Continuing the theme, Jacky Davis in the Observer on Saturday:

he British Medical Association is both a trade union and a professional organisation. Professional activities such as its successful campaigns around seatbelt legislation and smoking have added weight to its standing as a union. It is not noted for drama and histrionics.

So there was significant surprise when its governing body, the BMA council, recently voted to reject the recommendations of the Cass review…

BMA members were genuinely outraged. Letters to the BMJ accused the council of bringing “the BMA and the medical profession into disrepute”. One correspondent said they were “more shocked than anything I can think of in 40 years of practising medicine”. Some members, aghast at the BMA adopting such an irrational policy, resigned after decades of union membership. A letter accusing the BMA of being secretive and opaque, and of going against the principles of evidence-based medicine and ethical practice, quickly attracted 1,500 signatures, 1,000 of whom are BMA members. The signatories include many high-profile names in the profession, people not normally inclined to sign protest letters.

So what’s the deal? How did this happen?

How did the BMA end up so completely out of touch with its members? In brief, the union is the victim of entryism, a political strategy whereby members of an organisation join a larger organisation in order to influence and change its policies. Resident (previously known as junior) doctors were angry about the sharp fall in their pay since 2008 and organised a group called DoctorsVote to campaign for full pay restoration. Part of the group’s strategy was to get its members on to the BMA council, which they did with great success, taking almost half the voting seats in 2022.

So far, so reasonable: the BMA is a trade union and its core role is to improve the working conditions of doctors.

But, of course, the BMA council didn’t stop there.

DoctorsVote is disciplined when it comes to pursuing its agenda (which turned out to go beyond full pay restoration to include entrenched opinions on the transgender debate), and in voting group members on to BMA committees.

And of course the entrenched opinions on the transgender debate aren’t medical, in fact they’re more the opposite of medical. The opinions are religious rather than medical.

So why did the BMA, which is not a scientific body such as Nice, feel it could criticise and undermine Cass’s work? The BMA has allowed itself to get into a position whereby a vocal minority of council members with an anti-Cass agenda have engineered policy that the membership have not been consulted on and do not agree with. While they are sincere in their beliefs, these council members have no hard evidence for their opposition, and good intentions aren’t enough to guide medical practice. It must be underpinned by evidence.

And this is especially important when the contested policy is very bad for people. It’s not a good idea to help patients ruin their bodies on the basis of a political belief that contradicts medical realities.