DeSantis: raging against ‘medical authoritarianism’

In December 2021 Florida’s Governor Ron DeSantis sent this melodramatic fundraising email –

“No amount of smearing or whining from Fauci or Biden is going to cause me to sell out to their pursuit of medical authoritarianism. Indeed, Fauci lied to Congress about his involvement in funding gain of function research and should be prosecuted. “Faucism” has been terribly destructive to our country, and we will continue to reject it here in Florida.”

Fauci, of course, is the Chief Medical Adviser to the President, one of America’s most distinguished scientists. His guidelines on tackling Covid echoed the views of America’s medical community. On the day that DeSantis sent his email, Omicron had just taken root in Florida. In less than a month, Florida’s hospitals were to be ravaged by a new wave of Covid cases. Yet the last thing that DeSantis wanted was any advice from Fauci. For him, the enemy wasn’t Covid, but the medical establishment.

I start here for a reason. DeSantis’s fight to keep Florida ‘open for business’ during the pandemic may seem to have little connection with his assault on trans healthcare. In fact, it’s no exaggeration to say that the one couldn’t have happened without the other. In this article I will show how Covid denialism acted as a template for trans healthcare denialism, and how the same people that DeSantis appointed to positions of power to support him in his battles against Fauci were turned to again to endorse DeSantis’s rejection of the scientific consensus on the treatment of trans youth.

Covid denial

DeSantis modelled himself on Trump. For both men, Covid denialism came easily and naturally. They equated the scientific establishment with a ringfence of bureaucracy and regulations that restricted the freedom of American business to drill for oil and mine for coal. Well before Covid, Trump had a record of appointing former industry lobbyists to key positions while slashing the size and funding of government agencies responsible for research. For the left, this was crony capitalism at its worst; but Trump and DeSantis sold it as economic freedom.

In March 2020 the DeSantis administration refused to reveal details about the first suspected cases in Florida, then denied the virus was spreading from person to person. This set the pattern for the campaign of disinformation that was to follow. A couple of examples, just to give the flavour. In July 2020, when mass gatherings were banned across much of the Northern Hemisphere, DeSantis was confidently saying that holding the Republican National Convention in Jacksonville in a few weeks time would be “a safe environment”. Days later, Trump cancelled the event, admitting that “it’s just not the right time” to hold a “big, crowded convention.” In November, DeSantis claimed that kids can’t transmit Covid to adults, based on one Icelandic study. The study’s authors hit back, saying that their study showed no such thing.

DeSantis has also frequently made unsubstantiated claims about mask wearing. In July 2021 his office put out a statement saying “Experts have raised legitimate concerns that the risks of masking outweigh the potential benefits for children”. Which experts were these ? Fringe medics with an axe to grind were being deployed in order to undermine the overwhelming scientific consensus on the benefits of using masks.

It’s important to note that Ron DeSantis’s popularity, far from being damaged by this kind of behaviour, grew and grew. Even 82,500 Covid deaths in Florida, thousands of which could have been prevented by tougher policies, haven’t made him less electable. To his supporters, DeSantis is a champion of keeping Florida open for business, keeping kids in classrooms, and defending the rights of individuals to live their lives free of government regulation. In the recent midterms he was re-elected with a massively increased majority.

Joseph Ladapo

In March 2020, as America headed towards lockdown, USA Today published an opinion piece from an associate professor of medicine in California. “I spent the past week” readers were told “taking care of patients with COVID-19 at UCLA’s flagship hospital, and the atmosphere there is, appropriately, one of crisis.” The article then went on to argue that shutdowns weren’t the American way and only delayed the inevitable.

18 months later, the author Joseph Ladapo was unexpectedly appointed by DeSantis as Florida’s surgeon general. He wasn’t chosen for his medical qualifications (even the statement that he’d been treating Covid patients turned out to be a lie).  He was chosen because he was one of the few doctors willing to stand up publicly and support DeSantis in minimising the seriousness of Covid, pushing ideas like herd immunity, casting doubts on the efficacy of mask wearing, and so on. (It gets worse: Ladapo had also written a series of columns questioning the safety of Covid vaccines, and had promoted the anti-malarial drug hydroxychloroquine as a treatment for Covid 19.)

Ladapo’s appointment was confirmed by Florida’s Senate, voting along party lines. America’s long been used to political appointments, but the brazenness of some Trump and DeSantis appointments was shocking even by American standards. Today, all 14 Florida Board of Medicine members are DeSantis appointees. And as has been widely reported, eight Board members have donated a combined total of nearly $100,000 to previous DeSantis election campaigns.

If it was just a question of the money, it would be bad enough. But the appointments were always about more than that: DeSantis was seeking allies in his mission to “fight Faucism” and take on the medical establishment. And in 2022, this has increasingly meant doctors who are aligned to his ideas about trans healthcare.

Take for example Patrick Hunter, appointed to the Board of Medicine in June 2022. Hunter is a member of the Catholic Medical Association (CMA) which opposes “the use of any hormones, hormone blocking agents or surgery in all human persons for the treatment of Gender Dysphoria,” and also a public supporter of anti-trans lobby groups Genspect and SEGM. It’s a safe bet that he wasn’t picked because of his record as a pediatrician.

The Florida memo

In April 2022 Ladapo issued a memo that directly challenged official guidance from the U.S. Department of Health. Instead, Florida’s Department of Health advised physicians against prescribing puberty blockers or hormone therapy for transgender youths and asserted that gender transition should “not be a treatment option for children or adolescents.”

The memo was an insult to the intelligence of the scientific community. Researcher Jack Turban wasn’t exaggerating when he told the Washington Post “It’s shocking to see a public health organization spread healthcare misinformation. There are false statements on nearly every line of this document.” As well as misrepresenting the evidence, the memo cited the junk science claim that 80% of young trans people grow out of being transgender, which is debunked here.

The Florida Medicaid report

Six weeks after the memo, Ladapo published a report that he’d commissioned from Florida Medicaid which backed up his position, this time citing a superficially impressive range of papers and studies. In fact, it’s a hatchet job, which rather than seek after truth attempts to throw as much mud as possible at the knowledge base and official treatment guidelines for transgender care, hoping that some of it will stick. Many of the papers cited in support aren’t peer reviewed. The five “expert reports” attached as evidence are nothing of the kind: they’re submissions by anti-trans zealots, members of CMA and SEGM, who’ve never treated any trans patients.

Take Patrick Lappert. Lappert converted to Catholicism late in life; he now divides his time between plastic surgery and serving as a Catholic deacon. He has links with the far-right Alliance Defending Freedom legal and advocacy group (ADF). His credentials for acting as an expert witness in trans cases were demolished recently by a federal court in North Carolina, which found him to be totally unqualified

Lappert attended an ADF-sponsored conference in which a speaker lamented the “poverty of [experts] who are willing to testify” against the treatments at issue in this case, and where attendees “were asked whether they would be willing to participate as expert witnesses.” Prior to attending this conference, he had not been published on gender dysphoria or the risks of hormone blockers or served as an expert witness, although he had spoken publicly about gender dysphoria. Since attending, he has “actively lobbied” for laws that would prohibit doctors from offering medical or surgical treatments for gender dysphoria to adolescents in Alabama, Arkansas, Texas, and Utah, and agreed in deposition that doctors offering these treatments should be “criminally prosecute[d].” And he has stated publicly that parents who “discuss[ ] gender identity issues with children” are “sexualizing them” and “grooming a generation.” Plaintiffs argue that Lappert’s testimony did not grow naturally from his research, but was instead crafted at ADF’s request for purposes of litigation.

The scientific basis of the report was demolished in a critical review by a group of eight researchers and professors. “We are alarmed,” they wrote, “that Florida’s health care agency has adopted a purportedly scientific report that so blatantly violates the basic tenets of scientific inquiry. The report makes false statements and contains glaring errors regarding science, statistical methods, and medicine. Ignoring established science and longstanding, authoritative clinical guidance, the report instead relies on biased and discredited sources, including purported “expert” reports that carry no scientific weight due to lack of expertise and bias.”

Florida bans essential healthcare

Anti-trans and anti-LGBT hysteria is reaching fever pitch, with entirely predictable consequences. In September vandals threw rocks through windows in Gainesville’s Pride Community Center, and left a note to make it clear that this was no random attack. Days later Tiffany Banks, a 25-year-old Black transgender woman, was killed in Miami, becoming the fourth trans person murdered in Florida this year.

In Florida, as elsewhere, the Republican Party can’t seem to stop itself from whipping up hate. The anti-LGBT legislation keeps coming thick and fast. In 2021 DeSantis signed a bill banning trans women from competing in school and college sports, and earlier this year he signed the infamous ‘Don’t Say Gay’ law banning all “classroom instruction” on sexual orientation or gender identity. After strong opposition to this from the Walt Disney Company, DeSantis retaliated by stripping the company of some of its privileges.

DeSantis seems to share with Trump a bullish determination to crush those who challenge him. A practising Catholic, earlier this year he signed into law a statute that limits abortions in Florida to the first 15 weeks of pregnancy. Florida state attorney Andrew Warren added his name to a statement saying that it shouldn’t be the job of prosecutors to enforce laws like this. DeSantis suspended Warren, who then sued DeSantis, on grounds that he was an elected not an appointed official and his free speech rights were being violated. The trial is pending.

You wouldn’t have thought that banning essential healthcare was an obvious vote winner, but DeSantis made it one of the themes of his 2022 re-election campaign. He told outright lies – “They are literally chopping off the private parts of young kids,” “They’re actually giving very young girls double mastectomies. They want to castrate these young boys.” Anyone questioning the veracity of such statements could expect to get mobbed on twitter by people calling them groomers.

This time, DeSantis didn’t bother with the niceties of steering a bill through the House which would have to undergo public scrutiny. Instead Ladapo, at DeSantis’s behest, asked the Board of Medicine to act, which of course they were only too willing to do. At a meeting on August 5th they voted to begin a process to adopt a new standard of care for young trans people in line with the Medicaid report. State Rep Anna Eskamani angrily told the Board “There are so many other real-life problems people are facing… there was no local transgender person today who expressed concerns about the current standard or medical guidelines.”

On November 4th the Board met again and by a 6-3 vote decided to begin drafting a law banning gender-affirming healthcare for under 18s, including puberty blockers, hormone therapy and surgery. The decision flew in the face of well-established medical opinion, and repeated warnings about the dangers of following such a course. In 2021 the American Medical Association wrote in strong terms to the National Governors Association, informing them that “every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people.”

“Gender-affirming care is lifesaving care… and should be left to young people, their families, and their doctors. Not politicians.” said Nikole Parker of Equality Florida. “Shame on the Florida Boards of Medicine and Osteopathy for trading the suffering of transgender youth and their parents for cheap political points.”

The case of Sidhbh Gallagher

The internationally respected World Professional Organisation for Transgender Health (WPATH) specify no minimum age for treatments in the latest version of their Standards of Care, published in September 2022. Instead, the emphasis is very much on making very careful informed assessments on each individual case involving minors. At the heart of the issue is whether teenagers are capable of giving informed consent. It seems to me just fundamentally wrong that a question such as this should be decided by politicians rather than by those with relevant professional expertise.

A week ago, Kathleen Stock retweeted something about 13-year-olds having top surgery, saying “This is wrong from every angle.” What she omitted to mention was that the surgeon in question was based in Miami, and that in the UK gender-affirming surgery isn’t offered to anyone under 18.

Sidhbh Gallagher is an Irish doctor who set up a practice in Florida in 2020. In a short space of time this has acquired worldwide notoriety, due partly to her aggressive marketing techniques aimed at young people. She has 270,000 followers on TikTok, she’s always posting videos, and many people find her tone alarming – her catchphrase is “yeet the teets”.

Gallagher is a WPATH member. On her website she says “We are happy to offer top surgery to minors with consent of parents and the recommendation of the patient’s mental health professional. When we evaluate each patient, we keep in mind the risk benefit analysis and understand that it may well be much more detrimental to the patient to wait until the age of 18 for surgery. Each case is evaluated with patient and family.”

In 2021, she told the New York Times, she performed 13 surgeries on minors. She doesn’t perform surgeries on 13-year-olds as a matter of course, that was an exceptional case where there was clinical consensus that it was right to proceed.

Gallagher has claimed that none of her clients regret the surgery. The New York Times confronted her with the case of detransitioner Grace Lidinsky-Smith. Reuters did their own research, and found that “half a dozen of Gallagher’s patients who were minors when they got top surgery, told Reuters they were very pleased with the results. ” Even if the regret rate is indeed low, it’s legitimate to ask questions about the ethics of marketing surgery to young people.

Here’s the thing though: DeSantis could have campaigned to bring the state in line with countries like the UK by banning gender-affirming surgery on minors. He could have tightened regulation to deal with some of the more egregious social media advertising. Instead, he exploited fears about Dr Gallagher by targeting all forms of healthcare for trans teenagers, including puberty blockers and hormone treatment. And he justified this by misrepresenting what was actually happening – “They are literally chopping off the private parts of young kids.”

This isn’t just an American story. There are many people in the UK who, like Kathleen Stock, want us to be afraid of practitioners like Dr Gallagher, and their voices are continually being amplified by the UK media. There’s no reason to think that their agenda is any different from that of Governor DeSantis.

Trans Florida

The Florida law isn’t just discriminatory – it’s genocidal. People ask, how can you call it genocide. Genocide doesn’t just mean mass murder. According to the UN, it can also refer to “deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part.” This is exactly what healthcare bans are intended to do: to stop young trans people from ever transitioning.

They will fail. They will fail because people don’t choose to be trans, they become trans. For some, the answer will be to leave Florida. I just did a quick search, and found a number of crowdfunds from young people planning to move from Florida to safer states. If you’re able to donate to help Florida’s trans youth, please do so here. Many will stay and resist and find ways to survive in their chosen gender. Earlier this year, Florida’s Grammy award winning singer Ariana Grande pledged to match all donations up to $1,500,000 for a fundraiser to provide critical funds to organisations providing direct services to trans youth and advocating for the rights of trans youth in states currently targeted by anti-trans policies. So far, it’s received over $3,000,000 in donations.

Yes there’ll be casualties. The mental health cases, the suicides, the enforced detransitions. Entire families living in fear. This is what genocide looks like. In the short term, things will almost certainly get worse: more legislation is in the pipeline, and trans adults are all too aware that they could be next. None of this legislation though will last. People won’t stop resisting, and humanity will prevail.

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