Gone, but not forgotten
The gender-affirming model requires the erasure of inconvenient claims and data
Comment
Our gender clinic is “one of the world’s best” and our interventions to help children with gender dysphoria “adhere to strict clinical governance standards.”
Our treatment guideline has been “peer reviewed at the highest level, published in the Medical Journal of Australia [MJA] and adopted by healthcare providers across Australia and the globe.”
“As a public institution we expect and welcome public scrutiny that is fair, objective and factual.”
Such was the tone of the open letter issued by the Royal Children’s Hospital (RCH) Melbourne on 13 December 2019, the year in which international concern about experimental, “gender-affirming” medicine for minors reached Australia.1
But RCH Melbourne has shown little sign of welcoming scrutiny and now, sometime after April 18 this year, its open letter was taken down from the hospital website.
Why?
Was it because psychiatrist Alison Clayton began to ask difficult questions last year about a seeming lack of clinical governance oversight of the RCH gender clinic?
Was it because just two months before this open letter, a hospital governance committee—responsible for ensuring the efficacy and safety of new clinical practice—decided not to approve the radical new treatment model enshrined in the gender clinic’s treatment guideline? (We know this only now because of Dr Clayton’s inquiries.)2
Was it because a startling admission in the version of the RCH guideline published by the MJA led a pioneer of evidence-based medicine, McMaster University’s Professor Gordon Guyatt, to declare the document an “untrustworthy” guide for clinicians?3
Was it because that 2018 RCH guideline, misleadingly badged as “Australian standards of care,” has suffered other blows to its credibility, the most recent being a decision by Australia’s Health Minister Mark Butler to send it off for “a comprehensive review.”
Was it because, unlike the low-quality RCH document, the new guidelines to be developed by the National Health and Medical Research Council will be required to inform clinicians of the (low) quality of the evidence for puberty blockers and cross-sex hormones?4
Was it because the best-known global health provider to adopt the RCH guideline is the unguarded activist, Helen Webberley, who is the British co-founder of the online clinic GenderGP?5
Who knows?
Yesterday, I emailed RCH asking if the hospital still stood by its December 2019 open letter. No response, as usual.6
And then I began to find other broken links on the RCH website, other relevant material apparently poked down a “memory hole,” as Orwell would say.7
“A number of The Times [newspaper] which might, because of changes in political alignment, or mistaken prophecies uttered by Big Brother, have been rewritten a dozen times still stood on the files bearing its original date, and no other copy existed to contradict it. Books, also, were recalled and rewritten again and again, and were invariably reissued without any admission that any alteration had been made.”—George Orwell, 1984
Not found
Here is a list of some disappeared material at RCH Melbourne, with links to the remaining source page or automated Internet archives where they exist—
A September 2017 news item, “The RCH launches medical guidelines for trans youth care.”
A link to the hospital governance committee—the New Technology and Clinical Practice Committee—that denied approval to the gender service in October 20198
A link to the procedure for “Approval for the introduction of new medical technology, clinical practice, pharmaceutical agent or medical device.”
A September 2021 news item welcoming a ruling from a newspaper standards body, the Australian Press Council, which partially upheld a complaint by gender clinic director Dr Michelle Telfer against my 2019-20 coverage in The Australian.9
Social contagion
It’s not just RCH that has been spiriting away inconvenient material.10
The Sydney-based Sax Institute, funded by the Health Department of New South Wales (NSW), produced a 2020 gender dysphoria report with the capacity to oscillate between public and hidden status.
It was conveniently hidden when the Hunter New England Local Health District of the NSW department made the false claim that this “independent” Sax report had “found strong evidence for a gender-affirming approach to health care.”
After I wrote about this in March 2023, the Sax report magically reappeared in public mode.11
In mid-2022, New Zealand’s Ministry of Health quietly removed the reassuring phrase “safe and fully reversible” from its website’s promotion of puberty blockers.
Two years earlier, England’s National Health Service had shown the way, abandoning without announcement or explanation its online claim that blockers were “fully reversible.”
Towards the end of last year, the RCH Melbourne gender clinic also deployed a stealth edit to adopt a more defensive position on its website.
Its previous unqualified claim that blockers are “reversible”—a claim taken on faith by Australia’s Family Court in the 2013 case of a 10-year-old seeking puberty suppression—was transformed into the vague assertion that this intervention in normal development is “largely reversible.”
In the US, the World Professional Association for Transgender Health (WPATH) claimed in its current standards of care (SOC-8) that its treatment advice for adolescents was not based on a “gold-standard” systematic review because “the number of studies is still low, and there are few outcome studies that follow youth into adulthood.”
In fact, as part of preparations for SOC-8, WPATH had commissioned more than a dozen systematic reviews on treatment of adolescents and adults from researchers at Johns Hopkins University, presumably expecting positive data.
Court documents show that WPATH sought to suppress the unfavourable results of systematic reviews and to control their presentation and political effect, while requiring the Johns Hopkins researchers to state that WPATH had no influence in the process.12
In August 2019, I began to report the gender clinic debate in The Australian newspaper, drawing confidence from the fact of extensive, detailed media coverage in the UK ranging across outlets as different as The Times, BBC Newsnight, The Economist and The Observer.
As it happens, Googling away, I just found an old quote from then RCH gender clinic director Michelle Telfer which supports Dr Clayton’s argument that the 2018 treatment guideline represented a radical change from pre-existing practice at the clinic.
In 2014, Dr Telfer said: “We are committed to zero harm and the service is set up in quite a conservative way. We have a process that involves two child and adolescent psychiatrists evaluating the patient, a comprehensive medical assessment, fertility preservation counselling and extensive parent education counselling.”
What triggered Professor Guyatt was the RCH claim, made in a peer-reviewed version of the guideline, that, “The scarcity of high-quality published evidence on the topic [of youth gender dysphoria] prohibited the assessment of level (and quality) of evidence” said to support the guideline’s recommendations.
Mr Butler has said that the NHMRC will use the internationally recognised GRADE system to rate the quality of research data said to support treatment advice.
Unpersuaded by NHS England’s 2024 decision to cease routine use of puberty blockers on safety grounds, Dr Webberley insisted she would keep up the supply to British children in distress about their gender, prompting UK Health Secretary Wes Streeting to impose an indefinite ban on private prescription of these drugs to interrupt normal sexual development.
As ever, I don’t dispute that gender-affirming clinicians believe their interventions help vulnerable young people.
Some broken links may not be deliberate, but the opaque conduct of RCH and its gender clinic does not inspire confidence.
It appears some links that were public have been put behind the staff intranet and now require a log-in.
In 2019, the press council issued an activist-influenced guideline for reporting on “diverse gender identity.” The council, supposed to uphold accuracy, refers to sex being “assigned at birth.” It advises journalists to use the language rules of ACON, a trans activist group. The press council cited “privacy” when refusing to tell me which groups it had invited to help shape its trans reporting guideline.
In its 2021 ruling on Dr Telfer’s complaint, the council said my reporting had caused her “substantial distress” because my coverage implied that gender medicine was “out of step with mainstream medical opinion.”
It objected to my quoting non-gender experts, such as Carl Heneghan, Oxford University’s professor of evidence-based medicine, to the effect that gender medicine was experimental, so weak was its evidence base. Professor Heneghan’s 2019 review has been amply vindicated.
The RCH claim that gender-affirming medicine had been approved “at the highest level” first appeared in an August 2019 statement by the Australian Professional Association for Trans Health (AusPATH).
That statement defending the RCH model failed to disclose that AusPATH’s president, Michelle Telfer, was also director of the RCH gender clinic and first author of the clinic’s 2018 treatment guideline.
Nor was that conflict picked up by the Media Watch program of Australia’s public broadcaster, the ABC, which presented the hybrid professional-activist lobby AusPATH as if it were a normal medical college.
Hosting the program on 19 August 2019, Media Watch’s Paul Barry said my newspaper had been “accused of ignoring research. Last week, the professional body representing 250 doctors and workers in gender health, AusPATH, put out a statement condemning The Australian’s gender reporting as biased, emotive and not based on fact.”
Mr Barry also upbraided me for failing to “talk to any transgender children or their parents who could give first-hand experience of what it’s like to feel you’ve been born in the wrong body.”
From Dr Clayton’s work, we know that the following month, the RCH gender clinic would acknowledge the “paucity” of evidence to the hospital’s own clinical governance committee responsible for scrutinising new treatment models.
The AusPATH statement invoked the authority of Australia’s Family Court, saying its judges had “twice reviewed the academic and clinical evidence for medical intervention in [trans, gender-diverse and non-binary] adolescents through [the gender dysphoria cases] re Jamie (2013) and re Kelvin (2017).”
In the 2020 re Imogen case, however, a judge declared that the RCH treatment guideline was misleading clinicians about the law by advising them that “parental consent is not required when the adolescent is considered to be competent to provide informed consent”. After this ruling, the RCH gender clinic corrected the guideline, without any public explanation, and removed past Family Court decisions from its reference list.
Six months later, I noticed that the 2019 AusPATH statement had disappeared from the “news and advocacy” section of its website. I reported this fact, and then the statement resurfaced, albeit with the incorrect date stamp of 1 August 2018.
To bulk up the appearance of evidence, the Sax review of the scientific literature included low-quality treatment guidelines such as RCH’s.
See also the account of WPATH’s conduct in the recently issued HHS Gender Dysphoria Report from P155.
Brilliant work as usual, Bernard.
I can’t unsee the admission in the hearing before Family Court judge Andrew Strum that 100% of children referrred to the Gender Clinic that prides itself on having a “multidisciplinary approach” were put on puberty blockers.
Not one was treated with what every one of these children need - proper mental health support.
In the past, the ABC would have done its job as our public broadcaster of a thorough journalist Investigation that exposed exactly what we all know through your amazing work. The ABC’s negligence is unbelievable, and leaves the excuse “we just didn’t know” open to the politicians who actually do know, but are so cowardly they won’t act. “Governing for all Australians, but not vulnerable children” apparently.
I hope the demise of the Greens millstone will prompt a resurgence of reliance on science and ethical medical practice rather than ann unscientific (but immensely profitable) ideology.
The Australian Medical Association (AMA) Position:
The AMA supports gender-affirming care for children and young people, advocating for access to puberty blockers and hormone therapies, as well as gender affirmation surgery.
. . . . The AMA has again lost the plot in the pursuit of wokeness; It’s not difficult to understand why less than 30% of Australian doctors are members of the AMA