Eager to Affirm, Yet Unwilling to Defend Their Claims
The peer-review process for the HHS report on pediatric gender medicine exposed the ideological capture of major medical organizations.
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About the Author
Dr. Colin Wright is an evolutionary biology PhD, Manhattan Institute Fellow, and CEO/Editor-in-Chief of Reality’s Last Stand. 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 scientific journals.
Yesterday, the U.S. Department of Health and Human Services re-released its major report on the treatment of pediatric gender dysphoria after putting it through post-publication peer review. It emerged unscathed. For years, America’s leading medical associations have insisted that “gender-affirming care” for minors is grounded in a solid scientific foundation. This review process gave them a chance to prove it. Instead, what happened says more about the state of U.S. medical groups than anything we’ve seen in a long time.
HHS invited three organizations that have spent years insisting that “gender-affirming care” for minors is safe, effective, life-saving, and evidence-based: the American Academy of Pediatrics (AAP), the American Psychiatric Association (APA), and the Endocrine Society. This was their chance to show the public the solid data behind those claims.
Two of the three didn’t bother. The AAP and the Endocrine Society simply refused to participate.
This is not like declining to join a combative panel discussion on cable news or a hostile podcast debate. This was an invitation to professionally participate in the scientific process at the highest level of federal policymaking, on an issue they claim to understand better than anyone else, and on which they have demanded public trust. If they were truly confident the evidence was on their side, this would have been the moment to demonstrate it. Instead, they walked away, representing an astonishing dereliction of responsibility.
The lone group that did participate—the APA—submitted a review so careless and superficial it’s hard to believe they read the report at all. The HHS authors’ reply reads like an adult patiently explaining basic concepts to a child, as they walked one of the nation’s largest medical organizations through the most elementary principles of evidence-based medicine.
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The APA’s review opened with a complaint that the authors of the HHS report weren’t named. They argued that “transparency regarding authorship is essential to the integrity of scientific and policy analysis.” But this is exactly backwards. Anonymous (i.e., double-blind) peer review is standard practice in science precisely because it reduces bias. Reviewers should evaluate methods and evidence, not the personal politics, professional affiliations, or Twitter feeds of the authors. The wisdom of anonymity became obvious earlier this year when activists tried to stir up outrage over one contributor, MIT philosopher Alex Byrne, after identifying him through document metadata. That was just one name. Imagine the circus if HHS had published the full list prior to peer review. Keeping names concealed forced the APA to respond to the report itself, which is much harder than simply shouting “bigot!”
The APA’s next criticism was that the HHS report didn’t clearly describe its methods. But anyone who had even skimmed the report would know this is nonsense. Every detail they claimed was missing was thoroughly explained in a 174-page appendix that the APA apparently didn’t notice. Two independent methodologists commissioned to evaluate the report—both from the Belgian Centre for Evidence-Based Medicine—had already praised the report for its methodological rigor and transparency. Yet here was the APA, making a fool of itself by confidently declaring the methods didn’t exist.
The APA also submitted a list of 16 “additional studies” it suggested the HHS had either ignored or failed to properly consider. But twelve were already included in the report. Three didn’t involve pediatric outcomes. And the last one was published too late to be included, and wouldn’t have met the inclusion criteria had it been published earlier. Again, these are the kinds of mistakes you make only if you didn’t read what you were reviewing.
Their other complaints were equally nonsensical. The APA claimed the report failed to consider the “potential harms that have been associated with withholding intervention,” such as depression and suicidality. But the review explicitly included every systematic review comparing youth who were medically transitioned with youth who were not, and those reviews found no credible evidence that the treatments improved those outcomes.
They also accused HHS of misrepresenting the U.K.’s landmark Cass Review. But Cass’s findings couldn’t be clearer: the evidence of benefit is weak, clinicians cannot predict which children will persist in gender distress, and youth gender medicine has run ahead of the evidence. Cass is exactly why the U.K. banned puberty blockers for minors outside of research settings and sharply restricted cross-sex hormones. The HHS authors painstakingly walked through the relevant evidence, explained why the APA’s interpretation was wrong, and corrected basic factual misunderstandings.
The APA’s review wasn’t a good-faith critique. It was a collection of talking points—none of them accurate—from an organization that wanted to appear engaged without doing the actual work.
And yet, as embarrassing as the APA’s response was, at least they showed up. The AAP and the Endocrine Society did not. Their refusal to participate in the peer-review process is even more telling than a poor quality critique. These organizations have spent years proclaiming that the evidence for pediatric “gender-affirming care” is clear and compelling. They have accused skeptics of “misinformation,” smeared dissenting physicians as bigots, and told parents that medical transition is necessary to prevent suicide.If they truly believed the evidence was clear, they would have welcomed the chance to defend it when it mattered most.
Imagine being a pediatrician who has trusted AAP guidelines, or a parent who believes the only way to save your distressed child is through medical transition. Now imagine learning that the very organizations that told you the evidence is rock solid refused to defend that evidence when asked to do so by the federal government. They didn’t present a counterargument. They didn’t submit an alternative review. They didn’t even offer a protest letter. They just ignored the request.
Why would they do this? Because they know the evidence isn’t what they’ve claimed. From a game-theory standpoint, silence was their safest option. The APA attempted a response and exposed its total incompetence. The AAP and ES avoided that fate by refusing to engage. They can now frame their silence as principled rather than as an attempt to hide the weakness of their evidence.
Meanwhile, HHS did not limit itself to responding only to the critiques solicited for review. It also responded to unsolicited critiques from Dowshen et al. and Rider et al. published in academic journals. HHS was not required to do this. It did so because it was committed to addressing the strongest possible challenges to its conclusions. The authors of the HHS report acted like scientists who care about the truth; their critics acted like activists trying to ignore or distort it.
The report’s re-release demonstrates that when the evidence is reviewed openly and rigorously, the scientific case for pediatric medical transition collapses. It also exposes the intellectual bankruptcy of the medical organizations that have promoted these interventions most aggressively. When given the chance to defend their claims, they offer either superficial talking points or silence. That should serve as a wake-up call that ideology, not science, has been driving U.S. medical policy on this issue.
The public deserves better. Families deserve better. And the children whose futures depend on these decisions deserve institutions that will confront the evidence honestly, not hide from it.
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One can only hope for some justice for these people who have exploited innocent children for their own ideological purposes.
Thank you son much for this. The point that it is not WHO wrote the HHS Report, but WHAT it said - the substance - is what matters cannot be stressed enough.
I don’t care who says the Earth is round or gravity is a real force or 2 plus 2 equals 4. I care whether those things are true.
I care about treating young vulnerable individuals in distress with proper interventions (which may mean no interventions, talk therapy, behavioral therapy, dietary changes, or many other things - with the most drastic being chemicals and surgeries to alter their appearance and their bodily functions). If Donald Trump’s administration funded proper research that can help these individuals, I want to hear about it and fairly critique it - despite the fact that I disagree with much of what he has to say on other topics. If this is the one good thing his administration does to help this country and maybe the world, we should certainly take that and use it to our advantage.
If someone wants to deny facts, it is incumbent on that dissenting party to explain why those facts are not true. If someone wants to challenge the principles of gravitational force, they must explain their alternative theory, not scream about what a bigot Isaac Newton was (not that I know anything about Isaac Newton’s opinions about race and ethnicity).
Clearly, the AAP and APA and Endocrine Society don’t care about the vulnerable individuals they are pushing into extreme interventions or they would have properly engaged in the HHS Report.