One study purportedly tipped the balance. How was it that Johns Hopkins, the center which for many years was the foremost institution in the treatment of transsexuals later became the epicenter of medical opposition to transsexuals including the genteel attack in The New Atlantis?
Dr. Paul McHugh cited one study that “led the psychiatry department at Johns Hopkins Medical Center (JHMC) to discontinue surgical interventions for sex changes for adults,” a study not conducted by Dr. McHugh himself.1 This was a study published in 1979 by Jon K. Meyer and Donna J. Reter, namely Sex Reassignment: Follow-up. It first appeared in the Archives of General Psychiatry 36, no. 9: 1010 – 1015.2
The Meyer-Reter study stated:
“sex reassignment surgery confers no objective advantage in terms of social rehabilitation, although it remains subjectively satisfying to those who have rigorously pursued a trial period and who have undergone it.”3
The study consisted of a longitudinal follow-up on the well being of adults who underwent sex-reassignment surgery (SRS). Dr. Mayer describes the following groups for comparison:
- 15 people who received surgery at Johns Hopkins
- 35 people who requested but did not receive surgery at Johns Hopkins
- 14 people from the group of 35 who had been refused surgery but received surgery at a later time
The study scored these outcomes using an index of well being based upon a composite of the following factors:
- Psychiatric variables
- Economic variables
- Legal variables
- Relationship outcome variables
The follow-up period consisted of 5 years for the 15 who had surgery and 2 years for the 35 who didn’t.4
Clearly, 15 patients is far too few to establish any kind of statistical sample for a population. 35 can but with a low degree of confidence. Considering that 14 of the 35 had surgery at a later date, and quite possibly more of them had surgery after publication of the study, we can have no certainty concerning the claims regarding the 35, Worse yet, the unequal 5-year evaluation between the 15 who had surgery and the 2-year evaluation period for the 35 immediately raises questions concerning methodology.
Dr. Mayer admits this in the following statement:
“However, the study has important limitations. Selection bias was introduced in the study population, because the subjects were drawn from those individuals who sought sex-reassignment surgery at JHMC. In addition, the sample size was small. Also, the individuals who did not undergo sex-reassignment surgery but presented to JHMC for it did not represent a true control group. Random assignment of the surgical procedure was not possible. Large differences in the average follow-up time between those who underwent surgery and those who did not further reduces any capacity to draw valid comparisons between the two groups. Additionally, the study’s methodology was also criticized for the somewhat arbitrary and idiosyncratic way it measured the well-being of its subjects. Cohabitation or any form of contact with psychiatric services were [sic] scored as equally negative factors as having been arrested.”5
The Meyer-Reter study, therefore, deserves special attention beyond what has been admitted in the New Atlantis report. After all, this study purportedly ended the program at Johns Hopkins… or could it have only provided a convenient excuse to close down a program of which Dr. McHugh disapproved when he took over Dr. Harry Benjamin’s program in 1975?
A reasonable question like this cannot be answered without a review of the actual study. Unfortunately, unless one is at least a medical student, obtaining a copy of this story for one’s individual review is extremely difficult. One can possibly obtain it through a university offering at least a pre-med program or the Journal of the American Medical Association who expressly prefers those connected to the medical profession.6 Those of other professions may subscribe to JAMA Psychiatry, in which the study may be found, pay $335 for a subscription. That’s a sum out of reach for many laypeople like me. Even if a layperson manages to obtain a subscription, the site expresses the requirement that the journal only be used for personal purposes, thereby denying its use to writers outside the medical profession. Johns Hopkins’ website currently does not show the research even though Google links to it, suggesting that the information was there at one time but has since been removed.7
This raises in important issue for public policy. In all areas of democratic government transparency is one of the most vital issues to maintain its function. Dr. Paul McHugh, one of the contributors of the New Atlantis report indicates by its publication as well as other activities of his that he desires his position to become a matter of public policy. However, all changes in policy demand scrutiny and that not restricted to one field. It’s the same scrutiny demanded of science at any level, whether or not one happens to be a physician or not. Scientist must criticize, not as a system of tearing down an idea to destroy, but to weed out the kernels of truth to be found therein… if any indeed exist. So must journalists.
While several publications allude to the pivotal Meyer-Reter study, none of them examine the study in detail. One cannot make a judgment or offer criticism concerning a scientific study on the basis of hearsay. The doctors at Johns Hopkins know this. But what’s offered instead is a fallacious demand: that because certain people with 30 page curricula vitae say something it must be accepted by everyone as the unadulterated truth. Blind appeal to authority in this matter is blatantly unacceptable. It’s the same reasoning as that demanded by various clergy who condemn the study of Greek and Hebrew texts and question the spoon-feeding they offer to their congregations.
Beyond this restriction one might ask about who the authors of the Meyer-Reter study are. Transgender writer Dallas Denny raised this issue in The Campaigns Against Transsexuals offered to the 2013 Southern Comfort Conference. Convinced of a conspiracy at Johns Hopkins, Denny writes:
“Two others at Hopkins played a role in the conspiracy. One was psychiatrist Jon Meyer, who was director of the Hopkins gender clinic. Meyer was firmly in the psychoanalytic camp. Transsexualism was a mental illness. Period.
“The second was Meyer’s secretary, Donna Reter. I have been unable to find a picture or autobiographical information for her. In a fascinating article that appeared in Baltimore City Paper in 1994, science writer Ogi Ogas noted she had no background in mental health. I suspect her name comes into play here is because
“Meyer was unable to find anyone else willing to sign onto a paper he would soon be publishing.
“I was convinced Ogi Ogas was a nom de plume and suspected the name was an anagram or other type of puzzle. It wasn’t. The editor of City Paper told me Ogas was a science writer, a real person. Earlier this year I was able to contact Ogas to see if he knew more than he had written. He told me he hadn’t. I didn’t believe him.”8
While the lack of available information may be intriguing we must be careful here. Lack of information about authorship does not automatically disqualify the research. What Donna Reter’s credentials may have been we don’t know. A secretary in a medical department may have some excellent credentials of her own. Again the challenge comes to Johns Hopkins: exactly who was Donna Reter? What were her credentials that recommend her work for a scientific journal? What was her role in the research? Exactly what did she do or not do? We cannot trust the words of Ogi Ogas one way or another on the basis of what Denny had written. But one would reasonably expect that a study that was so pivotal to practices at Johns Hopkins and reaching toward alteration of public policy pertaining to medicine should not be so shrouded in mystery.
At the same time the New Atlantis report’s statement about admitted criticism raises questions about the writers of the report and their relationship to the study. If we did take Dr. Mayer’s words concerning it at face value, then we must question his comments concerning the 35 who had been denied surgery. If 14 received surgery later then Dr. Mayer is correct in stating thus concerning them: “resulting in three cohorts of comparison: operated, not operated, and operated later.” 9 However, no statement appears in the New Atlantis report about whether Meyer and Reter actually used 3 cohorts or simply left it at 2. This needs to be clarified for those of us who don’t have direct access to the Meyer-Reter study. Was this an intentional gloss or a simple oversight?
The stated factors of composites of this study as written in the New Atlantis report also raises questions. We may well expect that psychological factors should be given scrutiny. So might relationship outcomes, though, again we have too few details concerning relationship criteria, except Dr. Mayer’s criticism concerning patients being “scored down for cohabitation in the same way as an arrest.”10 But the validity of economic and legal factors raises a red flag, particularly with respect to discriminatory practices which had been more pronounced in 1979 than they are today.
To help laypeople picture how this can be a problem, consider the case of a state like Florida who in 1979 did not permit changes of birth certificates for post-operative transsexuals. An adverse case like this should have resulted in a patient being marked down in the follow-up period just from the misfortune of having been born in Florida and this would be marked as a negative outcome for sex reassignment. I would ask of anyone with any sense of logic whether it would be correct to do away with sex-reassignment or gender-affirming surgery because of the legal issues of a Florida-born transsexual or whether it means we should work for change in laws for such cases. The only ones who would not agree to the latter would be those with a religio-political agenda against the existence of transsexuals and those who act in fear of those with such an agenda.
Likewise, in the case of economic factors, consider the transsexual who comes out to an employer only to encounter daily harassment and taunts by coworkers culminating in the transsexual being fired and blacklisted for having transitioned. Do we do away with transition for all people because of corporate politics or do we work to educate businesspeople? Again, those who would not agree to the latter would be those with a religio-political agenda against the existence of transsexuals and those who act in fear of those with such an agenda.
More importantly, the patients Dr. Mayer describes are patients from Johns Hopkins. While this study still does not represent actual research by either Dr. McHugh or Dr. Mayer, it represents cases in which Dr. McHugh certainly had a hand. When Dr. McHugh took over Dr. Benjamin’s program in 1975 he began to direct that treatment be denied to patients before shutting down the program altogether in 1979. Anyone would infer that the 35 in the Meyer-Reter study had been refused because of the work of Dr. McHugh and that some of these rejects would go on to transition elsewhere.
You can see how the details need to be made more available than what the New Atlantis report offers. We cannot rely upon them at face value even when they come from someone with credentials as impressive as Dr. Mayer or with his even-handed temperament.11
We can’t rely upon his or anyone else’s words simply because there are laypeople who produce good science and there are professional scientists who produce bad science. Since the New Atlantis report urges the positions it does upon makers of public policy this writer asks that Johns Hopkins provide the Meyer-Reter study in its original form or public access. If a study of this much importance does not have the problems cited by Dr. Mayer in the New Atlantis report then Johns Hopkins has nothing to fear from dissemination of the truth. If, however, the study turns out to be at least as problematic as Dr. Mayer’s comments suggest, then it behooves Johns Hopkins to investigate anew the decision to shut down the sex reassignment program and that this investigation not be restricted to Dr. McHugh and his cohorts.
Not a few alumni of Johns Hopkins would agree. This week a petition has begun to circulate opposing the New Atlantis article addressing the President and the Dean of Johns Hopkins, stating that they find it an embarrassment to graduates, professors, and alumni of Johns Hopkins.12 This story of the Meyer-Reter study at the core of Dr. McHugh’s directives necessarily is the fulcrum in the tipping of the balances at Johns Hopkins. We must recognize that perchance faulty research becomes the fulcrum of the tipping of the balances for public policy in general.
- Mayer, Lawrence S. M.B., M.S., Ph.D., and McHugh, Paul, MD Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences (Fall 2016) Web: New Atlantis 50. www.TheNewAtlantis.com20160819_TNA50SexualityandGender.pdf, p. 110, 111. Retrieved August 26, 2016.
- p. 142.
- Ibid, p. 110.
- Ibid, p. 109.
- Op. cit.
- (n.a.) Archives of General Psychiatry (n.d.) Web: JAMA Psychiatry: http://archpsyc.jamanetwork.com/issue.aspx?issueid=12317. Retrieved September 13, 2016.
- (n.a.) Research Output (n.d.) Web: Johns Hopkins University:. https://jhu.pure.elsevier.com/en/publications/sex-reassignment-follow-up-5. Retrieved September 13, 2016
- Denny, Dallas. The Campaigns Against Transsexuals: Part I: The Conspiracy at Johns Hopkins University (September 5, 2013) Web: http://dallasdenny.com/Writing/2014/03/06/the-campaign-against-transsexuals-part-i-2013/. Retrieved September 13, 2016.
- Mayer and McHugh, p. 109.
- Ibid, p. 110
- Mayer, Lawrence S. M.B, M.S., PhD. Professional Vita (August 2016) Web: http://www.jurispro.com/files/documents/doc-1066205152-resume.pdf. Retrieved September 13, 2016
- (n.a.) Petition Hopkins to Address False LGBT Reports (Deadline 9/30/16) Web: GoogleDocs: https://docs.google.com/forms/d/e/1FAIpQLSf02pElovrEp2XQUrOxxIxQV7gVvrjctMjZG9EaFwzXR4k32Q/viewform?c=0&w=1. Retrieved September 15, 2016.