No policies are more fraught right now than those involving gender transition and children. That makes it all the more important that research on the issue be grounded in the best science, giving policymakers the insight they need to do what’s right. Yet the opposite is happening: the peer-review process, designed to ensure research quality, is failing.
Consider the recent study, “Anti-transgender rights legislation and internet searches pertaining to depression and suicide,” published in December 2022 in PLOS One, a high-impact multidisciplinary journal. The authors claim to show a link between the passage of “anti-transgender rights” legislation and Google searches for “depression” and “suicide,” which could be proxy measures of mental-health distress. They assert that “the passage of a single [anti-trans] bill led to around a 13 to 17 percent increase in the volume of searchers for the word ‘suicide’ within that state” and that “that for every anti-transgender bill passed in a week, there was about a five percent increase in searches for the word ‘depression.’”
The findings are provocative, and predictably, the study drew the attention of prominent transgender activists including Jack Turban and Erin Reed, as well as a plug from MSNBC. Yet the study is a complete sham—one that PLOS One’s peer reviewers should have caught.
Peer review is supposed to be rigorous, with experts poring over a study, catching errors and requesting edits until every possible issue is addressed. But something obviously went deeply wrong with the process for this study.
To start, the authors identify only two pieces of legislation that they characterize as “anti-trans,” both of them passed in Idaho in the week of March 22, 2020—when a very real public health crisis, Covid-19, was at the top of everyone’s mind. That fact alone prevented the authors from testing their hypothesis with any precision and should have caused PLOS One to reject the paper summarily.
The study has another problem: Google Trends data for suicide searches in Idaho for that week were below the state average for the year and aligned with national trends. Similarly, searches for “depression” were consistent with national trends and marginally higher than the state average for the year.
So how did the authors arrive at their conclusion? Because Google searches constantly fluctuate, they performed a sophisticated analysis to try to find changes in the volume of searches for “suicide” and “depression” caused by “anti-trans” legislation rather than random variation or other factors. The methodology for this analysis, however, is riddled with technical mistakes so profound that even a cursory glance at the results should have revealed their absurdity.
It would be one thing if this failure of peer review had been a one-off, but it isn’t. When it comes to gender medicine, the peer-review process appears to be consistently failing. The quality of the evidence base has been a problem from the beginning. Critics have sounded the alarm about two Dutch studies foundational to current American standards of care for pediatric gender medicine, concluding that the work is “methodologically flawed and should never have been used in medical settings as justification to scale this ‘innovative clinical practice.’”
The core problems with the Dutch clinical studies are much the same as those of studies since published in the United States. Broadly, gender medicine studies tend to celebrate changes in self-reports of dysphoria as successes but fail to evaluate whether they culminate in improved mental health over time, don’t use control groups to assess how outcomes compare with other therapeutic approaches, and don’t investigate long-term impacts on physical health.
These are major problems, and the researchers and organizations that tout these studies merit scrutiny for their lack of candor about the limitations. Still, these studies at least appear to report data faithfully. What makes the new PLOS One study so disturbing is that it uses the pretense of empiricism to arrive at a false conclusion.
The editing process at PLOS One has been called into question in another case. The journal forced Brown University assistant professor Lisa Littman to issue petty and insubstantial “corrections” to her 2018 study suggesting that “rapid onset gender dysphoria” is a social coping mechanism. The corrections followed protests from progressive activists. In other words, the journal takes its gatekeeping role seriously—but only when it comes to political dogma, not scientific rigor.
One would hope that expertise would be evident in the study of gender medicine and the laws and policies surrounding it. It is not, and policymakers should maintain a robust skepticism when activists tout the “science.”
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