Of all the papers in the special issue of the Journal of Controversial Ideas on censorship in science, the one below is perhaps the most important, as the censorship being imposed can cause permanent damage to humans. I’ve described this censorship before: it involves papers on or critiques of extreme claims of gender ideologues, especially those touting the benefits of what’s called “affirmative care” (adolescent dysphoria—> doctor on board prescribes puberty blockers almost immediately—> hormones, surgery, and gender transition). The recent history of the field, documented in the first paper below, involves repeated attempts to allow questionable claims to stand in the literature. Two examples of this are the unsupported claim that affirmative care prevents suicide, and the release of the paper by Johanna Olson-Kennedy et al, which was held back because the results (puberty blockers did not improve mental health) were not in line with what author thought gender activists wanted to see. The paper by Cohn below (click to read), summarizes many of these forms of censorship or distortion.
Here’s the abstract:
The integrity of the gender medicine research literature has been compromised, not only by censorship of correct articles, but also by censorship of critiques of articles with unsupported (for instance exaggerated), misleading or erroneous statements. Many such statements concern the evidence base, which can be evaluated rigorously using a key component of evidence-based medicine, systematic reviews of the evidence. These reviews currently find there is limited to very little confidence that estimates of benefit from (and sometimes harm from) medical gender intervention, that is, puberty blockers, hormones and/or surgeries, are likely to match true outcomes. Several medical societies and articles in medical journals have been claiming otherwise, misrepresenting the evidence base as a whole and/or relying upon unsupported or non-representative individual study findings or conclusions. For example, high likelihood of benefit and low risk of adverse outcomes from medical gender interventions are often claimed, while less invasive alternative treatment options are either omitted or mischaracterized. Other unsupported, erroneous or misleading statements occur when studies minimize or omit mention of significant limitations, or report findings or conclusions not supported by their own data; these are then sometimes quoted by others as well. In addition, correctly reported studies are sometimes misrepresented. Critiques which attempt to rectify such statements are frequently rejected. Some examples are presented here. Such rejections have stifled scientific debate, interfering with the continual scrutiny and cross checks needed to maintain accuracy in the research literature. Currently, erroneous and unsupported statements circulate and repeat between journals and medical society guidelines and statements, misinforming researchers, clinicians, patients and the general public.
If you want a three-page summary of the paper above, which you really should read in toto if you’re interested in gender medicine, read the article below (click headline to read) gives a terse summary.
I can’t summarize the first paper in detail, and you really should read it for yourself. I can, however, give a few quotes from Linehan’s summary on his Substack, which is a bit choppy (quotes indented below). Linehan begins by citing the paper above:
‘Censorship of Essential Debate in Gender Medicine Research’ has the dullest possible title for what it reveals. In yet another example of trans ideology destroying everything it touches, the most prestigious journals in medicine are refusing to publish corrections to papers that contain demonstrably false claims about gender medicine.
The author, J. Cohn, didn’t set out to write about censorship. She tried to correct errors in published papers. When that didn’t work, she described what happened. She found that multiple systematic reviews (the gold standard in evidence-based medicine) have found low or very low-certainty evidence for the benefits of medical gender interventions. This includes puberty blockers, hormones, and surgery. ‘Low certainty’ means there’s limited confidence the estimated effects will match what actually happens to patients.
The Cass Review, published in 2024, found the evidence for paediatric interventions “remarkably weak.” Several other systematic reviews found the same for patients under 21 and under 26.
None have found that these interventions reduce suicide risk.
Meanwhile, major medical journals keep publishing papers claiming the opposite.
Papers in JAMA, the New England Journal of Medicine, and Pediatrics have variously claimed that gender-affirming medical interventions are:
“Widely recognised as essential, evidence based, and often lifesaving”
Known to “clearly improve health outcomes”
Associated with “demonstrated health and well-being benefits”
Linked to regret rates “less than 1%” or “exceedingly rare”
The regret claim is particularly bold given that the studies cited have major flaws. The often-quoted Bustos review included 27 studies, of which 23 had moderate-to-high risk of bias. All included studies suffered from premature follow-up, significant loss to follow-up, or both.
And one more bit:
Medical guidelines are supposed to work like this: researchers conduct systematic reviews of all available evidence, assess its quality, and make recommendations that match the strength of that evidence. Strong evidence gets strong recommendations. Weak evidence gets weak recommendations or no recommendation at all.
That’s not what happened here.
The American Academy of Pediatrics policy statement recommending gender-affirming care wasn’t based on systematic reviews. A subsequent analysis found its cited references “repeatedly said the very opposite of what AAP attributed to them.”
The Endocrine Society guidelines make strong recommendations based on evidence they themselves rate as low or very low certainty. They don’t explain why.
WPATH commissioned systematic reviews, then interfered with them. After publication, they dropped all but one minimum age recommendation (for phalloplasty) under pressure from the Biden administration and the AAP.
This whole field is rife with a form of advocacy so extreme that researchers not only hesitate to publish results that go against the preferred ideological narrative, but also repeatedly distort studies that criticize affirmative care.
This is not the way science is supposed to be done, but it’s what happens when ideology begins to erode the norms of science. This of course is not new: it’s what happened with the Lysenko affair in Soviet Russia (documented in our paper, Jussim et al.), when ideological distortion (and outright cheating) ultimately killed millions of people. Nobody’s claiming that kind of toll for gender medicine, but there is still a palpable human cost to sloppy research.
h/t: Joolz