Irish Examiner view: Irish questions arising from the Cass review
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Despite a busy week for news, dominated by the accession of Simon Harris to the role of Taoiseach, it’s slightly surprising that more attention was not paid to a serious matter which touched upon one of his previous portfolios — health.
The controversies generated by a review of the work of the , at one time projected as the centre of expertise for healthcare for transgender children, might superficially seem to be several steps removed from the Republic of Ireland. However, between 2011 and 2021, some 234 young people in Ireland, an average of 21 per year, were referred to the establishment in north London which offers a gender identity development service programme.
The service was discontinued in 2022 following the publication of a highly critical independent report, with some 70 Irish youngsters still on the waiting list.
The review, carried out by Hilary Cass, a distinguished paediatrician and former president of the Royal College of Paediatrics and Child Health, investigated, as far as she was able in the teeth of scandalous obstruction from gender clinics, the provision of treatments for children under 18.
The findings, which posed fundamental questions about gender-related care, will have a significant impact on Ireland’s policies in the future. Children’s Health Ireland (CHI) issued a statement declaring there are fewer than 10 children in the Republic being prescribed what are known as “puberty blockers” — drugs which restrict the hormones, testosterone, and oestrogen that lead to puberty-related changes in the body. Some reports suggest the figure is higher because it does not include supplies obtained from overseas specialist clinics.
Dr Cass, who conducted the largest analysis of its kind in the world, said she found “remarkably weak evidence” for the field of gender care for children.
The debate, she reported, was exceptionally “toxic”, and “polarised”, stifling medical and scientific progress. Healthcare professionals were afraid to discuss their views openly. “This must stop,” she added.
Adult gender clinics attempted to thwart the inquiry by refusing to disclose whether transgender people who started their treatment as children later changed their minds about transitioning, or went on to suffer mental health problems. More than 9,000 children were treated by the gender clinic at Tavistock between 2009 and 2020. The majority of referrals were adolescent girls.
Dr Cass said it was “hugely disappointing” that the clinics would not engage in research that would help to inform future treatment. They have now been instructed to comply under threat of legal action.
The HSE says the Cass report will be reviewed as part of a new model of gender healthcare which be developed up to 2026. Until then, it says: “Service users will continue to receive healthcare in the community and under the endocrinology service in the adult and paediatric centres in Ireland East Hospital Group and Children’s Health Ireland.”
A new head for the service is reported to have already been recruited.
Ireland has never run a dedicated healthcare service for transgender children and the route to Tavistock is now shut. Its facilities were available to our practitioners under four health ministers: James Reilly, Leo Varadkar, Simon Harris, and Stephen Donnelly.
It is perhaps another reminder that while outsourcing treatments and tests to other countries can seem a smart and efficient solution, it can — as it did with the cervical smear controversy — produce its own problems. We are unlikely to have heard the last of Tavistock, and of the legal and political ramifications on this subject.
There are high stakes involved in attempting to ensure that Saturday night’s airborne attack by Iran on Israel does not escalate into a prolonged and full-scale conflict which will have profound effects on the world.
Iran, principal backer of the Hamas terrorist organisation, launched more than 300 drones and missiles in its first ever direct attack on the Jewish state. It was its response to the bombing, attributed to Israel, of an Iranian embassy annex in Damascus 15 days ago which killed several Islamic Revolutionary Guards officers and a senior commander. Hezbollah in Lebanon and Yemen-based Houthi forces also fired missiles in what appeared to be a concerted offensive.
For a time, the skies over Israel recalled the scenes from the Gulf War of 1990/1991, where Patriot missiles were used, with mixed results, to intercept incoming Russian-made Scuds. Israel’s Iron Dome defence system, developed with substantial financial backing from the US, has proven to be a much more formidable barrier.
Jerusalem claimed that, with the help of allies such as the US, France, Britain, and Jordan, that 99% of the launches were thwarted. It was, they said, a “significant strategic success”. An emergency session of the UN Security Council was being called last night by Israel but in advance, Tehran said it regarded its action — Operation True Promise — as a conclusion to its response to the attack on its staff in Syria.
“Should the Israeli regime make another mistake, Iran’s response will be considerably more severe” it said on X. “It is a conflict between Iran and the rogue Israeli regime, from which the US must stay away!”
It is vital that these flames are doused before they ignite a wider crisis. Such a conflict would jeopardise the world, prevent any chance of ceasefire or hostage release in Gaza, and render any discussions on recognising Palestine hopeless. Progress relies on the forbearance of Benjamin Netanyahu. Prospects do not look good.
Tánaiste Micheál Martin is correct to up the ante with technology companies and warn them to “get underage children off your apps” or face legal consequences.
His comments came in a week when WhatsApp, with its sophisticated end-to-end encryption, joined TikTok, Instagram, X, Snapchat, and Facebook in reducing its minimum age to 13 — and when the paediatrician Dr Hilary Cass cited online influencers for circulating “dangerous” and “unbalanced” information.
One commentator this week suggested we will look back on the current obsession with social media in much the same way we do at smoking and alcohol abuse — and wonder why we were so liberal and reckless in allowing its growth. The time for change is long overdue.