A Dose of Sanity in the Media Madness

BMJ's new bombshell and NYT's award nomination

Photo by Bank Phrom on Unsplash

During my wee-hours insomniac perusal of The New York Times app this morning, I noticed a story about the financial success of a new Hogwarts video game, despite JK Rowling’s comments on “transgender rights.”

Why, I wondered, doesn’t the media frame her views as being about women’s rights? Because that’s actually her concern, isn’t it?

Short answer: Much of the media has ceded the most important part of their job, which is to examine issues from multiple viewpoints. How this happened is something I’ll be writing about in depth in coming months. But for now, we can see the stirrings of an important shift, media coming out of its ideologically-induced slumber and doing actual reporting. The recent letter by GLAAD and another by NYT contributors demanding censorship seems to be backfiring spectacularly, forcing the powers that be to err on the side of good journalism.

That shift probably began last summer, when staffer Emily Bazelon published “The Battle Over Gender Therapy” in the Times magazine. For many of us deep in this issue, and aware of the discrepancy between the reality and the reporting on it, the article was a bit of a disappointment—we were too deep in the scandal to ignore as much of it as she did. It felt about four years too late. Bazelon assumed that those actually following the Dutch protocol were the reasonable ones, and focused very little on those who’ve gotten hurt.

Still, it was a start. It opened the door to better reporting, and correctly dismissed the notion that transition prevents suicide. “A 2020 study of trans patients of all ages, over more than four decades, at the Amsterdam clinic, found that deaths by suicide, which are fortunately rare, though still higher than for the general Dutch population, seem to ‘occur during every stage of transitioning,’” Bazelon wrote.

Earlier this week, the American Society of Magazine Editors nominated that piece for an award in the category of public interest journalism. For those who stand firm in the idea that there should be no debate on this topic, it’s a painful indication that the media has begun to refuse to kowtow to activist narratives. But for folks like me, it’s a sign of how far we still have to go, and a reflection of just how badly this whole thing had derailed. The idea that acknowledging the controversies—which parents, therapists, doctors, a few journalists, detransitioners, LGB folks and many others have been crowing about for years—is somehow brave, well, that just shows how low our standards had dipped.

But last night, the British Medical Journal released a piece which anyone praising (or critiquing) Bazelon’s article should read. Jennifer Block, an investigative reporter and health journalist, looked into the claims not just about settled science, but that the gender-affirming approach is evidence-based.

Jennifer Block @writingblock

Gender-affirming care for adolescents in the US is frequently called evidence-based, even lifesaving. But there is little certainty in the evidence about the benefits of medical treatments, and growing professional concern about possible harms. My latest:

bmj.comGender dysphoria in young people is rising—and so is professional disagreementMore children and adolescents are identifying as transgender and are being offered medical treatment, especially in the US—but some providers and European authorities are urging caution because of a lack of strong evidence. Jennifer Block reports Last October the American Academy of Pediatrics (AAP…

The piece smartly frames the debate as about science, not just politics. “There’s little dispute within the medical community that children in distress need care, but concerns about the rapid widespread adoption of interventions and calls for rigorous scientific review are coming from across the ideological spectrum,” Block writes.

Block explains what evidence-based medicine is and interviews experts who show why WPATH’s, the Endocrine Society’s and the AAP’s policy statements and/or guidelines don’t meet the criteria. We cannot accurately use the term “life-saving” to describe these approaches, based on the evidence we have.

She also reveals how those trying to raise awareness about the limits of the affirming approach are unable to reach those promoting it. At a protest during the AAP’s conference last year, detransitioner Chloe Cole, who went on testosterone as a depressed teen and underwent a double mastectomy at 15, asserted that “This is not informed consent but a decision forced under extreme duress.” But a doctor at the conference dismissed the protestors as “cruel,” and tweeted that “Inside 10 000 pediatricians stand in solidarity for trans & gender diverse kids & their families to receive evidence-based, lifesaving, individualized care.”

If you really wanted to provide evidence-based care, it wouldn’t look like what many kids are getting. As Block writes, recommendations by the Endocrine Society “paired strong recommendations—phrased as ‘we recommend’—with weak evidence.” The fervor, the devotion, the surety of its defenders doesn’t match the science. And weak evidence “doesn’t just mean something esoteric about study design, it means there’s uncertainty about whether the long term benefits outweigh the harms,” Block’s source explains.

So how can clinicians claim to care? If they were providing, say, interventions for diabetes, and former patients said we lost body parts we shouldn’t have, and our bodies are changed in irreparable ways, would they dismiss those people as bigots?

We don’t have good evidence. This is where the discussion could and should begin in the media, not by repeating that the model has the support of medical associations. Because remember: Our medical associations are not non-partisan. They don’t commission and base their recommendations on systematic evidence reviews—and in countries that have done so, they’ve all come to the same conclusion about the evidence, and pulled back from affirmation to rigorous, multidisciplinary evaluation. In fact, the AAP refuses to do a systematic evidence review. Perhaps they know exactly what such a document would show.

The BMJ piece is important, because it refutes the “life-saving” claim. But it’s also important because it’s from the journalistic wing of a medical journal. It’s been heavily reviewed. It pushes past politics. It’s an example of what should be—and, hopefully, what’s to come.