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The British Medical Association’s decision to challenge the Cass review and condemn the puberty blockers ban has started a civil war
The anger is palpable in the voice of Dame Professor Clare Gerada as she demands to know what right Britain’s biggest doctors’ union has to second-guess the Cass review – the landmark report on NHS child gender services, which found that children had been let down by a lack of research into medical interventions – after it announced it would lobby against implementing the recommendations.
“Cass took four years and did thousands of interviews, eight independent systematic reviews, had endless consultations and has come up with a very good report,” Gerada, a former president of the Royal College of General Practitioners, says. “Then along comes the British Medical Association in a meeting that no one is really invited to and makes this ruling.
“What right has the BMA to second-guess the Cass review, the Academy of Medical Royal Colleges – which represent our professional values – and the three major royal colleges covering psychiatry, paediatrics and GPs?”
Published in April by leading paediatrician Dr Hilary Cass, the review found that there is “remarkably weak evidence” about the long-term impact of puberty-suppressing hormones, known as “puberty blockers”. Last month, the Government renewed a temporary ban on the drugs’ prescription to children not already taking them.
But while the review has been accepted and supported by the vast majority of the medical establishment, the BMA announced on July 31 that it would lobby against the implementation of its recommendations.
The union said that following a motion passed by the BMA council it will set up a “task and finish” group to “publicly critique” the review. It went on to publicly condemn the Government’s restrictions around puberty-blocker prescriptions.
Today the BMA’s membership is at risk of being riven apart by this extraordinary decision – and more than 1,400 doctors have signed an open letter expressing their “dismay” at the BMA’s position. Among them are 70 professors and 23 former or current presidents of medical royal colleges and clinical leaders – some of the country’s most eminent physicians.
Gerada is one of them. She says she wants to know: “Why is the BMA doing this?
“I prescribe medicines to children and adults and every single one of those medicines has been through rigorous clinical studies. I can tell patients what the reason for that medicine is and the risks and benefits. That’s standard.
“All the Cass review is doing is saying we need to do the same for puberty blockers. This is about making medicines safe for children.”
Gerada, 64, who has been a member of the BMA since she was 18, also questions how the union is going to carry out a thorough “critique” of the Cass review by January, which is when it has said it will present its evaluation.
“What does the BMA think it is going to do in four months and what expertise is it going to draw on? My view is it should not be doing this. The arrogance of that beggars belief…
“After Christmas I am going to seriously consider whether I will apply for a council position on the BMA or resign.”
Dr Az Hakeem, a consultant psychiatrist, has specialised in treating patients with gender dysphoria. He resigned his BMA membership some years ago and today he has his own take on why the union has taken this stance.
“The BMA has been taken over by a brigade of people wearing red braces and putting pronouns in their bios who have turned their back on evidence-based medicine in favour of a cult of ideology,” he argues.
“To dismiss the very hard work of Dr Hilary Cass and her team and their four years of evidence-based research is a mockery of the position that they hold.”
Other doctors, current members of the BMA, feel equally vehement about the issue. Dr Stella Kingett, who heads a group on women and mental health at the Royal College of Psychiatrists, argues that the union hasn’t “protected debate” and believes that the debate at council didn’t involve enough people.
“As doctors we should be used to having difficult discussions and appraising the evidence dispassionately and I’m just disappointed that that’s not been done better,” she argues.
“I felt I had a duty to speak up to say this motion doesn’t represent me.”
For Dr Camilla Kingdon, who until March this year was the president of the Royal College of Paediatrics and Child Health, the biggest concern with the BMA’s stance is the effect it might have on the children using these services.
She points to the fact that thousands of children – in excess of 5,700 at the last count – are on the waiting list for gender services and warns that by effectively calling for the implementation of the Cass review recommendations to be delayed, the BMA is “not serving children well”.
“My heart sank when I saw the BMA motion,” she admits. “We cannot afford to have any further delays in offering them high quality care. Yet the BMA is essentially saying it wants to delay the Cass review because it wants to have another look at it.
“I find that extraordinary when Hilary Cass took four years and consulted all over the world. Her report is also underpinned by some robust reviews undertaken by the University of York. How the BMA thinks it is going to do better than that by Christmas I find quite staggering.”
The letter from doctors revolting against the BMA’s position on the Cass review, first revealed by journalist and author Hannah Barnes in The New Statesman, accuses the BMA of failing to represent doctors.
Entitled “not in my name”, the correspondence criticises the union of being “opaque and secretive” in passing the motion on the review.
It stressed that no information had been released on how many of the BMA’s individual council members had voted for the proposed “critique”, adding that the outcome did “not reflect the views of the wider membership, whose opinion you did not seek”.
Consultant psychiatrist Dr Lenny Cornwall, who has been a member of the BMA since 2016, argues that the incident has exposed the “outrageous way” the doctors’ union is operating.
“I hadn’t quite realised how it [the BMA council] operates in terms of it being so secretive,” he says. “It is taking an ideological decision when the Cass report is a scientific review. That is not an appropriate thing for a medical union to do.
“It should be saying you have to accept the medical scientific process. It is not a matter for the BMA to review medical scientific evidence.”
Responding to criticism, a BMA spokesman says: “The BMA will not be re-doing the Cass review; rather, we are at the start of what will be an impartial, neutral and evidence-led process – critical analysis and understanding of published evidence against accepting it on face value is hugely important.
“We will begin with gathering more detailed information on the nature of the criticism of the review and investigate the validity of those concerns with appropriate scientific rigour.”
One of the questions Cornwall still has is why the council voted for this motion, when so many of its members have since vocally opposed it. Speaking about past BMA council elections, he recalls: “Last time round, there was a slate of people standing who were saying ‘please vote for me’ and taking a more radical position, mainly with regards to junior doctors’ terms and conditions.
“I don’t know who voted on this motion [about the Cass review], but my guess would be that it’s a group of largely younger doctors,” he speculates.
“I’ve seen some comments on the discussion groups of junior doctors advocating strongly on the strikes saying actually this issue is undermining us on that.”
The BMA council currently has 69 members who can vote, all elected by the membership, with a geographical mix as well as five seats designated to ethnic minority members. Council members are intended to represent all branches – from GPs, consultants and specialists to public health medicine and academics, as well as junior doctors and retired doctors. At present some 22 of the 69 council members are listed as “Junior Doctor”. A further five are medical students.
The motion was reportedly tabled by Vassili Crispi, a junior doctor in Yorkshire, and consultant anesthetist Dr Tom Dolphin, who was previously a chair of the BMA’s junior doctors committee.
Dolphin, who has acted as a media spokesman for striking doctors, has previously boasted of charging the NHS £1,870 for a single cover shift during the strikes. Later he donated the sum to the BMA’s strike fund, writing on X (formerly Twitter) that the war chest “supports people to strike, meaning the strike is stronger and the win will come sooner”.
Last October, in another post on X, he described the Conservative government’s decision to ban trans women who were born male from female hospital wards as “cruel, unworkable and almost certainly illegal”.
Crispi, meanwhile, who was also said to have been active in driving the doctors’ strikes, is the co-author of a paper, published in a medical journal, that called for the adoption of “gender-neutral terminology”, and demanded that LGBTQ+ education must be “embedded” with the undergraduate curricula for medics and ‘regularly revisited during postgraduate training”.
A third doctor who backed the motion was Emma Runswick, 28, the deputy chairman of the BMA council. She too has been central in the pro-strike coalition of junior doctors who were elected to the BMA’s leadership body in 2022 and she describes herself as “unashamedly socialist”. (She is the daughter of two Labour activists who have supported former Labour leader Jeremy Corbyn.)
She has been open on social media in sharing her view on puberty blockers. In one post, she criticised Health Secretary Wes Streeting’s ruling to continue the ban on puberty blockers for children as a “terrible political decision”.
For many medics, one of the greatest surprises isn’t the motion to challenge the Cass review but the sheer number of medics willing to publicly oppose the BMA’s stance. Gerada and Cornwall point out that previously many doctors were fearful of speaking out on issues of child gender treatments. That “bubble” has now burst.
“This has fired up doctors in a way that I hadn’t quite grasped when I signed the letter,” Cornwall says. “When the signatories go up to more than a thousand you realise that actually there’s a massive strength of feeling here.
“That’s because the Cass review was seen as such a relief because people have been so frightened to challenge gender-affirming care for children for fear of being called a bigot.”
The longer term impact on the BMA – and whether such deep fractures within it can ever truly be healed – remains to be seen. It has prompted Kingett, a BMA member since 1999, to consider her future with the union, despite being an active member and chair of a local committee.
“I have considered leaving the BMA,” she admits. “But [for now I will] try to get my voice heard and see if the senior BMA leadership will listen and change course somewhat… I think the BMA is worth fighting for.”