A Quick Word About Arkansas
A Quick Word About Arkansas
The bumpy road to reform just got bumpier
As many of you know, I have been working forever on a piece about the bans—the curious collection of people working behind the scenes on legislation to stop pediatric and adolescent gender medicine, which remains unregulated. Each person I talk to leads me to a new person, and thus I haven’t yet finished.
But as of yesterday, the whole landscape has shifted, because a federal judge struck down Arkansas’ Save Adolescents From Experimentation (SAFE) Act—the first such ban that had successfully passed.
As I’ll say more about in the bans piece, those who pushed for them always knew they’d be challenged. In many ways, the point was to air the medical industry’s dirty laundry, to expose the flimsy evidence, to give voice to those who’d been hurt. We don’t have nonpartisan government groups to conduct systematic evidence reviews here, as they do in much of Europe, where these interventions are being restricted and reformed. Thus, the legal challenges to the bans would allow the introduction of those other evidence reviews.
And yet, the Obama-appointed judge, James M. Moody Jr., wrote this: “Rather than protecting children or safeguarding medical ethics, the evidence showed that the prohibited medical care improves the mental health and well-being of patients and that by prohibiting it, the state undermined the interests it claims to be advancing.”
I admit I was taken aback when I read this. If you scrutinize the original Dutch studies that led to this protocol, or the widely cited studies that claim medical interventions improve mental health—or lack of interventions cause it to plummet—they all crumple into dust. We have personal testimonies of people who feel better, and we have personal testimonies of girls who got their breasts removed as teens and now feel they were recklessly pushed by the medical community to embrace a deeply damaging lie.
Who should we listen to? What should the positive-to-negative outcome ratio be before we have reform instead of the false binary of bans versus a free-for-all? Who will listen to the evidence?
It’s not over. The ruling will be appealed. It’ll probably end up before SCOTUS. But perhaps before then, a group of moderate reformers will emerge who want less furious partisanship and more unity. We can embrace gender diversity and still be concerned about the medicating of it. In fact, we have to.
“Who should we listen to? What should the positive-to-negative outcome ratio be before we have reform instead of the false binary of bans versus a free-for-all?”
I want this question pushed hard and asked by every single journalist and policy maker: HOW MANY KIDS IS IT OK TO GET THIS WRONG FOR AND WHAT IS YOUR PLAN FOR THESE KIDS?
According to Reuters, between 2018 and 2021, there were at least 776 “top surgeries” performed on girls ages 13-17 that were submitted to private insurance for reimbursement. That does not include all the surgeries that were done and paid for out of pocket. For the sake of argument, let’s go with the often cited number of only one percent regret. Also, for the sake of argument, let’s round the number of surgeries on minors in that three-year. period up to 1000 to account for privately funded surgeries. That’s 10 girls who regret having their breasts removed before they even reached legal adulthood. We need to have doctors, pediatricians, psychiatrists, and the therapists writing the approval letters say that getting it wrong for these 10 girls is an acceptable mistake rate and that they are fine with moving forward and continuing to do unnecessary and irreversible major surgery on a certain number of girls each year. And this doesn’t include a 1% regret rate for the even larger number of girls who start testosterone before age 18. What would happen if we forced that into the record of the AMA, the AAP, the New York Times, NPR, NBC, and from the mouth of those in the Biden administration? What if we made Biden, Rachel Levine, AOC, Jack Turban, or the heads of the American Medical Association and the American Academy of Pediatrics go on TV sitting directly across from some of those kids in that one percent who now regret these treatments and feel devastated, betrayed, and harmed for life, look them in the eye, and say to them, “I’m sorry you’re not happy now, but you were an acceptable number for us, and we are not going to change anything so that this doesn’t happen to other kids because we think the system we have now works just fine and if anything needs fewer restrictions.” What would happen to public opinion and discourse if we forced these people who repeatedly cite the 1% regret rate to say on record what that number actually translates to and that 1) they are not willing to change the system in any way to prevent future cases, 2) that there is no system or treatment protocol in place for supporting the kids they got it wrong for 3) that the 1% number is an old number from a very different cohort of patients, i.e. not teenage girls with no childhood history of dysphoria, and diagnosed and treated under very different protocols, and no one knows what the regret rate is for this new group of teenage girls, and 4) that they are unwilling to make any changes to the system to prevent these mistakes.
Honestly, I think we need to stop focusing on the bans, and thinking there’s a political solution to this. It’s not going to work and it’s a waste of time and resources. We need to go after the doctors, the therapists, and their professional associations, and start forcing them to go on record saying they are willing to get it horribly wrong for at minimum this number of children, and that they don’t even have a medical code to count and document misdiagnoses. And then we need to start pushing for doctors and therapist to take ownership of their diagnoses and treatments, and the outcomes they have. If a doctor or therapist gets it wrong then they are also on the hook for getting treatment for the patient they misdiagnosed. I know so many people want there to be laws and political solutions to this, but if you look at past medical scandals, that’s not how they ended. I think change will only happen when the doctors, therapists, and their professional organizations are pressured and held accountable.
If the judges, health practitioners, and ideologues would step back and think about the regressive nonsense that's driving this whole craze—the belief that children who don't conform to societal expectations need to be chemically and surgically redesigned—it would all be over in a minute.