What a breath of fresh air to listen to British paediatrician Dr Hilary Cass ‘live’ link from the UK, Tuesday, 2 July 2024. Her world-leading review, ’Cass Review’ published in April 2024, provided a new benchmark of scholarship for gender-affirming care of children and young people.

The Australian webinar, hosted by Professor Philip Morris, president of the National Association of Practising Psychiatrists (NAPP), welcomed Dr Cass. She summarised key points from her Cass Review – final review and recommendations and responded to many questions. Some questions were challenging, not surprising given the Review, based on the University of York’s independent findings, that Melbourne’s Royal Children’s Hospital’s guideline for gender affirming care lacked rigour and independence.

In The Australian newspaper the following morning, Health Editor Natasha Robinson quoted Dr Cass:

‘The evidence base is weak…international guidelines have for the most part not followed standard evidence-based approaches. And it has influenced most other international guidelines. There is a sort of echo chamber of sort of copying and pasting off each other. The only guidelines that have taken an independent and evidence base approach are the Swedish and the Finnish guidelines.’ (Page 3, 3. July, 2024) 

Speakers following picked up on various themes from the Review. Professor Patrick Parkinson, asked ‘After Cass in Australia, will there be a tsunami of litigation?’; Dr Alison Clayton The Cass Review – Relevant to Australia? provided arguments in support of its relevance; Dr Andrew Amos tackled Gender, Medicine & Politics: Why Australia’s health authorities refuse to address the Cass Review; and Professor Dianna Kenny’s scholarly paper covered Sociological Approaches and Psychological Therapies for Gender Dysphoric Young People: Challenging Underlying Assumptions and Attributions.

From the get-go participants were treated to a masterclass as Dr Cass surveyed her key recommendations, the source of tensions arising from the clash of ideology and evidence, driving medical decision making in this controversial field.

I felt her words as breaths of fresh air.

Each speaker’s knowledge, evidence based, ethically informed, shaped by scholarship, led listeners to stand outside the ‘echo chamber’.

We heard how the UK experience of gender affirmation ‘overshadowed’ other diagnosis where children present with gender distress. We heard ideology ‘overshadowed’ scientific method. We heard how ‘overshadowed’ clinical ethical practice led to the closure of London’s Gender Identity Development Service run by the Tavistock and Portman NHS Foundation Trust.

All as breaths of fresh air.

By the conclusion of the evening there were calls for further conversations, need for more nuanced understanding, long-term follow up and research, an urgent demand for a national inquiry in Australia. Perhaps the setting up of a national registry. 

Professor Morris suggested the following: 

  1. A national inquiry into the application of the Cass recommendations in Australia
  2. A national audit of a random selection of medical records of young individuals treated for gender dysphoria in public and private settings to determine how well these individuals are assessed and treated in relation to the Cass recommendations
  3. At a minimum, a national registry of young patients treated for gender dysphoria

These creative suggestions were partly motivated by a deep desire to restore trust in ethical medicine.

After years of betrayal, following allegations that the World Professional Association for Transgender Healthcare (WPATH) suppressed the lack of evidence-base for devising standards of care, restoring the public trust in gender medicine seems finally a possibility.

All as breaths of fresh air.

A standing ovation from behind the screen, loud virtual applause, bravo and congratulations appeared on the screen, outside the echo chamber.

All as breaths of fresh air.

Thank you, Dr Cass, for your courage, honesty and integrity.

 Thank you for providing a breath of fresh air.

 Please visit us again, soon.

 

Dr George Halasz

Wednesday 3 July 2024

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Addressing the Ailing State of Australian Mental Health Care 2024