Talking sense about the Omicron variant

December 1, 2021 • 12:00 pm

Reader Tom sent me this 19½-minute video about Omicron from health science expert and nurse John Campbell, who’s apparently been dispensing sound information on the coronavirus for a long time. Tom said this:

Dr. John Campbell has been my go-to-guy for the past 14 months on a nearly daily basis.  He’s lucid, authoritative, clear, concise and engaging, just a superb source of reasonable advice.

When I asked for more information because Campbell’s Wikipedia bio was scanty, Tom added this:

He’s had a YouTube channel since 2008 and is an evidence-based medicine proponent to the bone.  His videos are daily, usually about 20 minutes long and shot in a spare room of his home.  Just him wielding a sharpie, an overhead camera, printed sheets of the day’s topic and a calm, no nonsense discussion delivered in a clipped English accent.  No histrionics.  Like visiting a well-loved teacher during office hours.

Now remember, we know very little about this virus—neither about its infectivity or its virulence (which really encompasses severity and spreadability).  So take this with a grain of salt. However, Campbell readily admits our ignorance while claiming, with support, that this variant will be the dominant strain throughout the world.

He does sound a note of hope, i.e., the vaccinated, when infected with Omicron, seem to get generally mild cases, and hypothesis that its spreadability is negatively correlated with how sick it makes peope.

John also gives us a pessimistic timeline for a vaccination (early to mid-2022). He summarizes where all the cases are (everywhere), and the mortality rate (thankfully, zero).  Remember, it’s early days.

It must be the full moon

November 5, 2021 • 8:25 am

Yep, the wackos are out: here’s a comment I got (but didn’t post) on my piece “Bret Weinstein and Heather Heying go unvaccinated for Covid, take and promote Ivermectin instead“. It’s from one Stephanie, who won’t be posting here again:

I have ivermectin and didn’t get it at an animal feed shop. It’s for human beings, prescribed by a human internist that treats Covid patients (a real living MD). He also prescribes it to ease vaccine side-effects. It helped mine, I had my period for months after the Moderna shot, along with neuropathy in my right arm which prevented me from working for 2 weeks. I did not follow up with a second dose and will not until at least third generation vaccines are available.You are a dangerous person and I challenge your view, your vaccine indoctrination. There are safe, healthy options for All and instead of promoting health, an MD’s ability to practice and prescribe, you support a billionaire class who wants you hooked into a booster program. You’re the laughable one, the one that should be shamed but you’re so insecure, you point at Bret and Heather

No control in her assertion of “it helped mine”, of course, and if she listened to Bret Weinstein and Heather Heying she wouldn’t have gotten the shot in the first place. If ivermectin is a “safe and healthy option,” why did she get a jab?

I stand by what I said: there is no convincing evidence that Ivermectin is either a palliative, a cure, or a preventive for Covid 19, much less a reliever of symptoms from the vaccination. There are mixed results from some studies of the drug, but those are almost all retrospective analyses, have pathetically small sample sizes, and many lack real controls.

We will have more definitive data in a couple of months. But regardless of that, we know that the shots are powerfully effective in preventing Covid, and, if you get it anyway, you get a milder case. Faced with the assurance of that result contrasted with our ignorance about Ivermectin, which simply cannot have as powerful a result as the vaccines, you’d simply be dumb to forego up the shots (which Weinstein and Heying have been urging; neither is vaccinated) and take a medicine designed for roundworms and head lice.

It’s not me who’s the dangerous person.

The hypocrisy of the AMA (and other elite organizations like the NYT)

November 2, 2021 • 9:15 am

I call your attention to my post yesterday on the apparent metastasizng wokeness of the American Medical Association (AMA) in its new Medspeak guide, “Advancing Health Equity: A Guide To Language, Narrative and Concepts.” That guidebook, full of new medical euphemisms, was an almost unbelievable display of wokeness, so outré that it was funny—except of course that instantiated what’s happening in every college, every venue of mainstream media, and every professional and scientific organization in America. In fact, one of my friends who reads this site wrote me this assessment of the AMA pamphlet:

 I honestly think that the woke are minting new Republicans by the hour. We’ll be back to Trump, and then we can really kiss our collective ass goodbye.

Indeed. You don’t have to be a rocket scientist to see that!

But lest you think the whole AMA has gone woke, have a look at this article from The Hill (click on screenshot):

It’s pretty much what it says it is: the AMA President doesn’t want a “Medicare for all” system. Maybe for poor people (though they already have one), but President Dr. Patrice Harris says this:

The president of the American Medical Association (AMA) criticized “Medicare for All” as a “one-size-fits-all solution” on Wednesday, but acknowledged that some doctors, particularly younger ones, support the idea.

“We just don’t think a one-size-fits-all solution works,” Dr. Patrice Harris told The Hill when asked about a Medicare for All, single-payer system.

“And so, we believe that there should be choice for patient, choice for physician, and there should be a plurality of available options, but absolutely having a strong safety net,” she added in the interview at the group’s national advocacy conference in Washington.

Of course a “plurality of options” means different forms of medical insurance and that in turn means that doctors get to keep their high salaries and prestige. (I’m not of course implying that all doctors have this notion.)

Dr. Harris adds:

But attitudes among doctors could be changing. Asked if younger doctors are more open to single-payer, Harris said, “I’ve seen that, I’ve witnessed that.”

“I think there are folks of all, you know, age ranges and specialties that might support that,” she added. “But again, that’s the beauty of the AMA and our democratic process and our value of diverse thoughts and opinions.”

In other words, Harris’s sense of “diversity” is not the one we’re used to: she means, “Let a thousand insurance companies blossom,” which of course is good for the well-being of doctors, but not perhaps of patients who are well off or who have job-provided medical care. In fact, the article admits that:

The American College of Physicians, the second-largest doctors group after the AMA, made waves in January when it endorsed single-payer health insurance, as well as a public option, as ways to achieve universal coverage.

The rest of the health care industry, including hospitals, drug companies and insurance companies, remains strongly opposed to single-payer, though.

Many doctors worry that the payment rates under Medicare for All would be insufficient, given that Medicare currently pays lower rates than private insurance does.

This is about salary and prestige that some doctors are insistent on keeping. “But,” you might be asking yourself, “how can the AMA be against single-payer insurance and yet issue a document that is ultra-woke in prescribing the language to use?”

Well, how doctors use language to conform to current ideology doesn’t affect their wages, does it? Instead of coining euphemisms, if they really cared about the well being of poor people and minorities, they’d be lobbying Congress for “Medicare for All.”

The point, as Batya Ungar-Sargon suggests in her piece below on Bari Weiss’s site, is that Wokeness is not mainly a race issue but a class issue, one largely promulgated by privileged and well-off white people who use it to buttress their self-esteem while simultaneously propping up a meritocracy from which they benefit. That, after all, is what the AMA seems to be doing.

Click below to read Batya’s article. She’s an opinion editor at Newsweek and has a new book out, Bad News: How Woke Media Is Undermining DemocracyRead also Bari Weiss’s introduction to her article.

Now Ungar-Sargon is concerned with journalism and not medicine, but there are parallels. Journalism was once a middle-class profession, but has risen to an elite profession whose practitioners are not only uber-woke (at least in the Left media), but also pretty well off (she gives some salaries).  Not all of them are white, but you already know that wokeness is promulgated primarily by the white folk that own and manage the MSM. As Ungar-Sargon says, “Once working-class warriors, the little guys taking on America’s powerful elites, journalists today are an American elite, a caste that has abandoned its working class roots as part of its meritocratic climb. And a moral panic around race has allowed them to mask this abandonment under the guise of ‘social justice.’”

And here’s her argument. The more I think about it, the more I think it does explain how elite organizations such as the AMA and NYT can at the same time promulgate big-time wokeness and yet try hard to keep their position as members of the “elite.”

. . .Wokeness perpetuates the economic interests of affluent white liberals. I believe that many of them truly do wish to live in a more equitable society, but today’s liberal elites are also governed by a competing commitment: their belief in meritocracy, or the fiction that their status was earned by their intelligence and talents. Today’s meritocratic elites subscribe to the view that not only wealth but also political power should be the province of the highly educated. Still, liberals see themselves as compassionate and progressive. And perhaps unconsciously, they sought a way to reconcile the inequality that their meritocratic status produces with the compassionate emotions they feel toward the less fortunate. They needed a way to be perpetually on what they saw as the right side of history without having to disrupt what was right for them and their children.

A moral panic around race was the perfect solution: It took the guilt that they should have felt around their economic good fortune and political power— which they could have shared with the less fortunate had they cared to—and displaced it onto their whiteness, an immutable characteristic that they could do absolutely nothing to change.

This is how white liberals arrived at a situation where instead of agitating for a more equal society, they agitated for more diverse elites. Instead of asking why our elites have risen so far above the average American, they asked why the elites are so white. Instead of asking why working-class people of all races are so underrepresented in the halls of power, white liberals called the working class racist for voting for Trump. Instead of asking why New York City’s public school system is more segregated than Alabama’s, white liberals demanded diversity, equity, and inclusion training in their children’s exorbitantly priced prep schools.

In other words, wokeness provided the perfect ideology for affluent, liberal whites who didn’t truly want systemic change if it meant their children would have to sacrifice their own status, but who still wanted to feel like the heroes of a story about social justice, who still wanted to feel vastly superior to their conservative and even slightly less radical friends.

This clarifies a lot of things, including the fact that wokeness is highest at the most prestigious universities: places like Harvard, Princeton, and Yale. It explains why many of the white Woke are obsessed with trivialities like policing languages, art installations, and other behavior, and don’t really get out there in society and actually help poor people.  It’s why they can get away with dismissing the poor and working class as racists because so many of them vote for Trump.

I don’t think (nor does Batya) that this is the sole explanation for fulminating Wokeness. But I think she’s got a handle on one reason, and an important one.

 

Advice from my primary care doc: Should you get a booster? If so, which one?

October 25, 2021 • 10:45 am

If you’re contemplating getting a booster shot, as I did (the Pfizer), you should read this blog post by Dr. Alex Lickerman, my primary care doc who has, as you may know, written a whole series on Covid-19 for the layperson.  This is post #16.  Click on the screenshot below to read his booster take and see links to the other posts.  NOTE: Alex has kindly agreed, as he often does, to answer readers’ questions about Covid, so fire away in the comments section below.

Here’s the intro, the short take, and then below I’ll list the topics he takes up:

In this post, we explore the pros and cons of getting a third booster shot (or second booster shot if you got the J&J vaccine) against COVID-19. As usual, if you’re less interested in how we got to our conclusions than you are in the conclusions themselves, feel free to skip to the BOTTOM LINE in each section and the CONCLUSION at the end.

Question: Should you get a third booster shot?

Answer: It depends on how likely you are to have a bad outcome if you contract COVID-19 as well as your specific goals in getting vaccinated.

The topics of the post:

ESTIMATES OF CONTINUING VACCINE EFFECTIVENESS

WHAT DOES WANING EFFECTIVENESS MEAN IN THE REAL WORLD?

BENEFITS OF A THIRD SHOT

RISKS OF A THIRD SHOT

WHAT THIRD SHOT SHOULD YOU GET?

I got my booster because I’m older and thereby in the ‘at risk’ group, but I’m also going to Antarctica on a ship for a month in March, and wanted the extra protection.  Note: Alex also recommends in his post which of the possible boosters will boost you the most. But you’ll have to see that for yourself.

My booster shot

October 1, 2021 • 12:00 pm

Yesterday at about 10 a.m. I got the booster shot for the Pfizer vaccine at the University of Chicago Hospital, which was offering it to all staff (I count). I confess that when I called my doctor to ask his advice, he didn’t think it was necessary. This is because given the low infectivity rates, a waning of immunity over six months of about 10% makes almost no difference in your chance of landing in the hospital or dying. I raised the objection that I wasn’t worried about those outcomes, but simply about getting sick, as even a breakthrough infection can last several weeks and make you miserable.  When I added that I was likely to be on a ship in Antarctica this winter, and wanted extra protection in that situation, he said that that a booster was fine for me.

Here I’m reporting my physiological reaction to the booster.

I had no reaction to the first Pfizer jab save a bit of soreness in the arm that abated within a day.

The second shot, though, had more severe effects, as it does with many people. I got that one about 8 a.m. on January 25, and was fine for the rest of the day. I also woke up the next day and felt good. The side effects didn’t set in until about noon on day 2: a flu-like feeling, malaise, some chills, and general debility. I went home early, a no-no for me, and woke up the next day completely fine.

I suspected that the effects of the booster would resemble those of the second shot, which represented my antibody reaction to the spike protein after my system was programmed. And, sure enough, that’s what happened. The effects did come on a bit earlier. My arm was sore most of yesterday, but otherwise I felt fine. I woke up this morning, though, and knew I was AFFLICTED. I trudged into work in the dark and labored away at those three posts, and then took a nap at my desk for an hour. After checking on the ducks (there are ten now, including Honey and Dorothy), I still felt like the bottom of a birdcage, and so took two Advil. I don’t know if it was the pills or the side effects are wearing off, but I feel much better now.

Everyone has to make their own decision on this, though I see nearly all the gub’mint experts are recommending getting a booster. To me, it’s worth a half day of malaise to avoid the possibility of a breakthrough infection, even though a booster may not have a substantial effect on even that.

If you’ve had yours, report in below on the effects.

Oh, and I have received NO pictures of polydactylous cats from any reader, despite my plea. Seriously, I don’t ask much from you, so if you own a Super Scratcher, send me a photo or two (paw and cat, perhaps), and a short paragraph of explanation.

Credit: Mike Kai Chen for The New York Times

The fallacy of using observational study to guide medical treatment: about 40% of medical procedures and drugs reported as not useful

September 27, 2021 • 9:15 am

Apropos of yesterday’s post on the unproven efficacy of ivermectin for Covid-19, I talked to my GP, Dr. Alex Lickerman, about the drug (he’s read the studies). I learned not only that there is no publication of high-quality controlled double-blind tests needed to show that ivermectin is effective against Covid-19 (there’s a big one that should be published by the end of the year), but also, surprisingly, nearly half of the medical drugs and procedures we use have not been subject to these tests. Very often the outcomes of clinical practice are just assumed to be efficacious without any rigorous tests with placebos and so on. Sometimes some people improve, but there is no randomized control group to compare them to. This is also true for some operations, in which “sham operations”—procedures that mimic real operations without the real surgical manipulation—have shown to be no better than the placebo procedures.

This is all summarized in a 2015 book shown below (click screenshot to go to Amazon link), and in a 2011 paper below that written by the same two physicians (Vinay Prasad and Adam Cifu, the latter from University of Chicago Medicine). What they mean by “medical reversal” is that later and better tests often show that drugs or procedures are either not helpful or could be harmful, so there’s a reversal of opinion and—if doctors are aware of this!—the procedure is abandoned or modified. We will soon know whether ivermectin is such a case.

Alessandra Montalto/The New York Times

If you want a shorter read on medical reversal (I haven’t read the book), see the paper below by Prasad and Cifu from the Yale Journal of Biological Medicine.  It gives lots of examples, including both drugs and surgery, and describes why medical reversal is important. It’s not detected as often as it should be because double-blind randomized tests with controls are time-consuming, expensive, and hard to do for surgery. Neverthetless, I was surprised to find out that roughly 40% of procedures or drugs prescribed by doctors have been shown to be either unnecessary or harmful.  Now I’m not a doctor, but I recommend you at least scan the paper below (click on screenshot) or listen to the audio link below that.

If you prefer listening to reading, you can find an hourlong conversation with Dr. Cifu on econtalk in which he summarizes “medical reversal” and gives examples.

Here are a couple of excerpts from the paper:

The second phenomenon is reversal: A medical practice falls out of favor not by being surpassed, but when we discover that it did not work all along, either failing to achieve its intended goal or carrying harms that outweighed the benefits. Although this phenomenon should be rare in the age of evidence-based medicine, it is ubiquitous. Common use of avandia [], ezetimibe [], atenolol [], hormone replacement therapy [], and the class 1C antiarrhythmic agents [] all stopped when trials showed they were either ineffective or harmful. Reversal not only affects medications. Previously accepted indications for surgical and medical procedures also have been abandoned. In 2009, stenting for renal artery stenosis was shown to be ineffective for many patients by the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial [], and in 2007, the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) [] trial found no benefit to support percutaneous coronary intervention (PCI) (versus optimal medical therapy) in most patients with stable coronary artery disease. In these cases, reversal does not mean that for every indication and purpose the therapy in question was shown not to work, but simply that it was contradicted for key indications.

. . . Reversal differs from replacement in that it produces three perils. First, reversal implies mistake or harm to patients cared for under the old model. The abandoned practices were ineffective or harmful. The cases of CAST and Avandia demonstrate harms, while COURAGE and Atenolol suggest only the harm of misplaced financial and social resources.

. . . Second, removing a once-commonplace practice can be more difficult than imagined. Adherence to the contradicted claim furthers malfeasance. The idea that beta-carotene could diminish cancer gained popularity in the early 1980s []. By the mid-1990s, however, three randomized controlled trials overturned the claim [,,]. However, nearly a decade passed before counterarguments were uncommon in the literature [].

. . . Third, reversal undermines trust in the medical system. In the case of hormone replacement therapy (HRT) — once thought to be beneficial for reducing a woman’s risk of heart disease while treating menopausal symptoms and contradicted by the Womens’ Health Initiative — patients report feeling “furious” with doctors who “pushed” therapy upon them [].

I asked my doc about hormone replacement therapy (HRT), as of course it’s still being widely used (check the internet). However, it was long thought, without any real tests showing it, that HRT, among other benefits, would also help postmenopausal women prevent the development of heart disease. A controlled test of that claim showed it was wrong: if anything, HRT increases the risk of heart disease. The problem may have been, as Cifu mentions in the podcast, that women seeking HRT could have been younger, thinner, and healthier (conditions that help prevent heart disease) than those who didn’t seek HRT. The “control” group was the latter, but it wasn’t a randomized trial: the “controls” may have been a nonrandom sample more likely to develop health disease. The upshot is that HRT, which used to be given to all symptomatic post-menopausal women, is not given to women with heart conditions, and patients are (or should be) informed about the slightly increased risk of heart disease.  (See the Mayo Clinic’s advice here.)

Dr. Lickerman added this (quoted with permission):

If you’re a post-menopausal woman with post-menopausal symptoms and known heart disease, you probably shouldn’t get it. If your risk of heart disease is otherwise average and your post-menopausal symptoms are severe, it’s a tool that can be used. Think of it like using Advil to treat arthritis. There are definitely risks, but we judge them against the benefits in each individual case. What we no longer do is give HRT to all post-menopausal women because our original thinking was it would benefit them all as a preventative. Now we know better. We no longer use it for prevention; only for treatment when benefits outweigh risks.
Most of what we do in medicine is done based on observational studies. Prospective, placebo-controlled randomized trials are very expensive and time-consuming. My colleague, Adam Cifu, co-wrote a book called Ending Medical Reversal in which he did a survey of the literature and estimated that ultimately 35-40% of medical practices, when finally prospective studies are conducted, are found to be useless or even harmful. It’s quite shocking. This is why I focus so much on evidence.

The lesson, as Cifu says in the podcast, is to interact with your doctor, and ask for evidence if you’re dubious or unclear, for a patient doctor relationship is just that—a relationship. A doctor who is imperious or who won’t even talk about evidence isn’t worth having.

Finally, a couple of quotes from the New York Times‘s 2015 review of Ending Medical Reversal:

The incremental progress of ordinary science is one thing, as individual treatments are progressively replaced by better variants. We all happily accept that kind of revision. But medical reversal, the authors’ sober term for sudden flip-flops in standards of care, unnerves and demoralizes everyone, doctors no less than their patients.

Dr. Vinayak K. Prasad and Dr. Adam S. Cifu, of Oregon Health & Science University and the University of Chicago, have set themselves the task of figuring out how often modern medicine reverses itself, analyzing why it happens, and suggesting ways to make it stop. If this short list of objectives explodes into a breathless and somewhat unwieldy critique of all of Western medicine, you still have to appreciate both their ambition and their argument.

An old saw has long held that 50 percent of everything a student learns in medical school is wrong. Actual calculations suggest that number is not too far off base — Dr. Prasad and Dr. Cifu extrapolate from past reversals to conclude that about 40 percent of what we consider state-of-the-art health care is likely to turn out to be unhelpful or actually harmful.

Recent official flip-flops include habits of treating everything from lead poisoning to blood clots, from kidney stones to heart attacks. One reversal concerned an extremely common orthopedic procedure, the surgical repair of the meniscus in the knee, which turns out to be no more effective than physical therapy alone. The interested reader can plow through almost 150 disproved treatments in the book’s appendix.

. . . What could make more sense, after all, than finding some cancers early, fixing a piece of torn cartilage, closing a hole in the heart, and propping open blood vessels that have become perilously narrow? And yet not one of these helpful interventions has been shown to make a difference in the health or survival of patients who obediently line up to have them done.

. . . Dr. Prasad and Dr. Cifu offer a five-step plan, including pointers for determining if a given treatment is really able to do what you want it to do, and advice on finding a like-minded doctor who won’t object to a certain amount of back-seat driving. Of course, there are no guarantees that their tips will endure forever, but they probably have a longer shelf life than most medical advice.

h/t: Alex Lickerman

Ex-editor of Science-Based Medicine chews the site’s tuchas for its treatment of Abigail Shrier’s book

September 26, 2021 • 12:15 pm

On June 22 I reported on a sort of “cancellation”. The respected website Science-Based Medicine (SBM), at the urging of editors David Gorski and Steve Novella, removed a review of a book by one of the other editors, physician Harriet Hall. As I wrote at the time:

So much the worse, then, that the site removed a book review written by another respected physician, Harriet Hall, known for being one of the Air Forces’s first women flight surgeons as well as a notable advocate for science based medicine and a vociferous debunker of quackery.  And—get this—Hall is one of the journal’s five editors.

Hall’s “mistake” was to write a fair and objective review of Abigail Shrier’s new book, Irreversible Damage (see my post here)  about the sudden increase in transgender males drawn from teenaged girls. (The numbers have increased 4,400% from 2008 to 2018!) Shrier and Hall, who admittedly note that there are very few studies about why these transitions have skyrocketed, and involve nearly all girls who want to transition to males rather than the other way round, call for more research and argue that transitions should be done under “a research setting”.

I read Shrier’s book and thought it was fair, empathic, and certainly not transphobic. But because Shrier was unfairly accused of transphobia for simply calling for more research on a topic that deserves it, it seems like SBM got cold feet. They replaced Hall’s review with three negative articles about Shrier’s conclusions, saying that Hall’s analysis failed to meet SBM’s standards for “high quality scientific evidence and reasoning to inform medical issues.” I’ve written a fair bit about this controversy, which does debase SBM quite a bit for promoting science because it conformed to a preferred ideology; see my collection of posts here.

Jesse Singal, who knows this literature well, has spent a fair amount of time taking apart SBM’s behavior in this case as well as the criticisms leveled at Hall and Shrier (see here and here, for example). Singal:

SBM has, in the wake of this retraction, published three articles about Shrier, Hall’s review of her book, and the broader controversy over youth gender medicine: “The Science of Transgender Treatment” by Novella and Gorski themselves, “Abigail Shrier’s Irreversible Damage: A Wealth of Irreversible Misinformation” by Rose Lovell, who as of February was finishing up a medical residency, and “Irreversible Damage to the Trans Community: A Critical Review of Abigail Shrier’s book Irreversible Damage (Part One)” by AJ Eckert, who serves as “the Medical Director of Anchor Health’s Gender and Life-Affirming Medicine (GLAM) Program” in Connecticut. Part Two is presumably on the way and I’ll read it when it’s published. (For what it’s worth, neither Lovell nor Eckert had written for SBM previously — they appear to have been brought on specifically for the task of responding to Irreversible Damage.)

Yet according to Kimball Atwood, a former editor at SBM as well as a physician and clinical professor, the articles that replaced Hall’s were laden with their own problems—philosophical, biological, and logical.  Atwood wrote a letter to Gorski and Novella and gave Singal permission to publish the letter on Singal’s own website. So here it is in all its glory. Click on the screenshot to read. PCC(E) gets a brief mention at the end.

The first bit is my favorite (I’ve added a link to “DSD”):

Hi Steve,

Harriet has told me that you stated that her article “dragged SBM into a raging controversy.” She feels, and I agree, that it was your retracting that article and replacing it by very bad articles written by advocates of “gender affirmation” that dragged SBM into a raging controversy. I’ve attempted to explain why previously, but here I’ll mention a couple of the most obvious reasons.

You claimed that Harriet’s article was below SBM’s minimal standard for “high quality scientific evidence and reasoning to inform medical issues.” Yet you replaced it with articles stating things such as the following:

  • “Biology is a binary and differences of sex development (DSDs) are vanishingly rare”. False. DSDs are as common as 1 in 5,000 births, and increase to 1 in 200 or 1 in 300 if you include hypospadias and cryptorchidism. Biology is very, very well known to be a spectrum.

[Lovell attributes the sentence in quotes to Shrier; I’ve been unable to find it in her book]

Do you, Steve, think that sex is a spectrum? Yes, I know Lovell wrote “biology is a spectrum,” but that is an incoherent claim. Her implication is that sex is a spectrum. If that were true, it would upend all that we know about sex in mammals and many other life forms, including sexual dimorphism, reproduction, and selection. Do you think that Lovell’s statement constitutes “high quality scientific evidence and reasoning”? OMG, apparently you do. What’s happened to you?

Do you think that hypospadias and cryptorchism are DSDs? They are not, and to suggest that they are does not meet SBM’s minimal standard for reasoning about medical issues.

The citation is to a paper that discusses real DSDs, not cryptorchism or hypospadias, and makes no claims about a “spectrum.” It supports the very statement that Lovell claims to be false (even though Shrier seems never to have made that statement). Where was the editor here?

There’s more, and the letter is short but sweet. I still think Gorski and Novella stepped in it by ditching Hall’s review. There’s no explanation other than the fact that Hall generally liked Shrier’s book, that the book has been attacked (wrongly) as “transphobic,” and that Gorski and Novella were afraid of backlash for being insufficiently attentive to the Zeitgeist of trans-activism.