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sources for consideration

[edit]

Consider the other side

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I disagree with these edits:

  • this removes a line (who said the Cass Review "amounted to powerful scientific evidence in support of restrictions on the supply of puberty blockers") that summarises the argument the judge used to close the legal case against the puberty blocker ban. The edit summary says " I don’t a single judge’s opinions on a medical matter bear tremendous weight". That's an argument, certainly, though when I've mentioned some of our quoted figures lack of professional qualifications others get upset this is some kind of insult or personal attack. But consider the other side. Imagine the judge had said the ban was illegal, and that Cass and their systematic reviews did not amount to convincing scientific evidence to justify a ban. Holy cow, half the editors here would be fighting with themselves about our best our LEAD SENTENCE could mention the word "legally discredited" and the judges verdict would be quoted extensively. This was an important legal decision, highlighting the line between what politicians could do and what doctors should decide for themselves. That it was dismissed is important and the reasons for that dismissal are important. We don't need to agree with the judge about the evidence being "powerful", we just need to report that this was the reason the judge gave for dismissing the challenge. So I think it should be restored.
  • this (mentioned above) removes the response by the editor of the journals where the seven scientific reviews were published. We have given extensive space to the critical opinions of random people making mostly factually dubious claims about these seven reviews. A couple of editors have claimed we now have a consensus against citing individual doctors. Well, here we are citing someone in their role as journal editor, not as a random doctor with an opinion. That they have robustly defended the reviews is notable. And, really, if you think that's your threshold now, there's plenty material citing activist doctors are heading for the chopper. Think carefully what you wish for. I think this should be reverted and consider that on the balance of positive/negative opinions right now, we are over-quoting the critical activists. That isn't NPOV and doesn't help the reader understand that, in the UK at least, this report is (barring the council of a trade union) universally accepted by professional bodies and politicians that matter and in no way likely to end up being retracted.
  • this, while were are discussing removal, is baffling. The closure of GIDS, a result of the interim report and other assessments, was the earliest and most significant change. The creation of regional centres is one of the recommendations and so these two new centres is an early and significant development. Snokalok, please remember this is an article on a UK commissioned serious independent report that took 4 years to determine the future of UK's gender identity services. It really isn't a plaything for activists to argue over or a PDF stuck on a web server somewhere. For crying out loud, the closure of the largest such centre and the creation of others, under a new "holistic" model and with a new referral pathway, is the point. This is like having a report about whether we should build this or that new railway, and then chopping out the paragraph that mentions we are building this one. Could you, or someone else, please revert that. Try to remember please that to American activists this topic is "something we hate that must be destroyed" but in the UK this is part of our healthcare and is shaping what happens. -- Colin°Talk 07:45, 9 August 2024 (UTC)[reply]
Holy cow, half the editors here would be fighting with themselves about our best our LEAD SENTENCE could mention the word "legally discredited" and the judges verdict would be quoted extensively. No, they wouldn’t, because most wikipedia editors don’t see the opinions of judges in civil court as determinations of truth and fact. All a case going one way or the other means is that you’ve managed to convince one lawyer in a powdered wig of something. A judge does not speak with the voice of god. “Legally discredited” is an entirely nonsensical term thusly.
And in that vein, the edit remains valid, because it’s simply the singular opinion of a relatively uninvolved lawyer in a powdered wig.
We have given extensive space to the criticalopinions of random people making mostly factually dubious claims about these seven reviews. A couple of editors have claimed we now have a consensus against citing individual doctors. Well, here we are citing someone in their role as journal editor, not as a random doctor with an opinion. That they have robustly defended the reviews is notable. And, really, if you think that's your threshold now, there's plenty material citing activist doctors are heading for the chopper. I’d be very interested to see this material you say exists, because up until this point the consensus has been to cite organizations, not individuals; and I can’t find - looking at the reception section - a single instance of an individual doctor being cited.
The creation of regional centres is one of the recommendations and so these two new centres is an early and significant development. If these centers had been built, I perhaps would agree with you, but that’s not what this is about, the section cut out more or less just said “They’ve begun thinking about it”. When the centers are actually built and running, then perhaps it’s warrant space in the lead, but at the current moment the largest and only really impact of the review thusfar is the puberty blocker ban. Snokalok (talk) 14:43, 9 August 2024 (UTC)[reply]
The first two regional centres opened in April. Please look these things up before editing. 212.36.63.7 (talk) 16:56, 9 August 2024 (UTC)[reply]
I've removed the sentence "BMA Council Chair, Philip Banfield, said the task force commissioned to review the Cass Review "will work with patients to ensure the evaluation invokes the old adage in medicine of ‘no decision about me without me’"". This is personal puffery by Banfield (the BMA statement separates this as a personal remark by Banfield) and we don't crystal ball how this review might operate before it is even started, assuming they find someone to do it. It doesn't add information as we already noted that the review was to be conducted and report by Jan 2025. It implies that unlike the Cass review, theirs will consult with patients. This is basic misinformation commonly reported in some activist texts, which has been addressed already and completely false. The irony, not missed by many of the signatures to the letter complaining about this, is that the BMA's sole purpose to represent doctors, not patients or politicians (other groups serve those roles). -- Colin°Talk 10:03, 10 August 2024 (UTC)[reply]
@Colin's argument for putting back the text that has the reason the High Court judge gave for rejecting the legal challenge seems entirely convincing ("We don't need to agree with the judge about the evidence being "powerful", we just need to report that this was the reason the judge gave for dismissing the challenge"), so I have reverted it back in. Peckedagain (talk) 19:41, 9 August 2024 (UTC)[reply]
I agree, this isn't about amplifying an undue opinion, this is directly relevant to the case. It is entirely within the gift of the health secretary to engage emergency legislation in response to strong scientific evidence, which is what happened. Void if removed (talk) 07:14, 10 August 2024 (UTC)[reply]
I have restored the text again as the consensus seems clear. This was a remarkable removal. The case was widely reported when launched and widely reported when closed and is of national significance both to the prescription of these drugs but also the debate about political power over medical decisions. Snokalok, we all get that you don't like the judge's opinion, but were are not stating it as a fact that Wikipedia agrees with. I haven't looked, but I'm pretty sure the US supreme court, who like this judge, dress up in historical costumes, rulings on abortion are widely detailed on Wikipedia despite most editors finding them horrendous. -- Colin°Talk 10:11, 10 August 2024 (UTC)[reply]
I've removed it again. There's no consensus here, and it runs into similar problems as the sentence below. This is not the quality standard being enforced by you in other parts of this page. This judge is not a medical expert, so his opinion on the level of evidence does not carry significant weight for inclusion. Especially not when the next sentence already points out that it was an "evidence-based" decision, so it's effectively duplicating information. --Licks-rocks (talk) 11:05, 11 August 2024 (UTC)[reply]
This is not being quoted for opinion on the review - this is being quoted because it contributed to the judge's ruling.
You've ignored my comment above explaining why it's relevant. Please engage with that, which has nothing to do with medical expertise, and everything to do with legal relevance to this specific case. Had the health secretary acted on weak evidence, the challenge could have succeeded. Void if removed (talk) 13:37, 11 August 2024 (UTC)[reply]
What's relevant here is how the judge ruled. Since it's a judge and not a doctor, I think it's more relevant what precedents he based his ruling on, than what he thought about the medical stuff. Currently it just says he thinks it's "powerful evidence", which, as I pointed out, is then repeated in the next sentence, so in my view it doesn't contribute much to quote that snippet there. --Licks-rocks (talk) 14:24, 11 August 2024 (UTC)[reply]
It's relevant because this is what Transactual argued:
They argued that she had not identified the “serious danger to health” needed to justify emergency legislation and that she should have consulted before issuing the order.
I suggest including an explanation that this is what they argued, and the quote from the judge strongly disagreeing, because that is what the ruling is based on. Void if removed (talk) 17:59, 11 August 2024 (UTC)[reply]
That would be spending a lot of text on what ends up amounting to a small tangent. --Licks-rocks (talk) 18:04, 11 August 2024 (UTC)[reply]
I have edited as @Void if removed suggests: which seems a reasonable balance of all views.
I disagree with @Licks-rocks view that the court case is a 'small tangent': on other occasions judges' ruling have caused the roll back of legislation: and it is not a 'small tangent' that a High Court challenge has tested the legality, which has been confirmed as legal. Peckedagain (talk) 02:03, 16 August 2024 (UTC)[reply]
A summary of the argument by which the case was dismissed is entirely normal for important legal rulings. And this ruling is not a "small tangent" but critical to both trans youth healthcare in England and to the line by which politicians can interfere with medical matters. This was not dismissed, for example, because the health secretary thought trans children did not exist and the judge agreed with them, which is perhaps a viewpoint more common in the US. And we need to remember that the UK "ban" is not absolute, unlike some US states. The Cass Review did not recommend banning this treatment entirely and considered it appropriate for some children. But that we needed more research to figure out who those children were and what the risks were. -- Colin°Talk 17:56, 23 August 2024 (UTC)[reply]

I'm minded to restore the response by the editor of Archives of Disease in Childhood. These systematic reviews the the core evidence publication of the "Cass Review", which have been attacked over many paragraphs in this article. This criticism doesn't just focus on Cass's own 400 page document, but equally on these reviews with claims of methodological flaws and typos and citation errors and so on. It seems that several hundred words of criticism over many paragraphs vs a single sentence is DUE and Snokalok doesn't have consensus to remove it. -- Colin°Talk 10:49, 10 August 2024 (UTC)[reply]

I do have the consensus because if you look in the thread above, there are several editors as well as myself who agree with the longstanding decision that was settled on to avoid individual doctors. I can tag them if you like. @LokiTheLiar
@Hist9600. Snokalok (talk) 15:04, 10 August 2024 (UTC)[reply]
And also, onus is on inclusion. Snokalok (talk) 15:04, 10 August 2024 (UTC)[reply]
As I said above this is not the same. This is the editor of the journal that published the systematic reviews standing by then, against criticism of the reviews. As things stand we are accumulating false imbalance.
Adding ever more random doctors cheerleading or condemning the report back in April added little so we rolled them all up and focused on major organisational and political responses.
We now have eg. the Yale white paper which purports to critique the systematic reviews. A response from the journal editor saying this is bunk is relevant and due and not the same thing at all as the earlier matters. This is an evolving back and forth and back and forth. This is another forth (or back), and to leave it out misleads the reader that there has been no answer to the later criticisms of the York reviews. Void if removed (talk) 17:52, 10 August 2024 (UTC)[reply]
And if the editor was speaking on behalf of the org, I’d perhaps agree with you, but he’s not, he’s speaking in his own personal capacity - same as Ada Cheung. Yale is different because Yale is on behalf of an organization, not a single doctor speaking independently of his org Snokalok (talk) 19:14, 10 August 2024 (UTC)[reply]
The Yale doc now has a note (added July 11th) explicitly stating it is the opinion of the individual authors, not on behalf of any institution. So we should remove it. Void if removed (talk) 13:50, 11 August 2024 (UTC)[reply]
Nope, it was still published by the Integrity Project as shown on their site in the White Papers section - the clarification you mentioned is a standard disclaimer (a group of multiple experts from many different respected schools and organizations) that they are not talking on behalf of their universities/employers at large.
This persistent attempts to silent expert (and in this case, well cited, since even the BMA review has referenced the Yale Integrity Report for the basis of their own inquiry) critique of the Cass Review from respected experts is bordering on running afoul of WP:NOTCENSORED/WP:IJUSTDONTLIKEIT. Raladic (talk) 16:29, 11 August 2024 (UTC)[reply]
Just to confirm, I do in fact agree with Snokalok here. If we're going to exclude individual doctors (and I agree we should), we should exclude all individual doctors. Conversely if we include this guy we should include the opinions of individual doctors critical of the Cass Review. You can't have it both ways: either they're all in or they're all out. Loki (talk) 20:28, 10 August 2024 (UTC)[reply]
Colin and Void have been very aggressive in arguing against inclusion of a lot of what they claim to be "low quality" material on this page, up to and including some scientific papers and even a bit beyond. I don't see a good reason to then make an exception for an individual editor's personal remarks here. As far as his personal opinion matters, I'm sure it is already included in the published reviews he was involved with. So yes, I, too, agree with snokalok here.--Licks-rocks (talk) 23:51, 10 August 2024 (UTC)[reply]
Yes, I would agree that the views of a random doctor are not WP:DUE. Just because a quote exists in an article, does not mean that it belongs in an encyclopedia. Hist9600 (talk) 17:23, 11 August 2024 (UTC)[reply]
It sounds like the question here is whether a person who is all of these things:
  • the editor-in-chief of the medical journal where the reviews were published,
  • a clinician,
  • a faculty member at both Uppsala University and Aga Khan University,
  • an epidemiologist, and
  • an international child health expert
should be treated as exclusively a clinician when speaking about the actions and beliefs of the journal. The relevant text in the article says this:

"Nick Brown, editor of the Archives of Diseases in Childhood, told The BMJ, “A common thread in the review findings was the breathtaking dearth of quality evidence to guide care in this vulnerable group of young people.”
Brown is adamant that the York research is robust. “All of the systematic reviews underwent expert, independent peer review, and each was revised accordingly. We were, and remain, entirely confident as to their veracity. Counter to claims to the contrary, rigorous methods were adhered to at every step,” Brown told The BMJ.
Brown continued, “Criticisms of the methodology hold no water. The single search strategy used by the York group is far more yielding than the scattergun approach advocated by those still struggling to come to terms with the findings.”"

This source, which identifies the speaker in the role as the journal editor, is taken by some editors to be him speaking personally, and not on behalf of his organization.
The competing source, which is a press release, says

"A ‘task and finish’ group, established by the BMA’s Chair of Council Professor Philip Banfield, who will also appoint the group’s chairperson, will pay particular attention to the methodology used to underpin the report’s recommendations. [...]
Professor Banfield said:
“It is vitally important we take time and care to get this work right. This is a highly specialised area of healthcare for children and young adults with complex needs, and as doctors we want to be sure they get the most appropriate care and the support they need. The task and finish group will make recommendations to improve the healthcare system that has, for too long, failed transgender patients. It will work with patients to ensure the evaluation invokes the old adage in medicine of ‘no decision about me without me’. It is time that we truly listen to this group of important, valued, and unfortunately often victimised people and, together, build a system in which they are finally provided with the care they deserve.”"

This source, which identifies the speaker in the role as the organization's council's chair, is taken by these same editors to be him speaking on behalf of his organization, and not personally.
This looks like a double standard to me. What's it look like to you? WhatamIdoing (talk) 04:19, 14 August 2024 (UTC)[reply]
The difference is that people directly related to the review, such as the authors of it, or as you pointed out, the editor of the journal in which the review is published defending its rigor is that WP:MANDY applies - of course they'll deny any criticism with it, so the simple words of refutation are just that, no one expects anything other than the people involved rejecting any criticism, which is why we have Mandy (incidentally, thanks to the UK of which the Cass Review originated) to avoid creating the appearance of false balance.
A contrast would be if someone uninvolved, with relevant credentials in the space, would go to defend the review, but such people appear to be notably largely absent outside the involved institutes/doctors since internationally the review appears to be amassing criticism, with little support (aside from anti-trans groups). Raladic (talk) 04:48, 14 August 2024 (UTC)[reply]
Maybe, or maybe it's normal to include such denials. It looks like the exact quoted phrase "denied the allegations" appears in about 2,000 articles right now.
But I'm less concerned about whether to include it at all than about the Wikipedia editors above claiming that a news article that identifies someone by their professional role is just him "speaking in his own personal capacity", and specifically on the grounds that this is just a case of "a single doctor speaking independently of his org" and "the views of a random doctor", and then – when we look at a source in a nearly identical style, except the speaker presents the Right™ POV – the editors claim that that individual doctor is speaking on behalf of the organization.
This particular choice about labeling seems neither logical nor consistent to me. It seems POVish and even hypocritical, actually. WhatamIdoing (talk) 05:26, 14 August 2024 (UTC)[reply]
I point, in particular, to the editor-in-chief's use of the word "we". Unless he's in the habit of using the Royal we, that looks like he's speaking for more than himself.
I want to be clear that we could agree that he's speaking on behalf of his org, and that we still don't think it's worth including, and that would not bother me at all. I just want editors to apply a consistent standard, even here on the talk pages. WhatamIdoing (talk) 05:28, 14 August 2024 (UTC)[reply]
I read his remarks as being made as if he is speaking on behalf of the org but it is not explicitly stated and so I don't think we could attribute it to the org. I think if it were clearly attributed to the org, it would be included without question, but I still think it's due simply because it's a response by a notable person connected to the reviews to the criticism of those reviews, which at present is not balanced.
But compare this to the quote from Stella O'Malley, which I've repeatedly argued is not due, but keeps being defended. Again it seems to be taking a personal quote and extrapolating that it is the position of the org. That's inconsistent IMO. Void if removed (talk) 06:37, 14 August 2024 (UTC)[reply]
When I search the article, I don't see any mentions of Professor Banfield. The only quote in the BMA section is not his quote, it's a quote directly from the motion. So, what double standard are you even talking about? Loki (talk) 05:01, 14 August 2024 (UTC)[reply]
I'm talking about the discussion on this talk page. WhatamIdoing (talk) 05:27, 14 August 2024 (UTC)[reply]
OK. I don't support quoting Banfield. I don't think that we should quote individual doctors period. Loki (talk) 08:18, 14 August 2024 (UTC)[reply]
I wouldn't support quoting banfield either, and I can't find a single mention of him in the article, because, as I can see now that I've done a word search for it, colin removed it. I can't for the life of me find anyone on this page who disagreed with that particular edit. Is there some edit war I overlooked? Dit it somehow get wrapped up in a more general discussion where I missed it? why are we talking about this? --Licks-rocks (talk) 08:35, 14 August 2024 (UTC)[reply]
I think if that press release wanted Banfield's views to be considered representative of the BMA Council (never mind representative of the BMA as a whole, which it appears it isn't) then the statement it attributes to Banfield would be incorporated into the base text of the press release. They'd write that the council as a whole had expressed a belief that they, unlike the Cass Review, were going to consult patients, because, duh, that's what a doctor's trade union does. They didn't and we shouldn't. Even in his role as trade union council chair, when did we agree that trade union council chairs are worthy of personal quotation? This is not a body setup to vet medical questions of the day, but a union that argues with the government about getting more money for hospitals, better conditions, better employment terms, better wages, and so on. The reason this generated a modest amount of news coverage is the polarised and shocked response by both sides in this culture war.
Banfield said many things but an editor here singled out the misinformation to quote, which is particularly troublesome. Cass consulted with a couple of thousand individuals, including many patients and their representatives. I really have a hard time wondering how doctors BMA trade-union subscriptions are going to be spent interviewing a comparable number of patients and experts in order to do a better job over the next six months. My guess, frankly, is that they won't find anyone to do this and it will fade away. Why we are including misinformation about a "review" that hasn't been setup yet is another point.
I note above that Raladic referred to the BMA Council press release as a "BMA review". Goodness me, this is how misinformation propagates round the would.
WP:MANDY is about people, individuals, being accused of something bad. This isn't that at all. This is about systematic reviews and evidence and about a four year review and its published report. Nobody is denying "allegations", they are disagreeing with supposedly factual claims which reliable sources show to be false and unfounded. MANDY doesn't let us say "We can fill the article with criticism but cannot mention any counter criticism or defence, especially not counter criticism coming from someone associated with the review or its journal papers". The editor of the Archives of Diseases in Childhood, is a significant voice in the debate over whether these systematic reviews are flawed or not. It is not a given that they will 100% defend their work. Papers get retracted and correction notices issued. What I'd expect is that if these claims had any foundation, that there would be a corrective response. After all, these are the very highest reliable sources and a reputation for fact checking and accuracy includes responding to errors and failures. Our readers are being given entirely the false impression that these criticisms and falsehoods are accepted by the professionals involved who are presumably all hanging their heads in shame somewhere. The editor clearly represents those journals and those systematic reviews. Trying to paint them as just some random doctor isn't valid at all.
Loki, I don't think your approach of saying "X is a doctor therefore we can't quote them" is helpful. It doesn't work, for example, if the Editor of the ADC wasn't actually a doctor, but had a degree in journalism and medical ethics or whatever. Similarly the repeated removal of the judge's closing rationale is just "I'll invent an argument to remove text I don't agree with". Which is why I started this section to "consider the other side". One can regard that rationale as a decision and justification by UK High court, not as a decision by an individual. Banfield's remarks we quoted wouldn't be nearly so problematic if they weren't pure misinformation. -- Colin°Talk 08:24, 14 August 2024 (UTC)[reply]
Thinking about people, individuals, being accused of something bad, we do normally include statements along the lines of "Chris Criminal denied the charge of jaywalking", even when that has to be sourced to a weak source. Not including such a statement is generally considered to be an NPOV problem.
I wonder whether it would be better to say something like "The editor-in-chief of the Archives of Disease in Childhood has said that they stand by the quality of the review articles they published". WhatamIdoing (talk) 23:40, 18 August 2024 (UTC)[reply]
That's at least better. The comments are notable mainly to the extent that they come from the journal itself, and not some specific person no matter how notable their credentials are. He did make some comments that he said are on behalf of the journal, and as editor-in-chief it's certainly not crazy to say he can say things on behalf of the journal.
I'm mostly trying to avoid the situation where the reader's opinion of the Cass Review is determined purely by credentialism. Whether the Cass Review is sound science does not depend on whether X doctor with a fancy title thinks it's sound, it depends on the actual quality of the research, and on whether future research bears it out or not. Opinions of whole medical organizations do have some informational value here, but opinions of individual doctors really don't. Loki (talk) 00:16, 19 August 2024 (UTC)[reply]
This does do a lot to make the sentence sound less sensationalist, which I think was a large problem with the original. --Licks-rocks (talk) 11:25, 19 August 2024 (UTC)[reply]
Works for me. Void if removed (talk) 11:49, 19 August 2024 (UTC)[reply]
The originally inserted text said
"The editor of Archives of Disease in Childhood, which published the seven systematic reviews produced by York University for the Cass Review, said he was confident in the reviews and that the criticisms they had received "hold no water", and were made by "those still struggling to come to terms with the findings.".
The source text says
"Nick Brown, editor of the Archives of Diseases in Childhood, told The BMJ, “A common thread in the review findings was the breathtaking dearth of quality evidence to guide care in this vulnerable group of young people.”
Brown is adamant that the York research is robust. “All of the systematic reviews underwent expert, independent peer review, and each was revised accordingly. We were, and remain, entirely confident as to their veracity. Counter to claims to the contrary, rigorous methods were adhered to at every step,” Brown told The BMJ.
Brown continued, “Criticisms of the methodology hold no water. The single search strategy used by the York group is far more yielding than the scattergun approach advocated by those still struggling to come to terms with the findings.”
WhatamIdoing's proposed edit says:
The editor-in-chief of the Archives of Disease in Childhood has said that they stand by the quality of the review articles they published"
This is a remarkably insipid summary of what is a robust and insulting response by Brown. I wonder if editors here would be so keen to insipidly summarise the BMA Council or WPATH to being merely "critical" rather than quoting many sentences of profoundly dubious and clearly angrily hostile material. For example, to neuter PATHA's comments about "harmful recommendations" to merely noting they disagreed a bit. And I could pick plenty other examples.
Part of the point of quoting sides in this issue is to give readers a flavour of the intensity of opinion and the hostility each side has towards the other. When we summarise this as A agrees and B disagrees level of blandness, the reader would wonder what the fuss is. Nick Brown doesn't merely stand by the "quality..of the review articles" which could be read as a vague generalisation about articles that do contain flaws but are mostly good enough. He "entirely" dismisses the criticisms as "hold no water" and is extremely rude towards his critics, calling them "those still struggling to come to terms with the findings". I can quite understand why some editors don't like those opinions on this page, but they belong on this page as much as WPATH's unprofessional remarks about Cass's qualification for the job, or numerous other factually dubious comments. Without these, there's no flavour. It would be like watching a war movie where there were no bangs and no blood and nobody died. "Germany went to war and after a few years it lost" is not a summary of WW II.
Please consider that even if you don't agree with Brown, what he forcefully and rudely said about the critics of his journal's papers is part of the story we should tell. If you think the Cass Review and its underlying systematic reviews will ultimately be judged poorly by history, then Brown's stubborn and hostile comments look more damning on him than a bland remark that he stood by their general quality. -- Colin°Talk 18:36, 23 August 2024 (UTC)[reply]
I'm not sure that reproducing the emotional content of any of the sources is a good idea. Maybe it's true that one side is insulting the other; maybe it's true that the other side sounds panicky. I'd still be inclined to consider an article that sounds like "They had some concerns" and "He dismissed their accusations as scientifically unfounded" than one that sounds like "The trans activists are behaving like a dying cancer patient who demands more ineffective chemo because 'even if it doesn't actually work, it gives me hope that it might', and the researchers are standing outside the oncology ward yelling 'Give me science or give me death, and you're just being emotional!'"
Even if the researchers are rationally correct, and I suspect that they are, it's still not the way to help people understand anything.
If you want this in soundbite form, I'd say this: The internet outrage machine does not need Wikipedia to contribute to it.
Also, this article will be much easier to write five years from now. WhatamIdoing (talk) 19:43, 23 August 2024 (UTC)[reply]
Have you not been listening at all? The whole point of my objection is that it doesn't matter one bit what Nick Brown the individual says one way or the other. All that's important is what the journal he's editor-in-chief for says, and he made one relatively short statement as the head of that journal, so we should only include that statement.
For what it's worth, if we do include that statement I'd prefer to phrase it as The Archives of Disease in Childhood has said that they stand by the quality of the review articles they published, and not include mention of the editor-in-chief at all. Loki (talk) 03:49, 24 August 2024 (UTC)[reply]
Your internet outrage comment is a fair one, but we control that with various success that by putting a threshold on what we consider reliable sources. So we don't sink to the level of blogs or twitter or activist magazines. The text I quoted above appear in the British Medical Journal, Whatamidoing, not some angry doctor Redit feed. When reliable sources report that these criticisms are robustly defended, it is entirely wrong of us to summarise that as though they were weakly defended. Particularly so when we have paragraphs and paragraphs of robust quotes critical of those reviews. Whatamidoing, would you look at the other parties that we quote extensively, and consider whether we are repeating "emotional content" vs solid factual statements that will stand the test of time. The WPATH "is rooted in the false premise that non-medical alternatives to care will result in less adolescent distress" and commenting on Cass's "negligible prior knowledge or clinical experience" are just a longer way of saying Cass is prejudiced and ignorant, which seems no different to Brown's claim that his critics are slow to accept disappointing scientific findings.
Loki, the source identified the comments as from Nick Brown, editor of the journal. We don't report journals has having positions (or having discovered or found something). And your suggestion is so vague it appears to apply to any review it has ever published.
We are required to summarise our best sources, not to water them down because we wish all parties were kinder and less passionate. Could folk have another go at actually summarising our source, which I have included above (and is available on the Wikipedia library should it be paywalled), rather than writing some neutered text that is essentially meaningless ("High quality journal says it published high quality reviews"). -- Colin°Talk 10:03, 24 August 2024 (UTC)[reply]
Glancing through the Cass Review#Reception section, I would say that a large majority of direct quotation in that section is unnecessary and/or inappropriate, beginning with the second paragraph. WhatamIdoing (talk) 05:30, 29 August 2024 (UTC)[reply]

Refreshing the Puberty Blocker page - inviting all editors to help there too

[edit]

Many editors here of all views have done a good job of summarising and making readable the evidenced findings of the Cass review.

If any of you wish to also give time to refresh the Puberty Blocker page - I have listed there a list of places where that page contradicts this one. Peckedagain (talk) 21:57, 19 August 2024 (UTC)[reply]

The list of Recommendations is very very long, and lacks meaningful groupings

[edit]

Which makes it hard to for the reader. (see the left side of the image) so I made an edit, to group things into related groupings: -see the right hand side of the image.

I edited the page in [edit]: which was reverted by an editor who wanted to revert something else I had done, but regard changing the list they said my edit was:

  • doing something that I can only describe as a "reverse copyedit". Also broken english"

I've checked wiki, and am not sure why the change was not a good 'copy-edit': but my 2nd attempt was also reverted, with the editor saying'

  • "It was reverted before by the other user because it appears to be "reverse copyediting" which this still is, many of those new sentences are hard or unreadable "prescription of this" is not easier than "prescription of hormone therapy"

I have read the change again -and only 2 sentences had the words change, both to bring the key words in the sentence to the left side. eg

  • FROM:
  • There should be a clear clinical rationale for the prescription of hormone therapy below the age of 18, and absolutely no hormone therapy below the age of 16.[64]
  • TO:
  • Hormone therapy: There should be a clear clinical rationale for the prescription of this below the age of 18, and absolutely none below the age of 16

The rational for that change, is it makes it easier for the reader to scan down the list: with the' most important words are brought to the left: acting almost like a table of contents. which is easier than having to scan deep sentences before finding out what it is about.

It is something I often do in documents at work - the higher the number of people who will read a document, the more people-hours are saved by making the document easy to digest: is the understanding.

But maybe there is some underlying wiki principle that I am un-intentionally breaking?

So I'd be grateful if other editors can suggest how the list can be made more readible, within the wiki rules. Maybe it is just my personal preference, but that un-structured list grates on me. :)Peckedagain (talk) 20:32, 20 August 2024 (UTC)[reply]

Why not both? Consider:
Hormone therapy: There should be a clear clinical rationale for the prescription of hormone therapy below the age of 18, and absolutely none below the age of 16. WhatamIdoing (talk) 20:01, 23 August 2024 (UTC)[reply]
I think that your idea of grouping them in some sensible way would be more helpful than re-writing. Perhaps these three categories would cover most of it?
  • NHS structure (regional network, national multi-disciplinary team, increase the available workforce, training, etc.)
  • Research (data linkage, central evidence and data resource, continual data collection, unified research strategy, etc.)
  • Care provision (treat anxiety and depression, designated medical practitioner, see kids sooner, pathway for pre-pubertal treatment, hormone therapy, fertility counseling, detransitioning services, etc.)
WhatamIdoing (talk) 20:08, 23 August 2024 (UTC)[reply]
I think some grouping would be good. And then individual recommendations could be slowly copyedited if they can be improved. Some recommendations are likely more important than others. Could the section/chapter heading be used to group or prefix a recommendation? That might still work inside WAID's three levels.
Thinking long term, all the noise about criticisms and acceptance will eventually be condensed, even though it appears to matter now. This is an "Independent Review of Gender Identity Services for Children and Young People" for NHS England that has been enthusiastically accepted by those that matter wrt what NHS England does (though whether money follows words and whether they can hire staff in this toxic field is something else). In future, people will be writing about which of these recommendations were implemented and which did not and why. -- Colin°Talk 10:24, 24 August 2024 (UTC)[reply]
Do note that this user is now tbanned from gensex and cannot reply here. Flounder fillet (talk) 11:43, 24 August 2024 (UTC)[reply]
I've had a go at rearranging the long list into three groups. I tried to keep the order of items the same, but that might not be the best in the end. Please feel free to adjust and otherwise improve that section. WhatamIdoing (talk) 05:36, 29 August 2024 (UTC)[reply]

BMA (percentage)

[edit]

@Raladic I don't know if others will agree, but IMO I don't think combining different parts of the source to calculate a percentage like this when the source doesn't straightforwardly put the numbers together like that is quite simple enough for WP:CALC but I could be wrong! All the examples for percentages in WP:AVRC are trivial, this doesn't look exactly the same. It states The numerical data from the source is copied directly with an added conversion near to it. and the example is "were 120 of 200", but that isn't how it is formatted in this source.

I also think it overcomplicates a section where fewer numbers would be better, as this is the third time the numbers have changed in reported sources I believe (indeed, I already took one out with my edit as it kept rising, but was vague and didn't add much). I'd also add that based on this source we can fairly describe the original BMA Council motion as having been passed by a group comprising 0.035% of members. I don't think this is a road anyone wants to go down.

Rather than edit warring, maybe take it to talk. Void if removed (talk) 16:41, 27 August 2024 (UTC)[reply]

agree it is WP:OR to state the percentage until there is a source stating the relative percentages.
Though, the small percentage does seem to lead to question if the survey is WP:UNDUE on this article. Bluethricecreamman (talk) 16:45, 27 August 2024 (UTC)[reply]
IMO the inclusion of the BMA Council's original statement and the subsequent widespread coverage of this response is what determines WP:DUE. Void if removed (talk) 16:50, 27 August 2024 (UTC)[reply]
The simply calculation is important and allowed per WP:CALC/WP:AVRC and is absolutely not OR as CALC says - Routine calculations do not count as original research and the cited source itself lists the 195,000 member count. Most people don't typically do partial fraction calculations to less than a percent in their head, which is why it was relevant to add the 0.5% calculation here.
And the inclusion of the membership number and the showing that it is such a miniscule amount of members who have shown opposition is important exactly as that, as otherwise the "over xxxx" appears to be a WP:SCAREQUOTE to appear like there's a massive opposition, when it's really very-very small. So either the numbers are properly contextualized as I have now, or the whole paragraph may actually be WP:UNDUE entirely as Bluethricecreamman pointed out since it look like there really isn't much opposition to it. Raladic (talk) 16:49, 27 August 2024 (UTC)[reply]
If the purpose of the calculation is to undermine the statement by making the number look smaller, then it’s OR unless the sources also engage in that type of undermining.
The DUEness/UNDUEness of a viewpoint is by weight of source coverage, not by number of participants in the viewpoint. Barnards.tar.gz (talk) 17:22, 27 August 2024 (UTC)[reply]
There is no viewpoint in objective neutral reporting of the facts as stated in the source.
In August 2024, over 1400 doctors; 900 (0.5%) of which were members of the 195,000 that the BMA represents.. is a simple summary of the numbers from the article, nothing more, nothing less. Raladic (talk) 17:44, 27 August 2024 (UTC)[reply]
Could we do, In August 2024, over 1400 doctors of the 195,000 that the BMA represents...? Bluethricecreamman (talk) 17:50, 27 August 2024 (UTC)[reply]
No, because as the article points out, only 900 of the 1400 are BMA members, so we would have to say In August 2024, 900 doctors of the 195,000 that the BMA represents.. and that's again, why I used our WP:CALC policy as most readers don't do fractional percentage calculations in their head and added the (0.5%) there, as permitted by policy. Raladic (talk) 18:00, 27 August 2024 (UTC)[reply]
It is not. If the source said "900 of which were members of the 195000" you could possibly argue adding the percentage is a trivial calculation, maybe. But that's not the case, it's combining numbers from non adjacent paragraphs to make a point about relative size the source explicitly doesn't. In fact the source brings up the mental numbers in reference to the size of the BMA Council, ie that the original statement was made by a small group in private without polling the membership. Void if removed (talk) 17:53, 27 August 2024 (UTC)[reply]
And most governments of the world have elected council/house/senate leaders that make decision on behalf of their members that elected them to represent them, so your point being? Raladic (talk) 18:02, 27 August 2024 (UTC)[reply]
The BMA is a Union, and ordinarily members vote on policy at the ARM. Void if removed (talk) 18:10, 27 August 2024 (UTC)[reply]
Actually the article itself points out that the council is the policy forming elected body of representatives of all Union members - The union’s council, an elected policy-forming body of 69 members, was asked to vote on a motion .... The motion passed, making it formal BMA policy..
So, this seems quite normal order of business. Raladic (talk) 18:26, 27 August 2024 (UTC)[reply]
The viewpoint is “this is a really very-very small number”, as you stated. To understand whether this is truly a very small number we would have to know how many people typically sign similar complaint/protest letters. Maybe 0.5% is actually really high compared to the response that BMA motions normally get. The source doesn’t say, so we can’t say it or imply it. Barnards.tar.gz (talk) 18:08, 27 August 2024 (UTC)[reply]
Which is why there is no mention of "very small" or any such words with implications in the text (as that could be a point of view). Just simply the full statement of the facts of the numbers from the article, with one WP:CALC added to simplify the summary for the readers of this article, as outlined by our policies. Raladic (talk) 18:30, 27 August 2024 (UTC)[reply]
What you said was And the inclusion of the membership number and the showing that it is such a miniscule amount of members who have shown opposition is important exactly as that, as otherwise the "over xxxx" appears to be a WP:SCAREQUOTE to appear like there's a massive opposition, when it's really very-very small. so your reasoning is not a simplification but an WP:OR "contextualisation" that isn't given in the source in that way at all (and which, as Barnards rightly points out, is incomplete and misleading because without the information about how many usually respond like this in this sort of situation, you have absolutely no idea if this is a large or small percentage).
What you've done is add multiple, more confusing, duplicative numbers, and made this section harder to read, in a way that isn't in line with WP:CALC, is potentially misleading, and right now there are multiple editors disagreeing with you, yet you've persisted with this change and further changes, rather than follow WP:BRD. Void if removed (talk) 09:05, 28 August 2024 (UTC)[reply]
No, you yourself probably accidentally omitted the 900 doctors that are BMA members when you added the new source and changed the number itself. I added the 900 as the source article said so in the very sentence from the source: More than 1,400 doctors, 900 of whom are BMA members,... and so because the article itself added the important note that only some are members to fix your omission and also added the actual member number from the very article you added and added a simple WP:CALC, since the article mentioned the members specifically, so the adding of the member numbers was relevant and sourced from the very same article that introduced them for that same purpose.
Fixing your omission is what I did with the contextualization, that is not OR. It is a simple stating of the facts of the article and helps us accurately summarize here for the reader.
Also your strange accusation that I've made "further changes" that just help summarize the new article ref you added is unfounded, I don't think you'll find anyone disagreeing that adding what the ref said - The union’s council, an elected policy-forming body of 69 members, was asked to vote on a motion...the BMA’s membership base of 195,000 doctors... that the council members are elected to create policy for the BMA to represent them is in any way not useful to the reader for the purpose of WP:SUMMARIZE in the article here.
And as you know yourself, commentary of WP:OR does not apply to talk pages - This policy does not apply to talk pages, so the fact that I mentioned that the number is small in words here on the talk page is irrelevant for the policy, I did not mention any such thing in the article to maintain perfectly neutral of any such point of views and just simply summarized what the article said, including fixing your accidental omission of the member numbers. Raladic (talk) 14:52, 28 August 2024 (UTC)[reply]
When you said showing that it is such a miniscule amount of members, presumably you intended some part of your edit to show that? And whether you intended it or not, displaying a small number like 0.5% has the actual effect of downplaying the preceding number, which is not something that the source does. Barnards.tar.gz (talk) 16:05, 28 August 2024 (UTC)[reply]
And as outlined by WP:CALC, a routine calculation like this is perfectly ordinary and allowed and is not OR per our policy, so I don't know how else to say it for you to stop calling it OR. Raladic (talk) 16:40, 28 August 2024 (UTC)[reply]
The percentage is WP:OR, because you've gone beyond the allowable simplicity of WP:CALC and created a novel contextualisation of the information expressly for the purpose of making the scale of the open letter response seem comparatively small even though that is a) not how the source presents it and b) incomplete because you haven't properly contextualised it against the percentage of typical scale of such responses, creating a wholly misleading impression, which is why editors should not do this sort of thing off their own back.
To accuse other editors of WP:IDHT at this point is interesting. Void if removed (talk) 16:58, 28 August 2024 (UTC)[reply]
The very first sentence of the policy section that CALC links to says …provided there is consensus among editors that the results of the calculations are correct, and a meaningful reflection of the sources.. This conversation is about whether the calculation is a meaningful reflection of the sources, and I don’t think there is consensus that it is. Barnards.tar.gz (talk) 17:03, 28 August 2024 (UTC)[reply]
If you disagree that 900 divided by 195,000 is not 0.5%, then that would not be consensus, note that the next sentence of CALC says Mathematical literacy may be necessary to follow a "routine" calculation.
Of course we could keep it precise at 0.461%, but I took the liberty to round it up to 0.5%.
As to the meaningful reflection of the source, yes of course it is a reflection of the source, the source has the 900 members that signed the letter and the total membercount of 195,000. Raladic (talk) 17:14, 28 August 2024 (UTC)[reply]
I do think it is and I don't think that section means what you think it means. The agreement that needs to be had is that 900 is 0.5% of 195000 (it is) and that 900 and 195000 are sourcable numbers that can be meaningfully divided by each other (they are). That clause is intended to prevent stuff like adding statistics gathered by different methods, not simple math on simple numbers.
Per WP:CALC, 0.5% is just another phrasing of 900/195000. The policy I think you're looking for is WP:DUE. Loki (talk) 17:15, 28 August 2024 (UTC)[reply]
Can you point to the line in the source that says something like "900 of 195000" Which would make this sort of thing appropriate? Because by my reading, that's when routine calculations are appropriate, but combining different parts of the same source to state a conclusion that the source itself doesn't is SYNTH. Void if removed (talk) 17:39, 28 August 2024 (UTC)[reply]
WP:CALC is explicitly an exception to the overall WP:OR policy, which WP:SYNTH is part of. So, no: doing math with two numbers in the same source is not WP:SYNTH as long as the calculation is reasonable, even if the source did not explicitly make the calculation itself. Loki (talk) 04:43, 29 August 2024 (UTC)[reply]
The test for WP:CALC is not that it is possible to do some basic math with numbers that happen to be in the source. CALC says obvious, correct, and meaningful reflection of the sources. Raladic has stated in this thread that the clear intent is to demonstrate this particular percentage is miniscule. That's not a neutral, obvious CALC, that's combining different aspects of the source in a novel way to advance a specific POV, completely inverting the tenor of the source itself which strongly implies the opposite (ie, the BMA council's actions are unrepresentative of the membership, and the dissent in response is significant). Why can't we do what you're suggesting with many of the other numbers here? Do you think we really should say that the BMA council is 0.035% of members, which I offered as an absurd argument above? After all, at least in that case the numbers are in the same paragraph, rather than opposite ends of the source. Should we say that 2% of signatories are "former or current presidents of medical royal colleges"? That 1.4% of the BMA council described the motion as "a waste of time and resources"? That Emma Runswick who backed the motion is 0.0005% of the membership and that some members had resigned after she had served for 4% of their membership duration?
This is an enormous waste of time. Void if removed (talk) 11:13, 29 August 2024 (UTC)[reply]
I mean, no, 1400 out of nearly 200k isn’t significant dissent, flat out, and it is a tiny percentage, and if the goal of the source is to try and make it seem significant then that only seems like more reason for the sake of npov to clarify the percentage. Snokalok (talk) 11:43, 29 August 2024 (UTC)[reply]
if the goal of the source is to try and make it seem significant then that only seems like more reason
And this is where it is veering into WP:OR and not straightforward WP:CALC, because this is an additional analysis not clearly made by the source, with the intention to reframe the material in the source to advance a different POV than that in the source, which is instead based on your own personal and unsubstantiated opinion that this is insignificant. Void if removed (talk) 12:11, 29 August 2024 (UTC)[reply]
Seems like a pretty straightforward CALC inclusion that gives better understand for readers of what the information represents. Some editors here seem against such proper neutral representation of what the numbers represent. I wonder why. SilverserenC 17:22, 28 August 2024 (UTC)[reply]
The reasons why are laid out extensively above. Barbs like “I wonder why” are not helpful. Barnards.tar.gz (talk) 20:34, 28 August 2024 (UTC)[reply]
I’m in favor of stating the percentage. This is elementary school math Snokalok (talk) 19:29, 28 August 2024 (UTC)[reply]
The mathematics of it is not in dispute. Barnards.tar.gz (talk) 20:34, 28 August 2024 (UTC)[reply]
Right, so then you surely agree it falls under CALC, since it’s simple enough math as to remain obvious Snokalok (talk) 10:48, 29 August 2024 (UTC)[reply]
I'm indifferent about whether to include the percentage, but it would be permissible as per WP:CALC. Anywikiuser (talk) 20:31, 28 August 2024 (UTC)[reply]
WP:CALC says obvious, correct, and meaningful reflection of the sources
These two numbers are 8 paragraphs apart in the source and not presented this way at all. This is not an obvious or meaningful reflection of the source. If the source had not happened to mention in passing the size of the BMA in a completely different context earlier in the piece, this conversation would not be happening.
And WP:SYNTH says do not combine different parts of one source to state or imply a conclusion not explicitly stated by the source.
The source does not explicitly compare these numbers, at all, and I think 8 paragraphs separation counts as different parts of one source. Void if removed (talk) 21:39, 28 August 2024 (UTC)[reply]
Both these compare and contrast exercises read like editorializing to me. The membership numbers of the BMA is listed on the other side of a wikilink. I'd rather we didn't do this. Draken Bowser (talk) 21:45, 28 August 2024 (UTC)[reply]
Emphasis on the ...to state or imply a conclusion not explicitly stated by the source. - there is no conclusion whatsoever in stating the membership numbers, they are simple fact from the source to help summarize. Raladic (talk) 21:48, 28 August 2024 (UTC)[reply]
It's not a CALC violation, but it sure smells like POV pushing.
To give an example closer to home, elections for the board of directors of the Wikimedia Foundation are coming up. We expect a couple thousand editors to vote. Let's say that if things go like they have the last couple of times, we would expect 2,000 editors to vote.
Now let's imagine that we are unhappy about the election results, and that 2,500 editors voted. Do we say:
  • only 2,500 (2.5%) of the 100,000 eligible editors voted?
  • only 2,500 (0.25%) of the 1,000,000 registered editors who contributed during the last year voted?
  • only 2,500 (0.01%) of the 30 million ever-contributed editors voted?
  • more editors voted than usual?
All of these are true, but they advance different narratives, and the choice of which (if any) numbers to include reveals the POV of the person making the choice.
What we know about the BMA situation appears to be:
  • A few dozen committee members voted to do something.
  • A thousand non-committee members publicly disagreed.
  • Twenty times as many members said nothing in public.
What I don't know is:
  • What's typical? Is this a big number or a small number for them? Have there ever been any similar petitions circulated?
Wikipedia will look biased if we say "Only 0.5% of current members signed this" and the facts turn out to be (I am making up this example) "This is the first public petition against a council decision ever, more members signed this petition than voted in the last election of the council, and shortly after the council reversed their decision, the petition writers banded together to promote a vociferously pro-science slate during the council's next election cycle." WhatamIdoing (talk) 06:07, 29 August 2024 (UTC)[reply]
Perhaps I'm being pedantic, "obvious, correct and meaningful reflection of the sources" is my issue here and why I think it goes beyond CALC into SYNTH.
The source says in paragraph 6:
The union’s council, an elected policy-forming body of 69 members, was asked to vote on a motion rejecting the Cass review at a meeting described by critics as “secretive and opaque”. The motion passed, making it formal BMA policy, although the breakdown of votes has not been made available and the BMA’s membership base of 195,000 doctors was not consulted.
The clear comparison here is between the size of the council, and the size of the membership. The inference is that this is a decision by a tiny minority, taken without consulting the huge majority (which, despite Raladic's claims, is unusual as the BMA sets policy democratically at the annual meeting, with the council only rarely setting policy in between annual meetings, and largely being responsible for steering and implementing the policy decided by the members). The acrimony over this action continues in further coverage today in The Guardian, but I digress.
The source then says, 8 paragraphs later, in paragraph 14:
More than 1,400 doctors, 900 of whom are BMA members, have signed an open letter calling for the BMA to drop its opposition to Cass.
I think it is improper to pull the number from earlier, and use it later in a different context, even if it is correct, as it is neither obvious to do so nor a meaningful reflection of the way the information is presented in the sources. And I think that if it is legitimate to do it for this number, it is arguably more legitimate to do it for the size of the council, where this size comparison is actually made more directly - but of course that would be absurd, and this whole thing is needless clutter. The comments in talk clearly reveal the intention is to make the response look miniscule, and that is not a reflection of this source at all, or any other covering this controversy. Maybe I'm reading WP:CALC too narrowly, but I don't think this is at all in the spirit of that policy.
As for correctness, as a further aside, despite the Times saying in passing it has a membership of 195,000 doctors, 20,000 are actually medical students, which is why we shouldn't take such passing numbers added as colour in news reporting as gospel to focmulate our own novel statistics. If 900 BMA doctors have signed an open letter, what's the proper comparison? The BMA membership, or the BMA membership who are doctors? This is all a completely needless can of POV worms and exactly why WP:CALC is limited in scope, not just free rein for any old calculation that you can happen to construct from numbers in a single source, and I'm exhausted by the amount of time spent defending something so trivial and WP:UNDUE that should have been discussed per BRD after it was removed, not reverted back in. Void if removed (talk) 09:09, 29 August 2024 (UTC)[reply]
I think it'd be clear to most readers and uninvolved editors that noting the fraction and percentage is making an implied claim—that the petition signers constitute a small portion of the BMA membershiup. At least one participant here has made it clear that assertion of such a claim was intentional. I think the opposers of this content have it right. If the source were making the claim, or linking those numbers, we could calculate the percentage. Since the source does not, we should not present the numbers next to each other, let alone calculate a percentage.
One useful test for assessing whether an inappropriate SYNTH claim is being made is to consider whether the two parts of an implied claim could instead be separated. In this case, we already mention the overall membership of the BMA in the first paragraph of §British Medical Association. If we remove the later mention of 195k and the percentage, will all participants be content that all the relevant knowledge has been shared? If not, it's a sign that there is a claim you're trying to make, and it is (at least according to the sources presented so far) not one made explicitly by the sources. Firefangledfeathers (talk / contribs) 12:44, 29 August 2024 (UTC)[reply]
Snokalok, even including the total BMA membership (sans percentage) alongside the 900 is making an implied claim. Do any sources connect the two figures? Why should we? Firefangledfeathers (talk / contribs) 18:42, 30 August 2024 (UTC)[reply]
I agree with FFF. I add that it's not just a claim that it's a small percentage; it's an implied claim that the small percentage is meaningful.
For example, if you run an ordinary survey, and the sample size is small, you should call out the smallness as a reason why your survey results could be inaccurate. But in this case, we don't have sources (that I've seen) suggesting that a vote of the full membership would produce a different response. There is no reason, either in the sources or according to common sense, to believe that this is unrepresentative. In fact, as painful as it may be to consider, given the way transphobia is baked into society, including medicine, any suggestion that most healthcare providers understand the Cass Review and support the "pro-trans" criticisms against it would likely fall under the rule that Wikipedia:Extraordinary claims require extraordinary evidence. The default assumption should be that most physicians don't pay attention to anything outside their own specialty. WhatamIdoing (talk) 18:45, 30 August 2024 (UTC)[reply]
Per my original edit here (which was solely to update the numbers on existing consensus wording) it didn't even reference the size of the BMA or how many BMA members had signed. As others said above, the BMA membership is one click away, there's no point in it here and it will be swiftly outdated. I favour reverting to this earlier wording with fewer numbers. Void if removed (talk) 20:54, 30 August 2024 (UTC)[reply]
I mean, the Times source does say both the 900 and the 195k number, so, it’s not as though it’s synth or anything, it’s just repeating material from the same source. Snokalok (talk) 05:01, 31 August 2024 (UTC)[reply]
I’d also like to add that on its own, 1400 doctors protesting makes it sound to the lay reader like the entire UK medical community is in an uproar, which is misleading. Adding the BMA membership number puts the actual scale of the protest in accurate perspective. Snokalok (talk) 06:03, 31 August 2024 (UTC)[reply]
The actual scale could be unprecedentedly large, if BMA members don’t normally write protest letters about the actions of their own union. But sources don’t engage in this analysis, so neither should our article. Barnards.tar.gz (talk) 08:32, 31 August 2024 (UTC)[reply]
Presenting information from different parts of the same source in a way the source doesn't is WP:SYNTH.
do not combine different parts of one source to state or imply a conclusion not explicitly stated by the source. Void if removed (talk) 09:03, 31 August 2024 (UTC)[reply]
Again, WP:CALC is a specific exception to the entire WP:OR policy including WP:SYNTH. Loki (talk) 20:16, 31 August 2024 (UTC)[reply]
True, but CALC requires that the result be a "meaningful reflection of the sources", which is specifically disputed in this instance. WhatamIdoing (talk) 01:17, 1 September 2024 (UTC)[reply]
Exactly my point - CALC is not carte blanche to combine any numbers in any source to produce a percentage to make a specific point not made in the source (which does seem to have been the intent, based on comments here). If it isn't a meaningful reflection of the source, then (no matter how simple and arithmetically correct the calculation) it is SYNTH. Void if removed (talk) 09:20, 1 September 2024 (UTC)[reply]
But... it is though. One common use of WP:CALC is dividing population by area to make population density. Now, population density can be used to make comparisons and rhetorical points that neither population nor area can be used to make on their own... but it's still fine and not WP:SYNTH as long as both those numbers are sourcable.
This thread to me is, IMO, a bunch of people trying to make WP:CALC say stuff it doesn't say to avoid the obvious implication that this percentage is sourced. Loki (talk) 23:15, 1 September 2024 (UTC)[reply]
The article currently says "900 of which are members of the BMA’s 195,000", which needs some help. That makes it sound like there's a program at the BMA called "the 195,000", and not all BMA members are part of it. WhatamIdoing (talk) 23:12, 30 August 2024 (UTC)[reply]
I agree with WhatamIdoing and Firefangledfeathers that this "sure smells like POV pushing". Juxtaposing membership size or calculating percentages in an attempt at downplaying the importance or relevance of the complaint, in direct contradiction of the point made by our sources, is POV pushing. Seriously, why so much arguing about something high quality sources don't mention? Our reliable sources note this is a significant complaint both in size and also that many presidents of royal colleges have contributed. We absolutely cannot push numbers to give the opposite POV. What next? Add that the BMA membership is only 0.003% of the UK population so, you know, why should anyone care what they think? -- Colin°Talk 17:58, 3 September 2024 (UTC)[reply]
So, there's really two questions here - first is whether it complies with OR/CALC to take a count of some of X that meet Y criteria from one source (or one part of one source) and calculate the percentage of X that count is based on another source/part of the source. I don't think anyone is questioning that is permissible in the vast majority of cases. The other question is whether the calculation being performed is actually warranted to be performed in the first place, and if so, whether the information is due for the article at all. Quite frankly, it's not. The source does not state a percentage or compare the number of doctors signing the letter precicely because that is an attempt to push the POV that their views should be diminished. The notable thing being reported on is that 1200 doctors signed the open letter. In other words, they are two distinct portions of the reporting. The source is not reporting the number in the background information to compare the later number to the total membership - it's reporting it as background information. The sentence should thus be reduced to state only the total number (over 1200) and can break that down into 900 of which are members of the BMA. But to include the total number of BMA members there is an inappropriate SYNTH violation. Even if sourcing was found that attempted to minimize the impact of this open letter by directly comparing the number of member-signatories to total membership... that would still be inappropriate here as it would be editorializing.
To see how inappropriate this is, just rewrite it to read instead: An open letter was signed by 1200 doctors, 900 of whom were members of the BMA, but that is only 0.5% of their total membership or the same but the total membership has 195,000 members total. Those two sentences would be blatantly inappropriate attempts to impart a POV on the fact being reported. It is no different just because most of the words have been cut out or it's worded differently. The information about the open letter cannot, per NPOV, be presented in a way to lead the reader to the conclusion that it's irrelevant/a "small" portion of the population. The reader themselves may very well make that conclusion after looking into how many BMA members there are. But the reader may also understand that there are a plethora of reasons someone chose not to sign the letter (not aware of it, didn't want the publicity, disagreement of wording but agreement with principle, etc). -bɜ:ʳkənhɪmez | me | talk to me! 11:22, 4 September 2024 (UTC)[reply]
Note: I've gone through and affected a plethora of MOS:LISTGAP issues by removing whitespace in between comments and changing bullets to colons as that is what the start of this discussion was using. This is an accessibility issue for screen readers and also causes issues with reply tools when people reply to a comment and it uses a mixture of * and : characters. The indentation character changes here consisted solely of swapping initial *s to :s, keeping the same indent level as the comment had before. -bɜ:ʳkənhɪmez | me | talk to me! 11:22, 4 September 2024 (UTC)[reply]

I have restored the text per Raladic's edit here which had edit summary Per FFF on talk, I don't think this is making it easier for the reader per WP:FALSEBALANCE, but since we now have the membership number a few paragraphs above, as cited from the ref, the reader can do the math themself. It seems that would be a suitable compromise. I should warn that if editors continue to juxtapose the letter-writers size with the membership size, which no source does and which has the obvious POV of suggesting to the reader a small unrepresentative number, in direct contradiction to all reliable sources, I shall likely take this to ANI. Several editors have now warned this appears to be POV pushing, so I think that's fair enough warning that this should stop.

We currently juxtapose the 69 council members with the 195,000 BMA members. Our source does this too, in a paragraph suggesting the vote may be unrepresentative as the members were not asked. While this is a sourcable comparison, The Times is a biased source, so one could argue that this comparison is still not neutral or fair. After all, many bodies have elected councils of size that is infinitesimal compared to the main body (think ministers of government vs population, or board of a large corporation or charity). I would not be opposed to moving this 195,000 figure to a more neutral position. How about at the end of "which is both a trade union and professional body representing 195,000 members".

As aside, the council is voted for a 4-year term, and the current council members were voted for by just 11,312 members, which is 7.1% of the 159,632 eligible voters. In comparison, the last UK General Election had 60% turnout. One can offer up no end of comparisons of sizes, if one wants to make a point. But the point has to be sourcable and overall we are required to be neutral. -- Colin°Talk 16:47, 5 September 2024 (UTC)[reply]

I like that change. I would also be fine with removing the 69 and not mentioning the 195,000 anywhere. None of the numbers are surprising or interesting. Firefangledfeathers (talk / contribs) 17:20, 5 September 2024 (UTC)[reply]
Agree on both numbers.
@Firefangledfeathers, wrt this edit. A problem with moving the RCPCH text is that although you wrote "their statement does not mention the BMA and shouldn't be in that section" they really were responding to the BMA "calling for a pause in implementation of the new Gender Identity Services until further reviews [theirs] have taken place". The consequence of having the BMA response (and the ongoing response to that) in its own sub-section is it now appears after the RCPCH text and so readers at this point are unaware of anyone calling for a "pause" and planning their own "further reviews". Their announcement cannot possibly be referring to any other call to pause or further reviews, as there aren't any bodies making such in the UK. I appreciate they don't name them, presumably out of some gentlemanly weirdness about not dissing your colleagues by name. What to do?
If nobody seriously contests that the RCPCH (5th August) were responding to the BMA (31st July) then I think it may be chronologically and meaningfully more sensible to the reader to move the text back, as one of the many responses to the BMA. If you'd rather not, then another option is to move the BMA section up one, between the NHS England and other UK bodies sections. -- Colin°Talk 18:40, 5 September 2024 (UTC)[reply]
Their statement doesn't mention that the calls came from "bodies" in the UK specifically, and at that point there were indeed many such calls. They also refer to "academic criticism". I don't think the reader needs to know the specifics of the calls for a pause. I have no real opinion on moving up the BMA section. Firefangledfeathers (talk / contribs) 18:48, 5 September 2024 (UTC)[reply]
I don't agree there were "many such calls". There were other non-UK bodies who disagreed, but they did so fundamentally, not with the "pause" language. Nor has any other body suggested a pause until further review, as those non-UK bodies simply reject it. Clearly if there isn't an editor consensus that the RCPCH were responding to BMA alone, and we can't find sources linking them, then it is difficult to do here. I thought it was as obvious as someone saying "I climbed the highest mountain on earth" and us writing "They climbed Everest" but this sort of thing needs agreement. Let's then move the section, because otherwise I do think our readers will be confused about what on earth the RCPCH are referring to. -- Colin°Talk 20:19, 5 September 2024 (UTC)[reply]

Rephrasing BMA's initial paragraph

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I rephrased the BMA's initial paragraph as follows (main changes underlined), trying to keep things as simple as possible:

"On 31 July 2024, the British Medical Association, representing the greater part of the UK’s medical practitioners, published a statement [NOTE] calling for a pause on the Cass Review's implementation while it conducted an evaluation, to be completed by January 2025. In anticipation of this, a motion was passed by the BMA's council to publicly critique the Cass Review, lobby the Government and the National Health Service for unhampered trans healthcare, and condemn what it called "political transphobia." Criticism was also levelled against the Review's allegedly "unsubstantiated recommendations driven by unexplained study protocol deviations, ambiguous eligibility criteria [viz. for inclusion in clinical studies], and exclusion of trans-affirming evidence".

No numerology here. Instead, I took the trouble to inspect the connection between text and sources referred to in the notes, and removed notes not clearly supporting the text. I could not trace the statement in the published version, "arguing that is was not a decision for politicians to make", back to the sources to which the two adjacent notes refer, and therefore removed it. Instead, I added two important points in the BMA council's motion. Would anybody care to comment? Retal (talk) 20:38, 31 August 2024 (UTC)[reply]

representing the greater part of the UK’s medical practitioners
This is IMO leading wording, as it carries the implication that the BMA's statement was representing the greater part of the UK's medical establishment. It is also needless, as - again - anyone can click the link to the BMA page and we have no need to repeat this information here.
to be completed by January 2025
I'd leave this out, because the aspirations of the BMA council are something we shouldn't have to keep updating here if it slips.
In anticipation of this, a motion was passed by the BMA's council to publicly critique the Cass Review
This divorces the statement from the motion (indeed, reversing causality almost with this wording), when the two are the same. This is all needlessly convoluted and the prior wording lays it out quite straightforwardly.
lobby the Government and the National Health Service for unhampered trans healthcare, and condemn what it called "political transphobia."
This is a page about the Cass Review, not the BMA's motion, we don't need every single detail.
[viz. for inclusion in clinical studies],
I see no reason for this inline explanation.
The wording before editors started adding percentages was pretty much fine IMO and I don't see the need for this when frankly the continued story is about the hostile response to the BMA council's statement and how they seem to have gone well outside their remit in this matter.
Responsibility for making BMA policy lies with the union’s representative body — a group of 560 members representing different medical disciplines and geographical areas — not the council. Policy is generally agreed at the annual representative meeting. Outside of this, the council can “formulate and implement policies” as long as it is not “inconsistent with any policy already laid down by the representative body”.
Void if removed (talk) 09:30, 1 September 2024 (UTC)[reply]

* Comment I reverted a reply by User:Retal here, because it was left inside of Void's comment above. This reply can now be found here in the version history. I've also, of course, notified the user in question of this change so they can recompose their comment.--Licks-rocks (talk) 15:06, 1 September 2024 (UTC)[reply]

I don’t mind this change, I think it’s fairly balanced Snokalok (talk) 14:59, 1 September 2024 (UTC)[reply]
The suggested text fails verification to the sources and is over editorial and joins too many dots. Also we don't write things like "allegedly". That this claim is in quotes is sufficient for us to be not making it ourselves. Wrt the "arguing that is was not a decision for politicians to make" you say is not in the source. Our text:
The BMA criticised the related ban on puberty blockers, arguing this wasn't a decision for politicians to make, while calling for more research."
Source text:
The BMA has been critical of proposals to ban the prescribing of puberty blockers to children and young people with gender dysphoria, calling instead for more research to help form a solid evidence base for children’s care – not just in gender dysphoria but more widely in paediatric treatments. The Association believes clinicians, patients and families should make decisions about treatment on the best available evidence, not politicians.
I think we have a fair summary of that with the current text. -- Colin°Talk 17:08, 5 September 2024 (UTC)[reply]
I took into account some of your objections above. I also conceded your last point of critique and restored the sentence quoted above, putting back its two notes. In addition I use "methodological shortcomings" rather than the present opaque technical jargon ("unsubstantiated recommendations driven by unexplained study protocol deviations, ambiguous eligibility criteria, and exclusion of trans-affirming evidence"). Since I still believe the published summary lacks important points, I now suggest the following text: On 31 July 2024, the British Medical Association, representing the greater part of the UK’s medical practitioners, published a statement calling for a pause on the Cass Review's implementation while it conducted an evaluation.[NOTE] Criticism was levelled against the Review’s purported methodological shortcomings, and a motion was passed by the BMA's Council to lobby the Government and the National Health Service for unhampered trans healthcare (including “treatment at all ages”) and to condemn what it called "political transphobia." The BMA particularly opposed the temporary ban on puberty blockers, arguing this was not a decision for politicians to make.[NOTE][NOTE] Can we agree on this? Retal (talk) 23:37, 7 September 2024 (UTC)[reply]
I think this proposed paragraph adds text more focused on UK trans politics than about the Cass review and the direct fallout of that (the puberty blocker ban). We aren't writing an article about BMA's views on trans politics in general (the "political transphobia" comment), but specifically about their rection to the Cass Review. There are still several aspects that are unsourced, such as the "unhampered trans healthcare". I'm uncomfortable with the description of this published statement as "representing the greater part of the UK’s medical practitioners" because that's clearly a point of contention, with multiple sources saying BMA members don't agree this represents their views, never mind "the greater part of the UK's medical practitioners". So I think we should stay away from suggesting "representing". While the council do have the power to make statements in BMA's name, our article text makes it clear this is a motion coming from a council vote, not a membership consultation.
I wonder whether other editors are happy with your suggested replacing the long direct quote "unsubstantiated..." with "methodological shortcomings". It's a blander description and I agree the list of issues is likely to be meaningless to many readers and every one of them is contentious. It does however give a flavour that the BMA council have credulously repeated some of the nuttier ideas in the Yale PDF. -- Colin°Talk 11:07, 8 September 2024 (UTC)[reply]
I disagree with some of your assertions here. While the 195k has already been shot down, and “the greater part” is largely saying a similar thing; saying “BMA members disagree” as a general direction for how to steer our edits makes it sound as though the entire base or a large portion does when that’s just not supported by sources, and we shouldn’t be basing out edits off of such a sentiment.
Beyond that, the point about political transphobia is relevant because the Cass Review has been actively criticized in the past as exactly that, and we have several medorgs in this very article making assertions of a similar nature; so if the BMA is saying that in their response to the Cass Review, that’s a relevant detail.
As for “unsubstantiated”, I think the “allegedly” in the original already softens it enough. Changing the direct quote of unsubstantiated to a summarization as “methodological shortcomings” weakens it in a way that I feel is too extreme and goes out of its way to downplay the criticism. Snokalok (talk) 17:05, 8 September 2024 (UTC)[reply]
Yeah no looking back over it again, it softens it way too much. I’d much rather cut “greater part”, add “political transphobia”, and not remove the “unsubstantiated” quote than this new proposal. Tagging @Retal so they see. Snokalok (talk) 17:09, 8 September 2024 (UTC)[reply]
Would "methodological shortcomings and unsubstantiated recommendations" solve the problem for you? The original quote has the disadvantage that, as Colin observed, the list of issues is likely to be meaningless to many readers. Retal (talk) 18:49, 8 September 2024 (UTC)[reply]
I really like the current quote the most, as “methodological shortcomings” really downplays what they’re saying. A lay reader can absolutely understand what “unexplained deviations from study protocol and exclusion of trans affirming evidence” means, we really don’t need to change that. Methodological shortcomings makes it sound to the lay reader like a technicality, like oops they forgot to check a few boxes as a formality. Snokalok (talk) 10:48, 9 September 2024 (UTC)[reply]
Agree with Colin's assessment here. This section is already massive, please keep it on topic, ie what they say about the Cass Review, which is this page (WP:NOTEVERYTHING).
And the problem with the proposed construction:
the British Medical Association [...] published a statement [...], and a motion was passed by the BMA's Council
Is it reverses the order. The BMA council passed a motion, and then released a statement about it. The proposed text reads like the BMA made a statement, and afterwards the council passed a motion.
I would suggest revising the existing text to make this clearer, something like.
On 31 July 2024 the British Medical Association council passed a motion committing the organisation to lobbying against the Cass Review. In a statement, the BMA criticised the review for "methodological shortcomings", and called for a pause on implementation while it conducted its own evaluation, intended for completion by January 2025. Void if removed (talk) 18:00, 8 September 2024 (UTC)[reply]
(1) Divorcing the BMA’s reaction to the Cass Review from UK trans politics seems somewhat artificial. The BMA Council’s “political transphobia” accusation, for example, directly concerns the reaction of UK Government and NHS to the Cass Review.
(2) The "unhampered trans healthcare" aspect is not, as you assume, unsourced, but condenses the Council’s motion V: “prompt access to gender identity services and treatment at all ages” and motion VI: “condemn….blocking their (the transgender people’s] access to healthcare.”
(3) Then, the British Medical Association “representing” the greater part of the UK’s medical practitioners. Since the problem appears to reside in the ambiguity of “representing”, a simple change can save us a lot of unnecessary discussion: the BMA, “whose membership comprises” the greater part, etc.
(4) The reversal of temporal order: considering the BMA proclamation, it is not clear to me that all BMA comments on the Cass Review - not only those contained in the Council's motion - stem from that Council. This uncertainty made me distinguish the two.
(5) Calling the section "massive" is a judgement I cannot share. The BMA reaction is one of the most influential ones; it deserves an adequate treatment. Retal (talk) 19:22, 8 September 2024‎ (UTC)[reply]
@Retal, I think the part I'm most confused by is the [NOTE] stuff in your suggestions. Do you mean "add an Wikipedia:Explanatory footnote here"? Or "One of those little blue clicky numbers goes here"? Or something else? WhatamIdoing (talk) 01:53, 9 September 2024 (UTC)[reply]
[NOTE] means one of the notes in the section as published. What else causes you confusion? Retal (talk) 16:48, 9 September 2024 (UTC)[reply]
On the points:
  1. This looks like something that reasonable people could disagree over. It's relevant, but is it relevant enough? OTOH, it's relevant, but is it only the BMA's response that is relevant, or should we be adding context that says all of these orgs – UK and non-UK; supportive and critical – are responding within the context of their political millieu?
  2. Forgive me for the WP:FORUM-ish comment, but do we really want to push the idea that of all the people served by NHS England, all of whom find their health care is restricted in various ways (e.g., scientific evidence, cost effectiveness, waiting lists), it's only trans folks that the BMA thinks deserving of "unhampered" healthcare?
  3. We might need to have a discussion about who counts as a "medical practitioner" before saying that the BMA represents "the greater part" of them, but I suggest to you that simpler language, like "most doctors" would be much more appropriate.
  4. The thing about corporate life is that even if all the "BMA comments" actually "stem from" something other than the Council vote, the organization itself didn't take an action until the Council took their vote. Before then (and since then), various individuals doubtless said stuff, but only official resolutions and official statements are from the BMA per se. The Western world draws a distinction between "The org said..." and "Bob, speaking in his personal capacity, said..."
  5. It's about three times as long as the space given to other British organizations. Whether that's "massive" or just "larger" is not IMO important.
WhatamIdoing (talk) 02:10, 9 September 2024 (UTC)[reply]
On your point 5 about the section being larger, actually only 97 words are currently given to explain the BMA's opposition, while 203 words are given to discredit the BMA's resolution in that section of a total of 300 words. This does look a little bit like a WP:PROPORTION issue in favor of the people opposing it if more than 2/3 of the section are trying to discredit it instead of actually giving it at least a decent amount of space explaining the BMAs position.
I've tagged the section with a WP:BALANCE tag to fix the POV proportions of the section. Raladic (talk) 02:28, 9 September 2024 (UTC)[reply]
The BMA's position gets just as much space as medorgs. It then gets a direct response from the review for balance, and then a third paragraph with further coverage because it has sparked lots of dissent and criticism which has been newsworthy as the story has developed. I see no reason for a balance tag. At some point the way things are going this might even become a "BMA Controversy" section one day. Void if removed (talk) 06:19, 9 September 2024 (UTC)[reply]
We might be more likely to end up with a ==BMA Controversy== section in British Medical Association than here, and I doubt that we will know that until their next internal council election (in 2026). WhatamIdoing (talk) 08:05, 9 September 2024 (UTC)[reply]
I was just thinking about that - wondering if it would be better to expand this back and forth and coverage over there, because it is now turning into accusations of entryism and more coverage etc that aren't really directly relevant to the response to the Cass Review, more about internal politics, for which the Cass response was the flashpoint. Perhaps worth considering that approach, with a summary/main section link here? Void if removed (talk) 08:16, 9 September 2024 (UTC)[reply]
I’d be in favor of “most doctors” Snokalok (talk) 10:09, 9 September 2024 (UTC)[reply]
Technically, the BMA represents all UK doctors: "The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK."[1] Presumably they view this "represents" as what they aim to do even if you aren't a member. But their membership figures are similar to counts of the number of doctors employed on the NHS but I'm not sure how many doctors are members but perhaps work abroad or are retired. I can't find a recent source commenting on the relative membership size vs NHS doctors, likely because it simply isn't interesting to note. But "medical practitioners" is totally wrong, as there are well over 400,000 nurses and midwives.
The whole "represents" term is problematic wrt this council vote and motion. When Donald Trump "represented" the US on the international stage, no journalist would say "Donald Trump, who represents all citizens of the United States, said...". That would suggest that in this particular statement we know for sure he really is accurately representing them. And we know that is not the case. There's a clear separation that although the president is supposed to represent their citizens, what they actually say and do reflects the fact they are their own person. The proposed text here wrongly associates this council statement with the membership through the idea of "represents". And that's even before we get into the problematic idea that many democratic elections allow people to be elected on a minority of voters or that the BMA council were elected on only 7% of membership voting. So one can argue their position on the council represents the wishes of only a tiny percentage of BMA members.
This is just editorialising to try to enlarge the importance of this BMA motion, which currently is a big fat zero in terms of UK healthcare. -- 13:22, 9 September 2024 (UTC) Colin°Talk 13:22, 9 September 2024 (UTC)[reply]

I'm not seeing how this discussion is going anywhere useful. We have a paragraph that is reliable sourced and neutral. The proposal adds unsourced wording and deviates into trans politics generally. While some editors are joining dots between the Cass Review and political transphobia, the BMA council do not. Their target there is far more likely to be the previous government who enacted the PB ban and routinely played the trans culture war game, but they don't say so neither can we. I see someone has added a "balanced" request that somehow we are to expand on the BMA's very brief statement and reduce the overwhelming criticism that it has provoked both from their own membership and wider in the UK among related medical bodies. But hold on a second. This is an article on the Cass Review, not BMA council activism, not puberty blockers, and perhaps the balance is that we should better describe the review and its implementation, and not focus so much of our time an energy on a small set of complaints which, in the UK at least, are entirely impotent: the BMA council is being absolutely ignored. -- Colin°Talk 08:48, 9 September 2024 (UTC)[reply]

Just a wee reminder. The Cass Review did not recommend a ban on puberty blockers. Indeed it recognised that they were useful for some patients. It called for research into which patients benefited, and the BMA council also call for more research. The bits of the BMA motion that directly refer to the Cass Review are relevant. The confusion between both entirely blocking implementation and also wanting trans healthcare is relevant. But the rest is about the puberty blocker ban and the anti-trans culture war that so dominated the previous government and continues to be a focus of the right wing press. That is not "Cass Review". These things likely belong in articles on puberty blockers, on UK trans politics, on Tory/Labour politics, on the BMA itself, and so on. See WP:COATRACK. -- Colin°Talk 09:34, 9 September 2024 (UTC)[reply]

Btw, I propose the edit notice about "balancing" the BMA motion's detail with critical concerns be removed. We don't "balance" things to be how editors might wish the balance was. Nor to we give weight to minor aspects of an article. The BMA's motion is itself just a few bullet points (vs 400 page Cass Review) and the reception it got was overwhelmingly negative and has been entirely rejected by anyone who matters (NHS England, NHS Scotland, current governments of both nations, the medical bodies that set clinical standards or govern the relevant medical specialities). That's the hard reality and the balance we need to represent. -- Colin°Talk 09:34, 9 September 2024 (UTC)[reply]

Scotland

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Although the Cass Review was commissioned by and for NHS England, there has been an expectation that Scotland (which has its own separate NHS) would consider its findings. This led to a report Cass Review – implications for Scotland: findings report, Full PDF here. And it seems the Scottish government has accepted that report in full. (Be clear: they accepted their own "implications for Scotland" report, not the whole Cass report, which has findings and recommendations that are England specific).

I think our current text on this probably now needs condensed wrt various ministers saying they will consider things. And then something written about Scotland's response. I'm happy to work on that this weekend, just posting this here in advance. If anyone has useful sources to add to this please post here. Thanks. -- Colin°Talk 07:41, 6 September 2024 (UTC)[reply]

I have found these news sources:
I have also found several versions of https://news.stv.tv/scotland/scottish-government-accepts-findings-of-cass-report-on-gender-identity-healthcare-in-scotland, with various rephrasings or omissions. WhatamIdoing (talk) 02:24, 7 September 2024 (UTC)[reply]

Reflections from Hilary Cass

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A new source has been published with a summary and reflections on the Cass Review by Hilary Cass.

https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/gender-identity-services-for-children-and-young-people-navigating-uncertainty-through-communication-collaboration-and-care/D0F6B23F37C3D82B38C2470DF65854C9

I am not yet sure if or how it can be used yet, but it is is concise and worth a read to get a sense of what she considered the main points. I thought it that might help guide any focus or emphasis in this article on the key takeaways of what is a wide-ranging and at times hard-to-summarize review. Void if removed (talk) 13:29, 7 September 2024 (UTC)[reply]

Third paragraph change

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"The review has been criticised by several transgender-related medical organisations, and a number of international medical organisations have expressed disagreement with some of its conclusions."


It is true that the report has been criticised by several transgender-related medical organisations and non transgender-related medical organisations. It is also true that several medical organisations have rejected some all of its conclusions, its methodology, and its origins. It is also true that non-international medical organisations (BMA) have criticised the report. The sentence in its current form gives the impression that only transgender related organisations (with the implication here being they're biased) criticised (combative language) the report whilst non biased medical organisations merely disagreed (less combative) with only some (minimizing) of its findings.


Proposing it be changed to


"The review has been criticised by several medical organisations who have, variously, found fault with its methodologies and/or its findings." LDRnfr (talk) 22:44, 8 September 2024 (UTC)[reply]

@LDRnfr, are there any medical organizations (i.e., not individuals or publications, but official entities such as corporations and NGOs) that disagree with its methodologies and either agree with all of the findings or do not take any position at all on any of the findings? If not, then I don't think that methodological disagreements are important to call out.
It's a bit like giving directions to someone. You might disagree with their decision to take surface streets instead of the highway, but as long as they end up in the right place, the methodological disagreement is not very important. And if they don't end up in the right place, then the methodological disagreement is less important than the fact that they ended up in the wrong place. WhatamIdoing (talk) 01:34, 9 September 2024 (UTC)[reply]

Downplaying facts

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We seem to have a disagreement about whether the sentence that says:

  • Children with comorbidities did not receive adequate psychological support, endocrinologists administering puberty blockers did not attend multidisciplinary meetings, and the frequency of those meetings did not increase when adolescents received puberty blockers, all of which the Dutch Approach recommends.

should be taken as a fact, or if we should use language like "The report claimed that..." to imply that NHS England is probably doing a good job, or at least an adequate job, of providing psychological support for kids with autism, anxiety, and depression, and it's really just the Cass Review's unimportant opinion that it's not good enough.

Here's some sources that say that children on the NHS are not receiving adequate psychological support, including trans kids.

Content warning: Anyone who searches for this is going to find not only stories that sound like "We've been waiting two years for an autism assessment", but also stories that sound like "At the time of her suicide, she had been waiting two years for an autism assessment and two and a half years for her first appointment with NHS gender services". IMO that's not what stories of "adequate psychological support" sound like. Adding search terms like "children" seems to reduce the number of results focusing on suicide deaths, and I doubleplus-recommend doing that.

On the list of sources claiming that all's well and the kids are getting everything they need, I find: Nothing. Not even the Tories are claiming that the CAMHS is sitting around all day with nothing to do because kids are already so well supported, so we should urgently cut their budget and my taxes.

So with all of this in mind, could we please take out the WP:WEASELly language that's implying that "Children with comorbidities did not receive adequate psychological support" isn't a universally acecpted fact?

WhatamIdoing (talk) 02:57, 10 September 2024 (UTC)[reply]

I'm of a few views here that I'm not sure how to reconcile. On one hand, I think it's important when making claims that they are cited to their source if that source isn't "final". On the other hand, the Cass Review is such that it's a large scale review that, while some people dissent to it, should be able to have its findings taken without the attribution. Yet still, this statement in question is being cited to the interim report, which should be attributed if it's being discussed as something the interim report said (which it is here).
I'm not sure why this is only in background to begin with though - with barely any (if any) information in the actual discussion of the final Review. If there isn't going to be a section about the psychological support that is/should be provided in discussing the final results of the Review, then I'm not sure how it's relevant background information in the first place. If a section can be added discussing the findings of the final Review on this matter, then the background should continue to state that the interim report made that claim, since that's what the background paragraph in question is discussing. -bɜ:ʳkənhɪmez | me | talk to me! 03:11, 10 September 2024 (UTC)[reply]
I mean the Cass Review is not an undisputed report in the medical field by any stretch, and simply saying “According to the Cass Review, XYZ” goes a long way towards maintaining an NPOV on the topic. I think presenting the full report’s findings as undisputed fact without attribution, when we have countless medorgs across the globe including in the UK disputing it and accusing it of political machinations, misleads the reader at best and at worst is just pov. Snokalok (talk) 11:14, 10 September 2024 (UTC)[reply]
But we don't "have countless medorgs across the globe including in the UK disputing it". Where "it" means all of it. Nor are they "countless" vs "handful". The US ones have a common origin and united around a right-wing conservative domestic problem and are, sadly, playing at legal politics, not evidence based medicine.
There are two aspects to the review. One is the evidence both in terms of medical studies and the facts about the state of NHS England in this area. The other is in what should be done as a result. There is some criticism of the evidence, nearly all at an embarrassing level of competence by people with conflict of interest or no training at all in this field. Mostly that's about puberty blockers. And there's some criticism about what to do about it. Mostly that's about puberty blockers. And some of the criticism is of the puberty blocker ban, which isn't even recommended by the review.
But for the rest of it, as WAID points out, this is an NHS England commissioned report into the state of NHS England, which NHS England has accepted and vowed to fix. There isn't any need for any "According to the Cass Review" attribute any more than if National Highways published a report that said how long the A1 was and the condition of the road surface. None of these supposed "countless medorgs" dispute any of that. For our purposes, is the Cass Review a reliable source on the state of NHS England's trans healthcare? Absolutely. We can state these things as facts with a little numbered box after.
I've just finished reading Cass Review: Implications for Scotland. This is a 57-page NHS Scotland commissioned report written by a multidisciplinary team of experts and by the looks of it took weeks if not months to write. I wonder how many editors here have read it vs the Yale PDF or half-page BMA Council bullet-point statement.
The NHS Scotland report not only agrees with the Cass Review about the evidence and consequences, but goes through each of the 30+ recommendations working out how they apply to NHS Scotland. The differences, where they exist, are mostly because NHS Scotland is organised differently or has different programmes for improvement to occur within. They entirely accept Cass's analysis of the state of NHS England trans healthcare and agree NHS Scotland shares many of the same crises and solutions. What is interesting to me is that the NHS Scotland report will actually shape the future of trans healthcare in Scotland (much as the Cass Review will shape it for England). Unlike the other "publications" we have invested so much energy on, which will be forgotten about.
Snokalok, I really do encourage you to read the NHS Scotland report. Skim it at least. I know you won't agree with the puberty blocker bits but I think you will come away with a feeling that this is actually only a very very tiny part of the Cass Review. That most of it is about a health service that really is universally agreed as entirely failing its patients and for which radical change and investment is needed. I think you may also get a feeling that when the BMA council recommended to pause the implementation of the Cass Review and work to block it, why so many NHS doctors were aghast. -- Colin°Talk 12:27, 10 September 2024 (UTC)[reply]
IMO if you can't state a fact from a source like the Cass Review without attribution, I have no idea what level of source you ever could. Void if removed (talk) 12:29, 10 September 2024 (UTC)[reply]
Wrt Snokalok's "misleads the reader at best and at worst is just pov", we actually do that when we attribute something that really is considered a fact and for which our source is reliable. It really is pov-pushing to stick weasel words around hard facts. As an editor with experience outside of this particular medical topic, I'm astonished at the degree to which mainstream first class evidence based medicine is being attacked on this topic, citing random lawschool PDFs and trade union councils, to try to discredit what is the largest, most thorough, independent and professionally conducted review of this field ever conducted.
It is a bit like we are writing about British Doctors Study and editors are filling this pages with stories about their gran living to 85 and smoking 40 a day, and linking to PDFs written by tobacco firms, and where Richard Doll reports he's scared to take public transport because of the abuse he gets. -- Colin°Talk 13:15, 10 September 2024 (UTC)[reply]
My question is much narrower than this. We are saying that it's purely the POV of the Cass Review that "Children with comorbidities did not receive adequate psychological support".
@Snokalok, can you find any medorg that says that NHS England really has been providing trans kids with adequate psychological support? Just one medorg, anywhere in the world. If not, then this statement is not one that should have WP:INTEXT attribution. Probably lots of the others should, but I'm specifically talking about whether this exact claim should begin with that disclaimer-ish wording. WhatamIdoing (talk) 16:26, 10 September 2024 (UTC)[reply]
I think it’s important to ask what psychological support means here. In parlance on the topic in a UK context, it often means gender exploratory therapy and requiring the involvement of a mental health professional in perpetuity; which is of course, a highly controversial idea in the context of GAC, it’s considered conversion therapy to practice GET, etc. Thus, the statement requires attribution, because it makes the implication that they didn’t receive proper support *as the people doing the Cass Review considered it to be*. In other parts of the world meanwhile, it’s considered an intrusion to require continual therapy sessions in exchange for GAC - and we’ve even seen this opinion expressed several times by WPATH in a UK context. Thus, I’m not saying that the NHS or didn’t provide adequate support, I’m saying they didn’t provide adequate support as the Cass Review considered it, which is not necessarily a neutral position on the topic, and that’s why the attribution of “According to the Cass Review” is important. Snokalok (talk) 16:34, 10 September 2024 (UTC)[reply]
Here are two quotations about the absence of adequate support from the cited report (emphasis added):
  • "Additionally, children and young people with gender-related distress have been inadvertently disadvantaged because local services have not felt adequately equipped to see them. It is essential that they can access the same level of psychological and social support as any other child or young person..."
  • "The Dutch criteria for treating children with early puberty blockers were: (i) a presence of gender dysphoria from early childhood; (ii) an increase of the gender dysphoria after the first pubertal changes; (iii) an absence of psychiatric comorbidity that interferes with the diagnostic work-up or treatment; (iv) adequate psychological and social support during treatment; and (v) a demonstration of knowledge and understanding of the effects of gonadotropin-releasing hormones (puberty blockers), feminising/masculinising hormones, surgery, and the social consequences of sex reassignment"
Do you see anything in here that sounds like "Let's engage in conversion therapy"? I don't. I see "Local services are scared to provide ordinary treatment for autism in gender diverse kids because they worry that they might screw up" and "We actually need to support kids while they're on puberty blockers".
This sentence actually includes three claims:
  • NHS England is not providing adequate psychological support for the subset of trans kids who have autism, anxiety, depression, eating disorders, etc. while they're on puberty blockers. Note: The claim isn't about all trans kids. It's specifically about trans kids with comorbidities.
  • Endocrinologists administering puberty blockers did not attend multidisciplinary meetings.
  • The frequency of those meetings did not increase when adolescents received puberty blockers.
I think that all three of these are uncontested claims of fact. Your reply above, for example, does not even attempt to claim that anyone in the NHS with autism and anxiety has been well-served by the current system. It looks to me like you've swerved right away from "Children with comorbidities need adequate psychological support" to "Everyone agrees that conversion therapy is evil". Fine: Let's just stipulate here that every editor on this page agrees that conversion therapy is evil. But it's also evil to have one branch of the NHS wash their hands of a kid's crippling anxiety by saying that GIDS will deal with the anxiety, and after an education- and life-destroying multi-year delay, GIDS saying that they only do gender and CAMHS will deal with the anxiety ...after another year-long delay. This is not a case of "continual therapy is the price for GAC"; this is a case of "patients are allowed to have more than one health problem, and being trans should not disqualify you from the ordinary treatment for autism". WhatamIdoing (talk) 17:04, 10 September 2024 (UTC)[reply]
@WhatamIdoing the first claim is cited to page 18 which says Within the Dutch Approach, children and young people with neurodiversity and/or complex mental health problems are routinely given therapeutic support in advance of, or when considered appropriate, instead of early hormone intervention. Whereas criteria to have accessed therapeutic support prior to starting hormone blocking treatment do not appear to be integral to the current NHS process.
p32, right after your second quote, says However, the Dutch Approach differs from the GIDS approach in having stricter requirements about provision of psychological interventions. For example, under the Dutch Approach, if young people have gender confusion, aversion towards their sexed body parts, psychiatric comorbidities or Autism Spectrum Disorder (ASD) related diagnostic difficulties, they may receive psychological interventions only, or before, or in combination with medical intervention
Your first quote applies to all trans kids, it never specified those with comorbidities - it's a critique of local clinics turning away trans kids saying "idk what to do with them"
The second is just a summary of the Dutch protocol.
The article currently states The report stated that children with comorbidities did not receive adequate psychological support ... which the Dutch Approach recommends
That doesn't appear to be cited properly, as the section it's citing is talking about how the Dutch approach mandated trans kids with comorbidities have those addressed before or instead of receiving trans healthcare.
What the cited source supports is The report stated children were not required to undergo therapy prior to puberty blockers ... which the Dutch approach recommends Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:15, 10 September 2024 (UTC)[reply]
YFNS, the Cass Review does not refer to the patient cohort as "trans kids". I'm reminded of the comment Cass made, linked a few sections above: "During the course of the Review, we observed a change in attitudes, from an initial narrative among many trans advocates that only a minority of the young people presenting would have a longstanding trans identity and would benefit from a medical pathway to a belief in some quarters that all the young people on the waiting list for services were ‘trans kids’."
It would be helpful if you would stop doing using that language for this group. As Cass indicates, this is a recent and fringe activist-language, not something accepted by reliable sources. It makes discussing the treatment of children referred to CAMHS or GIDS-equivalent centres difficult. Only a minority of child and adolescent patients in the UK were referred for hormone therapy and this has been true for many years. The Cass Review refers to the patient cohort as "gender-questioning children and young people" which is a neutral term that does not prejudge diagnosis. This is aligned with WPATH. WPATH states for adolescents: "Given the emerging nature of knowledge regarding adolescent gender identity development, an individualized approach to clinical care is considered both ethical and necessary" and "We recommend health care professionals working with gender diverse adolescents undertake a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns and seek medical/surgical transition-related care, and that this be accomplished in a collaborative and supportive manner" and "We recommend health care professionals assessing transgender and gender diverse adolescents only recommend gender-affirming medical or surgical treatments requested by the patient when:...The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed." and "Professionals working with adolescents should understand what is and is not known regarding adolescent gender identity development, and how this knowledge base differs from what applies to adults and prepubertal children." I could go on quoting. And as for children: "This chapter employs the term “gender diverse” given that gender trajectories in prepubescent children cannot be predicted and may evolve over time". This is not the page to dig deep into that stuff, but the gist is WPATH make no diagnostic assumptions about the referral cohort and neither should we in our language. It is a bit like calling anyone who goes to the doctor with a lump in their breast a "cancer patient".
There are two aspects to "psychological support". The first is that a large chunk of the current cohort have psychological and neurodevelopmental conditions that are not being addressed at all, never mind before any medical treatment starts as recommended by both WPATH and the Dutch Protocol. The second is support during such medical treatment.
It is already well documented that CAMHS thought a referral to GIDS meant they didn't have to deal with that child as they thought the experts there would, and GIDS thought they didn't have to deal with anything other than gender dysphoria as they assumed CAMHS would deal with that. Both services were and continue to be massively overloaded, understaffed and with huge waiting lists. Which is part of what led to perhaps wishful thinking that someone else was dealing with it. That's a UK health service issue that is uncontested. This is the feature of "holistic" treatment that Cass recommends and is being addressed by NHS England and Scotland.
I think the issue that although these children's comorbid conditions were being neglected by all services in the UK, and especially so if they were gender questioning with a GIDS referral, it is being combined by some with the current activist battle that is uncomfortable with the fact that all international guidelines for children and adolescents have a psychosocial/neurodevelopmental gatekeeping component in them. It would be easier to fight the US battle against affirmative care bans if there was no question that every single referral was a "trans kid" who needed puberty blockers cross sex hormones. And so we get the claim that this psychosocial gatekeeping and now even any holistic psychosocial therapy at all is "conversion therapy" despite the fact that WPATH's definition of such is in the same pages as their recommendations that one must deal with these other things in order to have, as they put it, "diagnostic clarity" or "standards of care"
So, could we please stick to the sources on this one. Cass is not talking about conversion therapy but about stuff that is even in the WPATH guideline and the Dutch Protocols. It is basic "standards of care", as the WPATH guideline calls itself, that the UK health services fell well well short of. -- Colin°Talk 08:31, 11 September 2024 (UTC)[reply]
I introduced the language of trans kids into this discussion, and I will attempt to remember your advice in the future. WhatamIdoing (talk) 18:29, 11 September 2024 (UTC)[reply]
@Colin "trans kids" is not "recent and fringe activist language" - that is complete and utter nonsense at best, ridiculously insulting at worst, and I will not stop referring to trans kids as trans kids.
Cass referring to kids sure of their gender as "gender questioning" is in fact one of the peer reviewed criticisms of the report btw[6]
It is not a "neutral term that does not prejudge diagnosis" because being trans isn't a bloody diagnosis. And nobody has ever argued trans kids shouldn't get any mental healthcare or the NHS is doing a good job, that's a strawman, everyone agrees.
Besides which, I am sticking to what Cass said, that's why I quoted her specifically talking about how the NHS differed from the Dutch Approach. We already talk about diagnostic overshadowing earlier in the section, I am talking about a fragment of a sentence not supported by the cited source which could be changed to match the source. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:09, 11 September 2024 (UTC)[reply]
I'm sorry, are you seriously suggesting that colloquially referring to children as "kids" is fringe and activist language? --Licks-rocks (talk) 19:12, 11 September 2024 (UTC)[reply]
I believe the main point is that we shouldn't conflate "kids who have been referred to NHS gender services" with "kids who are sure they are trans".
YFNS cites a paper that says this:
"Trans children are instead reduced to definition as “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of trans children."
But it seems to me that an opposite and parallel statement would be equally true, viz.:
"When WhatamIdoing said 'trans kids' to refer to 'kids who have been referred to NHS gender services', she excluded “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of gender-questioning children."
I don't know what your experience is, and I don't want to bother looking it up, but I remember in the 1980s when the "Q" in LGBTQ was "questioning", and the definition seemed to be "I'm gay but I don't want to admit it". IMO Colin is correct that we shouldn't get in the habit of assuming that every single kid referred for gender services is actually trans. WhatamIdoing (talk) 20:07, 11 September 2024 (UTC)[reply]
@WhatamIdoing one term correctly refers to the majority of the cohort, the other incorrectly refers to them. If Cass said "youth seeking GAC" or something it would be another issue, but describing trans kids as "gender questioning" is not neutral. Imagine a report into LGB healthcare for youth which said "sexuality questioning youth" throughout and never once referred to "LGB youth" - it would be an immediate red flag. Per p 160 of the final report, the majority of kids turning up already socially transitioned.
I'd appreciate a response to my main point, which is what specifically did the Cass Review say about how the NHS differed from the Dutch protocol. I quoted 2 excerpts from the Cass review comparing the NHS and Dutch approach, which say the latter was stricter about mandating therapy as a prerequisite/corequisite/alternative to GAC. The paraphrase we have in the article misrepresents that. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:55, 12 September 2024 (UTC)[reply]
Imagine a report into LGB healthcare
The problem with analogies like this is they beg the question. Is that the same thing or not? Pick a different analogy and you can argue the reverse.
"Gender questioning" is the language of the review and I see no reason to avoid it.
In a clinical setting we're invariably talking about kids distressed at the development of secondary sex characteristics (prospective or actual), there's all kinds of reasons for that, strong opinions in different sources, and not much in the way of neutral language available. Void if removed (talk) 21:24, 12 September 2024 (UTC)[reply]
@Void if removed 1) this completely ignores the issue with the citation I'm discussing in favor of quibbling over language not in the article.
2) There is no situation on Wikipedia where somebody says "I am trans" and we refer to them as "gender questioning" just because somebody else did. MOS:GID and all that. Cass explicitly notes the majority of kids she's referring to as "gender questioning" have socially transitioned. Calling them all questioning is flatly inaccurate and not neutral at all. If you have a room full of 99 kids who say "I'm 100 sure I'm gay", and 1 person who says "I might be", saying you have a room full of "sexuality questioning kids" is nonsense. Insisting that some are questioning doesn't make it true for all people described. Colin and WAID have cited WPATH using terminology like "gender diverse" and "adolescents who present with gender identity related concerns" - those, unlike "gender questioning", accurately describe the cohort. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:08, 12 September 2024 (UTC)[reply]
Just to be clear, I'm not saying the term "trans kids" is activist language when used anywhere. And I'm aware of an anti-trans idea that there is no so such thing as a "trans kid", so I should have been clearer about that. There absolutely are trans kids. But I stand by the quote I made of Cass. WPATH above describe the referrals as "adolescents who present with gender identity-related concerns" and otherwise the shorthand "gender diverse" for both adolescents and children, repeatedly stating that each is an individual who's path is unknown. WPATH themselves recognise not all referrals will go down the path of gender-affirming medical treatments. WPATH themselves use the term "diagnostic clarity" to refer to a physician deciding to prescribe a medical treatment. I completely get the discomfort those words have wrt an identity but please take those concerns to WPATH and remember this is a medical treatment being prescribed.
YFNS cites [7] an activist complaining that Cass using neutral non-activist terminology is a problem. And yet YFNS doesn't describe this activist opinion piece as such, but as a "peer reviewed criticism", as though that elevates it to the truth. And as though the peer review process for such opinion pieces exists to elevate opinion to truth. As WAID notes, Horton's criticism is logically nonsense. This friends, is the problem we have here. Cal Horton's opinions are Cal Horton's opinions, not "peer reviewed criticism", as though some kind of science or fact-based research is going on here. -- Colin°Talk 07:52, 12 September 2024 (UTC)[reply]
I appreciate the clarification in the first part. As for the second. Cal Horton's "opinion piece" has in fact gone through peer review and what's more it has not been published as a letter or opinion article, it has been published as a proper stand-alone article. So yes, "peer reviewed criticism" is a correct characterization. --Licks-rocks (talk) 08:30, 12 September 2024 (UTC)[reply]
I wish I knew the exact technical term for this piece of academic writing. I wonder how you'd view it if written by a gender critical activist criticising the WPATH standards of care. They'd have their own POV and conceptual framework around which to build their case. What do you think "peer review" exists for in this kind of work? Do you think it exists to agree that every single sentence in this polemic is The Truth? Or more that this isn't the work of a crazed individual divorced from all reality unable to make any kind of cohesive argument.
On the one hand we have a review that took four years to write and was explicitly asked to be independent and selected a most senior and respected doctor to perform. Such a review has to find a balance of terminology and careful wording that is likely to upset those on the extremes in either side. But the point of the review is not to appease activists by using the Correct Words (on either side) but to determine the correct healthcare for an area of NHS England.
On the other hand we have an activist who's body of research is in interviewing their social media circle and who has written this polemic to advance their opinion that the Cass Review is inherently transphobic and thus can be dismissed before its findings are even known. Which, you know, as a piece, is not any different to someone writing a polemic that socialised healthcare is the fairest system and advancing their arguments in support of that. Such an piece could be peer reviewed as a valid argument, but not as The Truth. Someone could equally write a piece that says the capitalist model of insurance and pay-as-you-go for healthcare is the fairest and best system and make their arguments in support of that. Both could be peer reviewed and published. But both can't be correct, and peer review does not exist to determine that for this kind of work.
So it is a problem, frankly, when the language used by both Cass and WPATH, both MEDRS sources, is being attacked by an article that is really just some activists opinion, and referred to in a way that suggest "peer reviewed criticism" is in any way special at discovering who is Right. -- Colin°Talk 09:56, 12 September 2024 (UTC)[reply]
What do you think "peer review" exists for in this kind of work? Do you think it exists to agree that every single sentence in this polemic is The Truth? I will, for the umpteenth time, note that that is not what anybody in this discussion has ever argued, least of all me. Neither have I or YFNS ever suggested that the sentence you're quoting is the only, or even the best, example of what YFNS pointed out the paper criticized in that paper. The reason that paper got through peer revieuw, though, is because it seeks to describe patterns of behaviour within the cass revieuw and its underlying research. Looking through the paper more closely, I don't get the impression that either you or whatamidoing (but especially you!) have made any real attempt to understand those arguments or represent them here in earnest.
I wish I knew the exact technical term for this piece of academic writing It's called a peer reviewed literary analysis. --Licks-rocks (talk) 11:08, 12 September 2024 (UTC)[reply]
I was responding to YFNS, who referred to Cal Horton's opinion as "peer reviewed criticism". Their overall paper, of 25 pages and about 16 thousand words, was "peer reviewed" in as much as that is worth something for a "literary analysis". But their specific criticism of Cass's use of the term "gender questioning", was not "peer reviewed" in the sense that Horton's peers examined that criticism and all enthusiastically agreed with it. That's what calling it "peer reviewed criticism" implies. I've lost count of the number of times YFNS has cited Horton as though this was definitive and widely accepted evidence, rather than one person's opinion, containing numerous factual misunderstandings, of the interim report. It is frustrating when two NICE systematic reviews and seven York systematic reviews and a four year independent review are repeatedly dismissed by citing a "literary analysis" written by an activist with no clinical background or experience conducting or reviewing clinical research of this kind. Is is though the very top of the MEDRS source hierarchy pyramid is "activist criticism". -- Colin°Talk 12:00, 12 September 2024 (UTC)[reply]
YFNS didn't quote that paper, she mentioned it. As far as I can tell, the quoting was done by whatamidoing. Just like YFNS didn't use the term Trans kids in any formal way, she used it as a colloquialism, with the actual text she suggested right next to it. just like whatamidoing did prior to her. Look, I already said this on AE, but I want you to stop taking the worst interpretation of what we are saying and running with it, because a lot of the time it isn't even what we said. --Licks-rocks (talk) 12:15, 12 September 2024 (UTC)[reply]
I don't understand your first sentence at all. Maybe read WAID's defence of the trans kids issue at AE, and consider if you are taking the worst interpretation of what I said. -- Colin°Talk 13:14, 12 September 2024 (UTC)[reply]
my first sentence is pointing out that the quote you and whatif are agitating against was not placed on this talk page by YFNS or me, and is not representative for the argument being made in the paper. I think it is a strawman of the argument YFNS is actually making, which is that the language used in the cass review and its underlying literature has been criticised for being non-inclusive, and for casting doubt on kids' ability to have a well-developed gender identity. The cited quote is one of several examples given.
Actually, I think the sentence whatamidoing did not include is very telling here. Let me introduce a more complete quote, including the sentence whatamidoing's quote is referencing:,the interim report does not include even one reference to a trans child, adolescent or young person. Trans children are instead reduced to definition as “gender questioning children and young people” (Report 5, p. 11) or “children and young people needing support around their gender” (Report 5, p. 7). This framing conflates trans children, including those who have socially transitioned and are settled and confident in their affirmed identity, with children who are questioning their gender. This conflation erases the existence of trans children. Yeah, if the report didn't make a single reference to gender questioning people, I would still consider that a problem, to paraphrase whatamidoing's argument above. I'm sorry, but this practice has a name, and it is called cherrypicking.
Also, before you get up in arms about this being about the interim report again: A, nobody said otherwise, B, YFNS did not introduce this quote as being about the main report, she didn't introduce this quote at all, and C: the same people that wrote the interim report also wrote the main one. and D. there are similar issues with the main review, as evidenced by several MEDRS having published statements about this by now.--Licks-rocks (talk) 14:15, 12 September 2024 (UTC)[reply]
I'm afraid you lost me at "quote". No idea what you are talking about. But to be honest, I've got bigger problems to deal with today, as you well know. -- Colin°Talk 14:24, 12 September 2024 (UTC)[reply]
For my money, Attribution is not just for when you want to draw a source's claims into question, you can also use it when you are describing what a source is saying. To me, it makes sense to point out that the cass review is saying this, because we're trying to describe what the cass review is saying. How about we follow MOS:CLAIM here and change it to say "the Cass review stated that...". That's how we usually avoid making a value statement in attributing something, and I think that makes a lot of sense here. --Licks-rocks (talk) 19:22, 11 September 2024 (UTC)[reply]
From WP:INTEXT:
When using in-text attribution, make sure it doesn't lead to an inadvertent neutrality violation. For example, the following implies parity between the sources, without making clear that the position of Darwin is the majority view:

☒N Charles Darwin says that human beings evolved through natural selection, but John Smith writes that we arrived here in pods from Mars.

checkY Humans evolved through natural selection, as first explained in Charles Darwin's The Descent of Man, and Selection in Relation to Sex.

Neutrality issues apart, there are other ways in-text attribution can mislead. The sentence below suggests The New York Times has alone made this important discovery:

☒N According to The New York Times, the sun will set in the west this evening.

checkY The sun sets in the west each evening.

When we say that the Cass Review stated that the NHS is failing pediatric mental health patients, are we implying that others disagree? Or that Cass alone has made this important discovery?
We might want to specify that the Cass Review says that the NHS has failed the kids referred to gender services even worse than they've failed all the other kids (that is the meaning of "Additionally, children and young people with gender-related distress have been inadvertently disadvantaged..."), as that might be their own discovery, but I suspect that even this is not original to the Cass Review. There are probably sources from the so-called trans activists complaining about exactly this problem that predate the Cass Review. WhatamIdoing (talk) 20:40, 11 September 2024 (UTC)[reply]
We're saying the cass revieuw stated that this was the case, which it sure did. I guess you could read implications into that, but then, it's a single sentence. Unless the next sentence is that some other source disagreed with that part I personally simply wouldn't get that implication out of it. --Licks-rocks (talk) 21:12, 11 September 2024 (UTC)[reply]
But INTEXT says that other people might, so if we don't think there are any other sources disagreeing with it, then we shouldn't use INTEXT attribution. WhatamIdoing (talk) 21:19, 11 September 2024 (UTC)[reply]
INTEXT also says In-text attribution may need to be used with direct speech (a source's words between quotation marks or as a block quotation); indirect speech (a source's words modified without quotation marks); and close paraphrasing. It may also be used when loosely summarizing a source's position in your own words. Which in my opinion is what we're doing here. I'll notice that the Darwin example still includes attribution, so clearly it's not quite as black and white as that. --Licks-rocks (talk) 08:21, 12 September 2024 (UTC)[reply]
The responses here exemplify so many of the problems in this area. The Cass Review is a high quality source and we should be able to use it to source facts like "Children with comorbidities did not receive adequate psychological support" without attribution. We can.
Instead of this being a minor point on which everyone can simply agree because the answer is so obvious, we have a massive thread full of comments recycling arguments about how using the language of the review "erases the existence of trans children". That's one opinion, others are available.
Relitigating this wastes time and space and stalls meaningful progress. There is an unresolved conflict in MEDRS, which is that some cleave to the US-based affirmative model, and some want to stick to psychotherapy as a first line treatment, and the language you choose to discuss the patient group affects how you think about the appropriateness of either of those approaches, and we can't simply attribute every claim in the Cass Review because that's implicitly picking a "side".
So, returning to the original question, I think that it absolutely can be stated without attribution, and I've not seen a good reason it cannot, especially since it is talking about comorbidities. Void if removed (talk) 14:50, 12 September 2024 (UTC)[reply]
I am also trying to understand his "US-based affirmative model" that appears to disagree with the US-dominated WPATH guidelines I quote 08:31, 11 September, which have "a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns" as a first-line step, and explicitly state that "gender-affirming medical or surgical treatments" be only recommended after "The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed."
Which MEDRS guidelines "cleave to the US-based affirmative model" for children and adolescents? Or is this describing current widespread practice that has yet to be updated into WPATH SoC? -- Colin°Talk 15:52, 12 September 2024 (UTC)[reply]
Well there's what WPATH say in SOC8 in September 2022, and there's what WPATH say about the Interim Cass Review in November 2022, and they don't exactly gel:
At several points in the document, there is an emphasis on “careful exploration” of a child or young person’s co-existing mental health, neuro-developmental and/or family or social complexities. There is also a suggestion that a “care plan should be tailored to the specific needs of the individual following careful therapeutic exploration…” WPATH, ASIAPATH, EPATH, PATHA, and USPATH are concerned that this appears to imply that young people who have coexisting autism, other developmental differences, or mental health problems may be disqualified, or have unnecessary delay, in their access to genderaffirming treatment. This would be inequitable, discriminatory, and misguided (Coleman et al., 2022). WPATH, ASIAPATH, EPATH, PATHA, and USPATH recommend that puberty suppression, where urgently indicated, can be commenced promptly, and proceed alongside and at the same time as any necessary diagnostic clarification of other conditions, or treatment of other conditions
I think the distinction really is: what do these different models mean by "assessment"?
The York review of the different standards says:
All guidelines recommend multidisciplinary assessment. Three types were identified: (1) comprehensive psychosocial assessment, (2) medical or ‘readiness’ assessment for adolescents seeking hormonal treatments and (3) diagnostic assessment for gender dysphoria/incongruence. Some guidelines integrate these, while others present them separately. In most guidelines, there is no distinct assessment section or recommendations. There is limited clarity about assessment purpose. Most cited reasons are to inform a care plan, or assess eligibility for hormone treatment. Although most guidelines describe different pathways for children and adolescents, only three provide separate guidance. Five recent guidelines propose that prepubertal children only require assessment if gender-related psychosocial care is needed but provide limited detail about this. Others propose all children be assessed. There is little consideration of how a psychosocial assessment might be different for children and adolescents.
Detailed guidance regarding assessment is lacking with no consensus about the aim or clinical approach, nor the necessity for assessment in prepubertal children. Although most guidance recommends assessing gender, mental health, psychosocial and family functioning, other domains vary. Few guidelines recommend exploring sexual orientation or assessing body image, despite these being identified as important factors. Few recommend specific assessment tools, and those suggested have not been developed and/or validated for this population.
Cass says that we need to understand why youth are distressed before any medical interventions because we might be misinterpreting comorbid conditions or other factors. I could be wrong, but my impression of the "affirmative" model is that the assessment does not really question "why". Void if removed (talk) 20:32, 12 September 2024 (UTC)[reply]

Who stripped away the BMA content?

[edit]

I went to grab a citation to put in the lede, and it was all gone Snokalok (talk) 14:02, 17 September 2024 (UTC)[reply]

Bon courage, someone's asking about you. Firefangledfeathers (talk / contribs) 14:06, 17 September 2024 (UTC)[reply]
Sorry I was out for a bike ride (nice to catch the autumn sunshine). I left an edit-summary didn't I? Quite why we had this bloated attention on the BMA was a puzzle! (Add: Oh I see it's snuck back in.[8] Seems undue to be; as if Wikipedia needs to surface the 'bad things' the BMA said. They're really not a reliable body for this stuff). Bon courage (talk) 14:19, 17 September 2024 (UTC)[reply]
While the section was a tad heavy for its weight, I don’t think we can really say what to me read as one sentence of ‘The BMA criticized the Cass Report,’ followed by two paragraphs of ‘but then everyone else told them that that was dumb because XYZ’ without including what those criticisms were Snokalok (talk) 14:37, 17 September 2024 (UTC)[reply]
I disagree, particularly since the BMA is only a trade union. I mean who cares, particularly when we have several more apt bodies making comments. More particularly this material should not be restored without consensus. Note WP:ONUS: "The responsibility for achieving consensus for inclusion is on those seeking to include disputed content" (my emphasis). By over-focussing on this body's pronouncements the article risks drifting into POV. Bon courage (talk) 14:48, 17 September 2024 (UTC)[reply]
I still stand by my earlier suggestion of expanding it as necessary over on BMA and summarize/link it here. The coverage since has been more about the resulting controversy within the BMA itself than the Cass Review, so it seems more DUE there than here. Void if removed (talk) 14:50, 17 September 2024 (UTC)[reply]
That sounds good; this is really more about the internal politics of the BMA than anything of real biomedical relevance to the Cass Review. Bon courage (talk) 14:52, 17 September 2024 (UTC)[reply]
Sorry, perhaps I’m misreading, but are you saying that the BMA’s specific criticisms of the Cass Review belong more on the BMA page than the Cass Review page? Snokalok (talk) 15:22, 17 September 2024 (UTC)[reply]
I'm saying that given the coverage in RS as the story has developed over time into one that centres on the BMA itself I think it is due for a fuller explanation over there, and a link and condensed summary with the most relevant parts here. Void if removed (talk) 16:40, 17 September 2024 (UTC)[reply]
Yes. For biomedical science, the BMA is not really a relevant body in the UK (we cite plenty that are). A sentence or two at most is due here. Otherwise it looks like Wikipedia is over-focussing on a bit-player in order to showcase the harsh words™ they put out. Bon courage (talk) 16:46, 17 September 2024 (UTC)[reply]
Right, and there was a longstanding consensus for inclusion before you changed it. Another relevant guideline is NPOV - because having two paragraphs on why critiquing the Cass review is dumb and all the people who are against doing so, needs to be balanced by what those critiques actually are. Otherwise it’s not neutral Snokalok (talk) 15:20, 17 September 2024 (UTC)[reply]
I don't think there was any consensus; you may of course try an establish it. After my edit the BMA content was:

The British Medical Association (BMA) has called for a pause on the review's implementation while it conducted a critique due to be completed by January 2025. The call has prompted some opposition from doctors, 1,400 of whom signed an open letter to the BMA characterising their planned critique as a "pointless exercise".

How is that "two paragraphs on why critiquing the Cass review is dumb"? Bon courage (talk) 16:10, 17 September 2024 (UTC)[reply]
You forgot the Academy of Royal Medical Colleges after that, but also look through the previous threads that even yet remain on this page - where several debates were had as to the content and where it was finally decided to keep it as it was before you changed it. That’s a consensus. A new editor coming in, while certainly welcome, does not break that consensus. Citing another guideline, we have BRD. You boldly shortened, I reverted as much as I could manually on mobile (hate the new html system, makes it impossible to manually revert things), and now we’re discussing. Snokalok (talk) 16:31, 17 September 2024 (UTC)[reply]
Nowhere was it "finally decided". Rather I see concerns about excessive quotation and smells of POV-pushing, and the section was tagged when I arrived here. BRD is not a "guideline", but an essay. WP:ONUS, on the other hand, is part of WP:V (i.e. core policy). Bon courage (talk) 16:36, 17 September 2024 (UTC)[reply]
Right, I forgot it was tagged.
Regardless, it was tagged as giving disproportionate weight to the criticisms of the BMA, not to the BMA’s original critiques. I’m not opposed to succinctness, but we can’t detail the counter-arguments of others if we’re not listing the original argument posed in the first place. Do you disagree? Snokalok (talk) 10:00, 18 September 2024 (UTC)[reply]
I agree with my own edit (i.e. we should have neither). The BMA is not a good source, especially compared to what we have, for biomedical science, and so their pronouncements are undue. Bon courage (talk) 10:56, 18 September 2024 (UTC)[reply]
They are a respected professional body though, representing a very significant number of doctors. If the spirit of your edit is to have neither criticism nor countercriticism, I don’t necessarily disagree, but I feel that your edit as you made it, read as being decidedly weighted in favor of the countercriticism. Reading through it from the perspective of the unknowing reader, my first thought was “What was said that provoked such documented backlash?” and inevitably a reader after asking that question, will fill in the blanks according to their own preconceptions.
Personally, I think that however little notability the BMA critique might have, the response to it holds decidedly less, and so I’m confused as to why you saw it as worth giving more space than the BMA themselves. Snokalok (talk) 12:48, 18 September 2024 (UTC)[reply]
Huh? what "countercriticism" are you referring to as being weighted? You you please show me which of my edits you are referring to with a diff. Bon courage (talk) 12:52, 18 September 2024 (UTC)[reply]
The BMA story is obviously important and not mentioning it would be strange, but it's also the only UK medical organisation not to accept the review, despite being the least qualified and relevant to do so. It makes sense to keep coverage of it lean to ensure the article appropriately balances coverage against the unanimous acceptance by the organisations that actually oversee clinical practice. I think Void's right that it should be covered as a BMA topic rather than a Cass Review one. 212.36.63.7 (talk) 16:51, 17 September 2024 (UTC)[reply]
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