Subscribe to Holyrood updates

Newsletter sign-up


Follow us

Scotland’s fortnightly political & current affairs magazine


Subscribe to Holyrood
by Mandy Rhodes
22 April 2024
The Cass Review is a watershed moment which should shame our politicians

Published earlier this month, Hilary Cass' review is already regarded as a landmark report | Alamy

The Cass Review is a watershed moment which should shame our politicians

I am not sure that Mhairi Black will remember with such clarity as I do, her ‘no debate’ assertion to me that puberty blockers were completely reversible. Or that Patrick Harvie will even recall the high-handedness with which he dismissed my genuine inquiry of why so many young girls with autism were presenting as transgender with a, “because they can”. 

But it was these dogmatic reactions, of four or five years ago, that helped draw a toxic dividing line in the whole sex and gender debate that pitted sides, prevented measured debate, and led us to a place now where, potentially, one of the worst medical scandals of our time has been committed in plain sight, with our children effectively used as guinea pigs. 

With clinicians so cowed by gender ideologues they felt compelled to use unevidenced treatments on troubled teens. Unquestioning politicians who believed they were on the ‘right side of history’ lining up as enthusiastic cheerleaders for lobbyists peddling contested ideologies.

And with parents caught in an invidious vortex of desperate children, long NHS waiting lists, inadequate counselling services, and the omnipresent threat of where failure to do the ‘right thing’ might, ultimately and tragically, take their child from them.

The Cass Review, 388-pages long, four years in the making, by exploring gender identity services for children in England, reviewing international practice, painstakingly reading records, and led by a world-renowned pediatrician, whose independence and medical credentials could not be faulted (although inevitably, in this febrile environment, they have been), has such profound consequences for our nation’s children that I for one could not believe that the Scottish Government’s initial reaction was to basically sit on it, because, well, it was quite long, only referred to England, and anyway, clinicians should decide.

Puberty blockers were banned down south for under-18s on the grounds of safety even before the final publication of the Cass Review as evidence of their harms became clear. But not so here, where we were following exactly the same clinical principles and procedures but where our politicians, caught in a maelstrom of gender ideology and doing the right thing, prevaricated and then deflected back to the views of clinicians. What did they think Professor Hilary Cass, former president of the Royal College of Paediatrics and Child Health, was, other than the clinical expert?

I am dumbfounded by the proposition that by some magic of Scottish exceptionalism, our young, gender-questioning people were somehow genetically predisposed to having built-in protections against their brains being damaged, their bones being thinned, or their sexual function in later life being catastrophically dimmed by the ongoing prescribing of an experimental use of drugs mainly used in male cancer patients with prostate problems. 

So now, of course, I welcome the announcement of a similar prohibition in Scotland even coming as it does, less than 48 hours after ministerial statements spelling out the fact that Cass didn’t apply here, and that time was needed to consider such a long report.

And for those people who disregard all this with a sigh, asking why politics is so consumed by the ‘trans issue’ when there are bigger fish to fry, perhaps they should put to one side their preconceptions about what ‘this’ is all about and their misinterpretation of what politics is for, and instead consider what is more important in terms of the power of our elected representatives than the safeguarding of the next generation.

What other potentially catastrophic child abuse scandal would be so lightly dismissed with the excuse that there is nothing to see here, particularly when Cass had delivered a blueprint to follow? 

I am old enough to remember the shock exposé of thalidomide and the seminal role The Sunday Times’ dogged investigative unit had in laying that bare. But just imagine if we had simply accepted the drug company’s assertion that babies born with no limbs was an act of God.

Imagine if we hadn’t probed the efficacy of the morning sickness medication that was being unwittingly downed by pregnant women. Imagine if we had just continued to trust in the integrity of clinicians and blindly accepted everything that big pharma regurgitated as fact. And imagine if we had ignored the political interference that undoubtedly thwarted the legal attempts to get to the truth. 

Scandals and cover-ups happen because of a combination and collision of powerful forces, albeit sometimes wrapped up in an initial desire to be doing the right thing. And as we unpick the incredibly detailed work of Dr Hilary Cass, the parallels of past scandals are there to be seen.

Cass found that the bar for allowing young people to change gender was built on incredibly flimsy foundations, and without good evidence of the long-term effects of chemical treatments such as puberty blockers and even more damaging, cross-sex hormones. She warned of the pressures that families were put under who felt forced to allow their children to transition for fear of being labelled ‘transphobic’ and similarly, clinicians who harboured any doubts about the direction of travel felt unable to voice their concerns for the same fear of being labelled a bigot.

Evidence wasn’t sought, records weren’t kept and shockingly, practitioners working with young people who had transitioned, simply refused to share any data so their outcomes are unknown.
The Cass Review is, as the former Scottish Children’s Commissioner says in the later pages of this magazine, “a watershed”.

Its publication should take the heat out of one the most contested areas of modern medicine and put the role of evidence, ethics and efficacy to the fore. Except, it appears, in Scotland where politicians seemed to concern themselves more with the harms to young people of the toxic debate (that ironically, they helped generate) than the toxins being pumped into our children’s developing bodies. Hopefully that intellectually deficient position can now change.

Holyrood Newsletters

Holyrood provides comprehensive coverage of Scottish politics, offering award-winning reporting and analysis: Subscribe

Read the most recent article written by Mandy Rhodes - The SNP doesn't need another 'reset', it needs a complete rework.

Get award-winning journalism delivered straight to your inbox

Get award-winning journalism delivered straight to your inbox


Popular reads
Back to top