More controversy over the puberty blocker trial

Should articulating a belief that it's wrong to allow men to self-identify into female sport disqualify a scientist from oversight of the clinical trials of puberty blockers?

Image from the MHRA

To be human is to have beliefs about the world. No one is opinion-free, and it would be ludicrous for professions where impartiality matters - like being a judge, a civil servant, or a scientist - to demand that. What impartiality actually requires is that people’s decision making is, as Akua Reindorf KC puts it “informed, evidenced and responsive to contrary evidence”. The Civil Service Code sets the standard for government officials: they must carry out their responsibilities in a way that is “fair, just and equitable”; they must not “unjustifiably favour or discriminate” against particular individuals or interests or allow their personal political views to determine the advice they give.

Impartiality is in the spotlight after the Medical and Healthcare Products Regulation Authority (MHRA) announced that Professor Jacob George, its chief medical and scientific officer, had “been recused” from any involvement with the planned clinical trial of puberty blockers “following the identification of social media posts made prior to his appointment”. Their spokesperson told me yesterday morning:

Civil servants, like anyone else, hold personal views but must also carry out their roles in line with the Civil Service core values of integrity, honesty, objectivity and impartiality. While there is no evidence to suggest that decisions taken were not impartial, Professor Jacob George is recused from further involvement in the Pathways clinical trial as a precaution.

The MHRA has not itself pointed to any specific posts. However, the Sunday Times says:

In the posts, now deleted, he criticised the “well-meaning idiocy” of those in the NHS in denying what he called the “basic biological fact” that gender is set at birth. He praised JK Rowling as a “treasure of our time” when she welcomed the Supreme Court’s ruling that the legal definition of a woman should be based on biological sex. And in another post, when questions arose whether Algerian Olympic boxer Imane Khelif was a woman, he said “the denial of basic biological fact is concerning.”

Other journalists have shared screenshots of a small handful of other tweets - Seen in Journalism links to them here - that relate to women’s rights and the problems with allowing men to self-identify into women’s sports.

None of the X posts now in the public domain express views on the puberty blocker trial. They were all posted before Professor George took up his role at the MHRA. Unless there’s something they aren’t telling us, the MHRA’s decision to remove Professor George from any involvement in the Pathways clinical trial is very troubling indeed.

The events leading up to this

This row has emerged from one of the most contested issues in medical science today: whether gender-questioning children should be put on an irreversible medical pathway, taking drugs to block puberty and ultimately progressing onto cross-sex hormones. I’ve written about the background to this here: an independent review undertaken by the paediatrician Hilary Cass called an overdue halt to this practice in the NHS. But her review controversially left the door open for a clinical trial of puberty-blocking drugs.

That trial is controversial because many experts (in my view, rightly) think it is impossible to to run an ethical trial of puberty blockers on gender-questioning children. I highly recommend this post from Genspect, and this open letter to health secretary Wes Streeting signed by hundreds of clinicians that explain why. It’s not possible to do them justice in a short summary. But for me the fundamental ethical problem at the heart of a puberty blocker trial is as follows.

The evidence we have is that for most children, gender dysphoria resolves naturally through puberty. Cass in her review is rightly concerned that subjecting these children to medical intervention that blocks their natural development will bake in mental distress that would otherwise be temporary. We have no diagnostic criteria for predicting which children are in the (probably very small) minority of gender-questioning children who will go onto have fixed trans identities in adulthood. The huge potential risks and side effects of this treatment, including for fertility; its limited benefits for '“passing in adulthood” especially for girls; and the fact that our starting hypothesis is that it will harm most gender-questioning children by making temporary distress permanent: all raise the question, how is it ethical to run a trial? That’s before you get to the fact that the Pathways trial is not even set up to investigate the long-term benefits and harms of puberty-blocking drugs.

None of this has stopped the trial getting signed off by medical regulators. Hannah Barnes, whose award-winning journalism has been critical in uncovering this medical scandal, has written about that process. The MHRA had to give its approval for the trial to take place. It raised several grounds of concern about the proposed trial in summer 2025 with researchers, including that the follow-up was far too short to measure the risks and benefits of puberty blockers. But it did eventually sign it off five months ago, despite those concerns not being fully addressed.

A few days ago, the MHRA effectively u-turned on that decision. Professor Jacob George, who was appointed chief medical and scientific officer at the MHRA just last month, wrote to the researchers who have designed and would run the Pathways trial on 13 February to raise a number of further concerns, including that the trial would be open to children as young as 10, despite questions about their capacity to consent to the risk of losing future fertility and sexual functioning. This letter triggered a much-needed pause in a controversial trial whose very approval raises fundamental questions about the robustness and adequacy of the architecture for signing off medical trials in the UK.

Which brings us to where we are today. During the pandemic, I wrote about the notion of “postnormal science”: science that takes place against a backdrop of great uncertainty and massive controversy. There are people with a strong ideological belief that gender-questioning children are children who have been “born in the wrong body” and who should be able to access medical interventions that try and adapt their body to their inner gender identity. Depressingly, this group includes doctors and clinicians. They have a vested interest in the kinds of questions that were posed in Professor George’s letter on behalf of the MHRA not being asked.

Why has the MHRA forced Professor George to step back from the trial?

We know “sources” passed Professor George’s X posts on women’s rights and women’s sports from before his appointment to at least one journalist, which led to reporting about them. The MHRA would have been contacted as part of that reporting, and issued its statement saying that Professor George had “been recused” before any reports were published. Hence the story reported was: social media posts uncovered, leading the MHRA to end any role he might play in relation to its oversight of the Pathways trial.

Not all the reporting has reflected, however, that the MHRA has made no suggestion of any wrongdoing by Professor George. In its statement to me above, it explicitly says there is no evidence that any of his decisions lacked impartiality. Instead it has forced him to step back as “a precaution”.

This raises huge ethical and legal questions for the MHRA. Given there is no suggestion that Professor George has been partial in any of his decisions - indeed, the questions raised in his letter reflect the concerns of a large number of medics and clinicians - the only conceivable justification for ending any involvement he would normally have as a senior MHRA expert is based on perception. In other words, perhaps they are worried that someone who previously expressed the view that women’s rights are not served by men self-identifying into women’s sports before he took up his MHRA role, and who has in his professional capacity raised appropriate and well-founded concerns about a controversial trial, might make it look as though it is behaving partially.

This is a very weak argument for causing someone a serious employment detriment: removing them from doing an aspect of their job, and making a public statement to that effect. It risks opening up the MHRA to McCarthyite political manipulation by activists. Will it take the same action whenever someone who may be ideologically motivated goes to the press with evidence that someone else has in the past publicly articulated a mainstream belief based on science and evidence (that men should not be able to self-identify into women’s sport) that has no direct connection with the decisions they are charged with at work? Citizen detectives on X have already uncovered social media posts from others involved in signing off clinical trials expressing sentiments aligned with a belief in gender ideology - will they be recused from anything to do with puberty blocker trials too? Where does this stop?

It also opens up a number of very important legal questions that can only be definitively answered by the courts. Professor George’s articulated beliefs about men in women’s sports are a protected philosophical belief under the Equality Act 2010: it is unlawful for an employer to discriminate again someone on the basis of those beliefs. Excluding employees who have in the past expressed any view on an important and live issue in democratic politics from an aspect of their job is a serious incursion of their rights to free expression under Article 10 of the European Convention of Human Rights.

Does the MHRA’s decision mean scientists who one day hope they might play a role in medical regulation in the UK have to in the future avoid publicly taking part in important democratic conversations? Imagine if we said that doctors who have publicly raised concerns about the safety of assisted dying legislation currently before Parliament are not allowed any role in regulating any future assisted dying service? Institutional impartiality at an organisation like the MHRA is achieved not just by those who work for it behaving impartially at the individual level, but through employees with different perspectives and worldviews holding each other accountable. If the MHRA were to roll over every time an activist does a search on X, it is quite possible to imagine a world where people from one particular viewpoint are disproportionately excluded from an area of public life, because some campaigners - in this case, gender identity activists - are much more enthusiastic wielders of this kind of cancellation technique than others.

Whether or not the MHRA’s action against him here is unlawful discrimination would depend on a number of factors, including how legitimate the MHRA’s justification is for taking this action, and whether they can show they have a consistent approach to deciding when a scientist is recused, which does not unfairly target scientists who have in the past expressed a mainstream albeit contested view about women’s sport. As I said above, I think it’s a weak justification, when an alternative strategy would have been for it to come out and robustly defend the latest set of questions it has asked of the Pathways researchers, on the basis of science and evidence.

Regardless of whether their action is lawful, this incident is very troubling for anyone who cares about the way science and medicine parse ethics in a highly-contested space. It was ideological activism that led in the first place to distressed children being prescribed unevidenced and potentially very harmful drugs, with long-term risks for their fertility, bone density and brain development. The MHRA needs to be on high alert to the risk of manipulation by those same activists.