Beauty and Brawn

Both medical science and society have long sought to categorize individuals as strictly male or female.

Los Angeles Daily News Negatives, Special Collections, Charles E. Young Research Library, UCLA

Identity Politics

A recent book shows how science is often judged by unscientific measures.

Alice Dreger. Galileo’s Middle Finger: Heretics, Activists, and the Search for Justice in Science. Penguin Press, 2015. 352 pp. $27.95.

It’s a strange journey that took Alice Dreger from historian of 19th-century hermaphrodites to the defender of scholars persecuted for their work. Dreger’s career offers a model for academics longing to influence the world beyond the classroom, but after reading Galileo’s Middle Finger I suspect many might hesitate to follow her example.

Underpinning Dreger’s work is the belief that evidence-based science and scientists will eventually triumph over the obstacles in their path, whether they be ideologically driven opposition, sloppy research, or the politics of the day. This book is a love letter to evidence-based research done well.

In the 1990s Dreger’s study of the biomedical treatment of 19th-century hermaphrodites—people now called intersexed—brought her to the attention of intersex activists. She was stunned to learn from them that some modern medical practices made 19th-century responses appear relatively benign. Not only have modern doctors practiced some fairly extreme cosmetic surgeries on babies born with ambiguous genitalia—including amputating clitorises deemed too large and penises and testes deemed too small—they also encouraged parents to keep this history secret from their children. The goal was to make these babies look and feel like standard little boys or girls.

Naively, many doctors assumed that all would be well, physically and psychologically, after these babies were assigned a gender that matched their postsurgical selves. Some babies slipped through the medical net only to be caught as adults. Dreger tells the story of one man who called her in a panic after a doctor discovered he had ovaries and a uterus and wanted to operate in order to turn the man into a woman. Dreger responded, “I don’t let my ovaries tell me what to do. I don’t think you should let your ovaries tell you what to do.”

Few of the babies who had their sex assigned through surgery were followed into adulthood to see if all was well. And Dreger writes convincingly about how all was not well. Some did not identify with the gender chosen for them; many dealt with ongoing physical issues as well as psychological issues such as shame, a side effect of the secrecy surrounding what had happened and why. Not surprisingly, many of those most affected began fighting to end surgeries that were not medically necessary. In the mid-1990s one such activist asked Dreger to marshal historical and medical evidence in an effort to persuade doctors to abandon these procedures. That was the beginning of Dreger’s life as a scholar-activist working at the intersection of science and human identity.

Underpinning Dreger’s work is the belief that evidence-based science and scientists will eventually triumph over the obstacles in their path, whether they be ideologically driven opposition, sloppy research, or the politics of the day.

A decade later Dreger was pulled into a new controversy centered on gender. In this case, though, she found herself pitted against activists in defense of a researcher with controversial ideas about transgender issues. A deep sense of being a woman trapped in a man’s body is a common complaint among individuals transitioning from male to female; this sense of physical misidentification compels many to match their external appearance to their internal identity. But Michael Bailey, a psychologist who studies transgender issues, argued instead that some males transitioning to females are motivated not by gender dysphoria but by a love of the female version of themselves, a distinction I’m not sure I fully understand.

In her case study on Bailey, Dreger found that identity politics were driving the attack rather than any significant lapses in Bailey’s research. Bailey’s opponents saw their own identities as under attack and responded by attacking Bailey himself and his identity as a scholar, accusing him of practicing psychology without a license and of doing research without ethics-board approval. Dreger describes how her defense of Bailey drew a sustained attack by some transgender activists, including personal threats, accusations of unethical behavior, and even the filing of ethics charges with her university.

The work of Bailey and other researchers Dreger has helped intrudes, often uncomfortably, onto our understanding of ourselves and our place in the world. If there is a common theme to be pulled from the case studies in Galileo’s Middle Finger, it is the rejection of simple dualisms when it comes to human identity, whether it’s good versus evil, nature versus nurture, or male versus female. The world and its people are too complicated to be put into one of two boxes.

In 2009, after Dreger had been awarded a Guggenheim Fellowship to study conflicts between activists and scientists, I asked her to write something for a publication I edited for the History of Science Society. What she provided was an early version of a small section of Galileo’s Middle Finger focused on Bailey’s research, his trials and tribulations, and her own resulting tribulation. Through her writing I learned what scholar-activists do: they write and publish papers that will be read by those they wish to influence; they form alliances with like-minded activists and scholars; they give talks; and they regularly run into trouble.

Since then Dreger has worked to help academic casualties of culture wars, people who have run into trouble in fields where empirical data are collected, analyzed, and interpreted. These multiyear projects have included trying to rehabilitate the reputation of Napoleon Chagnon, a well-known quantitatively inclined anthropologist who studied the evolutionary drivers of culture and behavior among the Yanomamö Indians in the Amazon rainforest. Chagnon found that the more violent a Yanomamö tribesman, the greater his reproductive success, a conclusion that unsettled many of his peers. His career was destroyed in the early 2000s by accusations that he had deliberately caused an outbreak of measles among his subjects in 1968, incited violence, and withheld medical care. While the accusations appeared in a book written by a freelance journalist, support for the attack had come from rival anthropologists who fiercely opposed Chagnon’s biology-focused approach to anthropology. Support for Chagnon, though not necessarily his theories, quickly came from other academic organizations, including the National Academy of Sciences, sociobiologist E. O. Wilson, and a few historians of science who dug up evidence debunking most of the accusations.

Despite this support Chagnon was essentially forced into exile. Why? The plausibility of the attack on Chagnon and the scholarly façade of the book, with its heavy footnoting. Or, as Dreger puts it, “Make it so unbelievable that people have to believe it.” Indeed, I found some of the tales in Dreger’s book so strange that I went searching for verification and further information to convince myself of their reality.

Of course my own biases intrude when it comes to understanding human nature. I want culture to be more powerful than genes in shaping human behavior. But what any of us want should be irrelevant. Unfortunately, that is not the case when righteousness stands in place of argument and trumps evidence. No doubt the academics who helped bring Chagnon down thought they were doing the right thing for science.

Some of the researchers’ conclusions discussed in Dreger’s book will likely turn out to be wrong; it is, or at least it should be, the job of those who patiently and often boringly accumulate data to destroy received wisdom as well as add to the scientific edifice. If we stop scientists from doing their work, we stop science in its tracks. In doing so we might find ourselves in a true scientific dystopia where beliefs rather than data get to define what is acceptable science.

Dreger does not expect researchers to be free of bias or ideology. But among the potentially toxic mix of politics, beliefs, and loyalties, she expects them to have “tried to adhere to an intellectual agenda that wasn’t first and only political” and to know that “good science [cannot] be done by just Ouija-boarding your answers. Good scholarship [has] to put the search for truth first and the quest for social justice second.”

The rise of the Internet has been a double-edged sword in fighting bad science: publicity can act as a disinfectant to the creeping fungus of bad behavior, but the Internet can also speed the propagation of untruths. The financial evisceration of the Fourth Estate has diminished both ability and appetite for in-depth investigations. Trigger warnings on university campuses for any material that might challenge or offend students succeed only in leaving them to the cozy embrace of their own certainties. Dreger offers peer review as the solution to such academic groupthink, an ideal she calls “the genius of science” that relies on the “light of many minds.” While Dreger presents peer review as an ideal, her solution appears overly optimistic. New biases and ideologies will arise to displace the old and will, in turn, be fought.

The last few chapters in the book come full circle, to the treatment of babies who might be born intersexed. Whereas in earlier chapters the response of those not involved in the controversy was that the scholars under siege must have been guilty of some bad behavior to justify the treatment they received, in this last case study the inverse applied.

Congenital adrenal hyperplasia (CAH) is a genetic condition in which the adrenal glands produce too little of the hormone cortisol and too much in the way of androgens, hormones that govern male characteristics. In genetically female fetuses, increased androgen levels may or may not produce a range of intersex conditions. Dreger tells the story of Maria New, a highly respected pediatric endocrinologist who has tried to prevent the masculinization of female fetuses by offering the synthetic steroid dexamethasone to newly pregnant women who (along with their partners) are carriers of CAH. Given that in the first few weeks of pregnancy it is too early to tell the sex of a fetus, let alone whether it has inherited CAH genes from both parents, the drug treatment is likely to help only one in eight fetuses, on average. Furthermore, lab-based studies of exposure in primates showed the drug could change fetal development in unpredictable ways.

In late 2009 some clinicians and allies from Dreger’s earlier intersex work called her with their worries about the dexamethasone treatment. Maria New has described her treatment as safe and effective, despite the lack of any rigorous studies done to see if intersex prevention using dexamethasone worked in laboratory animals, let alone humans. Swedish researchers had found enough to worry them in a study of children exposed to dexamethasone in utero that they stopped the study. Dreger and others saw worrying parallels to diethylstilbestrol, a synthetic hormone given from the early 1940s until 1971 to pregnant women to prevent miscarriages: in 1971 researchers discovered that the drug increased cancer risks in female offspring.

Since the 2000s Dreger and others have succeeded in persuading many doctors that surgery on intersexed babies should be done only for medical reasons, never for cosmetic concerns. For Dreger, New’s approach is a step back in time in terms of gender stereotypes: not only is New trying to prevent cosmetic intersex conditions in genetic females; she also is offering parents what might be described as a form of sexual engineering, which quite apart from preventing masculinization might also help prevent tomboy tendencies and even lesbianism, as she has claimed.

Maria New, with the best of intentions, is trying to simplify the external world, to make it match her internal sense of how the world should be. In this she is no different than the doctors who felt they were helping babies and parents by changing a child’s anatomy to meet society’s expectations, or those who set out to ruin Chagnon’s reputation because they believed his research on human behavior to be not only wrong but dangerous in its implications. While Chagnon was eventually vindicated and elected to the National Academy of Sciences in 2012, those trying to stop dexamethasone treatments failed. To the dismay of those who view such treatments as reckless fetal experimentation, it continues by means of an FDA regulatory loophole that shows no sign of being closed.

But change for the better is possible, Dreger says, and she offers an example in the form of a high-school girl described as a “pretty, Christian, cheerleader type” who talked openly about discovering that her cells contained a Y chromosome. Her doctor had spoken honestly with her and put her in touch with other people like her. The result: she did not feel the shame and fear commonly felt by the earlier generation of intersexed people. In this case and others like it, the world has become a more open-minded place because of attention to evidence.