Seriously, though, this just sort of explains why people don't trust 'science' anymore. Who has time to read all the pieces like Jesse's, let alone to do the research independently. It seems like every 'study' or 'survey' that bumps up against a political issue is subject to questions of bias, inaccuracy or worse.
This is why I tend to look at things based largely on my life's experience. I'm not saying this is a good state of affairs, but who am I going to believe, the New England Journal of Medicine, or my own lyin' eyes?
Something that seems a little crazy to me about this response is the double standard for who bears responsibility when readers misunderstand authors. Aaron and Konnoth seem to be defending their critique, in part, by arguing that people are interpreting the Cass review to be making a claim, so it should be treated as if it is making that claim, and it's the authors' fault if they wanted people to think they said something different. But then they write something that most reasonable readers will interpret one way (or, at least, Jesse, me, and three LLMs), and they say it's reader's fault if they misunderstood it.
One thing that I think could use some pushing back on the authors: RCTs *are* the gold standard in medicine. It would be better if we had RCTs on youth gender medicine. For a variety of reasons, we probably won't ever have RCTs on youth medicine, but that doesn't make something else the new gold standard. It's entirely appropriate for Cass to point out that there is an ideal research protocol, even if it can't/hasn't be(en) used for youth gender medicine.
I broadly agree. It's a nuance of whether you are noting that RCTs would be ideal whilst acknowledging the reasons they would be extraordinarily difficult to conduct, in the context of wide swathes of the medical consensus not being backed by RCTs, or whether you are using the lack of RCTs to argue that clinicians are irrational or sloppy or reckless to be operating without this gold standard.
I urge everyone to write to the NEJM and register your disapproval. I spend a certain amount of my down time just simply writing letters to school administrations, judges, prison officials, editors, etc. registering my disapproval of their policies in a dispassionate and logical fashion, making clear I am a progressive who always votes Democrat. This may seem like a minor act, but if scores of people do it, they must take notice.
This is egregiously troublesome for two reasons: it is the very reason those who support Trump and Trump himself can stand on firm ground as they wreak havoc on science funding and the reputation of science. This is the stuff that is fueling the anti-science backlash; the "why" of the slashing and burning of science that is taking place right now. It is literally their fault, these editors and writers, for publishing articles like this. Secondly, they are materially harming children, young people, and adults with this misinformation. When you think about the ultimate results that often occur from this misinformation, such as early osteoporosis, cognitive issues, possible heart problems, sterility, and many unknowns from puberty blockers, the permanent unwanted effects of cross-sex hormones, as well as the surgeries that remove health body parts from breasts to penises to uteruses, I think the word "carnage" is not inappropriate.
Let me add that the way I frame it for medicalization is that we should be in a golden age of helping trans people acquire the best possible medical care. We should be all-in on studying trans medical issues and designing the best possible appropriate medical measures (and psychiatric measuers) to care for these patients. Instead, we are harming them, and this undoubtably is stemming from the sudden profitability of this burgeoning area of medicine as well as politics that have gone off the rails. (And the authors of that NEJM piece profit greatly.)
<<A father of a trans man voted for Trump. Now he fears an order targeting gender-affirming care will upend his son’s treatment.>>
But didn't Trump pretty loudly and clearly campaign on doing exactly what he has been doing? Seems to me this is a case of not liking the taste of the wine he poured for himself.
I actually hadn't heard of Claude before, and I will henceforth pretend that you just asked some random Frenchman named Claude the question and took his response.
Claude is the best free one, and its company, Anthropic, was founded as a breakaway from OpenAI by people more concerned about safety (although arguably still not enough). I would strongly encourage everyone to use it over ChatGPT; it's simply better for most purposes, and it's vastly more ethical.
It's hard to imagine how the NEJM authors didn't feel their souls shrivel just a little when they decided to actually proceed with this disingenuous response.
“With Nixon in the White House, twelve skydivers leapt to their death.” That’s basically what those authors’ sentence is doing - yoking two unrelated things together as though they were dependent.
Should the differences between trans rights advocates and gender-critical feminists be resolved:
(a) through open debate leading either to the achievement of a consensus that transcends current differences, or the establishment of a clear and recognised majority; or
(b) through the coercive and other powers of the state being used to establish one side of this divide as correct and to suppress, deplatform, defund, etc, the other side?
And, specifically for US readers: would your answer to this question be different on and after 20 January 2025 to what it was before that date?
As someone from Qld where this is currently happening, I used the ABC complaint form
To list a number of issues with that piece yesterday (also adding in why should a parent believe that bit son is really their daughter for liking skirts & dancing like a fairy - yes, that is really in the piece & that I was dismayed that their parents had such a regressive attitude & believed in stereotypes & that I was outraged that the parents were harming their child’s future sexual health) yet it bumped me out & I lost it all. I then wrote a quick note to Bernard Keane who actually said it was a positive change that they had actually interviewed Andrew Amos (psychiatrist who calls for change to GAC model) on the video/ tv news piece so that alleviated some of my rage.
When people object to something, I like to ask them "Ok, then what standard would you use?"
If RCTs are "too high" a standard, what standards would they suggest to replace it, and what are the upsides/downsides of their proposed standards?
This starts a dialog about more substantive issues than quibbling over one standard or another. We can then also apply their version of an "acceptably high standard" and see where that takes us with the issues under question.
Often the standard being proposed can't be achieved, either... so it makes the quibble over which standard to use moot.
In this case I don’t think that would be fruitful, since they either don’t understand, or are being deliberately misleading about, the standards that Cass used.
Jesse, you have a great mind and I appreciate the detail but even for my capacity for repetitive annoying detail, the impact drained away after the 10th or 20th paragraph. The end of this note rewrites your article in your intelligent heterosexual adult male fashion into three broad paragraphs (no gay man I know would dream of writing “blew it”, or “losing my mind”) I’m being humorous.
Have you read “False Positive?” In its own diabolical way it’s better than “White Lotus” for watching humorous self-immolation. A systematic vivisection of 26 issues of NEJM, and how awful they actually are. I am surprised I can still be surprised.
Recommended.
===
The New England Journal of Medicine had a chance to correct a clear and obvious error, and it completely blew it. A few weeks ago, I pointed out that a Perspective piece by Daniel G. Aaron and Craig Konnoth contained a blatantly false claim about the Cass Review’s evaluation of gender-affirming care research. They asserted that the review “embraced RCTs as the standard” and judged studies accordingly, which is simply not true. The actual systematic reviews commissioned by the Cass team used a grading scale specifically designed for non-randomized studies. I flagged this for NEJM, expecting at least a basic correction. Instead, I got silence from the editors and a meandering, unserious response from the authors that completely dodged the issue.
Aaron and Konnoth’s response was a masterclass in slippery, bad-faith argumentation. Rather than addressing the simple fact that their wording was inaccurate, they shifted the goalposts, claiming they never explicitly said the Cass Review required RCTs. But their sentence clearly implies exactly that. Just to make sure I wasn’t losing my mind, I asked three different AI chatbots to interpret their phrasing, and all of them immediately saw what Aaron and Konnoth pretended not to: that they had misrepresented the review’s methodology. This isn’t a case of a reasonable disagreement over interpretation—it’s a case of authors refusing to take accountability for getting something wrong and a major medical journal letting them get away with it. That’s a serious problem.
If NEJM won’t correct something this simple and straightforward, why should anyone trust them on more complex matters? Obviously, they publish plenty of high-quality research, but if they’re willing to let outright misinformation slide because it serves a particular narrative, that puts their entire editorial process into question. This isn’t just about one bad article—it’s about whether expert institutions are willing to do the absolute bare minimum to maintain their credibility. Right now, NEJM is signaling that accuracy is negotiable, and that should concern anyone who cares about the integrity of medical science.
Another good piece, Jesse. Thanks for continuing to do the thankless but important work of calling out supposedly authoritative sources that can't be bothered to tell the truth.
Pedant! :D
Seriously, though, this just sort of explains why people don't trust 'science' anymore. Who has time to read all the pieces like Jesse's, let alone to do the research independently. It seems like every 'study' or 'survey' that bumps up against a political issue is subject to questions of bias, inaccuracy or worse.
This is why I tend to look at things based largely on my life's experience. I'm not saying this is a good state of affairs, but who am I going to believe, the New England Journal of Medicine, or my own lyin' eyes?
"this just sort of explains why people don't trust 'science' anymore"
It literally does not.
Something that seems a little crazy to me about this response is the double standard for who bears responsibility when readers misunderstand authors. Aaron and Konnoth seem to be defending their critique, in part, by arguing that people are interpreting the Cass review to be making a claim, so it should be treated as if it is making that claim, and it's the authors' fault if they wanted people to think they said something different. But then they write something that most reasonable readers will interpret one way (or, at least, Jesse, me, and three LLMs), and they say it's reader's fault if they misunderstood it.
One thing that I think could use some pushing back on the authors: RCTs *are* the gold standard in medicine. It would be better if we had RCTs on youth gender medicine. For a variety of reasons, we probably won't ever have RCTs on youth medicine, but that doesn't make something else the new gold standard. It's entirely appropriate for Cass to point out that there is an ideal research protocol, even if it can't/hasn't be(en) used for youth gender medicine.
I broadly agree. It's a nuance of whether you are noting that RCTs would be ideal whilst acknowledging the reasons they would be extraordinarily difficult to conduct, in the context of wide swathes of the medical consensus not being backed by RCTs, or whether you are using the lack of RCTs to argue that clinicians are irrational or sloppy or reckless to be operating without this gold standard.
I urge everyone to write to the NEJM and register your disapproval. I spend a certain amount of my down time just simply writing letters to school administrations, judges, prison officials, editors, etc. registering my disapproval of their policies in a dispassionate and logical fashion, making clear I am a progressive who always votes Democrat. This may seem like a minor act, but if scores of people do it, they must take notice.
This is egregiously troublesome for two reasons: it is the very reason those who support Trump and Trump himself can stand on firm ground as they wreak havoc on science funding and the reputation of science. This is the stuff that is fueling the anti-science backlash; the "why" of the slashing and burning of science that is taking place right now. It is literally their fault, these editors and writers, for publishing articles like this. Secondly, they are materially harming children, young people, and adults with this misinformation. When you think about the ultimate results that often occur from this misinformation, such as early osteoporosis, cognitive issues, possible heart problems, sterility, and many unknowns from puberty blockers, the permanent unwanted effects of cross-sex hormones, as well as the surgeries that remove health body parts from breasts to penises to uteruses, I think the word "carnage" is not inappropriate.
The email for Daniel G. Aaron is daniel.aaron@law.utah.edu and the email for Craig Konnoth is craig.konnoth@virginia.edu ; the email for the Editor in Chief, NEJM is
Eric Rubin at erubin@hsph.harvard.edu ; Executive Editor, NEJM is Mary Beth Hamel at
mhamel@bidmc.harvard.edu .
Let me add that the way I frame it for medicalization is that we should be in a golden age of helping trans people acquire the best possible medical care. We should be all-in on studying trans medical issues and designing the best possible appropriate medical measures (and psychiatric measuers) to care for these patients. Instead, we are harming them, and this undoubtably is stemming from the sudden profitability of this burgeoning area of medicine as well as politics that have gone off the rails. (And the authors of that NEJM piece profit greatly.)
<<A father of a trans man voted for Trump. Now he fears an order targeting gender-affirming care will upend his son’s treatment.>>
But didn't Trump pretty loudly and clearly campaign on doing exactly what he has been doing? Seems to me this is a case of not liking the taste of the wine he poured for himself.
Totally. This is just CNN giving its base delicious schadenfreude.
Keep fighting the good fight, sir.
I actually hadn't heard of Claude before, and I will henceforth pretend that you just asked some random Frenchman named Claude the question and took his response.
If Claude were a proper Frenchman his response would be a shrug and a muttered “Bouf”.
Claude is the best free one, and its company, Anthropic, was founded as a breakaway from OpenAI by people more concerned about safety (although arguably still not enough). I would strongly encourage everyone to use it over ChatGPT; it's simply better for most purposes, and it's vastly more ethical.
Ethical? How’s that? Not being a smart ass just asking.
Because it incentivises companies to be safety-conscious, if we take our business to companies that are more so than their competitors.
It's hard to imagine how the NEJM authors didn't feel their souls shrivel just a little when they decided to actually proceed with this disingenuous response.
My guess is they (mostly) believe what they're writing. Consistency bias is a hell of a drug.
“With Nixon in the White House, twelve skydivers leapt to their death.” That’s basically what those authors’ sentence is doing - yoking two unrelated things together as though they were dependent.
I will pose a "meta" question here?
Should the differences between trans rights advocates and gender-critical feminists be resolved:
(a) through open debate leading either to the achievement of a consensus that transcends current differences, or the establishment of a clear and recognised majority; or
(b) through the coercive and other powers of the state being used to establish one side of this divide as correct and to suppress, deplatform, defund, etc, the other side?
And, specifically for US readers: would your answer to this question be different on and after 20 January 2025 to what it was before that date?
Unfortunately Aaron and Konnoth are cited as credible critics of the Cass Review in this puff piece published by Australia's national broadcaster.
https://www.abc.net.au/news/2025-03-19/qld-gender-dysphoria-hormone-treatment-trans-puberty-blocker/105061976
As someone from Qld where this is currently happening, I used the ABC complaint form
To list a number of issues with that piece yesterday (also adding in why should a parent believe that bit son is really their daughter for liking skirts & dancing like a fairy - yes, that is really in the piece & that I was dismayed that their parents had such a regressive attitude & believed in stereotypes & that I was outraged that the parents were harming their child’s future sexual health) yet it bumped me out & I lost it all. I then wrote a quick note to Bernard Keane who actually said it was a positive change that they had actually interviewed Andrew Amos (psychiatrist who calls for change to GAC model) on the video/ tv news piece so that alleviated some of my rage.
This is Bernard Lane - the only Australian journalist who is covering the issue consistently https://substack.com/@genderclinicnews?r=1o5e0d&utm_medium=ios&utm_source=profile
Bernard Lane
Sorry you’re right! I read a reply by someone with the last name Keane & mucked it up 🤦🏻♀️ amended now
Is it possible that they’re just afraid to admit knowing there are any holes in The Science when there is certainly a wave of lawsuits on the horizon?
When people object to something, I like to ask them "Ok, then what standard would you use?"
If RCTs are "too high" a standard, what standards would they suggest to replace it, and what are the upsides/downsides of their proposed standards?
This starts a dialog about more substantive issues than quibbling over one standard or another. We can then also apply their version of an "acceptably high standard" and see where that takes us with the issues under question.
Often the standard being proposed can't be achieved, either... so it makes the quibble over which standard to use moot.
In this case I don’t think that would be fruitful, since they either don’t understand, or are being deliberately misleading about, the standards that Cass used.
If we can't trust experts or scientists, who are we supposed to trust? Random You Tubers or X accounts?
Substack?
Jesse, you have a great mind and I appreciate the detail but even for my capacity for repetitive annoying detail, the impact drained away after the 10th or 20th paragraph. The end of this note rewrites your article in your intelligent heterosexual adult male fashion into three broad paragraphs (no gay man I know would dream of writing “blew it”, or “losing my mind”) I’m being humorous.
Have you read “False Positive?” In its own diabolical way it’s better than “White Lotus” for watching humorous self-immolation. A systematic vivisection of 26 issues of NEJM, and how awful they actually are. I am surprised I can still be surprised.
Recommended.
===
The New England Journal of Medicine had a chance to correct a clear and obvious error, and it completely blew it. A few weeks ago, I pointed out that a Perspective piece by Daniel G. Aaron and Craig Konnoth contained a blatantly false claim about the Cass Review’s evaluation of gender-affirming care research. They asserted that the review “embraced RCTs as the standard” and judged studies accordingly, which is simply not true. The actual systematic reviews commissioned by the Cass team used a grading scale specifically designed for non-randomized studies. I flagged this for NEJM, expecting at least a basic correction. Instead, I got silence from the editors and a meandering, unserious response from the authors that completely dodged the issue.
Aaron and Konnoth’s response was a masterclass in slippery, bad-faith argumentation. Rather than addressing the simple fact that their wording was inaccurate, they shifted the goalposts, claiming they never explicitly said the Cass Review required RCTs. But their sentence clearly implies exactly that. Just to make sure I wasn’t losing my mind, I asked three different AI chatbots to interpret their phrasing, and all of them immediately saw what Aaron and Konnoth pretended not to: that they had misrepresented the review’s methodology. This isn’t a case of a reasonable disagreement over interpretation—it’s a case of authors refusing to take accountability for getting something wrong and a major medical journal letting them get away with it. That’s a serious problem.
If NEJM won’t correct something this simple and straightforward, why should anyone trust them on more complex matters? Obviously, they publish plenty of high-quality research, but if they’re willing to let outright misinformation slide because it serves a particular narrative, that puts their entire editorial process into question. This isn’t just about one bad article—it’s about whether expert institutions are willing to do the absolute bare minimum to maintain their credibility. Right now, NEJM is signaling that accuracy is negotiable, and that should concern anyone who cares about the integrity of medical science.
===
Do read my take on T
https://open.substack.com/pub/sufeitzy/p/mimesexuality-1-incipendum?r=o79yv&utm_medium=ios
Another good piece, Jesse. Thanks for continuing to do the thankless but important work of calling out supposedly authoritative sources that can't be bothered to tell the truth.