Commentary
Unicorns don’t exist.
More accurately, there’s no evidence that they exist, which isn’t quite the same thing. As astronomer Carl Sagan famously articulated, “Absence of evidence isn’t evidence of absence.”
Yet Sagan has also popularized the idea that “extraordinary claims require extraordinary evidence,” which is also true, and a reprise of a similar axiom articulated in the early 19th century by French mathematician and scientist Pierre-Simon Laplace: “The weight of evidence for an extraordinary claim must be proportioned to its strangeness.”
That “extraordinary claims” principle, as Italian cognitive psychologist and researcher Patrizio Tressoldi has put it, “is at the heart of the scientific method, and a model for critical thinking, rational thought and skepticism everywhere.”
And so you’re free to assert that unicorns are real, but that claim deserves to be dismissed unless you can find exceptional evidence to back it up.
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I raise all this in the context of a pair of papers recently published in the Archives of Disease in Childhood, authored by a McMaster University-based group of researchers which includes Dr. Gordon Guyatt, known as one of the godfathers of the “evidenced-based medicine” construct that underpins modern medical practice.
The two papers are rigorous systematic reviews and meta-analyses, which examine in the first instance the practice of administering puberty blockers to youth with “gender dysphoria,” and secondly, the practice of administering “gender affirming” hormone therapy to gender-dysphoric individuals under the age of 26.
The modern-day assertions that sex and gender are not binary in nature, but rather exist on a spectrum, and that it’s possible to be a male trapped in a female’s body (or vice versa), and finally that it’s possible to convert from one sex or gender to another, are certainly extraordinary claims. They are such because of their sudden introduction into medical discussion, and rapid acceptance as being self-evidently true. And so one would expect that extraordinary evidence exists to support the practices of administration of puberty blockers and “gender affirming” hormones to gender-confused individuals.
But here’s the conclusion of Dr. Guyatt et al. with respect to puberty blockers:
“There remains considerable uncertainty regarding the effects of puberty blockers in individuals experiencing GD [gender dysphoria]. Methodologically rigorous prospective studies are needed to understand the effects of this intervention.”
And the conclusion of their study of cross-gender hormones:
“There is considerable uncertainty about the effects of GAHT [gender-affirming hormone therapy] and we cannot exclude the possibility of benefit or harm. Methodologically rigorous prospective studies are needed to produce higher certainty evidence.”
None of this is particularly surprising—or it shouldn’t be—given that the United Kingdom’s exhaustive Cass Review (undertaken by esteemed pediatrician Dr. Hilary Cass and commissioned by the UK’s National Health Services) similarly concluded that the evidence supporting these practices is essentially non-existent.
What is surprising—and, well, extraordinary—is that the Canadian medical establishment continues to double down on the “gender-affirming care” model, with the Canadian Medical Association, the Canadian Pediatric Society, and the Alberta Medical Association going so far as to publicly challenge the Alberta government’s recent moves to place restrictions on the administration of puberty blockers and cross-gender hormones to youth. This, despite the significant pull-back from these practices in Europe and much of the United States in the face of the clear exposure of “lack of evidence.”
Here’s Guyatt et al. in the discussion section of their puberty blocker paper:
“Since the current best evidence, including our systematic review and meta-analysis is predominantly very low certainty, clinicians must clearly communicate this evidence to patients and caregivers. Treatment decisions should consider the lack of moderate- and high-quality evidence, uncertainty about the effects of puberty blockers, and patient’s values and preferences. Given the individualistic nature of values and preferences, guideline developers and policy makers should be transparent about which and whose values they are prioritizing when making recommendations and policy decisions.”
Their “gender-affirming” hormone therapy paper adopts similar language:
“Evidence about the effects of GAHT in individuals aged 26 years with GD is predominantly of very low certainty, with lack of moderate and high certainty evidence about the effects of this intervention. This information is crucial for patients, caregivers, clinicians, guideline developers and policy makers involved in treatment decisions. Beyond evidence certainty, decision making should consider other factors, including the magnitude and consequences of potential benefits and harms, patients’ and caregivers’ values and preferences, resource use, feasibility, acceptability and equity. Guideline developers and policy makers must transparently state which and whose values they prioritise when developing treatment recommendations and policies.”
All of this should serve as an enormous flashing light of caution to Canadian gender clinicians. Yet what we have is the opposite: full steam ahead.
It’s extraordinary. And strange. And extremely upsetting to clinicians like me and to the many others like me who care deeply about the well-being of our youth.
Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.
