The decision by Glasgow’s Sandyford gender clinic to pause the prescription of puberty blockers to children is good news for the children of Scotland. In due course, a public inquiry is needed into how doctors ever got involved in what may possibly be one of the greatest medical scandals of all time. For now, however, it’s important that no more children are harmed by an experimental treatment that in many cases did not improve children’s mental health and sometimes made the situation worse.
That’s what the Cass Report told us when it was published on 10 April. NHS England – who commissioned the report – had seen enough to halt the use of puberty blocking drugs the previous month. It raises the question of why it has taken so much longer for the health service north of the border to respond. Children are the same whichever side of the river Tweed they happen to live. Sadly the same is not true for politicians.
Activists, politicians, policy makers and doctors need be asked some rather difficult questions
Speaking for the UK government, Rishi Sunak welcomed the report immediately. The prime minister said, ‘We simply do not know the long-term impacts of medical treatment or social transitioning on [children], and we should therefore exercise extreme caution.’ Well said!
Meanwhile Humza Yousaf prevaricated. Earlier this week he told the BBC, ‘When it comes to the prescribing of medicine, clinicians are best placed – not politicians, government ministers or myself as first minister.’
The fact that the Cass Report was led by one of the most senior clinicians in the UK must have passed him by. Or perhaps he dismissed Dr Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, as an English clinician? Yes, her report may have been commissioned – and presumably paid for – by NHS England but doctors have duty to respond to such a comprehensive bundle of facts wherever they happen to practice in the UK.
That may well have sparked yesterday’s announcement by the Sandyford clinic. If there is to be a reckoning down the line, activists, politicians, policy makers and doctors need be asked some rather difficult questions. Activists, of course, can cite the obvious defence that they were hardly experts, and that they were simply setting forward their own opinions and ideas. Even those promoting harmful practices were only offering advice. If politicians and policy makers had done their job and shown the activists the door, we might not be in the mess we are today. They are answerable to their employers and the voters respectively, but a defence of incompetence may be enough to limit the consequences to dismissal from their roles.
Doctors, however, have a professional responsibility to do no harm, and a duty to be competent. The drugs peddled to children at the Tavistock and the Sandyford clinics might have been off list but they were still on prescription, and those prescriptions were signed by doctors. If there was any wiggle room before, there is none now. The Cass Report was damning, ‘no changes in gender dysphoria or body satisfaction were demonstrated’ during puberty suppression. In simple terms, the treatment doesn’t work.
At the same time Cass noted that, ‘bone density is compromised’ and there was ‘insufficient/inconsistent evidence about the effects of puberty suppression on psychological or psychosocial wellbeing, cognitive development, cardio-metabolic risk or fertility’. The risks, in other words, were profound.
Those facts are the same in London and Glasgow, whether the First Minister likes it or not. Any doctor who chooses to ignore them cannot be allowed hide behind a defence of ignorance or incompetence should they be called in to face the music. It’s telling that the Sandyford clinic has read the writing on the wall and fallen in line with England. Meanwhile we wait to see if Humza Yousaf can bring himself to do the same.
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