Tribalization does funny things to people. If you’d told me a decade ago that within a few years, Republicans would be against Ukraine defending itself from a Russian invasion, and Democrats would be pulling the Full Churchill to counter the Kremlin, I’d have gently asked what sativa strain you were smoking.
If you’d told me the Democrats would soon be the party most protective of the CIA and the FBI, and that Republicans would regard them as part of an evil “deep state,” ditto. And who would have thought that a president accused in 2017 of having “no real ideology [but] white supremacy” would today be doubling his support with black voters, and tripling it with black men? Who would have bet the Dems would go all-in on Big Pharma when it came to Covid vaccines? And who would have thought Republicans who long carried little copies of the Constitution in their suit pockets would lead a riot to prevent the peaceful transfer of power? You live and learn.
But would anyone have predicted that the Democrats and the left in general would soon favor a vast, completely unregulated, for-profit medical industry that would conduct a vast, new experimental treatment on children with drugs that were off-label and without any clinical trials to prove their effectiveness and safety? In the 2016 presidential race, both Dem contenders railed against Big Pharma, with Bernie going as far as calling the industry “a health hazard for the American people.” Back in 2009, you saw MSM stories like this:
The Food and Drug Administration said adults using prescription testosterone gel must be extra careful not to get any of it on children to avoid causing serious side effects. These include enlargement of the genital organs, aggressive behavior, early aging of the bones, premature growth of pubic hair, and increased sexual drive. Boys and girls are both at risk. The agency ordered its strongest warning on the products — a so-called black box.
Nowadays, it’s deemed a “genocide” if you don’t hand out these potent drugs to children almost on demand. Drugs used to castrate sex offenders and to treat adult prostate cancer have been re-purposed, off-label, to sexually reassign children before they even got through puberty. Big Pharma created lucrative “customers for life” by putting kids on irreversible drugs for a condition that could not be measured or identified by doctors and entirely self-diagnosed by … children.
And what if over 80 percent of the children subject to this experiment were of a marginalized group — gay kids? And the result of these procedures was to cure them of same-sex attraction by converting them to the opposite sex? I simply cannot imagine that any liberal or progressive would hand over gender-nonconforming children, let alone their own children, to the pharmaceutical and medical-industrial complex to be experimented on in this way.
And yet for years now, this has been the absolutely rigid left position on sex reassignments for children with gender dysphoria on the verge of puberty. And for years now, those of us who have expressed concern have been vilified, hounded, canceled and physically attacked for our advocacy. When we argued that children should get counseling and support but wait until they have matured before making irreversible, life-long medical choices they have no way of fully understanding, we were told we were bigots, transphobes and haters.
The reason we were told that children couldn’t wait and mature was that they would kill themselves if they didn’t. This is one of the most malicious lies ever told in pediatric medicine. While there is a higher chance of suicide among children with gender distress than those without, it is still extremely rare. And there is absolutely no solid evidence that treatment reduces suicide rates at all.
Don’t take this from me. The most authoritative and definitive study of the question has just been published in Britain, “The Cass Report,” by Hilary Cass, one of the most respected pediatricians in the country. It’s 388 pages long, crammed with references, five years in the making, based on serious research and interviews with countless doctors, parents, scientists and, most importantly, children and trans people directly affected. In the UK, its findings have been accepted by both major parties and even some of the groups who helped pioneer and enable this experiment. I urge you to read it — if only the preliminary summary.
It’s a decisive moment in this debate. After weighing all the credible evidence and data, the report concludes that puberty blockers are not reversible and not used to “take time” to consider sex reassignment, but rather irreversible precursors for a lifetime of medication. It says that gender incongruence among kids is perfectly normal and that kids should be left alone to explore their own identities; that early social transitioning is not neutral in affecting long-term outcomes; and that there is no evidence that sex reassignment for children increases or reduces suicides.
How on earth did all the American medical authorities come to support this? The report explains that as well: all the studies that purport to show positive results are plagued by profound limitations: no control group, no randomization, no double-blind studies, no subsequent follow-up with patients, or simply poor quality. Some are arguing that the report unfairly ignored countless studies that support child transition. I’ll leave it to the editor-in-chief of the British Medical Journal to address that point:
One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret.
The methodological quality of research matters because a drug efficacy study in humans with an inappropriate or no control group is a potential breach of research ethics. Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions …
The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider—from social transition to hormone treatment.
The invaluable Christina Buttons shows here what a circular, ideological, self-referential echo chamber the gender “medical research” became.
The British child-gender service had almost no followup with patients into adulthood, and, amazingly, when Cass asked for contacts for former patients to follow up herself, the doctors refused to cooperate. What on earth, one wonders, are they trying to hide? And why would any doctor want to restrict rather than expand our knowledge base?
One answer is what Megan McArdle has suggested: the doctors and activists behind this are now caught in the Oedipus Trap. Having conducted many sex-reassignments for children, sterilizing them, removing their capacity for orgasm, and rendering them patients for life, these doctors can hardly now admit they had no solid studies to back them up. But they didn’t. And they have no excuse.
But they can hardly now look in the eyes of parents they emotionally blackmailed into transing their child and concede that, actually, the risk of suicide is very small, and we don’t know if transing increases or lowers the chances anyway. It would be so self-incriminating that it would require the end of their medical license. Can you imagine the lawsuits that are coming?
Then there’s simply the psychological resistance to coming to terms with what you have irreversibly done to children who had no way to meaningfully consent. I think of Jack Turban, a gay doctor complicit in this assault on an overwhelmingly gay population of children, a gleeful advocate of transing children, and someone who hasn’t even addressed the Cass Report’s findings. These are palpable betrayals of the Hippocratic Oath, a violation of basic medical ethics. But then there were lobotomists who went to their grave still claiming they were right.
Accountability? Good luck with that. Will any of the Twitter mobs who hounded the skeptics take stock? Will the ACLU’s Chase Strangio feel any regret for trying to censor the first major book raising the alarm? Will groups like GLAAD and HRC confess to their grotesque lies — “The Science Is Settled” — and ugly bullying tactics to suppress reporting on the question? Will they cop to having supported gay conversion therapy in which many gay kids were “fixed” by being turned physically into the opposite sex?
Will HRC and countless educators temper the curriculum that tells small children that their bodies are irrelevant to whether they are a boy or girl, and that they can change their sex at will? Will these ideologues ever concede the foul homophobia behind questioning the maleness of a girly boy or the femaleness of the tomboy? Will they ever admit that their ideological extremism, and their “queer” conflation of trans and gay experiences, has led to one of the greatest medical abuses of gay kids in history? Of course they won’t. As I write, HRC and GLAAD have not uttered a peep about the report’s findings. They are intellectually and morally bankrupt institutions, desperate for money, and using the scarred bodies of gender-dysphoric children to fundraise.
In a sane world, the doctors who pushed these lucrative treatments and the leaders of the transqueer groups responsible for the wreckage of so many young gay and lesbian lives should resign in shame. So should the MSM journalists who were stenographers for these fanatics, acting to suppress the truth rather than expose it. So should the gay doctors who supported this insanity. This was — and remains — a horrifying case of gays betraying our own — and the most vulnerable and helpless among us.
History will be brutal to those responsible. But almost certainly not brutal enough.
(Note to readers: This is an excerpt of The Weekly Dish. If you’re already a subscriber, click here to read the full version. This week’s issue also includes: a productive debate with Eli Lake over Israel; a ton of reader dissents over my latest piece on Gaza; eight notable quotes from the week in news, including an Yglesias Award over the new Progress flag; 20 pieces on Substack we recommend this week on a slew of subjects; a Mental Health Break mocking OJ; and, of course, the results of the View From Your Window contest — with a new challenge. Subscribe for the full Dish experience!)
From a subscriber:
Thank you for including my observations in your substack. I’ve been a Dishhead ever since late ‘00s. At first, I read the blog every day as part of my IT job of understanding what drove traffic to theatlantic.com, but I quickly realized that the Dish modeled a method of intellectual engagement designed to try to understand oneself in an ever-shifting body politic. I’ve borrowed this method to become a more honest and self-aware adult. Thanks to you and Chris for showing me the way.
New On The Dishcast: Eli Lake
Eli is a journalist and friend. He’s a former senior national security correspondent for The Daily Beast and Newsweek, and a former columnist for the Bloomberg View. He’s now a reporter for The Free Press, a contributing editor at Commentary Magazine, and the host of his own podcast, The Re-Education. In this episode we talk about the grave predicament of Israel after 10/7, Eli’s love of hip-hop, and grappling with Kanye’s anti-Semitism. I thought I should have a strong Israel supporter to come on and challenge my recent columns.
Listen to the episode here. There you can find two clips of our convo — on the West Bank settlements, and Trump’s record on Israel. That link also takes you to a lot more reader dissent over my latest piece on Gaza, plus a little dissent over my take on Scotland’s hate-speech law.
Browse the Dishcast archive for an episode you might enjoy (the first 102 are free in their entirety — subscribe to get everything else). Next up: Kara Swisher on Silicon Valley. After that: Adam Moss on the artistic process, George Will on Trump and conservatism, Johann Hari on weight-loss drugs, Noah Smith on the economy, Nellie Bowles on the woke revolution, Bill Maher on everything, and the great Van Jones! Send any guest recs, dissents, and other comments to dish@andrewsullivan.com. A new subscriber writes:
Every Friday I listen to your interview with your fascinating guests, and I prepare myself for only getting half of the episode. Yet every time, I get pulled into the conversation and get frustrated when your voice breaks in to tell me to subscribe. I guess I finally had to do it!
Another newcomer used Swiss francs: “I’ve followed the Dish for years, but I was finally keen to subscribe for the full episodes with Nate Silver and Richard Dawkins.”
Among the dozens of dissents sent by readers over my latest column:
You failed to point out that the IDF has apologized for the incident and held high-level officers responsible for it with demotions and reprimands. By contrast, a US drone killed 10 civilians (including seven kids and an aid worker) on our way out of Afghanistan — and no one was punished. You understand that war is an awful endeavor but suggest that this action was reflective of IDF policy. That is wrong, and their actions since the accident demonstrate it.
You keep falling into the same moral trap where you want Israel to defeat Hamas without also having to kill the civilians Hamas hides behind. This is a moral trap because it is keeping you from weighing the moral value of the future lives lost if Hamas is allowed to endure.
No army in history has had to do more to avoid civilian death than the IDF in Gaza. The Allies eradicated the Nazis from Europe by inflicting hundreds of thousands of deaths to French, Belgian, Dutch, and German civilians. If the Nazis were in a town, the allies bombed the town. Technology allows the IDF to bomb the building in which Hamas is located instead of the town, but they don’t have magic weapons that can kill Hamas and not the civilians they hide behind.
The reason Hamas’ strategy is working is because so many in the West, like you, are losing our nerve to see the war to its conclusion. We must accept that many innocent lives will be lost now in exchange for hopefully many more innocent lives in the future. It’s the same calculation our grandparents’ generation made in WW2. They swallowed it for four years; we can’t even last six months.
You correctly point out that Israel is caught between surrender and civilian death. Do you advocate surrender? If not, what do you advocate?
I support taking Rafah. Anything else at this point would be a Hamas victory. And I don’t think it’s possible to avoid horrific civilian casualties. But there should be evacuation of civilians first, and a careful strategy that is not rushed as the original invasion was. Another dissent:
I love your podcast and newsletter, but dude, I really didn’t need to be blindsided by seven dead babies while checking my email. Please find another way to share those kinds of photos if you feel it’s important, like maybe some kind of warning up top before scrolling down.
For nearly a quarter of a century, the Dish has never flinched from publishing the war photos that mainstream outlets understandably won’t. I take your point, but I also think that independent media can complement the mainstream in this respect. More graphic images — of dead Israelis — are over on the pod page, so heads up. They’re accompanied by many more dissents over Israel, and more of them are here, with my replies. As always, keep the criticism coming: dish@andrewsullivan.com.
This is a feature in the paid version of the Dish spotlighting about 20 of our favorite pieces from other Substackers every week. This week’s selection covers subjects such as the OJ trial, mainstream eugenics, and the conundrum of whether to have kids. Below is one example, followed by a few new substacks:
David Lat is aghast at the anti-Semitic, First-Amendment-illiterate law students who protested at the home of a Berkeley dean.
Welcome, Charlie Sykes! He recently jumped ship from The Bulwark, and he’s better for it. Also, former execs at Business Insider launch a personal finance ‘stack.
You can also browse all the substacks we follow and read on a regular basis here — a combination of our favorite writers and new ones we’re checking out. It’s a blogroll of sorts. If you have any recommendations for “In the ‘Stacks,” especially ones from emerging writers, please let us know: dish@andrewsullivan.com.
The View From Your Window Contest
Where do you think it’s located? Email your guess to contest@andrewsullivan.com. Please put the location — city and/or state first, then country — in the subject line. Proximity counts if no one gets the exact spot. Bonus points for fun facts and stories. The deadline for entries is Wednesday night at midnight (PST). The winner gets the choice of a VFYW book or two annual Dish subscriptions. If you are not a subscriber, please indicate that status in your entry and we will give you a free month subscription if we select your entry for the contest results (example here if you’re new to the contest). Happy sleuthing!
The results for this week’s window are coming in a separate email to paid subscribers later today. One sends a View From Your Eclipse:
I thought I’d share my view from not-quite-a-window (Magog, Quebec at 3:29pm):
A former sleuth writes:
I love how the VFYW posts come together — gotta be a lot of work to edit all those emails and put them into a coherent narrative. My personal best is finding one window ever. I was so proud of this vast accomplishment that I kept it to myself and didn’t enter, then retired from competition.
