Galileo's Middle Finger
Alice Dreger
(Penguin)
(Note: this review covers some controversial ground, especially in the discussion of transgenderism).
From the title, I thought this was another "so you think you know history" book, a glib volume of bawdy historical incidents (like the time Galileo flipped off the Pope, apparently?) What I found instead was at first simply baffling - what the hell did this have to do with the 15th-century astronomer and his erstwhile digit? - But ended up being utterly engrossing. By the end of this book I was amused, outraged, and zealous for truth at all cost...but also unnerved and unmoored by a simple question: how can we believe anything we read - even this book itself?
Galileo's Middle Finger is hard to pigeonhole; it seems to lie somewhere between a memoir and an expose, with a bit of personal defense thrown in. Alice Dreger is a bioethicist, author, and part-time activist who specializes in some of the most tendentious scientific-research controversies of our times. In the first section of the book, she details her work as an advocate for people with intersex conditions, in which both sexes exhibit minimal, partial, or "switched" genitalia. For most of the 20th century, intersexuality was "fixed" by doctors in order to conform to our cultural gender binary - in other words, intersex children would undergo dangerous surgeries in order to make them typically male or female. This was often explained as a psychological necessity, in order to keep the children from depression and suicide, but this claim has always been dubious: intersex adults more often regret "corrective" surgery more than their inborn characteristics. In the first section of the book, Dreger describes her years as an advocate for intersex groups, hoping to undo the years of entrenched dogma in the medical establishment. Her approach to activism - through careful research and well-ordered, respectful, reasonable argument - stands in direct contrast to howling and emotional "mob activism", especially that seen on the internet today.
In the second part of the book she faces exactly this sort of twisted advocacy, when she defends scientific research that reached controversial conclusions, often ruining the reputations of the researchers involved. J. Michael Bailey conducted research on transgender males in which he detected two distinct "types": Transkids, who are essentially gay, feminine males who become female as a matter of convenience (especially in traditional cultures); and Autogynephiliacs, males who are strongly aroused by fantasies of becoming female. His book, The Man Who Would Be Queen, created a firestorm of controversy among transgender activists and progressives of all stripes. Dreger initially accepts the accusations of transphobia against Bailey, but as she cuts through the layers of mud she realizes exactly the opposite is true: Bailey represents a measured, reasonable, scientific case (however politically tone-deaf he might be), while his enemies are acting on gut reactions and entrenched prejudices. As she works on Bailey's behalf, Dreger begins to see myriad other cases where scientists were blackballed and ruined because they followed their scientific findings, rather than bow to the current cultural and political climate.*
Her most damning realization was the very institutions meant to uphold scientific and medical integrity are swarming with conflicts of interest, personal vendettas, and simple greed. In the book's third section, Dreger returns to intersex activism as she battles the use of dexamethasone on fetuses suspected to have Congenital Adrenal Hyperplasia (CAH). In brief, CAH is an adrenal condition that results in masculinization in females; a corticosteroid, dexamethasone, seemed to have a dampening effect on the condition. Clinical trials in Sweden, however, showed that "dex" was not only ineffective, but resulted in psychological side effects. Moreover, the overarching motivation for the use of dex against CAH was not its possible health effects - cancer of the adrenal gland, for instance - but to impose gender conformity on otherwise "manly" females. Sweden banned the use of dex; the United States did not. Dreger's battle against the use of dex centered on a single corrupt obstetrician who presented the treatment to her patients as safe and standard, while petitioning the NIH for research grants on these very same cases. Ultimately certain elements within the medical establishment conspired to block Dreger's motion to discontinue dex's use on pregnant women; though doctors are more aware of dex, the FDA has made no move to ban its use.
Galileo's Middle Finger is a fascinating look at both the scientific/medical establishment, and the political/activist atmosphere in the United States. They seem to stand on opposite sides of the divide - brains versus heart - but in fact contain a complex admixture of scientific inquiry, cerebrialism, passion, obsession, jealousy, drama, infighting, corruption, greed, and blind Party Line-ism. Dreger's thesis is that scientists need to dare to imagine a world other than the one we all agree on, to follow truth to its uncomfortable conclusions, and above all to have a community of objective reviewers who can repeat their work. In other words, she wants the scientific method and scientific establishment to do what they were meant to do...and realizes, depressively, that so often this simply does not happen. Human taboos are too powerful; money is too powerful; emotions are too powerful. Galileo pointed to the heavens, but the Church refused to look, and in the end he was forced to recant what he knew to be true. Only history has vindicated the Florentine astronomer, and then only as a sort of marble saint of establishment science, and not the mischievous, tendentious, conflicted contrarian he was in life.
Dreger's writing is curious; it comes off as a rant, or even a more literate blog post. Things get muddy when she's chronicling the sort of "he said, she said" of her battles with transgender activists, and there's more than a hint of self-justification; there are passages almost as brittle and bitchy as the people she's complaining about. She's at her best when describing the life and character of the ruined scientists she came to admire, and you can hear the love in her writing, especially when a he-man field researcher breaks down recounting his colleagues' betrayals. There is a deep yearning for truth here which I admire the most, the feeling that truth is transcendent, and a love of going further is one of the highest human desires.
But Dreger's worst act here, mostly unintentional, is to plant an insidious seed of doubt in scientific establishments and any and all other-than-firsthand information. Her bewilderment at the scope of the problem is infectious: how much research is repressed due to political correctness, personal vendetta, or corporate meddling? A quarter? Half? And the more she described how she dug down to original sources and original research publications, the more alarmed I became. The simple fact is, us laymen simply don't have the time, understanding, or insider acumen to know if what we are reading is true. We can't get to the original sources, especially if, as Dreger found, the high-standing authors of these reports may have conflicts of interest, and may even be using the very power of peer-review to squash researchers and all of their work forever. If even an incredibly well-educated, intelligent, connected bioethicist can be flummoxed by the labyrinth of the science-industrial complex, how do the rest of us stand a chance?
I recommend Galileo's Middle Finger, if only because it pointed me to so many controversial research topics, and lionized the discredited scientists who were only following the truth, no matter the cost. Here's my hope that Dreger will never give up the search, and that maybe, someday, truth will prevail.
Final Verdict: 4 out of 5.
*Update 3/5/19: At the risk of bowing to the current cultural and political climate...I've since become enlightened to the fact that, not only do most transwomen view Bailey's ideas as utterly alien to their experiences and pernicious in terms of bolstering anti-transgender arguments, he's also simply not very good at science. I don't think Alice Dreger is also inherently transphobic, just that, in the interest of defending outsider scientists, she backed the wrong horse. While I agree with her that the scientific community is very closed-minded, it goes to show that you have to be very careful: sometimes outsiders are outsiders for a reason. For more on this topic, see Natalie Wynn's excellent Contrapoints video, "Autogynephilia".
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