How Can Doctors Like This Provide Competent Care To Their Patients?

Some beef with Dr. Jonathan Howard

Dr. Jonathan Howard, a neurologist and psychiatrist at NYU Langone Health, is furious at Michael Shermer, the founding publisher of Skeptic magazine.

Howard is an impressive figure. Like many doctors at university-affiliated medical centers, he also serves as a professor, in this case at the NYU Grossman School of Medicine. He has, according to his biography, “authored and edited multiple textbooks” on multiple sclerosis, his area of specialty.

Why is Dr. Jonathan Howard furious at Michael Shermer? It has to do with a recent exchange between Senator Josh Hawley and an OB-GYN named Dr. Nisha Verma. Hawley, seeking to make a point about “gender ideology” (as he might call it) during a hearing, repeatedly asked Verma if men can get pregnant and Verma could not give a straight answer. Shermer chimed in to suggest an answer Verma could have given that accounts for the fact that, as Shermer (and anyone else using the traditional, biological definition of the term) sees it, men cannot, in fact, get pregnant.

That’s why Howard is furious, and that’s why he wrote a deeply aggrieved article in Science-Based Medicine about Shermer’s bigotry. The headline? “The Anti-Trans Obsessions of ‘Skeptic’ Michael Shermer: Hallucinating Imaginary Demons to Empower Actual Villains, Once Again.” The subheadline? “I want to demonstrate to Michael Shermer that it’s possible for men like us to not talk about trans people constantly. If I can do it, so can he.” (If you’re unfamiliar with Science-Based Medicine’s strange recent trajectory, see here or here.)

Not only does Dr. Jonathan Howard of NYU Langone Medical Center disagree with Michael Shermer that men can’t get pregnant — Howard thinks that to even ask this question puts other humans in danger.

That probably sounds like a caricature on my part, or a sloppy and inaccurate gloss of Howard’s actual views. But that’s exactly what he wrote in the SBM piece: “Keeping people safe matters, and the question ‘Can men get pregnant?’ puts people in danger.” Howard does not ever explain how asking “Can men get pregnant” puts people in danger, nor does he list examples of people who were endangered by the asking of this question. His article, which practically vibrates with anger at Shermer’s claim (that men can’t get pregnant), contains a number of these sorts of head-scratching claims.

Howard’s article is illustrated with a photo of a t-shirt that reads “Leave Trans Kids Alone You Absolute Freaks.” It seems like the article’s raison d’être is for Jonathan Howard to explain what a good man he is and to contrast his own high moral standards with those of his inferiors — men, like Michael Shermer, who express loathsome and dangerous views (e.g., “men can’t get pregnant”).

At one point, for example, Howard writes:

Unlike [Shermer], I am unconcerned with strangers’ genitals, and I recognize I have no unique insights on trans issues. As such, I’ve not written on this topic previously and will only do so again if I have something worth saying. That may be a while. I want to be a role model for Shermer and demonstrate to him that it’s actually possible for men like us to not talk about trans people constantly. If I can do it, so can he.

While it’s extremely generous for Jonathan Howard to offer to be another adult’s role model, what jumps out here is Howard’s inability to merely disagree with Shermer. He has to make Shermer’s position sound not only wrong or unreasonable but sexually creepy; according to him, Shermer is “concerned with strangers’ genitals.” How? How does making an argument about the definition of a (wo)man make you “concerned with strangers’ genitals”? Howard doesn’t explain, just like he doesn’t explain how asking this question puts people in danger.

But that’s not what I want to focus on. I want to focus on this:

I feel strongly that people have the right to make informed choices about their body with dignity and respect, but without government interference. It’s vital to use the best available evidence and to do rigorous research to make sure trans people receive compassionate care, grounded in science, like everything else in medicine. Though I don’t treat trans patients often, I hope I do so kindly and capably. I know there is deluge [sic] of malicious disinformation about trans people, and I know it comes from entirely untrustworthy people.

Clearly Howard is confident in the evidence base for gender medicine. And the study he links the word evidence to happens to concern an area I know a fair bit amount: youth gender medicine.

It’s a 2023 paper published by a federally funded research team in The New England Journal of Medicine that I critiqued at great length. In addition to the fact that the researchers simply didn’t report the results of a number of the key variables in their preregistration’s primary hypothesis — likely indicating they didn’t get the results they wanted — the seeming “improvements” they did report were of questionable size, mostly applied to female-to-male but not male-to-female participants, and could have been the result of any of a combination of factors other than the hormones youth in the study received.

Given that this study does not, by any reasonable standard, offer causal evidence about gender medicine, I have no idea why a prominent doctor at a highly rated health system would link to it and treat it as evidence. I have an even harder time coming up with any justification for referencing a one-off study rather than the numerous systematic reviews that have found that the evidence base for youth gender medicine is lacking. On top of all that, the leader of this research team, Johanna Olson-Kennedy, later admitted that her team withheld its data on puberty blockers for political reasons, only bolstering the theory that similar considerations explain the outcome-switching and missing data in the hormones paper.

If a random Bluesky goon posted a link to this study as evidence for youth gender medicine, that wouldn’t surprise me. But this isn’t some random Bluesky idiot — this is a neurologist at NYU Langone.

I wanted to give Howard a chance to explain his reasoning here, so I sent him an email:

Dr. Howard,

I’m a journalist working on a book about the youth gender medicine debate, and I might be writing up something for my newsletter about the dispute between you and Michael Shermer. I wanted to ask you about the NEJM paper you linked to, which I’ve written about at some length. Do you genuinely think it provides causal evidence in favor of youth gender medicine? Between the outcome switching, the small effect sizes, and the disappearance of so much of the data the team promised to publish, it’s just hard for me to understand how a doctor could point to it as meaningful evidence. And of course the questions only mount when you look at the various systematic reviews published by European countries.

Thanks,
Jesse

He responded shortly thereafter:

If you understood the point of my article, you wouldn’t have written me.

Goodbye.

For what it’s worth, Howard posted this exchange to Bluesky three minutes after sending me his response:

Maybe I’m projecting here, but my sense was that he posted the exchange to Bluesky for the same reason he wrote the SBM article: that it’s very important for him to inform the world, repeatedly and at great length, about the fact that he is a good man who is better than the bad men. A certain Freddie deBoer article comes to mind here.

But let’s linger on his link to the NEJM paper for a minute. If Howard generally views this paper as evidence in favor of his position, he doesn’t understand basic aspects of how to read a research paper. This is not a close call. The problems with this paper are so well-documented, so numerous, and so straightforward that for a doctor to point to it as evidence for gender medicine should raise a number of questions about that doctor’s judgment and ability to assess the research literature.

It could be that this is a one-off blunder on Howard’s part. Maybe when it comes to his area of native expertise, neurology, he is super careful. He would never allow such a low-quality paper to guide his clinical decision-making. In this case, he just didn’t look closely enough at it. But. . . isn’t he expressing a huge amount of outrage, moral condemnation, and confidence in his own ability, all while clearly not understanding anything about the evidence he’s pointing to? What is the probability that he exhibits these negative qualities when he’s wandering into a new area in which he is (by his own admission) unfamiliar, but that he exhibits tip-top epistemic humility when it comes to his day-to-day work?

If frustration is creeping in here, it’s because I’m astounded at how reckless advocates for these treatments have become, and at their utter inability to update their claims on the basis of new information. It has been established, by standards that would be readily accepted in just about any other medical controversy, that the evidence base for youth gender medicine is so weak that we don’t really know what to make of these treatments. Extremely basic questions about the etiology and natural progression of gender dysphoria remain completely unanswered.

Dr. Jonathan Howard says he does occasionally come across trans patients. Imagine one of these patients in his office. Imagine this patient asking him, a trusted, prestigious figure, if hormones are the right decision. Imagine this doctor thinking back to the abstract of one since mostly debunked paper and nodding, assuring this patient he is making the right choice. How can this not make you a little bit mad, this abuse of title and institution? How can it not make you a little bit mad that doctors who sit at the very top of society’s hierarchy can spout off so confidently about matters they know so little about?

I wouldn’t have written this if Howard were some isolated, outlying case, but he isn’t.

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Questions? Comments? Lists of questions you’re not allowed to ask because they’re too dangerous? I’m at singalminded@gmail.com.