Gender dysphoria and mental health: We need to see the studies

Almost 100 years ago, the philosopher Karl Popper put forward an important argument. He proposed that democracy needed science, and that, indeed, a society’s attitude towards science would help determine its capacity for democracy.
That is, in a society with citizens embracing a myriad of worldviews, beliefs, ideologies and cultures, there has to be a way to settle disputes as to what policies should be undertaken by the government. In the absence of a way to settle disputes rationally, might would again make right, and democracy would lapse into autocracy once more.
The scientific method, then, offers a relatively more objective way to settle policy conflicts. Suppose we wonder if our government should invest in universal preschool. Impartial experts could be employed to gauge whether preschool made a significant positive difference in important outcomes by comparing groups of similarly situated children, some of whom attended preschool and some who did not. With sufficient care to measurement, controlling for variables and considering alternative explanations, we could assess whether preschool was worth the societal investment. This approach could unify those with disparate views by providing a common foundation for policymaking, thereby buttressing democratic governance.
But in the years since Popper made this argument, we know things are not quite as simple as he supposed. For example, the words “There is no evidence that … ” are used nowadays to suggest that science has demonstrated an assertion is false, when instead the statement almost always means “no one has yet done a study on this subject.” The assertion may well be true, but we cannot yet say one way or the other. Nevertheless, such a ploy is today often used to tar ideas as “disinformation” and thereby shut down needed debate.
We’ve also found to our collective regret that money can persuade some researchers to abandon their impartiality, which has led scientific journals to mandate disclosure of funding and conflicts of interest. Researchers can also overstep their bounds, and so protections such as informed consent and confidentiality are now overseen by institutional review boards. Sometimes researchers even fudge their results, which has led to required submission of datasets for independent replication.
No matter what loophole we think we’ve closed, we will never close them all. Science is simply not the dispassionate enterprise that Popper understood it to be, because its practitioners are human beings with passions, greed and ego.
Even knowing all that, the revelation by The New York Times this week that a scientist refused to publish her results because she didn’t like those results was shocking. To deliberately withhold knowledge from society about a subject that society desperately needs and wants to know more about is patently unethical. And yet here we are.
Dr. Johanna Olson-Kennedy, who oversees the youth gender clinic at the Children’s Hospital of Los Angeles, undertook a multiyear, federally funded study of whether puberty blockers improved mental health indicators for a set of 95 children with gender dysphoria. The study began in 2015; the children were followed for two years, and the results were gathered and analyzed. And then Olson-Kennedy refused to submit them for peer review and publication. In effect, she buried the results.
What were the results? No improvements in mental health outcomes were seen from the use of puberty blockers.
Finally challenged about her decision, Olson-Kennedy said “she was concerned the study’s results could be used in court to argue that ‘we shouldn’t use blockers because it doesn’t impact them,’ referring to transgender adolescents.” In other words, she did not want policymakers to know that her study showed puberty blockers did not improve the mental health of gender dysphoric children.
Given the huge national controversy over medical treatment for children with gender dysphoria, what Olson-Kennedy did was akin to purposefully blinding her society to what the scientific evidence shows. Though she has now been pressured sufficiently that she says she will submit the results for publication, she has clearly acted unethically.
In the United Kingdom, Dr. Hilary Cass, the author of the largest and most comprehensive report on the evidence regarding gender treatment, asserts that Olson-Kennedy’s publication delays “had led the public to believe that puberty blockers improved mental health, even though scant evidence backed up that conclusion.”
However, it was author JK Rowling who summed up the situation best: “We must not publish a study that says we’re harming children because people who say we’re harming children will use the study as evidence that we’re harming children, which might make it difficult for us to continue harming children.”
This is not the first time that we have seen suppression of results around gender-related medical care for minors. An advocacy organization, WPATH, funded similar research by Johns Hopkins University, and then refused to allow the researchers to publish the full findings. The Economist found that WPATH demanded that all the Hopkins research be “thoroughly scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender health care in the broadest sense.” In other words, no negative results could or would be reported, no matter how important such findings would be to democratic debate over this treatment, which often has irreversible effects on the body and sexual function of children.
Those such as Olson-Kennedy and WPATH, who try to hide what scientific inquiry is telling us, are not only acting unethically, but are profoundly undermining our democracy. Ironically, they are also ensuring their position will eventually fall, and that the fall will be very public. The truth will out, one way or the other.