The BMA turns away from rejecting the Cass Report

The doctors’ union has voted to retain a neutral position on the issue.

The British Medical Association (BMA) has reversed its decision to call for a pause in implementing the recommendations of the Cass Review, the New Statesman can reveal. It follows intense criticism of the doctors’ union after this publication exposed its discussions regarding the rejection of the findings of Dr Hilary Cass’s independent review into gender identity services for children and young people.

Informed by seven new systematic evidence reviews, and more than a thousand conversations with trans young people, clinicians and others, Cass concluded in April that gender medicine was built on “shaky foundations” and “an area of remarkably weak evidence”. The reality, she wrote in her report, is that there is “no good evidence on the long-term outcomes of [hormonal] interventions to manage gender-related distress”.

Yet, on 16 July, the New Statesman revealed that a motion had been tabled by the BMA council – the executive body of the doctors’ union – which called for the BMA to “lobby… to oppose the implementation of the recommendations made by the Cass Review”. It also described Cass’s recommendations as having been “driven by unexplained study protocol deviations, ambiguous eligibility criteria, and exclusion of trans-affirming evidence”. The motion had originally called for the BMA to “disavow” the Cass Review too, though this wording was changed to “publicly critique” when the vote took place the next day. Sources have confirmed since that 45 of the 69 voting members of the BMA’s council took part in those votes. Less than half of them – 21 – voted to oppose supporting the Cass Review (11 voted against; 13 abstained). By comparison, 29 members voted to critique it.

In a press release that followed, the BMA also criticised the government’s ban on new prescriptions of puberty blockers to those aged under 18 (for the purpose of treating gender-related distress). NHS England had already confirmed in March that puberty blockers would no longer be prescribed on the NHS for the treatment of gender-related distress, because of a lack of evidence over their safety and clinical effectiveness. Instead, they would only be prescribed as part of clinical research. The ban meant that others could not continue prescribing routinely as well, and was judged lawful by the High Court in July. The Health Secretary, Wes Streeting, has extended the ban until the end of November, and to cover Northern Ireland

An open letter condemning the BMA’s stance followed, gaining more than 1,500 signatures, around 1,000 of which were from BMA members. The BMA was the only major medical group in the UK to consider rejecting Cass. Supportive statements have been issued by the Royal College of GPs, the Royal College of Psychiatrists, the Academy of Medical Royal Colleges and the Association of Clinical Psychologists. Many BMA members were dismayed, some resigning their membership in protest. Signatories to the letter accused the union of failing to follow an evidence-based approach to medicine. The letter, shown first to the New Statesman, criticised the process behind the BMA’s decision as “opaque and secretive” and said the motion did “not reflect the views of the wider membership, whose opinion you did not seek”.

After months of criticism and negative press coverage, it would seem the BMA has now listened. Earlier this week, the BMA’s council members voted to “retain a neutral position on the recommendations of the Cass Review… while a BMA task and finish group undertakes its own evaluation”.

Dr David Strain, chair of the BMA’s board of science is leading the union’s “critique” of the Cass Review, which is still going ahead. “I have no preconceptions and have every intention to lead our evaluation from a position of neutrality,” he said. “As a geriatrician, I do not treat children and young people for gender dysphoria, and so the first phase of my review will be to listen to people with lived experience and a range of healthcare professionals working in this area.” Strain explained that his group would also review the actions taken in the name of the Cass Review. “I do not know, nor do I pre-empt, what we will conclude,” he added.

Some of those who were critical of the BMA’s earlier stance are relieved. Dr Louise Irvine, who organised the open letter condemning the original motion, told the New Statesman, “I welcome the BMA’s decision to reverse its opposition to the Cass Review and adopt a position of neutrality. Its previous position… has damaged the reputation of the union and its commitment to evidence-based medicine. I hope this change can help the BMA to earn it back.”

The BMA has previously said that it hopes to have completed its review by the end of the year.