Nearly 900 doctors sign letter urging BMA to abandon inquiry into Cass review

Doctors and clinical leaders have called on the BMA to abandon its plan to “publicly critique” Hilary Cass’s review of gender identity services for children and teenagers and to retract its demand to allow puberty blockers to be given to children with gender related distress while this evaluation takes place.12

A total of 870 doctors, including 557 BMA members, have signed the letter addressed to Philip Banfield, the BMA’s chair of council, saying that they are “extremely disappointed” that BMA council members took part in an “opaque and secretive” vote on the Cass review last month.3 It was this vote that led the BMA to announce last week that it was setting up its own “task and finish” inquiry to “publicly critique” what the letter described as the “most comprehensive review into healthcare for children with gender related distress ever conducted.”

The letter, seen exclusively by The BMJ and New Statesman, has been signed by 57 professors and 22 clinical leaders, including former or current presidents of royal colleges. It was delivered to Banfield and six other council chief officers and co-chief executive officers on 7 August, the same day that NHS England launched a two year action plan to implement the findings of the Cass review.4

The plans for the NHS in England include six new regional centres, which will provide holistic healthcare for children and teenagers up to the age of 18 with gender incongruence and gender dysphoria, and a trial into the potential benefits and harms of puberty blockers.

Signatories to the letter include Simon Kenny, national clinical director for children and young people, Elaine Lockhart, chair of the child and adolescent faculty of the Royal College of Psychiatry, and Deidre Kelly, chair of Evelina London Children’s Hospital, one of the hospitals piloting the new NHS gender service for London.

The letter puts the BMA under pressure to abandon what the signatories call “this pointless exercise and to welcome and follow the Cass review as the Royal College of Psychiatrists, the Royal College of General Practice, the Royal College of Paediatric and Child Health, and the AoMRC [Academy of Medical Royal Colleges] have done.”

By lobbying against the best evidence available, the BMA is “going against the principles of evidence based medicine and against ethical practice,” says the letter.

In particular, it says, the BMA’s call to continue the current use of puberty blockers until there was a “solid evidence base” is “not an evidence based approach [as] the Cass review has got it right when it says that because there is so little evidence about their safety and efficacy, they should only be prescribed under research conditions.”

The letter continues: “We are told the BMA ‘task and finish’ group will pay particular attention to the methodology used to underpin the review’s recommendations. We note not all doctors or academics are suitably qualified to comment on systematic review methodology if they do not have specific expertise.

“We believe it will be very difficult for the BMA to produce a fair critique when it has already attacked the review and voted to oppose implementation of its recommendations.”

The letter says that the BMA council vote “does not reflect the views of the wider [BMA] membership, whose opinion you did not seek.” It adds, “We understand that no information will be released on the voting figures and how council members voted.” It says such “secretive conduct” is a “failure of accountability to members and simply not acceptable.”

The letter warns that the BMA has ignored a plea by the Academy of Medical Royal Colleges for “professional bodies to come together to provide leadership and guidance on the clinical management of this population taking into account the [Cass review’s] findings. We are dismayed that the BMA has done the opposite.”

In response to the letter, Banfield defended the processes at the BMA council meeting where the decision to hold an inquiry into the Cass review was taken, saying that it followed due process and that the voting results would be released to members once the minutes were approved. He announced that David Strain, chair of the BMA Board of Science, will chair the task and finish group that will examine the Cass review, which is expected to report at the end of the year.

“The idea that any review, even on such a sensitive topic, should not be critiqued, is, I believe, contrary to the very principles” of the scientific process, said Banfield in a two page reply.

He said that NHS England’s ban on the use of puberty blockers for transgender and gender diverse young people in March “went further than any recommendation in the Cass review,” which had advised that they be used only under research conditions.

The ban meant that “right now, today, there are those who could benefit from care who are being denied that option. This approach has made an already meagre NHS service non-existent,” said Banfield.