Last week’s release of the Cass Review brought to memory the old jingle: “Liar, liar, pants on fire; your nose is longer than a telephone wire.” Commissioned four years ago to probe the practices of the Tavistock gender clinic in Britain, the report methodically assembles a damning indictment of the flimsy evidence used to “transition” children.Its author, retired pediatrician Dr. Hilary Cass, is polite and professional, but she pulls no punches in exposing the false foundation upon which the entire edifice of “gender-affirming care” is built.Drawing extensively on a series of systematic literature reviews and in-depth interviews with doctors, parents, and patients, she writes:“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress… for the majority of young people, a medical pathway may not be the best way to achieve this.”Even social transitioning alone, she concludes, risks grave psychological harm for children. And social transitioning is often the prelude to puberty blockers. Dr. Cass skewers the oft-cited narrative that blockers are harmless and reversible, pointing to evidence of permanent negative effects on bone density and neuropsychiatric functioning. The report advises a U-turn from the “gender-affirming” construct of drugs and surgery toward a model of careful psychological counselling. Critically, this is the very “watchful waiting” approach that got Canadian psychologist Dr. Kenneth Zucker fired more than eight years ago as head of Toronto’s Centre for Addiction and Mental Health.Dr. Cass delivers a scathing indictment of the shaky evidence for guidelines used by the World Professional Association for Transgender Health, The American Academy of Pediatrics, and the American Endocrine Society. And she exposes their repeated practice of using non-evidence-based guidelines to justify other non-evidence-based guidelines.Not all lies are equal. White lies are the (mostly) harmless sort we tell to spare someone’s feelings. Black lies are the malicious untruths told to gain unfair advantage or to cause harm to others.But the “lord of the lies” is the “blue” lie: the sort of falsehood we tell each other and ourselves — often unknowingly — on behalf of our tribes. Such as in William Golding’s The Lord of the Flies, when a group of boys convinces themselves, without evidence, that there’s a beast in the forest — a delusion that turns deadly for Simon and Piggy.In my view, blue lies underpin the gospel of “gender affirming care”, which has led thousands of otherwise erudite medical professionals to discard the truth of the gender binary in favour of blatant interference with normal pediatric physiology.It’s important to emphasize that blue lies typically aren’t told with intent to mislead, or from a place of malevolence; their proponents genuinely believe they are on the side of truth. Combatting blue lies, therefore, is extraordinarily difficult. But not impossible. Two strategies are key:First, we need powerful insiders — not just members of the tribe, but prominent figures within it — to awake to their errors and begin to speak up. Such as when Finnish physician Riittakerttu Kaltiala, one of the architects of Finland’s youth gender transition program, stepped up last October to say:“Gender transition has gotten out of hand. When medical professionals start saying they have one answer that applies everywhere, or that they have a cure for all life’s pains, that should be a warning to all of us that something has gone very wrong.” Unfortunately, a common response to the Cass Review by gender-fluidity adherents has been to double down. Take Dr. Kristopher Wells, Canada Research Chair for the Public Understanding of Sexual & Gender Minority Youth:“The flawed UK Cass Report was issued today and is exactly what was expected from a country that is virulently anti-trans.”His is the sort of reaction that Washington Post columnist Megan McArdle, writing about the horrors of frontal lobotomies, describes as “The Oedipus Trap”: a situation where “it can be so psychologically devastating to discover you’ve made a mistake…that you will do everything in your power to avoid recognizing it.” Per Walter Scott: “Oh what a tangled web we weave, when first we practice to deceive!”Therefore, a second strategy — expertly employed by Dr. Cass — is crucial: the careful and patient exhibition of evidence, without hyperbole and without rancour.The Cass Review exposes a tangled web indeed. For her efforts, and for her courage, Hilary Cass deserves our deepest thanks.Dr. J. Edward Les, MD, is a pediatrician in Calgary and a senior fellow at the Aristotle Foundation for Public Policy.
Last week’s release of the Cass Review brought to memory the old jingle: “Liar, liar, pants on fire; your nose is longer than a telephone wire.” Commissioned four years ago to probe the practices of the Tavistock gender clinic in Britain, the report methodically assembles a damning indictment of the flimsy evidence used to “transition” children.Its author, retired pediatrician Dr. Hilary Cass, is polite and professional, but she pulls no punches in exposing the false foundation upon which the entire edifice of “gender-affirming care” is built.Drawing extensively on a series of systematic literature reviews and in-depth interviews with doctors, parents, and patients, she writes:“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress… for the majority of young people, a medical pathway may not be the best way to achieve this.”Even social transitioning alone, she concludes, risks grave psychological harm for children. And social transitioning is often the prelude to puberty blockers. Dr. Cass skewers the oft-cited narrative that blockers are harmless and reversible, pointing to evidence of permanent negative effects on bone density and neuropsychiatric functioning. The report advises a U-turn from the “gender-affirming” construct of drugs and surgery toward a model of careful psychological counselling. Critically, this is the very “watchful waiting” approach that got Canadian psychologist Dr. Kenneth Zucker fired more than eight years ago as head of Toronto’s Centre for Addiction and Mental Health.Dr. Cass delivers a scathing indictment of the shaky evidence for guidelines used by the World Professional Association for Transgender Health, The American Academy of Pediatrics, and the American Endocrine Society. And she exposes their repeated practice of using non-evidence-based guidelines to justify other non-evidence-based guidelines.Not all lies are equal. White lies are the (mostly) harmless sort we tell to spare someone’s feelings. Black lies are the malicious untruths told to gain unfair advantage or to cause harm to others.But the “lord of the lies” is the “blue” lie: the sort of falsehood we tell each other and ourselves — often unknowingly — on behalf of our tribes. Such as in William Golding’s The Lord of the Flies, when a group of boys convinces themselves, without evidence, that there’s a beast in the forest — a delusion that turns deadly for Simon and Piggy.In my view, blue lies underpin the gospel of “gender affirming care”, which has led thousands of otherwise erudite medical professionals to discard the truth of the gender binary in favour of blatant interference with normal pediatric physiology.It’s important to emphasize that blue lies typically aren’t told with intent to mislead, or from a place of malevolence; their proponents genuinely believe they are on the side of truth. Combatting blue lies, therefore, is extraordinarily difficult. But not impossible. Two strategies are key:First, we need powerful insiders — not just members of the tribe, but prominent figures within it — to awake to their errors and begin to speak up. Such as when Finnish physician Riittakerttu Kaltiala, one of the architects of Finland’s youth gender transition program, stepped up last October to say:“Gender transition has gotten out of hand. When medical professionals start saying they have one answer that applies everywhere, or that they have a cure for all life’s pains, that should be a warning to all of us that something has gone very wrong.” Unfortunately, a common response to the Cass Review by gender-fluidity adherents has been to double down. Take Dr. Kristopher Wells, Canada Research Chair for the Public Understanding of Sexual & Gender Minority Youth:“The flawed UK Cass Report was issued today and is exactly what was expected from a country that is virulently anti-trans.”His is the sort of reaction that Washington Post columnist Megan McArdle, writing about the horrors of frontal lobotomies, describes as “The Oedipus Trap”: a situation where “it can be so psychologically devastating to discover you’ve made a mistake…that you will do everything in your power to avoid recognizing it.” Per Walter Scott: “Oh what a tangled web we weave, when first we practice to deceive!”Therefore, a second strategy — expertly employed by Dr. Cass — is crucial: the careful and patient exhibition of evidence, without hyperbole and without rancour.The Cass Review exposes a tangled web indeed. For her efforts, and for her courage, Hilary Cass deserves our deepest thanks.Dr. J. Edward Les, MD, is a pediatrician in Calgary and a senior fellow at the Aristotle Foundation for Public Policy.
