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Artillery Row

Maiming a generation

The medicalisation of gender non-conforming young people is the biggest medical scandal of our time

In 1961 an Australian doctor, William McBride, wrote to the Lancet about a significant rise in the number of babies born with serious deformities at his hospital, noting that all the mothers had taken a recently developed anti-morning sickness drug. Thalidomide was withdrawn later the same year.

The only good thing about the subsequent scandal was the speed with which the authorities moved. Even so, an estimated 10,000 babies worldwide suffered severe birth defects; a similar number died in utero. The timely actions of medical regulators saved countless more.

We’re in the middle of another medical disaster that rivals — some would say dwarfs — the Thalidomide affair. But unlike previous scandals, the medicalisation of gender non-conforming (GNC) young people has continued for years after clinicians first raised concerns. Disturbingly, these whistleblowers have been maligned by the pro-transition lobby and, worse, by fellow clinicians for speaking up.

One of those was Sonia Appleby, children’s safeguarding lead for the Tavistock and Portman NHS Trust which runs the Gender Identity Development Service (GIDS), the UK’s only gender clinic for under-16s. Sonia was approached by several members of staff in 2016 and 2017 who expressed alarm that many young people waiting for assessment by GIDS were being provided with puberty-blocking drugs by a private GP.

Appleby raised numerous concerns in private; these ranged from the rogue GP to the lack of adequate record keeping at GIDS, to overworked staff and other serious safeguarding issues. Nor was hers a lone voice: in February 2019 GIDS governor Marcus Evans resigned, warning that the service had an “overvalued belief in [its own expertise] which is used to dismiss challenge and examination”.

Whistleblowers in many sectors can expect a rough ride

A couple of months later five further clinicians resigned, saying they felt treatment amounted to “conversion therapy” for young lesbian and gay people. They told of homophobic parents bringing in their GNC children to “correct” their aberrant behaviour.  “There was dark joke among staff that there would be no gay people left,” two of them told The Times.

These concerns were reported by Newsnight last year:

There have been many times when the push to transition has come from families who are uncomfortable with the sexual orientation of their child [Newsnight reported]…some parents express real relief that their child is not gay or lesbian, suggesting being trans is a better outcome for their child.

More whistleblowers told their stories to the distinguished psychiatrist David Bell, who in 2018 wrote a report that wasn’t just ignored by GIDS: for unspecified legal reasons, the trust’s chief executive and chairman of the board both forbade him to send it to the council of governors; he was also told not to write or talk in public about anything “not directly connected to his NHS employment”.

Whistleblowers in many sectors can expect a rough ride; even so, in paediatric healthcare one would at least expect their warnings to be taken seriously. Appleby made several recommendations, including that the trust introduce a manual or policy to assist “clear thinking” about cases and assess whether there was a history of abuse. But instead of being listened to, Appleby found herself “vilified” by GIDS and subjected to “quasi-disciplinary” proceedings that damaged her professional reputation in social work and psychotherapy and prevented her from performing her role as safeguarding lead.

Meanwhile, GIDS’s approach remained essentially unchanged, even as the number of referrals grew by almost 40 per cent in the two years after she first raised concerns.

There are, however, encouraging signs that this chilling effect on safeguarding discussions is beginning to lift. Last Friday, Appleby was vindicated at an employment tribunal where she was awarded £20,000 in damages. This summer saw the beginning of a marathon tribunal into the actions of Dr Helen Webberley, the rogue GP about whom Appleby raised concerns.

The tribunal began in late July, scheduled for 55 days. I’m one of a large team of observers who have been reporting and live tweeting the proceedings. (You can read the charges against her here and follow us at @tribunaltweets.)

It won’t be over until the people who undertook these barbaric treatments are in the dock

The tribunal will run until October, but has already heard evidence from numerous experts in paediatric gender care who have stated that children and adolescents presenting with gender dysphoria must be treated by a multidisciplinary team (MDT). This should comprise multiple experts including a paediatric psychiatrist, clinical psychologist, endocrinologist, family therapist and social worker. In many, if not most, cases Webberley appears to have acted alone, including in one charge where she allegedly prescribed testosterone to a 12-year-old girl.

We have no doubt that the medicalisation of GNC young people over the last decade is the biggest medical scandal of our time, perhaps of all time. It is robbing thousands of children of their fertility and future sexual function, while a host of other serious side effects are only just now beginning to emerge. (These have been superbly and chillingly documented by Professor Michael Biggs). Most damningly of all, hormones and surgery were found to have no mental health benefits.

For some campaigners, the fight against medicalising GNC children will be won when GIDS halts its treatments and commits, fully and transparently, to evidence-based, peer-reviewed medicine. For others, it won’t be over until the people who championed and undertook these barbaric treatments are in the dock. Until very recently, however, it’s been the whistleblowers who have been subjected to disciplinary action.

With Appleby’s victory and the ongoing Webberley tribunal, we can sense a change in the air. The cheerleaders of child transition — most prominently, Mermaids, Gendered Intelligence and Stonewall — have long followed a strategy of deliberate obfuscation; they will be deeply worried at the unaccustomed sunlight. Subsequent inquiries should — must — widen their focus and examine the role of the charities that are encouraging children to transition and the lobbyists who work so hard to make public debate impossible. If we only seek to understand what happened rather than why and how, it’s only a matter of time before we maim another generation.

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