Harriet Hall Is No Skeptic

Whoops! When I wasn’t looking, Harriet Hall had a peek at what her critics have been saying and created a revised version of her review of Shrier’s book. The last thing I’d like to do is spread misinformation about Hall’s views, so I spent some time going line by line through both her original review and the revised one, to see what changed.

[CONTENT WARNING: Transphobia, skeptics being capital-S Skeptics]

The first paragraph to see major changes is emblematic. Here’s how it was in Hall’s original review:

Historically, the conviction that one’s gender doesn’t match one’s anatomical sex typically began around age 2-4. It affected only .01 percent of children, almost exclusively boys. And in 70% of cases, they eventually outgrew it. Prior to 2012, there was no scientific literature on girls age 11-21 ever having developed gender dysphoria at all.

And here’s the revised version, with annotations added by me:

Historically Shrier says that historically, the conviction that one’s gender doesn’t match one’s anatomical sex typically began around age 2-4. It affected only .01 percent of children, almost exclusively boys. And in 70% of cases, they eventually outgrew it (she supports this claim with two published studies). Prior She says that prior to 2012, there was no scientific literature on girls age 11-21 ever having developed gender dysphoria at all.

This does answer my first complaint, that Hall wasn’t being clear about who was claiming what and thus dodging accountability. But notice what’s missing: any attempt to analyze or critique the original claims. My second complaint was that Shrier’s claim about the scientific literature is demonstrably false, a fact that you would think is noteworthy. As far as I know, I’m the only person to make a stink about weak attribution; if Hall’s revisions were based in part on a reading of my blog post, it’s damning of her character that she either didn’t bother to read past the first few paragraphs or turned a blind eye to obvious factual errors.

So which is it? Is Hall intellectually lazy or in denial? I’d argue both, in different degrees at different times. That may seem like a cop-out, but the evidence from the revision points to both theories. A constant theme in my critiques of Hall has been a condemnation of her lazy writing, but I don’t think I’ve effectively conveyed how bad it is. This example is taken from Hall’s original review, but the revised version is almost identical.

Comparing one section of Harriet Hall's review of Shrier's book, and what Abigail Shrier wrote. Click through to see a full-size version. Apologies for dumping a lot of text as an image, but I couldn't think of an HTML-friendly way to make it readable. The following text will give you a summary of it.When you cross-reference her review of Shrier’s book with the book itself, it’s almost certain Hall wrote large chunks of the review by copy-pasting notable sentences into a document, then tweaking most of those sentences to make it less obvious she copy-pasted. Sometimes she’s so lazy that entire sentences survive the process, with no indication they were actually written by Shrier. If Hall handed that document to me in class, I’d forward it to our academic misconduct department as an example of blatant plagiarism.

However, we’re not in an academic setting here. It’s common practice within journalism to recycle press releases into news stories, because a journalist who’s been tasked by their boss to write a half dozen stories a day has few other options. Direct copy-pasting does happen and is still considered unethical, but there’s room for a little devil’s advocacy. This is a book review, not a critical analysis, so is it truly necessary to restate someone else’s claims in your own words? Science-Based Medicine may care more about churning out articles than academic rigor or solid analysis, and would be happy to turn a blind eye to any ethical lapses if it earns them more clicks.

A side-effect of this style of writing is that you don’t put much thought into what’s being said. It wouldn’t be surprising to find a section where Hall copy-pasted something ridiculous without realizing it was ridiculous.

Those She says that those who transition rarely adopt the stereotypical habits of men (like buying a weight set), The example she gives of stereotypical habits of men is buying a weight set. (Whaat!?) Only 3% have had a phalloplasty (to create an artificial penis), and only 13% say they want one. (I don’t know what that means: there could be many other explanations for those phenomena.)

And, indeed, Hall did exactly that. While Hall has gone back to the source material for the revision, she still demonstrates a lack of understanding over what it says.

Adolescents are still trying to figure out who they are and which gender they are attracted to. Many of the adolescent girls who adopt a transgender identity have never had a single sexual or romantic experience and have never been kissed. Shrier is not suggesting that sexual attraction has anything to do with transgender; she just offers it as an example of how adolescents lack life experience and are trying to establish an identity.

Had she either read my critique or merely read Shrier’s book, though, she would have known Shrier features the work of Ray Blanchard.

One reason that the existence of autogynephilia matters has to do with women’s safe spaces. If transgender-identified biological men are completely uninterested in women sexually, one might argue that however uncomfortable it may be, there is little danger in admitting them to women’s private spaces. But if some transgender men are heterosexual, aroused by the idea of themselves dressed as women and generally by the female form, the nature of the debate shifts and the possibility of admitting trans-identified men into women’s safe spaces begins to seem untenable.

Nonetheless, it is hard to deny that autogynephiles exist. Many transsexuals conduct romantic relationships exclusively with women.
Irreversible Damage, pg. 139-140

It’s quite pathetic that I still have a better idea of what’s in Shrier book than Hall does, even though I’ve never read it.

Notice that Hall doesn’t have a substantial response to these ridiculous ideas, either. If you haven’t done or aren’t willing to do your homework, you’re forced to either respond with an argument from ignorance or by moving the goalposts with an appeal for more data. Indeed, if the most common edit Hall makes is clarifying who’s speaking, the second-most common is adding appeals for more data.

[…] In and that in 2016, natal females accounted for 46% of all sex reassignment surgeries; , while a year later it was 70%. Whatever the true numbers, an increase in adolescent gender dysphoria has been noticed by many observers, and this phenomenon deserves our attention and further investigation. […]

In the last decade, lesbians have seen the disappearance of lesbian bars and publications. I have seen numerous news stories about the disappearance of lesbian bars and publications over the last decade: the reasons are not clear. Lesbians Shrier says lesbians have been denigrated as transgender males who won’t admit they are supposed to be boys. Maybe; there are no data on how often that happens. […]

The achievements of gender-nonconforming women are downplayed because they don’t count as true women. Shrier says “The achievements of gender-nonconforming women are downplayed because they don’t count as true women.” Maybe, but we have no data on this. […]

In one study of adult transsexuals, there was a rise in suicidality after sex reassignment surgery. In my opinion, we need better data before we accept that affirmation prevents suicide. […]

“Top surgery,” or bilateral mastectomy, is advocated by surgeons who believe adolescents can make logical decisions, and is done on girls as young as 13 (legal in California). The Shrier says some of these surgeons don’t require input from a therapist; they accede to the patient’s wishes and rarely turn anyone away. If this is true, it is despicable. Does it really happen? How often? We need better data. […]

Critics of Shrier’s book have pointed to published guidelines for transgender care, which are laudable; but if Shrier is right, the official guidelines are not always being followed. If they are not, we need to know and take appropriate action. But the data are lacking.

It takes no thought to ask for more data. It takes a little thought to realize that medical guidelines aren’t invalidated by a few doctors that don’t follow them. It takes a bit more to realize Fenway Health has been offering affirmative care since 1997, and by the time of 2014 was helping over 1,200 transgender people with their health needs.[1] Based on over ten years of their data, plus data on affirmative care gathered in other centres, WPATH endorsed an affirmative care model in their 2012 Standards of Care document. Twenty years on, the data is good enough for major medical organizations to actively promote an affirmative-care model. Had Hall put in a minimal amount of research, rather than copy-pasting someone else’s, she might have been able to answer some of her own questions.

Conversely, she might have actively rejected expert opinion. One of the most substantial edits to Hall’s review is:

In California, students can opt out from sexual health education instruction but cannot opt out of gender identity and sexual identification instruction. Gender stereotypes are taught in kindergarten. Children are taught that they might have a girl brain in a boy body or vice versa; never mind that that is biologically nonsensical. (Shrier says that is “biologically nonsensical.”  When I read the book, I agreed with that statement, but I have since been educated in a long email exchange with Larry Cahill, a neuroscientist with extensive experience in the field who explained that neuroscience in the past 20 years has witnessed a remarkable shift, from simply assuming sex influences outside reproductive functions don’t exist, to recognizing that mammalian brains are deeply influenced by sex at all levels of their function, right down to the cellular level. He sent me links to seventy references supporting this. But he also said that these brain differences have nothing to do with gender dysphoria. He said “nobody knows what happens to create the feeling in a biological female that she is male, or vice versa.” [right parenthesis missing in original]

If someone presented me with seventy citations that contradicted a claim someone else made, I wouldn’t merely go “whoops, guess I disagree with that claim.” I would question every other claim that person has made, given just how badly their views contrasted with reality. And yet, one glaring omission from Hall’s revisions is any statement the Shrier was wrong about something. Hall now disagrees with Shrier about certain things, true, but she never states that anything Shrier says is factually incorrect.

Before Hall published her correction, though, she was also presented references from me, Steven Novella and David Gorski, Rose Lovell, AJ Eckert, and possibly more people. None of those references are worth a mention, let alone consideration. In contrast, neuroscience has not reached a consensus on the influence of sex, and Cahill himself is on one extreme of that debate. Nonetheless, his references are immediately accepted by Hall and his arguments are worth a mention, without no sign she double-checked his work despite the radical difference between his views and Shrier’s. Why the double standard?

Simple: Cahill doesn’t challenge Hall’s beliefs about transgender people. Hall is not merely lazy, she’s actively avoiding contradictory evidence. I just skated past another example: Hall changed “In the last decade, lesbians have seen the disappearance of lesbian bars and publications” to “I have seen numerous news stories about the disappearance of lesbian bars and publications over the last decade: the reasons are not clear.” That’s an argument from anecdote, and you’d think a skeptic who criticizes Shrier and others for using anecdotes would be conscious of invoking them herself.

But Hall isn’t thinking like a skeptic. She’s not only denying evidence, her revisions point back to Shrier’s evidence as if none of her critics thought to read any of it. On top of that, Hall goes out of her way to argue that evidence isn’t important.

Shrier’s book has 23 pages of references. Many of them were from internet or popular magazine and news sources, but she also included a large number of studies from the peer-reviewed scientific literature. Sure, she probably missed some studies that don’t support her thesis; but that’s not the point. After all, the book is not a scientific treatise; it is a descriptive and observational book by a journalist.

A self-described “skeptic” is openly stating that it doesn’t matter if Shrier considered contradictory viewpoints or alternative theories. All that matters is that the book is “descriptive” and “observational,” two subjective buzzwords that can mean anything you wish.

In my blog post on reviews of Shrier’s book, I mentioned the “engine” of the US’s “culture war” is an epistemological shift from empiricism to a cultural authoritarianism. My example was Hall’s 2018 elevation of Walt Heyer, a preacher, to greater authority than Dr. Kelly Winters, who is an expert in transgender health care with decades of experience under her belt. This is a second example: Shrier has been endorsed by Dennis Prager, Ben Shapiro, and Michael Knowles, therefore she is a cultural authority for Hall. Hence why Cahill’s orgy of evidence wasn’t enough to make Hall skeptical, Shrier’s social capital was too strong.

It also explains why Hall compensates for some disagreements with Shrier by explicitly emphasizing how much she still agrees. Disagreeing with someone higher on the social ladder can have consequences, and Hall is eager to please.

Shrier gives a personal example of how teens can’t always predict what they will want later in life. […] She says, “We are very good at knowing what it is we want right now; far less good at predicting whether the object of our desire will produce the satisfaction we take for granted”. I certainly agree with that! […]

Since Shrier says that since doctors have no way of predicting whose dysphoria will respond to gender surgery, Shrier says (and I agree) it should be clearly labeled experimental and should be restricted to patients participating in controlled studies overseen by an institutional review board (IRB). I agree.

Another change: the revised version now links readers to a page on Amazon where they can purchase Shrier’s book. The choice of Amazon is likely a coincidence, but it could also be a subtle pot-shot at Shrier and Hall’s critics. While Hall is keen to stay in the good graces of those she admires and considers authorities, she’s pledged to ignore all who would dare critique her.

SBM’s retraction resulted in a flood of comments and a brouhaha of controversy that I have decided to stay out of. I am observing a strict “no comment” policy. But I have taken some of the criticisms of my review to heart and have revised my book review accordingly.

It’s hard to observe Hall’s mix of lazy thinking and denialism, and still consider her a skeptic. But is she still a Skeptic? It’s true that Steven Novella and David Gorski did the right thing by yanking her book review down, writing up their own critique of it, and allowing two experts in LGBT health care to weigh in as well. But they also wrote:

Further, we wish to make it clear that Dr. Hall still remains an editor of SBM in good standing. She has worked tirelessly to promote SBM and its principles, contributing over 700 articles to SBM since 2008, all without any compensation or possibility of reward beyond public service. However, at SBM quality matters first, and so we have to remain open to correction when necessary.

And, true to their word, Hall has been welcomed back to Science-Based Medicine. After a post that takes a subtle pot-shot at Novella/Gorski, she’s gone on to write seven more articles for the site and another book review. Harriet Hall is, after all, a valued cultural authority within the skeptic/atheist movement. Who cares if she sometimes promotes medical misinformation, or engages in sloppy reasoning, or ignores evidence that contradicts her views? She’s a Skeptic, one of us, and that’s all that matters.

[1] Reisner, Sari L., et al. “Comprehensive transgender healthcare: the gender affirming clinical and public health model of Fenway Health.” Journal of Urban Health 92.3 (2015): 584-592.