David Smith

It is a pleasure to serve under your chairship, Mr Mundell. Any debate in which we are talking about the health and wellbeing of children and young people requires us all to be measured in our remarks, not least in the context of a debate that has been so toxic at times. Our focus in clinical studies and in any treatment that we offer anyone, let alone children, should be: “First, do no harm.” It is that axiom that seems to be at the heart of the Medicines and Healthcare products Regulatory Agency intervention that has paused the puberty blocker trial. To summarise where we have got to with the PATHWAYS trial, parents are being asked to consent to a potentially life-altering intervention to their children in the absence of a life-threatening condition, based on an unreliable diagnosis with an unknown trajectory. I urge the Government to go one step further and cancel the trial altogether, not least because there are alternative approaches for us to establish the facts regarding the use of puberty blockers, and to do so with an approach that is compassionate, understanding and holistic. The only question we should be asking in relation to gender dysphoria is: what is the best approach to support those who experience it? Dr Cass said in her review: “The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.” In the context of that really good review, the PATHWAYS trial was a mistake. I welcome the trial being paused, because there is so much else that we can do. The MHRA has said that ultimately puberty blockers can be very dangerous for bone health and cognitive development, with other long-term effects. We must move from a pause of the trial to its cancellation. There are other types of studies that we can do; I suggest we focus on a data linkage study.