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.
Immigration
Immigrant background checks are unrelated to national security?

By David L. Thomas for Inside Policy
Canadians are rightly under the impression that migrants have been properly vetted before coming into our country. But it’s clear we’re not living up to expectations.
A recently de-classified 2022 report of the National Security and Intelligence Review Agency (NSIRA) suggests we’ve entirely misplaced our priorities when it comes to protecting Canadians from foreigners with dangerous backgrounds. Apparently referring prospective immigrants from places in the world beset with violent extremism for deeper background checks could constitute discrimination against those individuals that is “not justifiable on security grounds.”
Arbitrary discrimination on a prohibited ground is wrong. However, it is obviously important, for example, for the government to conduct proper security checks when we admit people into Canada as immigrants. There are times when certain discrimination might be warranted.
Essentially, for fear of being accused of discrimination, our national security oversight committee has deemed that checking prospective immigrants for ties to terrorist organizations is not a matter of national security. This is plainly absurd and is a grave risk to our national security.
The decision-style report of the NSIRA tribunal related to a group of complaints before the Canadian Human Rights Tribunal (CHRT) under the Canadian Human Rights Act (CHRA). The large group of complainants were citizens of Iran seeking temporary or permanent visas to Canada and who were subjected to security background checks. They alleged discrimination on the basis of race and that the CSIS checks delayed the processing of their visa applications (reported by NSIRA as an average delay of 14 days for temporary visas and 26 days for immigration visas). Iran is a country with which we have no diplomatic relations and we have designated as a state sponsor of terrorism since 2012.
Without the resources of CSIS and a deeper security check, how could an immigration officer in the field determine if a visa applicant may have once been a member of a terrorist organization, like al-Qaeda, or a drug cartel? CSIS security checks are designed to look deeper into an individual’s background, sometimes with the co-operation of foreign spy agencies.
These complaints came across my desk in the final months of my term as the Chairperson of the CHRT. Having previously practiced immigration law for more than 20 years, I was well aware of CSIS security background checks. My expectation was that the NSIRA would recommend dismissal of the complaints because, well of course, checking whether a prospective immigrant is connected to a terrorist organization has to be related to the security of Canada, no?
Apparently not.
The CHRT complaints were suspended under a never-before-used section of the CHRA. Under Section 45, the Minister of Immigration, Refugees and Citizenship Canada gave notice “that the (alleged discriminatory) practice to which the complaint relates was based on considerations relating to the security of Canada.” Despite this notice, the Human Rights Commission declined to dismiss the complaints and instead referred the matter to the NSIRA to provide a report on the matter.
The NSIRA report was the first of its kind and acknowledged there is little legislative guidance on the nature of its role under a Section 45 referral. However, in my view, the NSIRA has usurped the role of the CHRT by determining that the criteria applied for requesting the CSIS background checks “was not justifiable on security grounds.” In my view, their determination should have been limited to only whether the alleged discriminatory practices related to national security.
Nevertheless, the complaints are now proceeding before the CHRT to determine if it was discriminatory to make referrals for security background checks.
Arbitrary discrimination is, in most cases, against the law. However, there are exceptions, and one of them is Section 45 of the CHRA which creates a “carve out” from the normal rules when a matter of national security is on the line. And yet, the NSIRA decision bizarrely set aside national security and failed to grant the exception.
Canada has drastically increased its intake of migrants in recent years. Since 2021, the annual target for permanent residents was almost doubled to 500,000. Non-immigrant foreigners, mostly students and temporary workers, accounted for 2.5 million people, or 6.2% or the population in 2023. As these are people entering Canada legally, Canadians are rightly under the impression that migrants have been properly vetted before coming into our country. But it’s clear we’re not living up to expectations.
Canada recently admitted Muhammad Shahzeb Khan from Pakistan, accused of plotting a massive attack against Jews in New York last October. When this news broke Canada was still reeling from the embarrassment of having just granted Canadian citizenship to Ahmed Fouad Mostafa Eldidi. Along with his son, Mostafa Eldidi, he was arrested in July last year as the pair was accused of being in the advanced stages of planning a violent attack on behalf of ISIS in Toronto. Apparently, Ahmed appears in a 2015 video dismembering an ISIS prisoner with a sword.
All prospective immigrants to Canada are subject to checks for past criminal activity. However, sometimes an immigration officer might flag an applicant for a security screening by the Canadian Security Intelligence Service (CSIS) to determine if a visa applicant has ties to terrorist groups, espionage, war crimes, crimes against humanity, etc.
In order to protect Canada, immigration officers in the field should have the unfettered discretion to refer any non-Canadian for a CSIS security background check. The referral is not a denial of entry into Canada. Applicants are just being asked to wait a little longer until we’re satisfied about their background. Immigration officers should not be second-guessing themselves about this discretion for fear of a human rights complaint.
Now is the time for Canada to set its priorities right. Our national security must be paramount and should not be hamstrung by unrealistic idealism.
David Thomas, a senior fellow at the Macdonald-Laurier Institute, is a lawyer and mediator in British Columbia. From 2014 to 2021, he was the chairperson of the Canadian Human Rights Tribunal.
Business
Why a domestic economy upgrade trumps diversification

From the Macdonald Laurier Institute
By Stephan Nagy for Inside Policy
The path to Canadian prosperity lies not in economic decoupling from the US but in strategic modernization within the North American context.
President Donald Trump’s ongoing tariff threats against Canadian exports has sent shockwaves through Ottawa’s political establishment. As businesses from Windsor to Vancouver brace for potential economic fallout, a fundamental question has emerged: Should Canada diversify away from its overwhelming economic dependence on the United States, or should it instead use this moment to modernize and upgrade its economic hard and software within the North American context? The evidence overwhelmingly supports the latter approach in which Canada reduces interprovincial trade barriers and regulations, builds infrastructure to move energy and other resources within Canada, and invests in Canadian human capital and relationships with the US to maximize synergies, stakeholder buy-in and mutual benefit.
The knee-jerk reaction to blame Trump’s economic nationalism misses a crucial point: America’s retreat from championing global free trade began well before his unorthodox political ascendance in 2016. The Obama administration’s signature Trans-Pacific Partnership (TPP) faced mounting bipartisan skepticism before Trump withdrew from it in 2017. Hillary Clinton, during her presidential campaign, explicitly stated she would oppose the deal, reversing her earlier support. “I will stop any trade deal that kills jobs or holds down wages, including the Trans-Pacific Partnership,” Clinton declared during a campaign speech in Michigan in August 2016.
When President Joe Biden took office, rather than resurrect the TPP, his administration proposed the Indo-Pacific Economic Framework (IPEF). Unlike traditional trade agreements, the IPEF conspicuously omitted market access provisions while emphasizing supply chain resilience and environmental standards. During the IPEF ministerial meeting in Los Angeles in September 2022, U.S. Trade Representative Katherine Tai specifically noted that the framework “moves beyond the traditional model” of free trade agreements.
These policy evolutions reflect a deeper transformation in American economic thinking: a bipartisan consensus has emerged around industrial policy aimed at rebuilding domestic manufacturing, securing critical supply chains, and maintaining technological leadership against authoritarian competitors such as China.
Prime Minister Justin Trudeau and his Cabinet fundamentally misunderstood these shifts, leading to a series of diplomatic missteps that have damaged Canada-US relations. Most damaging has been a pattern of public rhetoric dismissive of both Trump personally and his MAGA supporters more broadly.
In June 2018, following the G7 summit in Charlevoix, Quebec, Trudeau declared in a press conference that Canada “will not be pushed around” by the United States, characterizing Trump’s tariffs as “insulting.” This prompted Trump to withdraw his endorsement of the summit’s joint statement and label Trudeau as “very dishonest and weak” on Twitter.
Former Deputy Prime Minister Chrystia Freeland repeatedly aligned the MAGA movement with authoritarianism. In an August 2022 speech at the Brookings Institution, she characterized Trump supporters as part of a global “anti-democratic movement.” In October 2023, she went further, drawing parallels between MAGA and authoritarian regimes like Russia and China. These statements resonate poorly with nearly half of American voters who supported Trump in recent elections and are borderline disinformation with such exaggerated mischaracterizations of American voters.
Former Foreign Affairs Minister François-Philippe Champagne was caught on camera in December 2022 referring to Trump’s policies as “deranged” while speaking with European counterparts. The video, which social media users circulated widely, further inflamed tensions between the administrations.
Such diplomatic indiscretions might be dismissed as political theatre if they didn’t coincide with concrete policy failures. The Trudeau government neglected critical infrastructure projects that would have strengthened North American economic integration while reducing Canada’s vulnerability to U.S. policy shifts.
To illustrate, Japan and Germany approached Canada to secure liquefied natural gas (LNG) exports as part of their efforts to reduce reliance on Russian energy supplies. Japan expressed high expectations for Canadian LNG during Prime Minister Fumio Kishida’s visit, while Germany explored LNG opportunities during Chancellor Olaf Scholz’s visit, emphasizing the urgency of diversifying energy sources due to geopolitical tensions. However, Trudeau rejected these requests, citing a weak business case for LNG exports from Canada’s East Coast due to logistical challenges and lack of infrastructure. Instead, Trudeau shifted focus to clean energy initiatives and critical minerals, reflecting Canada’s evolving industrial policy priorities.
The economic relationship between Canada and the US represents perhaps the most thoroughly integrated bilateral commercial partnership in the world. The statistics alone tell a compelling story: daily two-way trade exceeds $3 billion, supporting approximately 2.7 million Canadian jobs – roughly one-in-six workers in the country.
This integration manifests in countless ways across industries.
For example, in automotive manufacturing, a single vehicle assembled in Ontario typically crosses the Canada-US border seven times during production. A Honda Civic assembled in Alliston, Ontario, contains components from both countries, with engines from Ohio and transmissions from Georgia integrated with Canadian-made bodies and electronics.
The energy infrastructure between the two nations functions essentially as a single system. The North American power grid delivers Canadian hydroelectricity to major US markets, while Canadian refineries process crude oil from both countries. TransCanada’s natural gas pipeline network serves both markets seamlessly, with approximately 3.2 trillion cubic feet flowing between the countries annually.
In aerospace, Bombardier’s commercial aircraft division collaborates with American suppliers like Pratt & Whitney and Collins Aerospace, creating integrated supply chains that span the border. Montreal’s aerospace cluster works in close coordination with counterparts in Seattle and Wichita.
Beyond traditional industries, American-Canadian technological collaboration has accelerated in recent years. For example, the Vector Institute in Toronto has established formal research partnerships with MIT’s Computer Science and Artificial Intelligence Laboratory, collaborating on foundational AI research. Their joint papers on neural network optimization have been cited more than 3,000 times since 2020.
Quantum computing initiatives at the University of Waterloo’s Institute for Quantum Computing maintain ongoing research exchanges with Google’s quantum computing team in Santa Barbara, California. Their shared work on quantum error correction protocols has advanced the field significantly.
In clean technology, Hydro-Québec’s energy storage division and Massachusetts-based Form Energy announced in 2023 a $240 million joint venture developing grid-scale iron-air batteries to enable renewable energy deployment across North America.
The SCALE.AI supercluster, headquartered in Montreal, includes American tech giants like Microsoft, Amazon, and IBM collaborating with Canadian start-ups on supply chain optimization technologies.
Against this backdrop of deep integration, calls for Canada to diversify away from the US toward markets like China reflect wishful thinking rather than economic reality. Dezan Shira & Associates in its China Briefing advocated expanding commercial ties with Beijing despite China’s documented history of economic coercion toward Canada.
This recommendation ignores the painful lessons of recent history. The arbitrary detention of Michael Kovrig and Michael Spavor for over 1,000 days in Chinese prisons, the imposition of punitive restrictions on Canadian agricultural exports following the arrest of Huawei executive Meng Wanzhou, and documented interference in Canadian domestic politics all demonstrate the risks of economic dependence on China.
The CD Howe Institute’s March 2025 analysis cites the overwhelming preponderance of trade flows: 76 per cent of Canadian exports go to the United States, compared to just 3.7 per cent to China, 2.4 per cent to the UK, and 2.32 per cent to Japan. As the report notes, “Given geographic proximity, linguistic compatibility, and complementary regulatory frameworks, any significant trade diversification away from the United States would require decades of sustained effort and acceptance of considerably higher transaction costs.”
Rather than pursuing illusory diversification, Canada should focus on strategic economic modernization that positions it as an indispensable partner in America’s industrial revitalization.
First, Canada must dismantle internal trade barriers that fragment its domestic market. The Canadian Federation of Independent Business estimates these interprovincial trade barriers cost the economy $130 billion annually – nearly 7 per cent of GDP. Harmonizing regulations and procurement practices would create a more efficient national market better positioned to integrate with the US economy.
Second, Canada should leverage its critical mineral resources – including lithium, cobalt, and rare earth elements – as strategic assets for North American supply chain security. The Minerals Security Partnership launched in 2022 provides a framework for such co-operation, but Canada has yet to fully capitalize on its geological advantages.
Third, Ottawa should accelerate east-west energy infrastructure development to enhance continental energy security. The proposed Energy East pipeline, which would have transported Western Canadian crude to Eastern refineries, fell victim to regulatory hurdles in 2017. Reviving such projects would reduce Eastern Canada’s dependence on imported oil while creating more resilient North American energy networks.
Finally, Canada should position itself as a key contributor to emerging technology initiatives. Trump’s proposed $500 billion AI infrastructure investment represents an opportunity for Canadian AI researchers and companies to integrate more deeply into US innovation ecosystems.
The path to Canadian prosperity lies not in economic decoupling from the US but in strategic modernization within the North American context. The integrated nature of the two economies – built over generations through geographic proximity, shared values, and complementary capabilities – represents a competitive advantage too valuable to abandon.
As American industrial policy evolves to address 21st-century challenges, Canada faces a choice: it can either adapt its economic framework to remain an essential partner in this transformation or risk marginalization through misguided diversification efforts. The evidence overwhelmingly supports the former approach.
For Canada, the answer is smarter, not less, North American integration.
Dr. Stephen Nagy is as a professor at the International Christian University, Tokyo and a senior fellow at the Macdonald-Laurier Institute. Concurrently, he is a visiting fellow with the Japan Institute for International Affairs (JIIA). He serves as the director of policy studies for the Yokosuka Council of Asia Pacific Studies (YCAPS), spearheading their Indo-Pacific Policy Dialogue series. He is currently working on middle-power approaches to great-power competition in the Indo-Pacific.
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