I applaud Sonia Sodha’s clarity and incisiveness. The de facto rejection of the Cass report by the BMA council is unconscionable (“The BMA’s stance on puberty blockers defies the key principle of medicine: first, do no harm”).
As a late-career GP, I have watched closely the debates around the treatment of adolescent gender dysphoria unfold over the past decade. There have been many red flags: the administration of experimental treatments with potential lifelong adverse consequences to vulnerable children; the influence of campaigning organisations on clinical decision-making; the exceptionalism used to justify overriding accepted standards of evidence and ethics.
So, like every doctor I know, I breathed a sigh of relief when Dr Hilary Cass published her report. Exemplary in its rigour, it demonstrated convincingly that puberty blockers and cross-sex hormones for distressed children have no place in medical practice, unless within a carefully regulated research framework.
Astonishingly, part of the leadership of our profession has rejected these clear conclusions. The history of medicine is littered with examples of well-intentioned doctors unwittingly causing harm.
Fellow doctors: please push back against the BMA on this issue. The harm caused by our profession on our watch is the responsibility of us all.
Dr Jim Boddington
London E8
I am a trans person who has known they’re trans since before seven years old. Until 13, I thought I was alone in my experience, and then concern around how I would be perceived meant not having the confidence to come out until my late 20s.
The BMA put out its statement after months of consideration. The Cass review has been condemned by paediatricians and endocrinologists who specialise in transgender healthcare for its dismissal of large-scale studies not using randomised control trials. The ethics of using randomised control trials on people experiencing gender dysphoria should be clear. If puberty blockers are being used to treat what is ultimately something mental and innate to oneself, depriving a young person of this via a placebo is tantamount to refusal of treatment, which will have untold consequences for the already vulnerable person. Trials using other methods show that puberty blockers are effective in relieving dysphoria – giving the patient time to consider their identity delaying an unwanted puberty.
I find the argument that transness is a conduit for other identity issues disingenuous. Teaching every child they aren’t alone in their experiences – whether it’s sexual or gender identity, body image, menstruation, trauma, neurodiversity – creates a non-individualistic mindset that fosters supportiveness of others. Depriving trans youths access to medical treatment from a professional teaches them that they aren’t equal, affecting their mental health and ultimately societal health. We entrust doctors with our health. “We” includes young trans people.
Jas Crowe
London EC1
Tax, not loans, for graduates
A graduate tax would have been better than student loans – it could have been charged to boomers and others who obtained the advantages of “free” higher education in an earlier generation (“‘I’d be better off if I hadn’t been to uni’: UK graduates tell of lives burdened by student loans”). The only advantage of loans was an accountancy quirk which meant that public expenditure on loans could be negated in the public accounts by the fictional value of future repayments. But those who take out student loans must recognise that being a student is a privilege that many people would like but cannot obtain. It is an investment that carries risks. It is a gamble that does not always work. It would be a mistake to simply cancel all student debt. Much better to give every teenager an entitlement to £100,000 of education which they can take at any stage of their life. And charge high earners accordingly.
John Bibby
York
Getting under Trump’s skin
I do not think Catherine Bennett has taken into account the difference between Trump’s personality and Boris Johnson’s in her argument that Americans have already “baked in” Trump’s weirdness, as the British apparently accepted Johnson’s antics, ludicrous comments and lies (“We know Trump is weird – it’s time for the Democrats to get creative with the insults”).
Johnson has an inbuilt superiority complex from his background and education and obviously thought it clever to act the clown. Trump has a massive inferiority complex, as is clear from his bullying and name calling of any antagonist or anyone even slightly different.
The “weird” label works brilliantly for two reasons: first, it gets under his extremely thin skin right into his fragile personality; second, it works perfectly on social media with the much younger audience that is now becoming engaged. Other approaches will also have to be used, but so far the Harris team, in concert with younger voters, is managing to turn everything Trump tries back on him.
Helen Carmichael
Maidstone, Kent
Share this land with the larks
I walk over Middlewick Ranges, near Colchester, with great appreciation, and am exasperated to hear the MoD blandly say it is “planning to sell the site to deliver the best value to the taxpayer” (“Ecologist taking on MoD to protect skylarks says he has faced threats and assault”).
Best value will be achieved by keeping the land in public ownership for a mix of social housing to let, leisure facility and nature reserve. If the land is sold to private developers, these companies immediately take a profit at taxpayers’ expense, and subsequent private property owners benefit from house price inflation, and/or the benefits system supporting tenants in their private rented property, again at the expense of the taxpayer.
Fabian Bush
Rowhedge, Colchester, Essex
Who’s to blame for sewage?
I have sympathy with the frustrations of those people refusing to pay their wastewater bills, but the article sheds no light on who is at fault (“It’s just raw profiteering”). The presumption is that it’s the water companies. Is this fair? Water companies are required to fulfil their regulatory obligations agreed at each price review.
Have they done so? If they have, then the wrath of protesters should be aimed at regulators. If they haven’t, the water companies must be held to account. I suspect it is a mix – with regulators prioritising lower water bills over environmental clean-up, while water companies took advantage of weakened regulatory oversight during the Tory years. Before jumping to conclusions, however, the government should order an independent review to get to the facts, determine root causes of failures and then take appropriate action to deliver better results.
Bill Kingdom
Oxford
You’ve got to hand it to Henry
Presumably, Thierry Henry’s “sense of what he perceives to be injustice” was only in development in 2009 when he handled the ball twice, leading to the goal that eliminated Ireland from World Cup qualification? (“Thierry Henry harnesses Olympic flame to stake claim for France job”).
Mick O’Driscoll
Heanor, Derbyshire
