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.
Automotive
The high price of green virtue
By Jerome Gessaroli for Inside Policy
Reducing transportation emissions is a worthy goal, but policy must be guided by evidence, not ideology.
In the next few years, the average new vehicle in British Columbia could reach $80,000, not because of inflation, but largely because of provincial and federal climate policy. By forcing zero-emission-vehicle (ZEV) targets faster than the market can afford, both governments risk turning climate ambition into an affordability crisis.
EVs are part of the solution, but mandates that outpace market acceptance risk creating real-world challenges, ranging from cold-weather travel to sparse rural charging to the cost and inconvenience for drivers without home charging. As Victoria and Ottawa review their ZEV policies, the goal is to match ambition with evidence.
Introduced in 2019, BC’s mandate was meant to accelerate electrification and cut emissions from light-duty vehicles. In 2023, however, it became far more stringent, setting the most aggressive ZEV targets in North America. What began as a plan to boost ZEV adoption has now become policy orthodoxy. By 2030, automakers must ensure that 90 per cent of new light-duty vehicles sold in BC are zero-emission, regardless of what consumers want or can afford. The evidence suggests this approach is out of step with market realities.
The province isn’t alone in pursuing EV mandates, but its pace is unmatched. British Columbia, Quebec, and the federal government are the only ones in Canada with such rules. BC’s targets rise much faster than California’s, the jurisdiction that usually sets the bar on green-vehicle policy, though all have the same goal of making every new vehicle zero-emission by 2035.
According to Canadian Black Book, 2025 model EVs are about $17,800 more expensive than gas-powered vehicles. However, ever since Ottawa and BC removed EV purchase incentives, sales have fallen and have not yet recovered. Actual demand in BC sits near 16 per cent of new vehicle sales, well below the 26 per cent mandate for 2026. To close that gap, automakers may have to pay steep penalties or cut back on gas-vehicle sales to meet government goals.
The mandate also allows domestic automakers to meet their targets by purchasing credits from companies, such as Tesla, which hold surplus credits, transferring millions of dollars out of the country simply to comply with provincial rules. But even that workaround is not sustainable. As both federal and provincial mandates tighten, credit supplies will shrink and costs will rise, leaving automakers more likely to limit gas-vehicle sales.
It may be climate policy in intent, but in reality, it acts like a luxury tax on mobility. Higher new-vehicle prices are pushing consumers toward used cars, inflating second-hand prices, and keeping older, higher-emitting vehicles on the road longer. Lower-income and rural households are hit hardest, a perverse outcome for a policy meant to reduce emissions.
Infrastructure is another obstacle. Charging-station expansion and grid upgrades remain far behind what is needed to support mass electrification. Estimates suggest powering BC’s future EV fleet alone could require the electricity output of almost two additional Site C dams by 2040. In rural and northern regions, where distances are long and winters are harsh, drivers are understandably reluctant to switch. Beyond infrastructure, changing market and policy conditions now pose additional risks to Canada’s EV goals.
Major automakers have delayed or cancelled new EV models and battery-plant investments. The United States has scaled back or reversed federal and state EV targets and reoriented subsidies toward domestic manufacturing. These shifts are likely to slow EV model availability and investment across North America, pushing both British Columbia and Ottawa to reconsider how realistic their own targets are in more challenging market conditions.
Meanwhile, many Canadians are feeling the strain of record living costs. Recent polling by Abacus Data and Ipsos shows that most Canadians view rising living costs as the country’s most pressing challenge, with many saying the situation is worsening. In that climate, pressing ahead with aggressive mandates despite affordability concerns appears driven more by green ideology than by evidence. Consumers are not rejecting EVs. They are rejecting unrealistic timelines and unaffordable expectations.
Reducing transportation emissions is a worthy goal, but policy must be guided by evidence, not ideology. When targets become detached from real-world conditions, ideology replaces judgment. Pushing too hard risks backlash that can undo the very progress we are trying to achieve.
Neither British Columbia nor the federal government needs to abandon its clean-transportation objectives, but both need to adjust them. That means setting targets that match realistic adoption rates, as EVs become more affordable and capable, and allowing more flexible compliance based on emissions reductions rather than vehicle type. In simple terms, the goal should be cutting emissions, not forcing people to buy a specific type of car. These steps would align ambition with reality and ensure that environmental progress strengthens, rather than undermines, public trust.
With both Ottawa and Victoria reviewing their EV mandates, their next moves will show whether Canadian climate policy is driven by evidence or by ideology. Adjusting targets to reflect real-world affordability and adoption rates would signal pragmatism and strengthen public trust in the country’s clean-energy transition.
Jerome Gessaroli is a senior fellow at the Macdonald-Laurier Institute and leads the Sound Economic Policy Project at the BC Institute of British Columbia
armed forces
Underfunded and undermanned, Canada’s Reserves are facing a crisis
The Macdonald Laurier Institute
By J.L. Granatstein for Inside Policy
With the new threats facing Canada and NATO, change must come quickly: Canada needs to fix the Army Reserves.
Canada’s once-proud Reserves force is fading fast – and without urgent action, it risks becoming irrelevant.
The Canadian Armed Forces Primary Reserves have an authorized strength of 30,000, but the present numbers of the Army, Navy and Air Force Reserves as of November 2024 are only 22,024. The RCN Reserves number 3,045, the RCAF 2,162, and the Army 16,817. This is frankly pathetic, all the more so as the regular forces are sadly understrength as well.
The Army Reserves have a long history, with some units dating back before Confederation. Before both world wars the Militia’s strength was roughly 50,000, generated by populations of eight million in 1914 and eleven million in 1939. Amazingly, despite a lack of training and equipment, the Militia provided many of the Army’s officers, up to and including successful division and regimental commanders, and large numbers of the senior non-commissioned officers. A century ago, even after some consolidation following the Great War, almost every town and city had an armoury and a Militia unit with a cadre of officers, good numbers of enlisted men, and some social status in their community. The factory owners, bankers, and well-off were heavily represented, and the Militia had real clout with representation in Parliament and easy access to the defence minister.
Not any longer. The armouries in most of Canada have disappeared, sold off by governments and levelled by developers, and those that still stand are in serious need of maintenance. The local elites – except for honorary colonels who donate funds for extra kit, travel, celebratory volumes, and to try to stop Ottawa from killing their regiment – are noticeably absent.
So too are the working men and women and students. As a result, there are Army Reserve units commanded by a lieutenant-colonel with three majors, half a dozen captains, ten lieutenants, a regimental sergeant major and any number of warrant officers, and under seventy in the ranks. It is a rare Reserve regiment, even those in Canada’s largest cities, which has a strength above 200, and ordinarily when a unit trains on a weeknight or a weekend only half that number turn up. Even in summer, when reservists do their serious training at Petawawa or other large bases, there will be many absentees.
And when a unit is asked to raise soldiers for an overseas posting – say for the Canadian-led brigade in Latvia – it might be able to find ten or so volunteers, but it will be highly unlikely to be able to do so when the next call comes. Reservists have families, jobs or school classes, and few are able and willing to go overseas and even fewer to do so for subsequent deployments.
Without reservists filling the ranks (and even with them providing up to 20 per cent of a battalion’s strength), the undermanned regulars must cobble together a battalion of 600 or so by seconding troops from another Regular unit. After being brought up to Regular force standards before deployment, the reservists have performed well in operations, for example, in Afghanistan.
So why can’t the Army Reserves find the men and women to join their ranks? The reasons are many and much the same as the recruitment difficulties facing the Regular Army. Sexual harassment cases have abounded, affecting the highest ranks and the lowest. Modern equipment has been and is continuing to be lacking.
Procurement is still bogged down with process, paperwork, and long timelines – for instance, approving a new pistol took a decade. And the Reserves get modern equipment only after the Regulars’ needs are met, which unfortunately means never. Instead of a tank or a Light Armoured Vehicle, units get pickup vehicles painted in dark green and see anything more only on their rare days of training in the field.
Leaders of the Reserves have called for a separate budget for years, demanding that they decide how the funds are allocated. National Defence Headquarters has refused, rightly claiming that the underfunded Regulars have higher priority. But the Reserves point to official documents that in 2019-20 demonstrated that of $3.018 million allocated to the Reserves, only $1.3 billion reached them, the rest being unspent or re-allocated to the Regulars.
With some reason this infuriates Reservists who point to this happening every fiscal year.
So too does what they see as the condescension with which they are treated. A Reserve major is equal in rank to a Regular major, but both know that the Regular is almost always far better trained and experienced for his job and that rankles. (Many years ago, when I was a junior officer, I remember another Regular referring to “the ****ing Militia.” I know that Reserve officers reverse the compliment.)

Today with unemployment above nine per cent and with young Canadians’ unemployment rate even higher, the Reserves pay a new private a daily rate of some $125 (The Carney government recently promised a substantial pay raise). This ought to be a good option to earn some money. The Toronto Scottish, an old and established infantry unit, for example, has a website that lists other benefits: up to $8,000 for educational expenses and up to $16,000 for full-time summer employment. The Toronto Scottish has two armouries in the western suburbs, a female Commanding Officer, but under 200 soldiers. There should be a real opportunity in the current circumstances to increase those numbers by a good advertising campaign pitched directly at young men and women in the Toronto suburbs. The same can be said for every big city.
But the small town and rural units, tiny regiments whatever their storied histories, are unlikely to be able to grow very much. National Defence Headquarters needs to set a number – say 150, 200, or 250 – above which a unit will keep its command structure. Below that standard, however, units will be stripped of their higher ranks and effectively consolidated under the Reserve brigade in their area.
Reservists have fought such suggestions for years, but if the Reserves are to become an efficient and effective force, this is a change that must come. One such experiment has combined the Princess of Wales Own Regiment in Kingston, Ontario, and the Brockville Rifles by putting the Commanding Officer of the first and the Regimental Sergeant Major of the second in charge. Unit badges can remain, but this reduces the inflated command staffs.
In reality, these small regiments are nothing more than company-sized sub-units, and sub-units of less than a hundred simply cannot train effectively or draw enough new members from their small town and rural catchment areas. Combined they can function effectively.
The federal government will soon release an army modernization plan. Change is always difficult but with the new threats facing Canada and NATO, change must come quickly. Canada needs to fix the Army Reserves.
Historian J.L. Granatstein is a member of the Macdonald-Laurier Institute’s Research Advisory Board. A bestselling author, Granatstein was the director and CEO of the Canadian War Museum. In 1995, he served on the Special Commission on the Restructuring of the Reserves.
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