Cheung C Ronny, Abbruzzese Evgenia, Lockhart Elaine, Maconochie Ian K, Kingdon Camilla C
General Paediatrics, Evelina London Children's Hospital, London, UK
School of Life Course & Population Sciences, King's College London, London, UK.
Arch Dis Child. 2025 Mar 19;110(4):251-255. doi: 10.1136/archdischild-2024-327994.
In April 2024, the final report of the Cass Review, an independent review chaired by Dr Hilary Cass, was published, offering recommendations to improve gender identity services for children and young people in the UK. The core purpose of the Review was to improve care for children and adolescents. Commissioned by National Health Service England, the Review identified a weak evidence base for medical endocrine interventions and recommended that these treatments be provided within a structured research framework. The Review received widespread support from the clinical community. However, in July, the British Medical Association Council, without consulting its own members, unexpectedly passed a motion calling for a public critique of the Review, citing concerns over methodological weaknesses - a position it then softened following public criticism from members, concluding that their review would come instead from a position of neutrality.The original motion was based on two non-peer-reviewed online papers, prominently the work of McNamara -a paper which was written for a primarily litigious, rather than academic, purpose. We critically examine these sources and analyse the wider legal context in which they have been applied. We conclude that these sources misrepresent the Cass Review's role and process (specifically, by mistakenly comparing the Review to clinical practice guideline development), while many of the methodological criticisms directed at the Cass Review, including its use of evidence appraisal and systematic reviews conducted by University of York (UK), are unfounded.These misunderstandings, based on flawed and non-peer-reviewed analyses intended for legal (rather than clinical) purposes, jeopardise the implementation of crucial reforms in the care of gender dysphoric youth. The UK clinical community should move beyond these critiques and focus on the Cass Review's recommendations to establish a safer, more holistic and evidence-based service model for children and young people experiencing gender identity issues.
2024年4月，由希拉里·卡斯博士主持的独立审查“卡斯审查”的最终报告发布，为改善英国儿童和青少年的性别认同服务提供了建议。该审查的核心目的是改善对儿童和青少年的护理。受英国国家医疗服务体系委托，该审查发现医学内分泌干预的证据基础薄弱，并建议在结构化研究框架内提供这些治疗。该审查得到了临床界的广泛支持。然而，7月，英国医学协会理事会在未征求其成员意见的情况下，出人意料地通过了一项动议，呼吁对该审查进行公开批评，理由是担心其方法存在缺陷——在成员的公开批评后，该立场有所软化，得出结论称他们的审查将改为基于中立立场。最初的动议基于两篇未经同行评审的在线论文，主要是麦克纳马拉的作品——一篇主要为诉讼目的而非学术目的撰写的论文。我们批判性地审视了这些来源，并分析了它们被应用的更广泛法律背景。我们得出结论，这些来源歪曲了卡斯审查的作用和过程（具体而言，错误地将该审查与临床实践指南的制定进行比较），而针对卡斯审查的许多方法学批评，包括其对证据评估的使用以及英国约克大学进行的系统评价，都是毫无根据的。这些基于有缺陷且未经同行评审的、用于法律（而非临床）目的的分析产生的误解，危及了对性别焦虑青少年护理的关键改革的实施。英国临床界应超越这些批评，专注于卡斯审查的建议，为面临性别认同问题的儿童和青少年建立一个更安全、更全面且基于证据的服务模式。
