The Reviews Are In

And they paint a rather different picture of Shrier’s book.

The author’s incantation of the First Amendment does not sufficiently emphasize her red-blooded passion for true democracy, but for the seductive image of a hermetically sealed and patriarchally sound America, one regressively nostalgic for midcentury convention, order, and heroism. Irreversible Damage is Shrier’s own simpering cry to Make America Great Again. And as far as she is concerned, the beneficiaries of free speech’s historic privileges — shabbily enforced where trans voices have been concerned — can only be cisgender. In this dismal and limiting cognitive space where the First Amendment matters — but Shrier’s access to it matters most — the author can write as she pleases: baselessly and brutishly.

Sarah Fonseca. The Constitutional Conflationists: On Abigail Shrier’s “Irreversible Damage” and the Dangerous Absurdity of Anti-Trans Trolls, Los Angeles Review of Books. January 17th, 2021.

This review in particular had the biggest impact on me. I thought that Shrier’s book was primarily evidence-based, for loose definition of evidence. In reality, it sounds like Shrier’s book is best thought of as a “military action” of the “culture war.” Much as with abortion, the goal is to provide a secular mask to religious arguments. What little evidence Shrier brings is really an afterthought, a light window-dressing to distract from the core arguments. In essence there’s two separate layers of arguments going on here, and by focusing on only one I’m giving the impression that I have no rebuttal to the other.

Whether intentional or not, the engine of the “culture war” is a shift from an empiric epistemology, where evidence is weighed to determine the truth, to a form of cultural authoritarianism where the opinions of authority figures are weighed instead. Hall’s 2018 article is a good example of this. She presents the discussion over the healthcare of transgender youth as a he-said, she-said affair. On one side is Dr. Kelly Winters, who has been part of a WPATH advisory panel, presented academic papers on health care, and been awarded for her promotion of the health of transgender people. On the other is Walt Heyer, a preacher who detransitioned and has been an outspoken critic of affirmative care. It makes no sense to put these two on equal footing if we arrive at the truth via evidence and reason. Preachers and media talking-heads carry quite a bit of cultural authority, however, more than an obscure scientist would. Hence why Hall not only places similar weight on the opinions of both, she mentions Walt Heyer by name but not Dr. Kelly Winters; the former carries more weight than the latter, after all.

That review shifted my entire approach to Shrier’s book and Hall’s writing, and I’m glad I read it before going any further on the subject.

As a physician and a researcher who has dedicated my career to taking care of and understanding transgender youth, I recognized the book as bizarre and full of misinformation. I assumed it wouldn’t gain much traction. I was wrong.

I should have realized the internet has dramatically changed the way politically charged misinformation spreads. Online, it often doesn’t matter what’s actually true. The book, full of irresponsible journalistic practices and outright falsehoods, has taken off.

Dr. Jack Turban. “New Book ‘Irreversible Damage’ Is Full of Misinformation“, Psychology Today. December 6th, 2020.

This other review pointed out something rather important. For instance, you’d think that if you’re writing about transgender youth you’d want to talk to transgender youth, right?

Shrier’s book tells the stories of several young people who came out as transgender to their parents. The book claims that these adolescents and young adults were not actually transgender, but actually just confused. The problem is Shrier didn’t actually interview any of these people she wrote about.

The author’s note points out that she only interviewed their parents, who uniformly did not accept their children’s transgender identities. Many of them were estranged from their kids because the children were so hurt by their parents’ rejection. To actually understand the psychology of these young people, one would need to talk to them, not simply rely on stories from parents with whom they do not speak.

To make things worse, the author’s note explains that Shrier changed details in the book to ensure the transgender people she wrote about would not be able to recognize themselves. In doing so, she ensured they could not provide their side of the story or point out any inaccuracies in her reporting.

It’s ROGD all over again! Ask bigoted people for their opinions on subjects they’re bigoted about, and you’ll get bigoted and distorted answers. Summarize those answers in a scientific paper or an in-depth book, and you give false legitimacy to those bigoted beliefs.

Full disclosure: I didn’t stumble on these reviews on my own. Remember how Novella and Gorski of Science-Based Medicine promised a part two on the healthcare of transgender youth? They delivered, by giving Rose Lovell a guest post to discuss the book. She’s a doctor with relevant clinical experience, and she ended her review by pointing readers to the two reviews I shared above. Unsurprisingly, she reaches similar conclusions:

In total, I simply cannot recommend this book to anyone honestly seeking to understand transgender science and medicine. Shrier has written a book in an attempt to prove her specific point, not to explore the nuances of a complex field. While there may be some legitimate concerns (e.g., that of how to support those who choose not to continue to transition or to detransition), the overall narrative in Shrier’s book is so tainted by biased language and misinformation that it throws into question its own legitimacy. I am also very concerned that this book, and others like it, will continue to be used as a primary source in efforts to prevent transgender youth from accessing desperately needed medical care.

Rose Lovell. “Abigail Shrier’s Irreversible Damage: A Wealth of Irreversible Misinformation.” Science-Based Medicine, July 2nd, 2021.

Lovell goes into two arguments of Shrier in depth, then gives a quick gloss over a dozen-ish others. One of those caught my attention:

“Biology is a binary and differences of sex development (DSDs) are vanishingly rare”. False. DSDs are as common as 1 in 5,000 births, and increase to 1 in 200 or 1 in 300 if you include hypospadias and cryptorchidism. Biology is very, very well known to be a spectrum.

Ah, the sex binary. I’ve been on that beat for, what, seven years now? Others agree that sex is not a clear-cut binary.

Consider the multiplicity of features relevant to sex determination: chromosomes, genitalia, gonads, hormone levels, reproductive capacity, and so forth. In order to say that a transsexual after genital reconstruction surgery has under-gone a “sex change,” we must discount other features, including chromosomes, and select genitalia as definitive. But consider a person who has an XY karyotype and is morphologically female due to complete androgen insensitivity syndrome. It’s not clear whether this person is male or female. Indeed, there doesn’t seem to be a factual basis on which to arbitrate the question. But postoperative transsexuality seems exactly analogous. In both cases, there’s no fact of the matter as to what sex or gender the person belongs to.

Bettcher, Talia Mae. “Trapped in the wrong theory: Rethinking trans oppression and resistance.” Signs: Journal of Women in Culture and Society 39.2 (2014): 383-406.

It’s telling that Shrier asserts that sex is binary, even though it isn’t necessary to make her case. It underlines that her true focus is not the health of transgender children, but a cultural rollback to a more patriarchal time. Listen to her in other interviews, and she’ll make arguments about the damaging nature of smart phones and the internet, how LGBT terminology is confusing, and that parents should have primacy over decisions relating to children. Transgender children are being used as a wedge for a grander cultural project, much as opposing abortion is used as a wedge for opposing contraception. This is what the aforementioned engine is pushing.

I’m rambling a bit, though. I found all three reviews quite interesting, and can recommend them if you’d like to read more.

A Good Start

It certainly didn’t seem like that at first blush, though.

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.

Hold on. Harriet Hall has repeatedly shared medical misinformation and lied about the scientific evidence, on a website that claims to promote “the highest standards and traditions of science in health care,” and it hasn’t impacted your view of her at all? Both Steven Novella and David Gorski are not concerned that her flagrant disregard of the science here might spill over to other topics she’s discussed? You’re fine with being used to launder medical misinformation, so long as the actors “remain open to correction?” Yeeesh, I just lost a lot of respect for Science-Based Medicine.

Their response to Hall’s article is also hyper-focused on the scientific literature, with only a few exceptions. That can be quite dangerous, as Allison points out.

Frankly, for a trans person, there’s something surreal and erasing in seeing cis people feuding with cis people over whether we exist. I mean, I am grateful that there are cis people being allies for us … But the fact that people have to come up with logical arguments and “evidence” that our transness is “real,” thus keeping the question alive of whether we do, in fact, exist, keeps giving me the creepy feeling that maybe I’m just a figment of my own imagination. […]

I was just reading HJ Hornbeck’s post about trans athletes, which has all kinds of “scientific,” “objective” evidence that gender dysphoria, gender identity, etc. are real. The problem with going down that path is not only that it concedes the possibility that it could be “disproven,” but also that trans people who don’t fit into the definitions and criteria in those “proofs” are then implicitly left out of the category “real trans.”

When writing about issues at the core of someone’s identity, you need to prioritize humanism over evidence. Hence why I went out of my way to point out the scientific literature is not the final word, that it is not prescriptive. If you doubt me, consider one of the after-effects of ACT UP:

The upshot of all this: “What they were able to revolutionize was really the very way that drugs are identified and tested,” says France. This included scrapping the prevailing practice of testing drugs on a small number of people over a long period of time in favor of testing a huge sample of people over a much shorter period — significantly speeding up the time it took to conduct drug trials.

Similarly, ACT UP insisted that the researchers and pharmaceutical companies that were searching for a cure for AIDS also research treatments for the opportunistic infections that were killing off AIDS patients while they waited for a cure. In the process, says France, “ACT UP created a model for patient advocacy within the research system that never existed before.”

Today it seems natural that people suffering from a disease — whether that’s breast cancer or diabetes — should have a voice in how it is researched and treated. But France says this was decidedly not the norm before ACT UP.

By just reciting the scientific record as if it is a holy book, you roll back the clock to a time when scientists acted as gatekeepers rather than helpers. Instead, start from a patient-centred care perspective where patient rights are placed first. The quality of the science will improve, if anything, and you won’t condescend or impose on the people effected. Novella/Gorski do make some attempts at this, to be fair, but I thought they were easy to miss.

At the same time I was filing away that objection away, though, Novella and Gorski’s follow-up article was really starting to grow on me. It calmly and patiently shoots down a number of arguments made by Shrier and Hall, and the meat of the article doesn’t hold back. They earn their conclusion:

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 that case is not valid. […]

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 could have used some more citations (shock surprise), but there’s enough there to establish that Novella/Gorski have done their homework. Also, did I mention this is only part one?

Part II of this series will include a far more detailed discussion of the key claims in Abigail Shrier’s book and where she goes wrong by an expert in the care of trans children and adolescents.

Giving a front-line expert a platform to share their insights will do wonders to counter the misinformation. Until that time, we still have a solid takedown of Shrier and Hall’s views on transgender people’s health. Despite my objections, it’s well worth a read.

The View from The Street

Whenever mass protests arise, I’m always indebted to the people and protestors who stand right in the thick of it. Hunter Walker, for instance, gave me quite a bit of insight into the Washington, DC. protests. For the Portland, Oregon protests, I got lucky and someone on this very network has been covering them.

1. yes, we’ve always had a few asshats in the crowd doing asshat-y things like throwing fireworks.

2. We actually didn’t have any of that last night, to the point where there was not even a single instance of coordinated banging on the fence to make noise (and not to damage the fence). Like, this shit was peaceful. 100% peaceful. No excuses peaceful. I was actually surprised we could get more than 1500 people down there for a protest like this, with real, legitimate grievances that would anger any caring heart, and have no one engaging in any of the behaviors that they’ve used to justify past attacks. No one at all. I was so fucking proud of us before the tear gas flew and chaos came down. This shit wasn’t even 1% on the protesters. This shit was all on the feds. All of it.

and,
3. Holy fuck, those assaults last night were BAD. Really bad. Mega bad. Even, if you’ll pardon the pun, MAGA BAD.

Crip Dyke has been on the case, which is amazing when you realize her ‘nym is quite literal.

And now we’re back where we started, with me telling you about the decision I had to make to stay and possibly be pushed away from the car, and because of my slower ability to flee inevitably coming into contact with cops that I **know** assault crutch users as if they were armed. If I fell, would I even be able to get up? Especially if the club was aimed at an arm or wrist?

I talk with BFF and she’s scared. We haven’t been together, but she has her own scary stories about how aggressive the cops have been tonight. She convinces me to get in the car. We’re sitting. We’re talking. We make the decision. We leave.

I felt bad retreating with others still facing the Feds’ rage, but it was the right decision.

Tonight was so bad.

If you’re listening to me, if you’ve been listening to me the past 11 days, I’m telling you, however bad the other nights have been, however much you thought those nights sounded scary, they weren’t tonight. Tonight was its own thing, a category to itself.

She has an extensive series on the protests, in fact. You can learn that expired tear gas was fired, watch as she ponders discomfort, cringe as she reveals the Feds were poisoning the air, enjoy a few flowers, witness a police-induced stampede, dream about glitter, observe people getting tear gassed without warning, sigh as people fall short, see the change that happens when Portland gets national press coverage or when the Mayor is nearby, listen to a detailed account of police violence, rewind back to when she was first tear-gassed as well as a first set of photos from the protests. It’s well worth your time.

I know it may not seem that way. Click on the first link to her blog, and you’ll see I’m only getting around to sharing these links a month after they were written. Why on Earth would I link to stale news, surely the protests stopped when the Feds pulled out?

The worst nights follow the same script: A large group takes to the streets calling for an end to police violence and systemic racism. A small fraction commits low-level crimes — often lighting small fires, graffiti-ing buildings and throwing fireworks or water bottles at officers. The police respond with force against the entire crowd.

Over the last month, demonstrators have been battered with batons as they left protests. Police have charged at crowds until they’re pushed deep into residential neighborhoods. Journalists have been shoved and arrested. Tear gas, while used more sparingly than in the early days of the protests, is threatened near nightly. And police regularly shut down protests by declaring them riots. That happened twice over the weekend, though police declined to intervene as far-right activists, some brandishing firearms, brawled with counter-protesters for hours on Saturday afternoon. […]

The mayor recognizes the problem with these scenes that play out on the streets of his city every night: non-violent protesters facing force as police respond to the misbehavior of a few. He just hasn’t found the answer.

“the weekend” referred to above is the weekend of August 22nd. The protests didn’t stop, we just stopped paying attention to them when the level of violence dropped to an “acceptable” level. As I type this, lawsuits are being launched against the US federal government over their behaviour in Portland. The events Crip Dyke documented continue to have resonance, and are due to be replicated elsewhere.

In fact it’ll probably happen this week. Jacob Blake was shot in the back seven times by the police of Kenosha, Wisconsin, as his three children watched on in horror. On day three of the protests against the incident, a gunman opened fire on peaceful protestors, killing two and wounding a third. By now, you shouldn’t be shocked at what happened next.

The apparent shooter, meanwhile, was seen on video walking away from the scene — his AR-style rifle clearly visible, his hands above his head. But Kenosha police who were responding to the reports of gunfire showed no interest in arresting or even questioning the man. Instead, they asked him for directions. “Is someone injured, straight ahead?” an officer asks him via loudspeaker. “Get out of the road,” said another.

He even approached an idling police car, going up close to the window, but then appeared to change his mind and walked away.

Brent Ford, 24, a photographer, witnessed the entire scene. “He had his hands up and they told him to get out of there, even though everyone was yelling that he was the shooter,” Ford told VICE News. “The police didn’t seem to hear or care what the crowd was saying.”

Yep, the police protected a murderer. After all, he was one of their own.

His connections to law enforcement, however, go beyond his vocal support of police on social media. In a statement to BuzzFeed News on Wednesday, the Grayslake Police Department confirmed that [the shooter] was a former member of the Lindenhurst, Grayslake, Hainesville Police Department’s Public Safety Cadet Program. According to a description that was recently removed from the department’s official website, the program “offers boys and girls the opportunity to explore a career in law enforcement” through “hands-on career activities,” such as riding along with officers on patrol and firearms training.

Along with the page describing the Public Safety Cadet Program, the organization’s official Facebook account was deleted after images from 2018 of a boy in a police uniform [resembling the shooter] began to circulate online.

Before he killed two people, he was apparently being thanked by the police for being there. Even as first-degree murder charges were announced against him, his actions were being obfuscated in order to make them easier to defend. And while I’m not aware of any Republican amounting an explicit defense, this is a party that celebrated two white people who brandished weapons against peaceful protesters, headed by a person who views all protestors as terrorists and fantasizes about torturing people he hates. They have innocent blood on their hands, and they’re likely to get a fresh coat of it.

We will NOT stand for looting, arson, violence, and lawlessness on American streets. My team just got off the phone with Governor Evers who agreed to accept federal assistance (Portland should do the same!) TODAY, I will be sending federal law enforcement and the National Guard to Kenosha, WI to restore LAW and ORDER!

Portland could easily become the new normal in the US. This makes Crip Dyke’s series all the more vital to read.

What’s the Message, Here?

The average age of death from COVID in Alberta is 83, and I remind the House that the average life expectancy in the province is age 82. – Premier Jason Kenney, May 27th 2020.

That really caught my ear, when it came across the local news. What the hell is our Premier saying, that the elderly are expendable? It was so outrageous, I wanted to dig into it further and get the full context. The original news report I heard only had that one sentence, though, so I did a bit of research. I couldn’t find an unedited clip of his speech, but I did find a clip with one extra sentence in place.

Mr. Speaker, it is critical as we move forward, that we focus our efforts on the most vulnerable; on the elderly, and the immuno-compromised. The average age of death from COVID in Alberta is 83, and I remind the House that the average life expectancy in the province is age 82. – also Premier Jason Kenney, May 27th 2020.

That radically changes the meaning, doesn’t it? Still, I have to point out I’m getting mixed messages here. [Read more…]

4.5 Questions for Alberta Health

One of the ways I’m coping with this pandemic is studying it. Over the span of months I built up a list of questions specific to the situation in Alberta, so I figured I’d fire them off to the PR contact listed in one of the Alberta Government’s press releases.

That was a week ago. I haven’t even received an automated reply. I think it’s time to escalate this to the public sphere, as it might give those who can bend the government’s ear some idea of what they’re reluctant to answer. [Read more…]