The British Medical Association’s (BMA) refusal to endorse the findings of a landmark independent review of studies and guidelines related to so-called “gender-affirming care” has led to a “fracture” between the organization’s leadership and the doctors it claims to represent.
Dr. Jacky Davis, who has been a BMA member for 18 years and serves as a member of its council, said the group’s rejection of the findings of British pediatrician Dr. Hilary Cass is “irrational” and has left the medical profession “in an uproar,” The Observer reported earlier this month. The Observer is the Guardian’s weekly magazine.
Cass and her team from the University of York conducted a systematic examination of studies and guidelines focused on the use of puberty blockers and other medical interventions used to treat children and adolescents suffering with gender dysphoria.
The reviewers concluded in a far-reaching report released in April that the “gender-affirming care” model of medical intervention for young people is based on “remarkably weak evidence.”
“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” Cass wrote, observing that puberty blockers – which suppress the natural production of hormones and delay the onset of puberty – were found in “multiple studies” to compromise bone density and fertility and lead to other harmful effects.
The review also found that the majority of minors who receive prescriptions for puberty blockers move on to cross-sex hormones, debunking the claim by LGBTQ activists that prescribing puberty blockers to young children simply allows them more time to consider a new gender identity.
Cass’ report was widely welcomed within the UK and in other countries, but the BMA’s council claimed the review contained “unsubstantiated recommendations” and urged its members to “publicly critique” it.
The organization also said it would be undertaking its own evaluation after academics expressed concern about Cass’ approach to the review.
As The Observer reported, the BMA is “the only medical organisation in Britain to not accept and to find fault with Cass’s findings, which were accepted by the last government and its Labour successor.”
Writing in The Observer as well, Davis, a consultant radiologist, described a high degree of rancor within the organization since the public rejection of Cass’ findings:
BMA members were genuinely outraged. Letters to the BMJ accused the council of bringing “the BMA and the medical profession into disrepute”. One correspondent said they were “more shocked than anything I can think of in 40 years of practising medicine”. Some members, aghast at the BMA adopting such an irrational policy, resigned after decades of union membership. A letter accusing the BMA of being secretive and opaque, and of going against the principles of evidence-based medicine and ethical practice, quickly attracted 1,500 signatures, 1,000 of whom are BMA members. The signatories include many high-profile names in the profession, people not normally inclined to sign protest letters.
Davis explained the BMA – which is also a trade union – appears to have grown “completely out of touch with its members” as a result of “entryism, a political strategy whereby members of an organisation join a larger organisation in order to influence and change its policies.”
Since 2008, she explained, some doctors in residency grew increasingly enraged about cuts in their pay and organized a group called DoctorsVote to work for higher pay.
“Part of the group’s strategy was to get its members on to the BMA council, which they did with great success, taking almost half the voting seats in 2022,” Davis observed. She also observed DoctorsVote is “disciplined when it comes to pursuing its agenda (which turned out to go beyond full pay restoration to include entrenched opinions on the transgender debate), and in voting group members on to BMA committees.”
“A toxic atmosphere developed in the council chamber, and a climate of fear and intolerance of genuinely held beliefs meant that some people were reluctant to express opinions that were out of step with DoctorsVote,” she added.
In August, the BMA called for the ban on the prescription of puberty blockers for young people under the age of 18 to be overturned.
“This is a highly specialized area of healthcare and as doctors we want to be sure they get the most appropriate care and support they need,” said BMA leader Professor Philip Banfield.
The organization, however, has been accused of undertaking a “witch-hunt” to try to determine which high-ranking member leaked that the BMA had decided to oppose the landmark Cass review.
A spokesperson for the Cass Review countered that their study is “the largest and most comprehensive review of evidence on the subject seen, looking at 237 papers from 18 countries,” as the BBC noted.
Additionally, a Department of Health and Social Care spokesperson said the Cass Review is “a robust report backed by clinicians and firmly grounded in evidence.”
“NHS England will be implementing Dr. Cass’s recommendations so that children and young people get the safe, holistic care and support they need,” the spokesperson said. “We do not support a delay to vital improvements from the NHS to gender services.”
“The BMA now finds itself isolated in its opposition to Cass, and with its reputation and integrity damaged,” Davis wrote. “The prognosis for the union is not terminal, but it needs to acknowledge the mess that it is in and then to pull itself back from the brink of what one critic has called ‘its descent into madness.’”
