MacDonald Laurier Institute
Are gender interventions helpful? First do no harm!: David Zitner for Inside Policy
From the Macdonald Laurier Institute
By David Zitner
Canadian public health bodies are lagging far behind peer nations in calling for evidenced-based approach to gender-affirming care.
Public health bodies in Europe and the United States are sounding the alarm, calling for serious research into the safety and benefits of youth gender transition interventions. On August 12, the American Society of Plastic Surgeons became the first major US medical association to challenge the consensus of medical groups over “gender-affirming care” for minors.
Meanwhile, systematic reviews of evidence conducted by public health authorities in Finland, Sweden, and the United Kingdom concluded that the risk/benefit ratio of youth gender transition ranges from unknown to unfavourable.
According to a US study, each stage of gender affirming treatment – social affirmation, pubertal blockade, administration of cross-sex hormones, and sex reassignment surgery – poses harms and risks that are not fully disclosed to minors and families.
Regulators in Europe and the UK have already reacted accordingly, with more emphasis on psychosocial support over medical interventions.
Canadian regulators, on the other hand, have been mum on the need for evidence-based treatment and they have not even insisted that proponents of aggressive treatments track the long-term physical and mental health outcomes of gender-affirming interventions.
Doctors and parents trying to support children with gender issues are faced with important, sometimes conflicting, moral and ethical dilemmas as they try to help distressed children while avoiding harm.
For most established treatments across the various areas of medicine, researchers have studied the chances and types of benefits and harms, the research is accessible, and patients can choose based on their own values and subjective assessment the anticipated benefits and risks. It is entirely different for those who consider gender-affirming interventions.
Parents acting as agents for children with gender identity issues are in a particularly desperate situation because of the absence of reliable research identifying those children who will someday detransition. Too many parents will likely feel deeply aggrieved when they realize that what might have been a passing fancy of childhood or adolescence produced permanent, irreversible harms.
In pursuing gender-affirming care, doctors and parents simply cannot avoid harm because the evidence is insufficient to identify those who might benefit from aggressive therapies and those who will be harmed.
Unfortunately, this absence of reliable scientific research does not prevent people, including Canadian regulators, from expressing strong opinions in favour of aggressive gender interventions.
Some adolescents experience gender fluidity and uncertainty as they grow. From time to time, a person might change how they feel, expressing their identity one way and subsequently another. Such persons might dress and accept the identity compatible with their genetic identity (male or female) at one period of their life, and at other times identify with or express an identity incompatible with their genetics. Like other emotional preferences, they can change over time.
A British Medical Journal article commenting on the Cass Review emphasized that anyone who genuinely cares for children should recognize that “gender medicine is built on shaky foundations.” Citing numerous articles in peer-reviewed pediatric journals, it concludes: “The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider — from social transition to hormone treatment. Of more than one hundred studies examining the role of puberty blockers and hormone treatment for gender transition only two were of passable quality…. Intervention studies — particularly of drug and surgical interventions — should be designed to evaluate relevant outcomes with adequate follow-up.”
Despite the opinion of some professional gender-modification advocates, evidence of benefit is scant. On the other hand, the risk of aggressive gender-transition interventions include changes to fertility, bone, and cardiovascular health, and growth. It simply must be said that tampering with a young person’s hormone levels and appearance leads to dramatic, and often permanent, harmful biologic changes.
Canada’s peers are waking up to the dangers of gender-affirming care for minors and the threadbare evidence on which it has progressed thus far. Where is Canada?
Canadian public health bodies and regulators should follow other international bodies and insist on evidence-based care following the systematic study of the benefits and harms of aggressive gender interventions. Until that study is complete, we must insist that doctors remember their obligation to “do no harm.”
David Zitner is a senior fellow at the Macdonald-Laurier Institute. He has participated at every level of Canadian health care including clinical practice, research, administration, governance and patient and professional education.
MacDonald Laurier Institute
Macdonald should not be judged through the warped lens of presentism
From the Macdonald Laurier Institute
By Patrice Dutil for Inside Policy
Sir John A. Macdonald was born January 11, in 1815 – but too often he is judged as if he was born in the late 20th century, not 210 years ago.
It seems that for many politicians, school officials, and members of the media, this is sometimes a difficult feat.
It’s not a new habit of mind – in the mid-nineteenth century, the eminent German philosopher and historian Leopold Ranke was so outraged by those who arrogantly dismissed the motives of historical figures that he dedicated a series of lectures on the topic. He declared that “every age is next to God,” explaining that historical periods had to be judged by how the almighty would have seen the events unfold; man’s actions would be measured by His commandments and in their own time, not by the standards of a new age.
The temptation to dismiss the past as “inferior” stood against reason itself. One could not condemn previous generations for their weak knowledge and prejudices. History could not be read “backwards,” and the “Middle Ages,” for instance, could only be considered as undeveloped by people who simply did not have the knowledge to appreciate them. Times were different and progress, whatever that was, was something that happened by fits and starts. “History is no criminal court,” Ranke declared.
Over the past fifteen years a number of commentators and scholars, including the collective leadership of the Canadian Historical Association, have condemned Macdonald and his governments as particularly unworthy. His memory has been erased from schools and streets, while nine of the eleven monuments erected in his memory across the country have been removed from public view. Macdonald is seen as source of shame because he inaugurated a new wave of residential schools and because of his treatment of Métis and Indigenous communities in the West.
This is fundamentally wrong-minded because Macdonald cannot be held responsible for things he did not do. His goal in establishing residential schools was to offer an education to Indigenous children – boys and girls – who could not go to school because their numbers in remote communities were too small. There is no evidence that children perished in those schools during his tenure in power though it is undeniable that many of them were ill.
The evidence also shows that Macdonald and his government were highly responsive in reacting to the transformative crisis that beset the Indigenous peoples on the Prairies during the late 1870s and 1880s by providing food rations, inoculations and instructors as well as tools to help communities learn the hard art of farming.
Were there unintended victims? Did Indigenous peoples lose a part of their culture as a result of the grand transformation imposed on them in the second half of the nineteenth century? Undeniably. But it is also undeniable that without the blanket of protection provided by Macdonald, the consequences would have been far worse.
Did he succeed unequivocally? Hardly. But he tried. He spent the money, elaborated new programs, and sought the best outcomes possible during an era when governments simply did not venture into social and economic policy.
Macdonald’s behaviour in 1885 – the most trying year of his career – is an effective prism through which to examine his career. In 1885, he faced a series of crises, including pressure from Great Britain to join a military campaign in Sudan, a new US president that sought to rip up commercial deals with Canada, a smallpox epidemic in Quebec, an insurrection in the North-West, led by Metis firebrand Louis Riel, and a backlash in Quebec when Riel was hanged for treason. He also needed to rescue a financially floundering Canadian Pacific Railway.
That year was incredibly trying for Canada’s first prime minister: it consisted of a cascade of twists, controversies, triumphs, and violence. Through it all, Macdonald creatively dealt with foreign affairs, Indigenous questions, democratic rights, nationhood, immigration, critical infrastructure, the role of the state, of memory, environmental issues, and life and death.
In this messy, chaotic world of politics, Macdonald acted sometimes strategically, sometimes improvisationally. He was at times entirely cerebral; sometimes he performed his emotions in order to convince more people. The journalist Edward Farrer observed that Macdonald had a knack for appearing “frail,” and always “asked people to support him on that account.” It worked. Writing in 1910, Farrer conceded that Macdonald had “a sagacity for meeting each political situation as it arose” and that, in hindsight, his policies were clearly popular with the voters (he won six majorities in his years as prime minister).
Commentators and historians should be dedicated to the task of explaining how Macdonald maintained his popularity during his long career, instead of viewing – and dismissing – his accomplishments through the warped lens of presentism.
Patrice Dutil is a senior fellow at the Macdonald-Laurier Institute. His new book is Sir John A. Macdonald and the Apocalyptic Year 1885 (Sutherland House).
Business
Canada needs to get serious about securing its border
From the Macdonald Laurier Institute
By Todd Hataley for Inside Policy
US President-elect Donald Trump has made clear his intention to call out Canada on weak enforcement on migration, money laundering, and the cross-border trafficking of narcotics, especially fentanyl.
Until just very recently, Canada has remained largely silent on these issues. Security agencies, such as the Royal Canadian Mounted Police (RCMP), Ontario Provincial Police (OPP), Sûreté du Québec (SQ) and the Canada Border Services Agency (CBSA), have tried to secure the border via memorandums of understanding, framework agreements, and legislated agreements that allow them to share information and even work together.
However, resources are limited for cross-border law enforcement co-operation. CBSA remains understaffed and RCMP Integrated Border Enforcement Teams (which work with US security agencies) have limited geographic reach, leaving much of the enforcement between ports of entry left to police of jurisdiction, who already are hard pressed to provide services to the communities they serve.
The Canadian government’s apparent strategy of largely ignoring the problem is becoming more difficult to maintain. With the United States Border Patrol intercepting increasing numbers of illegal migrants crossing into that country from Canada, it’s clear the porous border is a concern. Exacerbating the situation is the recent discovery of illegal narcotic super labs in Canada – where production far outstrips the market – and Canada’s unfortunate, albeit well-deserved reputation as a haven for global money launderers.
Thanks to Trump’s 25 per cent tariff threat, the crisis is now endangering Canada’s relationship with its largest and most-important trading partner. This announcement sent all sectors of government and the private sector into a frenzy, prompting Prime Minister Justin Trudeau to fly to Florida to seek out an early audience with Trump at his Mar-a-lago resort home. Trudeau’s team spun the trip as proof that the federal government is serious about working with the US to address its border security and public safety concerns.
But with political crises piling up, it will be difficult for Trudeau to also manage the political optics of kowtowing to Trump, who is widely unpopular among Canadians. Spending extra money to appease Trump during the ongoing housing, immigration, and health care crises could make the Trudeau’s popularity nosedive even further. Adding insult to injury, Trump is essentially demanding that Canada do America’s work by stopping illicit goods and people from entering the United States: customs and border security officials generally work on the principle of stopping goods from entering their country.
Trudeau faces many practical challenges, including the need to ramp up the number of border and law enforcement agents who have the skill sets and training required to police offences such as drug production, money laundering, and the cross-border smuggling of goods and humans. Purchasing helicopters and drones to conduct surveillance will do little to aid enforcement, since most goods smuggled across the border pass through legitimate border crossings. RCMP Commissioner Mike Duheme even suggested putting RCMP cadets along the border – a challenging proposition since vast swathes of the border are either wilderness or water. Surveillance is one thing, but the act of enforcement takes skilled people with the capacity to investigate, gather evidence, and articulate that evidence into something that can be used by the courts for convictions. These concerns are not being addressed in this current frenzy to spend money on border security.
There is also good evidence that fortifying the border, or what has become known as forward deployment along the border, does nothing to stop the cross-border transit of contraband goods and people. One need only look as far as the United States-Mexico border to see the failure of forward deployment.
As authorities increase border enforcement activities, the costs of smuggling goods and people mounts for criminals. Eventually, it drives out amateurs, leaving only the professional, skilled, and well-equipped criminal groups. This, in turn, often leads to increasing levels of violence along the border, making interdiction and disruption far more difficult for law enforcement agencies.
Canada has several clear options to address Trump’s border concerns. It can increase the staffing of frontline CBSA officers, including border agents, inland enforcement units that actively investigate and remove individuals from Canada, international liaison officers, and customs processing staff. It can also create a plan for CBSA to take over enforcement between ports of entry. Currently, CBSA enforces entry into Canada at the ports of entry and the RCMP are responsible for the areas in between. Having a single agency manage the border builds capacity and expertise, avoiding inter-bureaucracy competition and confusion.
Canada can also work to better integrate law enforcement, intelligence units, and border services at all levels of government and across international boundaries. Cross-border crime operations are often planned and execute far from the border.
Some of this already takes place, as noted above, but it needs to go much deeper and be more supportive at both institutional and individual levels. This process must also include private sector stakeholders: companies such as FedEx, UPS, and Amazon, as well as freight forwarders, trucking companies, and customs brokers, are all involved in cross-border trade. Their participation as partners in reducing cross-border criminal activity is essential.
Finally, the government needs to designate laws specific to cross-border crime and include meaningful penalties as a means of deterrence.
Hyper-focusing on the border while ignoring other aspects of cross-border crime may be good political optics, but it is a bad strategy. What we really need is functional enforcement – including an integrated process extended vertically and horizontally across all sectors of border stakeholders, at and away from the border, supported by strong policy and legislation. This is the path forward to better cross-border crime enforcement.
Dr. Todd Hataley is a professor in the School of Justice and Community Development at Fleming College. A retired member of the Royal Canadian Mounted Police, he worked as an investigator in organized crime, national security, cross-border crime, and extra-territorial torture. He is a contributor to the Macdonald-Laurier Institute.
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