Sunday, April 19, 2009

Burning Stupid: Colby Cosh Edition

I see that the bird cage liner called National Post decided to publish Colby Cosh's commentary on the Alberta Government's delisting of GRS.

Given where it's published, I don't exactly expect much out of Cosh's article, but it's so painfully obvious that he hasn't even done the most basic of research.

Starting off with the following:

Well, as it happens, they don’t; the only other province that was hitherto covering the whole tab was Liberal Ontario, which agreed to do so only after a human rights commission ruckus in 2008. This is dead wrong. Ontario is not the only government to pay for GRS. According to CPATH, as of 2008, the following provinces provided some degree of coverage for GRS: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and Newfoundland/Labrador.

There is a strong bioethical case against the very existence of surgical gender reassignment, not that most members of the newly empowered caste of professional bioethicists would ever dare advance it. (Indeed, that there is not a louder debate about gender reassignment suggests that bioethicists are a virtually useless species.) The case against is usually made by Catholics, but nothing about it depends on any religious premise. It boils down to this: Gender reassignment constitutes the irreversible surgical mutilation of a healthy body — and thus violates the traditional prime directive of medicine — in the effort to correct a delusion, one which may be reversible.

Oh brother. I've heard this bunch of trash before - a few dozen times. Unfortunately, what Cosh fails to understand is that the very reason that WPATH exists today, and that Gender Identity Disorder is seen as distinct from psychological delusion is that it has long since been demonstrated that transsexuals are clearly NOT delusionary:

In Schizophrenia, there may rarely be delusions of belonging to the other sex. Insistence by a person with Gender Identity Disorder that he or she is of the other sex is not considered a delusion, because what is invariably meant is that the person feels like a member of the other sex rather than truly believes that he or she is a member of the other sex.

Of course, Cosh continues down his misguided path and gets even more wrong. This time by criticizing the evidence for GRS:

What is needed in the field of gender reassignment, as papers in that field point out ad nauseam, are prospective studies with randomized controls. So far, there don’t seem to have been any. One non-randomized study containing just 40 GID patients has been recycled with almost comic frequency.

Ummm...yeah...right Cosh. Of course you don't even bother to cite the paper you are referring to. I'll accept the criticism that most studies have very small numbers of participants - given the infrequency of the condition itself, this should come as no real surprise.

However, I will point you to Pfaefflin et. al., a survey paper that spans over thirty years of surgery and follow-up studies. It's amazing how consistent the findings are.

In other words, no scientific claim about the therapeutic appropriateness of gender reassignment is possible.

Bull. As commenters DianeG and Zoe in the National Post article point out, there is tons of scientific evidence both for the validity of transsexualism as a condition, as well as the effectiveness of Therapy, Real Life Experience, Hormones AND SURGERY in helping transsexuals overcome their challenges.

But then, writers like Cosh are among the primary reasons I call the National Post birdcage liner.

1 comment:

Diane Gall said...

What I found particularly interesting in the discussion was the initial Cosh claim that "no scientific claim about the therapeutic appropriateness of gender reassignment is possible." Now, I'll even be charitable and interpret this as 'no claim such claim is possible now".

In a response directly to me in the comments thread, Cosh intentionally misunderstands my point about 'randomized testing' and then refers again to the study he originally quoted, saying that the evidence is 'MILES short' of any gold standard."

What is laughable about an article that claims to be resting on scientific research is that Cosh tried to glean conclusions about the therapeutic efficacy of GRS as a treatment for GID, when the paper he was citing was about the surgical efficacy of the procedures; i.e., what post-operative problems were there? Does everything work/look as it should? Etc. That's why you have so few 'randomised' studies of GRS as a surgical procedure. Of course the study you cite above and dozens of others more than adequately support a psychiatric prescription of GRS for severe GID.

You don't need to be a scientist or clinician to understand all of this. You simply need to care enough and leave your ideologies at the door. Cosh clearly had a political axe to grind and, in the finest traditions of yellow journalism, entitled his article in kind.