Testimony, or Evidence?
The New York Times’ coverage of the St. Louis gender-medicine scandal puts a too-friendly gloss on damning facts.
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One might think the fact that the medical establishment is endorsing and performing experimental, irreversible, and often sterilizing medical procedures on children would be an immense journalistic discovery. But a recent New York Times article—investigating allegations made by Jamie Reed, a former case manager at the Washington University Transgender Center at St. Louis Children’s Hospital who blew the whistle on medical malpractice at the clinic traveling under the guise of “gender-affirming care”—downplays the results of that discovery in a way that privileges personal testimony over evidence.
Reed’s allegations were numerous. She claimed that the clinic was inundated with requests for transition services without adequate protocols to handle them, that patients were hastily approved for transitioning despite notable mental-health comorbidities, that individuals were not fully briefed on the risks and side effects of their prescribed medications, and that any opposition within the clinic was quelled. As Leor Sapir observes, the Times investigation corroborated most of Reed’s claims. A discerning reader who cuts through the article’s euphemisms and sidesteps the author’s political asides would discern as much.
Indeed, the newspaper of record has verified concerns that critics of “gender-affirming care” have raised for years. The current influx of trans-identified youth, primarily girls with no previous gender-related distress, symbolizes a fresh patient group exhibiting a new and as-yet-unstudied form of gender dysphoria. Gender-affirming care is experimental, with no long-term, rigorous studies demonstrating its advantages over the many obvious risks.
Yet throughout, the Times article alludes to the realities of pediatric gender medicine, while simultaneously obscuring them. Consider some representative quotes.
[A]ccording to an internal presentation from 2021, 73 percent of new patients were identified as girls at birth. Gender clinics in Western Europe, Canada and the United States have reported a similarly disproportionate sex skew that has bewildered clinicians.
Here, the Times concedes that the children currently fueling the unprecedented surge in gender-clinic referrals differ significantly from the group (natal males) that the original, ostensibly more cautious, “Dutch protocol” for pediatric sex-trait modification was intended to serve. As a Reuters investigation recently revealed, U.S. gender clinics aren’t adhering even to the Dutch approach. Instead, they’re adopting a less rigorous, highly medicalized “gender-affirming” model, which entails automatic social transition and on-demand puberty blockers, cross-sex hormones, and surgeries. Considering that this form of gender dysphoria is new and rapid, it would seem prudent to gather more data about its possible causes before offering medical interventions.
Pediatric gender medicine is a nascent specialty, and few studies have tracked how patients fare in the long term, making it difficult for doctors to judge who is likely to benefit.
This dramatic understatement amounts to an admission that the current practice of “affirming” a child’s cross-sex identity with hormones and surgeries is completely experimental. It follows that advocates’ claims that such interventions are beneficial or “life-saving” are not based on any high-quality research. Those who have meticulously monitored the data have been aware of this from the beginning, and systematic reviews conducted in Sweden, Finland, and the U.K. support this view. Yet, despite such evidence, U.S. medical organizations, including the American Academy of Pediatrics, have obstinately maintained a pro-affirmation stance.
It’s clear the St. Louis clinic benefited many adolescents: Eighteen patients and parents said that their experiences there were overwhelmingly positive, and they refuted Ms. Reed’s depiction of it.
This particularly jarring statement showcases the post hoc, ergo propter hoc (“after this, therefore because of this”) fallacy: it presumes a causal relationship between phenomena merely because one follows the other. Being cautious of this fallacy, especially in the realm of human health, is fundamental to evidence-based medicine.
Few deny that many individuals are genuinely satisfied with the results of their hormonal or surgical transition. I’ve heard heartfelt accounts from minors stating that their mental well-being improved after gender-affirming treatment, and I don’t question their sincerity. However, modern medicine doesn’t—or shouldn’t—gauge the success of a treatment based purely on a patient’s personal testimony. Without comprehensive long-term-outcomes data and controlled experiments—which Ghorayshi acknowledges do not exist—it remains impossible to know whether the “positive” outcomes mentioned by the patients she references flow from the gender-affirming procedures or if the same contentment could have been achieved without resorting to body-altering hormones and surgery.
The Times article inadvertently suggests the importance of evidence-based medicine. Evaluating the effectiveness of a drug or surgery solely based on patient satisfaction constitutes a significant departure from its fundamental objectives. Were observers to start taking personal testimonies as sufficient evidence for the success of a medical treatment, the FDA would become obsolete. We’d all be forced to embrace the extravagant and pseudoscientific assertions of any self-styled health guru or medical quack.
Compare the use of testimony to support gender-affirming care at the St. Louis hospital with the Minnesota-based “healing center” known as Spring Forest Qigong (SFQ). SFQ champions the use of an ancient Chinese ritual called “external qigong” to heal the afflicted. According to its website, illnesses, or “dis-eases,” as they are fancifully labeled, are the result of “energy blockages within the body.” SFQ asserts that qigong is the magical wand that dispels these obstructions, thereby restoring the body’s “natural balance.” This involves the enigmatic Qigong Master Chunyi Lin waving his hands over one’s body, channeling energies and dissolving said blockages. If the idea of driving all the way to Minnesota for treatment seems tedious, fear not: Master Lin generously offers to transmit these energies and conduct qigong sessions over the phone.
The SFQ site provides links to several “scientific” articles from the Journal of Holistic Nursing and The American Journal of Chinese Medicine. These papers, apparently, endorse external qigong as an antidote for chronic pain. But for novices to the mystical realm of SFQ and qigong, the site offers glowing testimonials from satisfied SFQ customers.
One says: “I’ve tried different medicines. They gave relief but didn’t cure me. This season I’ve lived allergy free and I credit it to the [Spring Forest Qigong] Active Exercises I've been doing [for the past six months]. I didn’t take even one pill. Since there weren’t any other changes in my lifestyle, diet, or anything, I credit the [SFQ] active exercise. Channels were cleared, immune system adjusted and here I am, happy and allergy free.”
Another: “I was breathing into the shoulder and seeing the pain turn to air or smoke each night before I went to sleep, and it got better and better and better. I went back to the doctor months later and showed him the improvement. He said, ‘There is no way you should be able to do what you’re doing. You should be in excruciating pain. I can’t explain how you can do it, but whatever you’re doing, don’t stop.’”
Still another: “Chunyi Lin and Spring Forest have had an amazing impact on my life. It’s given me a way to live life more fully, happier. To me it’s a God send. The practice of Qigong is something everyone can benefit from. Once you have had an experience with Qigong you want to keep it a part of your life.”
One woman even says that qigong eradicated her Stage 4 breast cancer: “I rejected conventional cancer treatments from your classically trained oncologists because they didn’t work the first time. This time it was my life that hung in the balance and I was resolved to find alternative measures to find healing. And, fast forward, after six, seven months of both medical treatments and visiting with Master Lin in the Spring Forest Qigong Center I am completely healed. My cancer’s gone. My doctors call me a ‘walking miracle.’”
Should doctors and scientists view these “overwhelmingly positive” experiences as clear proof that Qigong Master Chunyi Lin healed these patients by simply waving his hands over their bodies (or through the phone) to dispel their energy blockages? Should we confidently endorse external qigong for people with Stage 4 breast or liver cancer? Probably not. Instead, we’d likely advocate for rigorous testing of external qigong through randomized control trials, demanding tangible evidence of its benefit before suggesting it could treat even minor ailments.
But if we’d be hesitant to accept these testimonials about how qigong cured some people’s energy imbalance, then why are many political progressives so quick to accept similar testimonials from minors who claim their mind-body imbalance was corrected after undergoing sex-trait modification procedures? Why is such testimony taken as definitive proof of these procedures’ benefits? Ideology couldn’t possibly be the reason—right?
This essay was originally published in City Journal.
About the Author
Dr. Colin Wright is an evolutionary biology PhD, Manhattan Institute Fellow, Academic Advisor at the Society for Evidence-based Gender Medicine (SEGM), and Founding Editor of Reality’s Last Stand.
Wright received his PhD in evolutionary biology from UC Santa Barbara in 2018, and was an Eberly Research Fellow at Penn State from 2018 to 2020. He is an expert on the biology of sex and the evolutionary behavioral ecology of collective behavior in social insects and arachnids. His writing has appeared in The Wall Street Journal, The Times, the New York Post, Newsweek, City Journal, Quillette, Queer Majority, and other major news outlets and peer-reviewed science journals. He has been a guest on popular TV shows and podcasts such as The Joe Rogan Experience, Tucker Carlson Tonight, Triggernometry, and others.
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There is no doubt that testosterone has an anti-anxiety and energizing effect in the short to medium term. Combine that effect with copious social support and "affirmation" and it's not surprising that a lot of these kids (mostly girls who want to be boys) feel better in the short term. Ten years from now it's going to be a whole other story. The guy who originated frontal lobotomies for psychiatric disorders won the Nobel Prize in 1949. You'd think we would eventually learn to be more cautious in with irreversible procedures in medicine.
NYT is far from unusual in its treatment of so-called "gender affirming" medical alterations of secondary sex characteristics. Every news item I've seen or heard recently about the efforts in some state legislatures to restrict such treatments for minors has featured a testimonial from an enthusiastic parent as to how the troglodytes in the legislature are preventing their child from accessing the "life saving" treatments. There is, of course, not one word about the teenage experts on TikTok coaching the kids in how to threaten suicide, much less about the systematic evidence reviews that have resulted in the recent restrictions on such treatments in European health care systems. I hesitate to attribute malice where ignorance is a sufficient explanation; but the persistence of the journalists' omission of any coverage of the developments in Europe is certainly degrading my trying to assume the journalists' good faith. At some point, the omission of such important and well-known evidence does indicate intentional propaganda, not good faith reporting.