Tuesday, March 6, 2018

A search for the evidence that Ryan T. Anderson promises to provide

Ryan T. Anderson
Ryan T. Anderson it s a poseur lacking any meaningful credentials to opine on gender identity.
It seems that the faithful cannot get enough of Ryan T. Anderson, the orthodox Catholic Defender of the One True Faith™ and employee of Heritage Foundation. Last night, Anderson's promoter du jour was Witherspoon Institute's pseudo-intellectual blog. Anderson is the editor of that outlet. The title of Anderson's latest bloated “eureka” is: “Sex Change: Physically Impossible, Psychosocially Unhelpful, and Philosophically Misguided.”

What is misguided is Anderson's presumption of expertise. Lacking any meaningful qualifications, Anderson turns religious advocacy into callous obtuseness. As for the title of the piece, no one contests the fact that gender affirmation cannot change genes. Rather, it attempts to align someone's physical appearance with their gender which, in the case of people seeking an intervention, is incongruent with their natal sex. The rest of Anderson's title is equally meaningless babble. As for the subtitle:
Modern medicine can’t reassign sex physically, and attempting to do so doesn’t produce good outcomes psychosocially. Here is the evidence.
I will seek the evidence in the balance of Anderson's polemic. Anderson's book is not evidence of anything other than his effort to conform the real world to the teachings of the Catholic Church.

Anderson goes on for three or four paragraphs about natal sex. He cites farmers and breeders and then he seemingly admits the obvious:
And yet, in an expert declaration to a federal district court in North Carolina concerning H.B. 2 (a state law governing access to sex-specific restrooms), Dr. Deanna Adkins stated, “From a medical perspective, the appropriate determinant of sex is gender identity.” Adkins is a professor at Duke University School of Medicine and the director of the Duke Center for Child and Adolescent Gender Care (which opened in 2015).

Adkins argues that gender identity is not only the preferred basis for determining sex, but “the only medically supported determinant of sex.” Every other method is bad science, she claims: “It is counter to medical science to use chromosomes, hormones, internal reproductive organs, external genitalia, or secondary sex characteristics to override gender identity for purposes of classifying someone as male or female.”
Anderson is quoting a real expert. Dr. Adkins is also a board certified pediatrician and a board certified pediatric endocrinologist. Dr. Adkins stated the obvious. Gender is controlling. For the vast majority of people gender is congruent with natal sex. There are some people who experience incongruent sex and gender. Gender is still controlling. That is a scientific and medical fact.

I am still waiting for Anderson to provide some evidence of anything. Instead, Anderson offers testimony:
Dr. Lawrence Mayer responded in his rebuttal declaration: “This statement is stunning. I have searched dozens of references in biology, medicine and genetics—even Wiki!—and can find no alternative scientific definition. In fact the only references to a more fluid definition of biological sex are in the social policy literature.” Just so. Dr. Mayer is a scholar in residence in the Department of Psychiatry at the Johns Hopkins University School of Medicine and a professor of statistics and biostatistics at Arizona State University.
Dr. Mayer is smart guy. However, he is not an expert in this area and, in fact, his rebuttal is ambiguous. This matter has nothing to do with a “more fluid definition of biological sex.” Gender is a separate and distinct construct. There exists an enormous amount of research on transgender people. The basic — and undisputed premise — is that these people have a difference in sex and gender.

Mayer's own professional association recognizes the condition and defines it as gender dysphoria. It is worth noting that a local expert was available for testimony. To get someone to contradict the expert, they had to fly in a non-expert from Arizona.

Mayer's testimony is just that. It is not evidence.

The next few paragraphs restate Anderson't proposition that chromosomes cannot be changed. No one has contended otherwise. Anderson provides no evidence of anything related to gender. These paragraphs include:
“Scientifically speaking, transgender men are not biological men and transgender women are not biological women. The claims to the contrary are not supported by a scintilla of scientific evidence,” explains Dr. Mayer.
Where are these “claims to the contrary?” Anderson and Mayer have constructed a straw man. Using an artifice they are refuting an argument that does not exist. Mayer's statement is not evidence. Anderson dutifully provides:
Or, as Princeton philosopher Robert P. George put it, “Changing sexes is a metaphysical impossibility because it is a biological impossibility.”
Who cares? What does that have to do with anything that is remotely relevant? George's opinions are not evidence.
Sadly, just as “sex reassignment” fails to reassign sex biologically, it also fails to bring wholeness socially and psychologically. As I demonstrate in When Harry Became Sally, the medical evidence suggests that it does not adequately address the psychosocial difficulties faced by people who identify as transgender.
Now he is claiming that there is medical evidence to support his religious inspirations. Let's see if Anderson provides some evidence:
Dr. Paul McHugh, the University Distinguished Service Professor of Psychiatry at the Johns Hopkins University School of Medicine, explains:
Transgendered men do not become women, nor do transgendered women become men. All (including Bruce Jenner) become feminized men or masculinized women, counterfeits or impersonators of the sex with which they “identify.” In that lies their problematic future.
McHugh's religiously inspired opinions are not evidence. I am still waiting. McHugh, who is pushing 90, does not submit original research for peer-reviewed publication. He just opines.

McHugh continues:
The most thorough follow-up of sex-reassigned people—extending over thirty years and conducted in Sweden, where the culture is strongly supportive of the transgendered—documents their lifelong mental unrest.
That misstates the study and its conclusions. What it demonstrated is that transgender people need counseling support. Furthermore, McHugh intentionally confuses the outcomes. Those transgender people were suffering with gender dysphoria. Neither McHugh nor Anderson can speculate on the condition of those people were they not to affirm their gender. In short this is bullshit.

And where is the promised evidence? A study with different intent and without a control group is not evidence.
Here’s how the Guardian summarized the results of a review of “more than 100 follow-up studies of post-operative transsexuals” by Birmingham University’s Aggressive Research Intelligence Facility (Arif):
Arif, which conducts reviews of healthcare treatments for the NHS, concludes that none of the studies provides conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, which skewed the results in favour of physically changing sex. There was no evaluation of whether other treatments, such as long-term counselling, might help transsexuals, or whether their gender confusion might lessen over time.
Now we are relying on the British press. That piece is 14 years old and ARIF did a literature search at the Guardian's request. ARIF no longer exists. Furthermore, and most importantly, what that says is that there is a paucity of relevant research. Fourteen years ago, doctors were routinely trying to prevent young people from transitioning. Due to more recent research that approach was changed about ten years ago. This is not research to begin with and it is seriously dated. Can Anderson not provide something more current and more relevant?

A 2004 article in a newspaper is not evidence of anything. Where is the twice-promised evidence?
In 2014, a new review of the scientific literature was done by Hayes, Inc., a research and consulting firm that evaluates the safety and health outcomes of medical technologies. Hayes found that the evidence on long-term results of sex reassignment was too sparse to support meaningful conclusions and gave these studies its lowest rating for quality.
I have requested a password for the full text. However, it is clear that the consulting firm understands gender and gender dysphoria. Hayes, by the way, is primarily a consultant to health insurers. Hayes might be correct that we need more research. The reason for the lack of research is (usually) the lack of grants. That might be a function of the fact that gender dysphoria affects a tiny percentage of the population.

Dr. Sari Reisner at Harvard is close to completion of a grant-funded Transgender Population Health Survey. The report will be issued sometime this year. Furthermore, NIH just funded two studies. They are similar but separate. Meanwhile, the clinicians who work with gender dysphoric people are overwhelmingly supportive of gender affirmation. This is not, and should not be, a religious issue but that is precisely what Anderson is doing.

Where is the promised evidence?
The Obama administration came to similar conclusions. In 2016, the Centers for Medicare and Medicaid revisited the question whether sex reassignment surgery would have to be covered by Medicare plans …
That is misleading. CMS (Center for Medicaid and Medicare Studies) did not issue an NCD (National Coverage Determination):
While we are not issuing a NCD, CMS encourages robust clinical studies that will fill the evidence gaps and help inform the answer to the question posed in this proposed decision memorandum. Based on the gaps identified in the clinical evidence, these studies should focus on which patients are most likely to achieve improved health outcomes with gender reassignment surgery, which types of surgery are most appropriate, and what types of physician criteria and care setting(s) are needed to ensure that patients achieve improved health outcomes.
Note that it is not whether patients benefit from surgery. The issue is which patients will benefit the most and what follow-up is required.

Anderson goes on to quote from a literature review without identifying who did it and where it was published. Then we go back to mis-characterizing that Swedish study. This time it is Anderson, not McHugh. Then we get this from Anderson:
If a man has an internal sense that he is a woman, is that just a variety of normal human functioning, or is it a psychopathology? Should we be concerned about the disconnection between feeling and reality, or only about the emotional distress or functional difficulties it may cause?
That is the rhetorical question positing a philosophical approach which is beyond irrelevant. The bottom line is that there is no intervention known to medical science that directly addresses gender dysphoria. Anderson has no answers. McHugh has no answers. Michelle Cretella has no answers either:
This philosophical view of human well-being is the foundation of a sound medical practice. Dr. Michelle Cretella, the president of the American College of Pediatricians—a group of doctors who formed their own professional guild in response to the politicization of the American Academy of Pediatrics …
Formed a hate group is more like it. Cretella is a crackpot who — for religious reasons — is a zealous proponent of thoroughly discredited pseudoscience of conversion therapy. Cretella is another Defender of the One True Faith©.

From there we go to Dr. Leon Kass (who is actually a good guy). Kass says absolutely nothing about gender dysphoria. Then it's back to Cretella. Finally this thing comes to a conclusion:
Our brains and senses are designed to bring us into contact with reality, connecting us with the outside world and with the reality of ourselves. Thoughts that disguise or distort reality are misguided—and can cause harm. In When Harry Became Sally, I argue that we need to do a better job of helping people who face these struggles.
First of all, reality for a person with gender dysphoria is their gender. While the Catholic Church does not approve, the bishops do not have the training and experience to guide compliant people like Ryan T. Anderson. Anderson is in no position to weigh in with respect to what is “misguided.” He is a Defender of the One True Faith to the end. People who buy his book are likely to be people who have already formed opinions consistent with Anderson's.

Nevertheless, Anderson promised to provide evidence twice. Anderson provided no evidence whatsoever. The reason is obvious. Points of view on current issues based on ancient texts do not survive critical thinking. It is like trying to find evidence of the Burning Bush or the parting of the Red Sea.

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