There was a bit of a shock recently when Science-Based Medicine published a positive review of Abigail Schreier’s godawful conservative anti-trans book, Irreversible Damage, by Harriet Hall. It was surprising that such poor science could get a good review on a usually reliable science site, especially when the typical review pans it as “full of misinformation”.
Good news, though: Hall’s terrible article has been yanked from the site (don’t worry, Freezepeachers: it’s still available on Michael Shermer’s wacky libertarian skeptic site), and now Novella and Gorski have written a strong rebuttal. Here’s just their conclusion, and they also promise some further details in follow-up articles.
Abigail Shrier’s narrative and, unfortunately, Dr. Hall’s review grossly misrepresent the science and the standard of care, muddying the waters for any meaningful discussion of a science-based approach to transgender care. They mainly rely on anecdotes, outliers, political discussions, and cherry-picked science to make their case, but it is not valid.
Most significantly, they warn about medical interventions for children, citing mainly the notion that children are not able to make such choices at such a young age and will likely change their minds, regretting their decision because their gender identity is still developing. However, the age group for which they cite (fatally flawed) statistics do not receive medical interventions, and the age group that is eligible are not likely to change their gender identity. This is a statistical bait-and-switch.
The standard of care waits until children are at an age where their gender identity is generally fixed, and then phases in interventions from most reversible to least, combined with robust psychological assessments. Further, regretting these interventions remains extremely rare, and does not support the social contagion hypothesis.
At this point there is copious evidence supporting the conclusion that the benefits of gender affirming interventions outweigh the risks; more extensive, high-quality research admittedly is needed. For now, a risk-benefit analysis should be done on an individual basis, as there are many factors to consider. There is enough evidence currently to make a reasonable assessment, and the evidence is also clear that denying gender-affirming care is likely the riskiest option.
I suspect that, like Freethoughtblogs, SBM gives their writers considerable autonomy, since they can generally trust everyone in their group. Every once in a while, though, something yucky will slip through, and then you have to do some retroactive peer review. I’ve been there. We’ve had a few dramatic incidents here, too. In this case, they announce that “Dr. Hall still remains an editor of SBM in good standing”. Here’s where we differ — if someone on FtB published something like that, there’d be a week or two of shrill in-house and public battles before the offending writer got the boot.