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I'm Barry Weiss, and this is Honestly. You may have recently seen that the American Medical Association board came out with a report, and that report recommended the removal of sex as a category on birth certificates. And the reason for this, the board said, was that, quote, "...assigning sex using a binary variable and placing it on the public portion of the birth certificate perpetuates the view that sex is immutable."
I think if you stumbled across that news item, having not followed the broader story, the broader story being the way that American medicine is being captured by politics, you'd probably shrug. You just scroll on to the next thing. Maybe you'd think, eh, who cares? Why do we need sex listed on birth certificates anyway? But stories like this one betray a much deeper shift, and it's a shift that is threatening American medicine.
The dogma that has created this shift goes by many imperfect names. Supporters often call it social justice. Critics often call it wokeness or a moral panic. Whatever it's called, here's what we know. Some of the country's top doctors and medical professors say that this ideology is stifling critical thinking. They say it is stifling important medical research and open debate.
They say that this ideology is turning students against their teachers and against their patients, and that it's racializing even the smallest interpersonal interactions. Perhaps most concerning of all, they insist that it is threatening the foundations of patient care, that it's stopping them from giving the best possible care to a patient, and it is prioritizing ideology over and above the individual.
Now, if you listen to this podcast or you read my newsletter, you know that I am very concerned about the ideological transformation, the forced ideological takeover in the world of the media, in the world of the universities. And the stakes are really, really high in those realms. But I cannot think of an area where the stakes are higher than in the realm of medicine, where the ability to speak truthfully is quite literally a matter of life and death.
Without being able to discuss reality and take intellectual risks, it's impossible to get to the truth. And if we can't do that, if we can't try and get to the truth, well then we don't have medical progress at all. The journalist Katie Herzog has been reporting on this story more than anyone else in the media.
And she joins me today to give us a tour of this chilling and sometimes bizarre phenomenon. She comes to this conversation having done an enormous amount of homework and with her characteristic and incredible sense of humor. I always thought that if you lived through a revolution, it would be obvious to everyone. But as it turns out, that's not necessarily true. Revolutions can be bloodless and incremental and subtle. And they don't always happen in the street, as I think today's episode makes extremely clear.
Please stay with us. I'll be back with Katie after this.
There are no other shows that are cutting straight to the point when it comes to the unprecedented lawfare debilitating and affecting the 2024 presidential election. We do all of that every single day right here on America on Trial with Josh Hammer. Subscribe and download your episodes wherever you get your podcasts. It's America on Trial with Josh Hammer.
Katie Herzog, I am so glad that you're here with me today. Thanks for having me, Barry. So we've been working for the past few weeks, maybe it's even been a few months, on this series for my sub stack on sort of this ideological takeover in the world of American medicine.
And I wanted to start off with this audio that was leaked to us from someone inside Yale University. Dr. K's life experiences, education and training has given her a unique, courageous and visionary voice. It is a voice of freedom and is one of the best voices that I ever heard. Will you please help me welcome Dr. K to the Yale Child Study Center? Thanks, Rob. I hope I can live up to that.
So can you tell me who is speaking in this leaked audio and who she's speaking to?
If racism exists in all aspects of our world, it also exists within our collective psychology. So the woman speaking is named Aruna Kilanani, and she's a New York-based psychoanalyst, and she gave a talk at Yale Medical School's Child Study Center as part of Grand Rounds. Nothing makes me angrier than a white person who tells me to not be angry because they have not seen real anger yet.
So what Grand Rounds is, for people who might not be aware, this isn't just sort of a typical lecture series. Grand Rounds are when clinicians and students get together. Some speaker comes in from either from outside the university or within the university, gives a talk. And then attending that talk, you can, in some cases, get state licensing credit for this. So Grand Rounds is a big deal. This is the cost of talking to white people at all. The cost of your own life as they suck you dry. There are no good apples out there.
So what was the title of this particular talk? It had the very catchy title, The Psychopathic Problem of the White Mind. White people make my blood boil. Around five years ago, I took some actions. I systemically, systematically, white ghosted most of my white friends.
And I got rid of the couple white BIPOCs that snuck in my crew too. What were some of the things that stood out to you from the lecture with this title, The Psychopathic Problem of the White Mind? The first thing that stands out is her fantasies of violence. Once I started, I couldn't stop. I had fantasies of unloading a revolver into the head of any white person that got in my way, burying their body and wiping my bloody hands as I walked away relatively guiltless.
For instance, she has this moment where she says she has a fantasy of unloading the revolver into the head of any white person that gets in her way. With a bounce in my step, like I did the world a fucking favor. She says at one point, this is the cost of talking to white people. The cost of your own life as they suck you dry. There are no good apples out there. White people make my blood boil. You may have heard of words such as psychopath and bully. None of these words come even close.
to capturing the pervasive racial terror of white people. White people are truly a phenomenon. She does not mince words at all. White people have been out of their minds since Western colonialism. White people tell themselves that they are the superheroes of the world. They started this lie to justify their violence. It is the mask of a psychopath. We keep forgetting that directly talking about race is a waste of our breath.
We are asking a demented, violent predator who thinks that they're a saint or a superhero to accept responsibility. It ain't going to happen. They have five holes in their brain. It's like banging your head against a brick wall. It's just like sort of not a good idea. We need to remember that directly talking about race to white people is useless because we're at the wrong level of conversation. Addressing racism assumes that white people can see and process what we are talking about. They can't.
That's why they sound demented. They don't even know they have a mask on. White people think it's their actual face. So that's not something that you would typically hear, I don't believe, a therapist talk about, especially in a professional context like this. But the whole talk is about what she sees as the white collective unconscious. So this is a very Freudian concept. And
And her idea, what she talks about in this series, and then I did a Q&A with her later on where she sort of extrapolates on some of these ideas, is that white people, for one thing, that white people have this sort of collective guilt because of the history of colonization. And for her, she told me in the Q&A, this manifests, she thinks this manifests in some interesting ways. Like, for instance, let me just read you a part from this Q&A we did. This is a quote.
She said,
I mean, I certainly know a lot of like, you know, kind of fake gluten-free people who were just trying to be skinny. But what is she talking about? Well, I brought that up with her. You know, yes, lots of people claim to have a gluten intolerance, but that's not really what she was talking about. She was talking about white guilt. She thinks that white people do not eat bread because of this historical white guilt over things that our ancestors perhaps may have done. And I...
When I pointed out to her, when I said, well, yeah, I mean, some white people don't eat bread, but I eat bread. She had this really interesting response. What was the response? I said, it seems like you generalize a lot about white people, but also people of color. And I asked her why that she does this.
She said, this is a quote, "You asked me before, what is the unconscious? I think the unconscious is coming out right now between you and I. The idea that I'm the one that's generalizing is, I think, a defensive reaction to my talking about whiteness. You feel put on the spot, and so I'm the one that's generalizing."
What? Yeah. So this idea, so my pushback, my observation that she generalizes about whole groups of people based on their skin color, she turned that around and said, actually, no, you're the one that's generalizing. Okay. I hate using this word because I feel like it's been...
just overused and stretched to the point of not meaning anything. But this, I think, is the classic definition of gaslighting. This is probably gaslighting, yes. You don't have to have worked one day in journalism or in media to know that this story would go absolutely viral. And knowing that, I think, made you, and I really respected this, a little bit hesitant to work on the story. Can you explain why? Yeah.
Yeah. So as soon as I heard the audio, I knew that this was just going to be an explosive story and it, and it, and it did go viral. This was covered by Fox news, everywhere from Fox news to the New York times. At one point it was on the homepage of the daily mail. Um,
Dr. K got inundated with complaints. I suspect that she probably got death threats, although I emailed her recently to check in and she did not respond to me, which I kind of understand. And when you came to me with the story, my concern was that exactly what was going to happen, what happened was that she would be, for lack of a better term, canceled.
I didn't want to be responsible for making someone's life more difficult, even if it's someone who's talking about murdering white people at Yale, Yale Med School. Kitty, I get that completely, in part because of my own experiences. I'm wondering if you could tell me a bit about how your own story with public shaming plays a role in this, too.
Sure. So for me, the story really started in 2017. I was a freelance writer living in Seattle and I wrote a story for The Stranger, which is Seattle's alt weekly called The Detransitioners. And it was about exactly what you would expect. It was about people who transition from one sex or gender to the other and then change their mind and they transition back. And the piece is
It was deeply reported. I had trans sensitivity readers. I made sure to include the voices of happily trans transition people in the piece. I sort of did all of the hedging, made sure to write about right-wing attacks on trans healthcare. Really, yeah.
Spent half the piece talking about the problems facing trans community, trans populations, thinking that that would somehow indemnify me to criticism. Well, it absolutely did not. There was a huge backlash, a huge outcry. A lot of it was online, as you would expect, but it also went offline. So I lost a bunch of friends. I'm a lesbian, so...
for most of my adulthood. I've sort of lived within the queer community if such a thing exists, and it kind of doesn't, but that's another story. But I lost a bunch of friends. Yeah, I lost a bunch of friends. People put up flyers around Seattle calling me transphobic. They made stickers calling me transphobic.
At one point, someone put up a sticker with a picture of my face calling me a Nazi sympathizer. Oh, my God. And people tried to get me fired. All the time, people would try to get me fired. And it really changed my life in a lot of ways.
And so I know what it's like. I know what it's like to be the subject of, uh, of internet vitriol and to get nasty emails and all of that stuff. Someone at one point, someone burned stacks of the paper and sent me video of it. So I've literally, my, my work has been burned. I'm not many people can say that now. Um, so that experience gave me a lot of empathy for people who
are publicly shamed. And in some cases that empathy might be misplaced. I have to sort of guard against being, I don't know, too skeptical of narratives sometimes. So why did you ultimately feel like this was a worthwhile story, knowing that she would get
dogpiled on the internet. It really comes down to the setting. Once again, this is not something that was delivered on YouTube. This wasn't something that was, that was, uh, you know, some random person's Facebook rant. This lecture was given at Yale medical school and even more disturbing to me than the content of her lecture was the response. So after the lecture, there was a brief Q and a, and what you heard was Yale faculty, uh,
praising this woman. There might have been a couple people saying, oh, this was difficult to hear, but thank you. But for the most part, it was this unequivocal support. It was as though nobody in the audience objected to it or was willing to express their objections. And we know that they objected to it because the audio leaked.
What that tells me is that the atmosphere in this particular lecture, maybe this is more indicative of the atmosphere at Yale Medical School, is one in which people are afraid to publicly voice their objections, even when it is so obvious that this thing, this idea exists.
needs to be objected. Another reason I wanted to take part in this was because I realized that by having a broader conversation with her, so instead of just putting the audio out there and letting that go viral, but by actually sitting down and having a conversation with this woman, I hope that it would give her a chance to more contextualize her beliefs and to clear up any sort of possible misinterpretation of the lecture itself.
So, Katie, I'd love if you could kind of take us through some of the biggest pieces of data that you found that have convinced you that this is a story that is well beyond sort of one unhinged professor offering a crazy lecture at Yale, but that is representing a sea change that's something much bigger. And I thought maybe we could start with the way that
so-called anti-racism or a particular version of anti-racism has really taken hold and not just
on Twitter feeds of individual doctors, but in a much broader way. Sure. So I spoke to many, many doctors for this series. And what they told me is that the same things that we're seeing in media, in education, in government are happening in medicine. As you said, for better or for worse, we can call this the awokening or wokeism invading these spaces.
And what I found was really an environment of palpable fear. For instance, I talked to a group of doctors
who meet in secret, none of them were willing to be named. And that's one of the difficulties of reporting out this series is that most people will not be named because they're terrified for their careers or terrified for their reputations. And while I was reporting the story, I found out that there are other secret Zoom groups where doctors are meeting up, discussing what's happening in their institutions, trying to figure out ways to resist it. And they're mostly people who see the problems, see these discrepancies in medicine, who are super aware that there are
disparities in outcomes based on things like race. But what they oppose is the proposed solutions to solve these problems. Katie, just hearing that there is a group of the country's top doctors and medical school teachers meeting in secret because they're unable to openly debate what sort of policies and practices would best help their patients, that to me sounds like something that
That would happen in the Soviet Union, not something that you would expect in the American medical profession in 2021. Right. I spoke to a clinician who was from the Soviet Union and he told me that exact same thing. This is what he told me. He said, people are afraid to speak honestly. It's like back to the USSR where you could only speak to the ones you trust. So what are the examples they're pointing to that describe themselves as anti-racist, but maybe are something different?
Well, some of these are policy proposals. Like, for instance...
There is an article in the Boston Review by two clinicians, one of whom is named Michelle Morse. She's a physician at Harvard and at Brigham and Women's. And she's also the chief medical officer for the New York City Department of Health and Mental Hygiene. So this is someone with real power. And what Dr. Morse proposed, along with her co-author in this piece in the Boston Review, was preferentially admitting patients based on their race.
And there are obvious problems for this. But there's another problem. So for instance, what Morse and her co-author wrote about was they started a pilot program at their institution that would automatically refer black and what they term Latinx, their term, not mine, heart failure patients to their specialty cardiology service. And as one of the doctors I talked to
told me, the problem with this is that medicine for decades has been trying to prevent unnecessary procedures because unnecessary procedures can be very bad for patients. The less time you spend in the hospital, the better. And so regardless of what's the most appropriate strategy for this patient's condition or what their primary care providers say or their own personal preferences, they're proposing that all of these people would get admitted to specialists.
And there's the potential for danger in this. You don't, everybody doesn't need to see a specialist. Every condition doesn't require a specialist. And so there's this real irony here where there's this anti-racist proposal solution to a problem may actually lead to worse outcomes for patients. Wow. And then there've been many proposals when it comes to vaccine distribution that come from this sort of anti-racist quote unquote anti-racist perspective. Like for instance,
In Vermont, the governor, who's ironically or surprisingly a Republican, Phil Scott, he announced in April that any resident over the age of 16 who identifies as black, indigenous or a person of color would be eligible for the vaccine before white people. I don't like does Rachel Dolas all fit into that category? I'm not sure. I'm not sure. But that.
Does not sound legal to me. It doesn't sound legal to me either. And according to some legal scholars, it's not. The CDC also contemplated, considered recommending that states prioritize essential workers over the elderly when it comes to vaccine distribution because elderly people are disproportionately white.
Wow. So that one I find particularly egregious because we know that the number one risk factor when it comes to COVID deaths is age. But there's too many old white people. So the CDC actually considered this. And what was the reaction when the CDC floated that idea? Well, it depends on who you were watching.
watching. There was a huge outcry, of course, from the right and both the, let's say, anti-woke left. And then, of course, some people said that this is anti-racist. And it is. This is sort of the Ibram Kendi anti-racist agenda, which stipulates that every policy is either racist or anti-racist. And also like that the only remedy to racist discrimination in the past is anti-racist discrimination in the present. Right. Right.
So those are all examples of things happening sort of on the maybe the policy level of major organizations and of sort of the philosophical debate. But one of the things that struck me is the way that these trends are trickled down into politics.
Like actual doctors treating people in hospitals already. It's not just about floating a provocative idea in a place like the Boston Review. You included this quote in one of your stories from a clinician that I thought was pretty chilling. It's a West Coast doctor and he's working in the emergency room and he says this to you.
I've heard examples of COVID-19 cases in the emergency department where providers go, I'm not going to treat that white guy. I'm going to treat the person of color instead. Because whatever happened to that white guy, he probably deserves it. I mean, he probably does.
I don't know if this white guy in particular did. Because he's an anti-vaxxer, Trump supporter, January 6th rioter? Exactly. The thing is, he came into the hospital with his KKK hat on. He was just brandishing the tiki torch on his way into the emergency room. Yeah, so doctors are seeing stuff like this, and some of them, the ones that I talked to, are deeply worried about this. They're also worried because they see...
the next generation of doctors coming up really embracing this ideology. As one doctor told me, this ideology has racialized every interaction. And doctors are, for instance, I talked to a bunch of doctors who were afraid to criticize residents who are people of color or in some cases women or some other marginalized identity because
Katie, talk to me about how this policing of language and the self-censorship among doctors and physicians and professors who are supposed to be teaching students is so important.
Talk to me about the role that it's played in preventing doctors from giving honest feedback to residents. Right. So some of the doctors that I talked to told me that there's this hypersensitivity among their trainees, and this makes it really difficult for them to give honest feedback.
And this is a problem because trainees deserve honest feedback, because patients deserve their clinicians to be as good as possible. But because they're afraid that, in particular, trainees who have some sort of marginalized identity are going to complain, say that, you know, you're criticized for something and go to HR and say, this instructor or this doctor is racist, they've stopped giving honest feedback to their trainees. Right.
One example that kind of blew my mind was the example you gave of a doctor and maybe several doctors who were reported to the head of their departments because they criticized their residents for being late.
Right. It is troubling. You would think that this is something that would be sort of a race neutral issue. But these clinicians are genuinely scared. So that's disturbing to me as a medical patient, this idea that this next generation of doctors won't be getting the feedback that they really need and deserve because their instructors are scared of them.
So it's like rather than the old model where students sort of lived in fear of pleasing their teachers, now it's sort of reversed where the professors are scared of saying something in any way that will microaggress their students. Right. And medicine is a very historically has been a very hierarchical field for good reason. And of course, that comes with some some problems. And there's an attempt right now to sort of dismantle the hierarchy of
Speaking of the hierarchy and sort of the old way versus the new, one of the things that leaps out to me in your reporting is this generational divide in the way that the doctors you spoke to understand their role and treat their patients. Maybe like a succinct way of putting it is that
older clinicians believe that their job is to treat a patient's ailment, to like focus on their illness. And a lot of the younger ones, maybe the ones more fresh out of med school, seem to believe that their job is not only to treat their patient's health or worry about their patient's health, but also to address their prejudices. I'm wondering if you could explain that a little further. Sure. So one of the doctors I talked to was a Jewish guy.
And he told me a story about some years ago, he had a patient who came to see him and the patient had a big swastika tattoo on his arm. And the doctor has a name that is recognizably Jewish. And he told me that this patient said his name and repeated it three times. So Bagel Lox Goldberger. It was Weiss, actually. And then Weiss at the end, of course. Nice. Yeah, that was it. And so...
And so this doctor, of course, you know, he's uncomfortable with this, but he diffused the situation. His response to this was to say, does it hurt to get a tattoo? I never learned much about that. And he said the patient sort of chuckled. And he kept seeing this patient, this patient who was an actual neo-Nazi. And over time, and this, of course, is not entirely due to the doctor's influence, but over time, the patient stopped doing drugs. He got a job. He got his life together. Right.
And the doctor told me that 12 years after this first visit, he was leaving the program. And so he had his last visit with this patient. And the guy, when he came in, he had this really nasty rash on his arm. And the doctor said, like, let's treat that rash. What's going on? And he told me that this guy, this big, tough neo-Nazi, started crying. And he said, I knew I was going to see you. I was trying to rub it off. Wow.
And so this was this doctor's perspective. You know, he's older, he's been practicing for a long time, and his whole ethos as a physician was that you meet patients where they are, you help them as much as you can, and you hope that they are better off for the encounter. But this philosophy, the doctors kept telling me, this philosophy is changing. And so this next generation of clinicians, of trainees,
seem to think that they have a moral duty not just to treat patients for whatever medical, you know, whatever they're in the hospital for, but is to confront them about their own prejudice. And if a patient isn't open to that, and I can imagine a lot are not open to that, you can imagine the relationship, how good the relationships between these patients and their doctors are. Can you give us an example of what sort of the new school interaction was?
would look like if, you know, one of the young medical students or residents that you describe, if they had encountered that patient with a swastika on his arm, how that would have played out? Or maybe you have other examples of similar stories?
So there was a piece about this very thing published in Teen Vogue recently. Teen Vogue, known to cover. Yeah. Known for its breaking coverage of the medical field. Right. Marxism in medicine. So last year at Harvard Medical School, there was a Zoom class about substance abuse. This was in the psychiatry department.
And a guy who'd been at Harvard, a very seasoned psychiatrist, interviewed one of his patients, an elderly white guy, about his battle with alcohol for this class. And during the class, this patient talked about
the shame that his alcoholism had brought him. And he said that he felt so much guilt over his drinking and his behavior when he was drinking and lying about the drinking. He said the only person he would have told was a, quote, Eskimo in Alaska who didn't speak English. And even then, he would have to slit his throat. So this is an insensitive thing to say. It's sort of that it's a weird play on that trope of like, I'd tell you, but then I'd have to kill you. Right.
And so this is the sort of thing that healthcare workers here, they are meeting people from every walk of life. And some of them are going to say some weird shit. And frankly, in the scheme of weird shit, I don't imagine that that ranks close to the top. Exactly. So historically, this would have been a situation and in this situation, the doctor would have just sort of ignored it because they weren't there to discuss his microaggression. They were there to discuss his addiction.
But there was a student in the class, and the student is the person who wrote about this in Teen Vogue. This is a quote from his piece. He said, "His words sparked an immediate visceral reaction. I felt my blood pressure rise and anxiety overtake my mind and body. My next reaction was to look at how the rest of my classmates were responding. The blank remote expression on some of their faces and the silence that followed remained burned into my psyche." It's a little dramatic.
And so no one paused in that moment to educate the man about what this student calls his violent and racist language. And so the student was appalled by this and he complained. And so in response, the medical school organized a session for faculty and for students on, quote, confronting anti-indigenous racism in the field of medicine. Yeah.
So this is just one example of the sort of changing zeitgeist in medicine where you have this older generation of people who are not there to make someone a better person, who are not there to make someone less racist, who are there to fix people's health problems. And then you have this other generation who is coming in and saying, we are going to make you anti-racist. So not only is this student who wrote in Teen Vogue upset that no one lectured the patient, but
He also saw like the silence of his peers as sort of an example of racist complicity. Exactly. Okay. So this idea or this theme of sort of policing language is a really, really pervasive one that we're seeing in your stories and obviously in all kinds of institutions.
institutions in American life, but medicine has not been spared from that trend. And this isn't just about like calling out overtly racist or sexist language. It's also about sort of the policing of doctors and professors by the students, including for using language that I think most people would see as totally normal and inoffensive, like
the terms male and female or like the terms pregnant women. Tell us about that. So I talked to a student at a medical school at the university in the university of California system.
And this was a student who has observed faculty members, her instructors, most of whom are clinicians, doing things like apologizing for using the term, for instance, pregnant women, menopausal women, words like male and female or man and women. Because according to students, these terms are cis-normative and reinforce the binary. And so these students...
Most of last year at this medical school happened online because of COVID. And so during these lectures, students have some sort of internal messaging system and they give...
They give lecturers feedback in real time. So a physician will say something like refer to a pregnant woman and then the students complain. And then in one case, an instructor actually apologized midway through a lecture, gave this sort of abject, pathetic apology. And we got the audio of this. It was really sort of shocking. Apologizing for using the term pregnant women. It sounded like he was apologizing for doing like
a horrible crime. Right. And the language of the apology is like, I don't want you to think I'm in any way trying to imply anything. And if you can summon some generosity to forgive me, I would really appreciate it. I'm very sorry. It wasn't my intention to offend anyone. The worst thing I can do as a human being is to be offensive. I can think of a few. Yeah, I can think of a few worse things. There are things worse than saying the term pregnant women, which is what he was apologizing for.
So in the view of his students, acknowledging the idea of biological sex is now considered transphobic. Yes. So it's not just to be super clear. It's not just the sort of like,
idea that I certainly encountered in college that, you know, gender is a social construct. Gender is a social construct. You heard that everywhere. But the idea of things being a social construct has moved beyond gender to the very idea of sex, which is, from what I understand, Katie, you know a lot more about this subject than me at this point, a
unequivocal biological reality. I mean, from my experience, yes, one would think. But yeah, there's this, and you know, and this isn't happening everywhere. In one case, this, an instructor at the school delivered a lecture and said, sex is a social construct. So to me, it's this, it's not just the denial of this biological reality. It's also in this weird, almost, almost fundamentalist denial of human beings as mammals, right?
Mm-hmm. Like every animal in the world is comprised of male and female, except human animals. Right. Although I did see recently on Twitter someone was complaining about assigning genders to our pet dogs. What? I guess that's next. Maybe it's coming for vet school next. More with the funny and brilliant Katie Herzog and just how far this policing of science and scientific inquiry has gotten in the world of medicine after this.
Let's just get a little bit deeper into the dynamic here of the way language is being policed and of the way these professors at some of these top medical schools are being policed.
They surely don't believe that biological sex is a construct. They know that biological sex is a scientific reality. So just like explain to us from the professors you've talked to how they explain what they're scared of. Like what punishment could these students possibly mete out? Okay. So for instance, at the school in the UC system –
The student I talked to told me that her classmates would send out petitions to name and shame her instructors for wrong things. So there's literally a series of petitions going around complaining about instructors' language.
And the student told me that this has had an effect. So all of these petitions were sent out at the beginning of the year. And since then, they've started to sort of slow down because the instructors are being way more proactive about correcting their own language or their slides for these courses. As the student I talked to told me, she said, at first, compliance is demanded from the outside. And eventually, the instructors become trained to police their own language proactively. So at one point in the semester...
A faculty member in this program sent out a preemptive email warning the students about all of these prerecorded lectures that included, you know, cis-normative language. And that included the term premenopausal women. So in the future, the professor said this would be updated to premenopausal people. So listen, obviously, like some of these things,
just feel so absurd that it's just really easy to dunk on them and poke fun at them. But it's also, as you found, quite dangerous both for medical students who are learning about diseases and the way they present differently in men and women, and also for patients, including perhaps most significantly transgender patients. You talk about a case that was published in the New England Journal of Medicine in 2019,
in which a patient comes into the hospital and the person's medical records said that he was male, but in fact he was a transgender man and that had profound implications for what happened.
Right. So the nurse who saw this patient assessed him as obese, and he had recently stopped taking medication for hypertension. So she didn't think that this was an emergency. Well, it turns out she was wrong. The patient was pregnant, and he was in labor. And by the time they figured out what was going on, it was too late. The baby had died. And according to this write-up in the New England Journal of Medicine, even though the patient didn't realize that he was pregnant, he was totally devastated by this.
Turns out that he wanted a baby and he was really devastated about this. So things like that. So for this reason, it's really important that medical records are accurate and they don't list someone as male when the person is a trans man. So there's this confusion between sex and gender happening right now and it's happened
Socially, it's happened in media, but it's also happening in medicine. The student also told me that her instructors have stopped emphasizing sex difference when it comes to things like diagnosis and treatment. And this is really bad. And there's also this sort of irony here where for years, women have been arguing that our symptoms need to be taken more seriously. There need to be more studies on things like heart attacks in women. Things present differently in males and females. Drug dosage is different.
Sex is really integral to treatment. And this school, at this school at least, they are downplaying this because their students will complain and they are afraid of their students. Even though sex has a huge impact on all kinds of ailments, including...
As you write, hernias, rheumatoid arthritis, lupus, MS, asthma. You know, there's different ranges in men and women for kidney function. They have totally different symptoms during heart attacks. Yes. If I walked into an emergency room complaining of dizziness and fatigue, I would want my doctor to understand that that might mean that I'm having a heart attack, but
a condition that presents itself really differently in women with those symptoms than in men who complain of chest pain. Right. So you better hope that your doctor is old. Yeah.
Let us pray. One other aspect to me that was really, really troubling here and is sort of very much something that I think we both have seen in the world of journalism and is terrible when you see it there, but is much scarier when you think of the life and death consequences that it has in the world of medicine. And that's the idea that certain ideas and certain research areas are just untouchable. And
if they are not excluded from medical journals, oftentimes if they find a way to get smuggled in, are met with unbelievable outrage. And I wondered if you could talk to us a little bit about the story of Lisa Littman, which to me was sort of a watershed moment when it comes to
self-censorship and cowardice in the world of medical research. Sure. So in 2014, Lisa Littman began to notice something a lot of people have begun to notice, which was this sudden uptick in the number of teenagers, particularly adolescent females, who are coming out in her community as transgender.
And so this is something that historically has been very rare. And as a lot of your listeners probably know, that's not so true anymore. And so Lisa Lippman observed this and she decided to do what scientists do. She decided to study it. She wanted to know what was going on, why the sudden spike of natal females coming out as trans and not just in her community, all over the U.S.,
And so she studied it. She surveyed about 250 parents whose adolescent children had suddenly announced they were transgender who had never before exhibited the symptoms of gender dysphoria, which until recently was sort of the precursor to coming out as trans and seeking medical attention.
And Lippmann published her results in a paper in the journal Plus One in 2018, and she coined the term rapid-onset gender dysphoria to describe this particular population. And what she posited was that this sudden uptick might in part be
due to not just the better social conditions for people to come out, but also that it might be a sort of social contagion. And that there also might be other underlying factors, trauma, depression, social influence from peers and from the internet. When you say social contagion, you mean...
things like, I mean, I think we're exactly the same age, the way that a lot of girls I imagine in your middle school and high school were cutters or had eating disorders. That's kind of what she meant? Exactly. So what was the reaction to this paper?
There was a huge outcry. So immediately after the piece was published, Lisa Littman, as well as the journal and Brown University, just got inundated with complaints and accusations of transphobia. So immediately, the journal announced that they were going to be investigating her study.
And then right after that, Brown University, which had put out a press release announcing this study, which is something that universities always do, they retracted the press release. Wow. So there was a big investigation into this. And then later they republished the piece. There were some sort of minor cosmetic changes, but her results stood. But it really didn't matter. Littman, she is no longer at Brown University. She lost her contract with the health department in Rhode Island.
So this had a really major impact on her career. And what's interesting or what's important is that this isn't just about Lisa Lippman.
This is about everybody who's getting this message, who says, if you study this, if you report that, if you dare to cross this one particular narrative, this one particular ideology, there will be consequences. And so there's a real stifling effect. And we've seen it in science. We've seen it in media. Now we're seeing it in medicine. So Lisa Lippman didn't get anything wrong scientifically, is what you're saying? Nothing. It was that she...
Right.
who they don't like or who they think are transphobic for many years. There have been lots of cases like this, and the concern for a lot of the clinicians and researchers that I've talked to is that they won't be able to get research published if it has an inconvenient result, but also that studies that have a sort of anti-racist agenda oftentimes have really shoddy methodology, that they shouldn't be published, but it's like, you know, if you want to write something... Yeah, I mean...
Not to go off on a tangent here, but that...
really was what I used to see at the Times, you know, in the small corner of the paper where I worked, which was the op-ed page, you know, things with, you know, real gaps in logic, pieces that weren't strong, those would sail through if they fit the narrative. And the pieces that didn't were just scrutinized and had to be, you know, fact-checked by four people and read by eight senior editors. And there was just a totally different standard. Right.
Yeah. And specifically when it comes to trans stuff, media outlets get this stuff wrong all the time. I co-host a podcast with the reporter Jesse Single and Jesse spends, I don't know, like half of his time when he's not playing video games or whatever, fact-checking these outlets for free because they are not doing their own fact-checking. They are publishing misinformation.
Yeah, they're publishing lies and misinformation. Sometimes they're probably aware of it. Sometimes they're probably not. But if you're a parent whose child, for instance, all of a sudden comes out as trans, it's going to be really difficult to get accurate information because the media has absolutely failed to do due diligence on this issue. And if you're a researcher curious about sex and gender, what's your take on that?
Like, this subject is just so ripe because, Katie, when you're talking about a spike, right, which I think anecdotally most people will say, yeah, there are more trans people, of course, because things have gotten more tolerant, etc. That's true. But like if you look at the last decade or so, the number of youth seeking treatment for gender dysphoria has spiked by over a thousand percent in this country. In the UK, it's jumped by four thousand percent.
The largest youth gender clinic in L.A. where I live saw 1,000 patients in 2019, and the same clinic in 2009 saw something like 80, all facts that I learned from your reporting. In other words, those numbers just seem so enormous that the idea of greater social tolerance might not be a sufficient enough number.
Right. Something is going on. And I talked to a trans clinician named Erica Anderson and Anderson, who is in favor of pediatric transition in cases where where the patient is properly diagnosed. She said to me, this is a quote, what makes us think that gender is the one exception to peer influence?
For 100 years, psychology has acknowledged that adolescence is a time of experimentation and exploration. It's normal. I'm not alarmed by that. What I'm alarmed by is some medical and psychological professionals rushing kids into taking puberty blockers or hormones. This is a trans woman who...
is deeply concerned about dysphoric children who is in favor of pediatric transition. And even she sees that social contagion and she doesn't, I should say, she doesn't like the term social contagion, but even she sees this and admits it. And this has made her as well, something of a target. And I mean,
It's also just so simple. It's like whatever it is that's going on here, it seems worth looking into. And it seems worth studying with the tools of scientific research that we've developed to see what they would reveal. But as you've well documented, people are just way too scared to go near it.
And they should be too scared to go near it. I don't recommend it. There are real consequences to this. You will get smeared as transphobic. You will get smeared as a bigot if you question the narrative. And I don't want to sound like a conspiracy theorist, but it's true. But some of... Part of me thinks that...
the tide is maybe starting to turn. Maybe you'll dash my optimistic feelings about this. But, you know, when I see that a book like Abigail Schreier's is like number seven on all of Amazon, at least it reveals to me that people are curious about the topic and curious about hearing other perspectives on the story. But
Maybe I'm maybe I'm being naive. No, I think you're right. I think there's a real market for for for information that you're not going to get from The New York Times and the success of Abigail Schreier's book, despite the many attempts to cancel it, as well as a few other other books that have come out this year on this issue, I think is is heartening. Yeah.
When I wrote my piece in 2017, it was hard to find detransitioners. Now they're everywhere. They're vocal about it. There's a subreddit that has something like 20,000 members. I'm sure many of them are not detransitioners. They're just lurkers. But you can look at this subreddit and you can see people every day writing about their experiences. And the reason they're turning to Reddit often is because they're not getting good information from their very own clinicians. Right.
And they have to kind of look to each other for support. Yeah. And the thing that really interested me about the detransitioners when I wrote this piece in 2017 was that for a lot of them, they told me that
Coming out as detrans was much harder than coming out as transgender in the first place. They lost their communities. They were immediately cast out. And, you know, ironically, the same thing happened to me by reporting on this. But there's just this real, it's sort of bullying. Yeah.
There's just this real pressure to shut these people down and make them not be heard. I mean, there's a 60 Minutes did a show on detransitioners a couple of months ago. And the efforts to get that show canceled before it aired, before anybody had seen it, were just remarkable. Right.
And I have to say, that's another data point that made me optimistic that sort of the tide back toward reason was turning because I was shocked that 60 Minutes gave this topic such a fair treatment. Sure. And I think it's worth mentioning, you know,
Trans people do have reason to be concerned, especially in states where there have been some bills to limit access to health care. I think it's a lot more complex than most of the media sort of lets on. But there is a backlash. The more activists push an agenda, the harder the backlash is going to be. And if you care about trans people, and I do care about trans people, that should be concerning.
Right. I think part of the problem, and I just had a really interesting conversation with this Harvard professor, Carol Hoeven, the other day, who has a new book out about testosterone, is the argument to be made on this score is an argument about being humane and about human rights and about inclusion and about tolerance, where people...
And I think that argument is extremely strong. When people start, though, to make their argument based in the denial of science, that's when you start to lose, I think, most people who want to be empathetic.
Yeah, it's sort of an emperor has no clothes situation where people say, I can see this happening with my own eyes and you're denying this. The same thing I think happened last year during the Black Lives Matter marches, where after months of having public health officials tell everybody to stay home, stay home for health care workers, they immediately changed the message and said, no, actually, the real pandemic is racism. Everybody go out and protest. That's fine. Yeah.
That was a real radicalizing moment for me, I have to be honest with you. Yeah. Just one last thing about detransitioners. You would think that by the logic of sort of, let's say, woke politics, that these people would be
respected because not only are they a minority, they're a minority within a minority. Right, right. But somehow they seem to be regarded as like turncoats or something. Yeah, they're seen as a threat. And part of this comes because a lot of detransitioners are
about the quality of health care they received. So clinicians that I talk to and patients that I've talked to talk about this fast tracking that Erica Anderson mentioned, where you go to a gender identity clinic and you say, you know, I'm trans, and then you're immediately prescribed hormone blockers or cross-sex hormones. There's just very little gatekeeping. And that comes in response to years when there was tons of gatekeeping. So until rather recently, a
A trans person would have to live as their preferred sex or gender for about two years. Kind of depends on where you are. But to get hormones, to get surgery, you would have to, you know, present as your perceived gender or your preferred gender for two years. And then, you know, lots of therapy. And that gatekeeping prevented people from getting hormones and therapy when they wanted it. And so part of this is a backlash to the previous standards. Mm-hmm.
transgender issues is not the only subject that has become sort of untouchable in the world of medical research. I'd love if you can share the story with us about the University of Pittsburgh cardiologist named Norman Wang and what happened to him.
Sure. So last year, Norman Wang wrote a paper in the Journal of the American Heart Association on basically affirmative action or diversity initiatives in cardiology, which is his field. He looked at 50 years of data. And in his piece, he argued that affirmative action and other sort of diversity initiatives fail to meaningfully increase the percentage of Black and Hispanic clinicians in the field or to improve patient outcomes.
And so his conclusion was that rather than admitting or hiring or promoting clinicians based on their race, he argued for race-neutral policies in medicine. What happened to him? You can guess what happened to him. So it actually took a little while for this to catch on fire. But four months after the study was published, screenshots of the paper began circulating on Twitter and on other social networks, and people in medicine began accusing Norman Wang of racism.
Surprise, surprise. There was this example of a cardiologist at the Mayo Clinic who was telling her colleagues to rise up. Yeah, she used the hashtag retract racist. And the article was indeed retracted. And this is really, really rare. So in this journal, I was able to find...
Two examples of retractions in the journals on their website using retraction database as well. So two papers. One of them was a 2019 paper that erroneously linked vaping to heart disease. And the other one was Norman Wang's paper. Wow. Yeah. He was also demoted from an administrative position that he held at Pitt. He was banned from seeing students. He's now suing the university. So one...
Right.
Tell us about like where that idea comes from, because to me it seems to sort of pervade all of these stories. Abigail Schreier's book, for example, is accused of causing trauma and harm. Norman Wang, he's accused of making his classroom inherently unsafe. Is this this idea of safetyism that I believe is Jonathan Haidt introduced? Yeah, I think it's related. Are you familiar with the term concept creep?
Yeah, but let's explain it. So concept creep and a related term, mission creep, sort of almost sort of describe the same thing. So the idea is that you have, when it comes to the idea of harm, that this expands from the original definition of what harm would be. So maybe physical harm and then bullying is included in this. And then saying nasty things on Twitter and then ideas themselves.
And this related concept, mission creep, I think I see this everywhere as well. So you have something like, you know, you have the ACLU or the Human Rights Campaign or different activist groups or hospitals or whatever. And they have this one central mission. And over time, it evolves to encompass many, many more ideas. And they sort of lose sight of the initial goal or the initial mission of the organization or the idea or whatever it is. And I think sometimes it's like,
the organization, let's just talk about, you know, gay rights organizations. Totally. They fulfill their mission and yet they still exist and have all of these salaries to pay. So they have to find a way to justify their existence. Exactly. I think this is part of the reason that trans issues have taken up so much space on the national stage is because
After the success of gay marriage in 2015, you had all of these advocacy groups. And instead of saying, you know what, mission complete, we did it, let's disband, the mission just changes. And so now you have, if you look at things like the human rights campaigns, you can look at their annual reports and you'll see trans issues take much, much more space. They're basically trans rights organizations at this point because they're
Gay rights, for the most part, have frankly been solved. Katie, the people that are sort of the true believers, the people that are pushing for these pretty radical changes, they have like one sort of foundational claim, which is that there is structural or systemic racism in the world of medicine. Let's take that argument seriously. What are the examples of there being systemic or structural racism in medicine?
Sure. So one of the examples is that, and this one is often repeated, is that black women or black parents perhaps are, it depends on where you are, but they're around two to three times more likely to die in childbirth than white women. And this discrepancy persists even when you control for factors like income and education. And those are the things that often make these racial disparities disappear. So
There's something is going on here that is making more black women than white women die in childbirth. Right. And you write about several examples that I think are compelling in the pieces that you've written for my newsletter.
One of them that I remember really clearly is that you spoke with an obstetrician and she talked about this calculator that OBGYNs have used for decades. And the calculator is used to sort of assess whether a patient is likely to have a successful vaginal delivery after they've had a C-section.
And the calculator used all of these factors. It used the age of the patient, the weight of the patient, all of this relevant medical information. And it also, though, included the race of the patient. And what they found over the years is that if the patient was black, the calculator would say that they were less likely to have a successful vaginal delivery on the second child. And that in turn meant that doctors were more likely to counsel their black patients to get C-sections.
which is a major surgery that they might not actually need.
What became clear is that there was no reason for race to be a factor at all in the calculator, which is why the calculator was finally changed this year. The reason that I point to this example is that I think it really drives home the systemic part of some of these disparities, the thing that is kind of like baked into the very system itself.
Exactly. There have also been big differences in research funding for various diseases. So if you think about a disease like cystic fibrosis, which affects mostly white people, lots more funding for that than a disease like sickle cell, which affects mostly black people. And this is despite the fact that four times as many people in this country have sickle cell than have cystic fibrosis.
Right. There are certainly disparities in medicine and medical outcomes. My wife is a nurse.
She works at a hospital in Seattle. And when they had COVID patients coming in, when they have COVID patients coming in, they were having a lot of these COVID patients were coming in from Eastern Washington where they were migrant workers. And one problem that they were running into at the hospital is that they didn't have enough Spanish speaking people at the hospital or enough translators at the hospital to give these people good discharge instructions.
So you would have a case where somebody would come in, get treated for COVID, hopefully get released, and they're not getting the information that they need to keep themselves and their families and their peers safe.
That's a really good example of a complicated case. Could there be systemic racism at play? Yes. But could it also be about how eastern Washington's population has been changing and lots of hospitals, or at least the hospital where your wife works, just haven't kept up with those population changes? Like my critique of the
Ibram X. Kendi vision of anti-racism is that racial disparities equal systemic racism. Like there's no need to investigate. There's no need to look into other variables. There's no other explanation that would even carry water.
Sure. And I think the, you know, the terms that we, that we give these things is less important than just solving the problem. So in the case of translation, you know, Seattle, my wife's hospital, there's an extremely diverse population and this idea of not having enough translators that could be solved if the hospital would spend more money.
money on translators, but they're not doing that. I don't know how much the president of the hospital made this year, but I am certain that you could knock that down 10% and buy some and get some more translators. So is it racism or is it the hospital trying to save pennies here and there by not hiring enough translators? And does it really matter? I think what's more important is solving the problem than sort of naming the problem. Has the ideology that we've been talking about
pervaded your wife's hospital? Let's put it this way. She recently joined the whites only caucus at her hospital. She did not do this because she is a white supremacist. She did this because she was curious about this, these anti-racism measures. So yeah, she attended a meeting where white people sat around and talked about things like how to be better ancestors.
Did she learn how to be a better ancestor? I don't think that she did. She did, however, ask for evidence about some of the measures they were talking about, and it was not supplied to her. I imagine that in reporting this piece and also just in conversations with your wife that you
You know, you probably have a sense like, hey, these priorities about language policing and whether or not the phrase premenopausal women is a fair term, that this is sort of a distraction from the fact that we live in a country with a pretty broken health care system. Do you have any ideas, having been reporting on this for a while, about how we can make medicine better and more fair?
I mean, this is the issue that the doctors were so concerned about. As one of the doctors that I spoke to told me, you know, we don't need more diversity trainings. We don't need more DEI trainings. What this doctor wanted was a single-payer healthcare system. You know, the system is so broken. And right now, I think that we are in a moment where there is this, especially after COVID, there is this public momentum behind things like single-payer. Of course, there are many, many
many, many difficulties in getting a system like that. But people see that the system is broken. There is real momentum and desire to fix it. But instead of these big, difficult changes, often what you're seeing is, you know, mandatory diversity trainings or, you know, whites-only caucuses where nurses and doctors are reading Robin DiAngelo books and talking about their internal implicit bias. Katie, thank you so much. Very thanks for having me.
The Anti-Racism in Public Health Act would create a national center for anti-racism at the CDC.
Over the weekend, Ayanna Pressley, a Democratic congresswoman from Massachusetts and a member of what's often called the Squad, sat down for an interview with Ibram X. Kendi. The newly created center will be charged with declaring racism a public health crisis and provided dedicated resources to support local and state efforts to educate the public on and to advance anti-racist public health interventions.
She talked about the Anti-Racism in Public Health Act, which she, along with Elizabeth Warren and Barbara Lee, are attempting to get passed into law.
This legislation will require the CDC to publish and promote anti-racist policy. Among other things, it would create a national center for anti-racism at the CDC. We'll finally have a robust, multidisciplinary, and race-conscious approach that acknowledges decisions on social determinants of health. Thanks for listening.
You can hear more reporting from Katie and more of her riffs with journalist Jesse Single on their podcast. It's called Blocked and Reported, and I cannot recommend it strongly enough. If you've got a tip or you just want to say hi, find us at honestlypod.com. And if you're one of the brave souls still on Twitter, follow us at The Honestly Pod. We appreciate you spreading the word about this podcast. We'll be back soon.