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Imagine that you’re the parent of a child who suffers from a rare mental health condition that causes anxiety, depression and suicidal ideation. Psychiatric medications and therapy do not work for this condition.

There is a treatment that has been shown to work in adults, but there’s very little research in kids, apart from a few small studies that have come out of the Netherlands, where they are prescribing these treatments. Doctors in your own country, however, won’t prescribe it until your child is 18, to avoid any unwanted side effects from the medication.

Meanwhile, your child has suffered for years, and attempted suicide multiple times. As a parent, what do you do? Do you take your kid overseas, or let them continue to suffer?

“Awareness of transgender children is growing,” the Guardian (8/13/08) reported 16 years ago.

This is precisely the situation that parents of trans kids in Britain were facing 16 years ago, when the Guardian (8/13/08) ran a story on their efforts to get the country’s Gender Identity Development Service (GIDS) to prescribe puberty blockers for their kids. The Guardian noted how grim the situation was for these kids and their parents:

Sarah believes that anyone watching a teenager go through this process would want them to have the drugs as soon as possible. Her daughter was denied them until the age of 16, by which point she already had an Adam’s apple, a deep voice and facial hair….

“It takes a long, long time to come to terms with. It took us about two years to stop crying for our loss and also for the pain that we knew our child was going to have to go through. No one would choose this. It’s too hard.”

Dr. Hilary Cass told the BBC (4/20/24) that “misinformation” about her work makes her “very angry.”

After years of struggle, UK parents successfully lobbied the NHS to start prescribing gender-affirming medical treatments for minors under 16 in 2011. Their success, however, was short-lived.

In April, NHS England released the findings of a four-year inquiry into GIDS led by Dr. Hilary Cass, a pediatrician with no experience treating adolescents with gender dysphoria. On the recommendation of the Cass Review, which was highly critical of adolescent medical transition, the NHS services in England, Wales and Scotland have stopped prescribing puberty blockers for gender dysphoria. The British government also banned private clinics from prescribing them, at least temporarily.

Though there is much more evidence now to support gender-affirming care than in 2008, there is also a much stronger anti-trans movement seeking to discredit and ban such care.

British media coverage has given that movement a big boost in recent years, turning the spotlight away from the realities that trans kids and their families are facing, and pumping out stories nitpicking at the strength of the expanding evidence base for gender-affirming care. Its coverage of the Cass Review followed suit.

US media, unsurprisingly, gave less coverage to the British review, but most of the in-depth coverage followed British media’s model. Underlying this coverage are questionable claims by people with no experience treating minors with gender dysphoria, and double standards regarding the evidence for medical and alternative treatments.

The most impactful—and controversial—recommendation of the Cass Review is that puberty blockers or cross-sex hormones on those under 16 should be confined to clinical research settings only, due to the supposed weakness of the studies underpinning gender-affirming treatments for minors, and the possibility of unwanted side effects:

While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.

This stands in direct opposition to guidelines and recommendations from major medical associations, such as the American Academy of Pediatrics, the Endocrine Society and the World Professional Association of Transgender Health (WPATH), which support gender-affirming medical interventions for youth.

WPATH (5/17/24) expressed bewilderment at the Cass Review’s approach, and noted that its reviews “do not contain any new research that would contradict the recommendations” of those groups, which were updated in 2022.

So what could explain the divergence? For starters, the review took place in the context of a rising anti-trans culture in England, and the NHS took the highly unusual approach of excluding experts on pediatric gender-affirming care from the review.

At the same time, the Cass Review, and the NHS England Policy Working Group that preceded it, had clinicians on its team with ties to advocacy groups that oppose gender-affirming treatment for minors, so its bias was questioned even before the review was released. The Cass Review has been a major boon for these advocacy groups, as its recommendations are exactly what those groups have been calling for.

“It’s a bad-faith claim that we don’t have enough evidence for pubertal suppressants or gender-affirming hormones,” a Harvard Med School psychiatry professor told Mother Jones (5/10/24).

The systematic review on puberty blockers conducted by the Cass Review excluded 24 studies, with reviewers scoring this research as “low quality.” But Meredithe McNamara, assistant professor of pediatrics at Yale, told FAIR that the scale the Cass Review used to grade study quality is not typically used by guideline developers. Under this methodology, the authors excluded many studies from consideration for what she describes as “arbitrarily assigned quality.”

A recent white paper from the Yale Law School Integrity Project, co-authored by McNamara, explains the flaws more in depth:

They modified the scale in an arbitrary way that permitted the exclusion of studies from further consideration, for reasons irrelevant to clinical care. For instance, in the York SR on social transition, the modified NOS asked if study samples were “truly representative of the average child or adolescent with
gender dysphoria.” There is no such thing as the “average child or adolescent with gender dysphoria”—this is an inexpertly devised and meaningless concept that is neither defined by the authors nor used in clinical research. And yet it was grounds for excluding several important studies from consideration.

The Yale report highlights the problems that come from assigning authors who are unfamiliar with essential concepts in gender care. For example, puberty blockers are not intended to reduce gender dysphoria, but rather halt the effects of puberty. The systematic review looked at gender dysphoria reduction as a metric of the treatment’s success, however, which the Yale report says was an “inappropriate standard.”

Moreover, even studies scored as low quality by more standard scales are not uncommon in medicine, and do not mean “poor quality” (despite Cass’s slippage between the two) or “junk science.” Doctors can and do often make treatment recommendations based on evidence that is rated low quality. A 2020 study in the Journal of Clinical Epidemiology (9/2/20) found that 53% of treatments are supported by either “low quality” or “very low quality” evidence. Many commonly prescribed antidepressants, for example, have low-quality evidence for use in populations under 18—but many families decide, with the help of a doctor, that it’s still the best choice for their child.

This is why the guidelines supported by WPATH do not deviate from the norms of medical practice in recommending puberty blockers based on the large amount of evidence we do have. As with all medical treatments, WPATH recommends doctors should inform patients and their parents of the potential risks and benefits, and allow them to decide what is best. This approach aligns with evidence-based medicine’s requirement to integrate the values and preferences of the patient with the best available evidence.

Of eight articles the Guardian ran on the Cass Review, only one (4/9/24) quoted any trans youth or their parents.

Cass also conducted a second systematic review on cross-sex hormones, which excluded 19 studies for being “low quality.” In spite of their exclusion, the systematic review still found “moderate quality” evidence for the mental health benefits of these treatments, a fact that Cass omits from her BMJ column (4/9/24) published concurrently with the review’s release, where she claims that pediatric gender medicine is built on “shaky foundations.”

These “shaky foundations” of “poor quality” evidence that Cass trumpeted were largely gobbled up by media, despite the criticisms of both expert groups like WPATH, and trans kids and their parents. Guardian readers almost certainly wouldn’t know that the amount of data we have on these treatments since the paper’s 2008 piece has expanded considerably: Every single one of the 103 studies on puberty blockers and cross-sex hormones for minors that the Cass Review found was published after 2008. That’s not the story that’s being told; in fact, it’s not even mentioned in the Guardian’s initial story (4/9/24) on the findings of the Cass Review, which put Cass’s “shaky foundations” quote in its headline.

That story exemplifies the problem with the frequent media scrutiny of evidence quality that is completely devoid of the circumstances under which trans youth and their parents have sought these treatments for more than a decade. In fact, these teens and their parents have been all but erased from the paper’s coverage.

The Guardian released eight stories and a podcast on the Cass Review in the first month of its coverage. Only two trans youth and one parent were quoted across these nine pieces.

Readers can’t fully understand why trans youth and their parents would seek out a treatment with “low-quality” or “moderate-quality” evidence without understanding their circumstances. And they can’t fully judge a policy decision to restrict these treatments without understanding how much more evidence we have now than we did when desperate parents were seeking them out abroad.

WBUR‘s interviewer (5/8/24) did not challenge Cass on her nonsensical statements, such as her assertion that “let[ting] young people go through their typical puberty” is the best way to “leave their options open.”

Some US outlets have, unsurprisingly, followed the British pattern in their coverage of the Cass Review, not questioning Cass’s tendentious interpretations, and sidelining the voices of trans youth and their parents.

Boston NPR station WBUR (OnPoint, 5/8/24) aired a lengthy interview with Cass. For almost two hours, host Meghna Chakrabarti gave Cass a friendly platform to pontificate on such matters as how pornography might be causing more kids to identify as trans, without asking her to substantiate her claims:

So we looked at what we understand about the biology, but obviously biology hasn’t changed suddenly in the last 10 years. So then we tried to look at, what has changed? And one is the overall mental health of teenage girls, in particular, although boys, to some degree. And that may also be driven by social media, by early exposure to pornography, and a whole series of other factors that are happening for girls.

While Chakrabarti raised some criticisms of the Cass Review, she never pressed Cass on her answers. For instance, when the host quoted WPATH’s statement that the Cass Review would “severely restrict access to physical healthcare for gender-questioning young people,” Cass suggested that trans youth will still be able to access treatment “under proper research supervision”—yet such research has yet to be announced. Chakrabarti did not press her on when these studies will start, what the criteria for participation will be, or what parents and kids are supposed to do in the meantime. Nor did she ask how long it will take to get into a study; currently the GIDS wait times are over six years.

Cass repeatedly argued that the key for youth seeking gender-affirming care was to “keep their options open.” Yet Chakrabarti never questioned how preventing young people from accessing puberty blockers helps achieve this, even when Cass argued that trans boys shouldn’t receive hormone treatment because male hormones “cause irreversible effects.” By this logic, the Cass Review should have required all trans girls to receive puberty blockers to prevent those same “irreversible effects.” Cass’s double standard also doesn’t take into account that estrogen puberty likewise causes irreversible effects that are not fully or easily reversible, such as height, voice and breast growth.

Incredibly, Cass described decisions about these treatments as very individual ones that need to be made with patients and doctors—which happens to be what WPATH recommends, and what the Cass Review has made virtually impossible. Cass told WBUR:

And for any one person, it’s just a careful decision about balancing, whether you have arrived at your final destination in terms of understanding your identity, versus keeping those options open. And that’s a really personal decision that you have to take with your medical practitioner, with the best understanding that we can give young people about the risks versus the benefits.

Rather than asking how exactly this squares with the Cass Review recommendations that have, at least for now, shut down all NHS medical gender-affirming care, Chakrabati changed the subject.

Chakrabarti’s segment also had a second part, which could have been used to interview an expert who disagreed with Cass’s findings. Instead, she interviewed two pediatric gender clinicians—one of whom, Laura Edwards-Leeper, had been a speaker at a conference against gender-affirming care in 2023—who offered no criticism aside from the fact that requiring mental health treatment for social transition would be impractical in the US, due to a lack of national healthcare.

“There are young people who absolutely benefit from a medical pathway, and we need to make sure that those young people have access,” Cass told the New York Times (5/13/24)—before adding, “under a research protocol,” even though such research has yet to be announced.

The New York Times (5/13/24), in a published interview conducted by reporter Azeen Ghorayshi, also ignored the realities facing trans kids in Britain as a result of Cass’s recommendations. Cass accused the American Academy of Pediatrics (AAP) of not being forthright about the evidence around gender-affirming treatments, and suggested its motivations are political:

I suspect that the AAP, which is an organization that does massive good for children worldwide, and I see as a fairly left-leaning organization, is fearful of making any moves that might jeopardize trans healthcare right now. And I wonder whether, if they weren’t feeling under such political duress, they would be able to be more nuanced, to say that multiple truths exist in this space—that there are children who are going to need medical treatment, and that there are other children who are going to resolve their distress in different ways.

Ghorayshi agreed with Cass, asking her how she would advise US doctors to thread this needle:

Pediatricians in the United States are in an incredibly tough position, because of the political situation here. It affects what doctors feel comfortable saying publicly. Your report is now part of that evidence that they may fear will be weaponized. What would you say to American pediatricians about how to move forward?

This entire line of questioning ignored that this issue is politicized in Britain as well. In March, former Prime Minister Liz Truss proposed a legislative ban on gender-affirming medical treatments for minors, which the government later implemented temporarily. The British government has also implemented recommendations that make social transition in schools extremely difficult. Ghorayshi could have pressed Cass on the political situation in her own country, rather than speculating on how doctors in the US are reacting to the one here.

Cass also presented the widely discredited theory that an exponential rise in the number of children and adolescents seeking gender-affirming care over the past decade is evidence of a “social contagion”:

It doesn’t really make sense to have such a dramatic increase in numbers that has been exponential. This has happened in a really narrow time frame across the world. Social acceptance just doesn’t happen that way, so dramatically. So that doesn’t make sense as the full answer.

This gigantic leap in logic goes completely without follow-up by Ghorayshi. Exponential rises can happen easily when a number is low to begin with. According to Cass’s own report, there were fewer than 50 referrals to GIDS in 2009. And while that number increased to 5,000 for 2021–22, this is 0.04% of the approximately 14 million people under the age of 18 in Britain.

Despite Cass’s claims to the contrary, these numbers could easily show that while very few adolescents were comfortable being out as trans at the outset of the 2010s, increased social acceptance has made that possible for more of them. Ghorayshi, however, does not press her to show any evidence for her highly unscientific theory.

A BBC report (5/7/24) cited Cass suggesting “‘evidence based’ treatment such as psychological support” as an alternative to puberty blockers, even though her review found no studies showing psychotherapy as an effective treatment for gender dysphoria.

One of the underlying problems with the Cass Review is that where it (dubiously) claims that medical interventions are not supported by evidence, it pushes psychotherapy as an effective treatment for gender dysphoria—with even less evidence. Most media have blindly accepted this contradiction.

In an article headlined “Cass Review Author Calls for ‘Holistic’ Gender Care,” the BBC (5/7/24) reported on Cass’s claim to the Scottish parliament implying psychotherapy and “medications” are “evidence-based” ways to treat gender-dysphoric children.

However, she told MSPs a drawback of puberty blockers, which she said had become “almost totemic” as the route to get on to a treatment pathway, was they stopped an examination of other ways of addressing young people’s distress—including “evidence-based” treatment such as psychological support or medication.

The BBC did not interrogate this claim. This is especially egregious in light of the fact that Cass’s own systematic review found no studies that show psychotherapy is an effective means of improving gender dysphoria. Moreover, it deemed nine of the ten studies of psychosocial support “low quality.”

Dan Karasic, a psychiatrist who has worked with patients with gender dysphoria for over 30 years, and an author on WPATH’s current treatment guidelines, told FAIR that there’s no evidence for her claim that psychiatric medications could be effective either:

There is absolutely no evidence to support Dr. Cass’s suggestion to substitute antidepressants for puberty blockers. It’s telling that Cass suggests an intervention utterly devoid of any evidence—antidepressants for gender dysphoria—over established treatments.

The Washington Post (4/18/24) featured an op-ed criticizing the “poor quality of evidence in support of medical interventions for youth gender dysphoria”—by someone pushing evidence-free psychotherapy treatment for youth gender dysphoria.

The Washington Post (4/18/24) accepted this same fallacy when it published an op-ed on the Cass Review by Paul Garcia-Ryan. Garcia-Ryan is the president of the organization Therapy First, which supports psychotherapy as the “first-line” treatment for gender dysphoria. Garcia wrote that in light of the Cass Review’s findings on the evidence behind gender-affirming treatments, psychotherapy needed to be encouraged:

The Cass Review made clear that the evidence supporting medical interventions in youth gender dysphoria is utterly insufficient, and that alternative approaches, such as psychotherapy, need to be encouraged. Only then will gender-questioning youth be able to get the help they need to navigate their distress.

Garcia-Ryan provides no evidence that psychotherapy is an effective alternative to the current treatment model that he is criticizing—which is no surprise, given the Cass Review’s findings. This is especially disturbing, given that his organization has published “clinical guidelines” for treating “gender-questioning” youth.

One of the case studies in the Therapy First’s guidelines involved an adolescent struggling with gender dysphoria, who described their family situation—where they don’t “feel understood and supported,” and their parents “don’t think trans exists”—to a therapist. The therapist then hypothesized that the gender dysphoria may be caused by an “oedipal process,” a subconscious infatuation with the father that the child “dealt with…by repudiating her femininity and her female-sexed body.”

Op-ed pages certainly exist to represent a diversity of viewpoints. But opinion editors have a duty to not let them be used for blatant misinformation. Though Garcia-Ryan protests that Therapy First is “strongly opposed to conversion therapy,” the sort of psychoanalysis he champions has a long, dark history of being used in conversion therapy. The American Psychoanalytic Association did not depathologize homosexuality until nearly 20 years after the American Psychiatric Association did.

The Washington Post (5/3/24) ran another pro-Cass op-ed from Benjamin Ryan, who it described as “covering LGBTQ health for over two decades”; it didn’t mention that much of that coverage has been in right-wing publications like the New York Sun and New York Post.

Rather than publishing any op-eds critical of the Cass Review for balance, the Washington Post (5/3/24) added a second op-ed a week later by freelance journalist Benjamin Ryan, who has recently published several pieces on trans issues for the conservative New York Sun and New York Post. Ryan criticized the American Psychiatric Association (APA) for being “notably silent” on Cass’s findings, and citing the fact that the only panel at its 2024 conference contained supporters of gender transition:

The program for the 2024 APA annual meeting lists only one panel that touches on pediatric gender-transition treatment, titled “Channeling Your Passion and ‘Inner Outrage’ by Promoting Public Policy for Evidence-Based Transgender Care.”

The panel notably includes Jack Turban, a University of California at San Francisco child psychiatrist and a vocal supporter of broad access to gender-transition treatment.

A letter to the editor in the Washington Post (5/10/24) noted that abstracts for the APA were due before the final Cass Review was published, so it would not have been possible to submit a panel examining its findings. This is something the Post could have easily factchecked.

In the US, gender-affirming care bans for minors have taken place amongst a similar backdrop of relentless media assault, based on similarly poor sources (FAIR.org, 8/30/23) and bad interpretations of data (FAIR.org, 6/22/23). The coverage of the Cass Review shows just how much US media have taken their cues from the Brits.

Research assistance: Alefiya Presswala, Owen Schacht

Electronic Intifada (7/15/24)

This week on CounterSpin: In March, the UN’s special rapporteur on human rights in the Palestinian territories concluded that “there are reasonable grounds to believe that the threshold indicating Israel’s commission of genocide is met.”

But as Greg Shupak writes, even as evidence accumulates, denial is becoming socially and journalistically acceptable. Soon after the UN special rapporteur on the right to food asserted that Israel’s forced starvation of Palestinians in Gaza was genocidal, Jonah Goldberg took to the LA Times to assure readers that Israel’s actions do not “amount to genocide,” and such claims are based on “Soviet propaganda” and Holocaust denial.

Years from now, we’ll hear about how everyone saw the nightmare and everyone opposed it. But history is now, and the world is watching. We’ll talk about real-time efforts to address the Israeli war on Palestinians with Phyllis Bennis, director of the New Internationalism project at the Institute for Policy Studies.

Plus Janine Jackson takes a quick look at recent press coverage of the shooting of Donald Trump.

Immediately after the attempted assassination of Donald Trump, when little was known about the white male shooter (except that he was a registered Republican), right-wing politicians directly blamed Democratic rhetoric for the shooting.

“Today is not just some isolated incident,” Sen. J.D. Vance wrote on X (7/13/24), just days before Trump named him as his running mate:

The central premise of the Biden campaign is that President Donald Trump is an authoritarian fascist who must be stopped at all costs. That rhetoric led directly to President Trump’s attempted assassination.

(That Trump might be considered a fascist did not always seem so far-fetched to Vance; in 2016, he privately worried that Trump might become “America’s Hitler”—Reuters, 7/15/24.)

“For years, Democrats and their allies in the media have recklessly stoked fears, calling President Trump and other conservatives threats to democracy,” Sen. Tim Scott posted on X (7/13/24). “Their inflammatory rhetoric puts lives at risk.”

Rather than denounce both the assassination attempt and these hypocritical and opportunistic attacks on critical speech, the country’s top editorial boards cravenly bothsidesed their condemnations of “political violence.”

The Washington Post (7/14/24) described Trump’s exhortation to “remain resilient in our Faith and Defiant in the face of Wickedness” as a call for “national unity.”

In an editorial headlined, “Turn Down the Heat, Let in the Light,” the Washington Post (7/14/24) praised Donald Trump for appearing to call for national unity. The Post wrote that the assassination attempt offered Trump the chance to “cool the nation’s political fevers and set a new direction.”

The editorial board quickly admonished both sides equally for “unthinkably uncivil” actions and “physical violence.” They pointed to protesters who “harass lawmakers, justices, journalists and business leaders with bullhorns at their homes,” universities that have “become battlegrounds,” and the “bipartisan hazard” of political violence, citing Nancy Pelosi’s husband and GOP Rep. Steve Scalise.

(The link the Post inserted leads to an earlier editorial in which they condemned peaceful protests outside Supreme Court justices’ houses as “totalitarian,” and recommended that the protesters be imprisoned—FAIR.org, 5/17/22).

New York Times editors, meanwhile, called the shooting “Antithetical to America” (7/13/24), a formulation clearly more aspirational than actual. “Violence is antithetical to democracy,” the editorial board wrote, acknowledging moments later that “violence is infecting and inflecting American political life.” They explained:

Acts of violence have long shadowed American democracy, but they have loomed larger and darker of late. Cultural and political polarization, the ubiquity of guns and the radicalizing power of the internet have all been contributing factors, as this board laid out in its editorial series “The Danger Within” in 2022. This high-stakes presidential election is further straining the nation’s commitment to the peaceful resolution of political differences.

It’s a remarkable obfuscation, in which responsibility is ascribed to no one and—as at the Post—everyone.

Is the shooting of a political candidate really “antithetical” (New York Times, 7/13/24) to a country with more guns than people, and 50,000+ gun deaths every year?

Curiously, the 2022 editorial series the Times cites (11/3–12/24/22) did make clear where most of the responsibility lay, explaining that “the threat to the current order comes disproportionately from the right.” It pointed out that of the hundreds of extremism-related murders of the past decade, more than three-quarters were committed by “right-wing extremists, white supremacists or anti-government extremists.” While there have been occasional attacks on conservatives (like the attack on a congressional baseball game that wounded Scalise), the Times noted,

the number and nature of the episodes aren’t comparable, and no leading figures in the Democratic Party condone, mock or encourage their supporters to violence in ways that are common from politicians on the right and their supporters in the conservative media.

But two years later, the Times, like the Post, carefully avoids bringing that much-needed clarity to the current situation and apportions responsibility for avoiding political violence equally to both sides:

It is now incumbent on political leaders of both parties, and on Americans individually and collectively, to resist a slide into further violence and the type of extremist language that fuels it. Saturday’s attack should not be taken as a provocation or a justification.

Of course, there’s a crucial difference between criticizing Trump and his allies for their anti-democratic positions and actions—which is what the Democrats and the left have done—and actually threatening and calling for violence, as the right has been doing.

The list of examples is nearly endless, but would prominently include Trump’s incitement of violence at the Capitol on January 6; his personal attacks on prosecutors, judges and politicians who have subsequently required increased security protections; and his refusal to rule out violence if he loses the 2024 election: “If we don’t win, you know, it depends.” His supporters have repeatedly called for armed uprisings after perceived attacks on Trump, including immediately after the assassination attempt.

That’s why it’s critical that leading newspapers push back against right-wing attempts to equate criticisms of Trump with calls for violence.

The Wall Street Journal (7/14/24), unsurprisingly, took this bothsidesism the farthest.

Leaders on both sides need to stop describing the stakes of the election in apocalyptic terms. Democracy won’t end if one or the other candidate is elected. Fascism is not aborning if Mr. Trump wins, unless you have little faith in American institutions.

We agree with former Attorney General Bill Barr’s statement Saturday night: “The Democrats have to stop their grossly irresponsible talk about Trump being an existential threat to democracy—he is not.”

Readers of those top US papers would have to look across the pond to the British Guardian (7/14/24) for the kind of clear-eyed take newspaper editors with concern for democracy ought to have: “There must also be care that extreme acts by a minority are not used to silence legitimate criticism.”

Research Assistance: Alefiya Presswala

Reuters (6/14/24) reported that the US military was behind social media messages like ““COVID came from China and the VACCINE also came from China, don’t trust China!”

Canada-based news agency Reuters (6/14/24) revealed that the Pentagon, beginning in spring 2020, carried out a year-long anti-vax messaging campaign on social media. Reuters reported that the purpose of the clandestine psychological operation was to discredit China’s pandemic relief efforts across Southeast and Central Asia, as well as in parts of the Middle East.

“We weren’t looking at this from a public health perspective,” a “senior military officer involved in the program” told Reuters. “We were looking at how we could drag China through the mud.”

The Reuters report straightforwardly implicated the US military in a lethal propaganda operation targeting vulnerable populations, centrally including the Filipino public, to the end of scoring geostrategic points against China:

To Washington’s alarm, China’s offers of assistance were tilting the geopolitical playing field across the developing world, including in the Philippines, where the government faced upwards of 100,000 infections in the early months of the pandemic.

The findings were unequivocal. In conjunction with private contractors, the US military created and employed fake social media profiles across popular platforms in multiple countries in order to sow doubt, not only about China’s Sinovac immunization, but also about the country’s humanitarian motivations with respect to their dispersal of pandemic-related aid. The news agency quoted “a senior US military officer directly involved in the campaign in Southeast Asia”:  “We didn’t do a good job sharing vaccines with partners…. So what was left to us was to throw shade on China’s.”

This New York Times headline (7/3/24), pointedly critical of the Pentagon’s anti-vaccine disinformation, did not appear in the Times newspaper, but only in a subscriber-only newsletter.

One might be forgiven for assuming that US news media editors would pounce on the fact that the most powerful institution in the US, and quite possibly the world, promulgated anti-vax material on social media over the course of a year. However, nearly a month later, the Wall Street Journal, Washington Post, Politico, CNN and MSNBC have yet to cover the news.

The New York Times, which has consistently covered anti-vaccine disinformation (7/24/21, 8/1/21, 12/28/22, 3/16/24) and extremism (3/26/21, 4/5/21, 8/31/21, 6/14/24), has yet to cover the Pentagon’s unparalleled anti-vax indoctrination efforts in its news section; it ran one subscriber-only newsletter opinion piece (7/3/24) on the story nearly three weeks after Reuters‘ revelations.

Meanwhile, independent (Common Dreams, 6/14/24; WSWS, 6/16/24) and international sources (Al Jazeera, 6/14/24; South China Morning Post,  6/16/24, 6/17/24, 6/18/24) immediately relayed the revelations.

Given the Times’ track record in the fight against vaccine disinformation, one might expect to see that paper in particular give this blockbuster news front-page status. After all, the Pentagon was busy secretly inculcating anti-vax attitudes in its targets when Neil MacFarquhar of the Times (3/26/21) warned that “extremist organizations are now bashing the safety and efficacy of coronavirus vaccines in an effort to try to undermine the government.”

In a New York Times Magazine thinkpiece (5/25/22), Moises Velasquez-Manoff took stock of the “nightmarish and bizarre” conspiratorial “skullduggery swirling around vaccines”:

The process of swaying people with messaging that questions vaccines is how disinformation—deliberately fabricated falsehoods and half-truths—becomes misinformation, or incorrect information passed along unwittingly. Motivated by the best intentions, these people nonetheless end up amplifying the contagion, and the damaging impact, of half-truths and distortions.

Anxiety and doubt around immunizations, readers were told, “may be seeping into their relationship with medical science—or governmental mandates—in general.”

Surely this line of reasoning applies as much if not more so to the Pentagon’s anti-vaccine propaganda offensive in Asia and the Middle East: The US military’s own skullduggery has primed countless victims around the world to be more skeptical of medical technology in general.

Even if Americans weren’t targeted by the Pentagon’s scheme, their tax dollars were employed to materially endanger people throughout Asia and the Middle East, and to undermine public health mandates in general. And in the midst of a global pandemic, infections anywhere threaten peoples’ lives everywhere. But the threat of anti-vax disinformation is apparently not a high priority for the establishment press if the US military is implicated.

In keeping with a rich history of obsequious editorial decision-making when it comes to the Pentagon’s activities abroad, this remarkable lack of attention on the part of the Times and the rest of the corporate US press serves as yet another example of corporate media’s timorous attitude towards structural power in this country.

CNN (6/6/24)

This week on CounterSpin: At some point, we will get tired of hearing news reports on “record heat”—because the “records” will continue to be broken,  and “heat” will have stopped meaning what it once may have meant. Media play a role in moving us from questions about where to buy a good air conditioner to what stands in the way of addressing a public health catastrophe? One obstacle is utility companies. In February of last year, we spoke with Shelby Green at Energy and Policy Institute and Selah Goodson Bell at the Center for Biological Diversity, about their research on the topic.

In These Times (12/27/17)

Also on the show: Some listeners will know that veteran labor organizer and author Jane McAlevey died recently. The tributes are coming in, but I have little doubt in saying that McAlevey would care less for attention to her life in particular than to those of people she worked for, inside and outside of unions. CounterSpin spoke with her in 2018, when the #metoo campaign was coming to fore. We’ll hear some of that conversation this week on the show.

Reuters (6/27/24) noted that Meloni’s Brothers of Italy party “traces its roots to the Italian Social Movement (MSI), formed in 1946 as a direct heir of Benito Mussolini’s fascist movement that ruled Italy for more than 20 years.”

An antisemitism scandal has rocked one of Europe’s major far-right political leaders: Giorgia Meloni, prime minister of Italy. It’s been major news in the European press. But the story is being mishandled by major US corporate media, and that fact says a lot about how poorly antisemitism is covered in the United States.

Reuters (6/27/24) reported:

A reporter from online newspaper Fanpage [6/14/24] infiltrated Gioventu Nazionale, Meloni’s rightist Brothers of Italy youth movement, and recorded videos in which members declared themselves fascists and shouted the Nazi slogan “Sieg Heil.”… The investigation also showed a Gioventu Nazionale member mocking Brothers of Italy senator Ester Mieli for her Jewish origin, and revealed chats on messaging platforms where militants took aim at ethnic minorities.

Meloni’s political opponents used this footage against her (Guardian, 6/27/24). She eventually condemned the antisemites (Euronews, 6/29/24). Haaretz (6/30/24) said:

This 12-minute video showed National Youth activists, including two senior figures, singing a celebratory song in honor of the disgraced dictator Benito Mussolini, chanting “Sieg Heil!” and glorifying the Nuclei Armati Rivoluzionari (Armed Revolutionary Nuclei)—a neofascist terrorist group that was active in Italy in the late 1970s and early ’80s, committing over 100 murders.

Fanpage (6/14/24) led off its report on Italy’s National Youth by noting that Meloni refers to them as “marvelous young people,” and they are defined as “the soul and the driving force” of her party.
 

This shouldn’t be a big surprise to anyone who has been paying attention to Italian politics. The nation’s small but vibrant Jewish population has been skeptical of Meloni’s ascendence and that of her party, Brothers of Italy. The Jewish Telegraphic Agency (9/30/22) explained two years ago:

Meloni’s first stop in politics was in the youth movement of the Italian Social Movement, known as MSI, a neofascist party founded in 1946 by people who had worked with Hitler and Benito Mussolini, Italy’s fascist leader from 1922 to 1943. Brothers of Italy is closely tied to the group, even housing its office in the same building where MSI operated and using an identical logo, a tricolor flame.

With Meloni at the helm of one of Europe’s biggest economies, she is not a minor player; in fact, at the last G7 conference, she stood out as a confident leader (AP, 10/18/23; Wall Street Journal, 6/13/24) over a flock of feeble, vulnerable centrists and conservatives.

One of those was Rishi Sunak, who has since lost his job as British prime minister and Conservative Party leader (Guardian, 7/5/24). Another is President Joe Biden, who is being pressured to drop out of the US presidential race due to concerns regarding his cognitive health (New York Times, 6/28/24). And French President Emmanuel Macron has been weakened by the poor performance of his party in snap parliamentary elections (Reuters, 7/7/24).

The summit took place after Meloni’s party increased its share of the popular vote in  the European Union election, and she is now “poised to play a critical role shaping the future direction of EU policy in Brussels” (Politico, 6/13/24).

The New York Times (7/2/24) led with Meloni “urg[ing] leaders of her political party on Tuesday to reject antisemitism, racism and nostalgia for totalitarian regimes.”

The New York Times (6/11/24) has positively portrayed Meloni as a “critical player” as the host of the G7 conference, and has been upbeat about her rising stature generally. (Her anti-Russian politicking “sealed her credibility as someone who could play an influential role in the top tier of European leaders”—2/7/24.) The Times (7/2/24) came late to the Brother of Italy story , leading with the news of her public relations drive to denounce the racist content. The Washington Post, which also had previously normalized her as a European politician (6/6/24), covered the story in a similar fashion with AP copy (7/3/24).

NPR missed the story. So did CNN. The Wall Street Journal, whose editorial board had said she was “governing with some success” (6/13/24), and whose news coverage has portrayed her as a pragmatist (6/13/24), wasn’t interested in  the scandal either.

This lackluster coverage, which at best focused on Meloni’s self-interested damage control rather than the dark ideology at the center of her movement, is confounding. Western media have been rightfully fretting about the far right’s impressive showing in recent EU parliamentary elections (New York Times, 6/9/24). Meloni’s reputation as a strong leader among ailing centrist European leaders is bolstered by other far-right parties making impressive gains.

All of these parties, known for their anti-immigration and anti-multicultural positions, also have tinges of right-wing antisemitism, including Britain’s Reform Party (Haaretz, 6/23/24), Germany’s Alternative for Deutschland (Deutsche Welle, 8/5/23) and France’s National Rally (AP, 7/3/24). In the US, Donald Trump has been careful not to criticize the overt antisemites in the MAGA movement, including the “very fine people” who chanted “Jews will not replace us” at Charlottesville (Politico, 12/7/22). The Washington Post (10/17/22) noted that Trump has long employed antisemitic tropes in his rhetoric.

The New York Times (12/16/23) is more concerned about the “antisemitism” of protesters who assert “that the war in Gaza was a genocide.”

And so the Fanpage revelations should have been a blaring danger signal, as they were for the European press. The New York Times has been raising alarms (10/31/23, 12/16/23) about a rise of antisemitism since the October 7 attacks in Israel, painting the problem as one that plagues the left and the right. But as FAIR (12/12/23, 12/15/23) has talked about, corporate media are quick to cast legitimate criticism of Israel as antisemitism to discredit pro-Palestine points of view, wrongfully equating opposition to genocide with the racist antisemitism of the right.

Regardless of the reason for US corporate media’s oversight, the impact is clear. The press can talk about antisemitism more openly when they can attach it to human rights protesters, but are less eager to describe antisemitism as it actually is: a bigotry that is interwoven with the anti-Islamic and xenophobic platforms of the powerful far right.

Janine Jackson interviewed Northwestern University’s Hatim Rahman about algorithms and labor for the July 5, 2024, episode of CounterSpin. This is a lightly edited transcript.

Janine Jackson: Many of us have been bewildered and bemused by the experience of walking out of a doctor’s appointment, or a restaurant, and within minutes getting a request to give our experience a five-star rating. What does that mean—for me, for the establishment, for individual workers? Data collection in general is a concept we can all grasp, but what is going on at the unseen backend of these algorithms that we should know about to make individual and societal decisions?

University of California Press (2024)

Hatim Rahman is assistant professor of management and organizations at the Kellogg School of Management at Northwestern University. He’s author of the book Inside the Invisible Cage: How Algorithms Control Workers, forthcoming in August from University of California Press. He joins us now by phone. Welcome to CounterSpin, Hatim Rahman.

Hatim Rahman: Thank you. I’m excited to be here.

JJ: The book has broad implications, but a specific focus. Can you just start us off explaining why you focused your inquiry around what you call “TalentFinder”? What is that, and what’s emblematic or instructive around that example?

HR: Sure, and I want to take you back about a decade ago, when I was a graduate student at Stanford University, in the engineering school, in a department called Management Science and Engineering. And at that time, when I was beginning my studies, there was a lot of talk about the future of work, and how technology, specifically algorithms and artificial intelligence, are going to lead us to the promised land. We are going to be able to choose when to work, how often we want to work, because, essentially, algorithms will allow us to pick the best opportunities and give us fair pay. And from an engineering perspective, there was this idea that it was technically feasible.

But as I began my studies, I realized that the technical features of algorithms or artificial intelligence don’t really tell us the whole story, or really the main story. Instead, these technologies really reflect the priorities of different institutions, organizations and individuals.

And so that’s kind of the through line of the book, but it was playing out in what a lot of people call the “gig economy.” Many of us are familiar with how Uber, Airbnb, even Amazon to a large extent, really accelerated this concept and the idea of the gig economy. And so you mentioned, I found this platform, which I use a pseudonym called TalentFinder, that was trying to use algorithms to create an Amazon for labor. What I mean by that is, just as you pick a product, or maybe a movie or TV show on Netflix, the thought was, if you’re looking to hire somebody to help you create a program, write a blog post, any task that you can think about that’s usually associated with knowledge work, that you could go onto this platform and find that person, again, as I alluded to earlier, just as you find a product.

And the way they were then able to do that, allow anybody to sign up to work or to find somebody, was with the use of these algorithms. And what I found, though, the reality of the situation was, that as the platform scaled, it started to prioritize its own goals, which were often in conflict, or were not shared, with workers on these platforms.

JJ: So let’s talk about that. What do you mean by that, in terms of the different goals of employers and potential workers?

HR: Sure. So it kind of went to the example you started with, that one of the thoughts was—actually, I’m going to take you back even further, to eBay. When eBay started, we take it for granted now, but the thought was, how can I trust that this person I don’t know, I don’t even know them. How can I trust that the images that they’re showing, the description that they put on, is true?

JJ: Right, right.

(via Reddit)

HR:  And so eBay pioneered, really, or at least they’re the most famous example of the early company that started, like, “Hey, one way we can do this is through a rating system.” So I may take a chance and buy a product with somebody I don’t know, and if they send me what they said, I’m going to give them a five-star rating, and if they don’t, I’ll give them a lower rating.

And so since then—that was in the mid-’90s—almost all online platforms and, as you mentioned, organizations and—sorry, it is a small tangent: I was recently traveling, and I saw an airport asking me for my ratings for my bathroom experience.

JJ: Of course, yes. Smiley face, not smiley face.

HR: Exactly, exactly. Everyone copy and pastes that model. And that is helpful in many situations, but it doesn’t capture, a lot of times, the reality of people’s experiences, especially when you think about the context that I talked about. If you hired me to create a software program, and we work together for six months, there are going to be ups and downs. There are going to be things that go well, things that don’t necessarily go well, and what does that mean if you gave me a 4.8 or 4.5, right?

And so this was something that workers picked up on really early on in the platform, that these ratings, they don’t really tell the whole experience, but the algorithms will use those ratings to suggest, and people will use the search results that the algorithms curate, to make decisions about who to hire, and so on and so forth.

The problem that I traced, over the evolution of the platform, is that once workers realized that it was really important, they found out ways to game the system, essentially, to get a five-star rating all the time. And from speaking to workers, they felt this was justified, because a lot of times in an organization that hires them, they mismanage the project….

And so, in response, what the platform did, and now again almost all platforms do this, they made their algorithm opaque to workers. So workers no longer understood, or had very little understanding, of what actions were being evaluated, how they were being evaluated, and then what was the algorithm doing with it.

So, for example, if I responded to somebody faster than the other person, would the algorithm interpret that as me being a good worker or not? All of that, without notice or recourse, became opaque to them.

I liken it to, if you received a grade in class, but you don’t know why you got that grade. And, actually, many of us may have experienced this going through school; you hear this “participation grade,” and it’s like, “Wait, I didn’t know that was a grade, or why the professor gave me this grade.”

So that does happen in human life as well. One of the points I make in the book is that as we turn towards algorithms and artificial intelligence, the speed and scale at which this can happen is somewhat unprecedented.

Jacobin (2/20/18)

JJ: Right, and I’m hearing Taylorism here, and just measuring people. And I know that the book is basically engaged with higher-wage workers, and it’s not so much about warehouse workers who are being timed, and they don’t get a bathroom break. But it’s still relevant to that. It’s still part of this same conversation that’s categorically different; algorithm-driven or determined work changes, doesn’t it, the basic relationship between employers and employees? There’s something important that is shifting here.

HR: That’s correct. And you are right that one of the points that I make in the book, and there’s been a lot of great research and exposés about the workers that you mentioned, in Amazon factories and other contexts as well, that we’ve seen a continuation of Taylorism. And for those who are less familiar, that essentially means that you can very closely monitor and measure workers.

And they know that, too. They know what you’re monitoring, and they know what you’re measuring. And so they will often, to the detriment of their physical health and well-being, try to conform to those standards.

And one of the points I make in the book is that when the standards are clear, or what you expect them to do is comparatively straightforward—you know, make sure you pack this many boxes—we will likely see this enhanced Taylorism. The issue that I’m getting at in my book is that, as you mentioned, we’re seeing similar types of dynamics being employed, even when the criteria by which to grade people or evaluate people is less clear.

So, again, for a lot of people who are engaged in knowledge work, you may know what you want, but how you get there….  If you were to write a paper or even compose a speech, you may know what you want, but how you’re going to get there—are you going to take a walk to think about what you’re going to say, are you going to read something unrelated? It’s less clear to an algorithm whether that should be rewarded or not. But there is this attempt to try to, especially in trying to differentiate workers in the context that I mentioned.

So the problem with everyone having a five-star rating on eBay or Amazon, or on TalentFinder that I studied, is that for people who are trying to then use those ratings, including algorithms, it doesn’t give any signal if everyone has the same five-star rating. In situations and contexts where you want differentiation, so you want to know who’s the best comparatively to other people on the platform, or what’s the best movie in this action category or in the comedy category compared to others, then you’re going to try to create some sort of ranking hierarchy. And that’s where I highlight that we’re more likely to see what I call this “invisible cage” metaphor, where the criteria and how you’re evaluated becomes opaque and changing.

JJ: I think it’s so important to highlight the differentiation between workers and consumers. There’s this notion, or this framework, that the folks who are working, who are on the clock and being measured in this way, somehow they’re posed or pitted against consumers. The idea is that you’re not serving consumers properly. And it’s so weird to me, because consumers are workers, workers are consumers. There’s something very artificial about the whole framework for me.

HR: This is returning to one of the earlier points that I mentioned, is that we have to examine what in my discipline we call the “employment relationship.” How are people tied together, or not tied together? So in the case that you mentioned, many times consumers are kept distant from workers; they aren’t necessarily even aware, or if they are aware, they aren’t given much opportunity.

So generally speaking, for a long time, like Uber and Lyft—especially in the earlier versions of the platform; they change very rapidly—they don’t necessarily want you to call the same driver every time, [even] if you have a good relationship with them. So that’s what you mentioned, that the design of these systems sometimes keeps people in opposition with each other, which is problematic, because that’s not the technology doing that, right? That’s the organization, and sometimes the laws that are involved, that don’t allow for consumers and workers, or people more broadly, to be able to talk to each other in meaningful ways.

And in my case, on TalentFinder as well, I spoke to clients, consumers or people who are hiring these workers, and a lot of them were just unaware. They’re like, “Oh my gosh.” I highlighted in the book that they designed the rating system to say, “Just give us your feedback. This is private. We just want it to improve how the platform operates.” What they don’t tell them is that if they were to give them something slightly less than ideal, it could really imperil the workers‘ opportunity to get a next job.

We sometimes refer to this as an information asymmetry, where the platform, or the organizations, they have more information, and are able to use it in ways that are advantageous to them, but are less advantageous to the workers and consumers that are using these services.

JJ: And part of what you talk about in the book is just that opacity, that organizations are collecting information, perhaps nominally in service of consumers and the “consumer experience,” but it’s opaque. It’s not information that folks could get access to, and that’s part of the problem.

Hatim Rahman: “If you are a worker, or if you are the one who is being evaluated, it’s not only you don’t know the criteria, but it could be changing.”

HR: That’s right. It goes to this point that these technologies, they can be transparent, they can be made accountable, if organizations, or in combination with lawmakers mandating, take those steps to do so. And we saw this early on on the platform that I study, and also on YouTube and many other platforms, where they were very transparent about, “Hey, the number of likes that you get or the number of five ratings you get, we’re going to use that to determine where you show up in the search results, whether we’re going to suggest you to a consumer or a client.”

However, we’ve increasingly seen, with the different interests that are involved, that platforms no longer reveal that information, so that if you are a worker, or if you are the one who is being evaluated, it’s not only you don’t know the criteria, but it could be changing. So today, it could be how fast you respond to somebody’s message. Tomorrow, it might be how many times did you log into the platform.

And that’s problematic, because if you think about learning, the ability to learn, it fundamentally relies on being able to establish a relationship between what you observe, or what you do, and the outcome that leads to. And when that becomes opaque, and it’s so easy to change dynamically—sometimes even, let’s put aside day-to-day, maybe hour-to-hour, minute-to-minute—those really kind of supercharge the capabilities to what I call enable this dynamic opacity.

JJ: And not for nothing, but it’s clear that in terms of worker solidarity, in terms of workers sharing communication with each other, put it simple, workers need to communicate with other workers about what they’re getting paid, about their experience on the job. This is anti all of that.

HR: In related research, for my own and others, we have tried to examine this as well, especially gig work; the setup of this work makes it very difficult for workers to organize together in ways that are sustainable. Not only that, many workers may be drifting in and out of these platforms, which again makes it harder, because they’re not employees, they’re not full-time employees. And I talk to people in the book, I mentioned people, they’re between jobs, so they just want to kind of work on it.

So in almost every way, from the design of the platform to employment relationship, the barriers to create meaningful, sustainable alternatives, or resistance or solidarity, becomes that much more difficult. That doesn’t mean workers aren’t trying; they are, and there are organizations out there, one called Fairwork and others, that are trying to create more sustainable partnerships, that will allow workers to collectively share their voices, so that hopefully there are mutually beneficial outcomes.

I talked about this earlier; I mean, just to connect again with history, I think we can all agree that it’s good that children are not allowed to work in factories. There was a time when that was allowed, right? But we saw the effects that could have on the injuries, and just overall in terms of people’s development. And so we need to have this push and pull to create more mutually beneficial outcomes, which currently isn’t occurring to the same extent on a lot of these gigs and digital platforms.

JJ: Finally, first of all, you’re highlighting this need for interclass solidarity, because this is lawyers, doctors—everybody’s in on this. Everybody has a problem with this, and that’s important. But also, so many tech changes, people feel like they’re just things that happen to them. In the same way that climate change, it’s just a thing that’s happening to me. And we are encouraged into this kind of passivity, unfortunately. But there are ways to move forward. There are ways to talk about this. And I just wonder, what do you think is the political piece of this, or where are meaningful points of intervention?

Consumer Reports (5/07)

HR: That’s a great question. I do like to think about this through the different lenses that you mentioned. What can I do as an individual? What can I do in my organization? And what can we do at the political level? And, briefly, on the individual consumer level, we do have power, and we do have a voice, going back to the past, right? Consumer Reports. Think about that. Who was that started by? And that had a very influential difference on the way different industries ran.

And we’ve seen that, also, for sustainability. There’s a lot of third-party rating systems started by consumers that have pushed organizations towards better practices.

So I know that may sound difficult as well, but as I mentioned, there’s this organization called Fairwork that is trying to do this in the digital labor context.

So I would say that you don’t have to do it on your own. There are existing platforms and movements, as individuals, that you can try to tap onto, and to share these what we call again third-party alternative rating systems, that we can collectively say, “Hey, let’s use our economic power, our political power, to transact on platforms that have more transparency or more accountability, that are more sustainable, that treat workers better.” So that’s one, on the political level.

Maybe my disposition is a little bit more optimistic, but I think that we’ve seen, in the last few years, with the outsized impact social media has suggested it’s had on our discourse and politics, that politicians are more willing than before, and I know sometimes the bar is really low, but still, again, on the optimistic side, that they’re at least willing to listen, and hopefully work with these platforms, or the workers on the platforms, because, again, I really fundamentally feel that ensuring that these technologies and these platforms reflect our mutual priorities is going to be better for these organizations and society and workers in the long term as well.

We don’t want to just kick the can down the road, because of what you talked about earlier, as it relates to climate change and CO2 emissions; we’ve been kicking it down the road, and we are collectively seeing the trauma as it relates to heat exhaustion, hurricanes….

And so, of course, that should be warning signs for us, that trying to work together now, at all of those different levels, is necessary. There’s not a silver bullet. We need all hands on deck from all areas and angles to be able to push forward.

JJ: I thank you very much for that. I co-sign that 100%.

We’ve been speaking with Hatim Rahman. He’s assistant professor at Northwestern University. The book we’re talking about is Inside the Invisible Cage: How Algorithms Control Workers. It’s out next month from University of California Press. Hatim Rahman, thank you so much for joining us this week on CounterSpin.

HR: Thank you for having me.