Medicine and Science from The BMJ Revisiting the Cass Review on gender identity services, and non-invasive brain stimulation for children with autism
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May 8, 2026 David Strain, associate professor in cardiometabolic health and Chair of the BMA Board of Science, breaks down the BMA critique of the Cass review and its clinical implications. Benjamin Becker, professor of psychology and neuroscience, discusses accelerated transcranial magnetic stimulation research in childhood autism. They focus on evidence gaps, clinical uncertainty, trial design, safety and how brain-targeted approaches might be combined with behavioral training.
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Political Bans Remove Clinical Autonomy
- The BMA criticised the Secretary of State's outright ban on puberty blockers as politicising clinicians' ability to prescribe off-label.
- Strain argued clinicians routinely use off-label drugs (e.g., amitriptyline) and political bans remove medical judgement and patient shared decision making.
Recommendation Versus Prohibition Had A Different Outcome
- Cass recommended specialist, research‑environment use rather than routine off‑label prescribing, but government responded with an outright ban.
- Strain compared the ideal response to the bariatric pathway: specialist centres with governance and long-term follow-up, not prohibition.
Manage Uncertainty As A Core Clinical Skill
- Manage clinical uncertainty by balancing available evidence and being prepared to change practice as new data arrive.
- Strain advises clinicians should respect differing opinions and focus on managing uncertainty as core medical practice.