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.

When Neutrality Isn’t

The details are a bit tough to track, so here’s a timeline.

June 15th, 2021: Harriet Hall publishes a book review of “Irreversible Damage” to Science-Based Medicine.
June 17th: That book review is removed by Steven Novella and David Gorski, as “we felt there were too many issues with the treatment of the relevant science, and leaving the article up would not be appropriate given the standards of SBM [Science-Based Medicine].”
June 17th: The book review is reprinted by Michael Shermer on Skeptic.com, with an editor’s note that reads in part:

While we have long admired the excellent work by the contributors at Science-Based Medicine on issues like vaccines and quack alternative medicine claims, they have long openly displayed a far-left progressive political bias that has compromised their otherwise stellar reputation as a trustworthy source. In science, facts cannot be bent or silenced by politics, however well intentioned, for nature cannot be fooled.

After June 17th: That paragraph of the editor’s note is removed, presumably by Shermer himself.

I’ll have a lot more to say on this, if my drafts are any indication, but first I want to circle back to the editor’s note by Novella and Gorski. Note that while they claim there are many issues with the science Hall presents, they don’t go into detail. In fact, what I quoted is all they have to say on the subject. In contrast, they spend several paragraphs defending their neutrality. A sample:

Already there are false accusations that this move was motivated by pressure from readers. This is not the case. SBM had and never will cave to outside pressure. We have endured a great extent of such pressure, including the threat of lawsuits and actual litigation.

If you’ve been part of the atheist/skeptic movement for a while, this is no surprise. Novella in particular has tried very hard to be politically neutral and “above the drama” when any major controversy comes up. The problem, as I’ve pointed out before, is that neutrality favours the status quo and the status quo is sexist. That a desire to avoid drama is easily exploited, as if bigots deliberately cause drama it grants them more control over the commentary.

We will leave the comments open for now and encourage full, open, and respectful discussion of the topic by anyone interested.

If you haven’t had your head clouded by a neutrality fetish, you know exactly how “respectful” the discussion has been. Transphobes have been recycling all the tired arguments about sports I’ve covered in depth before. They’re receiving a lot of pushback, thankfully, but transgender people and their allies should never be forced to defend their humanity.

Kudos to Novella and Gorski for retracting that book review, which was the right thing to do. But all they’ve done is turn a body blow into a slap in the face. They knew the science behind this review was dodgy, but kept silent on why to avoid stirring up drama, and in the process let the bigots fill the silence with their own spin.

This apologia for censorship is dishonest. Notice that the authors, Novella and Gorski, can’t be bothered to condescend to explain exactly what it is about the book review that made its deletion necessary as a matter of “quality control.” For some reason, it was impossible to allow discussion of the review and the book. The claim that the action had nothing to do with the bleats of the censors urging suppression of the discussion is not plausible.

Turning off comments is just a click of a button, and would have avoided the inevitable transphobic shit-show. Instead, they let it happen in the name of a “full, open, and respectful discussion” they must have known wouldn’t actually occur. Rather than help transgender people, they’ve left them and their allies to mop up the mess while only putting in a token effort to assist.

Guys, don’t do this.

Slavery in Canada

What’s a Canadian to do in honour of Juneteenth? In school I learned we were the end point of the underground railroad, which ferried slaves out of the USA in the decades before their Civil War. And, well, that was about it. Yay Canada! I guess we never engaged in slavery.

A moment’s thought suggests that is nonsense. Britain did indeed ban slavery before the USA, but even my decaying history knowledge tells me that happened in the 1800’s, about two hundred years after the Brits landed. The Atlantic parts of Canada were heavily engaged in shipping, so there’s a non-trivial chance slave ships landed there in passing at least. If only we had some historical documentation about the subject.

[Read more…]

I’ve Never Understood This

Consider this scenario, instead.

YOU: I’m in the mood for a soft drink. What do you have?
ME: Just Coke and Pepsi, at the moment.
YOU: I’ll take a Coke.
ME: Here’s a Pepsi.
YOU: I thought you said you had Coke?
ME: Oh I do, you just look more like a Pepsi person to me.

This time around, it’s pretty obvious I’ve done something unethical. Given the choice of providing you with what you wanted, I instead imposed something else on you. Both alternatives carried about the same cost to me.

[CONTENT WARNING: TERFs and transphobia] [Read more…]

Fundraiser Update: Continue!

Well, I’m continuing anyway. I had such fun with Super Metroid last weekend that during the second part I suggested resuming it this weekend. When I then got word of how successful the fundraiser had been (while others have spilled the beans, I’ll defer to PZ for the big reveal), well, I simply had to.

As per my usual, I’ve already been streaming for an hour. You can catch up with it on Twitch, and later on the video will migrate to my YouTube channel.

Fundraiser Update: Still Chugging Along

This is another halftime post. I just managed a sequence break by bomb-jumping to get the ice beam, and I’m about to start a big long backtrack where I go back through prior areas with all my new gear. The second half of the live stream is currently active at this link, FYI.

If you like this, for loose definitions of “this,” consider donating to us or Skepticon to help pay off our legal bills. Either way, you can tune into the stream. Can’t make the stream? It’ll stay on my Twitch channel for two weeks, then migrate over to my YouTube channel.

Fundraiser Update: Super Metroid is LIVE!

As usual, I didn’t give myself enough time to write a post reminding you of the game stream before I started streaming. Oh well, at least I can make up for it during the break! The live stream is currently active at this link, and right now I’m just at the start of Brinstar.

If you like this, for loose definitions of “this,” consider donating to us or Skepticon to help pay off our legal bills. Either way, you can tune into the stream. Can’t make the stream? It’ll stay on my Twitch channel for two weeks, then migrate over to my YouTube channel.

Fundraiser: Mother’s Day Gaming

Howdy, strangers! Gawd, I think I’ve promised myself and others that I’ll start blogging again a half-dozen times or so, and up until this moment it’s never stuck. This time is different, if only because I have a good cause: it’s fundraiser time again at this blog network! I’ve got two contributions planned, the first of which is a gaming stream on Saturday and Sunday. Since the theme this time is Mother’s day, I thought I’d celebrate two famous mothers.

Mother Brain, from Metroid (1986); “Samus and baby Metroid“, by zgul-osr1113 @ DeviantArt.

Mother Brain, from Metroid (1986); “Samus and baby Metroid“, by zgul-osr1113 @ DeviantArt

According to the manga, Mother Brain raised Samus Aran when she was young, which played out pretty much as you’d expect. Aran and the Metroids are two different species (though Samus’ DNA is all kinds of mixed up, and like what is a species anyway?), but she spends some time protecting and nurturing a baby Metroid. Both of them check the minimum required boxes, and one’s even got “mother” in their name. It’s perfect!

Saturday and Sunday, at 10AM MDT, I’ll be streaming Super Metroid over on my Twitch channel. It’ll stay there for two weeks before migrating to my YouTube channel. I haven’t played the game in decades, so I’ll keep a map handy, but otherwise I’ll be winging it.

If you like this, for loose definitions of “this,” consider donating to us or Skepticon to help pay off our legal bills. Otherwise, you’ll see me in a few days.