Dr. Gordon Guyatt revolutionized modern medicine. As a professor at McMaster University, he coined the term "evidence-based medicine" in 1991, created the hierarchy of evidence that every medical student learns, and wrote the User's Guide to the Medical Literature that taught physicians worldwide how to critically evaluate research. For 48 years, he's been the gold standard for rigorous scientific thinking in healthcare.
Then came his systematic reviews of pediatric gender medicine. His team found only low-quality evidence for youth interventions. When twenty U.S. states used his work to restrict access to these treatments, Guyatt called it "egregious, unconscionable misuse of our work." But in this explosive interview, he admits signing a statement endorsing "medically necessary care for gender diverse youth" without reading it carefully. "That was not my paragraph, and I didn't read carefully enough," he confesses. When pressed further: "I was a dope. Okay. I'm sometimes a dope."
"I Am a Total Non-Expert in This Area"
When it comes to pediatric gender medicine specifically, Guyatt repeatedly insists: "I am a total non-expert in this area." Asked if adolescents can consent to interventions affecting fertility, he deflects to his experience with cognitively impaired elderly patients. When reminded that "we don't offer vasectomies and tubal ligation to adolescents as birth control," his response: "You will have to talk to experts who have been for decades getting this care."
A pediatric endocrinologist is quoted: "talking to a 14 year old about fertility preservation is like talking to a blank wall." Guyatt dismisses it: "Classic, anecdote. Excellent anecdote. The single individual with a single opinion." Yet his own evidence for a treatable subpopulation? "My impression from talking to such individuals."
Asked about parallels to bone marrow transplants for breast cancer—where activists demanded access to treatments that ultimately harmed women—Guyatt becomes defensive: "I feel manipulated at the moment."
The Statement He Didn't Read
The most damning exchange comes when confronted with his August 14th statement: "We have also personally made a donation to Egale Canada’s legal and justice work, noting their litigation efforts aimed at preventing the denial of medically necessary care for gender-diverse youth."
Earlier, when asked about medical necessity, Guyatt claimed: "It's not a term I use, nor am I familiar with."
His defense evolves from "That was not my paragraph" to "I obviously if I had, if I had, what I paid attention to is the part that I wrote" to "I have 100 million balls in the air."
After his team pulled out of their contract with SEGM ("We got into something we shouldn't have gotten into"), after admitting WPATH's approach "seems clearly inappropriate," after 271 people signed demanding retraction, Guyatt maintains: "Maybe 100% of the kids it's the wrong thing to do. But from what I've heard, that seems unlikely."
The father of evidence-based medicine, relying on what he's heard.
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