If you have more time to write on this, curious if you can say more on common replies from other academics, that the bar for this type of “high quality” research in pediatric gender medicine may not be feasible, or in some cases would be unethical.
I find it interesting that the link is to Canada, which along with America seems to be committed to an ideological construct of "evidence" rather than any considered assessment of the evidence that does exist.
I'm familiar with that point about the bar for evidence, and it is little more than sophistry. For example, my "day job" field of research is nutrition science, a field with obviously important implications for public health that also struggles, methodologically, to produce "high quality" evidence.
This is largely because we can't study diets, foods, and nutrients, the way we would study drugs or surgical interventions. Yet this hasn't stopped nutrition science from producing a very actionable evidence base, by drawing on multiple lines of evidence to produce a coherent picture.
There are several examples I could use from a general public health perspective, e.g., evidence never relied on RCTs to "prove" that smoking caused cancer, nor would an RCT for Sudden Infant Death Syndrome ("cot death") have been ethical, and yet research figured out that sleeping in the prone position was a major risk factor.
In the SIDS example, the reason it was possible to act is because of the benefit-to-harm ratio; telling parents not to put a kid to bed in a prone position carries almost no risk of harm. So, the recommendation can be made in the context of lower-quality evidence (case-control and prospective studies).
However, for paeds gender medicine, we are talking about drugs and surgeries. There is far more potential for harm. And this begets an entirely different picture of what evidence is acceptable for action. There is no reason why well-conceived, controlled trials cannot be conducted. And nothing is more unethical than the "affirmative care" model, so I find that argument to be particularly disingenuous.
To be clear, RCTs are not required for every question, as the SIDS example shows; another example is the trans-fats ban, which also didn't rely on RCTs, and smoking, as stated above.
But the point made in that article, "there is evidence it just isn't an RCT", is a lie, unsurprisingly for the activist-clinicians in this area. There is also evidence of harm, from infertility to low bone mineral density.
So while no one with any scientific grounding would say we need an RCT to answer every question, in this particular case even the non-randomised, observational evidence is sufficient to raise the precautionary principle.
No one ever expects "high quality" evidence in every domain for which action is required. That is itself a sophist bar. With paeds gender medicine, the issue also runs deeper; research has not been allowed to be conducted openly and published unless it upholds a model for which there was little to no evidence anyway.
For example, several papers have indicated that among teenage girls, social contagion is a strong predictor of declaring a trans identity without any history of dysphoria. Activists go apoplectic and journals often retract, for no sound reason, these papers. Why activists are even in the research picture, or the evidential evaluation picture, is a travesty in the first place.
Maybe I'll do a follow-up essay on this point you've raised because I think it is a very important part of this debate.
Postmodernism is a faith-based movement made by and for disaffected secular intellectuals, who pose as enlightened philosopher-kings but are still chained in Plato's cave imagining their shadows as the totality of existence. It certainly can't be a coincidence that at the precise time the prior Opiate of the Intellectuals, Marxism, proved to be a disaster and academia opened its arms (and provided great salaries) to all sorts of spurious Studies Depts, that all of a sudden Oppression (and all ego wounds) was suddenly situated in language—thus our soi-disant radical class could still fight for the Cause while never leaving the library and never relinquishing their places on the tenure ladder. (I am as anti-Communist as they come, but still have a soft spot for Pol Pot, who produced perhaps Communism's one smart and practical idea: send all "intellectuals" into the country to actually work with their hands and maybe build up some muscles and callouses—when you have to wake up at dawn, down a bowl of rice, and farm your food, perhaps then Reality is no longer a social construct and all of life is not situated in language.)
Language, professed morals and priniciples, ideology are all abstractions that people at the apex of the Hierarchy of Needs can play with their whole lives, but the real test of anyone is their DEEDS AND ACTS. Our postmodern intellectual class has produced one product that will define them, Deconstruction, which is essentially an acid that can be poured on all our social bonds, any conception of Truth and Beauty, and mar them until they appear as their opposites; and this is done in the service of the single idea they repeat ad infinitum: Nothing exists but Power and Oppression.
The old saw is "Those that can't, teach", well here the saw is "Those who can't build and create, destroy."
Excellent contribution, Sir, thank you. I think we've discussed before the irony of the desire for destruction of the very social order that allows these pseudo-philosophers to ascend to their thrones in the first place, determined to bite the hand that feeds them.
Perhaps, as you say, it arises from a sense of ongoing bitterness that their glorious "cultural revolution" has never come to pass in any serious political way. Instead, they focus on local "cultural revolutions" in their institutions and, in certain contexts, formerly left-of-centre political parties that adopted their abstractions as a manifesto of sorts.
And while I think it is understandable, at least explainable, as to why this faith-based movement took hold in "social science" or the humanities as disciplines more vulnerable to postmodern pseudo-intellectual pontificating, the journey into the sciences and medicine is one that remains perplexing to me. Perhaps it does represent how thorough institutional capture by bureaucratic administrators was.
When I pull back the lens a bit I see the Permanent Revolution as one of the results of the change from the West's pre-Enlightenment feudal structure to our post-Enlightenment democratic structure.
So whereas the old power structure/tension was based on the Three Estates (1 clergy, 2 nobility, 3 plebs), what replaced Estates 1 and 2 was merchants/business class instead of aristocrats and philosophers/professors instead of priests.
And whereas our business class bases its right to rule not on inherited bloodlines but on their success in amassing assets and what this says about them (I ran the most successful business, so I can run the country!), our new priestly class bases their right to rule on their status as philosopher-kings who've read and written enough books (and built such beautiful cloud castles) that they have a special exalted wisdom—they also reinforce this by gearing their ideas to counteract the sins and weaknesses of the business class, meaning inequality, commercial values and their antisocial consequences, environmental despoliation etc.
This is all more or less downstream from the Jacobins' Temple of Reason and the establishment of a new priesthood based on liberating us from the old priesthood, replacing Revelation w Reason, and the inherited ties of God, country, family with various forms of "liberation" where all ties and bonds are chosen and not inherited.
The Permanent Revolution is different in each time and place, it's worked within Christianity when this was too powerful to displace, worked within national bonds when these seemed indissoluble (as in the prior conceptions of Socialism that were all predicated on benefiting a specific nation and people), worked inside governments when this was possible etc.
The Permanent Revolution is more or less the Will to Power crusade of secular disaffected intellectuals who want to displace liberalism/capitalism because it doesn't reward them and their values as much as they think they deserve, but always puts money and popular opinion ahead of them, which I think also helps explain why intellectuals supported/venerated the Soviet Union—it may have been a dictatorship, but it was a dictatorship that took intellectuals and ideas seriously!
The Soviets certainly took bad ideas and "science" seriously!
That all does make sense, cheers. Within that transition over the Enlightenment/post-Enlightenment, I've always been particularly fascinated by the dialectic tension with the Romantic Revolution as a competing force for Revelation vs. Reason, albeit in a more secular form. That last gasp to retain something of mystery in the face of Rationalism and Reductionism. The Romantics obviously lost, but the themes tend to rear their head in different times and places as a response to new technological (or social) innovations.
On the Soviets, science, and ideology, you might enjoy this paper:
i love Anna Krylov, she is our best canary in the Communist coalmine.
Is funny you should mention Romanticism, it feels like such an undiscussed yet crucial element of the zeitgeist, I just pulled out my copy of Berlin's "Roots of Romanticism". I'll let you know if I find anything juicy in there.
Recently listened to this conversation on the Cass report. I personally haven’t been through the report myself. It seems to me there’s so much nuance to this topic and there’s plenty of concerns and legit hesitation about proper care. https://www.youtube.com/live/WCD5bEDH7nk?si=Z6ngBYSdPp0QgOhC
There is nuance and concern, both factors which usually in medicine give rise to the precautionary principle. I've seen some fairly bad takes, from both "sides", as to what constitutes sufficient evidence and evidential bars that would justify certain interventions, so I'm writing a follow-up piece now on evidence, standards of proof, and certainty. Thanks for the link!
Thanks for that link. Wild. What a great example of activist-doublespeak and dishonesty masquerading as research. Even as one example, the Bell case was overturned as a matter of law which had nothing to do with evidential questions of research/science (the reason for the overturning was in fact because the lower court had made determinations that related to evidence).
Thanks a lot for this one again, Alan! While I am neither a "scientist" nor "practitioner" (medical doctor or the like), this "scientific thinking"/epistemology topic is one of my favourites I try and engage with a lot - especially as it, as your present essay so impressively shows (vielmehr, "einordnet"), has such enormous implications for various aspects of "human existence" (be it culture, history, medicine, you name it). Especially this postmodernization of science, as cultural zeitgeist :( , and its effects must really give us something "to think about" (pun intended)! Thank you for always taking up this topic, naming it - and "educating" (also in your "day job"/the Nutrition Literacy course!)!
Absolutely right, a sound epistemic basis extends across multiple domains. And while certain academic fields have always been more prone, and in some ways suited, to more subjectivist epistemic grounding, I find it quite frightening that this could take hold in evidence-based medicine or other healthcare domains that utilise this model of evidence. No good can come from it.
Somewhat relatedly, I'm wondering if you've read Delusions of Gender by Cordelia Fine. It's not about transgenderism, but it critically reviews the research underpinning the concept of "brain sex." Would be curious what you make of it if you ever pick it up.
I haven't read that, but I will no doubt at some point, particularly if it is more research-oriented. I have come across some of those arguments in the literature, but like any aspect of neuroscience (and to be clear, that is not my field) it seems like a tricky trait to research, from a methodological standpoint.
If you have more time to write on this, curious if you can say more on common replies from other academics, that the bar for this type of “high quality” research in pediatric gender medicine may not be feasible, or in some cases would be unethical.
https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920
I find it interesting that the link is to Canada, which along with America seems to be committed to an ideological construct of "evidence" rather than any considered assessment of the evidence that does exist.
I'm familiar with that point about the bar for evidence, and it is little more than sophistry. For example, my "day job" field of research is nutrition science, a field with obviously important implications for public health that also struggles, methodologically, to produce "high quality" evidence.
This is largely because we can't study diets, foods, and nutrients, the way we would study drugs or surgical interventions. Yet this hasn't stopped nutrition science from producing a very actionable evidence base, by drawing on multiple lines of evidence to produce a coherent picture.
There are several examples I could use from a general public health perspective, e.g., evidence never relied on RCTs to "prove" that smoking caused cancer, nor would an RCT for Sudden Infant Death Syndrome ("cot death") have been ethical, and yet research figured out that sleeping in the prone position was a major risk factor.
In the SIDS example, the reason it was possible to act is because of the benefit-to-harm ratio; telling parents not to put a kid to bed in a prone position carries almost no risk of harm. So, the recommendation can be made in the context of lower-quality evidence (case-control and prospective studies).
However, for paeds gender medicine, we are talking about drugs and surgeries. There is far more potential for harm. And this begets an entirely different picture of what evidence is acceptable for action. There is no reason why well-conceived, controlled trials cannot be conducted. And nothing is more unethical than the "affirmative care" model, so I find that argument to be particularly disingenuous.
To be clear, RCTs are not required for every question, as the SIDS example shows; another example is the trans-fats ban, which also didn't rely on RCTs, and smoking, as stated above.
But the point made in that article, "there is evidence it just isn't an RCT", is a lie, unsurprisingly for the activist-clinicians in this area. There is also evidence of harm, from infertility to low bone mineral density.
So while no one with any scientific grounding would say we need an RCT to answer every question, in this particular case even the non-randomised, observational evidence is sufficient to raise the precautionary principle.
No one ever expects "high quality" evidence in every domain for which action is required. That is itself a sophist bar. With paeds gender medicine, the issue also runs deeper; research has not been allowed to be conducted openly and published unless it upholds a model for which there was little to no evidence anyway.
For example, several papers have indicated that among teenage girls, social contagion is a strong predictor of declaring a trans identity without any history of dysphoria. Activists go apoplectic and journals often retract, for no sound reason, these papers. Why activists are even in the research picture, or the evidential evaluation picture, is a travesty in the first place.
Maybe I'll do a follow-up essay on this point you've raised because I think it is a very important part of this debate.
Postmodernism is a faith-based movement made by and for disaffected secular intellectuals, who pose as enlightened philosopher-kings but are still chained in Plato's cave imagining their shadows as the totality of existence. It certainly can't be a coincidence that at the precise time the prior Opiate of the Intellectuals, Marxism, proved to be a disaster and academia opened its arms (and provided great salaries) to all sorts of spurious Studies Depts, that all of a sudden Oppression (and all ego wounds) was suddenly situated in language—thus our soi-disant radical class could still fight for the Cause while never leaving the library and never relinquishing their places on the tenure ladder. (I am as anti-Communist as they come, but still have a soft spot for Pol Pot, who produced perhaps Communism's one smart and practical idea: send all "intellectuals" into the country to actually work with their hands and maybe build up some muscles and callouses—when you have to wake up at dawn, down a bowl of rice, and farm your food, perhaps then Reality is no longer a social construct and all of life is not situated in language.)
Language, professed morals and priniciples, ideology are all abstractions that people at the apex of the Hierarchy of Needs can play with their whole lives, but the real test of anyone is their DEEDS AND ACTS. Our postmodern intellectual class has produced one product that will define them, Deconstruction, which is essentially an acid that can be poured on all our social bonds, any conception of Truth and Beauty, and mar them until they appear as their opposites; and this is done in the service of the single idea they repeat ad infinitum: Nothing exists but Power and Oppression.
The old saw is "Those that can't, teach", well here the saw is "Those who can't build and create, destroy."
Excellent contribution, Sir, thank you. I think we've discussed before the irony of the desire for destruction of the very social order that allows these pseudo-philosophers to ascend to their thrones in the first place, determined to bite the hand that feeds them.
Perhaps, as you say, it arises from a sense of ongoing bitterness that their glorious "cultural revolution" has never come to pass in any serious political way. Instead, they focus on local "cultural revolutions" in their institutions and, in certain contexts, formerly left-of-centre political parties that adopted their abstractions as a manifesto of sorts.
And while I think it is understandable, at least explainable, as to why this faith-based movement took hold in "social science" or the humanities as disciplines more vulnerable to postmodern pseudo-intellectual pontificating, the journey into the sciences and medicine is one that remains perplexing to me. Perhaps it does represent how thorough institutional capture by bureaucratic administrators was.
When I pull back the lens a bit I see the Permanent Revolution as one of the results of the change from the West's pre-Enlightenment feudal structure to our post-Enlightenment democratic structure.
So whereas the old power structure/tension was based on the Three Estates (1 clergy, 2 nobility, 3 plebs), what replaced Estates 1 and 2 was merchants/business class instead of aristocrats and philosophers/professors instead of priests.
And whereas our business class bases its right to rule not on inherited bloodlines but on their success in amassing assets and what this says about them (I ran the most successful business, so I can run the country!), our new priestly class bases their right to rule on their status as philosopher-kings who've read and written enough books (and built such beautiful cloud castles) that they have a special exalted wisdom—they also reinforce this by gearing their ideas to counteract the sins and weaknesses of the business class, meaning inequality, commercial values and their antisocial consequences, environmental despoliation etc.
This is all more or less downstream from the Jacobins' Temple of Reason and the establishment of a new priesthood based on liberating us from the old priesthood, replacing Revelation w Reason, and the inherited ties of God, country, family with various forms of "liberation" where all ties and bonds are chosen and not inherited.
The Permanent Revolution is different in each time and place, it's worked within Christianity when this was too powerful to displace, worked within national bonds when these seemed indissoluble (as in the prior conceptions of Socialism that were all predicated on benefiting a specific nation and people), worked inside governments when this was possible etc.
The Permanent Revolution is more or less the Will to Power crusade of secular disaffected intellectuals who want to displace liberalism/capitalism because it doesn't reward them and their values as much as they think they deserve, but always puts money and popular opinion ahead of them, which I think also helps explain why intellectuals supported/venerated the Soviet Union—it may have been a dictatorship, but it was a dictatorship that took intellectuals and ideas seriously!
Hope this makes sense....Cheers!
The Soviets certainly took bad ideas and "science" seriously!
That all does make sense, cheers. Within that transition over the Enlightenment/post-Enlightenment, I've always been particularly fascinated by the dialectic tension with the Romantic Revolution as a competing force for Revelation vs. Reason, albeit in a more secular form. That last gasp to retain something of mystery in the face of Rationalism and Reductionism. The Romantics obviously lost, but the themes tend to rear their head in different times and places as a response to new technological (or social) innovations.
On the Soviets, science, and ideology, you might enjoy this paper:
https://pubs.acs.org/doi/10.1021/acs.jpclett.1c01475
i love Anna Krylov, she is our best canary in the Communist coalmine.
Is funny you should mention Romanticism, it feels like such an undiscussed yet crucial element of the zeitgeist, I just pulled out my copy of Berlin's "Roots of Romanticism". I'll let you know if I find anything juicy in there.
Cheers!
Recently listened to this conversation on the Cass report. I personally haven’t been through the report myself. It seems to me there’s so much nuance to this topic and there’s plenty of concerns and legit hesitation about proper care. https://www.youtube.com/live/WCD5bEDH7nk?si=Z6ngBYSdPp0QgOhC
There is nuance and concern, both factors which usually in medicine give rise to the precautionary principle. I've seen some fairly bad takes, from both "sides", as to what constitutes sufficient evidence and evidential bars that would justify certain interventions, so I'm writing a follow-up piece now on evidence, standards of proof, and certainty. Thanks for the link!
https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2328249
Thanks for that link. Wild. What a great example of activist-doublespeak and dishonesty masquerading as research. Even as one example, the Bell case was overturned as a matter of law which had nothing to do with evidential questions of research/science (the reason for the overturning was in fact because the lower court had made determinations that related to evidence).
Thanks a lot for this one again, Alan! While I am neither a "scientist" nor "practitioner" (medical doctor or the like), this "scientific thinking"/epistemology topic is one of my favourites I try and engage with a lot - especially as it, as your present essay so impressively shows (vielmehr, "einordnet"), has such enormous implications for various aspects of "human existence" (be it culture, history, medicine, you name it). Especially this postmodernization of science, as cultural zeitgeist :( , and its effects must really give us something "to think about" (pun intended)! Thank you for always taking up this topic, naming it - and "educating" (also in your "day job"/the Nutrition Literacy course!)!
Absolutely right, a sound epistemic basis extends across multiple domains. And while certain academic fields have always been more prone, and in some ways suited, to more subjectivist epistemic grounding, I find it quite frightening that this could take hold in evidence-based medicine or other healthcare domains that utilise this model of evidence. No good can come from it.
This was music to my ears. Thank you.
Somewhat relatedly, I'm wondering if you've read Delusions of Gender by Cordelia Fine. It's not about transgenderism, but it critically reviews the research underpinning the concept of "brain sex." Would be curious what you make of it if you ever pick it up.
I haven't read that, but I will no doubt at some point, particularly if it is more research-oriented. I have come across some of those arguments in the literature, but like any aspect of neuroscience (and to be clear, that is not my field) it seems like a tricky trait to research, from a methodological standpoint.