Doctors question Cass report’s dismissal of ‘poor quality’ trans healthcare research
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A recent report commissioned by NHS England and headed by paediatric expert Dr Hilary Cass has sparked controversy among Canadian doctors who question the decision to disregard a significant number of existing studies on gender-affirming healthcare for trans youth. The Cass report, which was published last week, recommended a holistic approach to treatment, including the creation of regional hubs across England in response to the rise in referrals to youth gender clinics.
While the report received a mixed reaction from experts, with some praising its findings and recommendations, others have raised concerns about the dismissal of existing research into clinical guidance for trans youth. One of the main criticisms is the report’s assertion that almost all existing research is of poor quality and lacks a reliable evidence base for making clinical decisions, including international guidelines.
Dr Tehseen Ladha, a paediatrician and assistant professor at the University of Alberta, has challenged this approach to handling clinical research. She highlighted the challenges in conducting high-quality scientific trials in paediatric research, citing systemic blockages and the difficulty in obtaining perfect evidence, especially when dealing with marginalized populations.
The Cass report also came under fire for dismissing organizations like the World Professional Association of Trans Health (WPATH) as lacking in developmental rigor despite being highly influential in directing international practice. WPATH has played a crucial role in shaping guidance on transgender healthcare in several countries.
Dr Sam Wong, the president of the Alberta Medical Association, emphasized the challenges of conducting gold-standard randomized controlled trials in trans healthcare. He explained that it would be difficult to blind patients and doctors in such trials due to the nature of the treatment, as individuals would quickly realize whether they were receiving puberty blockers or a placebo.
Despite the lack of randomized clinical trials, Dr Jake Donaldson, a family physician from Calgary, argued that there is still ample evidence to support the use of puberty blockers and hormone therapy for trans patients. He likened withholding care due to a lack of randomized trials to denying care to pregnant women based on the same criteria, calling it unethical.
Overall, the debate surrounding the Cass report highlights the complexities and challenges of conducting research in gender-affirming healthcare for trans youth. While some experts question the dismissal of existing studies and guidelines, others emphasize the importance of providing care based on the available evidence and best practices. As discussions continue on how to best support trans youth in their healthcare needs, it is essential to consider all perspectives and ensure that decisions are made with the well-being of patients as the top priority.
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