LES: Justice or ideology?

Dr. J. Edward Les is a Calgary paediatrician and senior fellow with the Aristotle Foundation for Public PolicyLast November, the Alberta Medical Association (AMA) released a statement taking aim at the Smith government for its new legislation banning puberty blockers and hormone therapy for trans-identifying youth. The AMA stated, among other things: “There is no place for the government in the medical decisions being made by parents and their children in conjunction with physicians.”In an ideal world, the AMA would be absolutely correct — just as in an ideal world there would be no hunger, poverty, discrimination or violence.But we don’t live in that ideal world. We live in an imperfect world where even the most well-intentioned physicians (and physician groups) get things wrong. Consider only the sad histories of frontal lobotomies, the Tuskegee syphilis experiments, the thalidomide disaster, the origins of the opioid crisis, and so on..Opponents of the Alberta government’s gender legislation (a cohort which includes the Canadian Medical Association and the Canadian Pediatric Society) surely felt vindicated the other week when Justice Allison Kuntz issued an injunction suspending Alberta’s new law. (Full disclosure: I and four other pediatric specialists provided affidavits in support of the government’s position.) .In her ruling favouring the several parties that jointly sued the government, Justice Kuntz wrote:"I find that there will be irreparable harm to gender diverse youth if an injunction is not granted. The evidence shows that the Ban will cause irreparable harm by causing gender diverse youth to experience permanent changes to their body that do not align with their gender identity. There is nothing speculative about this evidence."Justice Kuntz’ judgment makes for astonishing reading. For instance, stating “there is nothing speculative about this evidence” blithely ignores the alarm bells set off by medical authorities in the United Kingdom, Finland, Sweden and elsewhere who went in search of such evidence and found it to be grossly lacking. Those countries subsequently enacted severe restrictions on the provision of puberty blockers and cross-gender hormones to youth..Astonishing, too, is Justice Kuntz’ favourable emphasis on the World Professional Association for Transgender Health (WPATH) guidelines, while ignoring the grave concerns that exist regarding evidence-free “gender affirmation” practices.Justice Kuntz does devote space to summarizing the Cass Review — an exhaustive four-year investigation by esteemed paediatrician Dr. Hilary Cass into gender medicine practices in the U.K., which led to the shuttering of that country’s Tavistock gender clinic and a ban on the provision of puberty blockers to youth. She concedes that the Alberta government’s expert evidence is “consistent with the Cass Review”, yet in the end, inexplicably, sets this aside in favour of the complainants’ view that the legislation may “irreparably” harm children, rather than the “gender-affirming” model of care.And Justice Kuntz omits entirely any mention of the twin Canadian systematic reviews authored this year by Dr. Gordon Guyatt’s group at McMaster University, which also exposed the lack of evidence for “gender-affirming” care. Nor does she mention the U-turn on gender practices initiated by Dr. Riittakerttu Kaltiala of Finland, the very founder of Finland’s gender medicine service..On her weekend radio show, Alberta Premier Danielle Smith reacted to Justice Kuntz’ ruling: “The court… said that they think that there will be irreparable harm if the law goes ahead. I feel the reverse.”I and many other medical professionals (many of whom dare not speak openly) agree with the premier. Initiating puberty blockers in gender-confused children sets them on a pathway, which in most cases leads on to cross-gender hormones and in some instances to body-revising surgery. This is a pathway of no return, paved with lifelong medicalization and infertility — implications that adolescents are grossly ill-equipped to comprehend..HANNAFORD: The terrible cost of transitioning comes later.Those of us harbouring grave concerns will not use the hyperbolic language of trans activists, such as “denying the right of trans-identified youth to exist.” On the contrary; we want only for them to exist in the most healthy way possible, based on the best available evidence. We want them to become comfortable, if possible, in the body in which they were born—an outcome evidence has shown to be eminently achievable with appropriate counselling and “watchful waiting.”.On the other hand, the best available evidence for the “gender-affirming” approach is scant, notwithstanding Justice Kuntz’ capitulation to the unsupported conclusions of the complainants. And as Dr. Cass and others have discovered, the evidence suggests that the gender-affirming drug-administering model of care does more harm than good.Justice Kuntz ruling is an injunction, to be clear. It isn’t a final ruling — full adjudication will play out in court in the coming months. One can only hope that, after a complete and proper airing of the issue, sanity and level-headedness will prevail despite the toxic politicization that has poisoned the debate.That would be, well, ideal.Dr. J. Edward Les is a Calgary paediatrician and senior fellow with the Aristotle Foundation for Public Policy. His new book is “Cloudy with a Risk of Children: Straight Talk from the Pediatric ER.”