Anger at Trump, Anger at Americans

On CBC radio on Canada Day, the co-host of the “Canada Day in the Capital” special from Ottawa interviewed Adrienne Clarkson, Canada’s Governor-General from 2000 to 2005, introducing her as someone who embodied the essence of Canada perhaps better than any other individual. Most of what Clarkson said was the sort of bland platitude one expects on such occasions. There was one notable exception—when Clarkson was asked to comment on America, and Americans. You could hear an edge come into her voice as she asserted that Americans are “too dumb” to even try to understand Canada.

She didn’t say that Trump is “too dumb….,” or even that “Trump voters are too dumb….” She said “Americans.”

The interviewer seemed to take that comment as unexceptionable—all in the spirit of Canada being “elbows up” against Donald Trump’s tariff and annexation threats.

Imagine the reaction if Clarkson had said that Chinese people are too dumb to even try to understand Canada. Or if she’d said that Nigerians are too dumb to even try to understand Canada. She would have been met with appropriate outrage.

At the moment in Canada, it seems that almost any level of anti-Americanism is given a pass.

A new Pew survey reports that the same percentage of Canadians (34%) have “a favorable opinion of” China, while exactly the same percentage have “a favorable opinion of” the US. When asked the same question in 2024 only 21% had a favorable opinion of China, while 54% had a favorable opinion of the US. Does the US deserve to be regarded so unfavorably? Even those who are staunch opponents of the Trump regime and all it stands for—as I certainly am—should surely recognize that the United States remains a democracy. It’s a democracy under very serious threat, to be sure, but a democracy it remains. Compare it with China, which has never had free and fair elections, which tightly controls almost all aspects of its citizens’ lives, which flouts international law with impunity, and which has confined over one million of its people in internment camps. Or compare it to Russia under Putin.

A just-released Nanos Research poll reports that, when asked “Which of the following feelings best describes your views towards Americans?”, 24% of Canadians chose “anger.” Again, this is not Canadians' feelings towards Donald Trump or towards the Trump administration; it’s Canadians’ feelings towards Americans.

It’s worth doing the math here. In the 2024 American election, 65.3% of the voting-age population actually voted. Of these, 49.81% voted for Trump. That means that 67.5% of voting-age Americans did not vote for Trump in the 2024 election.

A very great many of those 67.5% feel as much anger towards the Trump administration as do Canadians.

I would argue that, much as anger towards Trump and his administration is appropriate, we should do everything we can to rein in feelings of anger towards those who voted for him; in the long run, I think we’re well advised to try to keep open the lines of communication with the United States—and with Americans of all stripes—even when the American administration is as antagonistic as is that of Donald Trump. (I’m buying far less that’s “made in America” these days, but I haven’t given up travelling to the US and talking to Americans.) But even those Canadians who don’t want any contact with anyone who voted for Trump and/or who have decided to protest what the Trump administration is doing by renouncing travel to the US should surely recognize that all Americans do not deserve our condemnation.

Katharina Rout's edition of All Quiet on the Western Front

A few months ago we at Broadview Press published Katharina Rout's extraordinary edition of Erich Maria Remarque's All Quiet on the Western Front--a new translation that's been described as "informed, gritty, and evocative" and as "far more accessible" than earlier translations. Rout's translation seems to me to be far better not only than the decades-old competitors but also than the one other new translation--and the Rout edition includes a superb introduction and over 100 pages of fascinating historical documents. I put the case for the Rout edition forward early this year in a letter to The Atlantic responding to their review of a competitor--a review that did not mention the new Broadview edition.

In his article on Remarque’s All Quiet on the Western Front (“The Warrior’s Anti-War Novel”), George Packer compares the new Kurt Beals translation from Liveright with the “frequently stilted and labored” A.H. Wheen translation from 1929, using a passage from just after the Kaiser has inspected the troops as an example. He gives the Wheen first:

Tjaden is quite fascinated. His otherwise prosy fancy is blowing bubbles. “But look,” he announces, “I simply can’t believe that an emperor has to go to the latrine the same as I have.”

Here is Beals’ translation:

Tjaden is completely fascinated. His mind isn’t usually so lively, but now it’s bubbling over. “Look here,” he announces, “I just can’t fathom that a kaiser has to go to the latrine just like I do.”

Packer is on solid ground in rating Beals’ translation over that of Wheen. But he may not have known when he was writing the article that there is another brand-new translation of Remarque’s great novel; Katharina Rout’s translation was published in a Broadview Press edition 9 October 2024 in Canada, and 1 January 2025 in the United States—the day on which the German original entered the public domain in America. Rout’s (already widely praised) translation aims to be “blunter and more pared down” as well as more accurate than earlier translations. Here is how she renders the same passage—using just 30 words, compared to Beals’ 36 and Wheen’s 33:

But Tjaden remains enthralled. His usually barren imagination is getting all worked up. “Look,” he announces, “I really can’t believe that the Kaiser must use the latrine just like me.”

Rout includes in her edition over 100 pages of historical background materials—among them a number of documents that have never before been available in English.

Our marketing team at Broadview has had a frustrating time getting the word out to the general Trade market about Rout's great new edition. The Atlantic was not the only major publication to have been fully informed about the book, only to ignore it in a review; a reviewer for the Wall Street Journal asked for a review copy after he'd been informed of the publication of the Rout translation--and then wrote a review of the competitor without ever mentioning the existence of the Rout translation. And Amazon, which is almost always bad at listing new editions of classic works correctly, has in this case been even worse than usual. At first Amazon didn't list the edition at all, and then, after endless efforts by our marketing team, they listed only the kindle edition--https://www.amazon.com/All-Quiet-Western-Front-Broadview-ebook/dp/B0DM9R7LDC. If you'd like a copy of the book, I'd highly recomend you order through your local bookstore--or direct from Broadview (https://broadviewpress.com/product/all-quiet-on-the-western-front/#tab-description). Broadview has published over 1,000 books in its 40 years; I don't think there's any question that this is one of the best--as well as one of the most important.

Letter to the New York Times: Alzhiemer's and a Whole-Foods, Plant-Based Diet

Back in late January I sent the following letter to The New York Times:

Charles Piller (“The Devastating Legacy of Lies in Alzheimer’s Science,” Jan. 24) writes that “despite decades of research, no treatment has been created that arrests Alzheimer’s cognitive deterioration, let alone reverses it.” The key word here is “created”; it’s quite true that researchers have not succeeded in creating new drugs that make a substantial difference. But a growing body of research suggests that lifestyle changes—in particular, adopting a whole-foods, plant-based diet—can make a substantial difference, not only in helping to prevent Alzheimer’s but also in many cases to arrest and even to reverse effects of the disease. The pharmaceutical industry has a great deal invested in persuading us that expensive drugs are the answer for health problems; in this area as in many others, lifestyle changes may be far more beneficial than expensive drugs.

The research is not dubious, Robert F. Kennedy Jr.-style medical research; it's for real. If you're interested, you can find out more online on sites such as nutritionfacts.org and the Physicians Committee for Responsible Medicine site (https://www.pcrm.org/health-topics/alzheimers). Or, if you'd like to check out some of the original research, here are some places to start:

Dean Ornish et al., “Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer's disease: a randomized, controlled clinical trial,” Alzheimer's Research and Therapy, June 2024 https://pubmed.ncbi.nlm.nih.gov/38849944/ (“Comprehensive lifestyle changes may significantly improve cognition and function after 20 weeks in many patients with MCI or early dementia due to Alzheimer’s Disease”)

Alzbeta Katanova et al., “Effect of a Vegan Diet on Alzheimer’s Disease,” International Journal of Molecular Science, November 2022 https://pmc.ncbi.nlm.nih.gov/articles/PMC9738978/ (“There is evidence indicating that a vegan diet could be beneficial in the prevention of neurodegenerative disorders, including Alzheimer’s disease”).]

Letter to the Globe: Zoos

Marsha Lederman had written a good column about elephants in zoos. My letter to the Globe made an obvious point following up.

Re “Why are we still keeping elephants in zoos?” (March 22): Marsha Lederman writes movingly and well about “the suffering of animals, particularly from human causes”—and in particular about “a mother and her calf being separated.” “Why are we doing this?” she asks. Why indeed? And why, on so-called “farms,” are we still separating calves from their mothers so that we can drink the milk meant for the calves? Zoos are horrific places for non-human animals; factory farms (including dairy and egg operations) are far, far worse. A whole-foods, plant-based diet is better for our own health and better for the planet as well as infinitely better for other animals.

Letter to the Globe: Leaders' Debate Eligibility

There was a bit of a fuss during Canada's recent election campaign over the decision to exclude the Green Party from the leaders' debates. The Party had not met either of the percentage-related criteria set out by the Leaders' Debates Commission--the party's candidates for the most recent general election (2021) had not received at that election at least 4% of the number of valid votes cast; and neither, when the 2025 general election was called, had the party received "a level of national support of at least 4%, determined by voting intention, and as measured by leading national public opinion polling organizations, using the average of those organizations' most recently publicly-reported results." But in between those two points in time, the party had often polled above 4%. This was the letter that I sent to the Globe (and that it published April 21, under the heading "Fair Play"):

Re “Green Party says it is being silenced after commission disinvites it from leaders’ debates” (April 17): The current rules take no account of polling fluctuations over time. It would be fairer if parties that have polled over 4% at any time since the previous election be allowed to take part. Under those rules, both the Greens (which have often polled above 4% since the 2021 election) and the People’s Party of Canada (which polled above 4% in the summer of 2022) would have met the polling criterion. Perhaps small parties should be allotted less time than the larger parties to make their case—but allowing them at least some time to make their case surely serves the interests of democracy.

Letters to the Globe: Supply Management

Canada's system of supply management, which protects farmers and smooths out prices in the egg, dairy, and poultry industries, has been the subject of considerable recent controversy. It keeps prices artificially high. It's not equitable; the majority of Canadian farmers do not enjoy the protection of supply management. And, as recent Order of Canada recipient and former civil servant Don Campbell pointed out recently on CBC Radio (The Current, July 10), it's bad for the economy as a whole:

We are a pariah on the international scene. This is not just a United States issue. This is an issue with the Europeans, it's an issue with the Australians, it’s an issue with the New Zealanders, it’s an issue with everyone. And what we are prevented from doing by virtue of our system [is] exporting. Canada should be one of the top three dairy product exporters in the world. Instead, we're comfortable in a declining market in Canada. We're now down to less than 10,000 dairy farmers. There were 140,000 dairy farmers in 1940. I remember a long time ago, the Canadian head of the National Retail Council said, do you realize there are more bureaucrats involved in supply management than there are farmers? And I think there's a certain truth to that.

The main issue here for people like me is of course the way in which the animals who are at the heart of these industries are treated--and to my mind, any solution to the problems must involve addressing the issue of cruelty to animals.

I have long argued that removing supply management and instituting much higher cruelty-to-animals and environmental standards in Canada would lead not just to better conditions for the animals but also to indutries that were economically healthier. Animal-cruelty and environmental legislation for farms in the USA tends to be even more lax than it is in Canada, but there are many consumers in the US who are willing to pay more for eggs, poultry and dairy products that are produced with less cruelty and less harm to the environment. Demand for free-range eggs in the US, for example, far exceeds the supply. If all the egg, poultry, and dairy products produced in Canada had to meet a higher standard, we would surely be able to export more Canadan-produced products, while the US industry would be unable to meet the standards required in Canada, and thus unable to flood our market with cheaper products. The current high prices could be maintained, but the animals as well as the farmers would be receiving some protection. (If it were deemed that abandoning supply management would increase the cost of living for low-income Canadians, a "protein income supplement" could be introduced as an amount added to current payments to low-income Canadians. If so, however, it should be made clear that the supplement could also be used to buy tofu or "Impossible" burgers or vegan "cheeze" or vegan ice "cream" or oat milk. And the change could (and should) be accomoanied by a campaign aiming to make more people aware of the availability of other, reasonably priced protein-rich products (chick peas, lentils, kidney beans, etc.).

In any case, here are the letters on this issue I've been sending recently:

Re “Sacred Cow” (April 4): Gordon Pitts makes it sound as if New Zealand’s dairy industry is largely unregulated, and that climate is the key to the industry’s success: But it’s not climate that ensures New Zealand cows’ welfare. It’s legislation—legislation that sets higher animal welfare standards than anywhere else in the world (among many other things, requiring dairy farms to provide cows with shelter from the elements—yes, even in New Zealand there is inclement weather).

If Canada ever does decide to move away from supply management and encourage an “export mentality” for the dairy industry, we would be wise before doing so to ensure that Canadian cows are treated at least as well as those in New Zealand. People will pay more for dairy products from a country that they know enforces high safety and animal welfare standards.

Re “How to crack open Canada’s egg market” (June 21): No mention is made in this long editorial of the central fact about egg production: the eggs that humans eat are made not by industrial machines but by living creatures—birds that are horrifically treated throughout their short lives in almost all commercial egg operations, in Canada as in the United States. A humane set of policies regarding egg production would require all eggs sold in Canada to come from farms where egg-laying birds are truly treated well. But the notion that cruelty to animals should be addressed seems not to have occurred either to our federal or our provincial governments, any more than it has to the industry.

Re “We must protect supply management from the trade war” (July 16): The authors are appropriately sensitive to the plight of farmers, arguing rightly that, if we do abandon supply management, we should be prepared to help those farmers who find they cannot compete, so that they can “make new lives.” Yet the authors express no sensitivity whatsoever to the plight of the non-human animals involved. Indeed, they do not even acknowledge their animal nature; “each cow,” they write, “is effectively an investment that pays a dividend in milk.” No, it isn’t. Each cow is a living, breathing creature—and, under our current agricultural system, one that endures extraordinary suffering.

Regardless of whether or not we replace supply management, our laws regarding cruelty to animals need to be rewritten so as to include farm animals.

The Globe didn’t print any of these three, but I was pleased to see that it did print in its June 26 issue two responses to the June 21 editorial. In one letter, P.J. Nyman of Toronto writes about how Canada’s supply management system “keeps hens locked in cages by stalling progress on animal welfare. While nearly half the U.S. egg market is now cage-free, Canada is lagging far behind for the tenth year in a row. Canadian grocery retailers once pledged to sell only cage-free eggs by 2025, but our supply management system hinders this progress, keeping hens in outdated cages with no more space than a single sheet of paper each.” In a second letter, Jane Harris of Vancouver points out that the supply management system “was initially devised to protect small farmers but has evolved into one that enables and enriches large industrial operations (which no longer can even be called farms) where millions of birds are crammed into cages, can barely move and never see the light of day. It is the small number of true farmers who humanely raised “free range” laying hens that now deserve to be protected.”

Less Heat, More Light

I sent off this letter to The Globe and Mail last weekend:

Re “There’s no place for politicians in the medical exam rooms of the nation” (July 7): Katharine Smart condemns Alberta’s proposed restrictions on puberty blockers, hormone therapy, and “top surgery” for minors. She argues with the Canadian Medical Association that minors, like other patients, should be allowed “to make the best decisions for their own health,” and asserts that such treatments help young people “thrive.”

Smart does not address the arguments of any of the authoritative recent studies from countries such as Sweden, Denmark, Finland, Britain, and Australia that have concluded the opposite: that the potential harms to minors from such treatments outweigh the benefits. In its unquestioning acceptance of “gender affirming care” for minors, Canada is quickly becoming an outlier.

I’m neither a doctor nor a researcher, but I do know that ignoring the case your opponents have made does not make it go away.

It’s a letter I’d like to expand on; I’ll do that now.

To be fair to Smart, her piece is an op ed column, not a full-length article; this is a hugely complicated issue, and she could not possibly have addressed everything that’s in dispute. But she could at least have acknowledged that a great deal is in dispute, and that numerous reputable medical associations and government authorities elsewhere in the world now take a stance that is very different from that taken by most Canadian and American medical associations.

None of the authorities elsewhere in the world, thank goodness, has adopted the anti-trans tone of hostility that is the norm among the many Republican lawmakers in the US, who aim to ban outright all these treatments for minors. On the whole, countries such as Sweden, Denmark, Finland, Britain, and Australia are taking a nuanced approach--but they are putting legal restrictions in place for patients younger than 18. Sweden, for example, restricts the use of both hormone treatments and puberty blockers for those younger than 18 to very rare circumstances, while banning transition-related surgery* before the age of 18; Britain allows hormone treatments for minors while banning puberty blockers and transition-related surgery before the age of 18. In short, authorities in these nations and others have been significantly restricting access to these treatments for minors. And in these and many other countries, there continues to be a lively debate as to the benefits and/or harms of these treatments.

In their unquestioning acceptance of “gender affirming care” for minors, then, Canadian and American medical associations do indeed seem increasingly to be outliers.

It’s not only the treatments themselves that are under scrutiny; claims that teens are more likely to commit suicide if they are denied these treatments are also now widely disputed.

These studies come from accredited researchers; they’re not the product of anti-trans or anti-science zealots. Nor do the governments that have in recent years restricted such treatments for minors (in ways similar to those proposed by Alberta) in any way resemble the Trump administration, with its appalling willingness to allow anti-trans discrimination in employment, in military recruitment, and in other areas.

You don’t have to go to right-wing media outlets to find out about this research; it’s been widely reported on in centrist or center-left media outlets such as The Globe and Mail, The Atlantic, The Economist, The Washington Post, and The New York Times.**

Strikingly, various organizations that unquestioningly support providing these treatments to minors have focused their attacks not on Republican lawmakers or on Fox News and other right-wing media outlets that have clearly provided biased coverage, but rather on The New York Times. GLAAD.org, for example, has run advertisements calling on the Times to “stop questioning trans people’s right to exist and access to medical care.” As you might expect, The New York Times has in fact never questioned trans people’s right to exist, and nor, except where children and teenagers are concerned, has it ever published anything suggesting that trans people should ever be denied any of these treatments. Indeed, the Times has been an outspoken defender of transgender Americans (see, for example, the Feb 9, 2025 lead editorial, “Trump’s Shameful Campaign Against Transgender Americans”). And the Times, it should be added, has also given a considerable amount of space to those who argue that minors’ access to treatments such as hormone therapy, puberty blockers, and transition-related surgery should not be restricted by any laws. (See, for example, Lydia Polgreen’s extended article criticizing Britain’s Cass Report, published in the Times under the headline, “The Strange Report Fueling the War on Trans Kids” [August 13, 2024].)***

Organizations such as GLAAD seem eager to paint anyone who does not share their position 100% as transphobic; the insults and misrepresentations at the other extreme are even worse. Republican Senator Roger Marshall of Kansas, for example, has introduced in Congress a bill titled the “Safeguarding the Overall Protection (STOP) of Minors Act.” Couched in incendiary language (“castration procedures,” “gender mutilation procedures”), it would prohibit all forms of youth gender transition treatment at any stage. Such treatments, Marshall claims, are part of “the Left’s dangerous transgender agenda. Let’s call it exactly what it is: child abuse.”

Let’s set that sort of hysteria to one side and return to the arguments made by Katharine Smart. There are three of these. The first is an appeal to authority; she cites various associations in North America that support such practices. But one can appeal to other associations and other authorities; neither Sweden nor Britain allows transition-related surgery to be performed on patients under the age of 18. Are the North American medical associations right about this, or are Sweden and Britain right? Again, I just don’t know. Smart and the Canadian Medical Association may well be right. But I certainly think it’s possible that Sweden and Britain are right—and that the policies Danielle Smith and her Alberta government have adopted on this issue in Bill 26 may eventually be acknowledged everywhere to make more sense than those recommended by the CMA.

Raising even the possibility that Danielle Smith and her government might eventually be acknowledged to have been right about anything may in itself seem objectionable to some readers. And I can understand that. I’ve disagreed with just about everything Danielle Smith has done and has stood for since she entered politics, from her gung-ho support of the oil and gas industry and her discriminatory policies against solar and wind energy to her recent move to remove books with sexual content from school libraries.

But I think it’s vitally important—at any time, but perhaps more than ever in times as polarized as our own—to be open to the possibility that people whose political orientation is entirely different from our own can sometimes make the right decision, or do the right thing. I disagreed with just about everything George W. Bush stood for when he was the American president, but I thought then and I think now that he deserves considerable credit for launching the Emergency Plan For AIDS Relief in 2003. I disagreed with just about everything Donald Trump stood for during his first term as American president, but I thought then and I think now that he deserves considerable credit for his Operation Warp Speed initiative to develop vaccines quickly in 2020.

I disagree as well with the rest of what’s included in the Smith government’s Bill 26 (the other provisions of which include giving parents a veto on whether or not their children receive sex education in school, and giving parents a veto on their 16- and 17-year-old children choosing their own pronouns in school). But when it comes to the bill’s provisions regarding hormone therapy, puberty blockers, and gender-transition-related surgery (provisions that would prohibit hormone therapy and puberty blockers for patients 15 and younger, and prohibit mastectomies and genital surgery for those under 18)--I’m just not sure. Given what I’ve read of the recent research and of the stances taken in countries such as Sweden and Britain, I think there’s at least a chance that the Alberta government--a government whose policies I detest in just about every other area--may have gotten it right in this one area. Certainly Katharine Smart’s argument from authority, citing only those associations that have approved all these “gender affirming treatments” for teenagers and ignoring those that haven’t, fails to convince.

What of Smart’s other arguments? One of these is an argument from personal experience. Smart speaks of how carefully she listens to her patients, and of how she prescribes hormone therapy or puberty blockers to "only a small minority" of her under 18 patients; she attests from her experiences with her own patients that, "for the youth who do receive" those treatments, it's often transformational." There's no reason to doubt any of this. But one can accept Smart's anecdotal evidence in its entirety and still have doubts as to whether the course she recommends is the best way forward. Even from this one column one can infer that she is an extraordinarily caring, sensitive, and conscientious physician. Reports from other quarters, though, have made clear that Smart's approach is not always followed by others; some teenagers have been put on hormone therapy or puberty blockers with barely any questioning having been conducted. And other reports have made clear that, for some, gender-transition treatments at an early age have not been "transformational"--or at least, not transformational in a positive way. Certainly the personal experience of one physician with her patients--no matter how positive--should not be taken as conclusive.

Smart's third argument is one of overarching principle; she argues that medical matters should be between “the doctor and their patient. Full stop.” She ends by warning of a slippery slope, suggesting that if the Alberta “precedent is left to stand, the care and treatment that you need may be next.”

But do we in fact as a society accept that all medical matters should be entirely left up to the doctor and the patient? For most medical matters, we do indeed accept it. But what of a Jehovah’s Witness teenager who is adamant that they do not want a blood transfusion? In Quebec in 2017, a court decided that a health center should be allowed to give a 14-year-old blood transfusions, against her own wishes; the judge ruled it lawful to protect patients against their own wishes when a decision had the potential to irreversibly alter the patient’s life. Many Jehovah’s Witnesses would I’m sure argue that, when psychological and spiritual health are taken into account, blood transfusions do not have any health benefit—and some doctors who are also Jehovah’s Witnesses would surely support that view. What of the practice of female circumcision (aka “female genital mutilation” or “female genital cutting”)? In Canada and in many other countries of the world we agree that the practice has no health benefits; many in Somalia, Egypt, and Saudi Arabia would I’m sure disagree—including many doctors and many young women.

I should make clear that I am not defending the Jehovah’s Witness view of blood transfusions or the horrific practice of female genital mutilation. I raise these examples merely to show that our society does not in fact accept that all medical matters “should be between the doctor and the patient. Full stop.”

Why are these issues so important? They’re important, first of all, because they affect the mental and physical health of a significant number of young people. It’s vitally important that we do everything we can to get it right when it comes to the question of what practices are likely to give those young people the greatest benefit and/or cause them the least harm. But it’s also important simply because it’s become such an inflammatory issue in so much of the world—and one that, rightly or wrongly, has become tightly entwined for many people with overall political and ideological orientation. The level of hostility—and the impulse to shut down reasoned debate—is staggering. On the left, it’s become common to label those who advocate any level of caution in gender therapy for minors as transphobic. On the extreme right, it’s worse; people such as Daily Wire host Michael Knowles call for the eradication of “transgenderism”: “For the good of society,” Knowles declared in 223, “transgenderism must be eradicated from public life entirely—the whole preposterous ideology, at every level.”

In such a climate, it’s understandable that many have become scared to voice an opinion—even an opinion as tentative as this sounds like an area in which more research needs to be done. Some conservatives have been scared of being condemned by the likes of Senator Marshall and Michael Knowles if they do not sound off viciously against trans rights generally. Not a few on the progressive left have been scared of being condemned by the likes of GLAAD.org if they raise questions as to the appropriateness of hormone therapy, puberty blockers, or surgery in the context of “gender affirming care” for minors.

Clearly these are difficult issues, and extraordinarily complicated ones; conducting the necessary research is fraught in all sorts of ways. But we need that research to be conducted—and lowering the temperature of public discourse will surely make it easier for that to happen. We need less heat, more light. Much as I may doubt her conclusions, Katharine Smart is clearly one who aims to bring light rather than heat to these controversies; this blog post is written in the same spirit.

*In rejecting Alberta's approach, Smart does not specifically mention transition-related surgery, though that is very much one of the foci of the Alberta legislation. Most defenders of unrestricted "gender affirming care" for minors have little to say about the practice of performing mastectomies on minors who want to transition, other than to say that the practice is very rare. Perhaps so; frustratingly, neither American nor Canadian official statistics are available. In the United States, the news agency Reuters conducted its own study several years ago and reported that in a three-year period, 2019–2021, 776 people younger than 18 had had mastectomies in connection with gender dysphoria. In Canada, the National Post reported in 2023 that over 300 Canadians under the age of 18 had undergone such treatment. No one knows the totals in 2025—but no one denies that such surgery has been legally unrestricted in most North American jurisdictions, and that it does continue to be performed on minors. Given that some at least who have transitioned as teenagers later come to regret their decision and want to detransition, and given that a double mastectomy is not reversible, it is hardly surprising that such surgery has become highly controversial.

**See, for example, these articles: Emily Bazelon, "The Battle Over Gender Therapy: More teenagers than ever are seeking transitions, but the medical community that treats them is deeply divided about why — and what to do to help them," The New York Times, March 17, 2023; Pamela Paul, “As Kids, They Thought They Were Trans. They No Longer Do,” The New York Times, Feb 22, 2024; Nicholas Confessore, How the Transgender Rights Movement Bet on the Supreme Court and Lost, The New York Times, June 19, 2025; Helen Lewis, “The Liberal Misinformation Bubble About Youth Gender Medicine: How the left ended up disbelieving the science,” The Atlantic, June 29, 2025; Robyn Urback, “Trans youth deserve better,” The Globe and Mail, April 26, 2024; “America should follow England’s lead on transgender care for kids,” The Economist, April 10, 2024; Alex Byrne, “I co-wrote the anonymous HHS report on pediatric gender medicine: The hostile reaction to our work shows why we needed to do it in the first place,” The Washington Post, June 26, 2025; “A landmark study of gender medicine is caught in an ethics row,” The Economist, 30 April, 2025.

***The Times also ran a selection of letters responding to the article ("The Cass Report: Biased or Balanced?", Sept. 1, 2024), and published over 800 comments on its website. To me, a letter from Gerald Ryan, of Madison, Wisconsin, was among the most persuasive. Let me quote from it here:

I am a retired physician who, as the medical director of a major university, instituted the provision of gender-affirming medications at our health facility, so I hold no bias against the appropriate use of these treatments. I found Dr. Hilary Cass’s report to be informative, well researched and balanced.

I think many would be surprised to learn that the movement toward expanding gender-affirming medication for children is based largely upon a couple of small studies by researchers in the Netherlands that utilized strict inclusion criteria for their cohorts.

Most current treatment guidelines on the use of these interventions stem from the collective opinion of experts in the field. This opinion alone, though helpful, is a shaky foundation for the initiation of sometimes irreversible procedures.

Dr. Cass is simply stating that the science of gender-affirming care for children and adolescents is very much in its infancy and its usage requires thoughtful deliberation until we know enough to make conclusive recommendations.

**** Appallingly, anti-trans extremists such as Senator Marshall conflate surgery to address gender dysphoria with the practice of surgically suppressing female sexuality through surgery; they use the term “female genital mutilation” to refer to gender-identity-related breast and genital surgery.