Marci Bowers, evangelist
Believe, All Ye Faithful
Marci Bowers is a natural-born evangelist.
In episode five of the NY Times podcast series “The Protocol,” Bowers never even attempts to engage Azeen Ghorayshi on the merits of the arguments of the critics of gender medicine. Not a word about the systematic reviews, conducted across several different countries, some conducted much earlier than those in the United Kingdom.
And it’s no wonder. Systematic reviews are fundamentally unsexy.1 What they finally proclaim is reliably bland... Here is one example of reporting a specific outcome after puberty blockers:
And then, in a footnote, we get this about why the evidence is rated so low:
Ugh!
Can you imagine the faithful reaching out for their checkbooks if Bowers tried to argue why the review team was wrong? “Rating it down three levels? Just because of the risk of bias with respect to prognostic imbalance associated with the observational study design not having a comparison group?”
Of course not. Bowers is far too clever to fall for that. The seasoned performer that he is, he knows that getting bogged down by systematic reviews is the death of the narrative—and the narrative is what the podcast is looking for. After all, what do you think makes for a better episode in a medical drama? One in which the young surgeon recites the relevant sections of the systematic review and convinces everyone that there is no good evidence to conduct the surgery, or the one where he goes against every (preferably, older) doctor’s advice, does the surgery, and saves the patient against all odds? I know which narrative I’d choose.
There is no hero in a systematic review. There is no villain. There is no redemption. And there is no uplifting anecdote to point to.
It is no wonder, then, that Bowers traipses down the path of the anecdote rather than joust with the totality of the evidence, safe with the knowledge that the interviewer, suddenly sprung with a dramatic storyline in the middle of an interview, will probably not think about its veracity… (and even if she does, there’s HIPAA and all that).
It is the tactic of the evangelist. Like the evangelist, Bowers doesn’t engage with the substance of the critics’ criticisms. He does not try to attack the conclusions of the systematic reviews that were conducted on behalf of the Cass Review. He does not mention that one of those systematic reviews even looked at the quality of the guidelines themselves—and found those of WPATH’s especially wanting. (He leaves those attacks for the Yale Integrity Project.)2
At the same time, like the magician pointing to the area where he wants his audience to focus, Bowers wants to come across as a model of openness. Of course, you can record this interview, Azeen [first name, always]. I trust you, I know you understand, and I know you will faithfully report what I say. You know me! I have nothing to hide.
Bowers knows that there is only one villain large enough and worth slaying. Every good narrative needs one. Those funny little Nordic countries with their highly-rated healthcare systems do not matter. It has to be that English-speaking country, which, in spite of its Labour government in power, has been such a thorn in the flesh. Ever since that retired old bag lady produced her so-called “review.” It has to be Cass.
And so…
“Azeen, I wish you could have been in my clinic last week [funny how it’s always just that last week!]. …these girls were—when I first met them, they couldn’t even look me in the eye. They could barely lift their head… They were barely alive. Their parents had deep circles under their eyes… I mean, luckily, they hadn’t taken their lives [ah, the ever-reliable trope of live-son-versus-dead-daughter, that never fails!], because they had supportive parents, and they had access to treatment.”
And then comes the triumphant flourish.
“But they went through surgery, and these girls are different. They are alive, and the personality that comes up… That is something that seeing once, [Cass] would change her mind. Her skepticism would melt, and that is what the AAP, the APA, and the AMA all know.”
Anecdote? Check.
Villain? Check.
Hero? Are you kidding? He’s been there all along! Of course, check.
Redemption? Hell yeah, check!
(Also, name-checking all AAP, APA, and the AMA—who, as Cass found out, all just referenced each other and the WPATH to manufacture synthetic consensus? Or the obligatory Holocaust reference? Or the double-obligatory suicide reference? Check, check, and check.)
Bowers then goes for the jugular. How can that old biddy, who should have been laid out to pasture years ago, even understand what I have seen? (His exact words were, “So for it to be dismissed by a haughty, old, retired pediatrician who, frankly, doesn’t know the population and hasn’t seen the light in the eye return to the patients they treat, that’s what makes it, in a way, fatally flawed.”)
To which the faithful reply in unison, “Yes, what does that old biddy know? She has never seen one of us! How could she even understand what we go through?”
We have seen this story so many times before. The story of the preacher. And the scientist(s) who think he is a fraud. And the legions who believe in the preacher’s miracles.
There’s also the inconvenient fact that the evidence in all those systematic reviews negates everything Bowers says.