Dr Bernadette Wren, the former Head of Psychology at the Tavistock and Portman NHS Foundation Trust and Associate Director of the Gender Identity Development Service, defended the Service at great length in London Review of Books (2 December 2021). The LRB has just published (17 December 2021) two devastating critiques by former clinicians at the Tavistock, Kirsty Entwistle and David Bell, which are essential reading. Here is the response of Dr Michael Biggs, Associate Professor of Sociology at the University of Oxford and contributor to Transgender Trend.
Richard Rorty is a favourite philosopher of Bernadette Wren, and her Diary (‘Epistemic Injustice’, London Review of Books, 2 December 2021) brings to mind his definition of truth as ‘what your contemporaries let you get away with saying’.
Wren blames the disarray in her Gender Identity Development Service (GIDS) on the increasing number of referrals starting in 2016. She must know that a whistle-blower, Sue Evans, had already raised concerns over a decade before. The ensuing internal review in 2006 highlighted all the problems that have become familiar: the failure to collect basic data on patients (the unit did not bother to count the number of adolescents subjected to endocrinological intervention); the inability to understand informed consent; and the pressure from patients influenced by lobbying organizations. The review was buried, of course, until the Information Commissioner’s Office forced its release last year.
As Wren notes, the National Institute for Health and Care Evidence found no evidence to justify puberty suppression as a treatment for gender dysphoria. (The drugs have never been licensed for this condition, in the United Kingdom or anywhere else.) What she does not acknowledge is the responsibility of the GIDS for this lack of evidence. For over thirty years it has refused to collect data on long-term outcomes, conveniently losing track of patients when they turn 18. Indeed, it only published the short-term results of its initial experiment with puberty blockers after a protracted campaign by Stephanie Davies Arai and me.
Wren highlights the Care Quality Commission’s 2016 evaluation of the GIDS as ‘good’. She omits its more recent verdict of ‘inadequate’. This time the inspectors actually examined the medical files: ‘None of the records included a clear statement of what the service was assessing. Whilst the criteria for considering referring young people for administration of hormone blockers was set out in the service specification, we saw no reference to this on any patient records.’ Moreover, ‘the records of young people who began medical treatment before January 2020 did not include a record of their capacity, competency and consent.’ Was it a coincidence that clinicians started taking consent from patients exactly when the legal challenge to GIDS was launched in January 2020?
Central to that legal challenge was Keira Bell. Her absence haunts Wren’s Diary, which cites the eponymous legal judgment but never refers to her as an individual person, let alone a woman with the courage to speak honestly about her treatment. Wren continues to deny the harms inflicted on vulnerable patients like Keira Bell—say her name!—by clinicians who pursued what Wren grandiloquently calls a ‘justice project’ rather than practicing evidence-based medicine. As the former Head of Psychology at the Tavistock and Portman NHS Foundation Trust and the Associate Director of the GIDS, she should not be allowed to get away with it.