Hundreds of doctors are protesting the BMA’s stance on contraceptives

Almost 900 doctors have written to the British Medical Association (BMA) expressing their “dissatisfaction” and disappointment with the medical association’s stance on contraceptives and the Cass Review, New statesman can reveal.

In a press release last week, the BMA criticized the ban on new prescriptions for anti-puberty drugs – restrictions introduced by the Conservative government from June in light of Dr Hilary Cass’s four-year review of gender education services for children and young people. Cass’s final report was published on April 10 this year. In response, the BMA has now called for a pause in the implementation of the recommendations made by the Cass Review, after labeling them “unsubstantiated”.

The letter, which is addressed to Philip Banfield, chairman of the British Council of the BMA, and has been seen in full exclusively by New statesman and British Medical Journalopens: “We write as doctors to say ‘not in my name.’ We are extremely disappointed that the BMA Council has agreed to a proposal to carry out a ‘critique’ of the Cass Review and to seek to challenge its recommendations.

It is signed by 57 professors and 22 former or current presidents of Royal Colleges of Medicine and other clinical leaders, among others. Of the 870 signatories, more than two-thirds are BMA members. “The number of signatories to this letter speaks volumes for how concerned doctors have been about the BMA Council’s proposal against the Cass Review,” said Dr Camilla Kingdon, former president of the Royal College of Paediatrics and Child Health (and letter signatory).

On July 16 last New statesman revealed a motion tabled by the BMA urging BMA members to “lobby and work with other relevant organizations and stakeholders to oppose the implementation of the recommendations made by the Cass Review”. The BMA’s policy-making body – the British Council – voted the next day on a slightly modified proposal: instead of voting to ‘reject’ the Cass Review, the council chose to publicly ‘criticize’ it. The proposal also described Cass’ recommendations as “driven by unexplained anomalies in research methods, unclear eligibility criteria and the exclusion of corroborating evidence.”

In a press release on 31 July, the BMA confirmed the outcome of the vote on the proposal as well as its final wording. The doctors’ letter to the BMA criticized the process that led to the association’s position on the Cass Review as “opaque and secretive” and “does not reflect the views of the wider membership, whose views you did not seek”.

We do not know how many of the BMA’s 69 councilors voted in favor of the proposal. The rules of the municipal council mean that proposals can be passed by a simple majority of the votes cast – abstentions are omitted. BMA members who have signed the letter say the refusal to provide information about the vote amounts to a “failure of responsibility to members” and describe it as “simply not acceptable”. Meanwhile, details of other recent BMA votes have been published. In a written reply to the signatories of the letter, Philip Banfield said that the discussion and vote in the council followed the correct procedure and BMA members would receive the results of the vote once the minutes of the meeting have been approved.

Following the vote, the BMA issued a press release criticizing the government’s ban on the private prescription of contraceptives to under-18s (for the purpose of treating gender-related distress).” In March, NHS England confirmed that contraceptives would no longer be prescribed on the NHS for treatment. on gender-based distress. There was, her statement said, “insufficient evidence to support safety or clinical efficacy.” [puberty blockers] to make the treatment regularly available at this time. Instead, they would only be prescribed as part of clinical trials. This ban was ruled legal by the High Court last month and Health Secretary Wes Streeting has signaled his support.

In his review, Cass found that gender medicine was built on “shaky foundations”: “This is an area of ​​incredibly weak evidence. The reality, she wrote in her report, is that there is “no good evidence of long-term outcomes.” [hormonal] interventions to manage gender-based distress’.

To talk only to New statesmanCass spoke of her “disappointment” that the BMA had not contacted her to discuss her concerns in the four months since the review was published. “The review [team] spoke to representatives of the BMA in the course of its work and the recommendations in the final report reflect the issues raised; particularly anxious about the lack of adequate training in this area and the pressure put on GPs by the private sector to prescribe in areas that many feel are outside their remit.’

The letter – which strongly supports Cass – has accused the association of failing to follow an evidence-based approach to medicine. The letter says: “The Cass Review is right to say that because there is so little evidence for [puberty blockers’] safety and efficacy, they should only be prescribed in a research setting.” The letter also states: “By going against the best evidence we have, the BMA is going against the principles of evidence-based medicine and against ethical practice.

The question of banning the prescription of anti-aging drugs was not directly put to the council’s vote. Following the BMA’s announcement, NHS England said: “Dr Cass spent four years gathering evidence for the most comprehensive report of its kind and her expertise and advice have been invaluable in supporting the NHS to fundamentally create better and safer services for children and young people.” people.” It had “full confidence” in her report and was “committed to following through on its recommendations”.

To talk to New statesmanboth Kingdon and Dame Clare Gerada (former president of the Royal College of General Practitioners, and another signatory) echoed the letter, claiming the Cass Review was “the most comprehensive review of its kind ever undertaken”. “Patients – including children – have the right to receive treatment based on the best evidence,” Gerada added. “This is especially important when this treatment is a life-changing intervention.”

A number of signatories to the letter added additional comments below the main text. They did not hold back: “scared”, “scared”, “shocked”, “reprehensible”, “responsible” and “wrong”. Some argue the move will cause direct harm to children, while one signatory claims it shows “absolute failure of leadership”. Another writes: “The BMA has overstepped its bounds in attempting to criticize a large body of carefully conducted peer-reviewed research.” Some are baffled as to why the BMA – the doctors’ union – is getting involved at all, suggesting its focus should be on pay and working conditions, rather than “challenging a proven document that took four years of painstaking research to produce”. . (These comments were sent to the BMA; the association declined to comment.) Several signatories say they have canceled their membership as a result of last week’s announcement.

Dr Peter Green, co-chair of the National Network of Designated Healthcare Professionals (NNDHP) – whose members are responsible for safeguarding children in the NHS – is a BMA Life Member. He also signed the letter.

“The NNDHP has supported the Cass Review from its inception as a way to provide answers to clinical controversies,” said Green. New statesman. “The review was admirably rigorous in its approach and provided sober clarity in the eye of a social storm.” The NNDHP is appalled by the BMA’s intervention and, with all due respect, urges the organisation, world renowned as it is, to reassess its approach and position.

“I cannot understand what the BMA thinks they can add to this complex area of ​​healthcare,” Kingdon said. “It is imperative that we start to implement the Cass Review’s recommendations and underpin our work with further research to answer important questions about our approach, particularly in relation to the use of hormones,” she added.

The undersigned are deeply concerned about the thousands of suffering children who need help. The latest figures indicate that over 5,700 are on the waiting list for gender-specific youth services.

In support of its position, the BMA has referred to articles critical of the Cass Review, written by some of its own research which was criticized in the evidence that informed Cass’s work. “We note that the sources relied on by the BMA to question the review are written by groups with serious conflicts of interest and have not been peer-reviewed,” the letter said. The seven systematic reviews that form the basis of the Cass report are all peer-reviewed.

The BMA is now planning to launch its own review of the Cass Review, which it hopes will be completed by the end of the year. The association’s “task and finish” group will, the BMA said in its July 31 press release, “pay particular attention to the methodology used to underpin the report’s recommendations”. However, the letter questions whether the BMA has the expertise to do this, arguing that it will be “very difficult for the BMA to make fair criticism when it has already attacked the review and voted against implementing its recommendations.”

“While the BMA Council chose not to consult its members,” Cass said in a statement, “the review consulted several hundred clinical staff most involved in the care of children and young people with gender-related distress, many of whom are of course Members of BMA. We also had regular discussions with the Royal College of Physicians and other professional bodies responsible for providing guidance and setting professional standards, and an extensive engagement program with service users and people with lived experience.

In a two-page response to the letter’s signatories, which was shared New statesmanBanfield said that while “the motion passed by the UK BMA Council criticizes the Cass Review and the actions that have been carried out in its name”, the criticism called for “must start from a point of neutrality and any assessment must be evidentiary”. . . “The idea that any review should not be criticized, even on such a sensitive topic, is, in my view, contrary to the principles of the scientific process,” he added.

Banfield said the ban on “the use of contraceptives by transgender and genderqueer young people goes beyond any recommendation in the Cass Review”, which said they should “only be used in research settings”. The impact of the government’s decision, he said, “means that now, today, there are those who could benefit from care who are denied that option”.

The release of the Cass Review’s final report in April 2024 appeared – for a short time – to establish a calm and clinical consensus on the noisy, toxic debate about how best to care for gender-questioning children. Its results have been accepted by both the previous government of the Conservative Party and the current government of the Labor Party. NHS England has pledged to fully implement its findings and yesterday issued an update on its plans to do so. A third Gender Center will open later this year in Bristol, with others planned for the future. As seen in the letter to the BMA, doctors are now seriously concerned that this could get out of hand.

The letter to Philip Banfield expresses the signatories’ “dismay” that the BMA has chosen to criticize Cass. The letter concludes: “We call on the BMA to abandon this pointless practice and to welcome and follow the Cass Review carried out by the Royal College of Psychiatrists, the Royal College of General Practitioners, the Royal College of Paediatrics and Child Health and the Academy of Medical Royal Colleges .