Can't believe someone as smart as Jennings would not be more discerning about trusting "experts", especially in a field like social science (where social trumps science in many cases). In the 1920s many "experts" from Ivy League schools advocated for "progressive" causes like sterilization of the "unsound", phrenology, lobotomies for difficult people, racial hierarchies...all based on expert science. Or the experts in the '50s filling moms with thalidomide. Or expert dietitians pushing carbs over protein in the famous pyramid that hung on so many school walls.
I'm not calling Ken Jennings an idiot, but being the world's foremost professional in bar trivia is not equivalent to a robust practice of analytical thinking.
"Turban is impeccably credentialed: He’s a psychiatrist"
Honestly I haven't met many psychiatrists who are good scientists, and thats not a claim I make lightly or that wouldn't cost me anything professionay to make to their faces, which I would and which I might in writing one of these days. Its an absurd field, at least the way its been practiced for the last 50 years.
You cant really have expertise in something that has no strong evidence for even its most basic ideas. Its like being an expert astrologer. While im not a psychiatrist, I am actually the exact guy who is meant to be assessing them, a scientist in a quantitative evidence driven science of the brain who has long professional and personal relationships witn them.
Its a stupid field with many chancers and charlatans engaged in it, as well as some more serious people. You cant tell who is who from their degrees or work history, no doubt about it. It's a problem, think of expert testimony in the courts.
This reminds me of something genuinely scandalizing I came across in that New Yorker write-up from last December (link below) about how Oliver Sacks wrote fiction and passed it off as published medicine:
"The historian of medicine Henri Ellenberger observed that psychiatry owes its development to two intertwined dynamics: the neuroses of its founders—in trying to master their own conflicts, they came to new insights and forms of therapy—and the prolonged, ambiguous relationships they had with their patients. The case studies of these relationships, Ellenberger wrote, tended to have a distinct arc: psychiatrists had to unravel their patients’ “pathogenic secret,” a hidden source of hopelessness, in order to heal them."
This is one of the fundamental problems with basing so much on self-report. The incentive structure is entirely in favor of encouraging exaggeration and expansion of symptoms and full on confabulation. Patients and providers are both pressured to do this in various ways.
Right, not that I entirely accept it's possible to be a good clinician psychiatrist. I don't think the training they receive or procedures they must follow really allow for that within the NHS. Some of them might develop a kind of wisdom of their own. Mostly what they are doing is just assessing if you're going to hurt someone or top yourself, whether you're seriously ill or whether you're not. Beyond that, they just guess what drug might help. But they don't admit that's all they do, it's dressed up to sound like more. I think the US is pretty similar.
It's possible to be a good clinical psychologist in my opinion, but the way psychiatry operates is significantly pseudoscientific, or cargo cult science or something. Clinical Psychologists aren't usually trying to make poorly evidenced ontological claims about their patients, they just want to help and see how that goes. It's of course also possible to be a terrible clinical psychologist.
It's not like I'm the only person to have said this, many have, Marcia Angell wrote well about it. Although being a researcher is a different skill, I think training in some medical fields is better preparation than others for scientific research.
Angell was editor of the New England Journal of Medicine for a long time:
Research in psychology is a bit of a mess and it's been hit hard by the replicability crisis. Part of it (I think) is that there are too many journals - this is true for all sciences - and that allows for shoddy research to get through. If you have 15 journals, you have to fill them with something! I wonder if fewer, but more high quality, journals would improve things. But the publishers will never allow for this as it would cut their profits.
I work at a NHS teaching hospital and only in the past couple of years have they been trying to develop a team to support researchers and are (or at least paying lip service) giving clinical staff time for research. I think giving people that support to do better quality research helps.
But it's also a problem in universities. I've know a couple of good researchers who then are forced into spending most of their time teaching (which is important, but I would argue a different skill) and thus can't focus on doing quality research.
If I had my druthers, and gobs of money, I'd set up an institution where researchers can just crack on with focusing on quality research.
Sorry, bit of a sperg about this but it's my area of interest.
I think research in psychiatry is not much better. I work as a researcher attached to a university and its teaching hospital. I don't do clinical research, but I do research that forms the basis for clinical applications.
You can do 100% research, but you must bring in the funds to cover salaries and the research costs. Most people I know do mostly or only research. Actually my entire department only does research. It has research students but no teaching or undergraduate degrees. It's divided into institutes in their own buildings which focus on different things like genetics or whatever. So that does exist in the UK and it's very competitive globally. It's stressful though because you lose your job if you can't bring in funding and there is luck involved in that as well as skill.
To bring in funding you need not only to publish, but to publish in what are seen as the top journals. It's difficult. Sometimes people in this line of work feel under so much pressure they fake their results to get into top journals and secure funding. That has not happened where I work, at least no one's been caught doing it that I've heard of. People would be extremely upset and our reputation would suffer. There is enough money coming in that established people can float less established people for a little bit while they reapply for a missed grant.
I'd better get to it I need to publish before my proposal goes in at the end of the summer.
There have been a couple of times where a physician has recommended something and I've pointed out that it failed via RCT and the response was that this wasn't relevant, and that there was plenty of other evidence for it. I'm not saying that RCTs are the be all end all, but if something is failing in RCTs, then you should have a very good reason to disregard them in favor of lower quality evidence, something akin to the RCTs not fitting with basic biology or well-validated mechanisms.
Welllll… I mean it's complicated. Maybe it was a bad RCT. Maybe lots of things. Experiments are really hard, and get harder the more complicated the phenomena is. Anything involving humans is an extremely complicated phenomena. A doctor is meant to use their judgement and try things out. Maybe that doctor got a good result with that drug.
But on the other hand when a drug really works you know. For example heroin. No one is in any doubt that heroin works to dull pain. Antibiotics. No one doubts they work. Even the cream I use for rosacea very obviously works or I wouldn't slaver it all over my face. Valium works. Also some of these are dangerous of course.
Prozac? Suddenly we have to worry about RCT results, and that's because whatever it's doing is more subtle and maybe isn't much better than placebo. Joanna Moncrief at UCL has a lot to say about that. Lots of people are critical of those drugs, because they do have side effects and withdrawal and might not really work.
I don't know. I know I mostly function better without them. But I'm one person. It depends on the person, drug and context. What choice do you have but to listen to the doctor until you've found out yourself?
I have found doctors can be unaware or blase about the negative consequences of dugs they prescribe. So there is that aspect.
And sometimes there just isn't the research in a specific area. I sometimes work with a neonatal team and sometimes there just isn't any research available on their question or research is available but on an older population. Sometimes you have to look at the best evidence you can find and then go from there.
Doing research is HARD. It's difficult to design a study to test the specific thing that you want to test and then participants don't always do what they are suppose to and apparently it's unethical to lock them in cages so there's no risk of outside influences. There's a reason that nearly all Cochrane Reviews contain the phrase "more good quality research is needed".
Heroin (and all the opioids) "obviously" work to dull pain. You don't need a randomized control trial to determine that. But surprise surprise the opioids *don't* work for chronic pain. Sure, everyone seems to think they work and are absolutely necessary even though they have side effects that are a necessary cost of the benefit. But RCTs show that opioids don't work for chronic pain. The benefit wears off and all you are left with are side effects and complications, which includes addiction. (There are a lot of reasons for this because chronic pain is such a heterogenous mix of unrelated conditions.)
Do we really need an RCT to show that? It happens unambiguously to every single opioid user. All anyone ever had to do was test their pain responses, or simply ask them, not necessarily do a complicated, expensive trial.
But it's a great point because it would certainly be useful to have trials of psychiatric drugs that last longer than 8 weeks and test withdrawal effects, given those drugs are not only of uncertain benefit, they are intended for long term use. But those don't really exist. This hasn't stopped most psychiatrists claiming they work long term, and dismissing their often severe withdrawal effects.
Yes we did need RCTs to show that, because if you just ask chronic opioid users if the drugs help their pain they will say yes, they do, because that's how they get the doctors to keep prescribing them. The only "test of a pain response" is asking someone to rate their pain on a scale of 1 to 10. There is no objective measure of pain. We are taught that people can have severe agonizing pain despite being calm-looking, with no grimacing or fast heart rate or sweating or any of the things that might be clues to comfort vs. pain. This is largely propaganda by the enthusiasts for opioids who got us into this mess. So to break down this strong bias to just giving patients what they say they want and not arguing with them, you do have to do controlled trials.
Yes, psychiatric drugs need to be studied the same way.
If it wasn't known, why did the prescribed doses keep going up?
Because it *was* known. Not knowing wasn't the issue.
The problem wasn't that people didn't know these things, it was that they denied them so they could make money. Anyway RCTs don't control for lying, nor do they blind the users of strong drugs, all of whom know they're on it even if the researchers don't. It also seems ethically tricky for a university to deliberately addict people for the sake of a trial. There has been a great deal of research about pain e.g. by Irene Tracey
RCT is not a perfect tool, it's just one possible experimental design. I wouldn't use that to investigate opioid addiction I'd do different experiments, and people have done those experiments. Almost certainly e.g. Purdue knew the pharmacology of opiod addiction in detail, just like tobacco companies knew about how cigarettes cause cancer. It was known that benzos lose efficacy and have a severe withdrawal syndrome, since at least the 80s. It was even known why to a good degree. That didn't stop people prescribing them for years at a time, or stop companies from pushing their products.
Gel not cream. And I use loads and loads of it. Three or four times a day every day. and lots at a time. I would say start with small amounts to make sure you aren't sensitive to it. But if you aren't, you can chuck that stuff on and I, at least, don't have rosacea anymore.
One of the most irritating aspects of this stupid debate is when the cabal of liberal culture icons sanctimoniously signs on even in the absence of reason. I'd list them all but it would be a long list. From memory, some are Mythbusters, Bill Nye, DeGrasse Tyson, Rebecca Skloot (ugh), and of course the late night comedians.
I was thinking of NdGT when I read Jesse’s post. The way he (NdGT, not Jesse) handled this topic was inane and regressive. “Oh today I feel like a woman so I’ll put on some makeup.” I don’t think I’ve worn makeup (other than on stage) since my wedding, decades ago. Guess I’m a man now!
Except that while it was inane, that's quite literally how many activists describe it. They regressively declare the most sexist of behavioral criteria as being indicative of biological reality. I've personally heard multiple parents and others note that a girl toddler playing with trucks likely means they could be trans, and that not wanting to wear dresses means the same.
In so-called “skeptic” circles I often hear the parallel declaration that schools should teach critical thinking skills or that people’s problems concerning misinformation is a lack of critical thinking. As with the trust the experts declaration, critical thinking here should simply read as “agree with everything I say.” Disagreement is for many de facto proof that the person lacks such skills. In my own field of psychology, the fact that trust the experts is not what is going on, and instead is nearly always (and here the irony is hilarious given the substance of psychology supposedly being about human cognition) an issue of motivated reasoning largely for purposes of tribal allegiance, is clear from how the same people going to the DSM to “prove” issues related to gender-identity will also use a previous iteration of the DSM to note that psychology gets it wrong when classifying homosexuality as a mental disorder. When do we “trust the experts”? Right, when they agree with me now. Hell, I think my favorite example is when I heard someone say that Richard Dawkins, an esteemed biologist, was outside his lane when talking about….the biology of sex.
Exactly. Conservatives have their own version of this, but there’s something just extra condescending when it comes from those calling themselves liberals. Admittedly, it undoubtedly strikes me as more of a problem precisely because I still largely ascribe to liberal (not to be confused with a single political party) ideals. That these are often the same people who rely on “lived experience” declarations as evidence for the truth of whatever is being said, only makes the whole thing more absurd.
I break out in hives when I hear "lived experience". In other words, "my anecdotes that should be considered evidence because I'm a member of an embattled minority group."
Yeah, the positional epistemology that has come out of social-justice activism completely undermines science as a discipline of inquiry. Admittedly, they can't even be consistent with their own "lived experience," as anyone who falls into a minority status but disagrees with the activist, will also be dismissed.
One of the 3 pillars of evidence-based medicine is patient values and experiences - BUT this should be balanced with the other 2 which are relevant scientific evidence and clinical judgement. In many cases, one or both of the second pillars are missing.
When a creationist tells me the world was created from whole cloth in a week, I just shrug because I expect a creationist to believe that kind of nonsense. When a self-proclaimed progressive tells me that vaccines are great but, oh, there are 22 genders, I get annoyed because progressives supposedly Trust the Science. Except of course they don't, which is why I am not a progressive but a liberal.
When it comes to so many belief statements, they fall into one of two categories: statements about the world, and/or statements about what group they belong to. Often it's far more the latter that is important, whether it's about creationism or even the number of genders. This can be helpful in judging nonsense, since if it's about the world, then there are critical concerns, but the desire to belong makes sense. Unfortunately, it often inspires a lot of ridiculous behavior. Just watch a sport event :)
Right. To me, I don't care what people believe, whether that's creationism or gender woo-woo. This nation protects loopy beliefs in law, so, fine. I get peeved when people with odd beliefs start making moral or reality claims about the world. Believe that the earth is 6000 years old if you like, but do not teach people that dinosaurs lived alongside human beings--particularly if said teaching is done on the public nickel.
Yup. There's an old way of looking at personal rights where such ends when fist connects to face. In other words, consequences matter. Which is likely why so many who advocate various policy matters will not have to deal with the consequences of their implementation. I'm that odd combination of liberal and libertarian, where the marketplace of ideas should be supported, and consequences should be handled by those who make the decisions.
I think there's also the idea that disagreement is somehow violence or wrong - of course a disagreement can escalate, but it used to be that people could hold different views and discuss them without it escalating. And challenging ideas was How can you convince anyone to change their mind if you can't have a reasonable discussion around a topic you disagree on.
Spot on. There's a considerable dovetailing into the equally ridiculous notion that "words are violence." This is connected to the increasingly prevalent view that discomfort equals bad, a view peddled, unfortunately, by a great many mental health therapists, particularly those on TikTok, and ends up being a denial of biological reality. The challenge you identify, which includes holding different views, is now often dismissed as cognitive dissonance and something to be avoided at all costs. It's a point I raise with all my clients, that thoughts are just thoughts and dissonance is not only an inevitable part of life, but should be embraced as a way to challenge one's hubris. The reasonabe discussion you want to happen most definitely needs to happen more.
That is part of the feminization of society, which may be irreversible. Disagreements that hurt feelings and cause women to cry must be prohibited as violent and harmful.
I say irreversible because the notion that society is being feminized and that is a bad thing is bitterly and tearfully resisted by the feminized class that runs HR departments. Heretics have to be very brave, and resign themselves to being largely impotent because the organs of the state and the Church are all organized against them.
Scientific expertise is worthy of respect when, and only when, it's based in actual science. Actual science always admits the possibility that its current conclusions are wrong, and takes evidence challenging those conclusions seriously. Gender medicine is practically the opposite of this, with major groups and figures openly declaring that evidence challenging current conclusions must be suppressed, lest the discussion of such evidence harm a vulnerable population. It's a catechism-and-heresy approach to the truth, not the scientific method.
This is one of the things that I think is so interesting about genderwang - how did it capture so many intelligent people? How did it get into medical practice without anyone going maybe we should wait for some good solid evidence before sterilising children?
Really the only conclusion is that many medical practitioners are not very good scientists and don't think critically about what they are taught. Of greater concern is that it seems many scientists are also not very good scientists.
But lots of them are, they've just stayed quiet. Which is very reasonable IMO, they don't want to lose their job over something they might not even care that much about. It's the ones that care that are loud, and those are more frequently the bonkers ones. I mean I like to tap anonymous comments about it, but I'm not risking my house over it thanks all the same.
It's really interesting to me that 10 or 20 years ago we'd all have said we're far too enlightened and modern for Salem witch "the crucible" stuff to happen with respect to an important societal issue. But we're not, and it did.
That's the million-dollar question, isn't it? I guess you cut off a teenage girl's breasts over gender confusion the same way you throw people in prison over a memory that was "recovered" by highly motivated advocates. You tell yourself you are doing the Lord's work, which means the consequences aren't yours to regret.
My GP once said to me, about consulting surgeons over various pains, “surgeons like to do surgery”. It was an observation and a warning. The latest RCT on knee surgery demonstrates this perfectly: those given placebo “surgery” did no worse - and often better - than those given actual surgery. Surgeons like to do surgery, but we should be wary of that impulse.
I think you are referring to arthroscopic lavage of the knee joint for osteoarthritis, (which did have a sham surgery control and shown to be of no value), not knee replacement surgery. Sham surgery masquerading as knee replacement would be very difficult to do as it would require a long incision across the knee, which wouldn't be ethical to do as a sham. (Arthroscopy requires just a little nick in the skin to fake it.) But if you know of an RCT on knee replacement surgery, do cite it. Being skeptical of all claims of benefit when the outcome is "soft", like how far the patient can walk in 15 minutes, is very important, so I take your point.
I think people assumed they did *not* know enough. (!ypo-sorry) Reasonable assumption.
They assumed that others did. Mistake.
They were told that reminding people of the concerns or even not giving the interventions would lead to more distress. And suicide.
Remember, the medical journals and guidelines were full of statements that are not true or are unsupported, in this topic. By people at prestigious universities. It was such a massive deception that no one would suspect it. A responsible physician would not think their colleague would do such a thing with such flimsy evidence. Even MDs in this field.
The second huge failure continues which is the claim by these people that one should continue to rely upon prestige even as the weakness of the evidence emerges and those being harmed, often very badly, seek help.
The third failure is the 4th estate covered this inaccurately or not at all, Jesse and a few others who were quickly canceled not withstanding. And made it about politics. Selling the framing of the very doctors who caused this mess.
Any of these groups could stop it.
A huge step by the asps and now the pas in bringing evidence to the debate, and for the former, to us treatment suggestions. (The HHS report has all you need but no left wing person who isn't already informed has the sense to read it.)
But yeah, strangio is now commencement speaker at grinnell...
My guess? Medical professionals are people, university educated, lean liberal, trained to trust the papers, told that what comes out the other side of peer review is reliable, and between trans friends that tell them they were always trans, and papers that repeat activist lines, they feel gross questioning the their friends and colleagues. I mean, I was bog standard lib on trans issues before I saw too many things that made me question the party line.
Expertise is great! However, in the field of youth gender medicine, the "experts" like Jack Turban are driven by ideology and not evidence. It's actually impressive in a perverse way that they continue to support transitioning minors given the amount of evidence that has come out that shows it doesn't produce improved long term outcomes. But as long as celebrities and talking heads continue to prop up the "experts," they can go on their merry way making false assertions and preaching to the converted.
Turban and pals are the perfect example of why medical and mental health organizations are drilling into their own boat and losing public trust. As for me, I trust processes, not names, though I trust names that explain processes and the complexity and nuances. And the data Turban refers to is crap, especially the data he produces himself.
This is related only because it touches on Jeopardy and trans-identified people.
But as a former Jeopardy contestant who is also female, it drives me absolutely nuts that the person with the title “winningest woman in Jeopardy history” is a man.
I mean, I didn’t even win the episode I was on. But I would like the woman who actually is the winningest woman to be the woman who gets credit.
I have no problem using Schneider's pronouns or treating her as a woman in most situations. But the whole reason we even take note that someone is the "winningest woman in Jeopardy history" at all is that women have historically been significantly underrepresented in trivia for reasons that likely involve both nature and nurture. That a biological man socialized as a man did very well on Jeopardy is not an achievement for women.
Well, that has a twist. The winningest woman – by games won in regular play, money won in regular play, and money won overall (including the recent primetime spinoffs) – identifies as non-binary (and consequently, would almost certainly reject such distinction).
However...we should be able to trust the experts. Medicine, science, training to build bridges etc., have criteria for establishing when something is correct and reliable or for assessing how reliable it is, e.g., in evidence based medicine. Specialized information is a cornerstone of advanced society. Even in medicine, we can't all be experts in heart disease, cancer, pediatric gender medicine, weight loss drugs, etc. It is their job. Sure, you can call out issues - if you have evidence, serious logical arguments, then the relevant professionals should respond and work to improve.
They aren't.
These institutions are not doing their job. You should be able to trust a UCSF physician. Instead, they hired someone who often makes incorrect statements and whose research is often wrong. Who attacks the competence of those who disagree, rarher than providing reliable evidence to make a point. It was their job to screen for unreliable work and pick someone trustworthy. They blew it.
Many of the attempts to rebut Turbans papers were just refused by the journals . Another failure. See Biggs 2020 and D'Angelo et al 2021.
Gender medicine protocols in the US are relying on failures of institutions -journals, societies, and universities to do their job. It is appalling.
And yes, it is also appalling that doctors are misleading the public, either because they are unable to understand things or because they understand and....?
Not good.
One point to emphasize that should be a red flag is that the us institutions and MDs and journals aside from the brave (it shouldn't have taken being brave) asps are refusing discussion of facts-of evidence -of uses and abuses of logic.
I don't want to build my own bridges or be my own doctor. I do want well trained reliable elites who can do these tasks. Whose competence and professionalism can trust .
The groups supposedly guaranteeing that reliability have failed in their responsibilities and are hurting vulnerable kids.
They should do their job.
Thank you (and JL) for all your work showing them what they should have been doing!
I wonder why respected scientific journals decided to put a political stance ahead of good research. If research is methodologically sound, I think it should be published (God knows there's enough journals out there) in an appropriate journal.
The journals are afraid of the activists. Just as Canada's parliament, police, universities, and Courts are afraid of aboriginal activists who threaten violence. Fear and greed explain everything, right?
Great article. It will never cease to amaze me that that the “gender experts” and activist journalists get away with making claims that are so easy for the average person to check for themselves to be false. They just know that telling the tribe what they want to hear is a great way to avoid anyone doing the work to fact check. I doubt Jack Turban would ever agree to a live discussion or debate with Leor Sapir because Leor would make quick work of Turban’s statements and arguments that go unchallenged in the echo chamber in which he operates. On the other hand Leor would jump at the chance to debate Turban.
It’s the appeal to authority fallacy in action. It seems to be one of the go-to moves for most of my fellow left of center people, and it’s no wonder we’ve lost credibility in the eyes of our peers who approach things from a more common sense perspective.
I am sympathetic to your position that deference to authority can lead us astray (and is applied variably anyway). I’d have been interested to know how you think lay people should try to navigate thorny topics where evidence-based practice meets people’s political values though.
In practice, we can’t dig into every medical controversy - we often lack expertise and also simply don’t have the time! As a result, we basically have a choice between a) starting from a default position of trusting experts, b) spending an awful lot of time reading journal articles, and c) the ‘Rogan approach’ of just assuming that the experts are wrong. Is a) really the worst option here?
My approach is a) for nearly all topics, and b) for the few that caught my eye because something didn’t quite seem to add up. I’m not a nihilist about experts though—for the b) topics that I choose to continue to follow it’s because I see there are at least some experts (and by that I mean active, currently affiliated researchers) who do disagree with the “consensus” as well.
Yeah, I think in practice most of us are a) for most stuff because b) isn’t practical and c) is a bad strategy. It’s a case of identifying the right topics to invest our scarce attention into. I don’t have a clear sense of how we do the latter bit though
I propose dividing expert knowledge into three categories, with the experts in category A getting the greatest deference;
A) Topics in which there is no obvious cause for political bias. I'm sure our current approach to treating various physical disorders is faulty in certain respects, but I can be reasonably confident that a competent doctor is acting on the best evidence available, and that that evidence is not going to be tainted by preexisting bias. It may be tainted by other things (namely research fraud or error), but that's not something I can meaningfully evaluate or guard against, and it isn't likely to point only in one direction. Fortunately, this category includes much of the knowledge least accessible to a layperson.
B) Topics that may have political implications, but which are either reasonably consistent with what I know and believe to be true of the world or involve matters that I have no real ability to assess, even were I to read a few scholarly articles. Again, this doesn't mean these experts are right; it just means I either have no ability or no incentive to question them.
C) Highly politically charged topics, especially involving claims that fly in the face of my common sense understandings of the world and in which "evidence" is often going to involve value judgments. Note that this doesn't mean the experts are wrong; it means I'm not going to take their claims on faith and am going to look into any available evidence more carefully.
I didn't question the line on gender medicine being "life-saving" until people in the movement started saying things that seemed obviously wrong or tendentious, like "sex isn't binary, because there are intersex people." That's really not a scientific claim at all; it is a philosophical and ideological one that I am perfectly capable of evaluating as a layperson. At that point, looking more closely at the data behind claims like "trans kids will commit suicide if they can't access gender affirming care" made sense.
Speaking for history here (as both a PhD and Some Random Blogger 😁) I spend much time trying to show and explain that historical interpretation is an ongoing conversation among experts who've devoted their lives to it, and an exercise in humility. Historians who present themselves as oracles, as unassailable authorities, worry the rest of us, as does a public which is quick to worship at their feet. What most interests me about this conversation is that much the same thing is going on in the relationship between the public and science as in the relationship between the public and history. Keep an open mind, and understand that not all experts think alike is advice we try to follow ourselves, until the preponderance of evidence appears to point in one direction, and even then, there's a good chance we might be surprised in future.
That’s an interesting perspective. I guess maybe history lends itself to an epistemological position where we hold our positions lightly, whereas in the field of health these debates often inform a decision on treatment or policy, which pushes us to commit to one position or another. Maybe I’m being naive about history though, and there’s less of a difference here than I think.
Definitely less of a difference! 😀 People’s perceptions of history and historians (or those claiming to be historians) absolutely influence their political views.
Ken Jennings is an "expert" at memorizing trivial facts and making witty comments. When he says we should suspend our critical faculties and trust highly-credentialed figures making sloppy and sometimes dishonest claims about an unsettled scientific question involving the welfare of vulnerable children, we should definitely listen. As Homer would say, "In case you couldn't tell, I was being sarcastic!"
I recall one political controversy that Alex was DRAGGED into. A Salon writer accused him of being a 'conservative' and a climate change denier, and he was annoyed enough to respond - 'I consider myself a social liberal and a fiscal conservative. I believe that climate change exists, and is contributed to by human activity. I have seen firsthand the effects of climate change, in trips to Antarctica and Mt. Kilimanjaro, both of which are showing huge changes due to global warming.'
I used to describe my political stance the same way, back when “social liberal” just meant stuff like being ok with homosexuality and mixed-race marriage and (moderate) abortion rights. But now that “liberal” implies all kinds of extreme/reality-denying beliefs (especially about “trans” issues) I don’t use that phrasing anymore.
Canada (which is of course where Trebek hailed from) used to have a party called the “Progressive Conservatives” who were in much the same space. Wonder if he was a supporter.
I think even the examples you give as credible e.g. "we trust engineers to build bridges" should be taken with a grain of salt; the American Society of Civil Engineers puts out an Infrastructure Report Card every year, saying that America needs (take a guess) more investment in roads & bridges. Do they sincerely believe that? I bet they do. Are they the ones best positioned to say if we should spend that money on infrastructure vs. healthcare or anything else? No, they're much too close to their problem and too far away from any other problem.
Generally you should maintain a healthy level of suspicion when experts say there needs to be more investment/less oversight/more rent-seeking regulation in their field. Otherwise you're doomed to spend your life getting bossed around by whoever has the fanciest letters next to their name.
Can't believe someone as smart as Jennings would not be more discerning about trusting "experts", especially in a field like social science (where social trumps science in many cases). In the 1920s many "experts" from Ivy League schools advocated for "progressive" causes like sterilization of the "unsound", phrenology, lobotomies for difficult people, racial hierarchies...all based on expert science. Or the experts in the '50s filling moms with thalidomide. Or expert dietitians pushing carbs over protein in the famous pyramid that hung on so many school walls.
I'm not calling Ken Jennings an idiot, but being the world's foremost professional in bar trivia is not equivalent to a robust practice of analytical thinking.
But you see, youth gender medicine is different from those other things, because, well, it just is!
I dunno, there’s a difference between being smart and memorizing facts.
The mistaken belief that IQ leads to good judgement. Frequently, it merely leads to bad judgement more quickly.
What is "appeal to authority," Ken?
Get it? Like Jeopardy!
"Turban is impeccably credentialed: He’s a psychiatrist"
Honestly I haven't met many psychiatrists who are good scientists, and thats not a claim I make lightly or that wouldn't cost me anything professionay to make to their faces, which I would and which I might in writing one of these days. Its an absurd field, at least the way its been practiced for the last 50 years.
You cant really have expertise in something that has no strong evidence for even its most basic ideas. Its like being an expert astrologer. While im not a psychiatrist, I am actually the exact guy who is meant to be assessing them, a scientist in a quantitative evidence driven science of the brain who has long professional and personal relationships witn them.
Its a stupid field with many chancers and charlatans engaged in it, as well as some more serious people. You cant tell who is who from their degrees or work history, no doubt about it. It's a problem, think of expert testimony in the courts.
This reminds me of something genuinely scandalizing I came across in that New Yorker write-up from last December (link below) about how Oliver Sacks wrote fiction and passed it off as published medicine:
"The historian of medicine Henri Ellenberger observed that psychiatry owes its development to two intertwined dynamics: the neuroses of its founders—in trying to master their own conflicts, they came to new insights and forms of therapy—and the prolonged, ambiguous relationships they had with their patients. The case studies of these relationships, Ellenberger wrote, tended to have a distinct arc: psychiatrists had to unravel their patients’ “pathogenic secret,” a hidden source of hopelessness, in order to heal them."
https://www.newyorker.com/magazine/2025/12/15/oliver-sacks-put-himself-into-his-case-studies-what-was-the-cost
This is one of the fundamental problems with basing so much on self-report. The incentive structure is entirely in favor of encouraging exaggeration and expansion of symptoms and full on confabulation. Patients and providers are both pressured to do this in various ways.
That was a bummer. I believe he was a neurologist. But he was faking it.
Being a good psychiatrist is also different from being a good researcher. Being a good researcher is a different set of skills.
Right, not that I entirely accept it's possible to be a good clinician psychiatrist. I don't think the training they receive or procedures they must follow really allow for that within the NHS. Some of them might develop a kind of wisdom of their own. Mostly what they are doing is just assessing if you're going to hurt someone or top yourself, whether you're seriously ill or whether you're not. Beyond that, they just guess what drug might help. But they don't admit that's all they do, it's dressed up to sound like more. I think the US is pretty similar.
It's possible to be a good clinical psychologist in my opinion, but the way psychiatry operates is significantly pseudoscientific, or cargo cult science or something. Clinical Psychologists aren't usually trying to make poorly evidenced ontological claims about their patients, they just want to help and see how that goes. It's of course also possible to be a terrible clinical psychologist.
It's not like I'm the only person to have said this, many have, Marcia Angell wrote well about it. Although being a researcher is a different skill, I think training in some medical fields is better preparation than others for scientific research.
Angell was editor of the New England Journal of Medicine for a long time:
https://search.brave.com/search?q=marcia+angell+psychiatry
https://archive.is/20250705015017/https://www.nybooks.com/articles/2011/07/14/illusions-of-psychiatry/
The nature of psychiatry has been a significant cause problems related to gender stuff in recent years IMO.
Research in psychology is a bit of a mess and it's been hit hard by the replicability crisis. Part of it (I think) is that there are too many journals - this is true for all sciences - and that allows for shoddy research to get through. If you have 15 journals, you have to fill them with something! I wonder if fewer, but more high quality, journals would improve things. But the publishers will never allow for this as it would cut their profits.
I work at a NHS teaching hospital and only in the past couple of years have they been trying to develop a team to support researchers and are (or at least paying lip service) giving clinical staff time for research. I think giving people that support to do better quality research helps.
But it's also a problem in universities. I've know a couple of good researchers who then are forced into spending most of their time teaching (which is important, but I would argue a different skill) and thus can't focus on doing quality research.
If I had my druthers, and gobs of money, I'd set up an institution where researchers can just crack on with focusing on quality research.
Sorry, bit of a sperg about this but it's my area of interest.
I think research in psychiatry is not much better. I work as a researcher attached to a university and its teaching hospital. I don't do clinical research, but I do research that forms the basis for clinical applications.
You can do 100% research, but you must bring in the funds to cover salaries and the research costs. Most people I know do mostly or only research. Actually my entire department only does research. It has research students but no teaching or undergraduate degrees. It's divided into institutes in their own buildings which focus on different things like genetics or whatever. So that does exist in the UK and it's very competitive globally. It's stressful though because you lose your job if you can't bring in funding and there is luck involved in that as well as skill.
To bring in funding you need not only to publish, but to publish in what are seen as the top journals. It's difficult. Sometimes people in this line of work feel under so much pressure they fake their results to get into top journals and secure funding. That has not happened where I work, at least no one's been caught doing it that I've heard of. People would be extremely upset and our reputation would suffer. There is enough money coming in that established people can float less established people for a little bit while they reapply for a missed grant.
I'd better get to it I need to publish before my proposal goes in at the end of the summer.
There have been a couple of times where a physician has recommended something and I've pointed out that it failed via RCT and the response was that this wasn't relevant, and that there was plenty of other evidence for it. I'm not saying that RCTs are the be all end all, but if something is failing in RCTs, then you should have a very good reason to disregard them in favor of lower quality evidence, something akin to the RCTs not fitting with basic biology or well-validated mechanisms.
Welllll… I mean it's complicated. Maybe it was a bad RCT. Maybe lots of things. Experiments are really hard, and get harder the more complicated the phenomena is. Anything involving humans is an extremely complicated phenomena. A doctor is meant to use their judgement and try things out. Maybe that doctor got a good result with that drug.
But on the other hand when a drug really works you know. For example heroin. No one is in any doubt that heroin works to dull pain. Antibiotics. No one doubts they work. Even the cream I use for rosacea very obviously works or I wouldn't slaver it all over my face. Valium works. Also some of these are dangerous of course.
Prozac? Suddenly we have to worry about RCT results, and that's because whatever it's doing is more subtle and maybe isn't much better than placebo. Joanna Moncrief at UCL has a lot to say about that. Lots of people are critical of those drugs, because they do have side effects and withdrawal and might not really work.
I don't know. I know I mostly function better without them. But I'm one person. It depends on the person, drug and context. What choice do you have but to listen to the doctor until you've found out yourself?
I have found doctors can be unaware or blase about the negative consequences of dugs they prescribe. So there is that aspect.
And sometimes there just isn't the research in a specific area. I sometimes work with a neonatal team and sometimes there just isn't any research available on their question or research is available but on an older population. Sometimes you have to look at the best evidence you can find and then go from there.
Doing research is HARD. It's difficult to design a study to test the specific thing that you want to test and then participants don't always do what they are suppose to and apparently it's unethical to lock them in cages so there's no risk of outside influences. There's a reason that nearly all Cochrane Reviews contain the phrase "more good quality research is needed".
Heroin (and all the opioids) "obviously" work to dull pain. You don't need a randomized control trial to determine that. But surprise surprise the opioids *don't* work for chronic pain. Sure, everyone seems to think they work and are absolutely necessary even though they have side effects that are a necessary cost of the benefit. But RCTs show that opioids don't work for chronic pain. The benefit wears off and all you are left with are side effects and complications, which includes addiction. (There are a lot of reasons for this because chronic pain is such a heterogenous mix of unrelated conditions.)
Do we really need an RCT to show that? It happens unambiguously to every single opioid user. All anyone ever had to do was test their pain responses, or simply ask them, not necessarily do a complicated, expensive trial.
But it's a great point because it would certainly be useful to have trials of psychiatric drugs that last longer than 8 weeks and test withdrawal effects, given those drugs are not only of uncertain benefit, they are intended for long term use. But those don't really exist. This hasn't stopped most psychiatrists claiming they work long term, and dismissing their often severe withdrawal effects.
https://www.medrxiv.org/content/10.1101/2025.02.27.25323057v1.full
Yes we did need RCTs to show that, because if you just ask chronic opioid users if the drugs help their pain they will say yes, they do, because that's how they get the doctors to keep prescribing them. The only "test of a pain response" is asking someone to rate their pain on a scale of 1 to 10. There is no objective measure of pain. We are taught that people can have severe agonizing pain despite being calm-looking, with no grimacing or fast heart rate or sweating or any of the things that might be clues to comfort vs. pain. This is largely propaganda by the enthusiasts for opioids who got us into this mess. So to break down this strong bias to just giving patients what they say they want and not arguing with them, you do have to do controlled trials.
Yes, psychiatric drugs need to be studied the same way.
If it wasn't known, why did the prescribed doses keep going up?
Because it *was* known. Not knowing wasn't the issue.
The problem wasn't that people didn't know these things, it was that they denied them so they could make money. Anyway RCTs don't control for lying, nor do they blind the users of strong drugs, all of whom know they're on it even if the researchers don't. It also seems ethically tricky for a university to deliberately addict people for the sake of a trial. There has been a great deal of research about pain e.g. by Irene Tracey
https://scholar.google.com/citations?user=eLQfLPgAAAAJ&hl=en&oi=ao
I see she did do opioid studies which I haven't read e.g. here
https://www.science.org/doi/full/10.1126/scitranslmed.3001244
RCT is not a perfect tool, it's just one possible experimental design. I wouldn't use that to investigate opioid addiction I'd do different experiments, and people have done those experiments. Almost certainly e.g. Purdue knew the pharmacology of opiod addiction in detail, just like tobacco companies knew about how cigarettes cause cancer. It was known that benzos lose efficacy and have a severe withdrawal syndrome, since at least the 80s. It was even known why to a good degree. That didn't stop people prescribing them for years at a time, or stop companies from pushing their products.
Not the point of your post but WHAT ARE YOU USING FOR ROSACEA THAT WORKS!?
https://medcare-healthclinic.com/rozex-gel-0-75/
Gel not cream. And I use loads and loads of it. Three or four times a day every day. and lots at a time. I would say start with small amounts to make sure you aren't sensitive to it. But if you aren't, you can chuck that stuff on and I, at least, don't have rosacea anymore.
One of the most irritating aspects of this stupid debate is when the cabal of liberal culture icons sanctimoniously signs on even in the absence of reason. I'd list them all but it would be a long list. From memory, some are Mythbusters, Bill Nye, DeGrasse Tyson, Rebecca Skloot (ugh), and of course the late night comedians.
I was thinking of NdGT when I read Jesse’s post. The way he (NdGT, not Jesse) handled this topic was inane and regressive. “Oh today I feel like a woman so I’ll put on some makeup.” I don’t think I’ve worn makeup (other than on stage) since my wedding, decades ago. Guess I’m a man now!
Except that while it was inane, that's quite literally how many activists describe it. They regressively declare the most sexist of behavioral criteria as being indicative of biological reality. I've personally heard multiple parents and others note that a girl toddler playing with trucks likely means they could be trans, and that not wanting to wear dresses means the same.
Oh I’m well aware. It’s so ridiculous.
And I've worn makeup on stage. Guess that makes me at least partly woman.
In so-called “skeptic” circles I often hear the parallel declaration that schools should teach critical thinking skills or that people’s problems concerning misinformation is a lack of critical thinking. As with the trust the experts declaration, critical thinking here should simply read as “agree with everything I say.” Disagreement is for many de facto proof that the person lacks such skills. In my own field of psychology, the fact that trust the experts is not what is going on, and instead is nearly always (and here the irony is hilarious given the substance of psychology supposedly being about human cognition) an issue of motivated reasoning largely for purposes of tribal allegiance, is clear from how the same people going to the DSM to “prove” issues related to gender-identity will also use a previous iteration of the DSM to note that psychology gets it wrong when classifying homosexuality as a mental disorder. When do we “trust the experts”? Right, when they agree with me now. Hell, I think my favorite example is when I heard someone say that Richard Dawkins, an esteemed biologist, was outside his lane when talking about….the biology of sex.
By "Educate yourself" they mean "Agree with me."
Exactly. Conservatives have their own version of this, but there’s something just extra condescending when it comes from those calling themselves liberals. Admittedly, it undoubtedly strikes me as more of a problem precisely because I still largely ascribe to liberal (not to be confused with a single political party) ideals. That these are often the same people who rely on “lived experience” declarations as evidence for the truth of whatever is being said, only makes the whole thing more absurd.
I break out in hives when I hear "lived experience". In other words, "my anecdotes that should be considered evidence because I'm a member of an embattled minority group."
Yeah, the positional epistemology that has come out of social-justice activism completely undermines science as a discipline of inquiry. Admittedly, they can't even be consistent with their own "lived experience," as anyone who falls into a minority status but disagrees with the activist, will also be dismissed.
"Lived experience" in science is called "n=1." Never the strong basis for any substantive conclusion.
Also, what other experience is there? Imagined experience? Feigned experience? If you haven't lived something, you really haven't experienced it.
Well, feigned and imagined experience is certainly part of the "experience" of being trans, so don't give them any ideas. :-)
I believe "lived experience" is a euphemism for experiences perceived but not tested against reality.
One of the 3 pillars of evidence-based medicine is patient values and experiences - BUT this should be balanced with the other 2 which are relevant scientific evidence and clinical judgement. In many cases, one or both of the second pillars are missing.
https://www.ncbi.nlm.nih.gov/books/NBK470182/
When a creationist tells me the world was created from whole cloth in a week, I just shrug because I expect a creationist to believe that kind of nonsense. When a self-proclaimed progressive tells me that vaccines are great but, oh, there are 22 genders, I get annoyed because progressives supposedly Trust the Science. Except of course they don't, which is why I am not a progressive but a liberal.
You should see the di-ag coffee mugs-- something like
Dear Democrats,
I miss you.
Love,
Science.
When it comes to so many belief statements, they fall into one of two categories: statements about the world, and/or statements about what group they belong to. Often it's far more the latter that is important, whether it's about creationism or even the number of genders. This can be helpful in judging nonsense, since if it's about the world, then there are critical concerns, but the desire to belong makes sense. Unfortunately, it often inspires a lot of ridiculous behavior. Just watch a sport event :)
Wrote about it more here:
https://www.humanitysvalues.com/p/your-beliefs-are-less-about-reality?r=v5x29
Right. To me, I don't care what people believe, whether that's creationism or gender woo-woo. This nation protects loopy beliefs in law, so, fine. I get peeved when people with odd beliefs start making moral or reality claims about the world. Believe that the earth is 6000 years old if you like, but do not teach people that dinosaurs lived alongside human beings--particularly if said teaching is done on the public nickel.
Yup. There's an old way of looking at personal rights where such ends when fist connects to face. In other words, consequences matter. Which is likely why so many who advocate various policy matters will not have to deal with the consequences of their implementation. I'm that odd combination of liberal and libertarian, where the marketplace of ideas should be supported, and consequences should be handled by those who make the decisions.
I think there's also the idea that disagreement is somehow violence or wrong - of course a disagreement can escalate, but it used to be that people could hold different views and discuss them without it escalating. And challenging ideas was How can you convince anyone to change their mind if you can't have a reasonable discussion around a topic you disagree on.
Spot on. There's a considerable dovetailing into the equally ridiculous notion that "words are violence." This is connected to the increasingly prevalent view that discomfort equals bad, a view peddled, unfortunately, by a great many mental health therapists, particularly those on TikTok, and ends up being a denial of biological reality. The challenge you identify, which includes holding different views, is now often dismissed as cognitive dissonance and something to be avoided at all costs. It's a point I raise with all my clients, that thoughts are just thoughts and dissonance is not only an inevitable part of life, but should be embraced as a way to challenge one's hubris. The reasonabe discussion you want to happen most definitely needs to happen more.
That is part of the feminization of society, which may be irreversible. Disagreements that hurt feelings and cause women to cry must be prohibited as violent and harmful.
I say irreversible because the notion that society is being feminized and that is a bad thing is bitterly and tearfully resisted by the feminized class that runs HR departments. Heretics have to be very brave, and resign themselves to being largely impotent because the organs of the state and the Church are all organized against them.
Scientific expertise is worthy of respect when, and only when, it's based in actual science. Actual science always admits the possibility that its current conclusions are wrong, and takes evidence challenging those conclusions seriously. Gender medicine is practically the opposite of this, with major groups and figures openly declaring that evidence challenging current conclusions must be suppressed, lest the discussion of such evidence harm a vulnerable population. It's a catechism-and-heresy approach to the truth, not the scientific method.
This is one of the things that I think is so interesting about genderwang - how did it capture so many intelligent people? How did it get into medical practice without anyone going maybe we should wait for some good solid evidence before sterilising children?
Really the only conclusion is that many medical practitioners are not very good scientists and don't think critically about what they are taught. Of greater concern is that it seems many scientists are also not very good scientists.
But lots of them are, they've just stayed quiet. Which is very reasonable IMO, they don't want to lose their job over something they might not even care that much about. It's the ones that care that are loud, and those are more frequently the bonkers ones. I mean I like to tap anonymous comments about it, but I'm not risking my house over it thanks all the same.
It's really interesting to me that 10 or 20 years ago we'd all have said we're far too enlightened and modern for Salem witch "the crucible" stuff to happen with respect to an important societal issue. But we're not, and it did.
That's the million-dollar question, isn't it? I guess you cut off a teenage girl's breasts over gender confusion the same way you throw people in prison over a memory that was "recovered" by highly motivated advocates. You tell yourself you are doing the Lord's work, which means the consequences aren't yours to regret.
My GP once said to me, about consulting surgeons over various pains, “surgeons like to do surgery”. It was an observation and a warning. The latest RCT on knee surgery demonstrates this perfectly: those given placebo “surgery” did no worse - and often better - than those given actual surgery. Surgeons like to do surgery, but we should be wary of that impulse.
I think you are referring to arthroscopic lavage of the knee joint for osteoarthritis, (which did have a sham surgery control and shown to be of no value), not knee replacement surgery. Sham surgery masquerading as knee replacement would be very difficult to do as it would require a long incision across the knee, which wouldn't be ethical to do as a sham. (Arthroscopy requires just a little nick in the skin to fake it.) But if you know of an RCT on knee replacement surgery, do cite it. Being skeptical of all claims of benefit when the outcome is "soft", like how far the patient can walk in 15 minutes, is very important, so I take your point.
It was a 10-year follow-up on placebo v real meniscal tear arthroscopy.
I think people assumed they did *not* know enough. (!ypo-sorry) Reasonable assumption.
They assumed that others did. Mistake.
They were told that reminding people of the concerns or even not giving the interventions would lead to more distress. And suicide.
Remember, the medical journals and guidelines were full of statements that are not true or are unsupported, in this topic. By people at prestigious universities. It was such a massive deception that no one would suspect it. A responsible physician would not think their colleague would do such a thing with such flimsy evidence. Even MDs in this field.
The second huge failure continues which is the claim by these people that one should continue to rely upon prestige even as the weakness of the evidence emerges and those being harmed, often very badly, seek help.
The third failure is the 4th estate covered this inaccurately or not at all, Jesse and a few others who were quickly canceled not withstanding. And made it about politics. Selling the framing of the very doctors who caused this mess.
Any of these groups could stop it.
A huge step by the asps and now the pas in bringing evidence to the debate, and for the former, to us treatment suggestions. (The HHS report has all you need but no left wing person who isn't already informed has the sense to read it.)
But yeah, strangio is now commencement speaker at grinnell...
My guess? Medical professionals are people, university educated, lean liberal, trained to trust the papers, told that what comes out the other side of peer review is reliable, and between trans friends that tell them they were always trans, and papers that repeat activist lines, they feel gross questioning the their friends and colleagues. I mean, I was bog standard lib on trans issues before I saw too many things that made me question the party line.
Expertise is great! However, in the field of youth gender medicine, the "experts" like Jack Turban are driven by ideology and not evidence. It's actually impressive in a perverse way that they continue to support transitioning minors given the amount of evidence that has come out that shows it doesn't produce improved long term outcomes. But as long as celebrities and talking heads continue to prop up the "experts," they can go on their merry way making false assertions and preaching to the converted.
The universities and journal and medical societies...reported by a credulous press aside from Jesse and a few others.
Turban and pals are the perfect example of why medical and mental health organizations are drilling into their own boat and losing public trust. As for me, I trust processes, not names, though I trust names that explain processes and the complexity and nuances. And the data Turban refers to is crap, especially the data he produces himself.
This is related only because it touches on Jeopardy and trans-identified people.
But as a former Jeopardy contestant who is also female, it drives me absolutely nuts that the person with the title “winningest woman in Jeopardy history” is a man.
I mean, I didn’t even win the episode I was on. But I would like the woman who actually is the winningest woman to be the woman who gets credit.
That bothers me as well.
I have no problem using Schneider's pronouns or treating her as a woman in most situations. But the whole reason we even take note that someone is the "winningest woman in Jeopardy history" at all is that women have historically been significantly underrepresented in trivia for reasons that likely involve both nature and nurture. That a biological man socialized as a man did very well on Jeopardy is not an achievement for women.
Well, that has a twist. The winningest woman – by games won in regular play, money won in regular play, and money won overall (including the recent primetime spinoffs) – identifies as non-binary (and consequently, would almost certainly reject such distinction).
Mattea Roach (23 wins, $560,983 regular, $897,983 overall) — they/them pronouns.
😩 🔫
As a fellow female Jeopardy! also-ran, right there with you.
🙌
I agree with a lot of your concerns and points.
However...we should be able to trust the experts. Medicine, science, training to build bridges etc., have criteria for establishing when something is correct and reliable or for assessing how reliable it is, e.g., in evidence based medicine. Specialized information is a cornerstone of advanced society. Even in medicine, we can't all be experts in heart disease, cancer, pediatric gender medicine, weight loss drugs, etc. It is their job. Sure, you can call out issues - if you have evidence, serious logical arguments, then the relevant professionals should respond and work to improve.
They aren't.
These institutions are not doing their job. You should be able to trust a UCSF physician. Instead, they hired someone who often makes incorrect statements and whose research is often wrong. Who attacks the competence of those who disagree, rarher than providing reliable evidence to make a point. It was their job to screen for unreliable work and pick someone trustworthy. They blew it.
Many of the attempts to rebut Turbans papers were just refused by the journals . Another failure. See Biggs 2020 and D'Angelo et al 2021.
Gender medicine protocols in the US are relying on failures of institutions -journals, societies, and universities to do their job. It is appalling.
And yes, it is also appalling that doctors are misleading the public, either because they are unable to understand things or because they understand and....?
Not good.
One point to emphasize that should be a red flag is that the us institutions and MDs and journals aside from the brave (it shouldn't have taken being brave) asps are refusing discussion of facts-of evidence -of uses and abuses of logic.
I don't want to build my own bridges or be my own doctor. I do want well trained reliable elites who can do these tasks. Whose competence and professionalism can trust .
The groups supposedly guaranteeing that reliability have failed in their responsibilities and are hurting vulnerable kids.
They should do their job.
Thank you (and JL) for all your work showing them what they should have been doing!
I wonder why respected scientific journals decided to put a political stance ahead of good research. If research is methodologically sound, I think it should be published (God knows there's enough journals out there) in an appropriate journal.
The journals are afraid of the activists. Just as Canada's parliament, police, universities, and Courts are afraid of aboriginal activists who threaten violence. Fear and greed explain everything, right?
Great article. It will never cease to amaze me that that the “gender experts” and activist journalists get away with making claims that are so easy for the average person to check for themselves to be false. They just know that telling the tribe what they want to hear is a great way to avoid anyone doing the work to fact check. I doubt Jack Turban would ever agree to a live discussion or debate with Leor Sapir because Leor would make quick work of Turban’s statements and arguments that go unchallenged in the echo chamber in which he operates. On the other hand Leor would jump at the chance to debate Turban.
It’s the appeal to authority fallacy in action. It seems to be one of the go-to moves for most of my fellow left of center people, and it’s no wonder we’ve lost credibility in the eyes of our peers who approach things from a more common sense perspective.
I am sympathetic to your position that deference to authority can lead us astray (and is applied variably anyway). I’d have been interested to know how you think lay people should try to navigate thorny topics where evidence-based practice meets people’s political values though.
In practice, we can’t dig into every medical controversy - we often lack expertise and also simply don’t have the time! As a result, we basically have a choice between a) starting from a default position of trusting experts, b) spending an awful lot of time reading journal articles, and c) the ‘Rogan approach’ of just assuming that the experts are wrong. Is a) really the worst option here?
My approach is a) for nearly all topics, and b) for the few that caught my eye because something didn’t quite seem to add up. I’m not a nihilist about experts though—for the b) topics that I choose to continue to follow it’s because I see there are at least some experts (and by that I mean active, currently affiliated researchers) who do disagree with the “consensus” as well.
Yeah, I think in practice most of us are a) for most stuff because b) isn’t practical and c) is a bad strategy. It’s a case of identifying the right topics to invest our scarce attention into. I don’t have a clear sense of how we do the latter bit though
I propose dividing expert knowledge into three categories, with the experts in category A getting the greatest deference;
A) Topics in which there is no obvious cause for political bias. I'm sure our current approach to treating various physical disorders is faulty in certain respects, but I can be reasonably confident that a competent doctor is acting on the best evidence available, and that that evidence is not going to be tainted by preexisting bias. It may be tainted by other things (namely research fraud or error), but that's not something I can meaningfully evaluate or guard against, and it isn't likely to point only in one direction. Fortunately, this category includes much of the knowledge least accessible to a layperson.
B) Topics that may have political implications, but which are either reasonably consistent with what I know and believe to be true of the world or involve matters that I have no real ability to assess, even were I to read a few scholarly articles. Again, this doesn't mean these experts are right; it just means I either have no ability or no incentive to question them.
C) Highly politically charged topics, especially involving claims that fly in the face of my common sense understandings of the world and in which "evidence" is often going to involve value judgments. Note that this doesn't mean the experts are wrong; it means I'm not going to take their claims on faith and am going to look into any available evidence more carefully.
I didn't question the line on gender medicine being "life-saving" until people in the movement started saying things that seemed obviously wrong or tendentious, like "sex isn't binary, because there are intersex people." That's really not a scientific claim at all; it is a philosophical and ideological one that I am perfectly capable of evaluating as a layperson. At that point, looking more closely at the data behind claims like "trans kids will commit suicide if they can't access gender affirming care" made sense.
Speaking for history here (as both a PhD and Some Random Blogger 😁) I spend much time trying to show and explain that historical interpretation is an ongoing conversation among experts who've devoted their lives to it, and an exercise in humility. Historians who present themselves as oracles, as unassailable authorities, worry the rest of us, as does a public which is quick to worship at their feet. What most interests me about this conversation is that much the same thing is going on in the relationship between the public and science as in the relationship between the public and history. Keep an open mind, and understand that not all experts think alike is advice we try to follow ourselves, until the preponderance of evidence appears to point in one direction, and even then, there's a good chance we might be surprised in future.
That’s an interesting perspective. I guess maybe history lends itself to an epistemological position where we hold our positions lightly, whereas in the field of health these debates often inform a decision on treatment or policy, which pushes us to commit to one position or another. Maybe I’m being naive about history though, and there’s less of a difference here than I think.
Definitely less of a difference! 😀 People’s perceptions of history and historians (or those claiming to be historians) absolutely influence their political views.
I’ve written a piece on my own (not very successful) substack if anyone has time on their hands! https://cwnsaville.substack.com/p/expertise-vs-roganism
Ken Jennings is an "expert" at memorizing trivial facts and making witty comments. When he says we should suspend our critical faculties and trust highly-credentialed figures making sloppy and sometimes dishonest claims about an unsettled scientific question involving the welfare of vulnerable children, we should definitely listen. As Homer would say, "In case you couldn't tell, I was being sarcastic!"
Had no opinion of Jennings before, but I'm utterly disgusted with him now.
I had no idea what Alex Trebek's political opinions were and that's how it should be.
I recall one political controversy that Alex was DRAGGED into. A Salon writer accused him of being a 'conservative' and a climate change denier, and he was annoyed enough to respond - 'I consider myself a social liberal and a fiscal conservative. I believe that climate change exists, and is contributed to by human activity. I have seen firsthand the effects of climate change, in trips to Antarctica and Mt. Kilimanjaro, both of which are showing huge changes due to global warming.'
https://www.salon.com/2014/05/28/alex_trebek_tells_salon_humans_are_causing_climate_change/
I used to describe my political stance the same way, back when “social liberal” just meant stuff like being ok with homosexuality and mixed-race marriage and (moderate) abortion rights. But now that “liberal” implies all kinds of extreme/reality-denying beliefs (especially about “trans” issues) I don’t use that phrasing anymore.
Canada (which is of course where Trebek hailed from) used to have a party called the “Progressive Conservatives” who were in much the same space. Wonder if he was a supporter.
I think even the examples you give as credible e.g. "we trust engineers to build bridges" should be taken with a grain of salt; the American Society of Civil Engineers puts out an Infrastructure Report Card every year, saying that America needs (take a guess) more investment in roads & bridges. Do they sincerely believe that? I bet they do. Are they the ones best positioned to say if we should spend that money on infrastructure vs. healthcare or anything else? No, they're much too close to their problem and too far away from any other problem.
Generally you should maintain a healthy level of suspicion when experts say there needs to be more investment/less oversight/more rent-seeking regulation in their field. Otherwise you're doomed to spend your life getting bossed around by whoever has the fanciest letters next to their name.
Strong point. (I guess I just should have clicked "Like," but my fingers are already on the keyboard, not the mouse, so.....)