Alice Domurat Dreger

this provocative and refreshing book presents the very important problem of politically progressive activists challenging and even bullying scientists whose findings are unwelcome. Dreger is the perfect author since she has a background as an activist (fighting for rights of intersex infants and their families) and also as a critic of activists who bullied a scientist who found that some trans women were motivated by sexual arousal at the idea of themselves as women, not because they feel show more "trapped in the wrong body." Dreger has a delightful prose style, as well. This important and difficult read would be a great book club selection, show less

A century after his death, Galileo’s remains were removed from a nondescript grave to a glorious tomb in the basilica of Santa Croce in Florence. In the course of dis- and re-interment, some bits became detached – in particular, the middle finger of one hand, which now rests in a little shrine in the History of Science collection in the Uffizi Gallery. The symbolism is not lost on Alice Dreger; the great scientist gestures at the people who tried to interdict his work. Hence, her book show more Galileo’s Middle Finger. (Although I’m not sure if the gesture was interpreted that way in Renaissance Italy; perhaps he would have bitten his thumb at them instead, or flicked his beard, or shown them the sign of the fig).


At any rate, this is a thought-provoking but frustrating and disconcerting book. Superficially, the overall theme is similar to History Lesson, reviewed earlier; naïve academic becomes involved in a controversy over “political correctness” and finds to her chagrin that her fellow academics do not subscribe to the idea of spirted but polite discourse over contending points of view, but rather are vicious as a pack of drunken Klansmen bent for someone to lynch.


However, Dreger shouldn’t have been that naïve, because she was an academic activist herself. Early in the book, she describes herself as a liberal feminist sympathetic to feminist and Marxist science studies; Stephen Jay Gould and his expose of racist skull and IQ measurements were a childhood inspiration. Her choice of a topic for her work toward a PhD in History of Science was the history of people born with “sex anomalies”, particularly in the 19th and early 20th century, and she admits she chose this particular period because it allowed her to beat on white conservative male doctors who felt it necessary to surgically adjust the genital presentation of some patients to conform to their ideas of femininity or masculinity. Her research was very thorough; after combing medical journals for articles on intersex patients, she then set up databases to continue to track the people involve – did they return for more surgery? Did they express dissatisfaction or puzzlement with what had happened to them? Were they content with the “gender” they had been surgically assigned? Were it not for the Internet, her research would have probably languished in obscure journal (Victorian Studies) or a microfilm dissertation archive; but she began to get correspondence from people who had tracked her down online – people who were intersex themselves and who had found her and each other while searching for information. And that brought her into activism; she became an activist advocate for them.


This was the heyday of “cognitive creationism”; the idea that gender was entirely “socially constructed” and if a doctor decided a baby boy had an inappropriately small penis all you had to do was surgically emasculate him and he would become a she. His parents would raise him as a little girl, with dolls instead of trucks for toys. There would be a little problem with motherhood, of course, but she could adopt. Rather astonishingly Dreger learned that not only had some of the people contacting her not been told about their condition – their parents hadn’t been told; in one case the parents were given a sealed envelope that they were instructed not to open but to give to their pediatrician. Dreger began writing press releases, propaganda, and policies and held fund-raisers. One of the obstacles she had to overcome is convincing people that her friends and clients didn’t want special status as a minority – they just wanted to be left alone (Dreger does note that there is a certain intersex condition – ovotestes, the presence of both ovarian and testicular tissue – that does require early surgery, else the patient is prone to testicular cancer).


So far, Dreger hadn’t really gotten into any trouble with other activists. That changed when she became involved with the case of Michael Bailey. Bailey was a Northwestern University psychology professor who challenged the politically correct view of transgender conditions: that transgender people had a “female” brain in a “male” body (or vice versa). Thus gender reassignment surgery for them was simply giving them the “correct” gender. You can see how this idea correlates with her earlier work; it presupposes the idea that there are only two genders, you belong to one or the other, and if you don’t that has to be fixed with a scalpel and hormones. Bailey’s sin was not subscribing to that view, noting that there wasn’t actually any scientific evidence for it; in this he was influenced by work by Canadian Ray Blanchard. Blanchard had argued that there were actually two types of transgender men (Dreger doesn’t discuss transgender people who start out as female); type one were men who were sexually attracted to other men and who wanted a woman’s body to accommodate that – i.e. they were gay in the sense that they were sexually attracted to other men, but not gay in the sense that they weren’t attracted to gay men, only straight men; they wanted to have sex with men but as a woman. Blanchard noted that these people were very “femme” growing up; they wanted to play with dolls and help with the housecleaning and wear girls clothes. Type two transgenders were not “femme”, instead they tended to be masculine and had often married and fathered children before transition; their friends and coworkers tended to be astonished when they came out. However, they always had found themselves sexually aroused by the idea of being a woman. Dreger doesn’t actually go so far as use the word “fetish” here, but she compares the condition with other sexual arousal fantasies – being tied up and teased, having sex with a movie star. Blanchard created the term autogynephilia – self-directed love of women – for this.


Blanchard had only published in a technical journal so his ideas didn’t reach a wide audience; however Michael Bailey took these ideas and ran with them, resulting in a popular-oriented book The Man Who Would Be Queen. This is when the excrement contacted the rotating blades. It’s a given that society – let’s say “the patriarchy” for contrast – has always been uncomfortable with transgenders, but Dreger notes that there has also always been tension between feminists and transgenders – one feminist wrote that gender assignment surgery was “the ultimate rape”, a man appropriating a woman’s body for himself. Thus the transgender community had tried to distance itself from the idea that gender reassignment was about sexuality, replacing the early term “transsexual” with “transgender”. And here was Bailey say that it really was about sexuality all along. Thus Bailey was targeted by transgender activists. Dreger originally bought into the activist side, and even though several of her intersex friends tried to put her and Bailey in contact she was reluctant to meet with him. She eventually did and found that he didn’t have horns, hooves, and a tail. Part of her conversion came with her appalled astonishment at the vituperation heaped on Bailey – he was accused of practicing psychiatry without a license, failure to get ethics board approval for his research, and having sex with one of his research subjects – all of this posted on university website belonging to one of his critics. And there were grade school photographs of Bailey’s children posted – with their eyes blacked out – captioned with the accusation that Bailey had sodomized them. That brought Dreger to write a blog post protesting this treatment – and, of course, her former “friends” in the LGBT community immediately turned on her, in the time-honored revolutionary tradition of eating your own.


This is where Dreger began questioning her own beliefs. She attended a conference where one of her enemies confronted her in a hall and promised to ruin her career; she comments that the same conference, although ostensibly a scientific meeting, consisted of nothing but various groups playing “identity cards”, leading her to comment that the feminist movement had degenerated into a game of Go Fish. She began to seek out others condemned by what you might call the liberal science establishment:


*Bruce Rind, Philip Tromovich, and Robert Bauserman, who had published a meta-analysis of cases of childhood sexual abuse that suggested that not all cases resulted in permanent psychological harm and advocated more careful study – for example, not lumping cases where a 60-year-old man rapes his 5-year-old granddaughter with cases of consensual sex between a 20-year-old and a 16-year-old. This has the distinction of being the only scientific paper ever condemned by a unanimous vote of the US House of Representatives (the resolution was phrased to condemn both the Rind paper and pedophilia; thus you couldn’t vote against the resolution without seeming to approve pedophilia).

*Craig Palmer and Randy Thornhill, who had written The Natural History of Rape, which suggested that under certain cultural conditions there could be selection pressure favoring rape. (In an amusing sidelight, Palmer and Thornhill noted that Rush Limbaugh had commented on the book on his radio show. Initially they though Limbaugh might be in favor of the book because it criticized the feminist interpretation of rape, or opposed to it because they used an evolutionary approach. As it turned out, Limbaugh was opposed because he thought they were trying to defend Bill Clinton).

*Napoleon Chagnon, who had worked with the Yanomamö of South America, and was railroaded by the American Anthropological Association based on accusations that he and coworkers had done all sorts of unspeakable things – deliberately infecting the Yanomamö with measles and paying them to kill each other.

*E.O. Wilson, the grand old man of sociobiology, who had been persecuted by Dreger’s childhood hero Stephen Jay Gould and colleague Richard Lewontin for alleged “racism” in suggesting that significant human behavior is genetically influenced.

Finally Dreger documents her current work – investigating Maria New, a pediatric endocrinologist and distinguished member of the National Academy of Sciences. One of the intersex conditions Dreger had confronted earlier is congenital adrenal hyperplasia (CAH). Most sex hormones are generated in the ovaries or testes; however the adrenals generate a small amount of androgens as well. Usually a small amount, that is; in CAH they generate a lot more. If a developing 46XX fetus has CAH – this is the most common cause of intersex conditions in females - the child will end up “masculinized”; depending on how much androgen is involved the baby girl can present perfectly normal; have a enlarged clitoris; have an extremely enlarged clitoris with the ureter exiting through the tip; have the labia fused to look like a scrotum; have a undeveloped vagina that will not allow normal sexual intercourse or menstruation; or be missing a vagina altogether. The CAH condition is recessive; if both parents are carriers there is a 1:4 chance that a female fetus will have CAH (either sex can be borne with CAH but it doesn’t cause sexual ambiguity in males; however it can cause other conditions, some potentially life-threatening; therefore all babies are screened for CAH at birth). What Dr. New had been doing is “treating” CAH carrier mothers with dexamethasone. “Treating” is in quotes there because Dr. New didn’t write the prescriptions herself but merely advised the parents, suggesting that if they didn’t get the treatment their child might have ambiguous genitalia or grow up to be a lesbian. This, of course, conflicts with Dreger earlier expressed view that intersex people should be allowed to make their own decisions rather than having a gender assignment enforced on them. Dreger concedes that CAH can be a life threatening condition, but also notes that there no evidence that dexamethasone will prevent CAH. On investigation she found that Dr. New was telling parents that dexamethasone was safe, and the “standard of care” for CAH, while at the same time telling the NIH that she was investigating the effects of prenatal dexamethasone, getting a recurring grant to do so, and then not actually doing any follow-up research on patients who had been treated with dexamethasone or their children. A whistle-blower in New’s lab eventually did report this, and the Cornell University Medical Center received a large fine for failure to follow proper human experimentation protocols – but New simply moved to Mount Sinai Medical School and continued recommending dexamethasone. Dreger continued to investigate and complained to the NIH, the FDA and the Office for Human Research Protection – and got nowhere. She found herself the subject of an article in the American Journal of Bioethics in which she was accused of making false claims, misrepresenting scientific evidence, failing to meet scientific standards, making unsubstantiated claims, offering opinion as a substitute for argument, and being contradictory – in short, that she was the one who was unethical. As she puts it, “much too late to do anything about it”, she discovered that the co-author on the AJOB paper was listed as a “key person” in New’s NIH grant application, and the FDA investigator assigned to the New case was on the AJOB board and was negotiating an editorial position for himself.


So what does all this mean? This is supposed to be a review and not a simple summary of the book. Well, as you can see from the above – and I’ve left a lot of stuff out – Dreger does not engage in a simple, serial narrative. Her writing style is highly anecdotal; she mentions her headaches, her bout with pertussis, her family life, and personal appreciations of all the people she meets; it’s often hard to keep track of who’s who. When she’s explaining the biomedical background – the various things that can cause intersex conditions, for example – she’s clear and understandable; when she’s talking about her activist work it’s easy to get confused and lost. I suspect this book might have been better if it were broken into three or four books, each focusing on one of the topics with more rigor and less anecdote.


She’s somewhat willing to admit her own failings – for example, her disillusionment with Stephen Jay Gould and her self-doubts about what it meant to be a “feminist”. However, there are some other places where some more self-doubt would appropriate. At one point, when she’s visiting the University of Missouri at Columbia, she finds the Barak Obama campaign plane on the airport runway and goes through a little frisson of excitement on how now everything will be different for Science with a Capital S after the Bush years of lies (she doesn’t actually mention “Hope and Change”, to be fair). Then some chapters later, during her investigation of Maria New, she complains that the OHRP “is simply not doing its job” – it was investigating about 20 cases a year prior to 2009 (without noting who was in charge of the Federal administration then) but in all of 2013 (again without noting who was in charge) only opened one new investigation.


There’s also a question about what sort of science she’s defending. Here, I don’t really know. The center of the book concerns the Michael Bailey case – which seems to be based on what Bailey’s subjects said in interviews. Well, anybody who’s ever taken a Myers-Briggs test knows that what you say about yourself and what you are actually like are often not strongly correlated (I stress again I don’t really know; I haven’t read Bailey’s book, maybe there’s a lot more quantitative data in it). The other cases she discusses – the Rind paper, Palmer and Thornhill, Chagnon, and Wilson – all do seem to have pretty solid, falsifiable and potentially reproducible science behind them.


Lastly – and this isn’t really her fault, of course – there’s no real resolution. Her book is a story of battles fought, but at the end there are no clear winners or losers, just possibly some progress. Well, sometimes that’s the best you can do. show less

As someone who works in academia and sometimes sees the kind of controversies discussed in this book from afar, Alice Dreger's work to pin down the truth is like a breath of fresh air. She's absolutely right that research which touches on sex, identity, and speaking for marginalized groups can become fraught with emotions and theories which have little to do with scientific evidence. It's also a lesson important for the world we live in today, with an internet ecosystem that has little to do show more with facts and almost no patience for the hard work of investigating scientific processes. This is a book that really makes you think about science, truth, and what we know and don't know. It's a book I hope more people read and think about deeply. show less

This book surprised and appalled me. Surprised because I didn't realize how subjective determining a person's sex is - the baby is born, the doctor takes a look, and then makes a declaration of boy or girl. Appalled because if a baby isn't easily identified as boy or girl in that look, the baby is probably in for a lifetime of surgeries and medical humiliations that are completely unnecessary health-wise but make the doctors feel better because they "fixed" a "problem".

Such a great book. I show more highly recommend it to everyone, but especially people who are going to have children so that they'll be better informed of the history and prepared for the doctors' b.s. pressures if they have an intersex child. show less