The pursuit of evidence is the most pressing moral imperative of our time

Galileos Middle Finger book coverGalileo’s Middle Finger: Heretics, Activists and the Search for Justice in Science
by Alice Dreger

This is a troubling book in many ways. It made me punch the air triumphantly and it made me angry. I was impressed by Dreger and I was annoyed by her. I think it’s an important part of the story of how science and activism interact, but it’s not the whole story.

Dreger is a science historian who got involved in intersex activism after studying the history of how intersex conditions were treated medically. She was able to occupy a middle ground between intersex people and medics, and use that position to investigate the current situation (in the 1990s and 2000s) and campaign for evidence-based change to treatment.

“Science and social justice require each other to be healthy, and both are critically important to human freedom. Without a just system, you cannot be free to do science, including science designed to better understand human identity; without science, and especially scientific understandings of human behaviours, you cannot know how to create a sustainably just system…The pursuit of evidence is probably the most pressing moral imperative of our time [but] we’ve built up a system in which scientists and social justice advocates are fighting in ways that poison the soil on which both depend.”

This is a great introduction to Dreger and her thesis, and I of course wholeheartedly support Dreger’s activism on behalf of people who were born intersex – for instance to not have their genitals altered during childhood (often immediately after birth) simply so that they conform visually to one of the two typical genders. Unfortunately that’s not where the book starts, and Dreger’s thesis is not always consistent.

The book opens with some background on Dreger’s childhood, which was strictly Catholic and right-wing, and also where she got her first taste for activism – picketing abortion clinics. This rang alarm bells right away, not necessarily because Dreger’s parents made her do this, but because she doesn’t express any unhappiness about having done it. Of course, a self-identified left-wing adult can be anti-abortion but otherwise do and say things I support, but it didn’t start my feelings about Dreger out on the right foot.

The introduction is also a little rambly and over-promises somewhat, as it suggests that this a book about a whole range of scientific controversies. But really, this book contains three very detailed case studies and three much briefer ones. The intro also explains the title, coming as it does from a holiday Dreger took to Florence where she saw Galileo’s preserved middle finger in a museum and was amused by it – that’s the whole story. She keeps coming back to Galileo, how he was labelled a heretic by the Church, but his scientific findings were proved correct by history. I can see the link to the situations she investigates, but it’s a misleading and weak title.

That said, the writing style is engaging and the intersex chapters were interesting and well-researched. So I wasn’t expecting what came next. Dreger is alerted to a controversy surrounding a Dr Michael Bailey after he wrote a book supporting a theory that trans women change their sex not because of a mismatch between their emotional gender and their genitals, but because of their sexual preference. Bailey argues that trans women fall into two types – those who were formerly effeminate gay men and those who are turned on by the idea of being a woman. His book understandably caused a stir and Dreger takes the surprising step of defending him.

Bailey’s evidence comprises a handful of case studies he undertook of trans women – a small sample who were specially selected, two of whom later sued him for, among other things, the things he wrote about them. Dreger admits that Bailey’s language is at times offensive and that not all trans women confirm to his two “types”, but she is clearly sold on the idea that he is mostly correct because a handful of trans women tell her they consider themselves to adhere to one of Bailey’s categories. This ignores the large number of trans women who do not agree with Bailey, and the fact that he has done very minimal research to back up his theory.

Bailey is also accused of having slept with one of his research subjects, which Dreger categorically states isn’t a problem. She later revisits this, and defends as a whole doctors or scientists who have sexual relationships with patients or study subjects. I just cannot agree with her on this and think it shows a fundamental misunderstanding of consent and power imbalance.

The Bailey matter is complicated by the fact that some of the people upset by him used pretty horrible tactics to fight back. They doxed him, sent him death threats, used language more abhorrent than his while making public accusations of miscondust and abuse. I can see why Dreger wants to be more reasonable in her response, but devoting a third of her book (and years of her life) to defending Bailey is taking it too far.

For a really good and clear explanation of why Bailey’s book and Dreger’s support of it are offensive, I recommend taking a look at the comment by Adrian Morgan on this podcast in which Sean Carroll interviewed Dreger.

From here, Dreger skips pretty quickly through some smaller investigations she undertook before she gets to her third meaty topic: Dr Maria New and her use of a non-approved medication to pre-natally treat an intersex condition called CAH. Dreger is alerted to the situation by her old friends in intersex activism, but she is determined to study all the available evidence before she takes a side. However, it becomes increasingly clear that New has treated hundreds of pregnant women without fully apprising them of the experimental nature of the treatment. Dreger also questions the need for the treatment in the first place, as CAH is not in itself a dangerous condition, and the aim of the treatment is largely aesthetic (and a little homophobic, as girls with CAH have a slightly higher than average likelihood of being gay and/or tomboys).

This is where Dreger won back my support. She spent years unearthing consent forms and submitting freedom-of-information requests. Once she had the information she tried legal, regulatory and journalistic means to educate doctors and prospective parents about the reality behind New’s research. And she took a lot of personal flak for it. (Though I do wonder if she would have been treated better if she hadn’t supported Bailey a few years earlier.)

Most of Dreger’s conclusions are well argued and make a lot of sense. She argues that investigative journalism and properly conducted peer-reviewed science are both vital, and are both threatened by funding crises. (I hope she is heartened by what I think has been a resurgence of investigative journalism in the last few years, from new outlets such as BuzzFeed and podcasts.) I even agree that activists should not be too quick to attack scientists working in politically sensitive areas – after all, fantastic books such as Angela Saini’s Inferior and Superior rely on researchers repeating questionable experiments in gender science and race science to demonstrate their flaws.

“So long as we believe that bad acts are committed only by evil people and that good people do only good, we will fail to see, believe, or prevent these kinds of travesties…The people who are against you are not necessarily evil, and your own acts are not necessarily good [but] most people I meet seem convinced that the goodness of their souls will keep them from committing bad acts.”

But, like much of the book, the conclusion is also a rant, one in which Dreger simultaneously defends the rights of people with intersex conditions to identify as any or no gender, and to choose gender-affirming surgery, while using language that contradicts those statements. She repeatedly uses the phrases “boys and girls” or “men and women” where a non-binary alternative could easily have been chosen. She never once uses the term cisgender. Is she just a little old-fashioned/out of date or are these deliberate choices? As she has been working with intersex and trans activists for decades, it’s hard to believe no-one has ever asked her to modify her language.

I support Dreger’s basic thesis – that both science and activism should be evidence-based. But I find it hard to recommend a book that contradicts its own argument by defending Bailey with minimal critical analysis; that uses outdated terminology that excludes many of the people Dreger claims to be fighting for the rights of; and that argues that there is no problem with doctors or scientists sleeping with their research subjects.

Published 2015 by Penguin Press.

Source: present from my Dad.