Brandt Files #6: A Race-Baiter Takes the Stand

Jack Turban makes stuff up and, like all the ACLU’s witnesses, is allowed to testify about whatever he wants

This post is part of the Brandt Files, a series on the lawsuit in which “trans kids” and their doctors successfully challenged Arkansas’ ban on youth gender medicalization. Read the introduction to the series here.

The trial documents cited in this piece are available on the ACLU’s website in several files. Witness testimony is in the “trial transcripts.” Volume 1 contains Adkins and Karasic; Volume 2 contains Turban; Volume 5 contains Levine; Volume 7 contains Hiatt.

When Super Mario touches a Super Star, he glows like a rainbow and normal rules don’t apply to him. He can run faster, jump higher, and bump off koopas (i.e. evil turtles) by running into them.

The legal system employs its own system of Super Stars: expert qualification. Once a judge deems a witness to be an “expert,” that witness gains superpowers that regular “fact” witnesses don’t enjoy as long as they testify on the subject they’re “qualified” for. Fact witnesses can only testify about things they’ve seen or experienced themselves, not their opinions or theories. But experts are supposed to theorize. Assuming their analysis is “reliable” (I’ll get to that in a minute), experts may pontificate based on articles they’ve read; they can riff about stuff their colleagues told them and debates in their field; they can spin complex studies that the judge lacks the wherewithal to parse himself. While one side’s witness is on the stand speaking on a topic they’re qualified as an expert in, that side is basically glowing like a rainbow and killing everything in sight, only limited by the witness’s conscience.

Enter Jack Turban.

A selfie grandmaster with 57,000 X (Twitter) followers, Turban is a psychiatrist who treats gender dysphoria in children and adolescents. His research has frequently been attacked for its dubious methods and junky data, and his popular writing mischaracterizes the findings from those chintzy studies. (Scroll to the bottom for links.) He testified in Brandt that he had published between 20 and 30 journal articles about youth gender dysphoria. At the time, he was only about five years out of school.

He has repeatedly implied that protecting women’s sports from trans-identified males is like discriminating against Black athletes. Here he is writing about the controversy for Scientific American:

“[T]his isn’t the first time people have tried to discredit the success of athletes from marginalized minorities based on half-baked claims of ‘science.’ There is a long history of similarly painting Black athletes as ‘genetically superior’ in an attempt to downplay the effects of their hard work and training.”

Here he is on CNN, sliming the “socially conservative” lawyers for girls who sued a high school track league:

“Is it a coincidence that the transgender [male] athletes they targeted were African American? It’s unclear, but there’s a history of trying to segregate sports on racial lines, based on presumed biological advantages.”

White Man’s Turban

Previously we met Deanna Adkins, an endocrinologist whose role in the plaintiffs’ case was to downplay the potential harms of medicalization. Testifying the next day, Turban’s role was to play up the potential benefits of medicalization. Well, one benefit: “better mental health.” Specifically, according to Turban, studies have looked at “anxiety, depression, quality of life, and suicidality.”

All these studies are considered “low quality” or “very low quality” because they’re not randomized controlled trials (RCTs), meaning they don’t compare medicalized gender-dysphoric patients with similar people treated under a different protocol. They suffer from other infirmities, too: they only track patients for a short time, lots of patients drop out of the studies, and they rely on samples of patients who self-report in surveys and are not representative of all medicalized youth—they suffer from high risks of bias. (The Society for Evidence-Based Medicine recently broke down this feeble body of literature.)

Nevertheless, Turban testified as though those studies were conclusive. He claimed, for example, that “an institutional review board … wouldn’t approve a randomized controlled trial because there would be concerns of the ethics of randomizing people to a treatment group where mental health would get worse when you could give them a treatment that would help.” If this were true, swashbuckling doctors could always preempt rigorous analysis of their new treatments by quickly pumping out a few low quality papers. Indeed, it’s not true. The results of an RCT about gender medicalization were published recently (they did not show that modifying sex traits improved mental health).

What about all the studies showing most kids with cross-sex identities desist? Turban claimed that in the past, gender clinic patients—the children featured in the desistance literature—were not all trans but rather included “cisgender kids” with “gender atypical interests.” This implied that clinicians today never mix up members of the two allegedly-distinct populations (I wrote about the plaintiffs’ baffling bifurcation of trans identity and gender nonconformity in Brandt Files #1). Then he claimed that the diagnosis used in older studies, “gender identity disorder,” “didn’t require one to have a gender identity different from their sex assigned at birth.” 

This was false. The Diagnostic and Statistical Manual of Mental Disorders recognized “gender identity disorder” in its third and fourth editions, in use between 1980 and 2013. One of its two requirements in DSM-IV:

“There must be evidence of a strong and persistent cross-gender identification, which is the desire to be, or the insistence that one is, of the other sex. This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex.”

“I apologize that it’s complicated,” Turban said when he introduced this piece of misinformation.

Mental health wasn’t the only subject he testified about. He also held forth on mastectomies: “there are different types of top surgery, and some procedures are more involved than others … for a patient that young [age 14], it’s possible that they would not have very much chest tissue so it might be a smaller surgery.” 

Was this shrink really “qualified” to testify about 14-year olds’ breasts?

From Expert to Omniscient

After the trial ended, the judge wrote in his Findings of Fact:

“Plaintiffs’ experts’ extensive experience, their testimony in court, and their demeanor and responsiveness to questions … show that all four … have deep knowledge of the subject matter of their testimony and were fully qualified to provide the opinion testimony they offered.” 

This was what the plaintiffs had proposed the judge find. As far as I could tell, Arkansas never fought to narrow the plaintiffs’ experts’ testimony. But the judge still shouldn’t have copied and pasted the plaintiffs’ proposal. It’s obviously not a “fact” that all the plaintiffs’ expert witnesses were qualified to opine on everything they did.

Like Turban, Deanna Adkins, the endocrinologist, testified about surgery even though she’s not a surgeon. She also gushed about the benefits of medicalization—but all the alleged benefits are psychological (“alleviating dysphoria”) and she is not a mental health professional. 

Turban and Karasic both maintained that treating gender-dysphoric kids with talk therapy alone didn’t help them. But how would they know? They did not employ the technique themselves and the research they cited was off-point. (The experts implied that all non-medical approaches were designed to change a patient’s “gender identity” and therefore “conversion therapy”—ignoring other possible treatment goals like accepting your janky body or realizing that gender identity is a ruse.) One of Arkansas’ witnesses, the psychiatrist Roger Lew Hiatt, had clinical experience providing that care but the judge ignored his testimony. He simply did not refer to it at all in his Findings of Fact. 

All Testimony in Favor of Medicalization Is “Reliable”

The Federal Rules of Evidence require that experts base their opinions on “reliable principles and methods.” Nodding to that rule, the judge found that all of the plaintiffs’ experts provided “reliable testimony relevant to core issues in this case.” But did they?

Crooked salespeople tend to avoid saying anything that is falsifiable, meaning, anything that the mark might know is a lie – or anything a prosecutor could prove is a lie. So they often resort to anecdotes about people they supposedly know. The plaintiffs’ expert witnesses followed this playbook. For example, Adkins testified about all her doctor friends who hadn’t gone through natural hormonal puberty, and Karasic testified that doctors he’d talked to followed WPATH guidelines. At points like these, the experts were prattling on unmethodically in violation of the Federal Rules of Evidence. But Arkansas didn’t object.

To understand the difference between an expert testifying appropriately and one who is just gleefully running amok like Super Mario on stardust, consider the question of sex ratios – that is, why trans patients used to be overwhelmingly male, but the newest cohort is mostly female.

Karasic mused that in the past, most young gender clinic patients were male because parents were bringing in their feminine sons who were not actually girls, just girly. At the same time, he said, parents were not seeking treatment for their “tomboy” daughters because masculinity in girls “did not elicit that same degree of attention.” Nowadays parents don’t try to change their gay-seeming sons anymore. (Jesse Singal has rebutted the argument that the kids in older studies weren’t gender-dysphoric.)

Arkansas asked its own witness, the veteran psychiatrist for trans patients Stephen Levine, for his opinion on the change in sex ratios. Levine demurred:

“Various people who have studied this have said that it's not clear why girls are more vulnerable these days to being trans. I wish I could tell you definitively the answer to your question. I think about that a lot, but I realize it's just Dr. Levine's thinking. It's not science.”

The judge did not find Levine’s testimony to be “reliable.”

The Experts Might Run into Some Green Pipes Soon

In Brandt, the plaintiffs had doctors testify about their pet theories, low-quality evidence, topics they didn’t know much about, and their own subjective impressions of how some patients subjectively responded to their treatments. The plaintiffs got away with it because the judge qualified these witnesses as experts in everything they said and Arkansas didn’t object when their opinions weren’t based on reliable principles or methods (or cross-examine them about their biases and conflicts of interest). The trial was like some technicolor bonus level where Super Stars just fell from the sky onto the plaintiffs constantly for no reason. 

The ACLU is now representing “trans kids” and gender doctors in similar lawsuits across red America. Having learned from Brandt, states’ attorneys will presumably challenge the qualifications and opinions of the ACLU’s “experts.” We can catch a preview of their arguments in B.P.J v. West Virginia Board of Education, a case about trans-identified boys who wanted to play girls’ sports. In May 2022 the state blasted a written submission by Adkins:

“On point after point, expert opinions proffered by Dr. Adkins are irrelevant, unreliable due to nonexistent or cherry-picked scientific support, or both. … [H]er opening expert report … cites a grand total of 24 ‘scientific’ publications … Seven of these publications only concern the wholly irrelevant topic of disorders of sexual development. Four of them are committee drafted organizational position and policy statements–advocacy documents rather than peer-reviewed scientific research publications. She cites no data or peer-reviewed publications at all to support most of the opinions she proffers. And Dr. Adkins claims no original clinical research of her own in support of any of her opinions.”

The judge in that case ruled for the state without addressing the arguments about experts.

If the ACLU’s experts face challenges in other gender medicalization lawsuits, and the judges actually apply the Federal Rules of Evidence (or in state courts, the similar rules that apply there), the ACLU may find its access to Super Stars curtailed. After all, it would need to find witnesses with “scientific, technical, or other specialized knowledge” based on “sufficient facts or data” supporting the safety and efficacy of youth gender medicalization.

This is the sixth entry in The Brandt Files. Find past entries on the author’s profile page.

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Criticism of Jack Turban’s Articles

Mental health clinicians attacked Turban’s study on “conversion therapy.”

Michael Biggs, a sociologist, criticized Turban’s study on puberty blocker’s impact on suicidality (search for “biggs”).

Leor Sapir, a political scientist, identified numerous misleading statements in a Turban article published in Psychology Today. PT ultimately issued four corrections and made additional edits. Sapir also published a detailed takedown.

Jesse Singal, a journalist who published a book on junk science, has taken apart Turban’s work on Rapid-Onset Gender Dysphoria and the suicidality study that Biggs criticized (search for “study 6”). 

JL Cederblom pored over the written statement that Turban submitted in Brandt and summarized it as “lukewarm perjury.” Read the piece in full.