Autonomy Does Not Trump Evidence: A Response to Dr. Gordon Guyatt
Dr. Guyatt’s deference to patient autonomy in the absence of evidence betrays the principles of evidence-based medicine he pioneered.
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About the Author
Dr. Eithan Haim is a general and trauma surgeon who was the anonymous whistleblower who exposed Texas Children's Hospital's secret transgender program. Dr. Haim then became a target of the Biden administration's weaponized justice system and faced up to a decade in prison. His case was finally dismissed with prejudice on January 24th, 2025. He is still practicing as a surgeon is a small town in Texas where he is also raising his family.
Everywhere you look, another pediatric transgender program is shutting down. Pronouns are quietly disappearing from social media profiles. Voices that were once silent are finally beginning to be heard. After our society’s collective descent into madness over the past few years, could it be that we’re finally emerging on the other side? Maybe so.
Life has taught me that optimism has value, but I have also learned it can make you blind. When our gaze is focused on the future, we risk forgetting the demons of the recent past. One eye must always look forward, but the other must remain wary, because vigilance is the antidote to complacency.
For those of us determined to stay vigilant, a rather astonishing series of events has unfolded around Dr. Gordon Guyatt, the world’s leading authority on clinical research. Dr. Guyatt has enjoyed a long and illustrious career, now approaching its twilight. One might assume this stage of life would offer a man the greatest immunity to societal pressure. After all, who in their right mind would tarnish an otherwise sterling legacy at the last moment?
Dr. Guyatt, it turns out.
Last week, he and four other colleagues published a letter that can only be described as a pathetic act of self-flagellation. In it, he professes guilt for a supposed transgression and bends the knee to the most radical faction of trans activists. And what was his crime?
He published the truth.
To appreciate the full meaning of this story, it is necessary to set the stage. Dr. Guyatt is a Canadian physician, inducted into the Canadian Medical Hall of Fame in 2016 and widely recognized as the founder of evidence-based medicine (EBM). He coined the very term in 1991. More importantly, he developed the worldwide gold standard for evaluating the quality of scientific evidence, known as GRADE—Grading of Recommendations Assessment, Development, and Evaluation.
GRADE provides a standardized method of assessing evidence, classifying it into four categories: high, moderate, low, or very low. The quality of evidence is meant to inform the strength of medical recommendations. When it comes to the medical side of the transgender debate, the center of gravity is precisely here: EBM and systems like GRADE. The only path to legitimacy runs through them.
🚨Watch or listen to biologist Dr. Colin Wright and journalist Brad Polumbo discuss this story on the Citation Needed podcast this weekend.
Although EBM methods are designed to minimize bias, they are still human creations. In the right hands, they serve an undeniable benefit. In the wrong hands, they can be hijacked by charlatans. WPATH offers the most explicit example of the latter, and eventually, all major medical organizations fell in line. Together, they built a consensus around the lie that “gender-affirming care” (GAC) was based on the highest quality evidence. This illusion of legitimacy brought social acceptance, and with acceptance came even more legitimacy. But like any house of cards exposed to the elements, collapse was inevitable.
One of the earliest signs of collapse appeared when England’s NHS conducted its own GRADE evaluation in 2020. They concluded that across the board, the quality of evidence for GAC was “very low.” Technically, “very low” means a doctor cannot say with any confidence that the recommended interventions—such as puberty blockers—will result in the proposed benefits, like improved mental health. In simpler terms: the evidence was dogshit—so poorly put together it wasn’t worth scraping off your shoe.
This underscores Dr. Guyatt’s unique role in the transgender issue. The discipline he pioneered and developed—EBM—is the very field in which this fight is being waged. One would expect him to be its most steadfast defender.
Which brings us back to his letter.
Reading through it, you notice there was nothing false in his published work. No one accused him of substandard methodology. He even stands by the accuracy of his conclusion: GAC is based on “low” quality evidence. Yet the letter contains what you least expect. He confesses he is “concerned” his findings will be used to justify “denying care to TGD individuals.” To square this circle, he invokes an amoral fallacy: patient autonomy above all else. As he puts it, “The high respect for autonomy becomes particularly important when the certainty of the evidence is low or very low.”
I had to read that a few times before the meaning fully sank in. Dr. Guyatt is claiming that a patient’s choice to pursue a medical intervention is most important precisely when there is no clear evidence the intervention has any benefit. It is hard to believe these words came from a man who devoted his life to elevating the virtue of high-quality evidence, but there they are.
The inversion is staggering, because these are exactly the circumstances—no evidence of benefit and high certainty of serious harm—when interventions should not be offered. In every other medical specialty, that would be considered criminal negligence, even assault.
Even setting aside ethics, his logic collapses under one simple question: why evaluate evidence at all with EMB techniques if the outcome makes no difference? If a GRADE analysis finds “high” quality evidence, the presumption would be that the intervention is justified. But if it finds “low” quality evidence, Dr. Guyatt insists the intervention is still justified based on patient autonomy.
See the problem? No matter the evidence, the intervention proceeds. So again, why bother with EBM if the intervention is offered regardless?
Towards the end of his letter, the real purpose becomes clear: “We acknowledge concerns have been raised.” The “concerns” are about the Society for Evidence-Based Gender Medicine (SEGM), a nonpartisan group of physicians committed to EBM. But Dr. Guyatt never specifies what the concerns actually are. In place of an explanation, he provides a citation—a suspiciously obtuse move in this context.
Clicking the link reveals why. It leads to a post by psychiatrist Margaret White responding to a British Medical Journal editorial from February 2025. White’s post is an unhinged political rant accusing SEGM of being an “anti-LGBT hate group.” Her source? The Southern Poverty Law Center, the radical smear shop notorious for branding anyone to the right of Leon Trotsky a “hate monger.”
Worse still, White’s rant cites Alejandro Caraballo, a radical trans activist and DEI legal scholar who once threatened violence against Supreme Court justices after the overturning of Roe v. Wade. To make matters worse, the BMJ editorial itself—authored by BMJ senior editorial staff Kamran Abbassi and Jocalyn Clark—is equally unhinged.
Dr. Guyatt, in his letter, never explains what SEGM supposedly did wrong. He keeps things vague, yet implies there was deception involved: “The organization appeared to us as non-trans, cis-gender researchers to be legitimately evidence-based.” No elaboration follows, and he closes by pledging to donate to Egale Canada, essentially the Canadian equivalent of the SPLC, with the only difference appearing to be the number of letters it uses to describe those outside of the “cis-gender, normative six binary”—2SLGBTQI versus LGBTQ.
Jokes aside, this letter represents something deeply sinister.
It reflects a growing trend across Canada and the Western world where the inherent dignity of the individual is being lost and replaced with dogmatic adherence to radical ideologies. Is it any surprise that Dr. Guyatt, one of Canada’s most preeminent physicians, comes from a country simultaneously expanding its euthanasia program—MAID, “medical assistance in dying”—that kills its own citizens under the guise of compassion? When leaders in medicine surrender to ideology, the unwanted are euthanized and the children sterilized.
This is why those of us in the medical profession—and everyone else—must call this out with maximum aggression. We must ensure that those who put radical ideology above human dignity face severe consequences. Because eventually, this ideology will extend beyond the most vulnerable. It will come to a doctor near you. One day, your life—or the life of someone you love—will depend on the person in the white coat standing above you.
It may appear that we have emerged on the other side of our society’s collective descent into madness, but Dr. Guyatt has shown us that the demons of the past are closer than we think.
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Dr. Guyatt was several times a candidate of Canada’s progressive New Democratic Party.
For a progressive scientist, like a progressive judge or progressive journalist, the Cause generally outweighs telling the truth.
For shame, Dr. Guyatt.