Scott Anderson On The Iranian Revolution

Scott is a war correspondent and author. His non-fiction books include Lawrence in Arabia, Fractured Lands, and The Quiet Americans, and his novels include Triage and Moonlight Hotel. He’s also a contributing writer for the New York Times Magazine. His new book is King of Kings: The Iranian Revolution: A Story of Hubris, Delusion and Catastrophic Miscalculation.

For two clips of our convo — on Jimmy Carter’s debacle with the Shah, and the hero of the Iran hostage crisis — head to our YouTube page.

Other topics: growing up in East Asia and traveling the world; his father the foreign service officer; their time in Iran not long before the revolution; Iran a “chew toy” between the British and Russian empires; the Shah’s father’s affinity for Nazi Germany; Mosaddegh’s move to nationalize the oil; the 1953 coup; the police state under the Shah; having the world’s 5th biggest military; the OPEC embargo; the rise of Khomeini and his exile; the missionary George Braswell and the mullahs; Carter's ambitious foreign policy; the US grossly overestimating the Shah; selling him arms; Kissinger; the cluelessness of the CIA; the prescience of Michael Metrinko; the Tabriz riots; students storming the US embassy; state murder under Khomeini dwarfing the Shah’s; the bombing of Iran’s nuke facilities; and Netanyahu playing into Hamas’ hands.

Browse the Dishcast archive for an episode you might enjoy. Coming up: a fun chat with Johann Hari, Jill Lepore on the history of the Constitution, Karen Hao on artificial intelligence, and Katie Herzog on drinking your way sober. Please send any guest recs, dissents, and other comments to dish@andrewsullivan.com.

From a fan of last week’s debate over medicalizing kids with gender dysphoria:

Your episode with Shannon Minter was great: beautiful and respectful.

Another listener dissents:

I am progressive in my politics, a supporter of trans health care, and I believe such decisions are better left to patients, their families, and physicians. However, I have modified my views, partly on thoughtful critiques like yours, for which I am grateful. Which is why I was so disappointed by your debate with Shannon Minter. While both of you extolled the virtues of “both sides listening to each other” during the first half of the episode, your constant interrupting of Minter during the second half went beyond rudeness.

Another criticizes “the tone and pressured pace of your questions”:

It was a welcome debate, pregnant with possibility. The very beginning and end was cloying in its gentility and manners. But the meat of the debate was combative, with you talking over your guest. You guys were quoting sources that neither seemed to acknowledge.

A dissent in the other direction:

I greatly enjoyed your debate with Shannon Minter, and he should be commended for participating, but parts of his remarks frustrate me. He again and again says, “I don’t see what you’re seeing in the people I speak to” (referencing your evidence of compromised ethics on youth trans-care, speedy hormonal care after minimal consultations, etc.). I’m sure that’s true. But does he acknowledge that data is better than anecdote? He cannot wish away the Cass Report just because the relatively few individuals he has met thrived under transitional care as minors.

Another writes:

Minter is clearly not a Chase Strangio figure taking a post-modernist sledgehammer to every institution and the idea of biological sex. He’s just a trans man who wants to help people with a similar life story — yet you continually confronted him with the worst excesses of trans activism as though that’s how he spends his days.

Of course, society needs people within the trans movement standing up to figures like Strangio. But when Minter commented, “The providers I know do not have patients who have detransitioned. And to my knowledge...” — I thought it was quite cynical when you glibly interrupted, “How convenient.”

Obviously, there’s now been ample reporting on people like Strangio and Lia Thomas, as well as places like the Washington University Transgender Center and Tavistock, so we have a lot of anecdotes about queer theory, locker rooms, detransitioners, and doctors run amok. So your concerns are understandable, and I share them.

But if clinics like the ones Minter cited are common, they should be celebrated. And he compellingly grounded his side of the conversation in the kids and clinics that don’t generate headlines. I did a quick Google search, and I was surprised at the number of facilities offering some form of trans care in Alabama, a state he referenced a lot. Are there far more of the clinics he knows than there are Tavistocks? We can’t be sure — as you observed, we are in the dark on those numbers — but I see no reason not to take him at his word that he works with people who engage in medicine rather than crusading.

Repeatedly, he made a strong point about not pitting trans kids’ health care against gay kids’ health care. I share your concern for gay kids — as well as for confused straight kids, kids on the spectrum, kids with body-image issues, and any kids who encounter an activist clinician. But for a child suffering severe dysphoria, outright bans (versus the more individualized care Minter advocated) are ultimately unfair and unhealthy too.

His brief anecdotes — e.g., about a kid hitting himself in the chest to stop breasts from growing — are profoundly troubling. One of the reasons I wished he’d gotten a little more time to shape some of his answers is that the best practices, best lawyers, and the best doctors aren’t getting nearly the attention as the activists and ideologues. A sort of trans “if it bleeds, it leads” drama dominates the headlines, even in new media.

Minter’s suggestion of talking directly to someone from one of those clinics is worth pursuing, assuming you could arrange it, because for all the disagreement over some facets of trans activism, you two seemed to agree on the basic way forward: medical guidelines that exhaustively investigate each kid’s needs and compassionately treat them on each kid’s terms with ample safeguards for that kid’s safety.

As Minter pointed out, there are no guarantees. A doctor might prescribe the wrong medication for depression or misdiagnose a major condition in favor of a minor one, and a doctor may not consider gender dysphoria or may be biased toward it. There will never be absolute perfection in any medical field in our lifetimes.

But if Minter is indeed working with clinics that have low detransition rates, small numbers of kids on puberty blockers, strong follow up data, and happy families, I think it’d be far more edifying to hear more about what they’re doing than it would be to continue to argue with activists. Eventually, we’ll need to crowd out those activist voices with the practical ones, to see the best ideas brought to the fore and used as the basis of a safe, well-informed, dignified path forward.

I’m happy to think that there are some places doing this ethically, although I think the inability to know for sure if a child really is trans makes treatment inherently unethical. But Shannon refused to concede the abuses, which are documented widely, and dismissed the Cass Review, which, for me, is dismissing evidence of abuse, misdiagnosis, and homophobia.

One more listener on the episode:

I’m glad you could find an adversary secure enough to talk with you about the trans-ing of minors. I clicked the link you provided to the “Utah study” mentioned by Shannon, but it is a simple summary of political opinions by NBC News. None of the quantitative study data are included. Do you have access to the report of this Utah study, with its data, etc.? I’d be interested to read the primary source.

It’s here. On the spot, of course, I couldn’t address something I wasn’t familiar with. The meticulous journalist, Ben Ryan, who covers this issue on his substack and elsewhere, texted me, so I invited him to write a response here, and have Shannon respond. In trying to get into the nitty gritty, it’s helpful.

Ben started things off:

Dear Shannon and Andrew,

Thanks for an enlivening Dishcast episode. I’m really glad that the two of you came together to have some healthy debate, disagreement and discussion. I wanted to email a few thoughts in response to some of your disagreements. Overall, I think that Shannon might benefit from a bit clearer understanding of the science. But I also think that Andrew sometimes overgeneralizes and expresses more confidence in what we know from the science than what the often very hazy research can say at this point.

Shannon, I appreciate that you were willing to go on Andrew’s show in the first place. It has become very rare that advocates in your corner are willing to be subjected to tough questioning on this issue.

This isn’t a comprehensive list, but I took a few notes of questions as I was listening:

Did Cass recommend a ban?

Hilary Cass recommended that puberty blockers be prescribed for gender dysphoria within a research program. She originally recommended the establishment of such a program in 2022. In the Cass Review, published in April 2024, she recommended:

The evidence base underpinning medical and non-medical interventions in this clinical area must be improved. Following our earlier recommendation to establish a puberty blocker trial, which has been taken forward by NHS England, we further recommend a full programme of research be established. This should look at the characteristics, interventions and outcomes of every young person presenting to the NHS gender services.

The NHS took this recommendation and applied a ban on its doctors prescribing blockers outside of a planned clinical trial. The trial was supposed to start early this year, but is still held up in the regulatory and ethics approval process. The NHS just announced the launch of an observational study of minors attending its new system for caring for minors with gender dysphoria. The puberty blocker study will be an outgrowth of that study.

Cass also advised that doctors should observe extreme caution when prescribing cross-sex hormones (CSHs) to 16 and 17 year olds, which under current NHS policy they still can. (Prescriptions for CSHs are barred for minors under 16.) But Wes Streeting, the UK health commissioner, is considering banning such prescriptions. Parliament, under the departing conservative government, applied an emergency ban on private doctors prescribing blockers, one that the Labour government made permanent.

Did Cass say gender-transition treatment improves mental health outcomes?