Gordon Guyatt, a distinguished professor of medicine at McMaster University in Canada, has ignited significant debate within the medical community regarding the treatment of transgender individuals. Guyatt has been called the “godfather” of evidence-based medicine. As a result, his groundbreaking research and work on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework has made monumental contributions to the formation of clinical recommendations. His methodology is now the gold standard, which has been adopted by over 100 medical and public health organizations, including the World Health Organization (WHO).
Guyatt was recently at the center of a Twitterstorm for his extremely harsh condemnation of the SEGM, Society for Evidence-based Medicine. He called out the advocacy group for twisting facts to withhold treatment from trans patients. New allegations have recently surfaced that SEGM and its members divested Guyatt’s research for their own nefarious purposes. As a result, this dispute has received unprecedented attention. As these developments unfold, the medical community grapples with the implications of his statements and the role of patient autonomy in clinical decision-making.
Gordon Guyatt’s Role and Influence
Gordon Guyatt’s groundbreaking work developing evidence-based medicine has rightfully gained him fame and glory well outside of the ivory tower. His colleagues still jokingly call him the “godfather” of the young discipline. This playful nickname underscores his impact on the way we make and measure clinical practices among the medical community. His GRADE framework has transformed the art of health recommendations, sharpening a systematic lens on evaluations of evidence quality.
His impact reaches into the political world, too. Even the Trump administration’s Department of Health and Human Services (HHS) has referenced Guyatt’s research. They relied on it to cherry-pick the evidence against transgender health care, most notably to undermine the effectiveness of gender-affirming treatments. The politicalization of medicine should ring alarm bells. Advocates caution that cherry-picking and misinterpreting evidence can create counterproductive and even dangerous policies.
Guyatt’s research is about more than political agendas. It has seeped into legal advocacy, such as the amicus brief filed in support of plaintiffs in Chiles v. Salazar. U.S. This Supreme Court case would do just that, by overturning Colorado’s ban on conversion therapy for minors. It deepens Guyatt’s involvement in the culture war, placing science directly opposed to the anti-trans ideology of gender identity.
The Dispute with SEGM
At the last SEGM conference, Guyatt jumped right into some spirited debates with other conference attendees. They fought for the importance of patient autonomy in the principles of evidence-based medicine. He went on to underscore that honoring patients’ values and preferences was one of the core tenets of the discipline. The trouble grew when he started publicly challenging SEGM members about how they cherry-picked evidence to misrepresent the current state of transgender health care.
“I have a responsibility to how it gets used,” Guyatt stated, highlighting his concern over how his research could be applied. He has unequivocally condemned how SEGM has used his work to falsely discredit gender-affirming care. He went on to describe it as “an unconscionable use of our work.”
Guyatt argued that “to deny it to people, to make people suffer unnecessarily, that’s another type of harm.” His commitment to patient-centered care highlights the ethical obligations that the healthcare community has to those who wish to access gender-affirming care.
The misgivings expressed by SEGM reviewers further complicates an already fraught situation. Two former paid consultants reviewers raised their opposition. Former paid consultants raised their criticism of Guyatt’s reviews. They claimed his findings didn’t match their narrative on transgender health care. This discord calls into question the integrity and objectivity of those who take part in discussions of evidence-based medicine.
Understanding Evidence Quality
At the heart of the continuing debate is how to interpret this low-quality evidence in the clinical arena. Guyatt has been clear that low-quality evidence does not mean bad care or an ideological agenda. He argues that there’s a lot of accepted medical interventions where the evidence is low-certainty. Because of this, patients are better equipped to make knowledgeable choices about their healthcare while keeping this knowledge in focus.
“It is profoundly misguided to cast health care based on low-certainty evidence as bad care or as care driven by ideology,” he stated. In collaboration with four colleagues at McMaster, he asserted that “enlightened individuals often legitimately and wisely choose such interventions,” reinforcing the idea that patient choice plays a crucial role in health care decisions.
Despite criticisms from many corners, Guyatt stood resolutely by his argument that patient values should drive clinical practice. As he said, “putting out good science is not enough.” The secret, he suggested, is for healthcare to change and address what people want in a personal way.
The discussion around transgender health care is rapidly changing. Guyatt’s comments are a helpful reminder about some of the unintended complications that can accompany evidence-based medicine. He feels that any skepticism has to be rooted in professional discussion as opposed to ideological counter-movement.
