Published by Taylor & Francis

Seriously: would you test the effectiveness of chemotherapy by giving a control group of cancer sufferers saline water? I mean, assuming you're not a raving lunatic who insists that cancer is a fashionable lifestyle choice spread by social contagion on TikTok?

The absence of RCTs studying the impact of gender-affirming care on the mental health and well-being of transgender adolescents does not imply that these interventions are insufficiently supported by evidence. Although RCTs are considered high-quality evidence because of their ability to control for unmeasured confounders, the impossibility of masking which participants receive gender-affirming interventions and the differential impact of unmasking on adherence, withdrawal, response bias, and generalizability compromises the value of RCTs for adolescent gender-affirming care. RCTs are methodologically inappropriate for studying the relationship between gender-affirming interventions and mental health. These methodological considerations compound the serious ethical concerns raised by RCTs in adolescent transgender healthcare. Given the limitations of RCTs, complementary and well-designed observational studies offer more reliable scientific evidence than RCTs and should be considered of sufficient quality to guide clinical practice and policymaking. Adolescent trans healthcare is on solid footing.

Theoretically, we make use of a framework that combines Andrew Baker’s work on social purpose with a novel conception of professional legitimacy, which we divide into internal legitimacy and external legitimacy. Especially when they articulate a strong sense of social purpose and are open to co-constitution, such forms of knowledge can have widespread popular appeal while being vehemently rejected by the economics profession. This means that policymakers must examine not just the potential of alternative expertise per se but also weigh the appeal of the two forms of legitimacy against one another. As a result, this framing can help us understand the complex and sometimes non-linear trade-offs associated with upstart forms of expertise.

Yet, this framing also leaves open crucial questions, that should be addressed by future research on the rise of indie economics. Indeed, as a broader field of ‘lay experts’ emerges, potentially challenging and undermining the more centralised form of knowledge production that has been dominant over the course of the long twentieth century, we will need to grapple with new questions of quality control. Science has always had to contend with tensions between scientific rigour and creativity and has developed mechanisms such as peer review to deal with it. But the changes we now face are altering the nature of this trade-off: co-constitution and the enrolment of lay actors can open new intellectual frontiers and democratise science, but they can also open the floodgates for manipulation, pseudoscience, and misinformation of various forms. Future research should explore the mechanisms of quality control (or lack thereof) that are evolving to navigate this new reality.

To return to Daniela Gabor’s question from the introduction, the rise of MMT shows in no uncertain terms we are in a political climate in which trust in mainstream economic knowledge is desperately frayed and – given this lack of trust – anti-establishment credentials become a crucial source of appeal. The rise of alternative forms of economic expertise is menacing to mainstream macro not just to the extent that it competes with it for finite attention, but also in that it is a symptom of the deeper malaise of the discipline and its failure to prove itself fit for social purpose in the face of interlinking crises.