Erring on the side of caution, or? The Cass Review.

Douglas Aerie

The first thing we learned was that

Dr. Hilary Cass met SEGM’s Patrick Hunter to discuss Florida’s anti-trans report
<https://genderanalysis.net/2023/11/new-trial-exhibits-in-doe-v-ladapo-doh-worked-with-
genspect-leaders-stella-omalley-and-joe-burgo-in-july-2022-hilary-cass-met-segms-patrick-
hunter-to-discuss-floridas-ant/>

(Note: Erin Reed explores the "Florida connection" in

Hilary Cass' NHS report is rife with debunked theories and falsehoods
<https://www.advocate.com/health/hilary-cass-nhs-report-debunked>

also see

Human Rights Campaign: Florida Boards of Medicine Relentless in Pursuing

Anti-Scientific, Harmful, Discriminatory Rule to Deny Care to Transgender
Youth
<https://www.hrc.org/press-releases/human-rights-campaign-florida-boards-of-
medicine-relentless-in-pursuing-anti-scientific-harmful-discriminatory-rule-to-
deny-care-to-transgender-youth#:~:text=The%20boards%20voted%20in
%20November,limit%20and%20partially%20ban%20such>

Florida Agencies Manipulated Research To Ban Trans Care And Coverage

<https://www.erininthemorning.com/p/florida-agencies-manipulated-research>

The Myth Of "Low Quality Evidence" Around Transgender Care

<https://www.erininthemorning.com/p/the-myth-of-low-quality-evidence>

and recall

Manufacturing the doubt that fuels the network

<https://www.splcenter.org/captain/disinformation>)

Perhaps Dr, Cass didn't realize that Florida's Public Health had fallen into the hands of cranks...
Florida’s surgeon general makes the conspiracy-theory podcast rounds
<https://www.washingtonpost.com/politics/2022/10/21/florida-covid-vaccines-desantis-
surgeon-general/>

Column: In threat to public health, Florida publishes flawed and unscientific anti-vaccine
‘study’
<https://www.latimes.com/business/story/2022-10-10/florida-publishes-anti-vaccine-study>

Florida surgeon general altered key findings in study on Covid-19 vaccine safety
<https://www.politico.com/news/2023/04/24/florida-surgeon-general-covid-vaccine-
00093510>
Then we read in the news...
GPs ‘scared off’ treating children over gender identity, says Dr Hilary Cass
<https://www.thetimes.co.uk/article/cass-review-report-nhs-gender-identity-puberty-
blockers-dfg3rz7bc>

Whatever the reasons,

Young people [are] being failed by long waits for gender care
<https://www.independent.co.uk/news/uk/nhs-england-great-ormond-street-hospital-
liverpool-childline-nspcc-b2526415.html>

Five thousand children with gender-related distress awaiting NHS care in England
<https://www.theguardian.com/society/2024/apr/11/five-thousand-children-with-gender-
related-distress-awaiting-nhs-care-in-england>

The impact of Gender Identity Clinic waiting times on the mental health of transitioning
individuals
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9567995/>

Delays, rows and legal challenges: inside the stalled new NHS gender identity service
<https://www.theguardian.com/world/2023/oct/27/delays-rows-and-legal-challenges-inside-
the-stalled-new-nhs-gender-identity-service>

The opening of the hubs has been delayed by more than a year amid difficulties
in recruiting staff, and tensions over how to train employees in caring for young
people with gender dysphoria. Meanwhile, the waiting list of young people
seeking help has grown to 5,766 [bolding added].

‘A contentious place’: the inside story of Tavistock’s NHS gender identity clinic
<https://www.theguardian.com/society/2023/jan/19/a-contentious-place-the-inside-story-of-
tavistocks-nhs-gender-identity-clinic>

Hilary Cass: Ideology on all sides directed gender care of children

<https://www.independent.co.uk/news/uk/rishi-sunak-ideology-nhs-england-government-
b2526082.html>

A concern is that primary health physicians will end up practicing gender medicine in much the same
way that they practice psychiatry--by default. The last thing we need is another iatrogenic catastrophe
like that seen with the widescale prescription of atypical anti-psychotics in mood disorders and so-
called "anti-depressant" and ADHD drugs.

So I was more than willing to extend the benefit of the doubt to a long-anticipated final report on Gids
services--NHS management of "gender dysphoria" and gender identity development...
What is the Cass Review into gender services and why is it controversial?
<https://uk.news.yahoo.com/what-cass-review-gender-services-why-controversial-
121531987.html>

What are the key findings of the NHS gender identity review?
 <https://www.theguardian.com/society/2024/apr/10/what-are-the-key-findings-of-the-nhs-
gender-identity-review>

The failure of NHS to meet the needs of young people (and their parents and families) experiencing
"gender related distress" (already noted above) was exacerbated by a "surge"--or "marked increase"--in
individuals seeking gender reassignment...
Individuals seeking gender reassignment: marked increase in demand for services
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189985/>

Commenting on the Report, Dr. Cass suggests that “biology hasn’t changed and adult biology hasn’t
changed in the last few years,"more or less implying that in some--perhaps many--cases "gender
dysphoria," "gender related distress" is (just) a new fad for teenagers struggling to deal with puberty.
(What Cass review says about surge in children seeking gender services
<https://www.theguardian.com/society/2024/apr/10/what-cass-review-says-about-surge-in-
children-seeking-gender-services>

Note: A New Study Debunks the Myth that Kids Become Trans Through “Social
Contagion”
<https://www.them.us/story/a-new-study-debunks-the-myth-that-kids-become-trans-
through-social-contagion>

--Sex Assigned at Birth Ratio Among Transgender and Gender Diverse

Adolescents in the United States
<https://publications.aap.org/pediatrics/article/150/3/e2022056567/188709/Sex-
Assigned-at-Birth-Ratio-Among-Transgender-and?autologincheck=redirected>)

Then Daily Mail "reported"

From GPs being pressured to prescribe gender-questioning children powerful puberty-
blockers to alarm over social transitioning, ALL the damning verdicts of the hugely-
anticipated Cass Review
<https://www.dailymail.co.uk/health/article-13288825/From-GPs-pressured-prescribe-
gender-questioning-children-powerful-puberty-blockers-alarm-social-transitioning-
damning-verdicts-hugely-anticipated-Cass-Review.html>

Psychiatrist says Tavistock gender clinic was a 'transing factory' for children
<https://www.dailymail.co.uk/news/article-11342541/Dr-Az-Hakeem-says-parents-
claimed-kids-trans-NHS-Tavistock-transing-factory-clinic.html>

Dr. Cass has expressed consternation at the ferocity of the debate surrounding access to care...
Doctor who led gender care review says ‘toxicity of debate is exceptional’
<https://www.independent.co.uk/news/health/hilary-cass-gender-care-uk-debate-toxicity-
b2526126.html>

‘This isn’t how good scientific debate happens’: academics on culture of fear in gender
medicine research
<https://www.theguardian.com/society/2024/apr/12/this-isnt-how-good-scientific-debate-
happens-academics-on-culture-of-fear-in-gender-medicine-research>
Given that gender science is very much an emerging science, and that there are far more unknowns
than knowns, it's not surprising that the road to "gender health" has been "paved with good intentions."
The case of John Money is illustrative. Re/which see
David Reimer and John Money Gender Reassignment Controversy: The John/Joan Case
<https://embryo.asu.edu/pages/david-reimer-and-john-money-gender-reassignment-
controversy-johnjoan-case>

In previous postings I've cited the study (NEJM 2004) of William G Reiner and John P Gearhart--
Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to
Female Sex at Birth
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421517/>

Findings such as Reiner's have led to a reconsideration of medical intervention(s) in cases of

"abnormal" genitalia--"abnormal" or "ambiguous" appearance at birth.

Should physicians wait, and consult the child? If so, when? At what age?

Obviously parents can consent to the "mutilation" of their child--male circumcision is routinely
performed, most often without serious questions of medical ethics being raised, even in Red States.

But should they?

(For an interesting discussion, see Kishka-Kamari Ford's Yale Law & Policy Review (2001) article,
"The Fiction of Legal Parental Consent to Genital-Normalizing Surgery on Intersexed Infants"
<https://openyls.law.yale.edu/handle/20.500.13051/16931?show=full>;

also interesting,
A Child's Expertise: Establishing Statutory Protection for Intersexed Children Who Reject
Their Gender of Assignment
<https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1076849>)

As I've indicated in a previous posting, the recommendation today is, unless medically necessary, wait.

Returning to Dr. Cass and NHS.

Reuters noted that "after the Cass Review published interim recommendations in 2022," the NHS
"announced that, in future, puberty-blocking drugs in England" would "only be available for young
people experiencing gender distress in the context of a clinical trial."
(<https://www.nbcnews.com/news/world/evidence-youth-gender-care-remarkably-weak-says-major-
english-review-rcna147136>) [Bolding added.]

The problem with this should be obvious...

"Waiting lists for all kinds of NHS treatments have been getting longer and longer, but for
trans people the wait for a first appointment at a gender identity clinic can now be five
years or more - despite a target of just 18 weeks."
(<https://www.bbc.com/news/uk-england-68588724>)
Ideally, management of gender dysphoria entails a long-term team approach. But not only does
enrollment in any long-term study substantially add to the costs of care, the scarcity of available slots
makes study participation a pipe dream for most.

It should be noted that

The lack of research is a recognized problem in clinical guidelines, which are used in daily
practice
<https://english.elpais.com/health/2024-04-11/scientific-evidence-on-the-use-of-hormones-
for-trans-minors-is-scarce-according-to-new-reviews-of-studies.html>

NOTE: We will return to this question of "evidence" when we look at some critical reviews
of the the report.

However, denying access to puberty-blockers to individuals not enrolled in a long-term clinical study,
supposedly on the basis of a "lack of evidence" regarding the safety and efficacy of the drugs and their
usefulness in treating gender dysphoria and transitioning in the long-term (*) is quite simply without
foundation. Not only is it false, but patently so!
(*) See, for ex.,

Gender medicine ‘built on shaky foundations’, Cass review finds

<https://www.theguardian.com/society/2024/apr/10/gender-medicine-built-on-
shaky-foundations-cass-review-finds>

Cass Review Finds Weak Evidence for Puberty Blockers, Hormones in Youth
Gender Care
<https://www.medpagetoday.com/special-reports/transgender-
medicine/109605>

Key findings of the Cass report: stop giving drugs to children and rushing them
into treatment
<https://www.telegraph.co.uk/news/2024/04/10/under-25s-trans-care-must-be-
slower-says-cass-report/>

Also see
Randomized-controlled trials are methodologically inappropriate in adolescent transgender
healthcare
<https://www.tandfonline.com/doi/full/10.1080/26895269.2023.2218357>
(note: "Ashley at al, below)

and
Gender Affirming Hormone Treatment for Trans Adolescents
<https://link.springer.com/article/10.1007/s11673-023-10313-z>;

and see "Maung" excerpt and ref's below.

The reason cited by the reviewers for denying access to puberty blockers was that the effects are
"unknown," long term. But are they, really, unknown?
Can the same be said of "the pill?"
We accept teenagers taking the pill -- why don’t we feel the same about puberty blockers?
<https://metro.co.uk/2023/09/28/we-accept-teenagers-taking-the-pill-but-not-puberty-
blockers-why-19564554/>

The NYT’s Big Piece on Puberty Blockers Mucked Up the Most Important Point About
Them
<https://slate.com/technology/2022/11/puberty-blockers-side-effects-controversy.html>

(They Paused Puberty, but Is There a Cost?

<https://www.nytimes.com/2022/11/14/health/puberty-blockers-
transgender.html>)

Facts and the myths around puberty blockers

<https://health.wusf.usf.edu/health-news-florida/2023-08-31/politifact-fl-the-facts-and-the-
myths-around-puberty-blockers>

Decades of data support the use and safety of puberty-pausing medications

<https://www.scientificamerican.com/article/what-are-puberty-blockers-and-how-do-they-
work/>

Is puberty delaying treatment ‘experimental treatment’? [Answer: No.]

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430465/>

Are Puberty Blockers Permanent?

<https://www.healthline.com/health/are-puberty-blockers-reversible>;

(Study Bolsters Evidence that Effects of Puberty Blockers Are Reversible

<https://www.physiology.org/detail/news/2024/04/05/study-bolsters-evidence-
that-effects-of-puberty-blockers-are-reversible?SSO=Y>)

The difference between puberty blockers and HRT for trans teens
<https://www.plannedparenthood.org/blog/whats-the-difference-between-puberty-blockers-
and-hrt-for-trans-teens>)

Refusing puberty blockers to trans young people is not justified by the evidence
<https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00233-9/abstract>

So it seems we're back to "ideology." But, as I've argued before, the "ideology" comes almost entirely
from the other side--from so-called 'Christian' conservatives who insist that "They [Elohim] made them
male and female." And then flatly refuse to acknowledge the reality of intersex. More than a simple
refusal to "admit" difference and variation, they wish to eliminate it! Either to "fix it," or to erase it.
And this hatefulness--because that's what it is, hatefulness-- has real effects, as I argued in Anti Trans
Myths.

Dr. Hane Maung's analysis of the deficiencies of the Cass Review--

Response to the Cass Review
<https://www.gendergp.com/response-to-the-cass-review/>
--led me to the conclusion that the Cass Review is bad science--and, very much on a par with the
Florida Medical Report on Transgender Care.
I find myself in complete agreement with Dr. Muang when he concludes that "the Cass Review is an
unethical and unscientific document."

Thus I emphatically reject the suggestion that

Hilary Cass’s proposals are mostly common sense
<https://www.theguardian.com/commentisfree/2024/apr/11/hilary-cass-trans-children-
review>.

(As Maung notes, "the recommendations of the Cass Review would impose... more
obstacles to access to gender affirming medical treatment for trans people aged under 25."

That the "recommendation" regarding social transition is, in fact, aimed at "conversion," is
made clear by Cal Horton in his review. See "Cis-supremacy," below.

As Erin Reed observes:

One of the most controversial sections of the Cass Review addresses social
transition, with the review recommending that individuals considering social
transition "be seen as early as possible" by clinical professionals. It claims that
social transition could "change the outcome of gender identity development," a
statement that notably lacks the validation or evidence level that the review
demands of transgender care. Significantly, there has been discussion about
prohibiting social transition in schools, even with parental consent.

--NHS report is rife with debunked theories and falsehoods;

above)

Maung's discussion of the evidence base is highly knowledgeable and sophisticated:

[The] review of the literature was profoundly inadequate. Notably, the Cass Review
dismisses a very large number of studies and omits studies from the past two years. Hence,
it neglects a vast amount of evidence on the benefits of gender affirming medical treatment
for trans youth in its analysis.
The reason [given] for dismissing this evidence is that it did not come from randomised
controlled trials. However, this indicates a serious misunderstanding of the roles and
limitations of randomised controlled trials compared with other sources of evidence.

For many medical interventions, including gender affirming medical treatment for trans
youth, randomised controlled trials are unfeasible and unethical, because the consequences
of not intervening would be very apparent to the participants and also would be
unacceptably harmful (Ashley et al., 2023). Accordingly, evidence from randomised
controlled trials is often not required of many medical interventions, including abortion,
appendicectomy for acute appendicitis, aortic aneurysm repair, and so on (Worrall, 2008).
Indeed, the assumption that randomised controlled trials represent the “gold standard” in
evidence-based medicine has been criticised for neglecting other important sources of
evidence (Anjum and Mumford 2017; Deaton and Cartwright 2018; Grossman and
Mackenzie 2005).

When randomised controlled trials are unfeasible or unethical, other forms of evidence are
used to inform clinical decisions. Generally, the assessment of a causal relation between a
healthcare intervention and a clinical outcome require: (1) evidence of a statistically
significant association between the intervention and the outcome; and (2) evidence of a
mechanism linking the intervention and the outcome (Russo and Williamson, 2007). These
forms of evidence are precisely what are provided by the numerous studies on the effects of
gender affirming medical treatment for the health and wellbeing of trans youth, which the
Cass Review dismissed.

Some of these studies used matched control groups and large sample sizes, which enabled
the demonstration of a statistically significant association between gender affirming
medical treatment and improved health in trans youth (Green et al., 2022; Tordoff et al.,
2022; Turban et al., 2020). Other studies found evidence of social, psychological, and
biological mechanisms through which gender affirming hormone treatment decreases
depression and anxiety in trans youth (Chen et al., 2023; Grannis et al., 2021). Numerous
other studies corroborate the findings that puberty suppression and hormone replacement
therapy are associated with improved mental health and social wellbeing in trans youth
(Allen et al., 2019; de Vries et al., 2014; Kuper et al., 2020; van der Miesen et al., 2020).

And so, there is ample statistical evidence and mechanistic evidence that gender affirming
medical treatment results in health benefits for trans youth. By dismissing this evidence
because it did not come from randomised controlled trials, the Cass Review is holding
gender affirming medical treatment to an unreasonable and unethical standard that is not
required of many other healthcare interventions (Maung, 2024).

Especially concerning is the way in which the Cass Review minimises the contribution of
untreated gender dysphoria to the increased risk of suicide in trans youth:

“Tragically deaths by suicide in trans people of all ages continue to be above

the national average, but there is no evidence that gender-affirmative treatments
reduce this. Such evidence as is available suggests that these deaths are related
to a range of other complex psychosocial factors and to mental illness.” (p. 195)

The suggestion that “there is no evidence that gender-affirmative treatments reduce [deaths
by suicide in trans people]” is false. As noted above, numerous studies with large sample
sizes and comparison groups provide ample evidence that gender affirming medical
treatment leads to decreased suicidality in trans youth (Allen et al., 2019; Green et al.,
2022; Turban et al., 2020). For example, in a recent study, trans adolescents who had
gender affirming hormone treatment delayed until they were older were shown to suffer
from significantly higher rates of depression and suicidality than trans adolescents who
received gender affirming hormone treatment promptly (Sorbara et al., 2020). Furthermore,
there is evidence that lack of access to gender affirming medical treatment is associated
with increased rates of mental illness and suicidality (Tan et al., 2023; Tordoff et al., 2022).

The extenuating claim that suicide in trans youth is “related to a range of other complex
psychosocial factors and to mental illness” is a vacuous statement. Suicide is widely
understood to be a complex multifaceted behaviour and there are always multiple social,
psychological, and contextual factors involved in its causation (Maung, 2020). Recognising
this multifactorial complexity does not preclude us from acknowledging that untreated
gender dysphoria is one of the factors that contributes to suicide in trans youth and,
moreover, that it is a factor that can be effectively alleviated with gender affirming medical
treatment.

Dismissing such a vast quantity number of studies on the basis of an unreasonable and
unethical standard amounts to flagrant evidence denial that could cause significant harms to
trans youth. Moreover, the double standard the Cass Review imposes between gender
affirming healthcare and other forms of healthcare... is highly suggestive of motivated
reasoning.

Ref's cited:

Allen, L. R., Watson, L. B., Egan, A. M., and Moser, C. N. (2019). “Well-being
and suicidality among transgender youth after gender-affirming hormones”.
Clinical Practice in Pediatric Psychology, 7: 302–311
<https://www.researchgate.net/publication/334466000_Well-
Being_and_Suicidality_Among_Transgender_Youth_After_Gender-
Affirming_Hormones>

Anjum, R.L., and Mumford, S. D. (2017). “A philosophical argument against

evidence-based policy”. Journal of Evaluation in Clinical Practice, 23(5):
1045–1050. (Sub'n Req'd)
<https://onlinelibrary.wiley.com/doi/10.1111/jep.12578>;
pdf copy attached

Ashley, F., Tordoff, D. M., Olson-Kennedy, J., and Restar, A. J. (2023).

“Randomized-controlled trials are methodologically inappropriate in adolescent
transgender healthcare”. International Journal of Transgender Health.
https://doi.org/10.1080/26895269.2023.2218357 (Open Access)
<https://www.tandfonline.com/doi/full/10.1080/26895269.2023.2218357>

Chen, D., Berona, J., Chan, Y. M., Ehrensaft, D., Garofalo, R., Hidalgo, M. A.,
Rosenthal, S. M., Tishelman, A. C., and Olson-Kennedy, J. (2023).
“Psychosocial functioning in transgender youth after 2 Years of hormones”.
New England Journal of Medicine, 388: 240–250 (Sub'n Req'd)
<https://www.nejm.org/doi/full/10.1056/NEJMoa2206297>; pdf copy attached

de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F.,

Doreleijers, T. A. H., and Cohen-Kettenis, P. T. (2014). “Young adult
psychological outcome after puberty suppression and gender reassignment”.
Pediatrics, 134: 696–704. (Sub'n Req'd)
<https://publications.aap.org/pediatrics/article-
abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty?
redirectedFrom=fulltext>;
pdf copy attached
Deaton, A., and Cartwright, N. (2018). “Understanding and misunderstanding
randomized controlled trials”. Social Science and Medicine, 210: 2–21. (Open
Access)
<https://www.sciencedirect.com/science/article/pii/S0277953617307359>

Grannis, C., Leibowitz, S. F., Gahn, S., Nahata, L., Morningstar, M., Mattson,
W. I., Chen, D., Strang, J. F., and Nelson, E. E. (2021). “Testosterone treatment,
internalizing symptoms, and body image dissatisfaction in transgender boys”
Psychoneuroendocrinology, 132:105358 (Sub.n Req'd)
<https://www.sciencedirect.com/science/article/abs/pii/S0306453021002328>

Green, A. E., DeChants, J. P., Price, M. N., and Davis, C. K. (2022).

“Association of gender-affirming hormone therapy with depression, thoughts of
suicide, and attempted suicide among transgender and nonbinary youth”.
Journal of Adolescent Health, 70: 643–649 (Open Access)
<https://www.jahonline.org/article/S1054-139X(21)00568-1/fulltext>

Grossman, J., and Mackenzie, F. J. (2005). “The randomized controlled trial:

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Access)
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Maung, H. H. (2024). “Gender Affirming Hormone Treatment for Trans

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Similarly, as noted above, Maung's offers a devastating critique of one of the main recommendations of
the Cass Review regarding "social transition." Not only does the recommendation clearly pathologize
transition, and reinforce cisnormative prejudice, as Maung (and Cal Horton: "Cis-supremacy," below)
observe, it "potentially enables harmful conversion therapy practices." On this, also see
"growinguptransgender"
The Failure of the Cass Review
<https://growinguptransgender.com/2022/04/06/the-failure-of-the-cass-review/>.

Despite evidence that conversion therapy on trans children is particularly

harmful, with research showing “For transgender adults who recalled gender
identity conversion efforts before age 10 years, exposure was significantly
associated with an increase in the lifetime odds of suicide attempts”.
 (Association Between Recalled Exposure to Gender Identity
Conversion Efforts and Psychological Distress and Suicide
Attempts Among Transgender Adults
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739904/>)

For days now, MPs and commentators have cited the Cass review, in
justification of the need for conversion therapy specifically for trans kids.

Of course they do not say conversion therapy for trans kids. They talk of
‘children suffering from gender confusion or gender distress’, they talk of
‘exploratory therapy. They talk of ‘unintended consequences, by which some
clearly mean, they fear the law would stop them conducting conversion therapy
on trans kids.

Those who want to conduct conversion therapy on trans kids hide behind a new
favourite term of ‘exploratory therapy’. It is a friendly sounding rebrand of
conversion therapy. It is focused on probing, delaying, questioning and at its
heart, problematising trans identities...

The same people who actually want conversion therapy for trans kids, are
trying to create confusion on the meaning of affirmative therapy. They are
trying to paint affirmation as a bad thing, as something forced.

Horton comes to much of the same conclusions, but at length, in

The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans
children
<https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2328249>

BOTTOM LINE: The Cass Review doesn't merely err on the side of caution. It is as wrong-headed as it
is factually wrong. And, one fears, wrong-hearted as well.