Intellectual Quackery

When medical journals won’t publish corrections

‘Censorship of Essential Debate in Gender Medicine Research’ has the dullest possible title for what it reveals. In yet another example of trans ideology destroying everything it touches, the most prestigious journals in medicine are refusing to publish corrections to papers that contain demonstrably false claims about gender medicine.

The author, J. Cohn, didn’t set out to write about censorship. She tried to correct errors in published papers. When that didn’t work, she described what happened. She found that multiple systematic reviews (the gold standard in evidence-based medicine) have found low or very low-certainty evidence for the benefits of medical gender interventions. This includes puberty blockers, hormones, and surgery. ‘Low certainty’ means there’s limited confidence the estimated effects will match what actually happens to patients.

The Cass Review, published in 2024, found the evidence for paediatric interventions “remarkably weak.” Several other systematic reviews found the same for patients under 21 and under 26.

None have found that these interventions reduce suicide risk.

Meanwhile, major medical journals keep publishing papers claiming the opposite.

Papers in JAMA, the New England Journal of Medicine, and Pediatrics have variously claimed that gender-affirming medical interventions are:

• “Widely recognised as essential, evidence based, and often lifesaving”

• Known to “clearly improve health outcomes”

• Associated with “demonstrated health and well-being benefits”

• Linked to regret rates “less than 1%” or “exceedingly rare”

The regret claim is particularly bold given that the studies cited have major flaws. The often-quoted Bustos review included 27 studies, of which 23 had moderate-to-high risk of bias. All included studies suffered from premature follow-up, significant loss to follow-up, or both.

The regret rate isn’t known. But papers keep saying it is.

Cohn submitted a letter to the NEJM in 2022 pointing out that a Perspective piece contained multiple unsupported claims. The piece had stated there was “no way” for a randomised controlled trial to have clinical equipoise because “evidence demonstrates mental health benefits, reduced suicidality.”

Clinical equipoise means genuine uncertainty in the medical community about which treatment is better. It’s what makes randomised trials ethical - you can’t knowingly assign patients to an inferior treatment. The argument was: if we already know these interventions work, testing them against alternatives would be unethical. But this only holds if the evidence actually demonstrates benefit. And it doesn’t.

The editor rejected the letter. When Cohn followed up, the editor said Perspective articles get “some license” as opinion pieces, and expressed “very little confidence” in the umbrella review Cohn had cited. The review was led by a McMaster professor who develops evidence-based medicine methodology. McMaster is a world leader in the field.

The NEJM Perspective, meanwhile, had itself cited two unpublished white papers on a Yale website.

Since that rejection, multiple additional systematic reviews have come out. They all found the same thing.

A letter to JAMA Surgery went through a stranger journey. Cohn pointed out that a paper claiming “profoundly low” regret rates wasn’t supported by evidence. The letter was accepted.

A month later, an editor asked for additional disclosure about Cohn’s affiliated institution. Cohn agreed to provide it. Then the editor requested other personal information unrelated to gender medicine or the letter. When Cohn asked for confidentiality protections before providing it, the editor rejected the accepted letter.

At no point was the accuracy of the letter questioned. The JAMA Surgery paper remains unchallenged in the journal.

PubPeer is a post-publication peer review site designed for exactly this purpose - allowing researchers to comment on published work. In 2024 it received an award from the Einstein Foundation for its contribution to scientific integrity.

Cohn submitted four critiques to PubPeer. All were accepted and published within days.

A month later, all four were removed within five minutes and listed as rejected.

Cohn sent multiple emails asking why. She used the site’s contact form. She emailed one of PubPeer’s founders. No one replied.

Medical guidelines are supposed to work like this: researchers conduct systematic reviews of all available evidence, assess its quality, and make recommendations that match the strength of that evidence. Strong evidence gets strong recommendations. Weak evidence gets weak recommendations or no recommendation at all.

That’s not what happened here.

The American Academy of Pediatrics policy statement recommending gender-affirming care wasn’t based on systematic reviews. A subsequent analysis found its cited references “repeatedly said the very opposite of what AAP attributed to them.”

The Endocrine Society guidelines make strong recommendations based on evidence they themselves rate as low or very low certainty. They don’t explain why.

WPATH commissioned systematic reviews, then interfered with them. After publication, they dropped all but one minimum age recommendation (for phalloplasty) under pressure from the Biden administration and the AAP.

What emerged was a closed loop. The AAP cited the Endocrine Society. The Endocrine Society cited WPATH. WPATH cited the AAP. A recent review of these guidelines found that most societies’ recommendations rely on each other rather than independent evidence. The authors concluded: “Healthcare services and professionals should take into account the poor quality and interrelated nature of published guidance.”

In other words: idea laundering. Weak claims get passed around between authoritative-sounding bodies until they take on the appearance of established facts.

What’s emerged is a closed system. Journals rely on medical society guidelines to evaluate submitted articles. Medical societies rely on each other’s statements and select journal articles rather than systematic reviews. Articles making unsupported claims go unchallenged because corrections are rejected.

When the Cass Review was published, several major US medical societies either didn’t respond or disputed its findings. The AAP characterised the evidence-based HHS report that followed as “prioritising opinions over dispassionate reviews of evidence.” WPATH said “studies consistently show” positive impacts. The Endocrine Society said “medical studies show that access to this care improves the well-being of transgender and nonbinary people.”

It was all lies.

Dr. Hilary Cass noted in her review: “Firstly, you must have the same standards of care as everyone else in the NHS, and that means basing treatments on good evidence.”

Several European countries have moved towards offering psychotherapy as first-line treatment in response to the weak evidence base. England, Finland, Sweden, and Scotland have all shifted away from the US affirmative model.

The US literature continues to claim established benefits.

In January 2025, JAMA published a Viewpoint acknowledging concerns about paediatric gender medicine and mentioning the Cass Review. It was a departure from their previous coverage.

The journal’s editors wrote elsewhere: “The integrity of the scientific process does not depend on blind trust in science or on an assumption that a scientific finding is always right. Rather, this integrity hinges on the confidence that the free exchange of scientific ideas grounded in rigorously conducted scientific inquiry, including the discussion, debate, and disagreement that results in further inquiry, ultimately leads to insights that are likely to be true.”

For several years, that free exchange hasn’t been happening in the field of ‘trans healthcare’.

Ethical informed consent requires patients to understand benefits, risks, and alternatives before agreeing to treatment. When authoritative journals publish incorrect claims about known benefits and low regret rates whilst omitting less invasive alternatives, it looks almost exactly like fraud and medical abuse. We know only one thing for sure: Vulnerable children and adults underwent irreversible medical procedures based on claims the journals knew were false and refused to correct.