Bigmouth Strikes Again: Carrie Marshall's blog

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Category: Health

Scare stories and newspaper nonsense

  • Basic biology

    The bigots are furious with doctors who dare to challenge their primary school-level understanding of human biology. Resident doctors of the British Medical Association approved a motion yesterday that called the Supreme Court verdict – which repeatedly used the term “biological women” but seemed unable to say what that actually meant – “scientifically illiterate” and “biologically nonsensical”.

    The anti-trans groups have of course lied about what the motion said, claiming that doctors said there was “no basis” for biological sex. But that’s not what the text said. It said:

    We recognise as doctors that sex and gender are complex and multifaceted aspects of the human condition and attempting to impose a rigid binary has no basis in science or medicine while being actively harmful to transgender and gender diverse people.

  • The Brexit of healthcare

    Another day, another demonstration that the Cass report into puberty blockers was a political move, not a medical one.

    As the epidemiologist and writer known as Health Nerd posted to Bluesky, “The BMJ journal Archive of Disease in Childhood has just published the epidemiological study done by York university that was commissioned as part of the Cass review into gender clinics in the UK. It contains some startling (and yet, unsurprising) revelations… this report undermines most if not all of the Cass review recommendations regarding clinical care.”

    The study found that gender dysphoria diagnoses were incredibly uncommon; that a tiny proportion of those studied were prescribed any medication; and rates of prescribing were falling, not rising.

    Elsewhere, solid criticisms of the Cass report continue to be published. This piece in the Journal of Paediatrics and Child Health describes it as the Brexit of health care and notes that “it is very unusual in the history of medicine that a time-honoured treatment, with a good safety record, even if based on non-randomised trials and experts’ opinion, is simply banned”.

    You can find a very comprehensive collection of links to Cass-related studies and commentary on Ruth Pearce’s website here.

  • A broken system

    Abigail Thorn, actor and writer of Philosophy Tube, posted a video two years ago about her (awful) experiences of the NHS. The short version: she demonstrated how the NHS is institutionally discriminatory towards trans people. So I imagine she was quite surprised when a very senior NHS figure approached her about being the face of a new campaign about changes in NHS trans provision.

    Thorn said no, and has written an article explaining why. Thorn is the first to say that there are some very good people working in the NHS, and in trans care specifically. But the organisation itself is broken, and treats trans people appallingly. And it’s getting worse.

    I’m writing this in my sixth month of having my basic healthcare refused by my GP, healthcare that the GP happily provides to dozens of cisgender people but which is apparently too difficult to provide to me. I’m a few months away from finally getting surgery I first asked to be referred for six years ago, a referral that was never made because the gender clinic doctor simply didn’t bother doing it, a mistake or deliberate omission that I didn’t find out about for two years. My next referral was delayed because the gender clinic made an appointment for the mandatory second opinion, never told me about the appointment, and then concluded that I had changed my mind about wanting referred because I didn’t attend. Another year gone.

    So it’s fair to say I’m sympathetic to Thorn’s argument.

    There are many problems with NHS care for trans people, and they’re about to get worse with a Cass-style stitch-up labelled as a review of adult care. That review isn’t going to recommend that the NHS does something about the infiltration of conversion therapists, or the humiliating assessments we have to go through, or the woeful lack of staff, or the waiting lists that mean many trans people will die before even having a first assessment. And it’s not going to do anything about making trans people’s access to care any easier, because as Thorn points out:

    every single person I have spoken to in the NHS- from local GPs to the National bosses- told me they are powerless. There is nobody at any level of the organisation who takes responsibility for the state the service is in and the suffering it is causing. Every single person blames the person above them, even the man at the top.

    …I agree with others who study this field that consultations and “stakeholder meetings” have become a form of abuse by the NHS and the government: we’re included nonperformatively – given time to speak in order to legitimise the process of ignoring us.

    In years to come, this will rightly be viewed as a scandal. But it’s going to harm many more people before that happens.

  • Sadistic pencil-pushers

    There’s a superb piece in Dazed by Sasha Baker, who explains how a vocal minority of religious and social conservatives has managed to dismantle trans healthcare and human rights in the UK without a single law being passed or revoked.

    The British gender critical movement purports to represent a silent majority, but knows it does not command enough support to publicly shred the documents guaranteeing our rights. Instead it has adopted the methods of sadistic pencil-pushers – its true constituency – burying human rights laws in reams of secondary legislation, statutory and non-statutory guidance, grey literature, and fudged equality impact assessments.

    As the article notes, a key part of that is the Cass scandal: a supposedly clinical review that was created and staffed in order to achieve a pre-determined political outcome, and which – despite repeated claims to the contrary in the press – found no evidence whatsoever that puberty blockers are dangerous or that their use should be curtailed.

    You’ll read a lot about “evidence” in connection with the Cass scandal. Here’s one of the crucial bits of so-called evidence on which Cass leaned heavily.

    In February, Sallie Baxendale, a psychologist, published a terrible academic paper that claimed to look at existing studies on the negative effects of puberty blockers on trans children’s cognition. In reality, most studies surveyed were performed on animals, with only one case study showing that a single trans child scored lower on an IQ test after taking puberty blockers… it was rejected by three journals and met with scathing comments from peer reviewers [but] Dr Hilary Cass chose to cite it four times in her final report, and determined that puberty blockers should not be prescribed to trans kids outside of an upcoming clinical trial, in part because of “potential risks to neurocognitive development”.

    What we’re seeing on a frankly frightening scale is the very opposite of evidence-based policy; the policies are decided first, and the evidence cherry-picked, distorted or manufactured to support them. This will not end with us.

  • Stacking the deck

    Yesterday, Wes Streeting made the UK ban on puberty blockers for trans kids permanent. The ban does not apply to cisgender children; puberty blockers are apparently magic medicine that are uniquely dangerous to trans and gender non-conforming kids.

    The decision was subject to a consultation, which – at the Government’s invitation – featured significant input from anti-trans, pro-conversion therapy organisations with no expertise in healthcare generally or trans healthcare specifically. And despite blatantly stacking the deck with those anti-trans groups, the consultation could still not produce evidence to justify the ban. It did, however, make it clear that the ban would have terrible effects on trans kids’ mental health. We’ve already seen more than a dozen children take their own lives as a result of the temporary ban.

    Streeting simply ignored the evidence and imposed the ideologically motivated ban on the UK, including Scotland. Pressure from the UK government ensured a similar ban was passed in Northern Ireland with the support of Sinn Fein. There’s bleak humour in seeing UK Labour and Sinn Fein finding common ground in killing children.

    I’ve long since given up on trying to get people to care about trans people. But an evangelical government minister banning medically necessary healthcare by prioritising the thinky thoughts of newspaper columnists and religious and social conservatives over evidence and international medical consensus is a terrifying precedent for everybody.

  • Fancy that

    The UK isn’t the only country where there have been reviews into the effectiveness and safety of puberty blockers. And it’s interesting to see what such reviews conclude when they’re not created to deliver, and staffed by people promised a peerage if they deliver, a pre-determined conclusion to support a political goal.

    The latest such study comes from France. Unlike the UK Cass Review, which decided that having medical specialists involved in a review of medicine would be biased, the French study was carried out exclusively by pediatric endocrinologists.

    Regarding puberty blockers, it notes that:

    None of the medical treatment used in the context of hormonal transitioning have marketing authorization for this indication, but these molecules have been used for a long time in the pediatric population for other indications (precocious puberty, puberty induction…). Nevertheless, they have been used for hormonal transition in trans youth since the late 1980s in some countries, and their use in adults goes back even further. In addition, off-label prescription is very common in pediatrics and child psychiatry.

    And based on the evidence, it recommends:

    We recommend that puberty suppression be offered by a multidisciplinary team or network trained in supporting transgender adolescents.

    In related news, a new scientific study funded by the IOC and published in the peer-reviewed British Journal of Sports Medicine demonstrates yet again that trans women do not necessarily have physical advantages over cisgender women in sports; in many cases, they have significant disadvantages in lower body strength and in lung function.

    I’m sure our trans-obsessed media will cover that story, and the French study, any day now.

  • Enemies within

    The evangelical movement has spent a very long time practicing institutional capture, where it inserts its people into positions where they can enact its policies. And the same appears to be happening with the anti-trans movement here in the UK, with “gender-critical” people who reject the scientific and medical evidence increasingly inhaibiting positions where they can influence healthcare and health policy.

    The latest example, as reported by Novara Media:

    Six leading gender clinicians associated with a controversial NHS review of transgender healthcare spoke at the conference of a designated anti-trans hate group that shares funding with key pro-Trump outfits

    They weren’t there to defend trans healthcare.

    Two of those people were involved in the ideologically motivated and widely discredited Cass Review, which has been used to stop healthcare for trans teens and which is being widely cited by people who want to stop trans adults’ healthcare too. A third is cited in that review and also sits on the board of the anti-trans pressure group SEGM, known as one of the “key hubs of anti-LGBTQ+ pseudoscience”.

    SEGM, for example, takes money (via the Edward Charles Foundation) from the Charles Koch Institute, a conservative political network that also funds the Heritage Foundation. The Heritage Foundation is the group behind Project 2025, a 900-page “wish list” to centralise presidential power and normalise religious conservatism, including by tightly restricting abortion access and expanding political appointees.

  • Killer conspiracies

    The BBC reports that members of an “anti-establishment cult” have been jailed for trying to kidnap a coroner. What the BBC hasn’t clearly reported (and neither has The Guardian or The Telegraph, the latter of which devoted three pages to the case) is why they were doing it. They intended to enact a “death sentence” on the coroner for supposed crimes related to “gender reassignment” in children and railed against “the transgender movement” in their radicalisation videos.

    Here’s Trans Safety Network’s Mallory Moore:

    Here’s the fake death warrant the group issued regarding the Essex coroner, directly claiming linking the coroner to supposed child mutilation relating to gender reassignment, authorising a “death sentence” for the targetted victim.

    [image or embed]

    — Mal-eficent (Sin #60) (@mall.bsky.social) October 29, 2024 at 9:23 AM

    As Mallory says, “so much of this rhetoric is impossible to differentiate from common [“gender critical”] rhetoric about trans people.” Which is perhaps why the BBC and The Guardian, both of which generally act as uncritical mouthpieces for anti-trans activists, have been so reticent about drawing attention to it.

    Sometimes the anti-LGBTQ+ links are too hard to ignore, however. Last month, a Scots neo-nazi was found guilty of planning a series of terrorist crimes – specifically including an attack on a Falkirk LGBTQ+ group. “They have been pushing their luck for years, now they will pay in blood,” he wrote. “We should get masked up and go do a few of them at their little gay club.” When the police arrested him, they found weapons including a crossbow with telescopic sights, fourteen knives, machetes, a tomahawk, a Samurai sword, knuckledusters, an extendable baton and a stun gun.

    We like to pretend that we’re not like America. But in an age of global media, bigotry and conspiracism are global too. I’ve long written about the parallels between UK anti-trans activism, neo-Nazism and QAnon; rhetoric that’s laundered in the broadsheets becomes murderous in the streets.

  • A brief history of torture

    There is a long and horrific history of conversion therapy being used against LGBTQ+ people, and we’ve known for a very long time that it’s dangerous, damaging quackery. This article by Mallory Moore is a good introduction and comes with a ton of content warnings; it describes some very awful things done by supposedly respectable doctors and psychiatrists.

    As Moore points out, the history is intertwined with so-called “race realism”, aka white supremacy; homosexuality and gender non-conformity were practiced by “savages” and “primitive races”, or were evidence of degeneracy among white people.

    Even if you accept the core assumption that being LGBTQ+ is unnatural, which of course it isn’t, we have decades of evidence proving beyond any doubt that conversion therapy, whether in the form of violent aversion therapy, electro-shock therapy or “pray the gay away” therapy, just doesn’t work. It’s simply abuse.

  • The real trans healthcare scandal

    More than 200 trans people (that we know of) in the UK have been refused basic healthcare by their GPs, in many cases after years of receiving that healthcare. A new report (PDF) by TransActual goes into detail: in most cases it’s not that new requests are being refused; it’s that existing healthcare is being stopped unilaterally by GPs. Almost half of the people who spoke to TransActual had been receiving the care for more than 5 years.

    I’m one of the people who’s been refused healthcare, and like many others I’ve been told it’s because of guidelines by the Royal College of General Practitioners, now clarified to make it clear that trans people’s healthcare should not be stopped. Others – adults – have been told that it’s because of the Cass Review, which was a (worthless, politicised) study of adolescent services and didn’t look at adult healthcare at all. Some have been told that their GP “doesn’t believe in” gender clinics.

    In Edinburgh, the gender clinic has stopped all surgical referrals for adults under 25 – again, citing the Cass Review. Meanwhile at current clearance rates the Glasgow gender clinic will see you for a first healthcare appointment seven years after you’re first referred, if indeed your GP will refer you; the reason we had self-referral, which has now been stopped, was because bigoted GPs were refusing to refer trans people.

    Stopping or refusing basic trans healthcare isn’t just dangerous and unethical. It is in defiance of the General Medical Council, which tells doctors that “you must not refuse to provide a patient with medical services because the patient is proposing to undergo, is undergoing, or has undergone gender reassignment.” And it’s the result of endless scaremongering and demonisation in the press and by politicians.

    You’d think that GPs deciding to stop treating hundreds of patients would be news. But of course, the papers who should be reporting this are the ones responsible for it.

    In the 1990s, the Labour government had to be dragged kicking and screaming through the European courts to give trans people basic human rights. It looks like history is repeating. And in the meantime, trans people will suffer.

    I try not to wish ill on people. But I hope that every so-called gender-critical columnist, celebrity and politician experiences all of the pain they want to inflict on trans people. May they never know peace.