by Dan Hitchens
Wednesday, 2
December 2020
Spotted
17:49

In the Keira Bell case, the NHS trust had no answers

Many open questions remain about puberty-blockers
by Dan Hitchens
Keira Bell

Yesterday’s High Court judgement, which set strict limits on how far children can consent to puberty-blockers, was not meant to be a verdict on gender-identity treatment, let alone on the transgender movement. As Keira Bell, who brought the case, said: “This judgment is not political, it’s about protecting vulnerable children.”

Nevertheless, the case has political implications. For years, anyone who raised concerns about gender-identity treatment was shouted down, and told that the experts knew what they were doing. But now those experts have had to present evidence in court: the defendant was the NHS trust responsible for gender-identity treatment, and the judges heard evidence from the country’s leading specialists. And the result is a judgement — from senior judges — that the standard practice was not doing enough to protect children. Moreover, the ruling exposed just how little is understood about these treatments.

For instance: in 2011 the male-female split in those seeking treatment was 50/50. Now, three-quarters are girls uncomfortable with a female identity. That seems worth accounting for; but, according to the judgement, the NHS trust “did not put forward any clinical explanation as to why there had been this significant change.”

What about the numbers who have a diagnosis of Autistic Spectrum Disorder — which some studies suggest could be linked? No, the NHS trust doesn’t collect those statistics either. “Again,” the judges write, “we have found this lack of data analysis — and the apparent lack of investigation of this issue — surprising.”

Were there any examples of children giving consent for PBs, but the doctors concluding that they weren’t really able to consent? You guessed it: the Trust “could not produce any statistics on whether this situation had ever arisen.” How often are PBs a direct pathway to more serious cross-sex hormones? “No precise numbers are available” on that either.

Not only is this kind of data absent, the actual effects of the treatment are also unclear. The judges note that until June 2020, the NHS website claimed that the effects of PBs are “considered to be fully reversible”. This has since been updated to say that “Little is known about the long-term side effects.”

PBs should, the judges say, be considered an “experimental treatment”, since there is “very limited evidence as to its efficacy, or indeed quite what it is seeking to achieve.”

The same mystery, of course, hangs over the trans revolution of the last decade. It, too, is an experiment. But what is it seeking to achieve? And what effect will it have? Given the furious reaction towards anyone who looks critically at these questions, we may not find out until it’s too late.

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Fraser Bailey
Fraser Bailey
1 year ago

…the NHS trust had no answers.’

Never trust any organisation with the word ‘trust’ in its title. I find this to be an infallible rule.

D Ward
D Ward
1 year ago
Reply to  Fraser Bailey

I have the same aversion to anything with the following words in them: “supreme”, “justice”, “democratic”

Andrew D
Andrew D
1 year ago
Reply to  D Ward

Yes, also ‘social’

emmamaysmith3
emmamaysmith3
1 year ago

An interesting fact which came out of this case: a therapist tried to persuade the claimant, Keira Bell, out of transitioning: “the psychiatrist attempted to talk of the gender spectrum as a way of persuading me to not pursue medical transition. I took this as a challenge to how serious I was about my feelings and what I wanted to do and it made me want to transition more. Now I wish I had listened to her.”

That doesn’t fit the narrative that most articles on this case wish to push, does it?

m pathy
m pathy
1 year ago
Reply to  emmamaysmith3

Keira Bell had a total of 3 one-hour sessions before she was ‘affirmed’ into medical intervention. I’d suggest that this was manifestly inadequate. There were clinicians and staff who had left their jobs in Tavistock because of disquiet over its overall direction. So a psychiatrist being reluctant to begin Bell on her transition is hardly a fact that destroys the “narrative”.

Ian Barton
Ian Barton
1 year ago
Reply to  emmamaysmith3

It doesn’t fit the narrative exactly. However, most people who have brought up teenagers know that questioning a path they have chosen is almost certain to just harden their resolve.

The case for the defence is not improved by this inclusion.

polidoris ghost
polidoris ghost
1 year ago
Reply to  emmamaysmith3

An illustration of what we have always known: There are people willing to carry out the most obscene acts in the name of their religion, or their ideology, or their science. It is the responsibility of the rest of us, the sane people, to keep them locked up.

emmamaysmith3
emmamaysmith3
1 year ago

Interestingly, I had a long comment in reply to this post which has not been approved. Unherd should seriously consider the benefit of open debate rather than censoring opinions, lest opponents accuse them of not being genuine in their stated beliefs of free speech.

Adrian
Adrian
1 year ago
Reply to  emmamaysmith3

If you posted a link, a bot would have removed it.

Laura Creighton
Laura Creighton
1 year ago
Reply to  emmamaysmith3

Also, if you use the word s*x, with an ‘e’ where I put the asterisk, a bot will moderate your post. Some human may let it in much later.

polidoris ghost
polidoris ghost
1 year ago
Reply to  emmamaysmith3

A surprising number of words that you think perfectly normal are automatically blocked because they have a different usage in the US. For example, one cannot sn*tch at something as I have been known to do. And woe betide you if you mention going to a stall at an agricultural fair and buying a pair of those nice f*ggots, as I did. Perhaps one day the US will acquire a civilised approach to life in general and the English language in particular. In the meantime, asterisk is your friend.

Adrian
Adrian
1 year ago

The Trans Movement (I don’t mean trans people themselves) is attempting to wrest power from The Matriarchy without acknowledging that The Matriarchy exists.
This power is to be given to a new Matriarchy composed of women who are not white and who are below the age of 60.

Judy Johnson
Judy Johnson
1 year ago

What about parental consent? I suppose we know from the numbers of youngsters having treatment how many parents give consent but I would be interested to know how many parents withold consent.

emmamaysmith3
emmamaysmith3
1 year ago

Were there any examples of children giving consent for PBs, but the doctors concluding that they weren’t really able to consent? You guessed it: the Trust “could not produce any statistics on whether this situation had ever arisen.” How often are PBs a direct pathway to more serious cross-sex hormones? “No precise numbers are available” on that either.

The trust explained that they would continue to see the child, maybe over many years, until the child was able to give consent.or was discharged. As the ability of children to consent changes over the course of years, this is the right approach.

They provided figures for the provision of puberty blockers and cross sex hormones from a case sample: 84% of referrals received neither puberty blockers nor cross sex hormones; 7.3% received puberty blockers only; and 8.7% received puberty blockers followed by cross sex hormones.

It is interesting to note that, contradicting what is often suggested, the vast majority of children referred to gender identity services receive only therapy and not medical intervention.

PBs should, the judges say, be considered an “experimental treatment”, since there is “very limited evidence as to its efficacy, or indeed quite what it is seeking to achieve.”

The doctors explained that a) most medicines used for children are effectively “experimental” as there is no licensed therapeutic use, and b) that a study on trans children receiving puberty is due to be published soon, but has had some delays due to recent events.

The same mystery, of course, hangs over the trans revolution of the last decade. It, too, is an experiment. But what is it seeking to achieve? And what effect will it have? Given the furious reaction towards anyone who looks critically at these questions, we may not find out until it’s too late.

I thought this case was about protecting the interests of children? I wouldn’t mind if authors stated clearly if a) they’re interested in the protection of children or b) they’re using this case to attack some supposed “trans revolution”. It’s tedious to read an article which appears genuine on the surface but in reality just dislikes trans people as a whole.

Let me be clear, we can debate trans people, but let’s do so directly. No more unfair Trojan Horse articles which pretend one thing but have a secret goal.

Matthew Powell
Matthew Powell
1 year ago

It sounds like an institution which should have been under the control of medical professionals, acting in the best interests of their patients, was captured by ideologues interested in advancing their own aims.

This is not to say gender reassignment isn’t the correct treatment for gender dysmorphia but that transitioning has not been rigorously analysed as medical treatment on the basis of individual case histories. Instead it has been has been treated as unquestionable fact, even encourage as the only option for some patients, by those with no medical background and this is dangerous.

If science not afforded independence from the political sphere, it is doubtful the West’s fine tradition in leading the world in it will survive into the future.

Sarah H
Sarah H
1 year ago
Reply to  Matthew Powell

It would seem a perfect storm of people seeking a treatment rather than coming with a problem and a group of people keen to meet their demand, some dedicated dissenters not withstanding.

Just noting that the terminology around sex and gender and unchallenged terms like ‘trans’ obscure more than they illuminate. There are a whole bunch of different things under this ideological umbrella pushed on to society. They need separating out. Clinical diagnoses seem worryingly fashion dependent but it’s not surprising. If someone says they are Jesus we don’t offer a spot on a cross yet here we are. There is a small group who I would call sex dysmorphic from early childhood who compassionately merit sex reassignment from say early 20s when they find they can’t live in their birth sex. Everyone else should be examined with the utmost scepticism and rigour to explore what else is going on simply for their own well being.