American Denial

"Nothing to see here" is a dangerous and anti-scientific position

Last week, the medical journal Pediatrics published a paper which asserted that the demographic shift in young trans patients seen in much of the Western world was…not a thing here. The study looked at data from 2017 to 2019, suggesting there was not an increase in trans identification among natal females (not that we actually know the sex of survey respondents), and concluded that social contagion was not causing rapid-onset gender dysphoria and “should not be used to argue against the provision of gender-affirming medical care.” (Oddly enough, it didn’t argue that desistance or detransition was increasing among boys in those years.)

Two important detailed critiques of the study’s methodology, by Jesse Singal and Leor Sapir, followed, but those weren’t the only ones. Even a group of gender-affirming practitioners who also deny the existence of ROGD or social contagion published a critique they titled: “Science and Public Health as a Tool for Social Justice Requires Methodological Rigor.” On Twitter, Nathan Williams unspooled a thread about the study’s flaws. (All these people are better at “what’s wrong with the methodology” than I am, so please read their critiques.)

The media, as usual, ran wild with research that confirmed its own biases. The American Academy of Pediatrics’ own news site claimed “Study finds no evidence of social contagion among transgender youths,” which is an incredible stretch from the actual findings. [UPDATE: Just before I hit publish, this article had been taken down. Interesting.] “‘Social contagion’ isn’t causing more youths to be transgender, study finds,” wrote NBC. The Hill noted “New research challenges claim that youth identify as transgender due to ‘social contagion,’” which is at least a little less didactic.

These headlines are an astounding failure of journalism, but they are also a reminder of an astounding failure of the American medical community and health care system. We do not have good data. We have not gathered prospective data on, say, those who sought pediatric gender medical transition since 2007, when the first pediatric gender clinic opened in Boston. We have not pressed clinics to gather and share that data. We rely on low-quality survey science to push theories that obscure reality rather than reveal it.

The thing is, in other countries we do have that data. Take, for instance, referrals to the Tavistock in the UK, whose closure was announced last week (more on that on Common Sense). Their data clearly show an increase in female referrals, with a steady rise in 2015, the exact same year Finland and Sweden, which also kept good records, reported a sharp increase.

These countries, these clinics, don’t know exactly why the demographic shift occurred. Some health officials and clinicians were curious, others concerned. They are making changes to try to figure out the safest and most effective way to treat this ballooning and unprecedented population. To do that, of course, they must acknowledge its existence.

Here, the American Academy of Pediatrics seems to have only certainty in place of curiosity and concern. They state clearly that there is not a problem, that this research shows Republican attempts to delay medical interventions (“bans”) until after 18 should be thwarted. This despite the organization Genspect, which “represents thousands of parents of gender dysphoric children, adolescents, and young adults, as well as trans people, detransitioners, clinicians, and allied groups” sending them an open letter asking them to consider a resolution that would require a systematic, non-partisan evidence review. Can you imagine a medical organization of doctors who care for kids refusing to conduct an evidence review? On the one hand, I can understand their hesitancy, when every other evidence review has led to the abandonment or rethinking of the informed consent/affirmative model. On the other hand: Don’t they want evidence-based care for kids? Isn’t that more important than digging in their heels and saving face?

This isn’t the first time the medical and mental health communities have embraced certainty about a fuzzy subject, ignoring evidence under the guise of “saving children.” Last week, I listened a terrific podcast called Conviction: American Panic, about the Satanic Panic, when hundreds of children, often at the suggestion of therapists, doctors and police officers, accused their parents of ritual satanic abuse, sending them to prison despite the pseudoscience on which those convictions were based. Many scholars and journalists have looked back and noticed how the poorly trained and ideologically captured “experts” participated in the creation of this panic, hurting children and their families in the process.

Near the end of the podcast, the narrators say that you can’t recognize a mass psychosis until you’re out of it. But I don’t think that’s true. There are physicians, therapists, journalists, trans adults and detransitioners all trying to sound the alarm, often while experts stick their fingers in their ears.

I’m incredibly concerned about the state of journalism and about a medical community refusing to admit what is clear to many of us who’ve been poking around in this world. I’ve talked to dozens and dozens of parents of ROGD kids, and to some of those kids who’ve desisted or detransitioned. I’ve scoured data from other countries. The demographic shift is real, and we can’t get these kids the best care they need if we’re pretending it isn’t. I’m also incredibly curious about how ideological capture works—how have both the media and the medical communities in America come to embrace science denialism instead of try to get to the bottom of what’s really happening?

Corinna Cohn posted that Pediatrics’ editor is Lewis First, and implored him to respond to the paper’s criticisms.

HeterodorxPodcast 🇸🇪 @heterodorx

The editor-in-chief of the AAP journal is @lewis_first. I’d like to see him publicly respond to the criticism of Turban, et al, doi.org/10.1542/peds.2… The methodology applied is extremely poor, and the AAP has reportedly rejected publishing comments on its flaws.

So far, First remains mum. I think the silence of so many who are skeptical, curious or concerned—because they risked their jobs, livelihoods, friends, family if they were to speak up—is part of how such poor science and poor health care has progressed this far. And the silence, or science denial, of leaders in the medical and mental health fields is how it continues.