Alice Domurat DregerCritiques

This one started out good, with the promise of being a deep dive into the history of how medicine has misunderstood and mistreated the trans population and what can and should be done to change that. But at some point it took a left turn into a sort of tell-all about a particular activist who went off the rails and spread all sorts of slander and libel about a couple of researchers, including the author. It got weird. And while the scandal was sort of interesting, it felt more like it belonged elsewhere. *shrug*½

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 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.

Ethics in science. What a concept. Factual research is ........ helpful.

I very much wish the majority of my fellow citizens would read this book.½

Kind of an odd book. Learned a lot of interesting stuff. She tries to be fair to those she criticizes but I'm not always convinced. I mostly liked her writing but periodically there would be a clumsy cliche that bugged me ("Hello!"). But the basic issue she talks about is really important: what happens when a quest for truth collides with a quest for justice.

There are two major aspects of this book, one which I abhor and the other which is valuable and important, making for a decidedly mixed bag.

On the one hand -- as the title intimates -- the author is completely taken in by simplistic, pop history of Galileo, one of the forerunners of the Enlightenment, as a bold truth-seeker and uncompromising man of science, spitting in the face of the stifling and oppressive powers of dogmatism and authoritarianism. Modern science and democracy, as twin daughters of the Enlightenment, freeing us from millenia of tradition and religion, which were opposed to these principles of free-inquiry and investigation. There is hardly a more painfully erroneous cliche that exists, yet Dreger buys into it fully.

This aspect of the book is the set-up and framework, not so much the true subject matter, but its farcical simplicity, not to mention falsity, spoils much of what is good about the book. And it keeps reappearing throughout, as she uses the "Galilean personality" to classify certain persons in her story and appeals to the basic paradigm of enlightened science vs. dogma.

And her flights of ecstasy on the subject of "enlightenment" verge on self-parody; the sort of thing you'd find in the most oblivious, unreflective reddit atheist. One of the more glaring examples are when she declares:

Religiously speaking, the pope had the power to stop Galileo from achieving salvation; he could excommunicate him, mark him as a bad soul forevermore. But I suspect that, in his heart and through his telescopes, Galileo had already achieved the kind of salvation that matters to the seeker. He had achieved a philosophy that had truly liberated him, and then also us, his enlightened descendents. The pope might claim to gatekeep for God, but in truth, even the pope couldn't stop Galileo from climbing into the heavens to pull down facts and bring them back to earth.

Oy vey. She is truly euphoric in this moment, enlightened by her own intelligence.

Her inchoate political theorizing fares no better. In democracy she sees the scientific principle of peer-review extend to the political realm, and sees that as the sine qua non of a most-likely-to-be-just political order. And yet, as she herself finds out later in the book, "peer-review" only works to the extent you have honest, self-critical, truth-seeking people using it. And when you don't, "peer-review" becomes a meaningless stamp of authority. The same goes for democracy, but even worse. While she sees how peer-review is abused, she doesn't reflect on what this could mean for her trust in democracy. Many minds working in concert, even under the guise of critical review, is no prescription for anything in particular; it gives rise to atrocity as often as it gives rise to discovery.

Now, the good parts of the book are the various episodes in Dreger's professional life where certain unthinking dogmas of the leftist establishment are questioned by scientific findings, and said establishment -- supposedly the openminded and science-loving -- reacts aggressively against them, as they don't fit into the PC narrative.

There's the instance of transgender activists opposing the science that there is a definitive type of male-to-female transsexual who decides to transition based on erotic fantasy of becoming female. This in opposition to the transgender community's preferred simplistic narrative of 'female brains trapped in male bodies.'

There's the anthropological research of Napoleon Chagnon, showing the Yanomamo tribe -- largely untouched by western influence -- to be violent, women-stealing, environmentally careless, and having serious drug addiction problems. In opposition to the liberal myth of the noble savage, at one with nature.

There is also the general opposition by liberals to sociobiology in general -- as in the person E.O. Wilson, for instance -- for giving sociobiological explanations of things like rape and genocide, which is construed as excusing such things.

This material is excellent for exposing a blinkered opposition to unpalatable science among the supposed stalwarts of science themselves: the liberal academic establishment.

When Dreger attempts to articulate her larger point, though, it is unconvincing. She states multiple times that one of her big takeaways is that "social justice", while important and critical, must take a backseat to bold truth-seeking (visa vis "science"). That we mustn't subordinate the truth to our desire to seek justice, and thus advocate for "justice" on the basis of a some falsehood.

This is what she sees many in the academic establishment doing when, for instance, they worry that certain un-PC scientific findings might hurt historically oppressed people (transgender, people of color etc.) While she wants to maintain her absolute desire for justice, and make sure that truth isn't sacrificed for it.

But does she really? At least one admission in the book highly calls this into question.

In her vigorous defense of Chagnon against his critics, she points out one instance where he sacrificed truth for the sake of justice (even though he normally went after 'truth' at all costs):

when [Chagnon] found out that the data he had collected on Yanomamo infanticide might be used by the Venezuelan government against them, he had essentially withdrawn the data. Like Bailey, like Palmer, like so many others, this was a scientist out for the truth, but never at the cost of justice.

Which raises two crucial points. First, is essentially hiding data that exposes infanticide actually in service of justice? One would think exposing such a heinous crime would be the just thing to do. Which in turn brings up the question of just what is justice. Dreger assumes it is essentially "enlightened liberalism" -- the conclusion of which here is, apparently, protect indigenous peoples from outside forces, even if they are committing infanticide. So much the worse for "enlightened liberalism", then.

The second issue it raises is that Chagnon is explicitly violating what she has described as her own modus operandi here: seek truth first, fearlessly and virtually at all costs, and do justice while you're doing it. Here, Chagnon subordinated truth to (an extremely dubious notion of) justice, and Dreger lauds him for it.

At times the narrative gets bogged down in details obviously important to the author, especially near the end of the book where she documents the ins and outs of the various factions fighting about the use of dexamethasone on fetuses. In addition to my fundamental ideological opposition to the book, this detracted a lot from it, though it's still very instructive as to the fact that secular, liberal institutions, in the sciences, journalism, and the academy, are as vulnerable to groupthink, dogmatism, authoritarianism, and personally attacking those who threaten their preferred narratives as anyone. But I already knew that.

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 "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,

من المهم جداً أولاً فهم الفرق بين الجنس البيولوجي (sex) والهوية الجنسية التي تحدد الميول (gender identity) وبين المتحول جنسياً الذي لا يطابق جنسه هويته الجنسية (transgender) وثنائي الجنس الذي يولد بأعضاء ذكرية وأنثوية (intersex). كما أن الهوية الجنسية هي أعقد بكثير من مجرد الانجذاب لذكر أو لأنثى، بل هي طيف واسع من الميول تنتجه عوامل جينية وتسوقه عوامل مجتمعية.

يوضح الكتاب، مستعيناً بأمثلة عن سجالات علمية شبيهة بمحاكمة غاليليو، كيف أن رفض الأفكار الجديدة يجعل قضايا التحرر التقدمية أيديولوجيات عنيدة متعنّتة تعمل على تفضيل وتمييز أجندة واحدة قبل كل شيء، حتى من قبل الناشطين المدافعين عن القضية أنفسهم. وكيف أن المجالات العلمية الموضوعية، مثل علم الأحياء، تتعرض لخطر الانجرار إلى صراعات سياسية وأيديولوجية.

قراءة مفيدة.

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 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.

I am pretty sure I need every single American I know to read this book.

Alice Dreger is my new hero. Her main point, about how if you want justice, you have to not just hope for, but *work* for truth, is so resonant. Her points about ethics in science, about the political demonization of fact, about activism and research and the intersectionality of the two, are spot-on, no matter what your politics.

And her points about the complete lack of oversight or robustness in American medical research should chill us all. The things she uncovers about shenanigans in research that looks reasonable on its face, even given what I know about how to critically examine research, make me question literally everything I've ever read, peer-reviewed or not.

Drop everything. Read (or listen to; I had this on audiobook) it now.

A very interesting book about an unusual but fascinating ethical situation. She describes the lives of several pairs of conjoined twins and observes that nearly all of them didn't or don't wish to be separated. It's parents and doctors who think they must be made as close to "normal" as possible, even when it means sacrificing one twin.

She's a professor of Clinical Medical Humanities and Bioethics and has written about the ethics of intersexuality, which has the same ethical problems: children operated on without consent, although it may rob them of sensation and function, in order to seem "normal".

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 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.

Interesting, for sure, but after a while it just started to feel endless.

Dreger hilariously and depressingly livetweeted an abstinence-focused sex ed class at her kid’s public school, https://storify.com/metkat_meanie/livetweeting-abstinance-sex-ed, and then wrote this Kindle Single as a followup. Dreger’s research is about the history of responses to intersexed and other non-sexually normative people, and she comes at it from that perspective. She believes that there are, on average, biologically based differences between the interests of people born with XX chromosomes and people born with XY, but there’s also a lot of variation, within as well as across since sex isn’t actually binary. Her emphasis is on giving children information and helping them understand that variation is normal, so that they can make choices that are pleasurable and consensual as well as say no to things that aren’t pleasurable and consensual.

Dreger also gives a lot of weight to culture, citing studies showing that adults reinforce gendered behavior. When adults are given “cross-dressed” babies, they “become more impatient with ‘boys’ who are crying and try to engage the ‘girl’ babies with ‘girl’ toys.” But still, she perceives gender as a source of pleasure for many people, so she wants to make that pleasure available without oppression. (I’m not sure it’s possible to have one’s cake and eat it too in this way.)

Because boys with traditionally “feminine” interests are more likely to grow up gay than boys with traditionally “masculine” interests, while there’s no real association between gender-normative behavior and sexuality for girls, she warns against concluding too quickly that a boy who likes to dress as/play as a girl is “actually” a girl. She considers that giving in too quickly to the two-gender system, which may represent discomfort with the full gender spectrum or even unconscious homophobia. Only if a boy’s identification as female persists until age 11 or 12 is there reason to consider intervention, in her view, because at that point it can be useful to use drugs to prevent some of the pubertal changes that the child will perceive as wrong for her. (She doesn’t have as much to say about trans boys; her research has mostly been about trans women. She does say that a toddler daughter who says she’s a boy should be reassured that her interests are fine no matter what they are, but shouldn’t be encouraged to think she’ll have a penis when she grows up.)

The writing is cute: “Babies’ genitals often look kind of funny to adults because they are immature. I mean the baby’s genitals are immature …” But it’s also hard to imagine people reading this who aren’t already really committed to being informative most of the time, rather than teaching their kids shame about sexual desire.

One of the most interesting points for me is that she says that the adolescents she talks to were often prepared to prevent disease and pregnancy, but weren’t prepared for the emotional consequences and difficulties of sex, especially how they often felt differently about sexual encounters than their partners did. She concludes that it’s worth telling kids why lots of sex between adults occurs in long-term relationships, even if you think—as she does—that there’s nothing wrong with consensual sex in any form.

This book was not what I expected.

The subject matter was somewhat interesting and I learned quite a bit about intersex issues.

The writer was horrible! Her way of telling her story was boring, self centered and naive'. Trying to finish the book was just a giant slog.

What It’s NOT

A book about Galileo.

What It IS

A book about the intersection of activism and research. Can they live hand in hand or are they doomed to conflict? As a researcher and activist for intersex patient rights, Dreger shocked the medical community by supporting a doctor she felt was wrongly attacked for publishing an unpopular peer reviewed study on the psychology of male-to-female transgender women.

“We scholars had to put the search for evidence before anything else, even when the evidence pointed to facts we did not want to see. The world needed that of us, to maintain—by our example, our very existence—a world that would keep learning and questioning, that would remain free in thought, inquiry, and word.”

Challenging. Not in the sense that it is difficult to read, but it will challenge your sense of right and wrong. Should activists be able to silence research they find politically incorrect? What if they know the research was gathered without following proper protocol? Dreger examines specific examples of scientists who were ostracized for their research as well as her own attempt to fairly stop what she believed to be an unethical study.

A starting point. I can’t think of the last time a nonfiction book left me so fascinated, morally conflicted and curious. I spent most of my reading experience with a Wikipedia tab permanently open to the rabbit hole Dreger sent me down, looking up scientists, studies and terms. Because of her personal connection to some of the studies, I feel like I still have research of my own to do before forming solid opinions on the ethics involved. But based on Alice Dreger’s experience, I’d imagine she’d mark Galileo’s Middle Finger a roaring success if readers checked every one of her sources.

More at rivercityreading.com

What is the role of the committed researcher who studies controversial topics or groups who’ve been historically oppressed? Dreger’s book, focusing on sexuality/gender, argues that the best course is always to tell the truth and be damned, and that social movements need to be more accepting of research as long as it is conducted in good faith and not doing harm to the subjects, even if they fear harm to the general cause. Dreger’s a sharp writer with a background in these controversies: she started out doing research on the historical treatment of intersex bodies, but became an activist when she found out that treatment of intersex babies was no better and often worse than it had been historically. She describes partial success in getting doctors to understand that, though there are certain conditions that require surgical intervention to improve health, cosmetic/gender-assigning surgery on young children--on the grounds that the alternative is social stigma--should be avoided.

Then she spends a while defending a Northwestern professor’s research on transgender women; he came under fire for (1) saying some dumb things and allowing a really dumb, exploitative cover for his book, and (2) maintaining that one category of transgender women identifies as such because they receive sexual pleasure from understanding/imagining themselves as women. If that’s where the science takes you, she says, then you have to say that, even if it risks feeding into a narrative of sexual deviance against which transgender people are quite rightly fighting. She cuts him a lot of slack for being well-meaning in the dumb things he said, and I’m pretty sure that it’s not okay to sleep with the subjects of your books unless (at the very minimum) you disclose that even if they aren’t in any way vulnerable to your power. (He refuses to say whether he slept with one of his subjects because he says it shouldn’t matter; this strikes me as bullshit, though it doesn’t invalidate all his research.)

Finally she recounts her experience on the other side—trying to halt a doctor’s use of an unapproved treatment on fetuses at risk of being intersex, which was designed to prevent girls from having externally male genitalia and also to prevent them from being lesbians. She finds that the institutions that are supposed to protect vulnerable patients aren’t doing their job, because the doctor is able to say she’s not doing “research,” even as she gets grants to research outcomes in these patients. It’s an engaging but crotchety book, and hard to take larger lessons from.

I thought this was a fascinating and well-written book, but it wasn't the book I had hoped for. The author starts with a story of medical abuse. She then briefly talks to several researchers who were attacked for their work and end with another story about medical abuse based on poor science. Neither the beginning nor the ending story were particularly interesting to me, because they seem so clear cut. There wasn't any question of what needed to be done to resolve the science and the activism. I do think these stories were very worthwhile. The way intersex children were and sometimes still are being treated is shocking and we must be aware of it in order to change it. And individual scientists who were targets of personal smear campaigns because of their work certainly deserve a platform from which to spread the true story.

I also understood why the author would focus on issues relating to gender, sexuality, and identity; this is her field of study. I don't think this meant the story had to be as purely anecdotal as it was. I loved the author's enthusiasm for using science to find the truth and then build an ethical system based on the facts instead of nice, simplistic stories. I only wish I'd seen some of that here. For example, I'm very curious about the number of scientists experiencing personal attacks because of their work and how many of them are in different fields. For example, I would guess that scientists have been personally attacked for controversial research in genetic engineering (a topic I work on) as well. This wasn't a bad book, but in retrospect, I think the stock description did it an injustice. Had this been billed as a memoir about the author's science activism, I probably wouldn't have been disappointed when she failed to more generally address the interaction of science and activism. As long as you go into this with more accurate expectations, it's a book I'd recommend.This review was originally posted on Doing Dewey.

The book has an axe to grind, that is true, but the subject matter is grotesquely interesting. The (lengthy) introduction promises it's going to be more of an examination of all freaks, but it really focuses on conjoined twins. Through a historical study on subjects like Chang and Eng, the original Siamese twins, disastrous attempts at separating twins, plus accounts from existing paired humans, Dreger is trying to say that we shouldn't try to fix what isn't broken. All these people say that they wouldn't separate if they had the choice. The medical industry sees pathology where the "freaks" find normalcy.

It makes some very good points and I agree with the author. Except there's one part where it really loses me. Where, if it was cut, it would have improved my rating/review. She tries to compare pregnancy to having a conjoined twin. She uses lines like "this entity is dependent on the other for food and oxygen supply. Eventually, through societal pressure and the dominant's personal desires for independence, she decides to make the separation." This, I feel, is deceitful, manipulating the reader through withholding information.

I don't think anyone can deny that pregnancy is a natural part of life, with the end goal being TO SEPARATE and become an independent entity, capable of making more offspring. Conjoined twins, while it may be natural, isn't the typical end state, and doesn't behoove propagation of the species. The fact that it often results in biological and reproductive problems for both parties emphasizes this fact. This attempt at melodramatic appeal, by saying that reproduction is just as normal as conjoinment, is misrepresentation to prove a point.

But if you can get past that fact, it's one of the better non-fiction books I've read. If you've got to do some kind of high school research project you could do worse than this source.

I enjoyed reading this book, and learning more about the debate surrounding separating conjoined twins. It sounds like what society thinks about conjoined twins, and what healthy conjoined twins think about themselves and their connectedness, are often polar perspectives.

One smaller point of the book that I found interesting was that people in history with unusual anatomies (conjoined twins, dwarfs, ususually tall people, etc) have made money making appearances, and in some cases have been looked down on for that, sometimes considered a "freak show," but people considered especially good looking (movie stars, models) make money for their appearances without the same criticism.

Dreger interweaves a thoughtful discussion of modern definitions of gender and sex as she tells the story of how “medical men” from France and Britain in the late nineteenth and early twentieth century struggled with the definition of sex in their increasing encounters with “hermaphrodites,” people whose biology didn’t fit the normal expectations for either men or women. She provides helpful context for the reasons why these doctors sought to draw hard boundaries when there were none, offering a relatively gracious critique while most certainly enjoying her ability to label medical eras with names such as “The Age of the Gonads.” In her final pages, Dreger is not nearly as forgiving when it comes to our own times, where, she argues that “in spite of all the cultural changes that have occurred” the medical profession continues to be “largely driven by the engines that drove it in the nineteenth century,” forcing intersexed bodies into a conformity that is driven largely by a desire for “clarity”, often even to the detriment of health.

The subject matter here is very much focused on the medical aspect to sex/gender without providing the personal and psychological descriptions of such historical people. Dreger explains that this is simply because of the lack of data from the time period she covers - only recently have intersexed people themselves had a voice, leaving a gap then in the history as to the feelings and experiences of the very people under scrutiny.

For those readers who are not interested in the history per se, but in the current state of medical affairs and definitions, the sections of most interest are the prologue (1-14) which provides a context for why definitions of sex should be re-visited and questioned, “current-day explanations and typing” & “question of frequency” (35-45), and the epilogue (167-201), which gives some short biographical sketches and talks extensively about modern-day medical procedures on infants of sex/gender “fitting”.

This is an excellent book. It is troubling that we are this behind the curve even as late at the 1990s. Has it changed in the last 15 years? I hope so.