Category: health

Jesse Singal’s op-ed in the NYT: A turning point in “affirmative care”?

February 25, 2026 • 9:30 am

For two reasons I think that Jesse Singal‘s long op-ed (really a “guest essay”) in today’s NYT will mark a turning point in public and professional attitudes towards “affirmative care.”  First, the NYT saw fit to publish a piece showing that many American medical associations have promoted “affirmative care” of gender-dysphoric adolescents, despite those associations knowing that there was little or no evidence for the efficacy of such care.  Indeed, it seems that some of those associations lied or dissimulated about it, all in the interest of pushing a “progressive” ideology. As we know, left-wing “progressives” have been in favor of immediately accepting a child’s self-identification as belonging to its non-natal gender, so that teachers, parents, therapists, and doctors have united to start such children on puberty blockers and, later, surgery and hormones.

The NYT, while it has published pieces questioning the evidence for affirmative care, has been reluctant to come out as strongly as Singal does in the essay. That America’s Paper of Record deems this worthy of publication is news in itself.

For a number of reasons, most concerned with recent evidence (e.g., the Cass Review), the rah-rah affirmative therapy treadmill is grinding to a halt.  As Singal relates, recently two American medical associations—the American Society of Plastic Surgeons (ASPS) and now the powerful American Medical Association (AMA)—have admitted that we don’t know whether a gender-dyphoric child will “resolve” as gay or non-trans without medical intervention, and also that there should be no surgical intervention aimed at altering the gender of minors.

Singal has long called attention to these problems, and for his troubles he’s been branded a “transphobe,” shunned and blocked on social media.  There was even a petition to ban him from the site Bluesky, though, thank Ceiling Cat, it didn’t work.  Now, at long last, his views are getting a respectful airing, and society is coming to realize that the American zeal for “affirmative care”—not shared so much in Europe—is not only misguided but harmful.

The second reason is that the author ID says this about Singal:

Jesse Singal is writing a book about the debate over youth gender medicine in the United States and writes the newsletter Singal-Minded.

Although he’s already written one book. The Quick Fix: Why Fad Psychology Can’t Cure Our Social Ills, this is his first book on gender medicine, and if it expands on the theme of this article, it will be a landmark work with the potential to create big changes in gender medicine and how we view it.  Yes, it’s true that gender ideologues will oppose the article and upcoming book, but they have long put ideology over science, a strategy that is a loser, as we know from the failures of creationism and intelligent design.

Click on the headlines to read the article at the NYT, or find it archived for free at this site.

A few excerpts:

It didn’t matter that the number of kids showing up at gender clinics had soared and that they were more likely to have complex mental health conditions than those who had come to clinics in years earlier, complicating diagnosis. Advocates and health care organizations just dug in. As a billboard truck used by the L.G.B.T.Q. advocacy group GLAAD proclaimed in 2023, “The science is settled.” The Human Rights Campaign says on its website that “the safety and efficacy of gender-affirming care for transgender and nonbinary youth and adults is clear.” Elsewhere, these and other groups, like the American Civil Liberties Union, referred to these treatme

. . .The science doesn’t seem so settled after all, and it’s important to understand what happened here. The approach of left-of-center Americans and our institutions — to assume that when a scientific organization releases a policy statement on a hot-button issue, that the policy statement must be accurate — is a deeply naïve understanding of science, human nature and politics, and how they intersect.

At a time when more and more Americans are turning away from expert authority in favor of YouTube quacks and their ilk — and when our own government is pushing scientifically baseless policies on childhood vaccination and climate change — it’s vital that the organizations that represent mainstream science be open, honest and transparent about politically charged issues. If they aren’t, there’s simply no good reason to trust them.

And then Singal documents how organizations representing mainstream science and medicine haven’t been so trustworthy. The American Academy of Pediatrics (AAP) has been particularly  vocal—and clueless—in relentlessly pushing affirmative care:

A 2018 policy statement by the American Academy of Pediatrics provides a useful example of how these documents can go wrong. At one point, it argues that children who say they are trans “know their gender as clearly and as consistently as their developmentally equivalent peers,” an extreme exaggeration of what we know about this population. (A single study is cited.) The document also criticizes the “outdated approach in which a child’s gender-diverse assertions are held as ‘possibly true’ until an arbitrary age” — the A.A.P. was instructing clinicians to take 4- and 5-year-olds’ claims about their gender identities as certainly true. It’s understandable why the Cass reviewers scored this policy statement so abysmally, giving it 12 out of 100 possible points on “rigor of development” and six out of 100 on “applicability.”

Policy statements like this one can reflect the complex and opaque internal politics of an organization, rather than dispassionate scientific analysis. The journalist Aaron Sibarium’s reporting strongly suggests that a small group of A.A.P. members, many of whom were themselves youth gender medicine providers, played a disproportionate role in developing these guidelines.

Dr. Julia Mason, a 30-year member of the organization, wrote in The Wall Street Journal, with the Manhattan Institute’s Leor Sapir, that the A.A.P. deferred to activist-clinicians and stonewalled the critics’ demands for a more rigorous approach. Dr. Sarah Palmer, an Indiana-based pediatrician, told me she recently left the A.A.P. after nearly 30 years because of this issue. “I’ve tried to engage and be a member and pay that huge fee every year,” she said. “They just stopped answering any questions.” This is unfortunate given that, as critics have noted, in many cases the A.A.P. document’s footnotes don’t even support the claims being made in the text.

In the face of a lack of studies supporting their preferred ideology, organizations like the American Psychological Association (APA) have waffled, weaseled, and dissimulated, sometimes making contradictory statements.  Here’s one example (the AMA has also changed its stand but wouldn’t give Singal an interview). Bolding is mine:

The A.P.A. presents a particularly striking case of why transparency is important. In 2024 it published what it hailed as a “groundbreaking policy supporting transgender, gender diverse, nonbinary individuals” that was specifically geared at fighting “misinformation” on that subject. But when I reached out to the group this month, it pointed me to a different document, a letter written by the group’s chief advocacy officer, Katherine McGuire, in September in response to a Federal Trade Commission request for comment on youth gender medicine.

The documents, separated by about a year and a half (and, perhaps as significantly, one presidential election), straightforwardly contradict each other. The A.P.A. in 2024 argued that there is a “comprehensive body of psychological and medical research supporting the positive impact of gender-affirming treatments” for individuals “across the life span.” But in 2025, the group argued that “psychologists do not make broad claims about treatment effectiveness.”

In 2024 the A.P.A. criticized those “mischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence.” In 2025 it cautioned that gender dysphoria diagnoses could be the result of “trauma-related presentations” rather than a trans identity and that “co-occurring mental health or neurodevelopmental conditions (e.g., depression, anxiety, autism spectrum disorder) … may complicate or be mistaken for gender dysphoria.” It seems undeniable that the 2025 A.P.A. published what the 2024 A.P. A. considered to be “misinformation.” (“The 2024 policy statement and the 2025 F.T.C. letter are consistent,” said Ms. McGuire in an email, and “both documents reflect A.P.A.’s consistent commitment to evidence-based psychological care.”)

Behavior like this should anger anyone wedded to evidence-based medicine and science, especially because the APA simply lies when it says that its stand has been consistent all along. And the APA is not alone in its bad behavior.  Other organizations are digging in their heels, maintaining unsupportable positions in the face of counterevidence—all because of the ideology that people can change sex and we should believe them when they say they are really of a different sex than their natal one. This is wedded to the view that surgery and hormones designed to change gender have been proven to be safe.

I should add here that many adults who have transitioned are nevertheless happy with the outcomes of their treatments. But note that Singal’s forthcoming book is about youth gender medicine. This is the focus of the controversy, and few people (certainly not me) would deny adults the right to go ahead with surgery and hormones, though perhaps the public shouldn’t have to pay for it.

Singal’s conclusion, which I hope is the theme of his book, is short and sweet:

Should we trust the science? Sure, in theory — but only when the science in question has earned our trust through transparency and rigor.

  It looks like most medical organizations should not be trusted until they start speaking the truth.

Kathleen Stock on female genital mutilation, cultural relativism, and a recent (odious) paper in The Journal of Medical Ethics

December 20, 2025 • 11:00 am

Over at UnHerd, philosopher Kathleen Stock, formerly of the University of Sussex, critiques a paper in The Journal of Medical Ethics that I discussed recently, a paper you can read by clicking below. (You may remember that Stock, an OBE, was forced to resign from Sussex after she was demonized for her views on gender identity. These involved claims that there are but two biological sexes, and her cancellation was largely the result of a campaign by students.)

As I said in my earlier post, this paper seems to whitewash female genital mutilation (FGM), and does so in several ways. The authors think that the term “mutilation” is pejorative, and is more accurate and less inflammatory than saying “female genital modification”, which covers a variety of methods of FGM, some much more dangerous than others, as well as cosmetic genital surgery on biological women or surgery on trans-identifying males to give them a simulacrum of female genitalia. (There is also circumcision, which some lump in with the more dire forms of FGM.)

The Ahmadu et al. paper also notes that anti-FGM campaigns in Africa, where the mutilation is practiced most often, have their own harms. As Stock comments in the article below,

And so our co-authors — the majority of whom work in Europe, Australasia, and North America — tell us that anti-FGM initiatives in Africa cause material harms. Supposedly, they siphon off money and attention that could be better spent in other health campaigns, and they undermine trust in doctors.
They also cause young women to consider genital cutting as “traumatising” in retrospect, we are told, where they would not otherwise have done so. Even though some who have been subject to it can experience “unwanted upsetting memories, heightened vigilance, sleep disturbance, recurrent memories or flashbacks during medical consultations”, there is allegedly no actual trauma there, until some foreign aid agency tells them so.

And if you don’t believe Stock, here’s a small part of the section of the Ahmadu et al. paper trying to push the word “trauma” out of descriptionos of FGM:

Most affected women themselves rarely use the word ‘trauma’ to describe their experiences of the practices. If they describe the experiences in negative terms, they may use words such as ‘difficult’ or ‘painful’, but some of them may simultaneously describe the experience as celebratory, empowering, important and significant. This may even accompany experiences of pain, but this pain, when made sense of in its cultural context, does not equate to trauma.

Researchers and clinicians often use the mostly biomedically based DSM-5 (the current version of the Diagnostic and Statistical Manual of Mental Disorders) to assess trauma, with a focus on post-traumatic stress disorder (PTSD). While narratives of women who have experienced a cultural or religious-based procedure may contain descriptions of symptoms that fall into the PTSD nosological category (such as ‘unwanted upsetting memories’, ‘negative affect’, ‘nightmares’ or heightened sensations, vigilance or sleep disturbance), the cross-cultural validity of PTSD as a construct and its use in migrant populations has been widely contested, because it applies Western cultural understandings to people who do not necessarily equate the experience of pain as directly causing trauma.

That is first-class progressive whitewashing! As Stock describes :

[Anti-FGM campaigns] also cause young women to consider genital cutting as “traumatising” in retrospect, we are told, where they would not otherwise have done so. Even though some who have been subject to it can experience “unwanted upsetting memories, heightened vigilance, sleep disturbance, recurrent memories or flashbacks during medical consultations”, there is allegedly no actual trauma there, until some foreign aid agency tells them so.

Finally, Ahmadu et al. note that anti-FGM campaigns, and the term “mutilation”, have led to unfair stigmatization of some groups in the West that practiced FGM in their ancestral countries (and still practice it in the West, though to a much lesser extent). You could argue, for example, that it leads to bigotry in the West against those of Somalian ancestry, as FGM is rather common there. And I agree that it’s unfair to stigmatize an entire group because some of them practice FGM. Only the perpetrators should be punished and the promoters rebuked. But the practice should be loudly decried, and aimed at communities who employ it.

In her article, Stock rebukes the article as a prime example of “cultural relativism,” the view that while people within a given culture can judge some acts more moral than others, considering different cultures one cannot judge some as having behaviors more moral than do others.  One might, if one were stupid, criticize this as forms of ethical appropriation. So, say the relativists, we shouldn’t be too quick to judge those in Somalia who practice infibulation of young women.

You can read Stock’s article by clicking below, but if you’re paywalled you can find the article archived here.

Stock is not a moral relativist, at least when it comes to genital “modification,” a term she opposes.  I’ll put up a few quotes, but you should read the whole piece, either online or in the archived version:

Progressives are notoriously fond of renaming negatively-coded social practices to make them sound more palatable: “assisted dying” for euthanasia, or “sex work” for prostitution, for instance. The usual strategy is to take the most benign example of the practice possible, then make that the central paradigm. And so we get images of affluent middle-class people floating off to consensual oblivion at the hands of a doctor, rather than hungry, homeless depressives. We are told to think of students harmlessly supplementing their degrees with a bit of escort work, not drug-addicted mothers standing on street corners. Perpetually gloomy about human behaviour in other areas, when it comes to sex and death the mood becomes positively Pollyanna-ish.

Similarly, the authors of the new FGM article are apparently looking for the silver lining. Some genital modifications enhance group identity, they say, and a sense of community belonging. And as with euthanasia and prostitution, they want us to ignore the inconvenient downsides. But at the same time, there is a philosophical component here mostly absent from parallel campaigns. It’s cultural relativism — which says that strictly speaking, there are no downsides, or indeed upsides, at all.

That is: from the inside of a particular culture, certain practices count as exemplary and others as evil. Yet zoom out to an omniscient, deculturated perspective upon human behaviour generally, and there is no objective moral value — or so the story goes. All value is constructed at the local level. Worse: when you zoom back into your own homegrown ethical concerns after taking such a trip, they seem strangely hollow. Like an astronaut returning to Earth after having seen the whole of it from space, everything looks a bit parochial.

Stock lumps the authors into three groups, which she calls “the Conservatives” (no genital surgeries of any type), the “Centrists” (okay with circumcision for males but no surgery on females), and “Permissives” (people who think that “it is up to the parents to decide what is best for their children, and that the state should refrain from interfering with any culturally significant practices unless they can be shown to involve serious harm.” [that quote is from the Ahmadu et al. paper]. These conflicting views lead to the tension that Stock and others can perceive in this paper. What are the sweating authors trying to say?

Cultural relativism, while in style among progressives, is a non-starter. You can see that by simply imagining John Rawls’s “veil of ignorance” and ask imaginary people who have not been acculturated to look at various cultures from behind that veil and then say which culture they’d rather live in. If you are a young girl, would you rather be in Somalia or Denmark? If you’re gay, would you rather be in Iran or Israel? And so on.  Here’s Stock’s ending where she asserts that not all forms of “genital modification” should be lumped together or considered equally bad:

Meanwhile in the Anglosphere, anti-FGM laws allegedly cause “oversurveillance of ethnic and racialised families and girls” and undermine “social trust, community life and human rights”. All these things, it is implied, are flat wrong. This sounds like old-fashioned morality talk to me. But then again, if old-fashioned morality talk is permissible, may not we also talk explicitly about the wrongs of holding small girls down to tables and slicing off bits of them, or sewing them up so tight that they are in searing agony? These things sound like they might undermine “social trust, community life, and human rights” too.

Rather than be a relativist about morality, it makes more sense to be a pluralist. There are different virtues for humans to aspire to, and they can’t be ranked. Sometimes there are clashes between them, resulting in inevitable trade-offs (honesty vs kindness; loyalty to family vs to one’s community; and so on). There are very few cost-free moral choices in this life. Equally, some virtues will vary according to cultural backdrop. The local environment may partly influence which virtues are paramount. For instance, family obedience and respect for elders will be stronger in places where close kinship ties help people to survive.

But still, there is always a limit on what behaviours might conceivably count as good; and that limit is whether they actively inhibit a person’s flourishing, in the Aristotelian sense. The most drastic and bloody forms of FGM obviously do so. They lead a little girl to feel distrust and fear of female carers; predispose her to infections and limit her sexual function for life; cause her pain, nightmares, and panicky flashbacks for decades.

With minimally invasive genital surgeries involving peripheral body parts, matters are not so clear. But whatever the case about those, you can’t just assume in advance that all genital modifications are equal, so that discriminating between them by different legal and social approaches is somehow “unfair”. If cultural relativism were really true, there would be no such thing as unfairness either. It would just be empty meaninglessness, all the way down. Academics with heroic designs on the English language should be careful not to fall into ethical abysses, even as they tell themselves the landscape around them is objectively flat.

Here Stock comes close to equating “more moral” with “creating more well being,” a position that Sam Harris takes in The Moral Landscape, and a position I’ve criticized. But here the niceties of ethics are irrelevant. There is simply no way that forcing FGM upon girls can be considered better than banning it.

What happened to me?

November 23, 2025 • 2:33 pm

Take a gander at my hand in the the photo below, and then tell me what happened. Be as specific as possible, but if I have already told you (a few people know), do not post it.  You have to guess. And do not say that I got injured: you have to be specific  If you know about my doings, you will be able to make a more informed guess.

Answer will be up tomorrow a.m.

Proprietor’s miscellany

November 1, 2025 • 8:25 am

Here is some information about my sleep test and a few miscellaneous photos from Chicago. Readers’ wildlife photos will return tomorrow, so keep sending them in!

First, wish me luck; next Tuesday I am taking a home sleep test, which involves the items shown below (you also need the right app on your phone). It used to be that to take a sleep test you’d have to spend the night in the hospital, all wired up to various devices. How can you sleep normally under such conditions? But things have changed for the better. After all, it’s much better to sleep in your own bed, which is what you can do with the equipment below.

Here’s the kit:

  1. A watchlike device that apparently transmits data to the hospital through your phone. You wear it on your non-dominant hand.
  2. The data come from the tubular device fastened to one of your fingers, as well as an electrode that you tape (using the medical tape provided) to the little hollow at the base of the front of your neck. You can use any finger on your non-dominant hand save the thumb.
  3. Your cellphone, which has to be within fifteen feet of the watch.

So, you put the battery in the watch, put the watch on your wrist, put the finger device on your finger, put the electrode on your throat, and then press “begin” on your app. Then you go to sleep—or try to. You have to record for seven hours at the minimum.  At the end you press “stop recording” on the phone app, and wait while the data (presumably mostly indicating your breathing) is transmitted to the hospital. In a few seconds it should be over, and you can discard the whole kit.

It appears to be designed to detect sleep apnea, but there is no sign I have the condition, as nobody has ever reported me snoring or waking up gasping for breath, and sometimes I’m up all night not able to sleep, with no breathing problems at all.  But the doctors tell me you can have sleep apnea without knowing it (I find this nearly impossible to believe when I’m awake all night breathing normally), but they won’t treat me further unless I take this test.  So be it: my own view is that the cause of my insomnia is pure anxiety.

And some miscellaneous photos taken on my walk home and to work. First, fall is here (don’t forget to set your clocks back tomorrow):

Given the number of immigrants in Chicago, with many surely undocumented, ICE is a big deal. There have been attempted apprehensions in Hyde Park, which have led to signs like the one below, on the door of a local bakery that employs Hispanics.  There are also other signs taped to lightposts that aren’t so polite, saying “F-ck ICE” and saying that ICE are Nazis. Note that in the sign below, ICE is depicted as a hungry alligator.

And good news for lovers of Botany Pond: Yesterday afternoon three of the five turtles put back in the pond (they were removed when the pond was drained several years ago), were sunning themselves on a warm rock yesterday afternoon. I haven’t seen them sunning themselves for a couple of weeks, so I think they’re getting used to the pond. They look healthy, no? I suspect the other two were either swimming around or were ensconced in their “turtle dens” on the pond bottom.

A strange solicitation of grant reviewers by the NIH

July 3, 2025 • 11:15 am

My friend Peggy Mason, a neurobiologist colleague here at Chicago, received the NIH’s email below, which was sent around to many people who get NIH announcements. This announcement is soliciting people to review grants on autism, and it has some pretty strange bits. I thought I’d let readers see it and give their take.  At the end I have a list of questions that struck me as I read it.

Peggy had no problem with me using her name, as she was also puzzled by the announcement. It’s indented below.  Bolding is both mine and the NIH’s; I’ve indicated which is which.

From: Ascanio Carrera, Emilia (NIH/OD) [C] <emilia.ascaniocarrera@nih.gov>
Sent: Monday, June 30, 2025 9:28 AM
To: Ascanio Carrera, Emilia (NIH/OD) [C] <emilia.ascaniocarrera@nih.gov>
Cc: Faulk, Kristina (NIH/OD) [E] <kristina.faulk@nih.gov>; Kellton, Karen (NIH/OD) [E] <karen.kellton@nih.gov>
Subject: The NIH Autism Data Science Initiative (ADSI) Review Recruitment

Hello,

The NIH Autism Data Science Initiative (ADSI) is seeking reviewers with scientific expertise, including those with lived experience, to review applications to be selected for funding under the Autism Data Science Initiative (OTA-25-006) research opportunity announcement.

The Autism Data Science Initiative’s goals are to explore novel contributors to autism, improve our understanding of mechanisms of co-occurring conditions to target in future clinical trials, and enhance our ability to deploy effective and scalable interventions and services across the lifespan through identification of effective components of care.

The application deadline is Friday, June 27th, and we are now looking for reviewers with scientific expertise in the following areas:

  1. Community engaged research methods and/or lived experience 
  2. Data science, bioinformatics, and/or Multi-omics integration
  3. Expertise with Electronic Health Records and Claims data and research methods
  4. Autism etiology (e.g., genetics, cellular/molecular mechanisms)
  5. Clinical diagnosis of autism, phenotyping, and diagnostic ascertainment procedures
  6. Co-occurring conditions and health outcomes in autism across the lifespan, including mental health, quality of life, educational and employment outcomes
  7. Autism interventions and services, including clinical trial methodology (i.e., efficacy, effectiveness, hybrid-type trials), dissemination and implementation research
  8. Toxicology and/or Epidemiology (e.g., environmental, maternal and child health)
  9. Proteomics, Metabolomics and/or Epigenomics (e.g., methylation, transcriptomics)
  10. Reproducibility and/or validation design and research

Please note that reviewers should have sufficient work experience and/or education in their area(s) of expertise. Early career investigator are welcome and encouraged to participate as a reviewer.

JAC: All bolding above is mine, while all bolding below is the NIH’s:

Reviewers will complete a required conflict of interest process prior to being assigned applications to review. We plan to assign these applications by Wednesday, July 9th and will offer a Webinar with explicit instructions on the Objective Review process. Written Objective Review evaluations will be due on Wednesday, July 23rd. Each reviewer will be assigned no more than 5 applications to review. If you are interested in reviewing but have time constraints during the July 9-July 23 review process, please comment on this within the webform (see hyperlink below).  All review materials will be accessed via MS Teams or NIH Box.

If you are willing to serve as a reviewer, please complete the Reviewer Intake webform by June 30th. Please note, your information will not be publicly available and will only be shared with the immediate ADSI team.  If you are not able to participate, then please respond using “reply all” so that we know to remove you from future correspondence seeking reviewers.

Please feel free to forward this email to anyone meeting the above scientific expertise qualifications that you think may be interested. Please contact Kristina Faulk (adsi-review@mail.nih.gov) if you have any questions or concerns.

Please note, there is a reviewer orientation video that will be made available on Tuesday, July 1st, 2025. If you volunteer, we will confirm receipt of your email and include a link to the reviewer orientation video.

Sincerely,
The ADSI Working Group

What is weird about this announcement includes the following:

1.) It invites people to nominate themselves to review grants (on autism)

2.) “Lived experience”, a phase often encountered in woke prose, can qualify you to be a reviewer.

3.) You do not necessarily have to possess an academic degree in the field to qualify as a reviewer.  I’m not sure whether this invitation thus includes people who worked with autistic people, high-functioning autistic people themselves, parents of autistics, or anybody connected with the condition. This is the first time in my career that I have seen not only people asked to nominate themselves as reviewers of several grants on a subject, but also the apparent substitution of work experience (which would be “lived experience”) for of academic work or degrees (“education” does count, though). Is this type of self-nomination, particularly without academic qualifications, also used by other organizations that hand out grants?

4.) It struck me that although the “lived experience” thing seems woke, the whole solicitation might be a way to get autism activists onto NIH panels, which is something that Robert F. Kennedy Jr., the new United States Secretary of Health and Human Services, might want. As we know, RFK, Jr. has promoted the idea (rejected by most experts) that there is a connection between vaccines and autism, with one culprit being the mercury compound thimerosal.  There are a lot of people who go along with this theory, and perhaps RFK, Jr. wants them to review (and perhaps fund) grants that could buttress the theory.

The last question is just speculation and a hypothesis that prompted Peggy to send me this solicitation. It certainly is outside the parameters of normal reviewing, what with the calls for reviewers, the us of “lived experience” as a qualification, the process of self-nomination, and the apparent lack of need for an academic degree in a field to review proposals in that field. I did genetics reviews for the NIH (all evolutionary genetics, my field), and I don’t remember any panels containing people with just “lived experience” in that field. But of course autism is a biomedical field very different from evolutionary genetics.

At any rate, both Peggy and I would appreciate readers weighing in on this. Is this a very abnormal way to get reviewers? And do you think this is a tactic to further RFK Jr.’s autism ideas? As an April article from the BBC reports, RFK, Jr. is on the fast track to find the cause of autism, a goal which seems bizarrely rushed:

US Health Secretary Robert F Kennedy Jr has pledged “a massive testing and research effort” to determine the cause of autism in five months.

Experts cautioned that finding the causes of autism spectrum disorder – a complex syndrome that has been studied for decades – will not be straightforward, and called the effort misguided and unrealistic.

Kennedy, who has promoted debunked theories suggesting autism is linked to vaccines, said during a cabinet meeting on Thursday that a US research effort will “involve hundreds of scientists from around the world.”

“By September, we will know what has caused the autism epidemic and we’ll be able to eliminate those exposures,” Kennedy said.

The Atlantic takes on “affirmative care”

July 2, 2025 • 11:02 am

One sign that there has been a sea change in America’s gung-ho enthusiasm for “affirmative care” of minors with gender dysphoria is the mainstream media’s recent critiques (or just objective analyses) of the problems with such care. These critiques have exposed the lies promulgated about such care, largely by the “progressive” Left. The new article in The Atlantic by staff writer Helen Lewis is one such journalistic corrective (read it by clicking on the screenshot below or by reading it archived here). And you should read it.

One of the factors prompting the article appears to have been the Supreme Court case The United States v. Skrmetti, which upheld a Tennessee law banning the use of hormones or puberty blockers for “gender affirming care” in cases of gender dysphoria in minors. Such care was allowed, however, if modification of sexual traits was necessary to allow an individual with a disorder of sex determination to “conform to their sex assigned at birth” (Wikipedia’s words, not mine).  The case was decided along ideological lines by a 6-3 vote, but in general I agreed with the decision, having felt that medical treatment for transition should be permitted only if a person with gender dysphoria was old enough to have mental maturity to decide. (I waffle between 16 and 18 on this one, but it’s 18 in Tennessee).

Author Lewis, in fact, was willing to allow medical transitioning to begin in younger children with dysphoria, but changed her mind after seeing WPATH, progressives, doctors, and government officials repeatedly lie about the condition and how to fix it. To quote her (all the article’s quotes are indented):

I have always argued against straightforward bans on medical transition for adolescents. In practice, the way these have been enacted in red states has been uncaring and punitive. Parents are threatened with child-abuse investigations for pursuing treatments that medical professionals have assured them are safe. Children with severe mental-health troubles suddenly lose therapeutic support. Clinics nationwide, including Olson-Kennedy’s, are now abruptly closing because of the political atmosphere. Writing about the subject in 2023, I argued that the only way out of the culture war was for the American medical associations to commission reviews and carefully consider the evidence.

However, the revelations from Skrmetti and the Alabama case have made me more sympathetic to commentators such as Leor Sapir, of the conservative Manhattan Institute, who supports the bans because American medicine cannot be trusted to police itself. “Are these bans the perfect solution? Probably not,” he told me in 2023. “But at the end of the day, if it’s between banning gender-affirming care and leaving it unregulated, I think we can minimize the amount of harm by banning it.” Once you know that WPATH wanted to publish a review only if it came to the group’s preferred conclusion, Sapir’s case becomes more compelling.

Here are three of the issues that Lewis raises:

1.) Lying or misleading people about gender dysphoria and its treatment.

ACLU lawyer Chase Strangio was guilty of promulgating the lie that failure to effect gender transition in dysphoric children would lead to their suicide. He in fact made this statement when he argued Skrmetti before the Supreme Court, and had to admit under questioning that there was acxtuallyno evidence for this assertion:

“We often ask parents, ‘Would you rather have a dead son than a live daughter?’” Johanna Olson-Kennedy of Children’s Hospital Los Angeles once explained to ABC News. Variations on the phrase crop up in innumerable media articles and public statements by influencers, activists, and LGBTQ groups. The same idea—that the choice is transition or death—appeared in the arguments made by Elizabeth Prelogar, the Biden administration’s solicitor general, before the Supreme Court last year. Tennessee’s law prohibiting the use of puberty blockers and cross-sex hormones to treat minors with gender dysphoria would, she said, “increase the risk of suicide.”

. . . But there is a huge problem with this emotive formulation: It isn’t true. When Justice Samuel Alito challenged the ACLU lawyer Chase Strangio on such claims during oral arguments, Strangio made a startling admission. He conceded that there is no evidence to support the idea that medical transition reduces adolescent suicide rates.

At first, Strangio dodged the question, saying that research shows that blockers and hormones reduce “depression, anxiety, and suicidality”—that is, suicidal thoughts. (Even that is debatable, according to reviews of the research literature.) But when Alito referenced a systematic review conducted for the Cass report in England, Strangio conceded the point. “There is no evidence in some—in the studies that this treatment reduces completed suicide,” he said. “And the reason for that is completed suicide, thankfully and admittedly, is rare, and we’re talking about a very small population of individuals with studies that don’t necessarily have completed suicides within them.”

Here was the trans-rights movement’s greatest legal brain, speaking in front of the nation’s highest court. And what he was saying was that the strongest argument for a hotly debated treatment was, in fact, not supported by the evidence.

Strangio is one of the biggest proponents of affirmative care, and even took to Twitter advocating censoring Abigail Shrier’s book on gender dysphoria, Irreversible Damage. (Strangio is a trans-identified female.) Imagine an ACLU lawyer advocating censorship!

The “Dutch Protocol” (see below) was often cited by American organizations like the World Professional Association for Transgender Health (WPATH) or by physicians to justify affirmative care of minors. But the Dutch Protocol (affirmative care with medical intervention in children of younger ages) is basically without convincing clinical evidence:

Perhaps the greatest piece of misinformation believed by liberals, however, is that the American standards of care in this area are strongly evidence-based. In fact, at this point, the fairest thing to say about the evidence surrounding medical transition for adolescents—the so-called Dutch protocol, as opposed to talk therapy and other support—is that it is weak and inconclusive. (A further complication is that American child gender medicine has deviated significantly from this original protocol, in terms of length of assessments and the number and demographics of minors being treated.) Yes, as activists are keen to point out, most major American medical associations support the Dutch protocol. But consensus is not the same as evidence. And that consensus is politically influenced.

There’s an article at the site of Our Duty that discusses the shortcomings of the Dutch protocol, and is accompanied by a video of Dr. Patrick Hunter  testifying before the Florida Board of Medicine; it’s a summary of the flaws of that protocol, which was applied to children much younger than 18. Here’s the video, which is short (9 minutes):

2.) Demoniziong those who question “affirmative care”.

There’s Strangio, of course, who tweeted this (and later removed it):

And this:

Marci Bowers, the former head of the World Professional Association for Transgender Health (WPATH), the most prominent organization for gender-medicine providers, has likened skepticism of child gender medicine to Holocaust denial. “There are not two sides to this issue,” she once said, according to a recent episode of The Protocol, a New York Times podcast.

Boasting about your unwillingness to listen to your opponents probably plays well in some crowds. But it left Strangio badly exposed in front of the Supreme Court, where it became clear that the conservative justices had read the most convincing critiques of hormones and blockers—and had some questions as a result.

. . .Trans-rights activists like to accuse skeptics of youth gender medicine—and publications that dare to report their views—of fomenting a “moral panic.” But the movement has spent the past decade telling gender-nonconforming children that anyone who tries to restrict access to puberty blockers and hormones is, effectively, trying to kill them. This was false, as Strangio’s answer tacitly conceded. It was also irresponsible.

Questioning affirmative care has been something that marks you as “transphobic” (I myself have been called that), but when all the facts are in, I suspect that this demonization of people who want to know the scientific and medical truth will be seen as oppressive and, given its medical results, even barbaric. As Lewis notes, the British Cass Review that resulted in closing all but one gender clinic in the UK has been falsely demonized as being discredited. It has not been discredited.

3.) Withholdiong research that doesn’t support “affirmative care”.

This is the other side of the Dutch Study coin. First you promulgate bad research that supports your side, then you are slow to publish better studies that do not support your side. The author notes that WPATH comissioned reviews of the flawed Dutch protocols and, apparently because the protocols were weak, tried to block their publication.

And then there’s the infamous study by Dr.  Johanna Olson-Kennedy on the effect of puberty blockers on mental health (remember, blockers were touted as essential to prevent depression and suicide in children with gender dysphoria). Olson-Kennedy, a big proponent of affirmative care, didn’t find what she hoped for, and so withheld the study for several years!

The Alabama disclosures are not the only example of this reluctance to acknowledge contrary evidence. Last year, Olson-Kennedy said that she had not published her own broad study on mental-health outcomes for youth with gender dysphoria, because she worried about its results being “weaponized.” That raised suspicions that she had found only sketchy evidence to support the treatments that she has been prescribing—and publicly advocating for—over many years.

Last month, her study finally appeared as a preprint, a form of scientific publication where the evidence has not yet been peer-reviewed or finalized. Its participants “demonstrated no significant changes in reported anxious/depressed, withdrawn/depressed, somatic complaints, social problems, thought problems, attention problems, aggressive behavior, internalizing problems or externalizing problems” in the two years after starting puberty blockers. (I have requested comment from Olson-Kennedy via Children’s Hospital Los Angeles but have not yet heard back.)

And note, this is in an unreviewed preprint.

Withholding evidence that doesn’t support your favored hypothesis is scientifically unethical, somewhat akin to falsifying data. That’s because doing this means you’re simply allowing false conclusions to persist when you have evidence for their falsity. And that means that medical practice based on those false conclusions also persists, and, in this case, children were being treated on the basis of untested ideas.

There’s a lot more in this article to chew on, but the important thing is that it was published in a reputable (and left-leaning) magazine. The NYT has had similar articles about the weak evidence for “gender affirming care.”  (In my view, Pamela Paul’s 2024 critique of this care in the NYT was a big factor in her being let go by the paper. They thus lost one of their best heterodox writers.)

To paraphrase Walter Cronkite, an advocate of gender-affirming care might say, “When we’ve lost The Atlantic and the New York Times, we’ve lost America.”

I don’t oppose the use of hormones or blockers when the decision to use them is made by adolescents with sufficient mental maturity. If you’re 18 and want to change, well, go ahead and take the hormones and cut off pieces of your top or bottom. But not in minors—not until we have evidence that that this practice actually helps them—and we don’t. Lewis closes her piece this way:

Some advocates for the Dutch protocol, as it’s applied in the United States, have staked their entire career and reputation on its safety and effectiveness. They have strong incentives not to concede the weakness of the evidence. In 2023, the advocacy group GLAAD drove a truck around the offices of The New York Times to declare that the “science is settled.” Doctors such as Olson-Kennedy and activists such as Strangio are unlikely to revise their opinions.

For everyone else, however, the choice is still open. We can support civil-rights protections for transgender people without having to endorse an experimental and unproven set of medical treatments—or having to repeat emotionally manipulative and now discredited claims about suicide.

Once again, Covid in humans: from a lab leak or a wet market?

June 2, 2025 • 10:00 am

The argument continues about whether the virus causing covid originated in a wet market in Wuhan or as an accidental release from The Wuhan institute of Virology.  While several U.S. government agencies have agreed that the evidence is tilted towards a lab-leak origin, in my view the evidence is not dispositive on either side.

Matt Ridley, however, has been a hard-core advocate of the lab-leak theory, and even co-wrote a book with Alina Chan that, at the time, presented both sides and, as Ridley says below, he “remained unsure what happened at that stage.”

No longer. Since 2021, Ridley has promoted the lab-leak theory, which he does in a Torygraph article shown below (click on headline below to get the archived version). Apparently Ridley teamed up with another collaborator, P. Anton van der Merwe, and wrote a scientific paper laying out his evidence for a lab-leak origin of covid. I’ve put the paper’s title below, but you can read it at the same Torygraph site. The scientific argument was published in the newspaper rather than in a scientific journal because the journal rejected it. (No explanation is given.)

In the intro before he shows the paper (surely a first for the Torygraph), Ridley explains how this came about:

In 2024 I was approached by a single member of the editorial board of a respected biological journal with a request that I team up with a British biologist with relevant expertise and compose an academic paper setting out the case for the lab leak hypothesis: he hoped the journal would consider it. With the help of Anton van der Merwe of Oxford University, and advice from Alina Chan, I drafted such a paper. The paper was rejected; I suspect that it was another case of not wanting to rock the scientific boat.
Now I am posting this paper online for all to read. It was composed several months ago so one or two small new items may be missing, but nothing in it has proved wrong. It is written not in my normal style but in dry, scientific prose, with each statement backed up by a source, in the shape of nearly 100 end-note references, so that readers can check for themselves that we have represented the sources faithfully. It deserves to be available to people to read.
So the paper was commissioned, but the reviewers’ comments that led to rejection aren’t shown. Here’s the paper itself:

Here is some of the evidence Ridley and van der Merwe adduce:

  • Attempts to find evidence for a wet-market leak have been unsuccessful. The cases found around the wet market could simply reflect sampling bias, as the Chinese concentrated on looking for infected people in that area.
  • The Chinese have not been forthcoming with their data, and in fact locked one site with a catalogue of the sequenced but unpublished viruses they were working on
  • If a person got infected with a bat virus from Yunnan (one theory), that person would have infected others on his/her journey to Wuhan, but there is no such trail of infection
  • The Wuhan institute was doing “gain of function” experiments to increase the infectivity of SARS viruses (not the progenitor of the covid virus), but these did involve making viruses more transmissible.
  • There were plans to put “furin cleavage sites” into SARS viruses, sites that make it easier for the viruses spike protein to get into cells. The virus causing covid has such a site—12 nucleotides long— which Ridley and van der Merwe insist was inserted into the virus progenitor by humans. As Ridley notes:

When the pandemic began in January 2020, Shi Zhengli of the WIV published two articles, one co-authored with Shibo Jiang, yet in both of them failed to mention the furin cleavage site, by far the most remarkable feature of the new virus’s genome. This may have been an oversight, but by contrast, it was the furin cleavage site that immediately alarmed several western virologists on first seeing the genome of the virus and led to the drafting of the Proximal Origin paper. Messages released during a congressional investigation reveal that the authors of the paper were not themselves convinced that a laboratory origin could be ruled out, either during or after the writing of the paper

  • The containment of viruses at Wuhan for the SARS experiments was Level 2, which American scientists think was far too lax for such potentially dangerous experiments (this itself, of course, is not great evidence for a lab leak).

Here’s Ridley and van der Merwe’s conclusion:

In only one city in the world were sarbecoviruses subject to gain-of-function experiments on a large scale involving human airway cells and humanised mice at inappropriate safety levels: Wuhan. At only one time in history was research to create novel sarbecoviruses with enhanced infectivity through furin cleavage under consideration: 2018 onwards. The surprising failure to find better evidence for a natural spillover, and the lack of transparency from the Chinese scientists, is therefore best explained by positing a laboratory accident involving a live virus experiment as the cause of the Covid pandemic and attempts to cover it up.

This is a Bayesian conclusion, arguing that the total weight of the evidence supports a lab-leak prior. And it sure sounds conclusive, but I’m wondering why the paper was rejected (they don’t say what journal they submitted it to).

Further, a number of virologists I respect either adhere to the alternative wet-market theory or remain agnostic.  When I asked a colleague some questions about this, he/she said this:

All the **data** (including new stuff) points to a natural origin. It might have been a leak, but all the evidence that has been obtained points in the direction of a spillover in the wet market. Not everyone who disagrees with the prevailing view of something is Galileo.

And then I asked “What about the furin cleaveage site?” This was something that Nobel laureate David Baltimore considered almost conclusive evidence for the lab-leak theory, but walked it back a bit:

The virologist David Baltimore commented that “these features make a powerful challenge to the idea of a natural origin for SARS2,” later clarifying that “you can’t distinguish between the two origins from just looking at the sequence” ().

h/t: Christopher for the Torygraph archive.