This is not how good scientific debate happens: academics on the culture of fear in gender medicine research | transgender

Ccritical thinking and open debate are pillars of scientific and medical research. However, experienced professionals are increasingly afraid to openly discuss their views on the treatment of children who question their gender identity.

That was the conclusion drawn by Hilary Cass in her review of gender identity services for children this week, which warned that a toxic debate had resulted in a culture of fear.

Her conclusion was echoed by doctors, academic researchers and scientists, who have said the climate has had a chilling effect on research in an area in desperate need of better evidence.

Some said they were deterred from pursuing studies they believed were crucial, saying that simply entering the arena would jeopardize their reputations. Others talked about social media abuse, the shutdown of academic conferences, publication bias, and the personal cost of speaking out.

In most areas of health, medical researchers are free to ask questions about problems without fear of judgement, said Dr Channa Jayasena, a consultant in reproductive endocrinology at Imperial College London. I have never known a field where the dangers are also in the way you see and your beliefs. You have to be careful about what you say both inside and outside the workplace.

Sallie Baxendale, a professor of clinical neuropsychology at UCL's Institute of Neurology, came under fire after publishing a review of studies that investigated the impact of puberty blockers on brain development. Her review found that critical questions remained about the nature, extent, and durability of any treatment-related impaired cognitive function development.

The paper, which summarizes the state of relevant research, was met with immediate reaction. “I've been accused of being an anti-trans activist, and that's now on Google and it's never going away,” Baxendale said. Imagine if this is the first thing that comes up when people Google you? Anyone publishing in this field should be prepared for this.

The lack of high-quality research highlighted by Cass has been a topic of growing concern among doctors, according to Dr Juliet Singer, a consultant child and adolescent psychiatrist and former governor of the Tavistock and Portman NHS foundation.

In 2020, Singer conducted a survey of child psychiatry trainees, which highlighted concerns about the lack of explanation for the exponential increase in referrals to adolescent sex services, the lack of long-term outcome studies on treatments, and insufficient evidence for long-term effects of hormone blockers.

She said raising questions such as what was driving the unprecedented rise in birth-registered girls presenting with gender-related concerns at puberty appeared to be considered unacceptable by some senior leaders at Tavistock.

There has been a shutdown of anyone who has suggested that we should think about a deeper understanding of why these young people are in such distress, she said. The difference from other common clinical practices has been remarkable.

Others have found that public comment on the scientific merits of work by other academics, usually a routine part of media coverage of science and health, has put scientists in the line of fire when it comes to related issues.

Jayasena described receiving hate mail afterward welcoming a study in the US in which a trans woman was given hormones so she could experience breastfeeding and, separately, was accused of transphobia after commenting on research about Athletic performance in trans women.

I felt concern for my safety, he said. I feel like my quotes are weaponized. This is very disturbing and most colleagues would never approach this type of subject for this reason.

Another senior researcher in endocrinology, who wished to remain anonymous, said medical professionals used to share concerns and views on anonymous WhatsApp groups.

Bad mouthing and social media ruining people's reputations and careers is so damning, the academic said. Professional people are concerned about how they will be characterized on social media and cannot express disagreement without resulting in very aggressive and inappropriate behavior. It makes people stop talking and just walk away from it and not get involved.

She added: That's not how good scientific debate happens, it happens when people can speak honestly and without fear.

The risk of being attacked is enough to deter younger searchers from entering the field, Baxendale believes. It's hard, I think most people would just walk away. Why risk your reputation? There are a lot of people early in their careers, and I don't blame them one bit, who wouldn't be prepared to accept that, she said.

The situation hampers efforts to create a strong medical basis for treatments, Baxendale believes. If the best researchers avoid the field, there is a danger that it will be dominated by less rigorous scientists and those who have an interest in their results supporting particular beliefs.

After publishing her review, Baxendale was contacted by a senior expert outside the UK who said they had walked away from a study after being told the team would only publish positive findings.

Jayasena says there has been a perception of research being dominated by a self-selected group of people who will be on both sides of the fence and perhaps not all that interested in advancing the field. And in the absence of a solid evidence base, there has been more room for ideology to fill the knowledge gap.

After all, I have seen completely useless views from both sides, Jayasena said. There is a very affirmative view of let's do everything. This results in what Id call bro-science. We were getting that disconnect between evidence and supposed knowledge because the internet is an echo chamber. Then there is the other side of things a more right-wing, moralistic view. Unfortunately, some members of the medical community are steeped in these views.

This can act as a barrier to learned societies, NHS bodies and scientific journals getting involved at any level.

In an attempt to find common ground between academics, doctors, patient groups and activists that could serve as a springboard for objective research, Singer attempted to organize a conference at Great Ormond Street Hospital in 2022.

The meeting was an invitation-only academic conference for specialist child psychiatry trainees and consultant child psychiatrists in London, and Cass was due to present her interim findings, alongside speakers with a range of perspectives, including ex- gender identity development services clinicians.

What I wanted to do with the conference was just to bring people with different perspectives together, she said. So clinicians working with children and adolescents can listen to different perspectives and, with an open mind, come to the right clinical and research questions to ask.

However, after a significant number of complaints were made and concessions were made to achieve a balanced programme, the conference was canceled by Health Education England a day before it was due to be held after a whistleblower report was submitted by someone describing himself as a researcher. on anti-trans conspiracy theories. Despite assurances that the conference would be reorganized by HEE and the Royal College of Psychiatrists, this has not yet happened.

Others spoke of the challenge of publishing studies in high-profile journals, raising concerns that some journal editors may prefer to reject studies rather than face potential criticism. As a consequence, papers that show gaps in knowledge in gender medicine can be ghettoized in particular journals, making those publications seem overly critical.

Prompted by concerns about the poor quality of research, the Cass report has set the stage for a major NHS trial due to start this year. It will examine the safety and efficacy of puberty blockers, but also cross-sex hormones used to masculinize or feminize people, and psychosocial interventions, with the aim of creating a strong evidence base.

Many hope that Cass's report, and the NHS trial it recommends, is an opportunity to draw a line under the infighting and abuse and create a more constructive field of gender medicine.

It will take time, but it allowed people to breathe and feel confident in addressing the questions, Singer said. People work in this field because they want to help young people, and that effort will still be there. His important and valuable work. Cass has now given us permission to do it.

Baxendale is acutely aware that many patients and their families, reading coverage of the Cass report this week, will be left wondering whether help will be available, whether treatments work and whether they can trust their doctors.

It must be so upsetting for them, she said. But I think there is hope. The NHS research will be rigorous, balanced to look at the benefits and harms, and I think once we get the results we will have a proper service for these children.