Emo fashion to the BMJ but it might happen.

(C) It gets factual information wrong, has dubious sourcing, and presents fringe right wing lobby groups as reasonable MEDORGs. The first two are your opinion, the last wouldn't be a reason to exclude even if it was true. Of course investigative journalists are allowed to quote lobby groups. BTW I think you have it backwards re RS citing potentially unreliable sources - you seem to think citing e.g. SEGM somehow "contaminates" the RS and makes it less reliable. In fact, the opposite is true: per WP:USEBYOTHERS widespread citation without comment for facts is evidence of a source's reputation and reliability for similar facts. So if RS like the BBC or BMJ frequently cite SEGM without comment, editors should eventually regard SEGM as a reliable source (not ignoring other RS criteria); it doesn't somehow downgrade the BBC or BMJ.

Per WP:FALSEBALANCE, we do not have to give factually incorrect, poorly researched, and fringe information a platform simply because of the media source that published it. Again "factually incorrect" and "poorly researched" are your opinion, and it isn't WP:FRINGE - what prevailing views or mainstream views regarding the media coverage of the Cass Report does it deviate from? I can't find any.

What WP:FALSEBALANCE actually says is Wikipedia policy does not state or imply that every minority view, fringe theory, or extraordinary claim needs to be presented along with commonly accepted mainstream scholarship as if they were of equal validity. I don't see how it can be a minority view, fringe theory or extraordinary claim to say that there has been a shift in how the UK media cover transgender issues since the Cass Final Report, when there no RS at all expressing a contrary view. Plus peer-reviewed articles in the BMJ would seem to typify commonly accepted mainstream scholarship.

Regarding your BBC article example, I think you are wrong, depending on the claim being sourced it might be quite acceptable to use the updated version of the article as an RS. FirstPrimeOfApophis (talk) 20:29, 4 November 2024 (UTC)

To be clear Snokalok, I personally think you are right that there has not been a shift in UK media coverage, but for the opposite reason to you - I see the Guardian and the New Statesman etc acknowledging the lack of evidence for GAC in editorials then continuing to take a pro-"affirming" line in their reporting e.g. of the puberty blocker ban. So this isn't about me trying to force my beliefs into the article.

But we have an RS which claims there has been such a shift, and as far as I understand WP:NPOV and WP:DUE we have to report the viewpoints expressed in RS. In the wording I propose, we would not state the shift has happened as a fact - we would keep it in quotes and attribute it to the source. Naturally, as soon as we have a secondary RS saying there has been no change in how the UK media report transgender issues post-Cass, we should add it. FirstPrimeOfApophis (talk) 20:47, 4 November 2024 (UTC)

That’s a misunderstanding of WP:DUE - represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint.

If this viewpoint is only supported as a claim by this one person, without other supporting statements by others, then by definition, it is not a significant viewpoint, which means we the use Generally, the views of tiny minorities should not be included at all of DUE and ommit this entirely.

Basically we are not obligated to publish every single point of view from somewhere, just because it itself may be RS. Raladic (talk) 21:21, 4 November 2024 (UTC)

If it is currently the only secondary RS which discusses this topic (media coverage of the Cass Review), of course the viewpoints it presents are significant.

If this viewpoint is only supported as a claim by this one person, without other supporting statements by others, then by definition, it is not a significant viewpoint

No, that is not a real policy. A viewpoint doesn't need to appear in multiple RS to be significant; not all topics are covered by a large number of RS and there is no interpretation of WP:DUE which requires that. Anyway, you don't really believe it yourself; what were the other supporting statements by others for the substack content you wanted to add here?

we the use Generally, the views of tiny minorities should not be included at all of DUE and ommit this entirely.

Obviously "tiny minority" in the context of WP:DUE means a minority of the sources which discuss the topic in question, not a minority of all the sources ever published on any topic. It cannot be a minority view unless it contradicts a "majority view" of the same topic, for example if a majority of RS said there has been no change in how the UK media report transgender issues, or said that reporting of the Review in the UK and US was the same. Do you have those sources? FirstPrimeOfApophis (talk) 18:15, 6 November 2024 (UTC)

At the end of the day no evidence has been provided that there is a shift and with no other sources the best we can say is Jennifer block thinks there has been a shift. This source can't get the age of SEGM right, it says the Cass review had a huge impact in the UK and Europe (citing the Cass review). I'm not aware of any impact this has had outside the UK in Europe. Given this is not an academic paper I'm treating BMJ investigations the same way I'd treat a highly respected newspaper and saying this is a poor peice put out by a respectable source and while it could be useful for some quotes or attribution, we probably shouldn't be writing our article based on this source. This is mainly given the level of unreliable claims (which are at best a matter of opinion) presented as fact within the peice. LunaHasArrived (talk) 10:51, 2 November 2024 (UTC)

At the end of the day no evidence has been provided that there is a shift

We represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in those sources, it doesn't matter whether editors find those viewpoints persuasive or not.

with no other sources the best we can say is Jennifer block thinks there has been a shift.

Once again, this is a peer-reviewed secondary RS published in a scientific journal, it would not be appropriate to try to diminish its conclusions by implying it is only the personal opinion of the author.

Anyway, the proposed text is:

An article comparing the reception of the Cass Review in the UK and US noted that after the Final Report was published "the tone of major print and broadcast media in the UK has shifted"

so the claim would be attributed to the article and even in quotes, so nobody will confuse it with wiki-voice.

If people prefer changing "noted" to "said", let's do that. FirstPrimeOfApophis (talk) 19:53, 2 November 2024 (UTC)

OK, I've added the Media Response section. I have tried to make the wording as neutral as possible but Snokalok and LunaHasArrived please can you check for any POV and adjust the wording as you see fit? FirstPrimeOfApophis (talk) 18:36, 7 November 2024 (UTC)

@Raladic has also been active against this inclusion, we should tag her.

Anyway, I personally am still thoroughly unconvinced on this source. Additionally, we should ask ourselves about notability. Why are we giving an entire section with two paragraphs to contentious claims made by a single unreliable source with no clear other sources reporting on such a thing? Snokalok (talk) 20:08, 7 November 2024 (UTC)

I have to agree, even if this source was top level quality there is the question of how much should we write based off of one rs. The main point being if only one source talks about the media reception, it really isn't a big deal. LunaHasArrived (talk) 12:17, 9 November 2024 (UTC)

Two minor errors in subsection header captions

"Adult Clinics" should be "Adult clinics" (capitalisation). "Other government bodies actions" should be "Other government bodies' actions" (apostrophe), or "Actions by other government bodies". 2A00:23C5:FE1C:3701:947F:B029:98CA:1E06 (talk) 14:16, 16 November 2024 (UTC)

See Also

@Snokalok and @Raladic You have added and reinstated a link to the page 21st-century anti-trans movement in the United Kingdom which you have been busily creating for the past few weeks.

That page has a somewhat inflammatory title to suggest an association with the Cass Review.

It also is justified by you because it contains the following:

In 2024, the publication of the controversial Cass Review of youth gender services led to a criminal ban on puberty blockers, and a general shift in NHS policy towards gender exploratory therapy, which many experts say is a form of conversion therapy. The review's recommendations were generally welcomed by the British medical community, however the international medical and academic communities generally criticised or rejected the review on grounds of both methodology and findings.

Which of course is not a reflection of the language on this page. I suggest this material is a WP:POVFORK and the relation to this page tenuous at best, especially the weasel-worded material on conversion therapy, which is itself flatly contradicted by the Cass Review. Void if removed (talk) 18:18, 4 December 2024 (UTC)

Please remember that Wikipedia is WP:NOTCENSORED and while you may take personal issue with the topic, it is a well sourced and neutral article that summarizes the anti-trans movement in the United Kingdom.

The article discusses the Cass Review in context, in fact it is mentioned 18 times in the article, so it is entirely appropriate as a related article link. Raladic (talk) 18:22, 4 December 2024 (UTC)

It’s a highly controversial government report that was used to justify a ban on puberty blockers and the mainstreaming of GET, which is widely recognized but everyone but the Cass Review as a form of conversion therapy. How is that not highly relevant to a major sociopolitical movement which has for a long time made both of those goals a centerpiece of itself? Snokalok (talk) 18:54, 4 December 2024 (UTC)

I don't think your repeated comments about GET are helpful.

In the final report, I find this:

"Terms such as ‘affirmative’ and ‘exploratory’ approaches have been weaponised to the extent that it is difficult to find any neutral terminology... 11.6 The intent of psychological intervention is not to change the person’s perception of who they are but to work with them to explore their concerns and experiences and help alleviate their distress, regardless of whether they pursue a medical pathway or not. It is harmful to equate this approach to conversion therapy as it may prevent young people from getting the emotional support they deserve."

It sounds like the twin goals are:

• "not to change the person’s perception of who they are" – which means not conversion therapy – and also
• "explore their concerns and experiences and help alleviate their distress".

Do you have a preferred term for this combination of not trying to change people's identities while still letting them have what one GIDS specialist calls "an open space for exploration of what this means to the individual, and what support they need in order to live a happy and fulfilled life"? The GIDS staff said they considered this to be compatible with the affirmative model, which they described in the report as "respecting the young person’s experience and sense of self whilst still exploring the meaning of that experience in a non-directive therapeutic relationship". Do you believe that this is a non-affirming approach? I could imagine someone (e.g., on social media) agreeing that this is actually an affirming approach, and agreeing that it is literally the approach recommended by the final report, but worrying that there will be a bait-and-switch scam: The Cass report might say not to change the clients' identities, but all of us smart people know that means exactly the opposite. WhatamIdoing (talk) 08:23, 5 December 2024 (UTC)

This goes back to the points I made here and the continual refusal to actually balance that material with the Cass Review over the past year. Unpicking this is hard, because it means an assessment of both the included and excluded sources over there. Which I did. But I am in a minority, and so this will keep spilling over onto this page.

Eg. Clayton et al (2024) says:

In contrast, Cass notes that alongside biological factors, psychosocial circumstances (such as trauma, homophobia, social influence) and mental health conditions might contribute to the development of youth GD/GI, rather than just being secondary or coincidental. Under the Cass model, the multidisciplinary assessment is geared towards identifying elements in these various domains relevant to the individual patient’s GD/GI. Cass notes the critical importance of a formulation to inform an individualized management approach which is developed by a collaborative process considering patient values, clinical expertise, and research evidence.4 In this model, GD/GI may well resolve with maturity, treatment of any co-existing psychiatric conditions, and/or supportive psychosocial care or psychotherapy – such as trauma-informed therapy or family therapy as indicated for each individual case. Importantly, this type of therapy does not aim to ‘change someone’s identity’ but validates a young person’s experience while opening space for self-reflection about their experiences and help with alleviating distress. This is not conversion therapy.

This could scarcely be clearer. However, since all three authors are associated with SEGM, and since editors have already decided SEGM are really espousing "conversion therapy" and are therefore fringe, the chances of my successfully citing this over such objections is nil, as with the arguments against the various BMJ sources that have been excluded from this page. Ie, it does not matter that this is a high quality peer-reviewed source, saying explicitly that it isn't conversion therapy, editors seem to already know it is (largely based on the current state of Gender exploratory therapy and SEGM), and that these authors can't be trusted, and thus it is excluded.

Likewise, Roberto D'Angelo, president of SEGM, writing in September:

Further, the current dominant understanding of trans identification in young people entails a very specific way of formulating (I would argue distorting) psychological distress, described in The Cass Review as “diagnostic overshadowing”. In effect, what this means is that any suffering, manifesting as anxiety, depression, eating disorders, etc, is subsumed under the diagnosis of gender dysphoria or “massive gender trauma”. This reconfiguration effectively trivialises and even erases these problems and their meaning, viewing them as secondary phenomena that will evaporate once gender transition has occurred. This clinical process reshapes psychic pain, which is difficult for both patient and analyst to bear, into a concrete problem with a concrete solution. Those who raise concerns about the quality of the evidence base for this concrete solution present a threat to this defensive phenomenon and are attacked with the same ferocity encountered when a patient becomes aware of dissociated material or “not-me” states. The net effect is that both analyst and patient can avoid and deny the psychic pain that is “humming” beneath the experience of gender dysphoria, maintaining a powerful prohibition on knowing.

Again, these are by my reading legitimate perspectives expressed in respectable, peer-reviewed journals. But if you start from the position that it is conversion therapy and cannot be legitimate (and is therefore fringe) then it creates a self-perpetuating cycle where no balancing sources are ever acceptable, because by saying the "wrong" thing they are fringe, something that has been applied even to sources as weighty as the Cass Review. It is WP:EXTRAORDINARY to claim the Cass Review espouses conversion therapy.

Do you have a preferred term

There is no preferred term. There cannot be one. The split is between the affirmative model, and anything else. If it isn't the affirmative model, then it is considered de facto conversion, and any labelling is mere obfuscation, is the reasoning. Exploratory therapy, gender exploratory model, psychotherapy, psychoanalysis, psychodynamic psychotherapy, ethical exploratory therapy, non-directed exploration - these have all been used and every single one has been collapsed into "conversion therapy". Cass drew attention to this as part of the reason GIDS was overwhelmed and failed - because clinicians didn't want to risk engaging in bog standard psychotherapy themselves and just dumped patients to GIDS. Void if removed (talk) 09:52, 5 December 2024 (UTC)

Diagnostic overshadowing could use some work. I wonder if the outrageous experience some trans people have reported, of having a provider ask to look at their genitals when they have a broken ankle, could be a case of this.

I suspect that it's mostly meant to cover cases of "He's screaming again so that's just his Level 3 Autism, not a sign of physical pain", but I haven't looked for sources that would show how narrow or wide it's usually understood. WhatamIdoing (talk) 17:29, 5 December 2024 (UTC)

Well quite, and in the context of the Cass Review the refusal of the adult clinics to provide follow-up information makes much of this unfortunately poorly understood. The outcome data is so poor it's hard to say with certainty. Void if removed (talk) 20:56, 5 December 2024 (UTC)

Ok, but regardless of what SEGM may or may not be saying on this particular subject, they are still a fringe group that hold scientifically unsupported positions, so they & those closely affiliated with them should not be cited as reliable sources for medical/scientific topics. Butterscotch Beluga (talk) 20:35, 5 December 2024 (UTC)

@Butterscotch Beluga, can you point me to the policy or guideline that says if someone holds a fringe position that nothing they write, and nothing written by anyone closely affiliated with them, can be cited as reliable sources for medical/scientific topics?

If you are looking for an example from another field, Linus Pauling won a Nobel for chemistry, and part of that work developed into proving that Sickle cell disease is genetic. He also advocated for fringe-y positions on Vitamin C megadosage. Now, according to what you've said, there's a policy or guideline that says Pauling can't be cited "for medical/scientific topics". Which policy or guideline is it, and what's the exact wording in it? WhatamIdoing (talk) 20:52, 5 December 2024 (UTC)

I feel that's a poor example.

Linus Pauling has some ideas that are very well accepted, and others which have been dismissed as quackery. Same with other semi-quacks such as John Ioannidis.

I think if multiple folks state that Linus Pauling's views on medical info post 1960 is inflammatory, his statements should be given attribution, alongside the appropriate criticism. If he is well respected in electrochemistry, and pre1960-ish, it would be undue not to include him.

We can include SEGM as long as we attribute to them, and if there is sufficient criticism, we provide the WP:DUE amount of context around them. Bluethricecreamman (talk) 21:06, 5 December 2024 (UTC)

That's not what Butterscotch Beluga was saying. WhatamIdoing (talk) 21:36, 5 December 2024 (UTC)

That actually was what I was saying. When I said "for medical/scientific topics", I did indeed mean in the context that they are considered fringe.

This I hope properly conveys why I don't think those who are members/have close relations with SEGM are reputable, nor should their positions related to SEGM's subjects of advocacy carry much weight. Butterscotch Beluga (talk) 22:00, 5 December 2024 (UTC)

I wonder occasionally if it would be worth setting up a section similar to the Talk:Donald Trump#Current consensus section (which, in general, I think is a terrible idea), in which we record some things that we all agree on, e.g., that citing something written by an SEGM-tainted person does not automatically violate any policy or guideline, or that the Integrity Project's paper is not peer-reviewed, or whatever little facts we've discussed more than once or twice.

Butterscotch Beluga, I don't really care why you/we/anyone consider them disreputable. What I care about is whether Wikipedia editors post non-existent, made-up rules, which are then read and sincerely believed to be The Truth™ by less experienced editors. If you write something like "The policy says SEGM can't be cited for medical/scientific topics", then even if most of us know that this is just a quick thing, to get the general gist across, someone is eventually going to read that and believe that there is an actual WP:Policy that actually says this. This is a consequence of our method of teaching Wikipedia's rules, which is basically the telephone game. That's not your fault, but it is something you can help with. So I ask: Please (everyone), be careful about what you describe as being required or prohibited by policies and guidelines. It'll save everyone a lot of hassle and drama in the end. WhatamIdoing (talk) 22:33, 5 December 2024 (UTC)

I didn't say "The policy says SEGM can't be cited for medical/scientific topics" & as such, I'm not sure why you're putting it in quotes.

I'm saying that if someone works with a group with controversial views on conversion therapy, we shouldn't cite them uncritically on what is/isn't conversion therapy. Butterscotch Beluga (talk) 00:30, 6 December 2024 (UTC)

Right. Your exact words above were they & those closely affiliated with them should not be cited as reliable sources for medical/scientific topics.

Quotation marks in English have multiple uses; marking exact quotations of prior speech is only one of the multiple uses. WhatamIdoing (talk) 00:44, 6 December 2024 (UTC)

Ok. Personally, I don't like using quotation marks if I'm not quoting someone/something specifically, as it may lead to miscommunication, but that's neither here nor there. Butterscotch Beluga (talk) 00:47, 6 December 2024 (UTC)

This is a non-independent source, engaged in legal action in the US in opposition to SEGM so should be taken with a pinch of salt, especially in light of this peer-reviewed critique of the Yale team in the BMJ.

Which has of course been discussed here previously, and been derailed - again - by one of the co-author's relation to SEGM, never mind that the others are not.

The problem here is that on the balance of sources, we have a difference of opinion.

But if you start from the position of SEGM are fringe, that balancing of sources never happens. Void if removed (talk) 22:33, 5 December 2024 (UTC)

This might seem like a tangential response, but I'm looking at the BMJ critique you linked & was wondering if you could help clarify something for me.

It says "Various versions of McNamara et al have already been introduced into evidence in at least two high-profile court cases", but despite the two citations they supply, I'm having issues finding any mention of McNamara in either case.

Citation 16's google scholar link only finds the original BMJ critique & citation 17 does link to a case (Specifically this), but I don't see where McNamara et al is being used as evidence.

I'm probably just misunderstanding how google scholar works/am missing something obvious, but I wanted to check if you knew what the issue I'm having is. Butterscotch Beluga (talk) 23:56, 5 December 2024 (UTC)

Google Scholar does not track documents in lawsuits. Try searching a specialist website like this one: https://www.courtlistener.com/docket/63252064/eknes-tucker-v-marshall/?page=4 Or just try your favorite web search engine.

The SCOTUS case documents are here: https://www.supremecourt.gov/search.aspx?filename=/docket/docketfiles/html/public/23-477.html WhatamIdoing (talk) 00:52, 6 December 2024 (UTC)

RE: the first, the Yale critique of the Cass Review was filed as an amicus brief in Boe vs Marshall the day it came out, you can read it here: https://storage.courtlistener.com/recap/gov.uscourts.almd.77755/gov.uscourts.almd.77755.629.7.pdf

From here:

https://www.courtlistener.com/docket/63252064/boe-v-marshall/?page=4 Void if removed (talk) 16:25, 6 December 2024 (UTC)

I don't think this statement actually shows that GET isn't conversion therapy. Having read the article in sandbox as well, I'm even more suspicious of this approach. All the talk of meaningmaking and finding a formulation suggests a process of looking to attribute transness to underlying psychological conditions. Once such "meanings"/conditions have been identified, the therapist is obliged to treat them per oath. Whether they intend to or not, this then becomes an attempt to treat transness itself – the transness becomes a medical problem to fix – and is thus conversion therapy.

The name is also a giveaway of intentions. Gender exploratory therapy isn't neutral, and isn't simply exploration and investigation; it means starting from the position of assuming a need to treat. The treatment begins before the rationale has even been developed, and you just make up the rationale (sorry, "find the formulation") as you go along. And this "psychological intervention" is also mandated before you can access anything else.

But all this aside (I know, I know, Wikipedia is WP:NOTAFORUM), most experts internationally do see GET as conversion therapy. As did many UK experts until recently. We aren't bound to enforce UK policy changes or new report findings, only the consensus among experts. And WP:SPOV trumps government reviews. If the UK and a couple of other countries are outliers, then they naturally represent a minority viewpoint and not the consensus, and should be presented as such. Lewisguile (talk) 10:26, 20 December 2024 (UTC)

SPOV is a {{failed proposal}}, and NPOV says that the views of Wikipedia editors – including whether Wikipedia editors deem a particular POV to be "scientific" – are irrelevant. WhatamIdoing (talk) 22:57, 20 December 2024 (UTC)

You ignored the bit about most international experts disagreeing with the UK view. The UK is therefore an outlier. Lewisguile (talk) 13:02, 21 December 2024 (UTC)

I responded only to your claim that And WP:SPOV trumps government reviews.

I wonder, though, whether it's really appropriate to talk about "international experts". WPATH claims to represent/serve the world, but much of the world (e.g., developing countries) is not especially interested in its views. We're kind of in a position of having UK+Norway+Sweden vs US+AU+NZ+some others vs a majority of countries that explicitly prohibit transition or have no legal provision for it. "The international consensus", if you determine this by population or the number of countries, is that trans people get no medical care and have no legal rights. Perhaps we should talk about "the scholarly consensus"? WhatamIdoing (talk) 19:40, 21 December 2024 (UTC)

We can call it that if you'd like. "International expert consensus" might be the best framing, but we're splitting hairs. Lewisguile (talk) 20:13, 21 December 2024 (UTC)

What's the difference between an "international expert" and an "Australian expert"? WhatamIdoing (talk) 22:44, 21 December 2024 (UTC)

I'm not sure this is a fruitful line of discussion, TBH. With all the good faith I can muster, I have still found most your responses a combination of pedantic, sometimes a little combative and often baffling. I'm often not sure what you're trying to say or why. I feel like there's no way to engage constructively with them at present but I don't want to ignore you completely, because it seems you are trying to say something useful. It's entirely possible I'm just not understanding your response style or what you're trying to convey, but that's as good a sign as any to leave this line of thought well enough alone. Thanks anyway. Lewisguile (talk) 08:57, 22 December 2024 (UTC)

I'm also finding some of this confusing, which is why I'm asking questions.

AFAICT the answer to my question is that if the source agrees with the True™ POV, then they're an international expert, but if the source disagrees with the True™ POV, then that's only a country-level expert (at best). So if an Australian expert writes something that aligns with their country's approach, then they're an "international" expert, but if a Norwegian or Swedish expert writes something that aligns with their country's approach, then they're not. Right?

If so, then maybe we should say "WPATH's SOC-8" instead of "international expert consensus". It would be more specific and more neutral, as well as preventing confusion about why the "international" consensus is rejected by a majority of countries. WhatamIdoing (talk) 06:50, 23 December 2024 (UTC)

The international consensus is the medical opinion of the big international organizations in this area of medicine, namely WPATH and the Endocrine Society. It's true that there are specific experts and even sometimes whole national health organizations that contradict them, but in order to be the international consensus, they would have to either get WPATH and the ES to agree with them, or make an organization that was as big and influential in the area as WPATH and the ES are. Loki (talk) 03:58, 25 December 2024 (UTC)

Which is to say that the "international consensus" is "the agreement of two US-based organizations". I think we should consider being more specific (e.g., "Cass rejected the treatment protocols from WPATH and Endocrine Society, which are the most widely used in the world").

"International" in medicine usually means a UN agency, especially the World Health Organization. When describing a protocol that is widely used around the world (e.g., the CHOP-R chemo protocol), nobody bothers to call it an "international" protocol; it would feel weird – like your science is so weak that you need to slap on some peacock words for marketing purposes. WhatamIdoing (talk) 17:41, 25 December 2024 (UTC)

The UN is also US-based, though. Its headquarters are in New York.

More to the point, it's true that the US has an outsize amount of influence in many international organizations. But that doesn't make them not international. WPATH and the Endocrine Society are both very clearly international organizations according to all sources on them and your attempts to argue against that sound frankly like WP:IDONTLIKEIT to me. Loki (talk) 03:48, 26 December 2024 (UTC)

The UN isn't US-based, though its main headquarters are there. The UN was founded by multiple countries working together.

The WPATH article, on the other hand, says "The founding committee was entirely American...", and it looks like most of the past presidents were from the US. WhatamIdoing (talk) 04:07, 26 December 2024 (UTC)

So? Again, it's true that the US has an outsize amount of influence in many international organizations, but that doesn't make them American organizations. NATO was established in America and has been very clearly dominated by the US throughout its history, and yet it's clearly an international organization. And WPATH isn't even nearly so American-dominated as that.

This whole argument feels like a clear no true Scotsman to me: no true highly respected international WP:MEDORG would take such a strong stance on one side, therefore WPATH must be fake or illegitimate for some reason. Loki (talk) 02:04, 27 December 2024 (UTC)

Both NATO and its predecessor were formed by a treaty, which means that NATO was inherently an international project from the beginning.

Highly respected international MEDORGs do (and IMO should) take strong stances. What feels "off" to me is that we have two US-dominated orgs that Wikipedia editors have repeatedly presented not as being "right" (or equivalents, e.g., "evidence-based"), but instead as "the international consensus", which is abnormal for a MEDORG. Compare some other, once-contentious claims:

• Measles vaccines do not cause autism.
• The CHOP-R chemotherapy regimen is widely used because it has the same survival rate but lower side effects than the alternatives.
• Antibiotics do not cure viral infections.
• Screening mammograms are inappropriate for women whose expected lifespan is short (<10 years).
• Breast self-exams don't save lives.
• HIV causes AIDS, but Undetectable = Untransmittable.

But:

• There's an international consensus that (some) trans kids should be eligible for hormone treatment before the age of 18.

Which leads one to wonder: How many other consensuses are out there, and do all of them disagree?

In the other examples, we don't need to prepend "There's an international consensus that...", because it's just facts, and everyone (i.e., every expert) around the world knows and agrees with these facts. So why is that necessary here? From where I'm sitting, it certainly sounds like it's because the "international consensus" isn't as widely agreed-upon as these other things. WhatamIdoing (talk) 04:52, 27 December 2024 (UTC)

The York review on international guidelines says that the majority of such guidelines are based on those by WPATH and the Endocrine Society. It does describe differences on specifics, but it also says, Overall, guidelines describe a care pathway similar to the original Dutch protocol that involves psychosocial care for prepubertal children followed by hormonal interventions for adolescents who meet specific criteria, provided by a specialist multidisciplinary team. This approach continues to dominate clinical guidance despite lack of high-quality evidence regarding treatments, or exploring alternative care models. Earlier it says, All but one of these promote a model of gender-affirming healthcare, which seems quite clear to me.

Their own conclusion was Published guidance describes a similar care pathway; however, there is no current consensus about the purpose and process of assessment for children or adolescents with gender dysphoria/incongruence, or about when psychological or hormonal interventions should be offered and on what basis. So the lack of consensus, per York, is in regards to the assessment process and when and why to offer interventions, not in the interventions themselves (the overall "pathway" is described as being broadly similar several times). From this, we can derive the following:

• Most GLs internationally are based on WPATH and/or the Endocrine Society
• All but one of the GLs advocate a "gender-affirming" model
• Most GLs describe the same or a similar pathway
• GLs differ on the specifics of when and why interventions are given (which isn't the same as saying they differ on which interventions are given)
• GLs differ on the specifics of why assessment is conducted

Therefore, it's fair to say there's a consensus for gender-affirming care based broadly on the Dutch model, but that variations and rationales differ in key areas. The Cass Review, also drawing on the e-survey on service delivery, concludes that Most national and regional guidelines have been influenced by the World Professional Association for Transgender Health and Endocrine Society guidelines which themselves lack developmental rigour and are linked through co-sponsorship. There is consensus across guidelines that those requiring specialist gender care should receive a multi-disciplinary assessment, although there is a lack of clarity about who should be involved in this and any differences in assessment for children and adolescents. Similarly, there is consensus that children and adolescents should be offered psychosocial support, but there is limited guidance about the process or approach for this and different recommendations about whether specialist gender clinics or mental health services should provide this. There are differing recommendations about when and on what basis psychological and hormone interventions should be offered, and limited guidance about pre-pubertal children or those with a non-binary gender identity. Cass isn't saying there isn't any agreement, but that there is divergence on key specifics, as per the York review; that the evidence base for them isn't robust enough; and that service delivery models are different in different places (unsurprisingly). WPATH, of course, disputes that its guidelines are unreliable (as do other orgs) as per the current "Responses" section. When we separate out the service delivery elements (which is driven by budget, politics, local need, etc, and isn't necessarily defined by treatment guidelines but rather by the operationalisation of them), Cass is simply reiterating the York review on international guidelines (as we'd expect). So my summary above stands here too. Lewisguile (talk) 07:45, 27 December 2024 (UTC)

The York review covers international, national, and regional guidelines. It cites a 2021 paper that defines "international guideline" as a guideline intended to apply across multiple nations (most commonly, the EU or globally). They found 12 such international guidelines (Table 1): the 2017 Endocrine Society guideline, WPATH's SOC-7, a speech/language guideline based on SOC-7, and nine others that weren't based on either of the two big US-based groups, several of which are only partially about gender care, but some of which are highly relevant for the subject of the Cass Review (e.g., "Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents"). Some of these criticize ES and WPATH (e.g., based on "limited" evidence or being out of date), though I haven't noticed any that fully reject either. WhatamIdoing (talk) 21:15, 27 December 2024 (UTC)

Let me rephrase. Void if removed referred to the York review as the "York review on international guidelines" and I was using the same language. We were both referring (I think) to the overall findings of the "York review on guidelines"; in my case, I used "international" to mean "not UK"/"beyond UK", rather than specifically "GLs intended to apply across multiple countries". Cass' synthesis/conclusions seem to draw from across these GLs, without distinction for whether they're regional, national, etc. She makes her conclusions based on broad similarities and specific differences across the entirety of all the GLs, so that's what I've done too. Lewisguile (talk) 08:09, 28 December 2024 (UTC)

The York review of international guidelines tells us there is no international consensus. Void if removed (talk) 21:30, 26 December 2024 (UTC)

Where in the York review on guidelines does it mention conversion therapies? I didn't spot that on my recent re-read, so a page reference would help. Re: guidelines, it finds lack of clarity in specifics but says most guidelines are based on the same two guidelines (WPATH and Endocrine Society). Consensus is therefore largely around following the WPATH and Endocrine Society GLs, but obviously there is greater divergence thereafter. It also says:

• "Guidelines describe a similar care pathway starting with psychosocial care for prepubertal children, puberty suppressants followed by hormones for eligible adolescents and surgical interventions as these adolescents enter adulthood."
• "In general, there is consensus that adolescents should receive a multidisciplinary assessment, although clear guidance about the purpose or approach is lacking. There are differing recommendations about when and on what basis psychological and medical interventions should be offered. There is limited guidance about what psychological care should be provided, about the management of prepubertal children or those with a non-binary gender identity, nor about pathways between specialist gender services and other providers."
• "Two guidelines explicitly adopt the Dutch model (the earliest paediatric treatment protocol), and most guidelines reflect this pathway. One of these, however, recommends that medical interventions occur under a research framework and modifies the original criteria for treatment. Four guidelines propose an individualised approach to medical interventions, while still describing a phased approach"
• "All but one of these promote a model of gender-affirming healthcare and indicate that those with 'a stable gender identity' and 'supportive family and school environment' may not require psychosocial care. This recommendation marks a departure from earlier guidelines which describe psychosocial care as the mainstay of treatment, and the recent Finnish and Swedish guidelines which describe it as first-line treatment for childhood gender dysphoria/incongruence."
• "Overall, guidelines describe a care pathway similar to the original Dutch protocol that involves psychosocial care for prepubertal children followed by hormonal interventions for adolescents who meet specific criteria, provided by a specialist multidisciplinary team. This approach continues to dominate clinical guidance despite lack of high-quality evidence regarding treatments, or exploring alternative care models" (So this last part is what I would say the consensus is beyond Cass. Recognising divergence from consensus doesn't negate consensus, and in some regards, the differences can be seen as matters of clinical judgement or service priority.)

Lewisguile (talk) 21:53, 26 December 2024 (UTC)

What you're doing there is recounting the POV of those who say exploratory psychotherapy is conversion therapy. This is of course one POV, and one which needs to be fairly represented in relevant articles.

But it is not the only POV, nor is it the only POV present in MEDRS, which are much more equivocal on this, nor is it a POV that can be taken as definitive and used to judge the validity of different POVs in MEDRS. Indeed, the most definitive statement in a high quality source comes from the Cass Review, explicitly stating that it is not conversion therapy, and that it is harmful to suggest it is.

As Cass said in a recent interview:

There are individuals who are saying that [psychological] therapists who just take that careful, exploratory approach with a young person are conversion therapists, and that’s why it becomes so difficult, because then those therapists working in that space who are getting attacked become fearful Void if removed (talk) 13:44, 21 December 2024 (UTC)

The way to deal with this is not to look at only one source (e.g., the Cass Review), but to look at the breadth of sources in English and what the consensus among them seems to be. On the matter of whether "exploratory psychotherapy" (which doesn't seem to be a clinically defined term, as far as I can tell) is conversion therapy or not, it would be useful to consult what experts on trans health and conversion therapy say, and if there's any consensus between them? If there isn't, then we try to portray the major disputes. We certainly shouldn't ignore any major differences of opinion to push only one side, whether that's solely the view of the Cass Review or solely the view of anyone else.

If exploratory psychotherapy isn't well defined, then we may run into a problem there, too. But we can deal with that bridge when we come to it. Lewisguile (talk) 09:02, 22 December 2024 (UTC)

Another way would be to conduct a systematic review of international guidelines to determine what the consensus was on the appropriate psychotherapeutic interventions, at what point, to what end, what outcomes are expected etc. Which of course the Cass Review did, and found there to be no international consensus.

I think you might be mistaking strongly-expressed positions for international consensus.

As an aside, it is worth reviewing the recent Italian National Bioethics Committee position (Italian, but machine translation is good). What is fascinating (to me at least) about this is that despite a near-unanimous statement in accordance with the findings of the Cass Review signed by numerous clinical experts, after a year of taking evidence, resulting in advice to restrict puberty blockers to a clinicial trial context, almost half of this publication (9 pages) is given over to the opinions of a single dissenter and a single abstainer.

In this thread you have very effectively put forward broadly the same position as the dissenting voice. That's fine, these are valid (and in some contexts majority) positions, and should be fairly represented. But they are not the only POV, and in some contexts they are outliers.

Navigating this neutrally is hard, when there is genuine dispute in MEDRS and widely varying expert opinion - and when the center of gravity for the strongest opinions is the US, and deeply enmeshed in US politics and legal struggles, that makes it even harder. But I'm afraid there simply is no international medical consensus that we can all straightforwardly defer to on any of these matters, the most comprehensive evidence-based independent review in this area is still the Cass Review, and the claims that the Cass Review espouses conversion therapy are WP:EXTRAORDINARY. Void if removed (talk) 12:15, 22 December 2024 (UTC)

The Cass Review is also just one source. Consensus is determined based on representing the balance of all major viewpoints, including those which dissent. So the Cass Review's conclusions are Cass' opinions based on systematic reviews, stakeholder consultation, grey literature, etc'.' The tools at her disposal may have been better than most (or even all) alternatives, but she still had to interpret that evidence to make her own conclusions from those tools. Which is why we still consider it one source among many. It can be appropriately weighted, but it isn't the be-all and end-all on the matter. It's about as useful and authoritative as a NICE guideline or Cochrane review, but unlike them, is significantly less transparent and vests decision-making in a single individual rather than a committee.Lewisguile (talk) 19:06, 22 December 2024 (UTC)

If this were an article about medical care for trans people in general, I would agree with you, but since this is an article about a document, then the due weight calculation is a bit different. It's not just "one source among many"; it is "the subject of the article". WhatamIdoing (talk) 06:52, 23 December 2024 (UTC)

If the article is indeed a WP:POVFORK of something you should propose merging or nominate it for deletion instead of removing links. Flounder fillet (talk) 18:16, 5 December 2024 (UTC)

I think it's unrelated, inflammatory, and adds nothing to this page. It shouldn't be in see also. I the idea that I cannot simply say the link shouldn't be there, but must instead be drawn into wider content arguments about a page I have no interest in and that has no bearing on this one. Void if removed (talk) 21:03, 5 December 2024 (UTC)

Bandying claims of POVFORK then saying it is entirely unrelated to this page are not compatible arguments. Bluethricecreamman (talk) 21:07, 5 December 2024 (UTC)

I disagree. The subject is nothing to do with this page. It also contains POV descriptions of the Cass Review. These are orthogonal concerns.

Not every page that mentions the Cass Review belongs in See Also, that's what "what links here" is for. The fact is the principal subject of that page has nothing to do with this one, and suggesting it does is inflammatory. Void if removed (talk) 21:27, 5 December 2024 (UTC)

No, the article discusses the Cass Review against the wider backdrop of the anti-trans movement in the UK and how it is being weaponized by anti-trans fringe groups, so this connection between the articles is very clear and the See Also is appropriate. This opposition appears to be a clear case of WP:IJUSTDONTLIKEIT. Raladic (talk) 21:46, 5 December 2024 (UTC)

According to MOS:SEEALSO articles linked should be related to the topic of the article or be in the same defining category.

21st-century anti-trans movement in the United Kingdom is unrelated to the topic of this article.

I can't find any decent independent sources making such a connection. There's this (which is not a reliable source), there's this (which is a garbage source that contains outright misinformation from the headline onwards) and there's this (which talks about the anti-trans movement in the US, not the UK).

The premise of your inclusion of the Cass Review in this article seems to be your own POV that it belongs there, and now you're reasoning backwards to say it is relevant, because your article says so. Void if removed (talk) 23:04, 5 December 2024 (UTC)

They both share several defining categories , most prominently Category:LGBTQ-related controversies in the United Kingdom and Category:Transgender topics in the United Kingdom and Hillary Cass's own statement in the article In an interview with The New York Times in May 2024, Hilary Cass expressed concern that her review was being weaponized to suggest that trans people do not exist... - this is the weaponization of the Cass Review that anti-trans groups are doing that she's referring to.

Again, the other article has several citations and links to the Cass Review, there is a clear link of the topics, so this see also link is entirely reasonable. Raladic (talk) 23:12, 5 December 2024 (UTC)

The Cass Review has been a corner stone of anti-trans advocacy since its release, and has been cited as the primary motivator for anti-trans policies such as Victoria Atkins puberty blocker ban. The link between the Cass review and the anti-trans movement is evident, and there is no scarcity of references which can be cited. Here is one example, which cites a government barrister saying that "Atkins “acted on the basis of her personal views about the conclusions of the Cass Review” : https://www.independent.co.uk/news/uk/crime/victoria-atkins-nhs-high-court-secretary-of-state-london-b2578759.html HenrikHolen (talk) 01:53, 6 December 2024 (UTC)

A page having POV issues is not equivalent to it being a WP:POVFORK. Flounder fillet (talk) 01:22, 6 December 2024 (UTC)

This comment feels like it falls into the category of WP: I Just Don't Like It.

The Cass review has motivated significant rollbacks of transgender rights in the UK. It is undeniably pertinent.

HenrikHolen (talk) 22:04, 5 December 2024 (UTC)

@Partofthemachine This is the discussion about the "See also". Please feel free to add your thoughts also, as people are still contributing (albeit more slowly than at first). Lewisguile (talk) 08:15, 28 December 2024 (UTC)

EBM as motivation

Hi @Snokalok, hope you're doing well.

I've seen you've undone my edit explicitly saying that enabling EBM was a motivation for the systematic reviews and Cass Review as a whole. Fundamentally, this is what the systematic reviews were for: to see the extent to which different types of transgender healthcare are supported by scientific evidence. Furthermore, it's supported by both the sources used for the sentence I changed.

Thornton said: "Fundamentally, Cass says that children with gender incongruence should receive the same standards of high-quality, evidence-based care expected elsewhere in the NHS. “They deserve very much better”, she wrote. Cass commissioned four systematic reviews of the evidence on key issues, including puberty blockers, hormones, and clinical guidelines."

The Cass Review itself said (amongst other quotes): "Although some think the clinical approach should be based on a social justice model, the NHS works in an evidence-based way. Whilst navigating a way through the surrounding ‘culture war’, the Review has been acutely and increasingly aware of the need for evidence to support its thinking and ultimately the final recommendations made in this report."

Please let me know what you think when you have time. Thanks! 13tez (talk) 20:17, 17 December 2024 (UTC)

So, there are a couple points I’d raise.

First, I feel that given the contested nature of the review among the medical and academic communities, statements like “we’re choosing EVIDENCE over SOCIAL JUSTICE” are something that at best need to be attributed and not simply repeated in wikivoice. Beyond that though, it is contested that Cass’ conclusions are the only evidence based ones, as seen in the response from countless MEDORGS below saying that the evidence does indeed support GAC and directly contradict the report’s conclusions. It’s a point that’s been rehashed countless times on this page as well, the basic “Only 13% of medical treatments have high quality evidence, citation cochrane” and the “why did the report say that psychotherapy had the same quality of evidence as HRT but recommended psychotherapy over HRT?”

I think that we can’t neutrally say that the Cass Review was doing this for EBM when we have countless MEDORGS contesting that in the article, as well as the BLUESKY on double standards of evidence here. Saying the Cass Review was done for EBM is at best a POV statement that we can perhaps place with attribution, but I’d argue not without the social justice part of the quote, and not without careful NPOV balancing that we’d have to work out on here beforehand. Additionally, regarding the systematic reviews commissioned, while they themselves are by all accounts fine reviews, the Cass Review itself is not a systematic review, it’s government recommendations made separately in response to those reviews and without any peer appraisal process.

I’m sort of rambling here, the point is, the EBM over social justice thing is in no way a neutral, scientifically vetted, or MEDORG uncontested statement and we shouldn’t be repeating it as though it is one. If you feel that it’s something still worth including based on notability (which I’ve not given strong consideration to yet), I’d like to hear that case more in depth. Snokalok (talk) 20:52, 17 December 2024 (UTC)

This comment (we can’t neutrally say that the Cass Review was doing this for EBM when we have countless MEDORGS contesting that) treats intention and result as the same thing. The review could be done "for the purpose of" evidence-based medicine but "actually result in" something else, just like a review of this type hypothetically could have been done "for the purpose of making sure the right political party won the next election" or "for the purpose of reducing healthcare costs" or "for the purpose of giving every child a lollipop", even if none of that is what actually happened.

If you want to contest a claim that the purpose/motivation was evidence-based medicine, then you need a source that says the intended purpose (i.e., not the actual outcome) was something else. WhatamIdoing (talk) 00:35, 19 December 2024 (UTC)

But the quotes you've given don't actually say "our intention is to reinforce EBM" or similar. You seem to be confusing intent with outcome. They have said the treatments weren't evidence based and they would like more EBM, but that was a finding. Lewisguile (talk) 07:56, 19 December 2024 (UTC)

Since I've given no quotes, you must be referring to a comment from someone else, but I can't figure out which comment you're referring to. WhatamIdoing (talk) 21:06, 19 December 2024 (UTC)

You're right! Sorry about that. I think I was replying to someone else and got lost in the branching replies. I've been ill on and off with COVID for the last two weeks, so I've had a bit of brain fog. Ignore me for now and if I figure out where this comment goes, I'll move it to the correct place. Lewisguile (talk) 14:56, 20 December 2024 (UTC)

I’m not saying that we should say it wasn’t for the sake of EBM, just that we can’t reliably or neutrally say it was given everything above. Snokalok (talk) 14:19, 19 December 2024 (UTC)

If we have sources saying that it was for the sake of EBM, then we can reliably say that; if we have no sources directly saying that it wasn't for the sake of EBM, it would even be neutral.

Note that one source saying "It was all motivated by a love for EBM, folks" is not contradicted by another source that says "But the result is a disaster!" We'd need a source that says something closer to "This was not motivated by EBM; this was entirely motivated by his political aspirations". WhatamIdoing (talk) 21:09, 19 December 2024 (UTC)

Such as the one medorg down below (PATHA) saying “This was a hit job by the people who pushed GAC bans in the US”? Snokalok (talk) 02:00, 20 December 2024 (UTC)

As I said, if you want to contest a statement that says that the motivation was EBM, then you need a statement that says it was not motivated by EBM. "This was a hit job" is not the same as "They were not motivated by EBM". WhatamIdoing (talk) 03:22, 20 December 2024 (UTC)

On that, I would respectfully disagree for two reasons:

1. Motivated by EBM implies a good faith dedication to science that a hit piece would not. Even if you disagree on this point, the fact remains that saying it was motivated by EBM carries a connotation of good faith and professionalism that is disputed by the latter statement, and thus we wouldn’t be presenting a neutral view.

2. The original quote above made a very strong point of saying ‘EBM over social justice’ which, besides lending credence to the hit piece idea, makes it inherently a politically aligned statement rather than a scientific one, and as such we can’t present it without neutral balancing or, at the very least, the full sentiment w/ the social justice part Snokalok (talk) 14:47, 20 December 2024 (UTC)

Hey, thanks for getting back to me. I hope you're having a nice day.

First, I feel that given the contested nature of the review among the medical and academic communities, statements like “we’re choosing EVIDENCE over SOCIAL JUSTICE” are something that at best need to be attributed and not simply repeated in wikivoice.

I don't think that framing accurately represents the point Cass was making. I think that she was explaining in good faith, to anyone who didn't already know, ⁣that while some people would advocate for other approaches, the NHS (and modern medicine in general) operates based upon EBM. NICE was created in 1999 to disseminate evidence and clinical guidance, based upon that evidence, to the NHS.

What she's saying is true, and she says that the transgender culture war is harmful. I can see why using the phrase "social justice" could, on first impression, make someone believe otherwise, since it is sometimes used in anti-trans and other reactionary rhetoric. However, she's making an explanation for transparency, to aid understanding, and in good faith here, rather than deriding anyone.

it is contested that Cass’ conclusions are the only evidence based ones, as seen in the response from countless MEDORGS below saying that the evidence does indeed support GAC and directly contradict the report’s conclusions

I don't think it's accurate or balanced to say that "countless" medical organisations either support the review or its findings or oppose it/them. Medical organisations in the UK, including the NHS and the RCP, generally support the review (the BMJ, amid controversy, is pending). WPATH and its regional branches, which some view as MEDORGs, have criticised it. Some international medical organisations, such as the American Academy of Pediatrics, have criticised the review and/or contradicted some of its findings. Regardless, the Cass Review's findings are based upon the systematic reviews, which are the highest level of evidence in medical research and were commissioned by the NHS, one of the few "reputable major medical and scientific bodies" explicitly listed as a suitable source for medical information at WP:MEDORG. It is based upon an extremely high-quality body of evidence.

“Only 13% of medical treatments have high quality evidence, citation cochrane” and the “why did the report say that psychotherapy had the same quality of evidence as HRT but recommended psychotherapy over HRT?”

Making arguments like these ourselves isn't really helpful, since what we write has to be referenced from (and based upon the contents of) MEDRS sources anyway (without WP:SYNTH), regardless of our own personal beliefs and analysis.

we can’t neutrally say that the Cass Review was doing this for EBM

To be clear, I don't think that the review was commissioned solely or primarily to enable EBM or that this specific motivation (like, I believe, any other) existed in a vacuum. My sincere impression, at present, is that the Cass Review was commissioned in light of concerns raised (e.g. extensive waiting lists, a huge rise in referrals, and reports of inappropriate practice, including that not based upon evidence) in the GIDS. I believe it was intended to examine these reported issues and the existing evidence and then to make recommendations, based upon what they found and in accordance with evidence-based medicine, on how to improve the care given to TGGNC children and young people.

Per WP:VOICE, we shouldn't state a fact as an opinion. Therefore, if we can substantiate that the Cass Review was created to enable EBM as a fact with suitable references (even if it is one of multiple motivations), we should state it as a fact rather than as an opinion. To this end, I believe the following MEDRS sources substantiate it as a fact. Some refer more to the lack of evidence underlying existing clinical practice in GIDS or elsewhere, and some mention that this led to the Cass Review more explicitly.

• pages 20 and 75-77 of the final report of the Cass Review
• Cheung, C Ronny; Abbruzzese, Evgenia; Lockhart, Elaine; Maconochie, Ian K; Kingdon, Camilla C (14 October 2024). "Gender medicine and the Cass Review: why medicine and the law make poor bedfellows". Archives of Disease in Childhood: 2. doi:10.1136/archdischild-2024-327994.
• Barnes, Hannah (8 March 2023). "Gender identity services in the UK are on pause as evidence comes under scrutiny". BMJ. 380: 509. doi:10.1136/bmj.p509.
• McCartney, Margaret (30 May 2024). "Medical institutions must treat the Cass review as a significant event and act upon it". BMJ: 1. doi:10.1136/bmj.q1189. I know many senior medics who were concerned about the lack of evidence for interventions...
• Evans, Marcus (October 2021). "Freedom to think: the need for thorough assessment and treatment of gender dysphoric children". BJPsych Bulletin. 45 (5): 286. doi:10.1192/bjb.2020.72.
• Thompson, Lucy; Sarovic, Darko; Wilson, Philip; Irwin, Louis; Visnitchi, Dana; Sämfjord, Angela; Gillberg, Christopher (8 August 2023). "A PRISMA systematic review of adolescent gender dysphoria literature: 3) treatment". PLOS Global Public Health. 3 (8): 3. doi:10.1371/journal.pgph.0001478.{{cite journal}}: CS1 maint: unflagged free DOI (link)
• D'Angelo, Roberto (18 November 2023). "Supporting autonomy in young people with gender dysphoria: psychotherapy is not conversion therapy". Journal of Medical Ethics: 1. doi:10.1136/jme-2023-109282.

Please get back to me and let me know what you think when you have time. Thanks! 13tez (talk) 15:46, 20 December 2024 (UTC)

• The Cass Review is not an impartial source on itself
• Cheung et al. is written by multiple people who are members of conversion therapy orgs or famous for pushing conversion therapy
• Barnes did not say it was evidence based
• McCartney is an opinion piece
• Evans is a member of conversion therapy orgs, and unsurprisingly spends a few paragraphs in that article attacking the Memorandum of Understanding on Conversion Therapy (fringe to say the least)
• Thomspon et al does not say Cass was motivated by EBM
• D'Angelo is the head of a conversion therapy org, and that's a primary piece where he defends it, and where he doesn't say the Cass Review was motivated by EBM

Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:14, 20 December 2024 (UTC)

Hey, thanks for your thoughts!

The Cass Review is not an impartial source on itself

Earlier consensus here was that the final report itself does qualify as WP:MEDRS and that it's suitable to use as a reference in this article, including on itself.

Cheung et al. is written by multiple people who are members of conversion therapy orgs or famous for pushing conversion therapy

Regardless of any (potentially valid) reservations about an author, it was published in Archives of Disease in Childhood by the BMJ Group, so it is a valid MEDRS source.

Barnes did not say it was evidence based

I'm not providing sources to say the Cass Review was evidence-based, because that has already been established. These sources are intended to show that there was concern that current practice before the Cass Review wasn't sufficiently based on evidence, and, therefore, that the Cass Review was, in part, motivated by a desire to enable EBM for this patient cohort.

Barnes highlighted the concerns on insufficient evidence, among other issues, that led to the Cass Review: "Some GIDS staff began to worry. The service, they believed, did not adequately consider that the evidence base underpinning the medical treatment of young people—the so called Dutch protocol—not only was limited in and of itself but applied to a different group of young people from those largely seeking the help of GIDS."

McCartney is an opinion piece

I checked, and it wasn't externally peer-reviewed, so I take that point.

Evans is a member of conversion therapy orgs, and unsurprisingly spends a few paragraphs in that article attacking the Memorandum of Understanding on Conversion Therapy (fringe to say the least)

Regardless of any (potentially valid) reservations about an author, it was published in BJPsych Bulletin by Cambridge University Press, so it is a valid MEDRS source.

Thomspon et al does not say Cass was motivated by EBM

From page 3, as cited: "...illustrating the acknowledged lack of good quality evidence regarding treatment comorbidities and outcomes to inform service design. Concern in the UK led to the commissioning of the Cass review..."

D'Angelo is the head of a conversion therapy org, and that's a primary piece where he defends it, and where he doesn't say the Cass Review was motivated by EBM

Regardless of any (potentially valid) reservations about an author, it was published in the Journal of Medical Ethics by the BMJ Group, so it is a valid MEDRS source.

From page 1, as cited: "Opinion is divided about the certainty of the evidence base for gender-affirming medical interventions in youth...critics claim the poor-quality evidence base warrants extreme caution...The Royal Australian and New Zealand College of Psychiatrists (RANZCP) articulates the central controversy in Position Statement 103, namely that ‘evidence and professional opinion is divided as to whether an affirmative approach should be taken in relation to treatment of transgender children or whether other approaches are more appropriate’. The recent Cass Review 2 and subsequent National Health Service (NHS) Interim Service Specification highlight the uncertainty about whether gender- affirming medical interventions or psychosocial and mental health interventions (including exploratory psychotherapy) are most helpful and safe for young people experiencing gender dysphoria."

Please let me know if you have any other thoughts. Thank you! 13tez (talk) 18:48, 20 December 2024 (UTC)

These quotes cannot possibly support the statement that the York reviews were commissioned to enable EBM, as the York reviews are not mentioned in them at all. Flounder fillet (talk) 11:51, 19 December 2024 (UTC)

From Thornton: "Cass commissioned four systematic reviews of the evidence on key issues, including puberty blockers, hormones, and clinical guidelines."

From the Cass Review's final report: "This lack of evidence placed limitations on the advice that could be given by the Review. An independent research programme was commissioned with the aim of providing the Review with the best available collation of published evidence, as well as qualitative and quantitative research to fill knowledge gaps. The research programme, led by the University of York, comprised appraisal of the published evidence and guidelines, an international survey and quantitative and qualitative research. A Clinical Expert Group (CEG) was established by the Review to help interpret the findings. This final report provides full details of the research approach and methodology used by the research team and a synthesis of the findings alongside interpretation of what they mean for the Review. The peer reviewed systematic reviews have been published alongside this report." 13tez (talk) 13:27, 19 December 2024 (UTC)

This in turn doesn't mention EBM. Flounder fillet (talk) 17:33, 19 December 2024 (UTC)

You said: "These quotes cannot possibly support the statement that the York reviews were commissioned to enable EBM, as the York reviews are not mentioned in them at all."

I was just showing you that this isn't true. The references from which the quotes are taken explicitly discuss the York systematic reviews. You can see this in the two new quotes from them I provided in my last reply to you.

Neither of the two pairs of quotes I have provided in this thread are the entirety of either of the two references from which they're taken. After all, one is the final report of the review itself. You are opining on whether the references discuss the reviews or EBM while assuming the quotes I am taking from them are the references in their entirety. This is not the case. 13tez (talk) 19:14, 19 December 2024 (UTC)

I wrote quotes, not citations. I was at no point "opining on whether the references discuss the reviews or EBM" - I was stating that the quotes you have chosen to include in your original post, the ones in quotation marks, are irrelevant to the statement you added to the page. Flounder fillet (talk) 19:39, 19 December 2024 (UTC)

You are correct in saying that the individual quotes I've provided in this thread don't discuss both EBM and the systematic reviews. However, the references from which they're taken contain more than just those quotes, and this isn't what I was arguing to begin with. 13tez (talk) 20:35, 19 December 2024 (UTC)

Well I've seen you added it to the motivating factors section now instead. Lewisguile (talk) 20:40, 19 December 2024 (UTC)

For clarity, I didn't add the enabling of EBM to the Motivating issues section. I only paraphrased those that are directly listed in page 77 of the review itself. I also qualified these factors by saying they're what the review listed as the key motivating issues. I don't think it would be appropriate to add enabling EBM there because it isn't included in this list from the review. 13tez (talk) 20:46, 19 December 2024 (UTC)

You probably shouldn't add so much text to an article while these issues are still being discussed. You've made a lot of changes, some of which are WP:POINTY and others which simply aren't well written. Because the edits are all done in small edits, I can't revert them partially to only remove the bad. I will have to revert them all, and you'll have to make your case for what you want to include here per WP:ONUS and WP:BRD. You can read about the enforced BRD process on this page here. Lewisguile (talk) 09:20, 20 December 2024 (UTC)

Revert per enforced BRD

I've just reverted a series of edits by @13tez per the enforced WP:BRD on this page described here. I responded in the ongoing EBM thread to let the editor know, but am also adding it here so it's easier to find/see this for others.

Some of the edits are issues undergoing discussion at present, some make the article harder to read, and some seem a little pointed (e.g., the constant references to how systematic reviews are the best), so 13tez will need to get consensus for the changes here. Some may be fine; others may require more discussion.

13tez, it might be a good idea to start a new topic for each key area you want to make changes in, with suggested wording. That way, it won't get as bogged down. Thanks in advance! Lewisguile (talk) 09:28, 20 December 2024 (UTC)

Hi, thanks for letting me know.

Please can you tell me which portions of content I added you thought should (and should not) be removed before your revert and why?

Thanks! 13tez (talk) 09:47, 20 December 2024 (UTC)

As per WP:ONUS and WP:BRD, you should justify why the text is needed in the first place. There were a series of edits, so I don't have time to go through them all, but off the top of my head, there were a few typos, the language became slacker in certain areas, and the framing seemed non-neutral/editorialising. E.g., you mentioned "huge increases" ("huge" always seems emotive to me), gave a lot of space and added an image to stress the idea that systematic reviews are the best (this isn't needed beyond maybe a few extra words, since readers can click on the relevant article to find more), added tangential sources to support the same, added a new section which hasn't been discussed or received consensus, etc. I didn't go very far back, so it seemed this would revert the fewest number of overall edits and this makes it easier for me to self-revert if others think there's a consensus for the additions/changes. Lewisguile (talk) 10:51, 20 December 2024 (UTC)

Thanks for getting back to me. I'll try to discuss each of your concerns in order; please let me know if I've missed any of your points or if you still have any.

From what you've said, you don't seem to be opposed to how I edited RCPH for consistency or the paragraph beginning "The Royal Australian and New Zealand College of Psychiatrists rejected calls for...". Please can you tell me if I'm right in thinking you're not opposed to these changes?

per WP:ONUS and WP:BRD, you should justify why the text is needed in the first place

I think that the Motivating issues section is an important addition to the Background section because, without it, readers will not know which key issues resulted in the decision to commission the review. This would prevent them from fully understanding the background or context that led to the review being made. Describing this background and context to readers is the purpose of the Background section of the article.

I added an illustrative diagram of the hierarchy of evidence, showing systematic reviews, to give readers a visual understanding that each level of evidence in medical research feeds up into the one above it and that systematic reviews are considered the highest of these levels. Since the systematic reviews it commissioned are the foundation of the Cass Review, this helps readers understand the make-up and quality of the evidence that informed it. I added the information on the journal in which the systematic reviews were published and that they formed some (really most) of the evidence that informed the report and its findings. Again, this helps inform readers on the nature of the evidence and how it was used to develop the conclusions of the Cass Review. This information is relevant to the Methodology section of the article.

There were a series of edits, so I don't have time to go through them all

Per WP:BRD-NOT, if you're unable or unwilling to explain the substantive reasons for reverting edits, you cannot do so.

there were a few typos, the language became slacker in certain areas

I'd have been happy for you to have tightened up the language or fixed typos, or I'd be happy to do so now myself if you pointed out the issues. Notwithstanding other reservations, these small issues could have been addressed with a fix, and wouldn't necessitate the revert, per WP:BRDR. How do you think we should fix the copyedit issues?

the framing seemed non-neutral/editorialising. E.g., you mentioned "huge increases" ("huge" always seems emotive to me)

I'd be happy to discuss any issues in regarding editorialising because I wouldn't want to do so, but nobody's perfect. I think "huge" is an objectively true way to describe an increase of 3442.86%, and the review used the word "exponential" itself. However, if you'd prefer a less emotive adjective, I take that point and am open to suggestions. Maybe we could cite an exact figure to get away from adjectives altogether?

the constant references to how systematic reviews are the best...gave a lot of space and added an image to stress the idea that systematic reviews are the best

I don't think two references to the position of systematic reviews as the highest level of evidence in medical research can be accurately described as "constant". As I tried to describe in the summary of the edit where I implemented it, I made one in-text reference to this fact to host the references and the nuance of some hierarchies (there are multiple) also including meta-analyses in the top tier of evidence there. This allowed the caption of the image showing the pyramid illustrating the hierarchy of evidence to be simplified and and not need references. It also benefited text-only readers who might not read an image caption. Can you think of a better, alternative approach here?

I think the image helps readers understand the role of systematic reviews, and, in turn, the methodology of the Cass Review. I think it's a useful illustrative aid in this regard. The only space is this one image and another single sentence, so I don't think it's a disproportionately large amount of coverage considering it's within the Methodology section of the article and the importance of the systematic reviews to the Cass Review's methodology. Do you think that the use of the image falls within MOS:IMAGES?

added tangential sources to support the same

What makes you think the sources are tangential? One was the Cass Review itself; one was published in Hospital Pediatrics, a journal of the American Academy of Pediatrics; and one was published in Evidence-Based Medicine, a journal of the BMJ. They were all relevant to the specific point, saying:

• "The highest form of evidence is that generated by a systematic review"
• "The quality of evidence from medical research is partially deemed by the hierarchy of study designs. On the lowest level, the hierarchy of study designs begins with animal and translational studies and expert opinion, and then ascends to descriptive case reports or case series, followed by analytic observational designs such as cohort studies, then randomized controlled trials, and finally systematic reviews and meta-analyses as the highest quality evidence."
• "A pyramid has expressed the idea of hierarchy of medical evidence for so long, that not all evidence is the same. Systematic reviews and meta-analyses have been placed at the top of this pyramid for several good reasons."

added a new section which hasn't been discussed or received consensus

Per WP:BOLD and WP:BRD, you don't need permission to make new edits. If something is under discussion or disputed, you can't unilaterally add it, but I never added what was being discussed: whether enabling EBM was a motivation for holding the Cass Review.

Please get back to me when you have time. Thanks! 13tez (talk) 13:07, 20 December 2024 (UTC)

Thanks for your quick reply! I'm ill with COVID, so bear with me if I don't check here immediately. I also appreciate your edits are in good faith, so I just want to get that out of the way.

Per WP:BRD-NOT, if you're unable or unwilling to explain the substantive reasons for reverting edits, you cannot do so. I did try to explain the main issues, re: NPOV (editorialising, pointiness) and lack of consensus, though in brief. I also explained that as you made multiple smaller edits, I couldn't just revert some parts without doing it manually for each one. But I'll go into a bit more detail below.

Even if material is verifiable, it doesn't necessarily mean it's notable or that it should be included. We have to make sure that what's included is WP:DUE and has consensus for inclusion. Neutrality can be affected by what is put into an article and what is left out, which means that using lots of detail in particular areas can reinforce the idea that this area is being emphasised. We should also keep it easy to read and stick to what's relevant.

In regards to the "systematic reviews" part, besides the issues I had mentioned already, you rearranged the paragraph to put that statement first, which seemed to emphasize that part. You also expanded the section on the York reviews to say where they were published, who the publisher was, its official affiliations and that it was peer-reviewed (which read, at least to me, like appeals to authority). Most of this isn't needed, as people can see who the reviewers are by following the references and clicking the relevant blue links. They can see who the publisher is. Describing all of this stuff at length can feel like the prose is trying to convince us of something, whether intended or not.

The motivating issues section also repeats much of the same information as the Methodology section, albeit in different wording and framing. It's largely redundant on that basis, and again, in the context of all the above, it reads as WP:POINTY.

All of this could've been trimmed for overegging the pudding anyway, and for adding extraneous detail, but the series of edits with these changes, plus the image, caption and repetition of the caption in the article body, do not appear to be WP:NPOV. In fact, the cumulative effect is like the article is trying to tell us a particular viewpoint. (I appreciate that it's easy to get swept up in detail that's interesting to us as editors without realising how it can make things seem lopsided.)

Of course, all of this is subjective, which is why I think we need to get more eyes on this. If others agree to keep the edits, I am always happy to self-revert if someone pings me. I'm also happy to workshop the text, although I may need to leave the detailed stuff till tomorrow since my attention is currently all over the place. Lewisguile (talk) 14:09, 20 December 2024 (UTC)

Tossing in my agreement with everything you said. Snokalok (talk) 14:47, 20 December 2024 (UTC)

It's possible that both of you need to read WP:POINTY again, since it is about Malicious compliance and Work-to-rule efforts, in which an editor disagrees with a rule and wants to screw up articles or processes by proving that following the rule can have unwanted effects. Don't rely on the name of the WP:UPPERCASE. A pointed statement (one that sharply [over]emphasizes a point) is not a WP:POINTY edit. WhatamIdoing (talk) 21:16, 20 December 2024 (UTC)

Totally my fault! Sorry about that! Lewisguile (talk) 12:58, 21 December 2024 (UTC)

(An aside: the page you mean is probably WP:TENDENTIOUS, which covers editing that is argumentative or biased.) Loki (talk) 20:52, 21 December 2024 (UTC)

I think the pyramid image is helpful. This kind of pyramid diagram is included in the report itself (p55), and it really speaks to the heart of the matter. Barnards.tar.gz (talk) 15:00, 20 December 2024 (UTC)

Thanks for getting back to me again, and sorry to hear you have covid; I hope you get better soon.

To know where we now stand on your previous concerns after trying to allay them, please can you tell me:

• If you understand the rationale for the edits I made to "RCPH" through the article for consistency and the paragraph beginning "The Royal Australian and New Zealand College of Psychiatrists rejected calls for...", and if you agree that they are suitable?
• If you understand my rationale for including the pyramid hierarchy of evidence image and if you think it is useful for readers and falls within MOS:IMAGES?
• If you still view the references substantiating that systematic reviews are the highest level of evidence in medical research as being tangential?

I also appreciate your edits are in good faith, so I just want to get that out of the way.

Thank you, I feel the same.

Even if material is verifiable, it doesn't necessarily mean it's notable or that it should be included.

I explained why I think my additions were due when justifying their additions in my last reply. Did you disagree with what I had to say?

you rearranged the paragraph to put that statement first, which seemed to emphasize that part

In all honesty, the reason why I made the paragraph breaks is simply because the single paragraph was getting too long. I think (?) you're saying that one of the new paragraphs started with the information that systematic reviews are the highest level of evidence to highlight it. However, that sentence came at the end of the first paragraph.

You also expanded the section on the York reviews to say where they were published, who the publisher was, its official affiliations and that it was peer-reviewed (which read, at least to me, like appeals to authority)...Describing all of this stuff at length can feel like the prose is trying to convince us of something, whether intended or not.

I don't see how it could be an appeal to authority when it isn't making an argument. If it went on to argue something based on an appeal to the authority of those who made the systematic reviews, it would be, but it doesn't. To some extent, MEDRS in a way works by appealing to authority anyway. Regardless, again, I think this information is due in the Methodology section, which exists to outline the methodology underlying the Cass Review, which was largely based upon the systematic reviews.

Do you think rephrasing this information somehow or even siloing it in a subsection, which people could skip if they're not interested in the particulars of the systematic reviews, could help this issue that it feels like an argument to you? How do you think we should resolve the issue of you feeling like my text is editorialising generally? Should we re-write it, e.g. with "huge" as we discussed before?

Most of this isn't needed, as people can see who the reviewers are by following the references and clicking the relevant blue links. They can see who the publisher is.

We could equally argue readers could go and read the references to see how the systematic reviews worked, what they discussed, etc. By this logic, lots of the content within the Methodology section (and the article as a whole) would be removed. The result would be that readers would be less informed. Can you understand why I don't see this as a good way to decide which content to include?

The motivating issues section also repeats much of the same information as the Methodology section...It's largely redundant on that basis

I really wouldn't have thought you'd think so. To be clear, do you mean the list of the "topics covered by the systematic reviews" in the Methodology section was too similar to the Motivating issues?

To me, the Motivating issues are the concerns which led to the review being commissioned, e.g. huge increases in referrals, intolerable waiting lists, unexplained drastic changes in the patient cohort, etc. To be neutral, I gave the caveat that the list was from and per the final report of the review. Conversely, the topics covered in the systematic reviews examine clinical practice caring for those patients, looking at things like puberty blockers, gender-affirming hormone therapy, psychosocial support, etc.

In short, I think the Motivating issues were concerns that caused the report to be created vs topics related to different areas of clinical practice assessed by the systematic reviews. I think the two are distinct enough to not be redundant. Do you still think including both is redundant?

I'm also happy to workshop the text

I'm very happy for my changes to be included while being rewritten more elegantly and simply, and I'm happy for copyedit issues to be fixed with or without me. How do you think this should be done?

I hope you feel better soon; please let me know what your thoughts are when you can! 13tez (talk) 18:13, 20 December 2024 (UTC)

About people can see who the reviewers are by following the references and clicking the relevant blue links:

Research indicates that most readers/non-editors will follow one reference about 1 out of 300 page views, and they will click on one or two links on desktop (either to get to this article, or to leave it for another), and zero or one link on mobile (about 65% of all readers) in an entire session. The Wikipedia rabbit hole behavior is uncommon.

For this article in particular, looking at last month's numbers, only 15% of readers click on a link to read another Wikipedia articles. So we should be writing the article, to use the wording from Wikipedia:The perfect article, to be "self-contained", because 85% of readers are not clicking through to any other articles, and >99% of readers are not clicking through to any refs.

In case you are curious, about 65% of readers last month came from Google/outside of Wikipedia. 8% last month came from our article on Kemi Badenoch (it was 1.5% the month before, so something must have happened in the news), 3% from Hilary Cass (5% the month before), and around 2.5% from Political views of J. K. Rowling.

85% of readers here stop after this article. Less than 5% of page views result in someone going to Hilary Cass, which is about 30% of the (small number of) readers who click on anything. Around 1% go to Bell v Tavistock and Time to Think (book), and everything else is tiny (less than 1% of page views/less than three readers per day). WhatamIdoing (talk) 22:08, 20 December 2024 (UTC)

Thanks for your patience, @13tez. I'm feeling a fair bit better at the moment — nighttimes are the killer because it's hard to breathe. I've gone ahead and reincorporated some of your edits with tweaks to make them, I feel, more balanced. There's one or two I haven't made yet, as I wanted tour input. I'll go through these in detail below:

• The Royal Australian and New Zealand College of Psychiatrists rejected calls for an inquiry into trans healthcare following the release of the Cass Review, characterising it as one review among several in the field. They emphasised that, "assessment and treatment should be patient centred, evidence-informed and responsive to and supportive of the child or young person's needs and that psychiatrists have a responsibility to counter stigma and discrimination directed towards trans and gender diverse people." This wording seems fine to me. I restored it as it was.
• Linking the RCPCH and adding the abbreviation afterwards is also fine. I have gone ahead and made that specific change for you.
• The refs to systematic reviews being the highest quality of evidence were as follows:
  • https://publications.aap.org/hospitalpediatrics/article/12/8/745/188605/Hierarchy-of-Evidence-Within-the-Medical
  • https://ebm.bmj.com/content/21/4/125

Neither of these seem relevant to the Cass Review, unless I'm missing something, so I feel like we're possibly veering into WP:COATRACK territory. This isn't an article about the use of systematic reviews. What's important is what the use of systematic reviews means for the Cass Review, not what they mean in general. Though I suppose we can use these refs if we end up adding an endnote for this (see further down).

• The image of the pyramid shouldn't be considered on its own but in conjunction with the other material added about systematic reviews. Whether people are likely to click through to a systematic review article or not is irrelevant; that's their choice. One reason for not clicking through might be that they already know what something is, for instance. But either way, a standalone article needs to introduce the concepts in sufficient detail to make them clear in the context of this subject, but no more, because those concepts aren't the main focus of this article. On that basis, I don't think the image is WP:DUE, because it's taking up space and word count for one detail. That detail can be added in other ways so it's less of a tangent. See below.
• This wording is clunky and is trying to do too much in general (even before your additions): The Cass Review commissioned several peer-reviewed, independent systematic reviews into different areas of healthcare for children and young people with gender identity issues, including gender dysphoria. Systematic reviews, sometimes along with meta-analyses, are generally considered the highest level of evidence in medical research.
• I think this is a better compromise: The Cass Review commissioned several independent systematic reviews into different areas of healthcare for children and young people accessing gender identity services in the UK. Would you be happy if we made this change? "Independent" isn't strictly needed, since we say in the next bit that the reviews were done by the University of York, but it's not a hill I'm willing to die on, so I've left it in.
• I would leave "peer reviewed" with the publication info, like so: The systematic reviews were published in Archives of Disease in Childhood, the peer-reviewed medical journal of the Royal College of Paediatrics and Child Health. Otherwise, you have "peer-reviewed, independent systematic reviews", which is really clunky. This way, we avoid repeating the same information in multiple places, and the same wording in the same sentence. This also avoids repeating that the reviews were used to inform the Cass Report, since this is also stated in the line beginning The systematic reviews performed meta-analyses... (Though this line was also clunky, so I rejigged it.)
• If anything else needs to go in here, I'd suggest an endnote, such as: This is where we could use your refs about the value of systematic reviews.
• I don't see how it could be an appeal to authority when it isn't making an argument. I think the wording, as it was, did read like it was making an argument, for all the reasons I outlined above (emphasis, etc). Besides, per WP:INCITE, there's very rarely a need to include detailed attribution in this way; a specific reason stated for that policy is that people can click on the reference to find out more (regardless of whether they actually do or not). The wording I've suggested here, I think, is hopefully a fairer compromise and more concise.
• To be clear, do you mean the list of the "topics covered by the systematic reviews" in the Methodology section was too similar to the Motivating issues? I do, in that the topics covered necessarily imply they were things being looked for, if that makes sense? However, I've suggested alternate wording that doesn't require another short sections within a short section: Key concerns which led to the creation of the review included increasing waiting lists due to larger numbers of children and young people requesting gender-affirming care from the NHS (over two years per patient), proportionally fewer patients who were assigned male at birth (AMAB) and an increasing number who were assigned female at birth (AFAB), a reported trend towards earlier medical interventions in this cohort, and concerns around the quality of evidence for treatment in this area.

What do you think of these suggestions in general? I think we've kept the main thrust of what you wanted to add, while keeping it all proportionate to what else is in there. If there's anything I've still missed (darn brain fog!), please let me know. Lewisguile (talk) 12:50, 21 December 2024 (UTC)

@Snokalok, what do you think about the above? Lewisguile (talk) 13:23, 21 December 2024 (UTC)

I’d change the “key concerns” bit, since as it’s currently worded it imo gives too much validity to some of the stated concerns. I’d reframe it as “stated concerns” instead. I believe it should change“medical interventions” to “medical treatment”. More neutral.

Past that, I think if we emphasize that the York reviews are peer reviewed systematic reviews, we need to make clear that the Cass Review *isn’t* any of those things, it’s just the opinion resulting from someone having read those reviews.

Those are my two main things. The first is a minor tweak that I’m going to BEBOLD on, the second we might need to workshop more thoroughly. Snokalok (talk) 16:04, 21 December 2024 (UTC)

Thanks. I support both those wording changes for neutrality. Good catch.

I also support your other suggestions, re: peer review, for the reasons you state. At the moment, the language might lead readers to assume the Cass Review itself is peer-reviewed. Though, I think that since the Methodology section now clearly states "peer-reviewed" in relation to the publication of the systematic reviews, I think it's definitely better than it was. I have also stated where another journal was peer reviewed for balance. Lewisguile (talk) 16:15, 21 December 2024 (UTC)

Hi @Snokalok, please can you undo your revert of my recent edit? Your stated reason was: "Removing excess info about publication, since per talk it was only agreed upon as being relevant if contrasted with the fact that the Cass Review is not peer-reviewed, as to avoid an appeal to authority"

However, my edit did not add any information. It only removed information, adjusted language, and rearranged text, for the reasons I explained in the edit summary. Thanks! 13tez (talk) 19:50, 21 December 2024 (UTC)

Ah! Yes, easy confusion. The text discussing the journal it was published in and that journal’s pedigree was boldly added earlier (which I personally disagree with doing but whatever) before consensus was obtained, and then solidified with the agreement above that it was only worth keeping if we contrasted it with the fact that the Cass Review is not peer reviewed and instead only built itself off other pubs, which I thought was made obvious in the report itself. However given that we can’t agree yet on the latter it seems, we shouldn’t have the former either - otherwise it creates the earlier issue stated by Lewis of reading as an appeal to authority. Snokalok (talk) 19:59, 21 December 2024 (UTC)

My bad! I thought my text wouldn't be controversial. Snokalok, what if we added the peer review clarification as an endnote? Would you settle for that? It might seem less objectionable to others if it's done like that instead? Lewisguile (talk) 20:27, 21 December 2024 (UTC)

I think that that’s giving it too much weight one way. If we had both the archives of disease in childhood AND the not peer reviewed thing in endnotes then fine, but otherwise it feels like we’re just trotting out a list of titles the Cass Review doesn’t actually hold, like medals given to North Korean generals. It gives the implication that the Cass Review was peer reviewed by the archives of disease in childhood, which it wasn’t. Snokalok (talk) 20:39, 21 December 2024 (UTC)

Sorry, @Snokalok, I didn't read my replies in order. It's a valid point. Hmmm. I'm not sure. On principle, I'm not opposed to saying where the reviews were published, but it's definitely not essential information and it's about as important as clarifying whether the Cass Review itself was peer reviewed. I think the RS for saying the Cass Review wasn't peer reviewed itself is the Cass Review? Nowhere does it state her recommendations and conclusions were peer reviewed – indeed, she says the opposite: that it was independent, and wasn't seen in advance by the NHS and Government. She details her process. If she didn't say the final report was peer reviewed, then it wasn't.Lewisguile (talk) 19:20, 22 December 2024 (UTC)

Hey @Snokalok, thanks for getting back to me! Sorry for my mistake - I originally thought your edit was just a revert of my edit, but it actually removed information Lewisguile added in an attempt to form a compromise.

I removed the information that the Cass Review was not peer-reviewed primarily because it was not referenced. The references placed at the end of that sentence were actually references for the previous sentence - that AODIC is the journal of the RCPCH. Their presence there was erroneous. However, that single sentence by itself, at the end of a paragraph otherwise discussing the systematic reviews, doesn't seem especially relevant.

I understand you think that if we say the systematic reviews were peer-reviewed, we need to say the Cass Review itself wasn't for balance. However, the latter was not referenced; this situation was already the status quo even before my originally contested edits; both Lewisguile and I were fine with it: this was the case in the changes they made and I agreed to; and the fact that the systematic reviews underwent a peer-review process is relevant to the methodology section because they were the foundation of the evidence upon which the Cass Review made its conclusions.

It gives the implication that the Cass Review was peer reviewed by the archives of disease in childhood, which it wasn’t.

How so? It's saying the systematic reviews commissioned by the Cass Review were peer-reviewed and published there, not the Cass Review itself.

Thanks! 13tez (talk) 21:03, 21 December 2024 (UTC)

So regarding citation, a small error on my part - I’d made the assumption that one of the citations was a direct Cass Report citation since, they’re everywhere, but it wasn’t and that was a mistake on my end.

Past that, as you can see above Lewis agreed with my take on the matter that there needed to be balancing via saying Cass is not peer reviewed.

As for your question, because the reader is very severely liable to see the words “Cass Review” and that it commissioned several systematic reviews, and come to the conclusion of the Cass Review just being the culmination of those and thus warranting the same prestige and pedigree as the peer reviewed pubs when in reality, the Cass Review is not that - it’s a non-peer reviewed government report that makes significant leaps in logic and conclusions not supported by the underlying systematic reviews (such as transness being caused by porn), and if we don’t make the distance between the two clear, a reader is very easily liable to mistake the statements of the Cass Review for the conclusions of the York Review, hence why we need to emphasize the difference or else not risk misattributing the authority. Snokalok (talk) 23:26, 21 December 2024 (UTC)

Once again, it's not a government report. Void if removed (talk) 23:48, 21 December 2024 (UTC)

The NHS is a government entity. An NHS report without peer review is therefore nothing more than a government report Snokalok (talk) 04:07, 22 December 2024 (UTC)

Hi @Snokalok, thanks for getting back to me again!

as you can see above Lewis agreed with my take on the matter that there needed to be balancing via saying Cass is not peer reviewed

However, they edited to the contrary, notwithstanding my other reasons for retaining the longstanding situation of the systematic reviews being described as peer-reviewed (which you alone have overridden) described previously and the views of other editors.

a reader is very easily liable to mistake the statements of the Cass Review for the conclusions of the York Review

Even though the latter did inform and lead to the former, I think we might find common ground here. I was thinking of adding a table summarising the results of the different systematic reviews, for example with the following columns:

• intervention (e.g. puberty blockers)
• number of relevant studies found
• number of low quality studies
• number of moderate quality studies
• number of high quality studies
• the strength of evidence overall (e.g. very low, low... very high)
• the ability to make conclusions on the merits and effects of the intervention (e.g. very low, low... very high)

Please can you tell me what you'd think of adding something like this to the article?

Thanks! 13tez (talk) 00:18, 22 December 2024 (UTC)

So let me start by answering your first point regarding Lewis:

Thanks. I support both those wording changes for neutrality. Good catch.

I also support your other suggestions, re: peer review, for the reasons you state. At the moment, the language might lead readers to assume the Cass Review itself is peer-reviewed. Answered by Lewis in regards to me adding that Cass is not peer reviewed. Diff provided. [21]

With that out of the way, yes the York Reviews informed them but they didn’t lead to the Cass Review, merely fed it. Again repeating my example, nowhere in the York Reviews did they say transness was caused by pornography, and yet the Cass Review did. Thus, we have to keep them separate, because the Cass Review draws conclusions not drawn in nor supported by the York Reviews, and to treat them as synonymous or as direct representations of each other would be facile.

As for your proposed table, I personally like the bar graph image you already added, I think that does a better job of conveying the info you want. Snokalok (talk) 04:13, 22 December 2024 (UTC)

Hey @Snokalok, thanks for getting back to me again!

So let me start by answering...Diff provided.

Again though: they edited to the contrary; the sentence saying the Cass Review was not peer-reviewed was not referenced; the status quo even before my originally contested edits was saying the SRs were peer-reviewed without saying the Cass Review wasn't, and one or even two editors cannot override that, especially while it's contentious; both Lewisguile and I were fine with it: this was the case in what they suggested and the changes they made and I agreed to; the fact that the systematic reviews underwent a peer-review process is relevant to the methodology section because they were the foundation of the evidence upon which the Cass Review made its conclusions; and the views of other editors weren't considered when you removed the fact that the systematic reviews were peer-reviewed.

yes the York Reviews informed them but they didn’t lead to the Cass Review, merely fed it

What do you mean by "lead" - leading to the creation of the review itself or leading to its findings? If you read the Cass Review, they definitely did lead to its findings.

the Cass Review draws conclusions not drawn in nor supported by the York Reviews

This isn't true. Apart from already being able to reference it from MEDRS sources, you can see in the final report for yourself how the findings of the systematic reviews are referenced, discussed, and used to create the findings and recommendations of the report. For example:

nowhere in the York Reviews did they say transness was caused by pornography, and yet the Cass Review did

How did you come to that understanding? Did it come from you reading the final report yourself? Did it come from you reading a discussion of it from a third party?

If you read the Cass Review, it discusses the effect of pornography on children on page 110. All it really says on the matter is:

• more children are exposed to pornography from a young age
• "Several longitudinal studies have found that adolescent pornography consumption is associated with subsequent increased sexual, relational and body dissatisfaction (Hanson,2020)"
• "Research commentators recommend more investigation into consumption of online pornography and gender dysphoria is needed. Some researchers (Nadrowski, 2023) suggest that exploration with gender-questioning youth should include consideration of their engagement with pornographic content."

What it says is objectively true. It doesn't make any claims or assertions on the effects of pornography on TGGNC young people, let alone the one you're claiming it made: "transness was caused by pornography". It recommends more research to understand any potential effects of pornography on gender-questioning youth, which doesn't necessarily mean a causal relationship whatsoever.

I personally like the bar graph image you already added

OK, glad we can agree on that.

Please let me know what you think when you can! 13tez (talk) 13:08, 22 December 2024 (UTC)

Both LewisGuile and I were fine with it Yes and then when I stated my reasons to Lewis, he changed his mind, as the diff I provided above shows. He is no longer in agreement with you.

Regarding pornography, the report still suggests it as a cause of transness, and however you wish to characterize its claims, it still makes them without the York reviews doing anything of the sort. Thus, it’s a statement made entirely separately, and thus we can’t treat Cass and York as the same. Snokalok (talk) 13:23, 22 December 2024 (UTC)

Thanks for getting back to me again!

Yes and then when I stated my reasons to Lewis, he changed his mind, as the diff I provided above shows. He is no longer in agreement with you.

Again, firstly, that's not addressing any of my other reasons not to overturn the status quo of saying the SRs were peer-reviewed without saying the Cass Review wasn't. Secondly, we can just discuss it with them, let them speak for themselves, and form a compromise, like we've been trying to do.

Regarding pornography, the report still suggests it as a cause of transness

No it doesn't. Which quote from the final report, in your view, substantiates that claim? I showed you the direct quotes from the page in the report that discusses the effects of pornography. It doesn't make any claims or assertions on the effects of pornography on TGGNC young people, let alone the one you're claiming it made: "transness was caused by pornography". How did you come to that understanding? Did it come from you reading the final report yourself? Did it come from you reading a discussion of it from a third party?

we can’t treat Cass and York as the same

I'm not seeking this. I just wanted to say the systematic reviews were peer-reviewed and where they were published, and that they formed the bulk of the evidence which informed the final report of the Cass Review and its findings, because this information is relevant in the methodology section and all of these points are objectively true.

Thanks again! 13tez (talk) 13:38, 22 December 2024 (UTC)

Thanks for getting back to me again, @Lewisguile!

I'm feeling a fair bit better at the moment — nighttimes are the killer because it's hard to breathe.

I hope you continue to get better! Having had covid myself, I know exactly what you mean.

The Royal Australian...This wording seems fine to me. I restored it as it was....Linking the RCPCH and adding the abbreviation afterwards is also fine

Thanks!

I think this is a better compromise: "The Cass Review commissioned several independent systematic reviews into different areas of healthcare for children and young people accessing gender identity services in the UK." Would you be happy if we made this change?...I would leave "peer reviewed" with the publication info, like so: "The systematic reviews were published in Archives of Disease in Childhood, the peer-reviewed medical journal of the Royal College of Paediatrics and Child Health."

Yeah, I'm happy with that. I can live without the sentence on them being the highest level of research. I don't mind the omission of peer-reviewed in the first sentence, so long as we include that they were published in aodic and that it is peer-reviewed later on.

If anything else needs to go in here, I'd suggest an endnote, such as: This is where we could use your refs about the value of systematic reviews.

Yeah, that's actually a good idea. Would you be ok with having the information on systematic reviews being the highest level of evidence in an endnote like that? It could be a couple of sentences to inform the reader as to what a systematic review is, why they're good evidence/were used, etc?

I do, in that the topics covered necessarily imply they were things being looked for, if that makes sense?

Fair enough, I honestly see the two as distinct, so I didn't anticipate it as a potential issue at all.

I've suggested alternate wording that doesn't require another short sections within a short section: Key concerns which led to the creation of the review included

Thanks for compromising! I would say I think it was more readable as a bulleted list and I did qualify it by saying those were the key issues the report listed (albeit on a single page which can't go too in-depth) as the key motivating issues. Even though the rise in referrals and other concerns have been documented and are objectively true, I feel like it's also useful to say they're what the report itself says were the key issues.

What do you think of these suggestions in general?

Comparing my originally reverted edit to the current one, I'd make the following points:

On the Background section:

• I'd say that the "stated concerns" were sourced from the review
• I'd move "over two years per patient" to immediately after "waiting lists" to make the link more clear
• We can omit the point re the change from mostly AMAB to mostly AFAB since it's shown in the graph and hard to explain in short form
• I wouldn't say it was a "reported trend" since it objectively did happen and "trend" seems a bit deriding and unobjective (I know it was my original wording, but it was something I was planning on changing anyway)

On the Methodology section:

• I (and Barnards.tar.gz) thought the pyramid image was helpful to understand the point of the systematic reviews. How would you feel about including the image with a similar caption, so long as we don't discuss it in the text as well?
• The information on where the systematic reviews were published (the journal and the fact it's peer-reviewed) has now been removed. I feel like this is useful for the methodology section and removes the way in which we compromised on the matter. There is now no reference to the systematic reviews being peer-reviewed, even though this detail was already present even before my reverted edits and its definite relevance in the methodology section.
• We are now excluding the information that the systematic reviews formed some (re MEDRS "the foundation") of the evidence for the findings of the Cass Review. Given its relevance in the methodology section, please can we restore this information?
• Can we frame the last paragraph as objective truth? We're saying "the report says it did x" regarding other types of evidence it gathered. However, the consensus here was already that the final report itself is a MEDRS source, including on itself, and, realistically, we will also be able to find other MEDRS sources to substantiate these facts anyway. Per WP:VOICE, we should "avoid stating opinions as facts."

Miscellaneous:

• Can we restore the external link to the GIDS series? I feel like it was useful.

Thanks again, hope you keep getting better! 13tez (talk) 20:39, 21 December 2024 (UTC)

Sorry for the late reply. I've been sleeping in an upright position this time to make breathing easier, and that's been working for me. I'm not so foggy-headed now.

Let me mull over your suggestions today and see if I can come up with some ideas that will also work for the others. I was quite happy with where things were yesterday, but I know a few people had issues with some of the wording since and we have, as a result, lost some of the wording I'd added as a compromise (as you noted).

I think we should be careful to avoid suggesting that the Cass Review was itself peer reviewed, rather than that it drew on peer reviewed sources (the systematic reviews). I think the picture gives the impression that the Cass Review itself is equivalent to the systematic reviews. I think a better image would be one which shows the relationship of the Cass Review to the published literature, grey literature, original research, and public engagement workshops. Does such an image exist? I'll re-read the reports today to see if I can find anything.

I think we can get to a consensus soon, but it is probably worth us tagging everyone currently active on the page, so we can make sure someone doesn't come along and undo any edits we've agreed upon here? Maybe I can start new threads for the Background and Methodology sections, so we can discuss the wording on them in their entirety in one dedicated place each? Individual tweaks that rely on other edits get lost when people start reverting or editing part of the text on isolation. Lewisguile (talk) 08:44, 22 December 2024 (UTC)

Hey @Lewisguile,

Sorry for the late reply. I've been sleeping in an upright position this time to make breathing easier, and that's been working for me. I'm not so foggy-headed now.

No problem! Take your time to get better!

we have...lost some of the wording I'd added as a compromise (as you noted).I think we should be careful to avoid suggesting that the Cass Review was itself peer reviewed, rather than that it drew on peer reviewed sources (the systematic reviews)

I'm yet to see a MEDRS source which can substantiate that the Cass Review itself wasn't peer-reviewed, so we still can't include it in the article. We could combine two of the sentences I made previously which might add the balance you want, something like: "The systematic reviews, which made up much of the evidence that informed the findings and conclusions of the Cass Review, were published in Archives of Disease in Childhood, a peer-reviewed medical journal..." This is more clearly saying that the systematic reviews were published in a peer-review journal and that they were some (per MEDRS "the foundation") of the evidence that informed the Cass Review, without suggesting the Cass Review itself was peer-reviewed. What do you think of that approach?

a better image would be one which shows the relationship of the Cass Review to the published literature, grey literature, original research, and public engagement workshops. Does such an image exist?

An illustrative image of the evidence base of the Cass Review can be found on pages 23 and 52 of the final report. I was thinking of making something similar and adding it to the methodology section myself to illustrate how the review gathered evidence then used it to inform its findings.

Maybe I can start new threads for the Background and Methodology sections, so we can discuss the wording on them in their entirety in one dedicated place each?

That's probably a good idea. I think we're almost there with the background section, so it doesn't make sense to conflate it with the discussions on the methodology section.

I think we can get to a consensus soon, but it is probably worth us tagging everyone currently active on the page, so we can make sure someone doesn't come along and undo any edits we've agreed upon here?

Yeah, that might be a good idea as well.

Hope you feel better soon! 13tez (talk) 13:20, 22 December 2024 (UTC)

Apologies again for the delay. I was feeling better, but then I took a heavy dip after lunch. I'm so sorry, because I feel like I've opened a can of worms and now can't deal with it as promptly as I normally would. Usually, I'm pretty good at getting back to people and offering suggestions. (Look at the November 2024 Amsterdam riots for an example – I'm obviously drawn to contentious topics!)

I want to dive into editing the Methodology and Background sections with you and @Snokalok, but I just don't think I can do it today.

Re: the image on p.24, I think that one's suitable (or obviously one like it which we can use).

I'll quickly offer my thoughts on this: The systematic reviews, which made up much of the evidence that informed the findings and conclusions of the Cass Review, were published in Archives of Disease in Childhood, a peer-reviewed medical journal...

Bearing in mind that Snokalok wants all this as an endnote, including the bit about the Cass Review not being peer reviewed, how about this tweaked version: The systematic reviews were used alongside [the things as show in the image based on the one on p.24] to inform the conclusions of the Cass Review. I don't want to say made up much of the evidence if Cass doesn't say that. From her intro and pages before and after the image on p.24, she states that she made her decisions based on the evidence she had available at the time, which doesn't specify any ratio or which evidence was given priority. She also says she drew her own conclusions based on that evidence, so she's interpreting things as she sees appropriate. She refers to the systematic reviews throughout, but she also refers to other forms of evidence. My experience of being involved in similar processes is that the systematic reviews inform a process of discussion and decision-making, but the committee (in this case, it may just be Cass on her own; I admit I don't know as much as some others here do) can decide whatever they think is justified, using all the available sources to explain it. Sometimes you lean more or less on the reviews, and clinical judgment and committed decision can count for a lot.

Is there any consensus among other experts on the ratio? Either way, for endnotes, I usually use {{efn|Text here.<ref name="x" /><ref name="y" />}}, which would look like this: (using two random citations from the article). ETA: Adjusted this based on Snokalok's reply upthread which I missed.

Lewisguile (talk) 18:58, 22 December 2024 (UTC)