[Jessie Singal] How Science-Based Medicine Botched Its Coverage Of The Youth Gender Medicine Debate

This sort of politicization of a very important scientific debate is pernicious for obvious reasons, and at first glance, a site like Science-Based Medicine would appear to be well-situated to serve as a useful balm to cool things down: Novella and Gorski enjoy leadership roles in a community of skeptics who aren’t afraid to step up and respond forcefully to confident overclaiming, whatever the politics of the overclaimer, on some of the most controversial subjects imaginable. And on this issue, confident overclaiming is rampant, so it’s a target-rich environment.

Unfortunately, that hasn’t happened. Instead, Science-Based Medicine has fallen into the exact same trap as numerous mainstream news outlets, violating some of its founding principles in the process. If you read the site’s recent coverage of this issue, you will come away thinking there is a big, broad, impressive body of evidence for youth gender medicine, that there isn’t any actual controversy here at all. Rather than evaluate the available evidence carefully, SBM defaults to just about every activist trope that has come to dictate the terms of this debate in progressive spaces. This is a disturbing example of what complete ideological capture of an otherwise credible information source looks like. Science-Based Medicine has “bought into the hype and failed to ask the hard questions.”

[...]

All three articles contain major errors and misunderstandings and distortions, ranging from straightforward falsehoods to baffling omissions to the re-regurgitation of inaccurate rumors first circulated years ago. Activist claims that stretch or violate the truth are repeatedly presented in a credulous manner, while the myriad weaknesses in the research base on youth gender medicine are simply ignored. The basic problem here is what Scott Alexander calls “isolated demands for rigor.” This is a standard aspect of human nature, a close sibling of confirmation bias. When it comes to claims we don’t want to believe we will insist the evidence isn’t actually as strong as it appears, demand more and more clarification, shift the goalposts of the debate, and nitpick if necessary; for claims we do want to believe, we’ll wave weak evidence right through the gate without interrogating it too harshly, even if it suffers from exactly the same problems.

Isolated demands for rigor are a particularly big problem in areas where we don’t have a robust evidence base to rely on in the first place. Youth gender medicine is one such area, and throughout SBM’s coverage of this issue, the isolated demands for rigor target only research and individuals who appear to complicate the site’s favored narrative: There is nothing to be concerned about here, because youth gender medicine is in overall solid shape. At one point, faced with a published finding that could complicate their narrative, Novella and Gorski write it off as irredeemably bad research (though without explaining why). Then, later in the same paragraph, they accept as true a conclusion produced by the same youth gender clinic, most likely because that finding slots easily into their priors. It’s sort of a Schrödinger’s Evidence type of deal: Source X’s credibility exists in a fuzzy superposition of “totally credible” and “entirely untrustworthy” until we find out whether its claim fits comfortably within our politics, at which point its status collapses conveniently into one state or the other.

What makes SBM’s coverage of this issue so frustrating is that it was a big missed opportunity. Youth trans issues invite a huge amount of screaming and denunciation on all sides, and as a result, sometimes people think the circus itself — all those personalities yelling at each other online — is the actual issue here. But the actual actual issue here is the growing number of American families who face really difficult choices about puberty blockers and hormones that they are forced to make under a condition of terribly insufficient evidence. They desperately need institutions like Science-Based Medicine to step up and provide rigorous, science-backed advice untainted by the toxic climate that besets this issue, because hardly anyone, anywhere is doing so.