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An Open Letter and a Challenge to My Facebook Community

But we have to be honest-- and it seems to me, when you turn science into ideology and politics into science, then you're not talking from an honest place...and I think that's muddying the waters regarding what side you're on, and rarely leads to anything good.

Mads Mikkelsen

Dear Friends

The ways in which we interact on social media erodes our trust in others. Relationships are decimated through that erosion. I write this open letter to express hope in the possibility that together we can offer a better model for discussing contentious topics and to issue a challenge towards that end. 

I don't know if you've noticed but I have not been doing my usual posting on the topics of the day I consider important. I was suspended for a month from Facebook for saying something true (and no, I didn't "misgender" anyone). I've thought about that a lot and its implications for the ways in which people disagree with each other. From my experience it's a lot of insulting people for having differing opinions or avoiding engagement by declaring the opinion bigoted or associating the argument with objectionable people, like white supremacists or anti-vaxxers. Those "bigoted" opinions are reported to the automated site moderation systems until something can be interpreted as bullying or harmful. 

We call social media our digital commons, the place where we engage on difficult topics to get at collective truth. All truths are not equal. For example, asserting that there are two immutable sexes, based on evolution and all of human history, and telling a man he isn't a woman may result in a suspended account. A man asserting that he is a better woman than actual women, even asserting that JK Rowling should die or be raped for her concern for women and children will result in no censure. If it's not clear from my posting, I believe that sex is immutable. There are exactly two sexes, AND, most importantly, a person's sex does not determine how they live or present to the world. People should do what best suits them. This position has been portrayed repeatedly as harmful by people who can't or won't explain what it means for a person born male to transition to female when our sex is encoded in every cell.

In the month that I was away from Facebook James Kirkup published an article in which he refined Occam's philosophical device that the simplest explanation is usually best, as a means of determining if someone is expressing bigotry. He called it Rowling's Razor:

My challenge is for us to apply Rowling's/Malone's Razor to disagreement and respond to what is said rather than what we believe it implies about the speaker. 

In June of 2020 Rowling published a long form essay in response to accusations of transphobia stemming from her statements on Twitter. If you are under the impression that JK Rowling has made anti-trans statements or advocates against the rights of trans people, this is a great opportunity to apply Rowling's Razor. The challenge is simple. Read the essay and say directly which statements are anti-trans or bigoted or if you are unable, consider what it means that she receives death threats for the sentiment expressed in the essay. 

Bigotry or Legitimate Concern: Applying the Razor

I have been asked repeatedly why I post on subjects designated as "trans issues".  My concern is with the way that gender identity has been used to confuse children about their own bodies. There has been a 4000% increase in people presenting with what they are self diagnosing as gender dysphoria or identifying as trans over the last decade. As the number of people self-identifying as trans has grown exponentially the profile has changed dramatically. Historically the small percentage presenting at gender clinics were predominantly male. The current cohort is mostly adolescent girls, the group most susceptible to social contagion. In 2008 1 in 2000 girls identified as trans, according to an American College Health Association survey, in 2021 it was 1 in 20. There is a medical protocol for treating adolescent gender dysphoria that begins with blocking puberty with a drug also used for chemical castration, followed by cross sex hormones, and possibly cosmetic surgery. This protocol is called gender affirmation and is portrayed as life saving.

It is altogether possible that my concern is based on bigotry towards people who choose to identify as trans. I may have started at a conclusion that prohibits me from seeing or considering evidence that contradicts that conclusion. It's possible that even saying, people who choose to identify as trans is an expression of that bigotry. The alternative is that my concerns reflect a massive and growing problem and the only way to be trans is to choose to identify as trans. Let us consider what might support these two opposite positions and weigh them together.

The strongest support for the idea that my concerns stem from bigotry is that every major medical association in the US supports gender affirmation. It has become the official position of the Biden administration that gender affirming care saves lives.  In January of 2022 the US Department of Health and Human Services (HHS) proposed a rule mandating the provision of surgical and medical interventions. Based on these facts alone it's reasonable to assume that I have ignored reams of evidence that negate my concerns. I have a Master's of early childhood education, not public health. I'm no doctor or medical researcher. Honestly, I wish that my concerns only stemmed from unexamined bias. We are not positioned to fully grasp all of the negative consequences if my concerns fully reflect reality.

Before we measure the evidence that would support my concerns, consider a few important questions. Every medical intervention has associated risks. For example, the treatment for cancer can debilitate the function of organs not directly impacted by cancer. Without considering the specific risks, what is the exact desired outcome of gender affirmation to justify those medical risks? Sterility is less a risk of the protocol and more an expectation of stopping sexual maturation in this manner. What is the goal of blocking puberty, using cross sex hormones, and cosmetic surgery that justifies ensuring a child is a sterile adult? More importantly, what is the evidence used by medical associations and the Biden administration to promote gender affirmation? I would expect there to at least be a well structured trial with a control group that provides evidence for the practice of blocking the critical developmental stage of puberty for adolescents as well as for the consequence of a child confused by their sex undergoing puberty. Since this does not exist, on what basis is gender affirmation promoted?

It is not my assertion that there is no study which offers evidence to support completely blocking adolescent puberty, but the finding of any medical authority looking for it. Every gender clinic that does a systematic review of evidence in support of adolescent medical transition severely restricts the practice or stops it with few exceptions. Following a study which found that "medical gender reassignment is not enough to improve functioning and relieve psychiatric comorbidities," the Finnish  Health Authority in 2020 revised treatment guidelines to emphasize psychiatric care. They concluded, "[i]n light of available evidence gender reassignment of minors is an experimental must be done with a great deal of caution, and no irreversible treatment should be initiated."

In 2020 the UK National Health Services commissioned two systematic evidence reviews for the use of puberty blockers and cross sex hormones by the National Institute of Health and Care Excellence (NICE). These were part of a larger review of gender related healthcare conducted by Dr. Hilary Cass. The preliminary report was published during my month away from Facebook and focuses heavily on the provision of services. Although the interim report lacks specific recommendations regarding puberty blockers and hormones, it acknowledges the inconsistent evidence in support. The NICE review of puberty blockers found that they "lead to little or no change in gender dysphoria, mental health, body image and psychosocial functioning." The positive results found in studies, including the Dutch study which informed the Dutch Protocol that first introduced this use of puberty blockers, can be attributed to bias or chance. The Dutch Protocol is considered by many as a higher evidence standard than gender affirmation. A podcast appearance with the researchers who originated the protocol, Thomas Steensma and Annelou de Vries during my month away from Facebook casts many doubts on that evidence. I'll return to that appearance later.

The review of cross sex hormones similarly showed weak evidence to support their use. The reviewers found that the studies made it impossible to determine if any improvement could be tied directly to the use of hormones. They concluded that these uncertain benefits must be weighed against a largely unknown safety profile. The absence of positive evidence for medical transition played a role in a UK High Court ruling that children can't give informed consent in 2020, which stopped the Tavistock gender clinic from providing medical transition. The ruling was overturned by a higher court with a caveat that doctors should be held responsible for the results of their treatment. The direction the practice moves in the future will lean heavily on the recommendations from the completed Cass Review.

In May 2021 Sweden's Karolinska Hospital announced a policy change ending the prescription of puberty blockers and hormones for patients under 18. This was followed by all 6 gender clinics meeting that September to review their protocols in anticipation of the Swedish National Board of Health and Welfare issuing new guidance. All but one of the clinics changed their protocol to make medical transition only possible in a well structured trial. That November Karolinska acknowledged that it was aware of 13 patients who had experienced serious side effects from puberty blockers. In February 2022, the Swedish National Board of Health and Welfare made the strongest recommendation against adolescent medical transition to date. Based on a systematic review of the evidence they concluded, "the risks of puberty suppressing treatment with GnRH-analogues (puberty blockers) and gender-affirming hormonal treatment currently outweighs the possible benefits, and the treatments should be offered only in exceptional cases." 

Clearly, my concerns are validated by any thorough examination of the evidence used to promote medical transition. Still, it's possible that my concerns were not strong enough. I have allowed myself to believe that what is called the Dutch Protocol was somehow significantly better than gender affirmation with little evidence in support. Listening to Thomas Steensma and Annelou de Vries on the Gender: A Wider Lens Podcast casts doubt on adolescent medical transition causing anything but harm. In a follow up episode unpacking the interview, the hosts, Sasha Ayad and Stella O'Malley, seem still shocked by disclosures from the interview. A strong lingering question is what exactly were de Vries and Steensma treating as gender dysphoria? Asked about their patient zero, de Vries said, "[i]nterviewing this patient who was in such distress about her developing body made me realize that blocking puberty was going to help a lot of people." Ayad and O'Malley noted that disturbance with a changing body in puberty is extremely common and the researchers were not trying to bring out a "gender identity" but  dealing with distress over puberty. 
Sasha- It really felt as though they started with the hypothesis that these kids need these interventions-
Stella- not because of gender identity though, but because of distress..
Sa- the distress avoidance kind of attitude, and then designed a study in a way to elicit such results...if they truly wanted to be neutral...they would have had a control group, they would have tried real psychotherapy.
The intervention can be viewed as avoidance of distress (over changes from puberty) rather than as a treatment for alleviating internal gender confusion.

Participants were given an assessment for their sex before intervention and then given an assessment for their target sex following the intervention. Standard practice is to use the same assessment scale as a means of measuring the impacts of the intervention. To do otherwise, as de Vries and Steensma did, is to compare apples and oranges. The entire premise of using puberty blockers for gender dysphoric youth is based on the findings of this incredibly flawed study. As Ayad notes, "not only would gender dysphoria results look different had you used the same scale; you could have used their method of switching scales and gotten a positive result without doing any medical intervention."

So returning to the question above: What is the goal of blocking puberty, using cross sex hormones, and cosmetic surgery that justifies ensuring a child is a sterile adult? I would suggest that for the likelihood of sterility, and the increased risk of heart attack, stroke, and cancer, since changing sex is impossible, the best possible outcome is to create a cosmetic facsimile of the opposite sex. I would also suggest that harming the body for a cosmetic effect through a protocol that doesn't address the condition for which it has been engaged is not actual healthcare. Any honest application of Rawling's Razor would make it obvious that my concerns are no more bigotry than those of medical authorities looking at the evidence.

My challenge is to consider what else might be obscured by automatically dismissing legitimate concerns and disagreements as transphobic. For example, contemplate the implications of The Endocrine Society commissioning two systematic reviews of puberty blockers and cross sex hormones, determining that the evidence is weak, and recommending affirmation anyway. Does it help people who identify as trans for serial killers and lesser criminals to use the identity as a "get out of jail free" card or hurt them? In my month away from Facebook, a woman who detransitioned that I follow shared a meme she called "The Iceberg of Trans Lore". I suspect that many of the people who struggle with recognizing any negative consequences of gender ideology have not honestly looked beneath the surface. It's impossible to ignore what is there once you actually see it.

Malone's Razor

Robert Malone is an internationally recognized researcher and physician. He is the original inventor of mRNA vaccination technologies. He also holds numerous patents in gene delivery and vaccine technologies. Following appearances on the Joe Rogan podcast and other independent media he has been accused of being an anti-vaxxer spreading misinformation. Malone's Razor works similarly to Rowling's Razor. The formulation:

Malone's Razor

Which of these is more likely?
  1. A researcher working with vaccines and the inventor of vaccine technologies who has been inoculated has become anti-vaccination for personal or political reasons.
  2. That person has concerns based on his own adverse reaction to the novel inoculations and due to his vast research has predicted problems that needed addressing that have not been.
I have commented much less on the science around the novel inoculations, COVID, and the public health response than on issues around gender ideology. I have mostly shared perspectives and data from people and sources that don't make their way into the mainstream media until many months after no longer relevant. What is labeled "misinformation" today, like the idea that the shots don't confer immunity, becomes something everyone should have already known a few months later. In sharing this information, I have been accused of spreading harm, called dishonest, and an idiot. It's possible that all of these accusations are true, it's also possible that it's easier to focus on me rather than engage what I have shared.

Before we apply Malone's Razor, consider some important questions. What is the best justification for mandating an inoculation with an unknown long term health profile that doesn't prevent infection or transmission? Should inoculations be mandated before the safety data has been released by the pharmaceutical company? Should a product associated with death be mandated? Is opposing a government mandate for a novel inoculation failing in real time the same as opposing vaccines? Are there valid concerns that would justify avoiding the novel inoculations that would not mean the individual is anti-vax?

                           Peter Doshi, British Medical Journal

For the idea that criticizing the public health response and vaccine mandates to be anti-vax the vaccines need to have performed precisely as predicted. Since they have not, expressing concern is not the same as opposing vaccination. I considered compiling all of the unexpected behaviors of the inoculations but the list is extremely long and difficult to replicate using search engines. This speaks to how little the media has engaged the important stories that contradict the promise of the inoculation. We were promised that the synthetic mRNA would quickly dissolve in the body, which necessitated the lipid nanoparticle as a delivery device meant to remain at the injection site. Instead the mRNA lasts in the body for at least 60 days. The spike protein is responsible for a major elevation of myocarditis, especially among young men. In one study from Sweden the spike protein was found to enter cell nuclei and impair DNA repair. In another study the mRNA was found to reverse transcribe into DNA in the liver

There are at least two ways to approach this information. One could ignore it because it's pre-print. Alternatively, one might note that these are incredibly loud signals of possible harm begging more study of the inoculations. To anyone paying close attention, these are just MORE loud signals begging further study added to those already ignored. A whistleblower from the Pfizer trial made public in November 2021 that the trial data in her lab had been manipulated. Her call to the FDA resulted in no additional scrutiny of her lab. Based on the limited trial data that the FDA has been forced to release for Pfizer we know that more individuals died in the inoculation group than the placebo group. We also know that the number of adverse events forced them to hire 600 more full time employees with a plan for up to 1,800 more. Over half the deaths and adverse events reported in the history of the Vaccine Adverse Events Reporting System (VAERS) have occurred with the distribution of the mRNA inoculations.

This visual representation of VAERS reports should be enough to recognize that concerns are legitimate. Many fewer reports stopped the distribution of products in the past. The products resulting in half of all reports of adverse events and deaths in the history of the system has not even stopped mandates. It doesn't even seem to matter that they don't work and may have done more harm than good at the population level. Afterall, nations where the inoculations still remain relatively unavailable had many fewer deaths than the highest inoculated nations.

Grasping the Dynamic

My Facebook community is comprised of people from my incredibly unique high school, my Quaker college, my family, and the many people I've befriended in educational and activism settings over the years. It's people across the political spectrum interested in justice, read broadly as a world which fulfills human need and capacity. They differ on the shape of that just world and how to achieve it. The most fascinating aspect is that the people who once actively opposed capitalism and government overreach now most commonly share the same positions on contentious topics as every major corporation, most of the corporate media, and most of the government. There seems to be little reflection on what that might mean.

A famous quote often attributed to Winston Churchill speaks to this. "If you're not a liberal when you're 25, you have no heart. If you're not a conservative by the time you're 35, you have no brain." People seem to approach these political identities as fixed positions rather than in relation to their beliefs. For some, as their beliefs have matured or changed, they retain fixed identities as liberals and progressives. They view these political identities on a binary where anything they support is inherently good and any opposition inherently bad. I tend to eschew political labels for myself to focus on what I support, in recognition that political coalition is stronger around shared goals than a shared political identity. My goals have remained relatively consistent over the years. For example, I have supported universal healthcare for decades. What has changed is how those goals might be achieved and my faith in a government increasingly led by corporate interests to fulfill those goals.

On the Dark Horse podcast shared with his wife Heather Heyrig, Bret Weinstein shared an understanding of conservatism that is useful here. He made the point that at heart conservatism is about preserving past values, including the achievements of past progressive battles. It helps to see progressivism detached from concrete goals as change for the sake of change. For example, we have made much progress toward the race blind society of MLK's dream. It's progressives now trying to ensure that we are increasingly race conscious. They seem to believe that MLK was right, it's not about the color of a person's skin, unless that person is white or Asian. 

They promote a form of racism for justice, reflected in corporate social messaging, that rejects race blind coalition building. They dismiss any cognitive dissonance between their values and any potential negative consequences of their advocacy by avoiding ever engaging perspectives or questions that challenge them. Why wouldn't they? The people they disagree with are racists, white supremacists, far right, transphobic, anti-vax, MAGA, or deplorables. It doesn't matter if their words match the depiction, disagreeing means it's automatically true. 

A recently published study, "Clarifying the Structure and Nature of Left-Wing Authoritarianism" sheds light on another driver of this dynamic. I have not read the paper, but the abstract is available
We find that LWA, right-wing authoritarianism, and social dominance orientation reflect a shared constellation of personality traits, cognitive features, beliefs, and motivational values that might be considered the "heart" of authoritarianism. Relative to right-wing authoritarians, left wing authoritarians were lower in dogmatism and cognitive rigidity, higher in negative emotionality, and expressed stronger support for a political system with substantive centralized state control.
From my anecdotal experience this rings true. When I have been accused of harm for sharing news articles; when people cheer lost jobs for refusing to follow mandates; cheerleading censorship; wanting a teen to be jailed after he's found innocent by a jury are all examples of left wing authoritarianism. Expressions of a cognitive rigidity born from self righteousness.

I don't know if it's possible to change this dynamic, if we are too addled by social media algorithms to be able. I have the great fortune of knowing many intelligent and thoughtful people. I would like to think that we can do better. This is my challenge to us. I know that I have been very adept at times at maintaining weak positions with strong arguments, or bad arguments delivered with certainty. I would like to pretend that it's an example of my genius, but it's actually just embarrassing.  It was a sign that I needed to employ more critical thinking in place of buzzwords and talking points. I needed to be vulnerable enough to be wrong and honest enough to admit it. Honest engagement through conversation requires humility, an acceptance that we may know less than we think. The current model of discourse requires that we assume that disagreement is born from bad faith and a degree of dishonesty. We undercut arguments by strawmanning rather than engaging. It's far more enriching to steel man, to render their argument as strong as possible before engaging. It is a sign of respect to assume the best. 

Is this a challenge that we can meet? Can we start with assuming the best of intentions until proven otherwise?


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