Dissing Cass

A human rights body misrepresents the inquiry run by paediatrician Hilary Cass

Photo by Abhishek Yadav on Unsplash

A senior official of an Australian human rights body has likened England’s landmark Cass report to disinformation from a “village idiot”.

In a public webinar earlier this week, Kenton Miller of the Victorian Equal Opportunity and Human Rights Commission also falsely claimed that the Cass review’s survey of the evidence for youth gender medicine was “based on a very limited number of studies only within the UK.”

He told the webinar audience that the Cass review was “not legitimate at all” and he put it in the context of a surge in “dangerous messaging” that it was “unnatural” to be transgender.

“Because we now live in a very global village, unfortunately, that means we get to inherit some of the village idiots from other places, which means that a lot of the disinformation that’s out there, such as the Cass report, makes its way into our headlines and our media, with very little information being shared,” Mr Miller said.

The 2020-24 Cass review was led by the distinguished British paediatrician Dr Hilary Cass, a former president of the Royal College of Paediatrics and Child Health. Her 388-page report outlines the world’s most comprehensive study of how best to respond to the unprecedented surge in gender-distressed teenagers, chiefly girls, many of them with autism, mental health disorders, awkward same-sex attraction and family trauma.

After systematic reviews of the international scientific literature, the Cass report found there was “remarkably weak evidence” to support puberty blockers and cross-sex hormones for gender-distressed minors. In England, blockers have been restricted to clinical trials and Dr Cass has urged “extreme caution” before any use of cross-sex hormones with minors.

Activists for the dogmatic “gender-affirming” treatment model have misrepresented the Cass review, forcing the publication of FAQs to counter false claims.

“Adults who deliberately spread misinformation about this topic are putting young people at risk, and in my view that is unforgivable.”—Dr Hilary Cass, BBC news, 21 April 2024

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Does he speak for the commission?

The Victorian human rights commission did not answer GCN’s questions about Mr Miller’s commentary on the Cass review.

He made the remarks on Tuesday when hosting a 90-minute briefing on Victoria’s Change or Suppression (Conversion) Practices Prohibition Act 2021, which is one of the more extreme versions of the template-driven “conversion therapy” bans pushed through parliaments internationally with scant evidence to support them.

As Mr Miller’s briefing slides explained, the Victorian law carries a penalty of ten years in prison for someone who engages in a prohibited practice causing serious injury.

Following the global activist template, the law treats “gender identity” like sexual orientation and provides a specific exemption to protect from prosecution those assisting a person undergoing or considering a medicalised gender change.

“If a young person who is attracted to others of the same sex experiences confusion or distress related to this sexual orientation and has few helpful adults or role models in the surroundings to present a positive image of being gay or lesbian, he or she may conclude that their body is ‘wrong’ in some way. Having reached this conclusion, they seek a referral to a gender clinic instead of mainstream mental health services. Such cases have been reported in the two [BBC] Newsnight documentaries covering the Tavistock youth gender clinic GIDS. These young people are misinterpreting the kind of service they need and seeking inappropriate solutions.”—LGB Alliance, UK parliamentary submission, January 2022

Puberty suppression

Victoria’s human rights commission, which has a role in reporting to the police, had until recently claimed on its website that a parent refusing to support a child’s request for puberty blocker drugs would be in breach of the law.

In its list of illegal practices, the commission included “a parent refusing to support their child’s request for medical treatment that will enable them to prevent physical changes from puberty that do not align with the child’s gender identity…”

In March this year, after this public claim had been quietly dropped, a spokesman for the commission acknowledged to GCN that “it is not clear how the law will apply to an omission by a parent, such as a parent refusing to consent to medical treatment for their child.”

“In the absence of case law, we are continually working to build our understanding of how the Change or Suppression (Conversion) Practices Prohibition Act may be interpreted by the judiciary.”

How the commission came to make its puberty blocker claim was not explained.

Emeritus professor of law Patrick Parkinson said: “Any decent lawyer should have known that an omission to do something could not possibly be a ‘conversion practice’ since it would do nothing to alter a child’s gender identity. So, was the commission being deliberately misleading?”

“[UK] Health Secretary Victoria Atkins has told MPs she has a ‘clear intention’ to introduce a ‘banning order’ on puberty blockers. The Conservative minister set out plans to use a power bestowed on secretaries of state through the Medicines Act 1968, which would stop medical firms from selling, supplying or importing puberty blockers. Labour’s shadow health secretary Wes Streeting said he ‘welcomed’ Ms Atkins’ approach to puberty blockers...”—PA Media, news report, 24 May 2024 

Promoting blockers

Mr Miller’s LinkedIn profile states that he was “principal advisor (change and suppression practices)” at Victoria’s human rights commission from October 2022 to August 2023 “on secondment to support the roll out and review of the important Change and Suppression (Conversion) Practices Act”.

His current position is listed as “principal adviser, projects” at the commission.

Under the heading “Resources” Mr Miller’s webinar slides this week linked to the gender clinic at the Royal Children’s Hospital Melbourne, whose “Australian standards” treatment guideline still claims that puberty blocker drugs are reversible, despite the gender clinic’s acknowledgement in 2022 that their effects on the still growing adolescent brain are unknown.

One of Mr Miller’s slides, seeking to dispel false claims about Victoria’s change and suppression law, depicts a person alarmed by a document that states, “You will go directly to jail for talking to your child.” This document carries a banner headline “LIES AND DISINFORMATION!”

“People who are gender non-conforming experience stigmatisation, marginalisation, and harassment in every society. They are vulnerable, particularly during childhood and adolescence. The best way to support them, however, is not with advocacy and activism based on substandard evidence. The Cass review is an opportunity to pause, recalibrate, and place evidence-informed care at the heart of gender medicine.”—Dr Kamran Abbasi, editor-in-chief, the British Medical Journal, editorial, 11 April 2024

Global view

Far from being confined to the UK, the Cass review commissioned eight international research projects, comprising six systematic reviews (the gold standard for judging the quality of evidence for health interventions), an evaluation of gender dysphoria treatment guidelines, and a survey of gender clinics.

The paper reporting the systematic review of puberty blockers, for example, summarised outcomes of puberty suppression from studies in the US, UK, Israel, the Netherlands and Belgium.

And the paper highlighted the fact that earlier systematic reviews—including a 2018 review involving Dr Ken Pang, the head of research at the RCH Melbourne gender clinic— had “consistently found mainly low-quality evidence [and] limited data on key outcomes or long-term follow-up.”

The Cass-commissioned evaluation of guidelines cites documents from the US, the UK, Finland, Canada, South Africa, Australia, Sweden, New Zealand, Spain, Italy, Denmark, and Norway. The treatment guideline from RCH Melbourne scored only 19/100 for the rigour of its development, compared with 71 for Sweden’s 2022 document.

The paper reporting the evaluation noted how treatment guidelines referenced one another in a circular fashion, creating a misleading impression of consensus for the gender-affirming model.

Australian gender clinics—including those at RCH Melbourne, the Perth Children’s Hospital and the Queensland Children’s Hospital—took part in the Cass review’s survey of clinics. The Cass-commissioned researchers pointed out that Australian clinics are using an experimental fast-track path to puberty blockers for children as young as age 8-9.

Video: The UK-based LGB Alliance sets out the risks of puberty blockers

Teachable moment

A spokesman said Victoria’s human rights commission was charged with “providing information and education about change or suppression practices and advancing the objectives” of the state’s 2021 ban on conversion therapy.

Mr Miller’s presentation this week made no mention of traditional exploratory psychotherapy, an ethical, non-invasive intervention which might help a gender-questioning minor.

In 2021, Victoria’s government was warned by doctors’ and psychiatrists’ societies that the draconian “anti-conversion” draft law conflated sexual orientation and gender identity and could criminalise normal therapeutic exploration of minors whose real issues might be masked by gender distress.

Earlier this month, in response to a question in parliament from David Limbrick of the Libertarian Party, Victoria’s Attorney-General Jaclyn Symes, said she was “giving careful consideration to the timing” of an in-built review of the state’s conversion therapy ban.

The human rights commission’s explanation of the law is here.

In her final report, Dr Cass warns UK legislators against the unintended consequences of an anti-conversion law that covers the novel concept of gender identity.

She points out that “children and young people with gender dysphoria may have a range of complex psychosocial challenges and/or mental health problems impacting on their gender-related distress.

“Exploration of these issues is essential to provide diagnosis, clinical support and appropriate intervention.

“The intent of psychological intervention is not to change the person’s perception of who they are but to work with them to explore their concerns and experiences and help alleviate their distress, regardless of whether they pursue a medical pathway or not.

“It is harmful to equate this approach to conversion therapy, as it may prevent young people from getting the emotional support they deserve.

“Throughout the [Cass review], clinicians working with this population have expressed concerns about the interpretation of potential legislation on conversion practices and its impact on the practical challenges in providing professional support to gender-questioning young people.

“This has left some clinical staff fearful of accepting referrals of these children and young people.

“Clinical staff must not feel that discharging their clinical and professional responsibility may expose them to the risk of legal challenge, and strong safeguards must be built into any potential legislation on conversion practices to guard against this eventuality.

“This will be of paramount importance in building (as opposed to diminishing) the confidence of clinicians working in this area. Any ambiguity could serve to further disadvantage these children and young people rather than support them.”