the medicine bag theme essay

The Medicine Bag | Summary & Analysis

Summary of the medicine bag by virginia driving hawk sneve.

“The Medicine Bag”, a short story by Virginia Driving Hawk Sneve was published in 1975 and reflects on the relationship between a Sioux man and his grandson in the nexus of reality, fiction, identity, and heritage. 

Virginia Driving Hawk Sneve is an American author whose works primarily focus on the representation of the Aboriginal Americans divorced from myth and savagery, and rather invested in a traditional yet non-stereotypical way of living to set an alternate outlook for her contemporary readership.  

The Medicine Bag | Summary

This is a story about a teenage boy Martin and his relationship with his grandfather who belongs to the Native American land of South Dakota. Hailing from a mixed heritage, Martin is conscious about his grandfather’s unexpected visit to his house and fears the oblivion of the fantastical image surrounding the old man that he otherwise shares with his friends after every summer visit.

The conflict of reality with fiction threatens his reputation and he adopts all means to prevent his friends from meeting the grandfather. But one day the friends coerce their way into his house and find the old man charming and nothing less than an exotic sight. Following the pleasant meeting, the grandfather reveals to Martin his knowledge of the latter’s anxiety and embarrassment over his visit. He further familiarizes the young boy with his mythical ancestry and past to convey the emotional significance of the medicine bag that has been around his neck for years. Since he is approaching the end of his life, the grandfather desires to pass on the bag to the rightful male heir and the story ends with Martin wearing the bag after his grandfather’s death, thus accepting his mixed identity with love and respect. 

The Medicine Bag | Analysis

This first-person narrative centers on embracing your mixed heritage and realizing the essence of traditions as a gesture of love and respect towards your familial identity as well as your ancestors. The story is set in Iowa and creates a light mood with sadly a regretful tone on the account of the narrator Martin whose dual feelings towards his grandfather stand as a commentary on the contemporary generational conflicts. While he doesn’t dislike his grandfather, he certainly does not enjoy his presence in the house which interferes and threatens his modern identity. Like any child of his age, he does not wish to be constantly reminded of his mixed ancestry and the inevitable ownership of the medicine bag which he despises until the end of the story. 

Martin is conscious of losing his popularity, a vanity that children of his age usually engage in. But gradually he begins to alter his opinions regarding the grandfather as he entertains his friends at his best. Still, the looming despair of having to adopt the medicine bag troubles him and it is only when the grandfather reveals to him about the past and significance of the bag that his bubble of exoticism bursts and brings him closer to reality.

The Sioux have long endured the limitations of the reservation scheme by the government and Martin’s great-grandfather ventured on a journey in search of a guiding spirit and envisions a dream about the “white man’s iron” which is not fully interpreted even by the wise men of his day. However, the great-grandfather finds a broken shell of an iron kettle and collects a piece to be treasured in his medicine pouch by investing faith in its magical property to keep all evils at bay. But one day he was forcefully taken away by the soldiers to work as a blacksmith and he learned the art of using the white man’s iron. Upon his return, the medicine bag was then passed down to the grandfather who attempted to pass it down to his own son i.e. the mother’s father but his reluctance to take it along to the war caused his death, according to the grandfather’s belief. 

While the medicine bag definitely carries along with it myth and a superstitious belief system, it also sustains emotions and love for children which only wishes well and safety for them. The grandfather’s inevitable passing away communicates the need to appreciate people and things when they are with you rather than subjecting them to avoidance and ignorance. The bag becomes a symbol of continuity and a driving force to live life spiritually and honestly. 

The Medicine Bag |  Themes

Reality V/S Fiction

The author’s primary focus to pen down a narrative that expels all stereotypes surrounding Native Americans is highlighted through Martin’s fantastical appropriation of his grandfather’s identity and life in South Dakota in his stories shared with his friends. People in other parts of the States know about the Native population only through the less realistic portrayal on television and cinema which is often colored with prejudice. They are exoticized and considered otherworldly which in truth is not an appropriate representation. They are in fact people with high reliance on traditions often misunderstood as a primitive way of living. Instead, it is their respect and homage to their ancestors that compels them to continue with customs such as wearing the medicine bag and passing it to subsequent generations. The emotions shadowing such rituals are buried under the mythical air and thus lose significance in the modern and young generation.

Martin conveys an unrealistic picture to his friends about his grandfather which amazes them every time they listen to one of his stories. The friends’ sudden visit one day puts Martin in a fix and threatens his reputation but his grandfather plays along with the fantasy his grandson has built upon him and dresses as per his narration without even informing him. Thus, the Native Americans are not unusually dressed braided men but just like any other U.S. citizen. 

Generational Conflict

There are three generations in the story— the grandfather, the parents, and the grandkids, each with their own worldviews. The old man represents tradition while the other two subsequent generations reflect modern ideals and lifestyle. At the vulnerable age of eighty-six, the grandfather journeys for two days to reach the house of his daughter to pay a surprise visit which they welcome with an overwhelming response. It is a poignant expression of the unrecognized responsibility that young people have towards their older family members. While this impression is implicit, the ideological conflict between Martin and the grandfather is evident through the former’s disgust at the sight of the ill-conditioned medicine pouch. It is not until he learns about the significance of the tiny bag that he experiences an ideological shift and prepares himself to step into the shoes of his grandfather. In the era of modernity and technology, the medicine pouch thus becomes a gentle reminder of Martin’s roots and his grandfather. 

The Medicine Bag |  Characters

He is the narrator of the story through whom the readers view the grandfather’s visit and thus the clash of tradition with modernity. Hailing from a mixed heritage, he is embarrassed about his native roots and prevents his friends from meeting his Sioux grandfather. For him, native America is a place of fantasy away from the real world he inhabits. He even fears and experiences disgust at the thought of becoming the heir to the shabby medicine bag his grandfather had been carrying around his neck for years because it represents a new identity for him, rooted in tradition and nativity. However, one-to-one interaction with his grandfather and the subsequent knowledge of the great mystical power of the medicine bag assures him to undergo a change of heart and accept his adherence and responsibility towards his mixed heritage. He is thus a bildungsroman character who grows mature during the course of the story and learns about the priorities in his life. 

She is the narrator’s ten-year-old sister who unlike her brother wholeheartedly welcomes her grandfather and even encourages her friends to meet him in person. At a young age, she exhibits maturity in her acceptance of her mixed ancestry and is far away from hypocrisy. 

Joe Iron Shell

He is the narrator’s eighty-six-year-old grandfather belonging to the Sioux tribe of Native Americans and thus a representative of tradition in the modern city setting. His old age loneliness and thus the consequent tiring journey he takes up to visit his family the latter in the light of guilt for abandoning the old man. But he never complains and instead settles well with them. However, he is aware of Martin’s unhappiness with his stay and thus familiarizes him with the purpose of his visit which is to pass over the medicine bag to him as the rightful heir in the nearing event of his death. His narration of the mythic past concerning the bag enlightens his grandson on the relevance and value of the little token of love, identity, and remembrance which enables him to assimilate his ancestral identity into his modern white American one. His death at the end of the story leads to Martin’s epiphany as he decides to wear the medicine bag. 

Mother and Father

An interracial couple, the mother belongs to the Native American Sioux tribe and the father is a white American. Their guilt of never inviting the grandpa to their house after his surprise visit is a powerful representation of the contemporary family setting where young children leave their hometowns to move into big cities and abandon their aging parents who reduce to recipients of annual visits and dinners. The mother loves her grandfather dearly and looks after him during his stay but her character also speaks volumes about her irresponsibility towards her old grandfather living alone in the remote setting of South Dakota. 

The Medicine Bag |  Literary Devices

“His rumpled black suit hung  like a sack  over his stooped frame.”

“We never showed our friends Grandpa’s picture. Not that we were ashamed of him, but because we knew that the glamorous tales we told didn’t go with the real thing. Our friends would have laughed at the picture because Grandpa wasn’t tall and stately like TV Indians. His hair wasn’t in braids but hung in stringy gray strands on his neck, and he was old. He was our great-grandfather, and he didn’t live in a tepee, but all by himself in a part log, a part tar-paper shack on the Rosebud Reservation in South Dakota.” 

This reflects the contrast between reality and fiction that commercial media tends to exhibit, blurring the truer version and existence of the Native Americans. 

“She was all smiles and was so obviously glad to see Grandpa that I was ashamed of how I felt.” This expresses the contrasting attitudes of the narrator and his sister towards their grandfather’s visit. 

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Home — Essay Samples — Sociology — Indigenous People — The Medicine Bag: A Symbol of Cultural Identity and Healing

The Medicine Bag: a Symbol of Cultural Identity and Healing

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Published: Mar 16, 2024

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Historical and cultural significance, traditional healing practices, contemporary relevance.

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The Medicine Bag: Full Lesson Plan w/ PowerPoints & Graphic Organizers

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The Medicine Bag – Characters

Cheryl 

Cheryl is Martin’s ten-year-old sister. She is portrayed as a cheerful, loving little girl, far from adulthood. She has no embarrassment over her great-grandfather’s arrival at their home. Indeed, she seems proud to have her friends meet Grandpa. She treasures her Native American heritage. Grandpa also loves her, but it is clear that he does not value her in the same way that he values Martin, whom he sees as the person who must carry on the family and cultural traditions. Sneve’s portrayal of Cheryl, and of her mother, suggests a pattern of patriarchy; that is, a system in which the male members of the family are more powerful and are responsible for the cultural heritage. 

Dad is Martin’s father, and Mom’s husband. He is a white man who teaches at the local college. Although he is white, he clearly respects the Native American heritage of his wife and her family. He visits the reservation with his family every summer, and he treats Grandpa with a great deal of kindness and respect. He apologizes to Grandpa for not thinking to bring him home with them after their visit to the reservation in the summer. Although not a well-developed character, Dad is nevertheless an important influence on Martin, because he models acceptance and respect for the elderly man. 

Grandpa 

Grandpa, whose real name is Joe Iron Shell, is a member of the Sicangu Lakota Oyate, the Burnt Thigh Nation, also known as the Rosebud Sioux. This is the same nation that Sneve belongs to. He lives on the Rosebud Reservation in South Dakota, the same place where Sneve grew up. He has traveled a long distance to visit Martin and his family at their home in Iowa. Martin describes him as an old man, with stringy gray hair. He always wears a tall black hat with a feather in it. In addition, he wears baggy pants, a red satin shirt, and a bolo tie (a cord necktie fastened by a clasp, often ornamented with silver). Grandpa always acts with great dignity, greeting people formally in his own language and shaking their hands. He also seems to have a deep sense of the timeliness of events. It becomes clear throughout the story that the reason he has come to Iowa is because he senses his own death approaching. When Martin’s friends come to visit him, he is patient with the young people and answers their questions. As well, he tells them stories from his heritage. Grandpa has a very strong attachment to the traditions of his people and wants to pass these on to Martin. The medicine bag that he wears around his neck is the physical symbol of this idea. Filled with a small piece of iron, a pebble from the butte, and a piece of sacred sage, the medicine bag belonged first to Grandpa’s father, who made it from elk skin in preparation for a vision quest. Grandpa is a very important character in this story, because he is the one who enables Martin to embrace his own heritage. 

Hank is Martin’s best friend. He is a very minor character in the story but serves an important purpose. When he visits Martin’s house to meet Grandpa, Martin is able to see his Grandpa through Hank’s eyes. When he realizes how impressed Hank is with Grandpa, Martin realizes that he has nothing to be embarrassed about. 

Iron Shell 

Iron Shell is Grandpa’s father. He is not technically a character in the story, but rather is a character in a story told by Grandpa within ‘‘The Medicine Bag.’’ Iron Shell was a Native American man who lived in the general region of what is now Montana and the Dakotas. As Sneve wrote ‘‘The Medicine Bag’’ in 1975, and the story seems contemporary with the writing, it is possible to make some guesses, based on the clues she provides, concerning the chronology of events and ages of the characters. For example, since at the time of the story, Grandpa is eighty-six years old, Grandpa must have been born around 1889. Consequently, it is possible to surmise that Iron Shell must have been a young man around 1880, and certainly would have been alive during the last of the great Indian wars fought in Montana and the Dakotas, ending with the Massacre of Wounded Knee in 1890. Grandpa notes that Iron Shell was a member of the Teton Lakota, and that it was in his generation that the Lakota were forced to live on reservations. 

Iron Shell’s importance to the story is great, as he is the ancestor who valued the ancient, honored traditions of his people despite the degradation he and his people suffered. He decided to go on a vision quest, a spiritual journey to find guidance for his life. He created the medicine bag in preparation for his vision quest, and while on the quest had a dream of iron. In addition, he found a small shell of an iron pot, which he put in his medicine bag. When he told his dream and experiences to the elders of the tribe, they gave him the name Iron Shell, which he passed on to his son. In addition, Iron Shell is important to this story, because he introduces the topic Indian boarding schools, where young Native Americans were forced to attend to learn English and white customs. That he was able to pass on cultural traditions to his son Joe Iron Shell, Martin’s great-grandfather, suggests that he was a very strong individual. 

Joe Iron Shell 

See Grandpa 

Martin 

Martin is the narrator and the protagonist, or main character, of this story. He is a young man, probably thirteen or fourteen years old, just on the verge of manhood. He is like most other young American boys, and he lives in what appears to be a white suburban neighborhood in Iowa. Although his mother is Native American, his father is white. Even though he visits the Rosebud Reservation every summer, during the rest of the year, he appears to live as a white boy rather than as a Native American.

Although Martin loves his Grandpa, he is very embarrassed by his appearance and odd ways. He does not want his friends to see Grandpa or to be associated with him in public. Most of all, he does not want to have to wear the medicine bag around neck. He considers it a dirty piece of leather, and he imagines how the other boys will make fun of him when he gets undressed in gym class, with the pouch around his neck. 

Martin, however, is a rounded character, and Sneve allows him to grow throughout the story. He soon comes to value his Grandpa, particularly after his friends come to visit and he sees how much they respect the old man and his stories. As a result, when Grandpa asks to speak to Martin alone, Martin listens carefully to the story about Grandpa’s father, the first Iron Shell, and he gracefully accepts the medicine bag that his Grandpa gives to him. 

In the last paragraph of the story, Martin returns to the reservation and does as his great-grandfather has instructed: he picks a piece of sacred sage and places it in the bag. This act signals that he has embraced the customs and traditions of his Native American heritage, and that he wants to honor the memory of his Grandpa. 

Mom is Martin’s mother, and Grandpa’s granddaughter. She is a Native American woman who has married a white man and moved off the reservation. Her character is not well developed. She clearly loves her grandfather, who also loves her, but it seems evident that she is not valued the way a male would be. Nevertheless, she welcomes her grandfather in her home and she cares for him while he lives with the family. In addition, her return to the reservation with her children every summer suggests that Mom holds her Native American heritage precious, and that she wants her children to know their own traditions and background.

Sara Constantakis, Thomas E. Barden – Short Stories for Students – Presenting Analysis, Context & Criticism on Commonly Studied Short Stories, vol. 28 (2010) – Virginia Driving Hawk Sneve – Published by Gale Cengage Learning.

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Comparison of "The Medicine Bag" and "TA NA E KA"

Tradition is a powerful history in society that builds our identities, cultures, and the way we interact with the world. In literature, traditions sometimes serve as central themes and provide valuable information into the complexities of human identity in different stories. In this essay, we will compare two short stories, The Medicine Bag and TA NA E KA, about the aspects of tradition, the structure, themes, and motifs of these stories, focusing on their similarities and differences.

One of the most important elements in analyzing the traditions in "The Medicine Bag" and "TA NA E KA" is their narrative structures. The structure of a story includes its characters, setting, conflicts, and solutions. These two stories have different story structures that focus on the role of tradition in their own cultures. In The Medicine Bag, the main characters are Martin, his sister Cheryl, and their grandpa, Joe Iron Shell. They represent the generational and cultural conflicts between modernity and tradition. Martin felt ashamed of his Sioux heritage at the beginning and learned to appreciate his family and culture as he realized the importance of familial culture. He is deeply proud of his Sioux heritage and respectful of his family's traditions. The setting of the story is primarily at their home, during Martine’s childhood. The major conflict is the cultural clash experienced by Martin, where he feels embarrassed about his grandfather's appearance. The Minor conflict is Martin's struggle about introducing his friends to Grandpa and worrying that they might mock him. Overall, the conflicts in the story “The Medicine Bag” revolve around cultural conflict, acceptance, tradition and modernity, embarrassment and shame. Martin's transformation from shame to appreciation of his heritage presents the solution to these conflicts. On the other side, TA NA E KA has similar characters to The Medicine Bag such as a grandfather, Amos Deer Leg, and a young girl, Mary. They belong to the Kaw tribe and the story's setting is in the woods when Mary goes to the Ta-Na-E-Ka ceremony. The major conflict is the endurance test that Mary and Roger, her cousin, are going to undertake. This conflict highlights the clash between traditional and modern life just as “The Medicine Bag” as Mary finds her own way to survive and differs from the conventional expectations. Overall, the conflicts in this story include endurance, tradition, modernity, and adaptation to challenges. The solution to these conflicts is Mary's resourcefulness and adaptability. In comparing these structures, "The Medicine Bag" and "TA NA E KA have very similar structures, they both include the conflict between tradition and modernity and show the characters’ personal growth of their culture. However, The Medicine Bag has a structure that focuses more on family, cultural identity, and the importance of honoring heritage. It explains the significance of traditional values and the acceptance of cultural heritage. On the other hand, "TA NA E KA" focuses more on self-discovery and adaptation.

The themes explored in "The Medicine Bag" and "TA NA E KA" play a significant role, these themes include family relationships, cultural identity, and the importance of heritage. The Medicine Bag has three central themes: Family and acceptance, cultural identity and tradition, and heritage. These themes present the transformation of Martin as he learns to honor his Sioux heritage. Martin and Cheryl feel ashamed initially about their Sioux grandfather's appearance when he visits them in the city. This reflects the common generational differences experienced in society. However, as the story continues, Martin has significant personal growth, leading to an appreciation of his family and cultural heritage. The theme of cultural identity and tradition is presented by the contrast between the traditional society represented by Grandpa and the modern lifestyle of Martin's family. The passing down of the medicine bag from Grandpa to Martin serves as a symbol of cultural transmission from one generation to another. It explores the importance of culture and reminds readers to honor their heritage. Heritage serves as another significant theme in The Medicine Bag. The story emphasizes the importance of heritage and the need to celebrate it. The medicine bag itself is a sacred item that carries significant meanings and it should be upheld with honor. T A NA E KA has central themes of tradition and the endurance to adapt it a changing world. These themes are exemplified through the Ta-Na-E-Ka ceremony. Young members like Mary of the Kaw tribe need to prove their worth and readiness for adulthood. Mary is tasting her endurance by surviving in the woods for five days, she shows her resourcefulness and adaptability to overcome the challenges she faced. The story explores the conflict between traditional values through generations just as in The Medicine Bag. TA NA E KA" highlights the enduring spirit of the Kaw people as they are facing a lot of challenges with the world around them. Comparing the themes in both stories, "The Medicine Bag" and "TA NA E KA" share some similarities. Both stories show the importance of cultural identity and acceptance of traditions. While "The Medicine Bag" develops themes on family dynamics and cultural symbols, "TA NA E KA" focuses more on adaptation and resourcefulness in the face of cultural traditions.

The motif also plays a role in how these two stories explore tradition, The Medicine Bag uses a common narrative style and TA NA E KA has a different writing skill. Motifs are important elements or ideas throughout a story that develop the narrative's depth and significance. The authors often use different writing skills to present motifs. The Medicine Bag has a traditional narrative writing skill, because it shows character development progressively by telling stories. The story has a common timeline that is to present the characters, conflicts and resolutions. This writing skill is easy to understand and it creates a strong emotional connection between readers and the characters. Particularly with Martin's transformation throughout the story. However, the disadvantage is that most of the story follows a familiar narrative pattern and readers are able to predict the end of the story only by reading half of the story. On the other hand, the short story TA NA E KA uses a different narrative writing skill and the motif of the story focuses on Mary’s self-discovery and adaptation. This narrative pattern gives a unique perspective between tradition and modernity. Readers are more immersed in the story and have a greater sense of experience. The advantage of this is its ability to immerse readers in the protagonist's experience. Readers feel like they become the protagonists and it creates more adventure and unpredictability. However, the disadvantage is that it has less character development and emotional connections. These two different writing skill has their own advantages and disadvantages, but they all display the motifs in the story very well.

In conclusion, The Medicine Bag and TA NA E KA both explore themes of cultural identity, acceptance of traditions, and the importance of heritage, they do so through different narrative structures and writing styles. These two stories show the richness and diversity of traditions in different cultural contexts and the ways in which they are passed down through generations.

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The Cass review: an opportunity to unite behind evidence informed care in gender medicine

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At the heart of Hilary Cass’s review of gender identity services in the NHS is a concern for the welfare of “children and young people” (doi: 10.1136/bmj.q820 ). 1 Her stated ambition is to ensure that those experiencing gender dysphoria receive a high standard of care. This will be disputed, of course, by people and lobbying groups angered by her recommendations, but it is a theme running through the review. Cass, a past president of the UK’s Royal College of Paediatrics and Child Health, seeks to provide better care for children and adolescents on one of the defining issues of our age. Her conclusion is alarming for anybody who genuinely cares for child welfare: gender medicine is “built on shaky foundations” (doi: 10.1136/bmj.q814 ). 2

That verdict is supported by a series of review papers published in Archives of Disease in Childhood , a journal published by BMJ and the Royal College of Paediatrics and Child Health (doi: 10.1136/archdischild-2023-326669 doi: 10.1136/archdischild-2023-326670 doi: 10.1136/archdischild-2023-326499 doi: 10.1136/archdischild-2023-326500 ). 3 4 5 6 The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider—from social transition to hormone treatment.

For example, of more than 100 studies examining the role of puberty blockers and hormone treatment for gender transition only two were of passable quality. To be clear, intervention studies—particularly of drug and surgical interventions—should include an appropriate control group, ideally be randomised, ensure concealment of treatment allocation (although open label studies are sometimes acceptable), and be designed to evaluate relevant outcomes with adequate follow-up.

One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret. The methodological quality of research matters because a drug efficacy study in humans with an inappropriate or no control group is a potential breach of research ethics. Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions. Yet this inconclusive and unacceptable evidence base was used to inform influential clinical guidelines, such as those of the World Professional Association for Transgender Health (WPATH), which themselves were cascaded into the development of subsequent guidelines internationally (doi: 10.1136/bmj.q794 ). 7

The Cass review attempted to work with the Gender Identity Development Service (GIDS) and the NHS adult gender services to “fill some of the gaps in follow-up data for the approximately 9000 young people who have been through GIDS to develop a stronger evidence base.” However, despite encouragement from NHS England, “the necessary cooperation was not forthcoming.” Professionals withholding data from a national inquiry seems hard to imagine, but it is what happened.

A spiralling interventionist approach, in the context of an evidence void, amounted to overmedicalising care for vulnerable young people. A too narrow focus on gender dysphoria, says Cass, neglected other presenting features and failed to provide a holistic model of care. Gender care became superspecialised when a more general, multidisciplinary approach was required. In a broader sense, this failure is indicative of a societal failure in child and adolescent health (doi: 10.1136/bmj.q802 doi: 10.1136/bmj-2022-073448 ). 8 9 The review’s recommendations, which include confining prescription of puberty blockers and hormonal treatments to a research setting (doi: 10.1136/bmj.q660 ), now place the NHS firmly in line with emerging practice internationally, such as in Scandinavia (doi: 10.1136/bmj.p553 ). 10 11

Cass proposes a future model of regional multidisciplinary centres that provide better access and, importantly, standardised care for gender dysphoria, including a smoother transition between adolescent and adult services. Staff will need training. All children and young people embarking on a care pathway will be included in research to begin to rectify the problems with the evidence base, with long term outcomes being an important area of focus. An already stretched workforce will need to extend itself further (doi: 10.1136/bmj.q795 doi: 10.1136/bmj-2024-079474 ). 12 13 In the meantime, some children and young people will turn to the private sector or online providers to meet their needs. The dangers in this moment of service transition are apparent.

But it’s also a moment of opportunity. Families, carers, advocates, and clinicians—acting in the best interests of children and adolescents—face a clear choice whether to allow the Cass review to deepen division or use it as a driver of better care. The message from the evidence reviews in Archives of Disease in Childhood is as unequivocal as it could be. Cass’s review is independent and listened to people with lived experience. Without doubt, the advocacy and clinical practice for medical treatment of gender dysphoria had moved ahead of the evidence—a recipe for harm.

People who are gender non-conforming experience stigmatisation, marginalisation, and harassment in every society. They are vulnerable, particularly during childhood and adolescence. The best way to support them, however, is not with advocacy and activism based on substandard evidence. The Cass review is an opportunity to pause, recalibrate, and place evidence informed care at the heart of gender medicine. It is an opportunity not to be missed for the sake of the health of children and young people. It is an opportunity for unity.

• Mitchell A ,
• Langton T ,
• Heathcote C ,
• Hewitt CE ,
• Hardiman L ,
• Wilkinson E
• Dixon-Woods M ,
• Summers C ,