There has been much controversy over lately at Science Based Medicine as they seem to have been institutionally captured by gender ideology and turning away from the foundations SBM was founded on.  When gender woo-magic takes precedent of science based facts the lambasting by those who keep their scientific integrity intact is inevitable, hence this letter by Emeritus Editor Kimball Atwood to Steve Novella about his decent into gender-woo.


Thank you for Jessie Singal for posting the letter.



Hi Steve,

Harriet has told me that you stated that her article “dragged SBM into a raging controversy.” She feels, and I agree, that it was your retracting that article and replacing it by very bad articles written by advocates of “gender affirmation” that dragged SBM into a raging controversy. I’ve attempted to explain why previously, but here I’ll mention a couple of the most obvious reasons.

You claimed that Harriet’s article was below SBM’s minimal standard for “high quality scientific evidence and reasoning to inform medical issues.” Yet you replaced it with articles stating things such as the following:

  • “Biology is a binary and differences of sex development (DSDs) are vanishingly rare”. False. DSDs are as common as 1 in 5,000 births, and increase to 1 in 200 or 1 in 300 if you include hypospadias and cryptorchidism. Biology is very, very well known to be a spectrum.

[Lovell attributes the sentence in quotes to Shrier; I’ve been unable to find it in her book]

Do you, Steve, think that sex is a spectrum? Yes, I know Lovell wrote “biology is a spectrum,” but that is an incoherent claim. Her implication is that sex is a spectrum. If that were true, it would upend all that we know about sex in mammals and many other life forms, including sexual dimorphism, reproduction, and selection. Do you think that Lovell’s statement constitutes “high quality scientific evidence and reasoning”? OMG, apparently you do. What’s happened to you?

Do you think that hypospadias and cryptorchism are DSDs? They are not, and to suggest that they are does not meet SBM’s minimal standard for reasoning about medical issues.

The citation is to a paper that discusses real DSDs, not cryptorchism or hypospadias, and makes no claims about a “spectrum.” It supports the very statement that Lovell claims to be false (even though Shrier seems never to have made that statement). Where was the editor here?

According to Eckert,

  • Throughout her book, Shrier refers to her subjects as “biological girls,” a term that conflates sex with gender and mischaracterizes Shrier’s subjects. The reason is that a person’s sex refers to the identity assigned by doctors, parents, and medical professionals at birth, most often based on external anatomy (genitals).

Do you, Steve, think that Shrier’s subjects were not biological girls? Do you think that this characterization conflates sex with gender? Do you think that sex is an “identity assigned by doctors,” rather than a fact noted by everyone in the delivery room in almost every case? Do you think that “human” is also an identity assigned by doctors? How does such an absurd passage meet SBM’s minimal standard for scientific evidence and reasoning? Do you really think that “this is good scientific practice—not political correctness”? How can you be so naive?

Finally, I’ll remind you of a previous objection that you haven’t answered, which refutes the crux of Lovell’s claim about “gender affirmation” for biological girls “lead(ing) to improved psychological outcomes”:

“Lastly, as clearly noted in the American Academy of Pediatrics statement, complete with many citations of their own, we use affirmation, pubertal suppression, and hormone therapy in youth because it leads to improved psychological outcomes. The literature is abundant and clear on this topic.”

The “abundant” link is not to several studies or a review of several studies, as the adjective implies, but to a single study that is irrelevant to Shrier’s thesis because it looks at a group of pre-pubescent, transgender children (age 3-12) undergoing only social transition, not at adolescent girls. It’s also not a good study because it controls its cohort with a cohort of non-transgender children, rather than with the appropriate control group (transgender children not undergoing social transition).

The “clear” link is to a paper that does not reveal whether its subjects were gender dysphoric (GD) in childhood or not, but whose abstract states:

Implications for impact: This study suggests that gender-affirming hormones are a helpful medical intervention for transgender youth. Gender-affirming hormones were found to be associated with decreases in suicidality and improvements in general well-being.”

That is all most SBM readers will read, if they even bother to click on the link. But in the discussion (behind a paywall; I got it on ResearchGate) we see this:

“Hypothesis 3 (i.e., those assigned female at birth will experience greater improvements in general well-being and larger decreases in suicidality) was not supported.” (My italics; parenthetical phrase in the original)

Need I mention (again) that this is the only outcome of the study that is relevant to Shrier’s book? Where was the editor here?

Speaking of editors, it appears that there have been none at SBM other than the original five. Of those, two ruled to retract Harriet’s review, two (Harriet and I) would have kept it, and one is dead. I knew Wally well enough to feel confident that he would have voted to keep the review, and that he would have been shocked, probably to the point of resigning, when you published the embarrassments by Lovell and Eckert and when you banned Andy Lewis from commenting.

No, it was not Harriet who dragged SBM into a raging controversy. It was you and David, because of some very poor choices, made worse by your doubling down after every reasonable objection by Jesse Singal, Andy Lewis, Michael Shermer, Jerry Coyne, Abigail Shrier, me, and several others.

Sincerely Yours,