Dr Ian Durrant discusses the importance of research following a landmark review into gender identity services for young people.

In April 2024, the final Independent review of gender identity services for children and young people was published by Dr Hilary Cass.

This comprehensive report has added to the debate about services for children who experience a range of issues related to their gender identity. The media have focused on the more sensational aspects of this report, fuelling accusations of transphobia, often made by self-proclaimed influencers, many of whom have probably not read the full report or have certainly misunderstood it. Dr Cass has received abuse and feels her report is the target of misinformation.  Her report notes how the debate around gender identity and transition, in particular, is polarised and now takes place in a toxic culture.

Critics and supporters alike are advised to read the report in full to evaluate the merits of the 32 recommendations and the evidence upon which they are based and to understand that decisions regarding the efficacy of medical treatments should be evidence-based rather than ideological.

Section 1 of the report reviews a variety of evidence and the methodology on which it was based, highlighting that large, carefully developed randomised control trials (RCTs), combined with systematic reviews and meta-analyses, are of the highest quality. This means comparing the long-term effects of a treatment to those of controls who have not received the treatment. RCTs are considered the gold standard of medical research; when properly conducted, their outcomes are hard to argue against. Evidence-based practice is now advocated across many other public services, including the police and education. Such an approach is often discussed under the umbrella of positivism. Although positivism has been criticised as reductionist and even patriarchal, at its core, it is about establishing facts through observation and logical reasoning based on objective evidence. A common misunderstanding of positivism arises from confusing causation with correlation and assuming that it relies solely on quantitative data, which in turn can be manipulated through statistics to support any claim. Or in the words of Balfour, ‘there are lies, damned lies and statistics.’

Those who criticise positivism and the use of statistical inference to establish the effects of interventions, whether medical, criminal, or educational, are often those who least understand it. As Ben Goldacre points out in his book Bad Science, it is often humanities graduates who make up much of the media. He cites the MMR scandal which, although started with the Wakefield paper of 1998, was fueled by an ill-informed media, the devastating consequences of which our children are still living with. Had journalists been more research literate in 1998, they would have quickly seen the flaws in the original Wakefield research and not championed its dangerous conclusions.

Similarly, in 2024, if journalists and the public took on board the merits of good-quality research and the flaws of poor-quality research, they would better understand the conclusions drawn by Cass and engage in rational debate.

What is needed to inform the debate about treatments and therapies, including those related to gender identity, is better education in and understanding of research methodologies and data analysis, rather than ideologically driven passion.

Dr Ian Durrant, is Senior Lecturer in the School of Humanities and Educational Studies.