The Baroness Cass | |
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Born | London, England | 19 February 1958
Education | Royal Free Hospital Medical School |
Occupation | Paediatrician |
Known for |
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Medical career | |
Profession | Physician |
Field | Paediatric disability |
Institutions | |
Research | Neurodevelopmental disorders |
Member of the House of Lords Lord Temporal | |
Assumed office 22 August 2024 Life peerage | |
Personal details | |
Political party | Crossbench |
Hilary Dawn Cass, Baroness Cass, OBE , FRCN , FRCGP (born 19 February 1958), is a British paediatrician. She was the chair of the British Academy of Childhood Disability, established the Rett Clinic for children with Rett syndrome, and has worked to develop palliative care for children. She led the Cass Review of gender identity services in England, which was completed in 2024. Cass was appointed to the House of Lords as a crossbench life peer in the same year.
Cass is a former president of the Royal College of Paediatrics and Child Health, and a honorary physician in paediatric disability at the Evelina Hospital, part of Guy's and St Thomas' NHS Foundation Trust. [1] Prior to Cass's appointment at the Evelina Hospital, she had been consultant at Great Ormond Street Hospital for 15 years. Her research and interests have included autistic spectrum disorders, cognitive impairment due to epilepsy, children with visual loss, and care of children with multiple disabilities.
Hilary Dawn Cass was born on 19 February 1958 in London to Ralph and Mildred Cass. [2] She attended the City of London School for Girls. [3] [4] Cass studied at the Royal Free Hospital Medical School, graduating with a degree in medicine in 1982. [5]
Cass spent her early medical career in a general practice training scheme, during which she changed to paediatrics. [6] From 1992 to 2018, she was a consultant in neurodisability at three tertiary centres in the UK. [1] Her research and interests have included autistic spectrum disorders, cognitive impairment due to epilepsy, children with visual loss, and care of children with multiple disabilities, particularly where there are difficulties with feeding and communication. [5] In this field she has higlighted that medical innovations have resulted in a greater survival rate of children with severe incurable diseases, with the result that there are a greater number of children with severe disabilities. [7]
In 1992 Cass founded the Rett clinic, a national outpatient service for children with the neurodevelopmental disorder Rett syndrome, based at the Evelina Hospital, part of Guy's and St Thomas' NHS Foundation Trust. [8] [9] She later reported that self-injurious behaviour in Rett syndrome had a prevalence of 73.8%. [10]
From 1994 to 2009 Cass was consultant in paediatric disability at Great Ormond Street Hospital (GOSH). [4] There, she was appointed director of Postgraduate Medical Education and held the post of deputy medical director. [5] During that 15-year period she also held some regional and national positions in medical education and policy development, including head of the London School of Paediatrics. [5] [11] At GOSH, she authored a book titled Snakes and Ladders, based on a programme she led that used role play to understand patient journeys in the NHS and to teach staff clinical governance skills. [5] [12] [13] The book addresses communication between doctors and patients, and primary and secondary care. [13] Other topics covered include informed consent, medical negligence, medical paternalism, randomised controlled trials, and unlicensed treatments. [13]
In 2008 she published findings that did not support the opioid excess theory. [14] She reported on a large study she led that found no difference in urinary opioid peptide levels between those with autism and control subjects, and concluded that "opioid peptides can neither serve as a biomedical marker for autism nor be employed to predict or monitor response to a casein- and gluten-free diet". [14] [15]
Cass left GOSH after raising concerns about patient safety at the hospital. [16] The hospital denied that she quit over patient safety concerns. [17]
Cass joined the Evelina Hospital as consultant in 2009. [18] There, she developed palliative care services for children. [1]
In September 2020, Cass was appointed to lead the independent Cass Review for the NHS into gender identity services for children and young people. [1] [19] The interim report of the Cass Review was published in March 2022. [20] It said that the rise in referrals had led to the staff being overwhelmed, and recommended the creation of a network of regional hubs to provide care and support to young people. The report noted that the clinical approach used by the Gender Identity Development Service (GIDS) "has not been subjected to some of the usual control measures" typically applied with new treatments, and raised concerns about the lack of data collection by GIDS. [21] [22] [23] The recommendations resulted in the closure of GIDS. [24] The final report was published on 10 April 2024. [25]
Cass said after the publication of the review that she had received 'vile' emails and that she was not travelling by public transport after receiving security advice. She also said that she would not participate in the forthcoming review of adult gender clinics. [26]
In May 2024, she made her first US media interview, on WBUR-FM's On Point, whom she told "The evidence was disappointingly poor". Cass also responded to WPATH's criticism about prioritising non-medical care, saying the review did not take a position about which is best. Cass hoped that "every young person who walks through the door should be included in some kind of proper research protocol" and for those "where there is a clear, clinical view" that the medical pathway is best will still receive that, and be followed up to eliminate the "black hole of not knowing what's best". On the allegation that the review was predicated on the belief that a trans outcome for a child was the worst outcome, Cass emphasised that a medical pathway, with lifetime implications and treatment, required caution but "it's really important to say that a cis outcome and a trans outcome have equal value". [27]
In an interview with The New York Times in May 2024, Cass said that US doctors were 'out of date' on gender care. However, she also expressed concern that her review was being weaponized to suggest that trans people do not exist, saying "that's really disappointing to me that that happens, because that's absolutely not what we're saying." She also clarified that her review was not about defining what trans means or rolling back health care, stating "There are young people who absolutely benefit from a medical pathway, and we need to make sure that those young people have access — under a research protocol, because we need to improve the research — but not assume that that's the right pathway for everyone." [28]
In 2012 Cass was appointed president of the Royal College of Paediatrics and Child Health for a three-year tenure. [29] [30] Between 2017 and 2020 she was chair of the British Academy of Childhood Disability. [1] She is a trustee of Noah’s Ark Children’s Hospice, and was formerly chair of the charity Together for Short Lives. [1] [9]
Cass was appointed Officer of the Order of the British Empire (OBE) in the 2015 New Year Honours for services to child health. [31] [32] In the same year, she became an honorary fellow of the Royal College of Nursing (FRCN), and in 2016 an honorary fellow of the Royal College of General Practitioners (FRCGP). [1]
In the 2024 Dissolution Honours, Cass was nominated for a life peerage as a crossbencher. [33] [34] [35] She was created Baroness Cass, of Barnet in Greater London, on 22 August 2024. [36]
Cass is Jewish [37] and signed an open letter after the 7 October 2023 attack on Israel affirming her "Jewish values", [37] including endorsing the existence of the State of Israel and a two-state solution for the Israeli–Palestinian conflict. [37]
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: CS1 maint: DOI inactive as of January 2025 (link)The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Diseases (ICD).
Pediatric endocrinology is a medical subspecialty dealing with disorders of the endocrine glands, such as variations of physical growth and sexual development in childhood, diabetes and many more.
Lars Christopher Gillberg is a professor of child and adolescent psychiatry at Gothenburg University in Gothenburg, Sweden. He has been a visiting professor at the universities of Bergen, New York, Odense, St George's, San Francisco, and Glasgow and Strathclyde. Gillberg is the founding editor of the journal European Child & Adolescent Psychiatry.
Failure to thrive (FTT), also known as weight faltering or faltering growth, indicates insufficient weight gain or absence of appropriate physical growth in children. FTT is usually defined in terms of weight, and can be evaluated either by a low weight for the child's age, or by a low rate of increase in the weight.
Neurodevelopmental disorders are a group of mental conditions affecting the development of the nervous system, which includes the brain and spinal cord. According to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) published in 2013, these conditions generally appear in early childhood, usually before children start school, and can persist into adulthood. The key characteristic of all these disorders is that they negatively impact a person's functioning in one or more domains of life depending on the disorder and deficits it has caused. All of these disorders and their levels of impairment exist on a spectrum, and affected individuals can experience varying degrees of symptoms and deficits, despite having the same diagnosis.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness with a history of controversy. Although it is classified as an organic disease by a majority of researchers, it was historically assumed to be psychosocial, an opinion still held among many physicians. The pathophysiology of ME/CFS remains unclear, there exist many competing diagnostic criteria, and some proposed treatments are controversial. There is a lack of education and accurate information about the condition among a significant number of medical practitioners, which has led to substantiated accusations of patient neglect and harm.
Classic autism, also known as childhood autism, autistic disorder, or Kanner's syndrome, is a formerly diagnosed neurodevelopmental disorder first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.
Pitt–Hopkins syndrome (PTHS) is a rare genetic disorder characterized by developmental delay, moderate to severe intellectual disability, distinctive facial features, and possible intermittent hyperventilation followed by apnea. Epilepsy often occurs in Pitt-Hopkins. It is part of the clinical spectrum of Rett-like syndromes. Pitt-Hopkins syndrome is clinically similar to Angelman syndrome, Rett-syndrome, Mowat Wilson syndrome, and ATR-X syndrome.
Autism spectrum disorder (ASD), or simply autism, is a neurodevelopmental disorder "characterized by persistent deficits in social communication and social interaction across multiple contexts" and "restricted, repetitive patterns of behavior, interests, or activities". Sensory abnormalities are also included in the diagnostic manuals. Common associated traits such as motor coordination impairment are typical of the condition but not required for diagnosis. A formal diagnosis requires that symptoms cause significant impairment in multiple functional domains, in addition to being atypical or excessive for the person's age and sociocultural context.
Douglas Montagu Temple Gairdner FRCP was a Scottish paediatrician, research scientist, academic and author. Gairdner was principally known for a number of research studies in neonatology at a time when that subject was being developed as perhaps the most rewarding application of basic physiology to patient care, and later his most important contributions as editor, firstly editing Recent Advances in Paediatrics, and then of Archives of Disease in Childhood for 15 years, turning the latter into an international journal of repute with its exemplary standards of content and presentation.
Developmental regression is when a child who has reached a certain developmental stage begins to lose previously acquired milestones. It differs from global developmental delay in that a child experiencing developmental delay is either not reaching developmental milestones or not progressing to new developmental milestones, while a child experiencing developmental regression will lose milestones and skills after acquiring them. Developmental regression is associated with diagnoses of autism spectrum disorder, childhood disintegrative disorder, Rett syndrome, Landau-Kleffner syndrome, and neuro-degenerative diseases. The loss of motor, language, and social skills can be treated with occupational therapy, physical therapy, and speech therapy.
Neena Modi is a British physician and Professor of Neonatal medicine at Imperial College London. She is the current president of the UK Medical Women’s Federation, and past president of the Royal College of Paediatrics and Child Health, serving in this role from April 2015 to April 2018. She is one of only four women to ever hold this position.
Otto Herbert Wolff, was a German born medical scientist, paediatrician and was the Nuffield Professor of Child Health at Great Ormond Street Hospital. Wolff was notable for being one of the first paediatricians in Britain to set up a clinic for obese children. Later research into plasma lipids with Harold Salt pioneered the techniques of lipoprotein electrophoresis. He later conducted research into the role of lipid disturbance in childhood as a precursor of coronary artery disease and his recognition in 1960 of the rare condition of abetalipoproteinaemia. Wolff was also co-discoverer of the Edwards syndrome in abnormal chromosomes.
In February 1998, a fraudulent research paper by physician Andrew Wakefield and twelve coauthors, titled "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children", was published in the British medical journal The Lancet. The paper falsely claimed causative links between the measles, mumps, and rubella (MMR) vaccine and colitis and between colitis and autism. The fraud involved data selection, data manipulation, and two undisclosed conflicts of interest. It was exposed in a lengthy Sunday Times investigation by reporter Brian Deer, resulting in the paper's retraction in February 2010 and Wakefield being discredited and struck off the UK medical register three months later. Wakefield reportedly stood to earn up to US$43 million per year selling diagnostic kits for a non-existent syndrome he claimed to have discovered. He also held a patent to a rival vaccine at the time, and he had been employed by a lawyer representing parents in lawsuits against vaccine producers.
Ramesh Dulichandbhai Mehta is an Indian-born British Paediatrician at Bedford Hospital, and president of the British Association of Physicians of Indian Origin (BAPIO), in the United Kingdom.
The Gender Identity Development Service (GIDS) was a nationally operated health clinic in the United Kingdom that specialised in working with transgender and gender diverse youth, including those with gender dysphoria. Launched in 1989, GIDS was commissioned by NHS England and took referrals from across the UK, although it was operated at a Tavistock and Portman NHS Foundation Trust site. GIDS was the only gender identity clinic for people under 18 in England and Wales and was the subject of much controversy.
Srinivas Gada is an Oxford-based doctor, lecturer and academic. His work revolves around autism/ASD in children, Dyspraxia, Developmental Delay, Learning Disability, Emotional & Behavioural Disorders and Cerebral Palsy. Dr Gada has been teaching at University of Oxford. Dr Sri Gada is an Hon Senior Lecturer since 2007.
Richard Henry Reeve White was a paediatric nephrologist, emeritus Professor of Paediatric Nephrology from the University of Birmingham morphologist and archivist for British Association for Paediatric Nephrology.
The Independent Review of Gender Identity Services for Children and Young People was commissioned in 2020 by NHS England and NHS Improvement and led by Hilary Cass, a retired consultant paediatrician and the former president of the Royal College of Paediatrics and Child Health. It dealt with gender services for children and young people, including those with gender dysphoria and those identifying as transgender in England.
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