By Dr. J. Edward Les

The thalidomide saga is particularly instructive: Canada was the last developed country to pull thalidomide from its shelves — three months during which babies continued to be born in this country with absent or deformed limbs

Physicians have a duty to put forward the best possible evidence, not ideology, based treatments

Late last month, the Canadian Medical Association (CMA) announced that it, along with three Alberta doctors, had filed a constitutional challenge to Alberta’s Bill 26 “to protect the relationship between patients, their families and doctors when it comes to making treatment decisions.”

Bill 26, which became law last December, prohibits doctors in the province from prescribing puberty blockers and hormone therapies for those under 16; it also bans doctors from performing gender-reassignment surgeries on minors (those under 18).

The unprecedented CMA action follows its strongly worded response in February 2024 to Alberta’s (at the time) proposed legislation:

“The CMA is deeply concerned about any government proposal that restricts access to evidence-based medical care, including the Alberta government’s proposed restrictions on gender-affirming treatments for pediatric transgender patients.”

But here’s the problem with that statement, and with the CMA’s position: the evidence supporting the “gender affirmation” model of care — which propels minors onto puberty blockers, cross-gender hormones, and in some cases, surgery — is essentially non-existent. That’s why the United Kingdom’s Conservative government, in the aftermath of the exhaustive four-year-long Cass Review, which laid bare the lack of evidence for that model, and which shone a light on the deeply troubling potential for the model’s irreversible harm to youth, initiated a temporary ban on puberty blockers — a ban made permanent last December by the subsequent Labour government. And that’s why other European jurisdictions like Finland and Sweden, after reviews of gender affirming care practices in their countries, have similarly slammed the brakes on the administration of puberty blockers and cross-gender hormones to minors.

It’s not only the Europeans who have raised concerns. The alarm bells are ringing loudly within our own borders: earlier this year, a group at McMaster University, headed by none other than Dr. Gordon Guyatt, one of the founding gurus of the “evidence-based care” construct that rightfully underpins modern medical practice, issued a pair of exhaustive systematic reviews and meta analyses that cast grave doubts on the wisdom of prescribing these drugs to youth.

And yet, the CMA purports to be “deeply concerned about any government proposal that restricts access to evidence-based medical care,” which begs the obvious question: Where, exactly, is the evidence for the benefits of the “gender affirming” model of care? The answer is that it’s scant at best. Worse, the evidence that does exist, points, on balance, to infliction of harm, rather than provision of benefit.

CMA President Joss Reimer, in the group’s announcement of the organization’s legal action, said:

“Medicine is a calling. Doctors pursue it because they are compelled to care for and promote the well-being of patients. When a government bans specific treatments, it interferes with a doctor’s ability to empower patients to choose the best care possible.”

Indeed, we physicians have a sacred duty to pursue the well-being of our patients. But that means that we should be putting forward the best possible treatments based on actual evidence.

When Dr. Reimer states that a government that bans specific treatments is interfering with medical care, she displays a woeful ignorance of medical history. Because doctors don’t always get things right: look to the sad narratives of frontal lobotomies, the oxycontin crisis, thalidomide, to name a few.

The thalidomide saga is particularly instructive: it illustrates what happens when a government drags its heels on necessary action. Canada was the last developed country to pull thalidomide, given to pregnant women for morning sickness, from its shelves, three months after it had been banned everywhere else — three months during which babies continued to be born in this country with absent or deformed limbs, along with other severe anomalies. It’s a shameful chapter in our medical past, but it pales in comparison to the astonishing intransigence our medical leaders have displayed — and continue to display — on the youth gender care file.

A final note (prompted by thalidomide’s history), to speak to a significant quibble I have with Alberta’s Bill 26 legislation: as much as I admire Premier Danielle Smith’s courage in bringing it forward, the law contains a loophole allowing minors already on puberty blockers and cross-gender hormones to continue to take them. Imagine if, after it was removed from the shelves in 1962, government had allowed pregnant women already on the drug to continue to take thalidomide. Would that have made any sense? Of course not. And the same applies to puberty blockers and cross-gender hormones: they should be banned outright for all youth.

That argument is the kind our medical associations should be making — and would be making, if they weren’t so firmly in the grasp, seemingly, of ideologues who have abandoned evidence-based medical care for our youth.

J. Edward Les is a Calgary pediatrician, a senior fellow with the  Aristotle Foundation for Public Policy,  and co-author of “Teenagers, Children, and Gender Transition Policy: A Comparison of Transgender Medical Policy for Minors in Canada, the United States, and Europe.” 

By Michael Bonner

A new ministry should be held responsible for ensuring we’re letting in people who will further our economic interests, and that infrastructure can keep up

Canadians deserve an immigration system that serves the national interest. This is exactly what we once had when most Canadians agreed with the economic and cultural arguments in favour of immigration.

For a long time, Canada avoided the sort of backlash seen in many places abroad. But the economic argument for immigration has collapsed during a time of stagnant wages, housing shortages and high youth unemployment. Likewise, cultural arguments about diversity and multiculturalism have given way to doubts about our ability to integrate newcomers.

Now, half of Canadians believe immigration harms the country. And according to a 2024 survey by the Environics Institute, 57 per cent of Canadians agree that too many immigrants “are not adopting Canadian values.”

In response, the Trudeau government began to reduce immigration targets and tinker with eligibility requirements. It was especially wise to reinstate caps on the Temporary Foreign Worker Program (TFWP), which many employers abuse to keep wages artificially low.

But Canada’s immigration system requires fundamental reform, with a sharp eye on integration — both economic and cultural. This reform will become increasingly urgent amidst a backdrop of deglobalization, domestic protectionism and falling birth rates.

Other countries will be motivated to hold onto as much of their own populations as they can, so we cannot count on a large and mobile cohort of educated professionals and low-wage workers for much longer. Canada must remain open to immigration, but immigration cannot be our only source of economic and population growth.

The federal government should begin by ending easy access by immigrants to the lower end of our labour market in nearly all sectors of the economy. That means phasing down and eventually eliminating the TFWP, except in limited areas such as seasonal agricultural work. High-wage, high-skill immigration should continue, but in lower numbers.

Meanwhile, governments should use incentives (tax credits, etc.) to encourage businesses to invest in domestic skills training and develop their workforces. Business, government and post-secondary institutions must work together to integrate domestic and international students into a general industrial strategy.

This means creating a pipeline of engineers, researchers and scientists for jobs in areas such as high-end manufacturing, robotics, batteries and advanced engineering. In short, we must gain much better control of immigration and ensure that it serves the national economic interest.

To make it all happen, Ottawa should create a new “population” ministry, formed out of every existing federal ministry and department that deals with immigration, housing, the labour market and family formation (such as Employment and Social Development Canada and the Canada Mortgage and Housing Corporation).

Of course, this is no small task and would take time. But the main policy areas (immigration, housing, labour, parental benefits and population growth) must be viewed as a single system, and a single ministry must be held accountable for the success or failure of future reforms.

In consultation with the provinces, this new ministry would be required to keep immigration at a manageable level, taking into account the state of infrastructure, housing and integration services, along with labour market needs. Artificial Intelligence could be a useful tool in helping predict labour and housing shortages before they happen.

This consolidated ministry would favour high-skill, high-wage immigration above all other categories. And, like some other countries, the ministry would be required to publish total immigration numbers, along with all other relevant population and labour-market information, as part of every federal budget, to ensure maximum transparency.

This ministry would also work with the provinces to develop pro-natal strategies to stabilize or, ideally, reverse the decline in domestic birth rates. This should be informed by successful policies implemented by our peers abroad.

Incentives could include cash bonuses, tax breaks, awards, more generous leave and other signs of public esteem for parenthood. Meanwhile, governments across the country must remove regulatory hurdles and revisit post-war mass production and prefabrication, in order to increase the supply of new housing.

Canada’s immigration policy has failed Canadians. But if properly managed, a new population policy, which includes immigration, can be a powerful force for nation-building and help create and maintain a prosperous and orderly society in an increasingly uncertain world.

Michael Bonner is a senior fellow at the Aristotle Foundation for Public Policy, a former senior policy advisor to a federal immigration minister, former director of policy to four Ontario ministers and the author of “Repairing the Fray: Improving Immigration and Citizenship Policy in Canada.”